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1. What is RAP?
2. How does RAP differ from KAP?
3. Who should use this manual?
4. How to use this manual
5. What is needed?
Rapid assessment procedures
(RAP) apply a set of common anthropological techniques to
specific health issues. Because only health issues are addressed
and the number of informants is limited, RAP is relatively fast
and inexpensive. Moreover, lengthy statistical analysis is not
needed, so that the data are available immediately for
decision-making. Focus groups can be used to determine whether
the findings apply to other, similar populations.
This manual describes the following techniques used in RAP:
• Unstructured interviews with key informants on local beliefs about diarrhea;
• Histories of diarrhea! episodes to determine how beliefs influence behavior;
• Card sorting to learn how community members categorize illness types, causes, and treatments;
• Decision models to determine the sequence and reasoning behind mothers' responses to diarrhea! episodes;
• Participatory research methods to map communities.
All the
steps of the RAP methodology should be completed in each study
community. The number of study sites will vary according to the
needs of the control of diarrhea! diseases (CDD) program or
project, the ethnic and cultural diversity within the country or
target population area, and the availability of time and other
resources.
RAP uses mainly
ethnographic methods that try to describe and understand a
culture from the perspective of a member of that culture. These
methods are quite different from those of the knowledge,
attitudes, and practices (KAP) survey:
• A KAP survey collects information about cultural beliefs by asking a structured and predetermined set of questions. In a RAP study, the researcher learns to understand a cultural belief system by asking a series of questions that build on answers to preceding questions. As the researcher learns a little, questions arise. As he/she learns more, the questions become more sophisticated.
• KAP survey methods produce quantitative information from a large number of randomly selected individuals. RAP methods usually start with identifying and collecting information from a few key informants. These are local people who are particularly knowledgeable about the topic and are willing to talk about it in detail and at length. This approach results in detailed, qualitative information from a few carefully selected people.
• The data from a KAP survey are usually analyzed at the end of the survey. RAP research involves a continuous process of gathering information, generating ideas, testing the ideas, gathering additional information, and generating new questions. The creative process of applying the information to program problems cannot be left to the end. Interaction with CDD program staff is required throughout the project.
• KAP surveys can identify cultural beliefs that may pose problems for CDD efforts. RAP studies describe these beliefs in the context of assumptions about the cause and transmission of disease, perceptions of how the body works, and explanations of what goes wrong or happens differently during illness. KAP studies describe what people believe, whereas RAP studies describe both what they believe and why they believe it. This enables the ethnographic researcher to suggest how to use existing beliefs to make the CDD program or project more effective and how to avoid problems with beliefs that might obstruct program or project efforts.
This manual is designed for
use by a social scientist or other professional with expertise in
conducting household interviews. It assumes that the user has
experience in applied qualitative research in the form of
observational studies, focus groups, unstructured interviews, or
semistructured interviews. Therefore, the manual does not provide
basic information on how to select and work with field
assistants, establish rapport, obtain informed consent, or take
field notes. Other documents that review these general skills are
listed at the end of this section.
Designing cultural
approaches to promote appropriate household management (AHM) of
diarrhea is a team effort that requires creative thinking and
critical analysis. CDD experts and experienced practitioners must
participate and communicate throughout the process. Therefore,
the researchers must meet with the technical staff of the ADD
program or health care project at several points:
• Before starting the field work;
• During the field work if preliminary results suggest ways to improve household management of diarrhea;
• During the field work to develop messages for promoting recommended diarrhea management practices;
• Before completing the final report;
• At the end of the study, to present the results and program or project recommendations.
Although the data can be collected by the social scientist alone, it is recommended that he/she work with one to three field workers. Field workers must be fluent in the local language(s), able to take notes during the interviews, and able to travel to and work at the field sites. They should have experience in conducting household interviews. Avoid using health care workers or health educators. People may not be willing to discuss their beliefs with those they associate with the biomedical health care system.
If visual aids such as simple drawings are needed, it is better to use a local artist unless a member of the team has artistic talent and time. Do not use a foreign artist or one from another ethnic group.
Usually
transportation to and from the field sites will be needed as well
as food and lodging at the field sites. Tape recorders and laptop
computers are not necessary but may be used according to the
social scientist's preference.
