Designing a Research Study to Obtain Accurate Wound Survey Data in Rural Ghana

Monday, 18 November 2013: 1:45 PM

Linda L. L. Benskin, PhD-C, RN, SRN (Ghana), CWCN, CWS, DAPWCA
Graduate School of Biomedical Sciences, University of Texas Medical Branch, Galveston, TX

Learning Objective 1: The learner will be able to explain reasons why valid quantitative research data in this environment cannot be obtained using traditional paper and pencil surveys.

Learning Objective 2: The learner will recognize the value of adapting this culturally-sensitive template to design other research studies, particularly in rural areas of developing countries.

Purpose: Unrelenting heat, poor sanitation, lack of knowledge, and poverty all contribute to a disabling wound prevalence often exceeding 20% in rural areas of tropical developing nations. Detailed descriptions of usual wound management practices by village care providers are needed to design effective, culturally-appropriate wound management protocols. No such descriptions were found in the literature. The purpose was to design a study to obtain accurate descriptions of usual topical wound management practices in Ghanaian villages. Barriers to obtaining accurate data in this setting include:

1. cultural differences that prevent classical surveys from being understood

2. a universal reluctance to expose ones’ work to strangers for evaluation

3. a sense of hospitality which dictates that one provide pleasing answers, in preference to accurate answers

4. the challenge of presenting queries with adequate relevance to elicit quantifiable responses

Method: Thirty actual wound cases (photos/histories) were presented to five Ghanaians experienced in wound care and familiar with village life. Based upon their responses, seven cases were chosen as representative interview prompts for the 75 study participants in 25 villages throughout Ghana. Semi-structured interviews were guided by these case studies because story-telling is integral to village cultures and is relatively unintimidating. Open-ended questions avoided inferring that any particular aspect of wound management, such as cleansing, is expected.

Results: Most of the study participants offered detailed descriptive responses, verifying that the seven chosen wound exemplars were familiar and the case study method put them at ease. The eclectic detailed nature of the responses indicates that the participants did not simply provide answers they believed would be pleasing.

Conclusion: Using representative wound cases to elicit objective data overcame the significant barriers that have prevented researchers from discovering actual wound management practices in rural developing areas. This study design template can be utilized in many diverse settings.