The Caribbean Exploratory [NIMHD] Research Center of
Excellence and Global Health Research Collaboration:
Protecting Haitian Women and Children Earthquake
Survivors from Violence and Abuse
Caribbean Exploratory [NIMHD]
Research Center of Excellence
University of the Virgin Islands
School of Nursing
Grant Support: National Institute on Minority Health and Health Disparities,
NIH (# P20MD002286).
METHODS, DESIGN AND ANALYSIS PLANS INCLUDING
AUDIO COMPUTED ASSISTED SELF INTERVIEWS
(ACASI) FOR HAITI PROJECT
Presenters:
Doris Campbell, PhD, ARNP, FAAN,
University of the Virgin Island
Hossein Yarandi, PhD,
Wayne State University
Desiree Bertrand, MSN, RN
Lorna Sutton, MPA
University of the Virgin Islands
Phyllis Sharps, PhD, RN, FAAN,
Johns Hopkins University
NBNA
JULY 13, 2011
OBJECTIVES:
At the conclusion of this presentation participants will be able to:
Discuss strategies for determining the prevalence of intimate partner
violence, non partner violence, sexual abuse and emotional abuse in
women and adolescent girl survivors of the Haitian earthquake.
Discuss strategies designed to build an effective advisory coalition to
support research on violence against internally displaced women and girls
following the Haiti earthquake.
Describe research design, methods and analysis plans and challenges to
conducting researching on violence and abuse of internally displaced
women and children following the Haiti earthquake.
STRATEGIES
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Determine prevalence of intimate partner violence, non
partner violence, sexual and emotional abuse in displaced
women and girls
– Audio computer assisted self interviews (ACASI) in
a descriptive survey.
Develop safety education and training program to protect
vulnerable women and girls from risk of violence and abuse
– Brief cognitive behavioral traumatic recovery
intervention adapted for the Haitian culture and
current context as well as engaging the community
(including boys and men) to decrease norms
tolerating VAW in Haiti.
Combine the expertise of members of the Advisory
Coalition from from Haiti with US consultants
Support ongoing violence prevention activities
Outcome evaluation
ADVISORY COALITION
Strategies for developing Advisory Coalition
• Identify researchers, health professionals,
governmental and community organizations and
advocates to participate as partners in study
• Conduct focus groups for input on adapting
methods for recruiting and screening participants,
access, availability and utilization of services,
• Identify major elements of program to protect the
safety of displaced women and adolescent girl
survivors of the Haitian Earthquake.
ADVISORY COALITION
• Use the situational analysis results to adapt and develop
culturally relevant and linguistically appropriate safety
protocols to be implemented with internally displaced
women and adolescent girl survivors in Haiti.
• Identify best practices for addressing violence and abuse in
Haiti, how to best work with the local government, local
NGOs and community partners to develop sustainable
programs for victims in communities.
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May 2011 – Small team of experts visited Haiti . Met with
Haitian potential partners to identify and observe the living
situations for the women and children in the IDP camps
NEXT STEPS
 Assessment of local governmental and NGOs and resources
prior to the earthquake and current functioning of those
agencies
– Identify gaps in services
– Interviews with international NGOs, service
providers
– Interview male survivors
 Challenges in Haiti
Insuring women get appropriate treatment for IPV,
depression, suicide or dangerous situations may be
challenging in Haiti due to disruption of service
delivery systems.
Conducting Surveys in Developing Countries
• Conducting survey in a developing country can
be a major undertaking, and the costs in terms
time and money should not be underestimated.
• It should be tailored to specific research
questions.
• It carries high potential to yield truly new
insights.
• Collaborating with local people on surveys is
essential.
Collaboration
• Successful surveys in developing countries depend on the
support of energetic, capable research collaborators from the
host country who know how to get things done within the
country’s institutional, political, and social environment
• They are skilled at interacting with government officials and
community leaders; have developed reputations within the
country that build trust; and have valuable substantive insights
into the research questions.
• On the flip side, collaborators pursuing agendas at crosspurposes with those of the researcher can easily frustrate
research plans.
• Researchers have limited ability to control either the
organization or the individuals with whom they must deal.
Collaboration
• It is critical to cultivate a positive working
relationship.
• Making sure that the collaborators perceive benefits
to making the collaboration a success.
