Elizabeth Sloand, PhD, CRNP Nancy Glass, PhD, RN, FAAN Betty Dennis, DrPh, RN

1. Caribbean Exploratory [NIMHD] Research Center of ExcellenceUniversity of the Virgin IslandsSchool of NursingGrant Support: National Institute on Minority Health and Health Disparities, NIH (# P20MD002286). The Caribbean Exploratory [NIMHD] Research Center of Excellence and Global Health Research Collaboration: Protecting Haitian Women and Children  Earthquake Survivors from Violence and Abuse

2. Situational Analysis and Community Based Participation in Port au Prince, Haiti Elizabeth Sloand, PhD, CRNPNancy Glass, PhD, RN, FAANBetty Dennis, DrPh, RN Strategies for Developing Relationships to Support Research in a Foreign Country

3. NBNA SYMPOSIUMJULY 13, 2011 OBJECTIVES: • Identify the benefits of a situational analysis prior to conducting research in a foreign county • Describe the components of a situational analysis and the steps needed to implement a situational analysis • Discuss Participatory Action Research (PAR) as an effective strategy for community based participation in a research project in a foreign country

4. Situational Analysis– what is it? • Definition from Sociology: To develop a statistical picture of the community based on currently available information, using secondary data to: • Identify and Describe trends • Compare the community with others in the region, state or nation • Includes a SWOT analysis: assessment of the organization’s current and future strengths, weaknesses, opportunities, and threats. • Involves key informant interviews – purposes: • Define the nature of an issue confronting the community -- how do people in the community define the issue, the nature of its roots, its consequences for the community • Enumerate the community groups or organizations interested in or involved with the issue -- who in the community has a “stake” in the issue • Identify community-based resources that can be mobilized to address the issue -- -- economic, social, cultural, human • From: http://srdc.msstate.edu/fop/levelone/trainarc/09fall/session5_garkovich_handoutb.pdf

5. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Done in Three Stages: • Background information – pre-travel • Trip One • Two team members • Included key informants and logistics • Trip Two • Six team members • Included key informants, logistics, and focus groups

6. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage One: Background exploration done pre-trip • Quantitative and qualitative data collected on • Geography of area, people and communities • Socioeconomic profile of area • Health status of people in area

7. Stage One: Background exploration done pre-trip • Other quantitative and qualitative data collected: • Health services and management systems in area • Political and policy environment • Activities of other sectors important in determining health status of populations (housing, education, water, sanitation, etc) Situational Analysis for Haiti Abuse and Violence study, Post Earthquake

8. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage One: Background exploration done pre-trip • Methods of background exploration: • Websites, reports, papers on relevant topics • Abuse and violence, Haiti post earthquake, cholera • Incorporated a wide variety of health care providers in this planning stage • Contacts using snowball technique • Incorporated NGOs already working in Haiti: International Rescue Committee (IRC), Pan American Health Organization (PAHO), Catholic Medical Mission Board, JHPEIGO • Careful review of reports already completed on abuse and violence against women and girls in Haiti post earthquake: IRC and PAHO • Email and phone

9. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage Two: • Onsite in Port au Prince • Assess and develop partnerships with Haitian based NGOs, Academic Institutions and other key stakeholders • Two academic team members plus one Haitian American • Essential to have a Haitian American on the team, before and during travel. Our “Fixer”.

10. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage Two: onsite in Port au Prince • Key informant meetings with: • Ministries of Haitian Government: Health, Women’s Affairs, Social Affairs/Labor • General Hospital (Hospital of the State University of Haiti) • University of Haiti, Director of Research • Nursing school : National Nursing School of Port au Prince

11. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage Two- onsite in Port au Prince • More Key informant meetings : • General Hospital and GHESKIO (Haitian HIV/AIDS organization)- In search of IRB approval • Local and national women’s groups: Solidarity for Haitian Women (SOFA), associated with Madre International; KOFAVIV • Catholic Medical Mission Board (CMMB), World Vision • Other community leaders, religious, academic, nursing

12. Situational Analysis for Haiti Abuse and Violence study, Post Earthquake • Stage Three: Continue to Assess and develop partnerships with Haitian based NGOs, Academic Institutions and other key stakeholders • Focus groups: • Women survivors of earthquake who are living in camps • Directors and Program Managers • Ministries • Health care providers • Police, criminal justice • Community organizers

13. Situational Assessment and Research Logistics of doing research: Hire Haitian staff, including project director, research assistants Housing and food for study team; price of housing Transportation – including car and driver Communication including phone and internet Power and water Office space that includes security for data Data collection sites

14. Logistic challenges abound

15. Other goals • Advisory Board: recruit appropriate members • Determine appropriate incentives for participants • Determine appropriate rate of pay for staff in Haiti • Determine logistics of paying staff in Haiti

16. Challenges and Obstacles • Communication – esp. pre-travel to set up appointments and later to confirm • Transportation • Cost • Time consuming • Difficult

17. More Challenges and Obstacles Safety and practical issues • Trips to Haiti postponed 3 times due to political unrest and cholera epidemic • The challenge of gaining interest for our project, “selling” it to those who are already overwhelmed with their circumstances and work • Other huge issues face professionals and organizations in Haiti, including the ongoing cholera epidemic, the overwhelmed and underfunded health system, and overextended personnel

18. More Challenges and Obstacles • Lack of clarity re: payment that is appropriate • IRB!

19. Participatory Action Research in Another Country • Components of promoting community based participation in research in a foreign country • Fostering partnerships over time • Understanding community trust/distrust of research initiatives • Motivating full participation of community representatives • Role of community representatives in providing guidance regarding research process, acceptability, cultural and social relevance • Evaluation and dissemination of outcomes Kelly, P. J. (2005). Practical suggestions for community interventions using Participatory Action Research. Public Health Nurs, 22, 65–73.

20. Participatory Action Research with Haitian Partners: • Critically needed to examine the health, social, cultural and economic factors that influence survivors’ lives • Approach: key informants and focus groups • Be prepared for the unexpected: a group of 20 youth leaders organized in one day • Another scheduled group did not come except for one person, a physician who was very helpful and articulate about the key issues and problems

21. Lessons Learned • Invite a fixer to join research team but don’t totally depend on that one person • Lack of email and phone contact may not mean a dead end: the potential value of a drop in visit • Email and phone is not enough – you have to discuss and negotiate in person • Make appointments, confirm, reconfirm! • IRB: start early and keep at it!

22. Questions? Return to Life; Haiti won’t die

23. Thank you !