Survey instruments
Three types of survey instruments were designed for assessing the HCPs' practice and knowledge about STI case management. These included: (i) structured interview schedule for exit interview of SPs, (ii) structured interview schedule for HCPs and (iii) guidelines for in-depth discussion with HCPs. All the instruments were finalized for the main survey after field-test during the pilot study and technical review by experts.
Table 1: Sample size of all four categories of HCPs in all six districts
HCPs Category
1. Allopathic doctors in Government service settings (Allo-govt)
2. Doctors either employed in private institutions or engaged in own private practice (Allo-pvt)
3. Doctors trained in indigenous medical systems (Homeopathy, Ayurveda, Unani and Sidha) (Ayur-Homeo)
4. Non-qualified, traditional health care providers (RMPs)
Total 4 categories of HCPs and 6 districts
|
SP visits |
HCPs' |
|
In-depth |
|
| |
Interview |
|
Interview |
|
|
126 |
66 |
|
12 |
|
|
126 |
66 |
|
12 |
|
|
126 |
66 |
|
12 |
|
|
126 |
66 |
|
12 |
|
|
504 |
264 |
|
48 |
|
Training
Training was conducted for all the investigators including simulated patients, exit interviewers, and interviewers of HCPs before the pilot study. The main aim of the training was to sensitize them to STIs/HIV issues and enhance skills related to their role in the survey. The SP's training focused on developing skills for narrating a STI complaint -urethral discharge - convincingly and handling sensitive or problem situations, if any, during his visit to HCPs. The Exit interviewer's (EI) training focused on interviewing skills and documenting SP's experiences accurately in the structured questionnaire without influence of their personal biases and assumptions. The training of interview team focused on interview techniques, non-threatening and culturally sensitive ways of probing and eliciting information on STI case management and related advice to patients.
Pilot study
The pilot survey was conducted in two talukas – Nadiad and Kapadwanj of Kheda District – under the direct supervision and support of the supervisors. The purposes of the pilot study were to: (a) to pre-test the tools for data collection, (b) to field test the skills of the research team, and (c) to assess the appropriateness of field plan to implement the major study.
Based on the experience of the pilot study, the following changes were made in the survey design:
- All Talukas/wards in a district/city were classified into about 3 to 4 zones based on distinct parameters and of these, about one-third of the district/city was identified for the major study;
- During fieldwork, the teams were divided into smaller groups in order to escape
being noticed, especially in rural areas, and
- Daily meetings of the field team were conducted in order to review the day's accomplishments, ensure quality of data collection and review plans for the next day.
Main survey
The major study was conducted in cities of Ahmedabad, Baroda and Rajkot, and Mehsana (old), Panchmahals (old) and Kutch districts. The sample of allopathic practitioners working in government settings in Ahmedabad was obtained from the entire city including the suburbs and HCPs from remaining categories were selected from 13 of the 43 (about one-third) wards. In Baroda, the whole city and the neighboring PHCs were selected for government allopathic doctors, whereas the entire city was covered for RMPs. In Rajkot, neighboring primary health centers (PHCs) were also covered for allopathic government HCPs as adequate number of HCPs in this category were not available from within in the District. In Mehsana District, four of the eleven talukas including Mehsana, Visnagar, Patan and Kheralu were covered for the study. Four of the eleven taluks of Panchmahals district including Kalol, Dahod, Jhalod and Lunawada were covered. In Kutch District, three of the nine talukas were covered. These included Bhuj, Anjar and Nakhatrana.
Data analysis
Data entry and analysis of the data were done using SPSS.
Report
A detailed report on the study was prepared and submitted by COHESION. Based on that detailed report, this summary report was prepared which contain the salient findings of the study.