– get them excited about the important contribution of the
research
– encourage collaborative research products
– help the collaborators realize their own intellectual goals
– provide adequate compensation for services
– take the time to develop personal relationships
Sampling
• Sampling is one of the most critical aspects of any
survey because it forms the basis for the key claim of
generalizability, which is the main strength of
quantitative research.
• Sampling designs can be very complicated, depending
on the goal of the research
• The first step in sampling is to clearly define the
population of interest
• The next step is to develop a sampling frame, or a list
of possible respondents.
Sampling
• Researchers must consider trade-offs among sampling
error, nonsampling error, and cost in making decisions in
the field regarding sample selection.
• Statistically, a larger sample makes it possible to measure
the relationships between variables with greater precision.
• In general, sample sizes of fewer than 200 observations
often make it challenging to employ appropriate empirical
methods or to produce results that are statistically
significant.
Questionnaire Design
• Clearly defining the research question is the first step in designing
an effective questionnaire.
• Do not ask an exhaustive set of questions about everything
without having a clear research question or methodology in mind.
• the quality of information that survey respondents provide
declines significantly after more than 60 minutes
• Questions included in survey instruments should be worded in
culturally appropriate language.
• Active participation by local collaborators, informants, and study
subjects is invaluable.
• Questions should be simple, direct, and familiar to respondents.
ACASI Software Systems
• ACASI stands for Audio ComputerAssisted Self-Interview. This
questionnaire system is especially well
suited for collecting sensitive data on
topics such as alcohol and illegal drug
use, risky sexual behavior, or intimate
partner violence.
ACASI Advantages
• Allows subjects to privately answer
sensitive personal questions on a
computer with headphones
• Eliminates data entry time and errors
• Questions are asked in the exact same
way.
• Works well for subjects with literacy
issues
ACASI Possible Question Types
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Yes/No
Multiple Choice – Select One Answer
Multiple Choice – Select All That Apply
Scale
Numeric Entry
Text Entry
Interviewer-Administered
Multiple Language
Translated Adult Questionnaire (Excerpt)
English Adult
• B.4.1 Since the earthquake,
has anyone forced you to
have sexual activities?
Yes No
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B.4.1.If yes, who did this to you?
(Circle all that apply)
a. Husband
b. Ex-husband
c. Boyfriend
d. Ex-Boyfriend
e. Partner (same sex)
f. Ex-Partner
g. Other
Haitian Creole Adult
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B.4. nan tan lontan 2 ane sa yo,
anvan tranbleman de tè a, te gen
yon moun fòse ou pou gen aktivite
seksyèl?
a. Wi
b. Non
B.4.1 pa te si wi, moun ki fè sa
pou ou?
(Lè sa a, tout sa aplike circle)
a. Mari
b. ansyen-mari
c. amoure
d. ansyen-anmore
e. patnè (bwa)
f. ansyen patnè
g. famil lòt
Translated Interview (Excerpt)
English Adolescent
SCREENING (AAS)
• B.1. Before the earthquake, had
you ever been emotionally or
physically abused by someone
important to you? Yes No
• B.1.i If yes, who did this to you?
(Circle all that apply)
• Boyfriend
• Ex-Boyfriend
• Partner (same sex)
• Ex-Partner
• Other family member
•
Haitian Creole Adolescent
Managing the Data
• Individuals responsible for interviewing respondents play a
critical role in determining the quality of survey data.
• They can be university students, research institute staff, or
professional survey staff.
• Training of collaborators should include basic interview
techniques; explanation of the goals of the research; and
discussion of survey protocols, the meaning and purpose of
each survey question, and protocols to follow when
respondents do not understand questions or refuse to answer.
• It is critical that the work of collaborators be monitored
systematically.
Managing the Data
• Data entry and cleaning.
• It is often cost effective to enter the data while in the
host country.
• Some surveys now enter the data in the field, by means
of notebook computers
– improve data quality,
– Can increase costs because of greater hardware requirements
Analysis of Survey Data
• The analysis of survey data may take many forms.
– Most often, descriptive statistics are used to summarize
responses.
– When quantitative data such as age are collected, we should
present summary measures (mean, standard deviation,
minimum, and maximum).
– With categorical data, we should report the frequency of
responses to specific questions.
• These frequencies are typically converted to a percentage
of the total sample.
