The Effects of Skilled Health Attendants on Reducing Maternal Deaths in Developing Countries - Essay Example

Skilled Health Attendants 17 March Questions & Answers (3) A main problem with reflexive designs is the difficultyin separating the cause and the effect, especially during the initial stages of the design process. A good designer must be alert for this close relationship. In other words, the cause will create an effect but then later on the effect affects back the cause in a continuous loop. Although helpful in situations like when one is trying to get feedback, researchers often are confused with the results of their studies and the data so collected could be muddled. This in turn affects the validity of some of their conclusions or might even render the whole study as defective or at best, inconclusive. A secondary problem is when the changes are quite rapid among the study groups of a research. Reflexive designs are used to overcome the problem of comparability by collecting data on the same study group before and after the introduction of an intervention (independent variable). The problem arises when the rapid changes have a significant effect on the outcome (dependent variables) and a situation arises on how to separate the cause from the effect and the effects of the effect back on the original cause (Kumar 2005, p. 290). It would be hard to separate one from the other and will require a keen mind and a sharp eye to do so. A third problem with these reflexive designs is that they are often cumbersome as the reiteration process needs to be repeated several times (multiple repetitions). A different new variable can be introduced into the study inadvertently that significantly affects the validity of the outcomes. The design work is often then cycled back to earlier designs to incorporate new ideas, values and information that is gathered so far (Boud, Cressey & Docherty 2006, p. 90). In this connection, even the mere presence of a researcher could possibly affect the outcome. (5) When considering or evaluating the impact of a program, the researcher must be aware of two factors that can affect how the evaluation process will turn out based on the sources of data: the sampling method used and the data collection method. Sampling design and sample selection affects the outcome of the results and hence the evaluation of a certain program. The two have a significant influence on the results of the evaluation (Issel 2008, p. 413). On the other hand, collection of the evaluation data is largely dependent on the collection methods to be used. In this regard, researchers should focus more on the collection of primary data (those newly-generated data) rather than from secondary data (using existing data). A lot depends on the sample size to be used and the specific type of evaluation question also (ibid. 426). (8) External validity of an experiment refers to its generalizability and internal validity pertains to the dependability of the results obtained (Powell 1997, p. 128). There are 3 threats that makes a politicians claims invalid which are the following: research environment, threats from different designs used among or between cases and lastly, longitudinal threats. For the first threat, a politician is always bound to influence a local population and its effect is known as demand characteristics and another is known as the expectancy effect. Second threat arises when a politician selects only a particular group that is sympathetic to what he will say or to his political platform. The third threat results from three factors, namely: history (as when a supervening event occurs), maturity (change in cases) and mortality when study subjects may change their political parties (Schwab 2005, p. 74). (12) It is possible to conduct random sampling in single-subject evaluations because these can be done on different time periods; individual changes can be studied since same persons are measured over various points in time (Tripodi & Potocky-Tripodi 2007, p. 122). It is research repeated over time to understand individual cases (Colton & Covert 2007, p. 39). Introduction The paper I will critique is the significance of skilled health attendants in helping to reduce maternal deaths in developing countries. The name of this article is “The Effects of Skilled Health Attendants on Reducing Maternal Deaths in Developing Countries: Testing the Medical Model” and the author is Cynthia T. Cook which was published in Evaluation and Program Planning in 2002. The author claims using skilled health attendants can be a factor in reducing women deaths from pregnancy-related causes and complications. She used the Medical Model to explain this based on social and economic factors on why maternal mortality rates are higher in some developing countries and not in others. Although she made some interesting observations about the factors causing maternal mortality rates (MMR), her conclusions are not definite due to use of data no longer current. Further, there were data gaps from some countries she had studied (only 100 countries had comparable data out of the 150 she studied). But some of the tentative conclusions she arrived at point to some interesting findings regarding MMR. Discussion More than half a million women die from pregnancy-related causes and complications each year. Most of these deaths (99%) occur in the developing countries. Practically all these maternal deaths are also preventable if only adequate medical facilities and expert care are available. A maternal death is defined as death occurring during pregnancy or 42 days after pregnancy termination. The author used her Medical Model for a correlation between maternal mortality rate (MMR) and number of skilled health attendants available to attend to pregnant women before, during and after a pregnancy. A skilled health attendant is someone who has proper training to give supervision, advice and care during a pregnancy, childbirth and postpartum period. Proper training is defined as skills to deliver babies on their own and to care for newborns. A problem encountered by the author was defining what constitutes a skilled health attendant because in developing countries, it is anyone who is a doctor, nurse, trained midwife, health care worker or a trained traditional birth attendant (Cook, 2001, p. 107). The absence of clear definition had a serious effect on separating data obtained and determining exact factors that influenced MMR. The author used some outdated data. For example, there was a mismatch in the data obtained for MMR which was in 1990 but corresponding data for the independent variables narrowed down to only three which are the number of medical doctors, registered nurses and number of births attended by skilled health attendant was obtained from 1997 (ibid. 109). Conclusion Despite these limitations and incongruities, the author has some interesting findings. A primary one is that there was a direct link between lowering MMR and raising the number of SKHA. Conversely, raising the number of medical doctors does not necessarily lower MMR. A probable explanation for this was the number of unnecessary surgical deliveries (ibid. 114). Reference List Boud, D., Cressey, P. & Docherty, P. (2006). Productive Reflection At Work: Learning for Changing Organizations. New York, NY: Taylor and Francis. Colton, D. & Covert, R. W. (2007). Designing and Constructing Instruments for Social Research and Evaluation. Hoboken, NJ: John Wiley and Sons. Cook, C. T. (2002). The Effects of Skilled Health Attendants on Reducing Maternal Deaths in Developing Countries: Testing the Medical Model. Evaluation and Program Planning, 25. 107-116. Issel, L. M. (2008). Health Program Planning and Evaluation: A Practical and Systematic Approach for Community Health. Sudbury, MA: Jones & Bartlett Publishers. Kumar, R. (2005). Research Methodology: A Step-by-Step Guide for Beginners. Vol. 2 Thousand Oaks, CA: Sage Publications. Powell, R. R. (1997). Basic Research Methods for Librarians. Westport, CT: Greenwood Publishing Group. Schwab, D. P. (2005). Research Methods for Organizational Studies. Florence, KY: Routledge. Tripodi, T. & Potocky-Tripodi, M. (2007). International Social Work Research: Issues and Prospects. New York, NY: Oxford University Press US. Read More