INTERNATIONAL MEDICAL UNIVERSITY

UNIVERSITI PERUBATAN
ANTARABANGSA

COMMUNITY FIELD VISIT PROGRAMME

STUDY GUIDE

1
 FORWORD
The Community Field Visit is designed for the undergraduates to understand how the
people and communities play vital roles in understanding health in general. This is a pioneer
initiative by the Community Medicine Department, of IMU to introduce health survey in its
curriculum. It is designed to understand the people, disease and the environment. The students
will also appreciate the Malaysian primary rural health care system.
There are three main objective of the programme. The main objective is to participate in
the planning of the rural health survey by the students. In this survey the students learn how to
prepare the questionnaire, and conduct a survey of a rural community. The students are expected
to learn many aspects of the community including socio-demography, income and expenditure,
housing, water supply, excreta and waste disposal, vectors and pest controls, working
environment, food nutrition and health, and the health seeking behaviors. This information will
give the students ideas as to how the communities live and utilize the health services. The second
component of the survey is the thematic project which is a research proposal designed for the
areas. This research can be any form of research from that area. Third component of the CFV is
the visit to the health clinics. The visit allow the students to understand some of the practical
aspects they has learned in the classroom. It is important to realize that the CRP programme also
teaches skills such as epidemiological skills, statistical skills, leadership skills, and managerial
skills. The students learn how to organize themselves and work as teams.
I hope that the students will participate fully in the programme and learn from the
programme. The students in the field will be supervised by a staff of the Community Medicine
Department. In the field the students are expected to behave well and the supervisor will evaluate
their performance individually. The fieldwork will be concluded with presentations from students,

Professor Dr. Hematram Yadav

Head of Department, Department of Community Medicine

2
The Community Field Visit

Before one can really begin to provide acceptable medical care to the people, one should know
and understand their way of life as well as have some knowledge of the diseases present in the
community and the environmental (ecological) factors that contribute to disease and death.

To achieve this end, a course on the Introduction to Community Health Survey to familiarise the
student with various aspects of urban and rural life and also a field exercise - the Community
Health Survey. This survey also allows the student to put into practice many of the aspects of
social and preventive medicine that has been learnt thus far during their pre-clinical years.

1. Learning Outcomes
At the end of the field survey, the student should be able to demonstrate that he/she has acquired
adequate knowledge regarding health status of rural communities in Peninsular Malaysia by:

1. participating in the planning of the rural health survey to be conducted by the group.
2. fully participating in the conduct of a community health survey,
3. contributing to and helping in the production of a group survey report of satisfactory
standard, and
4. presenting, some aspect of life and health in his survey area to the rest of his/her class.

3
Community Field Visit
Planning

4
Community Field Visit Planning

The class will be divided into six groups which will be located in various selected areas. Each
group will be under the care of a staff member from the Community Medicine Department. Each
group will be divided into sub groups. All groups will be required to perform the following tasks:

a) Health clinic visit

b) Household Survey
c) Health Issues Research
d) Visit to water treatment plants , sewage system, etc.
(If time permits)
Group members will have the opportunity to learn from all the activities listed above. The
coordinator for each group will organize the learning with the facilitation of the supervisor. The
responsibility for the production of a satisfactory questionnaire for use in the field will lie with the
groups concerned. Review of questionnaires will be conducted by the Staff of the Department of
Community Medicine. Groups will arrange for the printing and compilation of their own
questionnaires.

Conduct of the Community Field Visit Programme

Students will be assigned to groups and will travel to the respective clinics to carry out their field
survey. They are expected to be at their respective stations for at least TWO days

The groups will be introduced to their respective Medical Health Officers and other leaders.

Outcome
Students will be required to produce a portfolio as evidence of the learning. The portfolio will
consists of FOUR parts:

Part 1 : A brief write-up of the administration of the clinics

Part 2 : A report on the household survey
Part 3 : A brief report on the health issues research
Part 4 : A brief report on the visit to water treatment plants & sewage system (if applicable)

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SURVEY

6
Survey
The survey is one of the most widely used research methods in investigating social phenomena such as
health seeking behaviour, environmental issues, psychological and disease management. By definition
surveys can be anything from a short paper-pencil feedback form to an intensive one-to-one in-depth
interview. Survey research encompasses measurement procedures and techniques of gathering data either
by direct measurement or by soliciting it from written responses. A survey generally employs methods that
involve questioning respondents.

