(2004; 98 pages)
3.2 Describing and identifying medicines use problems
To identify drug use problems, it is best to focus on common health problems and on how these are treated. Examples of common health problems include respiratory infections, diarrhoea, aches and pains, and infectious diseases such as malaria, tuberculosis and AIDS.
However, as seen in Chapter 2, people increasingly use medicines such as vitamins and tonics to improve their quality of life as well as to treat illness. So we need to know more about such preventive use of medicines too.
Figure 3. Steps in developing an effective intervention aimed at enhancing rational drug use by consumers
We also need to find out what health workers, women and men in communities, opinion leaders, and essential drugs programme planners consider to be problems with drug use in communities. Key research questions in step one of developing effective communication interventions are:
• Where do you go if you or a family member is sick? If you don’t go there what do you do?
• What are the common health problems in the community? What do people do if they suffer from them? What medicines, if any, do people use to treat them? To what extent are these drug use practices rational?1
• What are the most common medicines used to promote health? To what extent are these practices rational?
• What do people consider to be drug use problems in their communities?
• What do health workers believe are drug use problems in the community?
1 In chapter 1 rational use was defined as: patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.
Additional questions that can help describe community drug use patterns include:
• What medicines do people keep in their homes? What are they used for?
• What medicines are commonly sold in community shops and other sources of medicines in the community? What are they used for? How much do they cost?
• Where do people go to obtain medicines? What are the advantages and disadvantages of the various sources?
Various quantitative and qualitative methods can be used to describe and analyse drug use problems. Each method has its own weaknesses and strengths. In the following sections, you will find more details on a selection of methods that are especially useful for collecting data in communities on drug use.
Quantitative data are needed to describe how often certain drug use practices occur. They are frequently used when the study’s aim is to obtain a representative picture of the situation amongst a given population. In that case, researchers need to use a so-called probability sample to make sure that the study population has all the important characteristics of the general population from which it is drawn. The size of the sample depends on what you want to measure. We give an overview of sampling methods in Chapter 5. This will help you to take decisions. You should consult a researcher with statistical knowledge to decide on the sample size. Because of the relatively large number of respondents involved, the number of questions to be included in a quantitative study should be limited. You need to define key variables and indicators that will be measured in the study in order to answer the research questions.
Qualitative methods are used to find out more about people’s ideas, the reasons why problems occur, what people see as possible solutions and constraints. The emphasis is not on representation but on in-depth understanding. When selecting informants you should choose people who can provide the information you need. Make sure you cover the heterogeneity in the population, as views and ideas may differ between older and younger people, men and women, and people with different religious or social backgrounds. Qualitative studies can also be used to formulate appropriate questions for a quantitative survey, or they can be used to elucidate findings from quantitative studies.
The following data collection methods are often used to investigate drug use:
a. Study of documents
b. Semi-structured interviews
c. Focus group discussions
d. Observation techniques, including simulated client visits
e. Structured interviews, including weekly health recalls
For each of these five research methods, we discuss how to use the method, and its relative strengths and weaknesses (see Additional Reading at the end of the chapter, which includes publications covering research methods in more detail).1
1 The methods we discuss can also be used in step 3 of developing an intervention, when we aim to analyse why specific problems occur (see Chapter 4).