• RAP is a relatively rapid and inexpensive way to obtain information specific health issues that can be used immediately for decision-making.
• RAP methods involve a creative process of gathering information, generating and testing new ideas, developing additional questions, and gathering more information.
• The manual is intended for use by a social scientist with the assistance of one to three field workers to complete a community study within 2 to 3 months.
• The methods require interaction with CDD program or project staff at specified points during the study.
• Transportation and food and lodging will be required; visual aids, tape recorders, and laptop computers may also be used.
Technical Background
and Methods
Brown, K., and Bentley. M. 1988. Improved Nutritional Therapy of Diarrhea: A Guide for Program Planners and Decision Makers. PRITECH, Technologies for Primary Health Care, 1925 North Lynn Street, Arlington, VA 22209
This manual provides technical information on case management of diarrhea! diseases and methodological guidelines for collecting household and community information on existing feeding and treatment practices. It also includes information on consensus building among program personnel. It is a good complement to the Griffithss et al. Volume (below)
Coreil, J., and Mull, D. (eds.) 1988. Anthropological Studies of Diarrheal Illness. Special Issue, Social Science and Medicine 27(1)
A collection of articles, some dealing with methodologic issues, others presenting the results of ethnographic research on diarrhea! diseases.
Griffiths, M., POWs, E., Gavin, M., and del Rosso, J. 1988. Improving Young Child Feeding During Diarrhea: A Guide for Investigators and Program Managers. PRITECH, Technologies for Primary Health Care, 1255 North Lynn Street, Arlington, VA 22209
Includes detailed step-by-step procedures for collecting information on infant feeding practices. It also provides a practical approach for testing the acceptability and feasibility of different interventions to improve nutrient intake.
Henry, F.J. (ed.) 1991. Combating Childhood Diarrhoea Through International Collaborative Research. Special Issue, Journal of Diarrhoeal Diseases Research 9(3)
A collection of papers presenting the results of research sponsored by the Applied Diarrheal Disease Research Project. It includes studies on household diarrhea management, many utilizing methods discussed in this manual.
WHO/CDD/SER/87.10. 1987. A Decision Process for Establishing Policy on Fluids for Home Therapy of Diarrhoea
Presents the relevant issues in selecting home fluids to be recommended during diarrhea.
Anthropological/Sociological Theory and Methods
The following references provide an extensive "toolbox" of methods. They contain detailed "how-to" information, which will be especially important for individuals who have minimal background in qualitative, applied research. In addition, several of the sources provide a discussion of the theoretical framework of applied medical anthropology.
Bernard, H.R.1988. Research Methods in Cultural Anthropology. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A comprehensive text on research methods in anthropology that is easy to read and very informative. Includes both quantitative and qualitative methods.
Crabtree, B., and Miller, W. (eds.) 1992. Doing Qualitative Research. Research Methods for Primary Care, Volume 3. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A practical resource book that focuses on qualitative research approaches in primary care. It is useful for teaching research methodology.
Gladwin, C.H. 1989. Ethnographic Decision Tree Modeling. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
Explains the concept of transforming interview data on decision-making into decision-tree models, with a qualitative focus.
Miles, M., and Huberman, M. 1984. Qualitative Data Analysis: A Sourcebook of New Methods. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A comprehensive yet practical sourcebook on qualitative data analysis methods written for professional social scientists.
Pelto, G., and Pelto, P. 1978. Anthropological Research. The Structure of Inquiry. Second Edition. Cambridge University Press, New York
This classic text provides a balanced description of theory and research methodology and their linkages within applied anthropology.
Pfaffenberger, B. 1988. Microcomputer Applications in Qualitative Research. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
Describes the use and limitations of microcomputer programs in qualitative research.
Spradley, J. 1979. The Ethnographic Interview. Holt, Rinehart, and Winston, New York
A handbook on conducting ethnographic research, especially unstructured interviews. Although fun to read, the examples are not easily transferable to developing country situations.
Wolcott, H.F. 1990. "Writing Up Qualitative Research." Qualitative Research Methods Series, No. 20. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A guide to the principles and problems of the writing process in qualitative research.
