Quantitative methods of data collection using aggregate data, health facility indicators or drug utilization evaluation can tell us if there is a medicine use problem, the nature of the problem and its size. However, these methods do not tell us why there is a problem. Figure 6.1 shows some of the factors that influence drug use. Knowing why prescribers and patients act as they do, and which factors are influencing them, is essential to designing effective interventions to change behaviour and correct the problem. Qualitative methods are used to investigate the ‘why’ of prescriber and patient behaviour.

Figure 6.1 Some factors influencing drug use

Source: INRUD materials from the WHO/INRUD Promoting Rational Drug Use Course.

Four methods to collect relevant information are briefly described and summarized in Table 6.4. Analysis generally requires the identification of common themes or patterns within the data to help explain the primary and secondary reasons underlying the incorrect use of drugs by the target groups (patients or prescribers). It should be noted here that the overall design of a qualitative study is a complex process and usually requires the input and expertise of a social scientist. A more detailed description of this type of investigation is therefore beyond the scope of this manual.

A focus group discussion is a group discussion lasting 1-2 hours on a certain topic, organized by the researcher. The group should consist of a small number (6-10) of homogeneous people, who share similar characteristics such as age, gender or type of work (for example, a group of prescribers or a group of mothers). A trained moderator encourages participants to reveal underlying opinions, attitudes and reasons for the problem being studied. The discussion is recorded, either on tape or by two observers, and analysed systematically to identify key themes and issues. Focus group discussions can be used by a DTC to identify a range of beliefs, opinions and motives of a target group, for example doctors, nurses, pharmacists, paramedical staff and patients.

The in-depth interview is an extended discussion between a respondent and a knowledgeable skilled interviewer. The discussion is flexible and often unstructured, allowing an interviewer to encourage the respondent to talk at length about a particular pre-defined topic of interest, which may include 10-30 related topics. The in-depth interview technique can be used to expand the results of a quantitative study by exploring the reasons underlying the behaviour of the persons responsible for drug use problems. It can also be used in evaluating the impact of an intervention to promote more rational drug use.

Table 6.4 Summary of qualitative methods

The structured observation study method utilizes trained people to observe a series of encounters between health providers and patients, following a structured form or checklist. The observers record behaviours and impressions they witness during the encounters. In some studies, they may record a score, based upon a set of specially prepared indicators, for each observed interaction. In general 10-20 patient-provider encounters per facility in 10 facilities (or 10-20 encounters per prescriber/dispenser in the case of a single hospital department) are observed, but the exact number would depend on the study objectives. The structured observation method can be used to study behaviours such as the interactions between staff and patients (for example the quality of communication) or the giving of injections. The data can be used independently or as a supplement to other study methods.

Using a structured questionnaire involves the preparation of a list of questions with a fixed set of responses or options in order to collect the desired information in a standard way from all respondents. The questionnaires may be administered by an interviewer or completed alone by respondents. Questions can focus on factual material, such as what a respondent knows about standardized diarrhoea treatment. Alternatively, questions can focus on a respondent’s attitudes, opinions and beliefs about the subject matter. Ideally the respondents are chosen randomly and the number will depend on the objectives of the study. The questionnaire method can be used by a DTC to quantify the frequency of attitudes, beliefs and knowledge about medicine use.