• For example, we might report that 40% of the sample was
male and 60% was female, or in a question about opinions,
that 25% strongly agree, 30% agree, 8% disagree, and so
on.
Analysis of Survey Data
• Percentages should always be accompanied by reference
to the total sample size, so that the reader can determine
the actual number of responses in each category.
– Percentages are usually more meaningful than actual frequencies
because sample sizes may differ greatly among studies.
• Another common approach to data analysis involves the
description of relationships between two or more sets of
responses.
– The chi-square test can be used to examine this relationship
statistically, to determine if there is a significant relationship
between the two variables.
Analysis of Survey Data
• Depending on the length and complexity of the
questionnaire, we can present response percentages for
all questions on the survey, or they may simply
summarize the more important relationships that were
studied.
• Some reports present purely narrative descriptions of the
results; others include tables showing the responses to
each question. We must determine which type of
presentation will be most effective for the data.
Final Thoughts
• Many unexpected things can occur during field
research, such as
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Delays due to political events,
Natural disasters,
Institutional factors, and so on.
Demands for more money,
Restrictions on research activity
• It is a good idea to think about contingency plans for
accomplishing the research goals well ahead of time,
just in case things do not go as planned.
Data Collection Challenges

Identify the best methods to screen and
collect data from abused women and girls
residing in Haiti.
1.
Develop and implement screening and data
collection methods that are culturally sensitive
and will facilitate Haiti women and girls
disclosing their abuse status and experiences.
Data Collection Challenges
SELECTION OF INTERVIEWERS – CONSIDERATIONS:
 Probability of interacting with participants postinterview unpredictable due to lack of stable living
situation.
 Hundreds of thousands still living in temporary housing
in tent cities in and around Port au Prince
 Collecting sensitive information
Audio Computer Assisted Self Interview
SOLUTION:
 Use audio computer assisted screeningACASI
 Intense initial and periodic training on
confidentiality issues
ACASI Background
Computer Assisted Screening
• Software = Talker – developed by David Bertollo
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Software is designed so researchers can use basic computer
programming skills to develop simple scripts
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Comprehensive questionnaire that uses text and audio for
each question
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Answers can be scored as participants responds to questions
ACASI Screening
Computer Assisted Screening: Talker Software
• Questions are presented one screen at a time
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Text is clear and LARGE
• BIG ANSWER BUTTONS
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Equipment
– Tablet PCs
– Touch Screen or stylus
ACASI: First Screen
ACASI Screen: Demographics
ACASI: Screening for IPV
ACASI Screen: Partner
ACASI Screen: IPV and Partner
ACASI Screen: IPV &Relationship
ACASI Screen: Eligible
ACASI Screen: Ineligible
Advantages of ACASI
 Increases access to health care by:
 Using culturally competent approach to Gender
Based Violence Screening including IPV screening
for women in all health care settings .
 Increasing accurate identification of IPV, rape and
other acts of violence against women and girls
 Increases collaboration with community resources
through referrals
 Increases collaboration with whole community by
increasing awareness of unmet health care needs of
abused women
Methods: Pilot of ACASI
 Pilot Sample: US
 Eligibility criteria
• Women aged 18-55 years
• Self-identify as Afro Caribbean or African American
• Report of a male sex partner in the past two years
 Women recruited from primary care, prenatal or family planning
clinics
 Questionnaire administered on a touch screen computer with
optional headphones - an important methodological strategy
• For women of low literacy
• For sensitive information
• Alerts interviewer if high score on DA or suicidality
• Allows increased recruitment among Spanish speaking
• Recording in Spanish & English by USVI residents
– for increased cultural appropriateness
 Study period: 2007 - 2012 – data collection began 12/2009
Pilot Sample Responses (US)
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3 of 21 participants preferred paper/pencil administration of
questionnaires
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All 21 participants stated ACASI was easy to use
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50% of the participants needed help with the ACASI system
Lessons Learned for Haiti Study
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Use bilingual speakers for recording of questionnaires
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Incorporation of culturally appropriate language into French
and French Creole translations
– Words
– Dialects
• ACASI system will be pilot tested with representative
sample of Haitian women and adolescent girls prior to
beginning study
• Displaced since earthquake
• Woman and adolescent girls 12-44
• Speak Haitian Creole, French or English
THANK YOU!!
QUESTIONS?