Rapid Assessment and Participatory Research Methods
In recent years there has been a virtual explosion of examples of research that is either "rapid" or "participatory." A few of the many sources that are available are listed.
Chambers, R. 1983. Rural Development: Putting the Last First. John Wiley and Sons, New York
This is a gem of a little book, written by one of the pioneers in the field for practitioners and academics interested in rural poverty and development.
Chambers, R. 1992. Rural Appraisal: Relaxed, and Participatory. Institute of. Development Studies, Discussion Paper 311, IDS Publications, Institute of. Development Studies at the University of Sussex, Brighton BN1 SIRE, England
This paper outlines the origins, principles, methods, and applications of participatory rural appraisal methodologies. It includes many recent references on the application of participatory rural appraisal methodologies within health and nutrition.
Scrimshaw, N., and Gleason, G. 1992. RAP: Rapid Assessment Procedures. Qualitative Methodologies for Planning and Evaluation of Health Related Programs. International Nutrition Foundation for Developing Countries (INFDC), Charles Street Station. PO Box 500, Boston, MA 02114-0500
This volume of 42 papers describes the wide range of applications of rapid assessment methodologies in nutrition and health programs. It is based on the proceedings of the 1990 International Conference on Rapid Assessment Methodologies for Planning and Evaluating Health Related Programmes.
Scrimshaw, S., and Hurtado, E. 1987. Rapid Assessment Procedures for Nutrition and Primary Health Care: Anthropological Approaches to Improving Programme Effectiveness. UCLA Latin American Center, Los Angeles, CA 90024-1447
This field guide is based on the experiences of a number of individuals in applying RAP to study the effectiveness of primary health care and nutrition programs.
Communications Research and Message Development
The following sources are particularly helpful in going from "data to messages."
Diarrheal Diseases Control Program of the World Health Organization (COD/WHO). 1987. Communication: A Guide for Managers of National Diarrhoeal Disease Control Programs. Diarrhoeal Diseases Control Program, World Health Organization, 1211 Geneva 27, Switzerland
A comprehensive, step-by-step guide to planning, developing, implementing, and evaluating the communications component of national diarrhea! disease control programs.
Manoff, R. 1985. "Designing the social marketing message," in Social Marketing: New Imperative for Public Health. Praeger Publishers, New York
This text describes the principles and methods of social marketing and provides many examples of its application in public health.
Rasmuson, M., Seidel, R. Smith, W. and Booth, E. 1988. Communications for Child Survival. HealthCom, Academy for Educational Development, 1255 23rd Street, NW, Washington, DC 20037
An excellent resource document that provides an overview of public health communications and methodologies and includes case studies, detailed examples, and a bibliography.
Focus Group Methodology
The following references provide step-by-step methods on how to conduct and analyze data from focus group discussions. These methods may be used to complement, but not replace, the other methods discussed in this manual.
Dawson, S., Manderson L., Tallo, V. L. 1993. A Manual for the Use of Focus Groups. International Nutrition Foundation for Developing Countries, Charles St. Sta., Box 500, Boston, MA 02114-0500
A step-by-step guide to the use of focus groups written to help researchers in the social and health sciences use focus groups to learn more about social and cultural issues influencing health behavior and the prevention and control of disease.
Debus, M. 1988. Handbook for Excellence in Focus Group Research. Distributed by HealthCom, Academy for Educational Development, 1255 23rd Street, NW, Washington, DC 20037
Provides practical guidelines on the correct use of focus group research, as well as suggestions for modifications to developing country realities.
Krueger, R. 1988. Focus Groups: A Practical Guide for Applied Research. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
Provides a thorough analysis of focus group interview techniques for professional use.
Morgan, D. 1988. Focus Groups as Qualitative Research. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A clear, step-by-step discussion of how to plan, conduct and analyze focus group interviews as part of qualitative research.
Stewart, D., and Shamdasani, P. 1990. Focus Groups: Theory and Practice. Sage Publications, 2455 Teller Road, Newbury Park, CA 91320
A simple and comprehensive guide to conducting focus groups, applying them within a specific problem, and interpreting the results.