How to investigate levels of Adherence to antiretroviral ... - INRUD

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Chapter 6 Planning and field methods Train personnel A key step in preparing for field work is to train the team leaders and data collectors to collect and code the data in a correct and consistent way. Training is addressed in the next chapter. Pilot-test the data collection methods During the training of the team leaders’ and data collectors’ trainings, the data collection methods should be piloted at separate facilities to make sure the methods work and that they are understood. This is an important step which will provide an opportunity to identify and solve unforeseen problems. It will also identify "natural leaders" who can assist the other data collectors in case of difficulty. Experience shows that during the pilot testing the rate of data collection is always very slow. Data collectors should be reassured that with practice their rate will increase dramatically. So study planners should not make calculations of the time required at each site based on this exercise. Ethics for data collectors All data collectors should understand that any patient information they receive is completely confidential. They should not under any circumstances divulge any of that information to anyone else outside the survey. Depending on where the survey is carried out, it may be necessary for the data collectors to sign a confidentiality agreement. It also needs to be understood that patients have no obligation to give exit interviews. Before the interview begins the interviewer should communicate the purpose of the interview and give an assurance of confidentiality. At that point, the patient needs to be asked for their consent to continue with the interview. If the patient agrees, only at that point should the interview begin. To select the sample of patients for the retrospective sample from the attendance register, the patient identifier form is used. For this only the patient identification number is recorded, not the name. This will enable the pharmacy records to be found in the most anonymous way possible. Collecting data Remember to arrive at the same time as the clinic opens to set up before the main rush of the day starts. After introducing the team members to the facility manager, the team needs to quickly decide: How can they sample the retrospective records? Where they can sit to extract the data from the records? 63
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Where they can sit to do the exit interviews? How can they have the patients directed to that spot? Sampling and retrospective data extraction The methods of retrospective sampling have been discussed before in Chapter 4 and Table 3, but these need to be established and started immediately so that if selected records need to be pulled, this can be done promptly so that the data extractors can start. It is important to minimize any waiting time. The first step is therefore to work out how the sampling is possible in that record-keeping system and start the process. This needs imagination and skill on the part of the team leader. Space is needed for data collectors to sit down with the pile of records and extract the relevant data. A separate room with one or two tables is ideal. All data collectors not interviewing should be engaged in this. In all, 100 sets of patient records are needed. It may be quicker to select 25 (or less) at a time so that data extractors do not have to wait while records are being found. Exit interview A location needs to be found and made comfortable and the dispenser needs to be briefed to direct the relevant patients to the place for interviews. The exit interviews take about 10 minutes each, so depending on patient flow the appropriate number of interviewers will be chosen. This will vary through the day. It may be that the pharmacist comes in late so there is a queue of patients and a sudden rush when the pharmacist starts work. Careful adjustment to this patient flow is needed. When no patients are available for interviewing, the data collectors should concentrate on the retrospective data extraction. Facility interview Once the sampling and record extraction process is working, the place and manner of exit interviews have been established and the data collectors know and are settled in their different roles, the team leader can start on the facility interview. It should only take one or two hours at most, so that the team leader should also do a fair share of retrospective data extraction. Computer entry Once the process is underway and at least 70 retrospective records have been extracted, one or two team members can start to enter the data on a computer. If this is the team leader, it becomes a chance to make sure the data are entered sensibly and gives the opportunity to ensure quality control and handling any problems that are encountered. Check to make sure the dating systems of the collected data and the data entry software are the same (i.e., dd/mm/yy) 64
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CONTENTS Acknowledgements .........
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