Although there are various approaches in a survey, the questionnaire survey is the most commonly used
method. There are many forms of questionnaire surveys like the mail survey, group administered survey,
household drop-off survey and internet survey for the questionnaire category while the personal interview
and telephone interview are most frequently used methods in the interview category.

Even though the survey exists in various forms, all surveys share some unique characteristics, as follows:

a) A survey involves collection of data from the respondents in some structured form
b) information is defined in quantitative form where information is described in terms of variables and
c) samples are used to gather information.

Classification of surveys

In terms of purpose there are two types of survey; i) descriptive surveys, where the aim is mainly to
describe the nature and the characteristics of the population, and ii) analytical surveys intended to
determine the relationship between variables .

Basically there are two categories of survey designs, namely the cross-sectional and longitudinal surveys.
Both of these designs commonly utilize samples. When the entire population is used in a study, the survey
is then termed a census. The cross sectional surveys could be either for descriptive or explanatory
(analytical) purposes. However the longitudinal survey, where the main concern is establishing causal
relationships, is used mainly for analytical purposes.

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Intended learning outcome of the Community Survey
At the end of the two sessions the student should understand
a. the stages of an investigation/survey
b. what are variables
c. types and sources of data
d. types of data collection techniques
e. aspects of questionnaire construction
f. methods of data processing and analysis

The Research Process

Scientific research is characterized by a systematic process which includes: identifying and
defining the problem, developing the theoretical framework, research design formulation, data
collection, data preparation and analysis, and report writing and presentation.

Identifying and defining the problem
Developing the theoretical framework
Research design formulation
Data collection
Data preparation and analysis
Report writing and presentation
Involves discussion with decision makers, interviews
with industry expert, analysis the secondary data, and
perhaps some qualitative research such as focus groups
The development of conceptual and theoretical
framework, framing of research questions,
identification of research variables, and construction of
research hypotheses
Research design is a framework or blueprint for
conducting research project. Research design includes
deciding on: the right paradigm, units of analysis,
sampling, instrument and measurement, data collection
and analysis
Can be either through personal interviewing,
observation, questionnaire survey, or document
analysis
Involves editing, coding, transcription or data entry,
data cleaning and verification of data. The data are
analyzed to derived information to address the research
objectives and/or hypotheses
the documentation of the entire research project
starting from problem formulation until data analysis,
interpretation and recommendations

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Learning Methods:
i) Lectures\Discussion [Duration : 1 hour]
ii) Field Survey [Duration : 3 days]

Stages of an investigation
1. Preliminary Steps:
a) Determining the purpose of the study
For the CFV, the purpose is to allow you to gain an insight into the lifestyle, socioeconomic,
cultural and other factors which may affect the health status of a community. It also allows you
the opportunity to plan and conduct a study and also enables you to understand the problems and
limitations of various data sources and methods of data collection.

b) Formulating the topic

A study of the health status of a community and the various ecological factors which may affect it,
either directly or indirectly,

c) Literature review
General information regarding the demographic and socioeconomic status of the district
population can be obtained from the District Office, Health Office or publications of the
Department of Statistics such as the annual "Vital Statistics". Library search of relevant journal
articles using Medline and other databases.

2. Planning Stage

a) Formulate study objectives

After identifying the various factors which you would like to study, you should state clearly the
specific objectives under each category so that you know precisely what information you require
and in what form.

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Objectives are specific quantifiable milestones that mark progress towards the achievement of a
set of broader goals. They are the desired outputs of a system. Objectives of a research project
summarizes what is to be achieved by the study. they should be clearly phrased in operational
terms, stating exactly what one is going to do. The results have to be compared with the
objectives.

Objectives should be stated in "action verbs" which are specific enough to be measured, i.e. to
determine, compare, verify, calculate, described and establish. Do not use vague "non-action
verbs" such as to appreciate or understand.

General objective is one which is planning for what is to be accomplished by the study in general
terms. This is then broken down into smaller logically connected parts or the specific objectives.

b) List the variables

Define the variables to be collected, selecting those which can be readily obtained. A variable is a
characteristic of a person, object or phenomenon, which is measurable. It is a qualitative or
quantitative entity that can vary and take on different values.

Types of variables:

1) Independent variable refers to the "cause".

2) Dependent variable refers to the "effect/outcome". E.g. in a study to determine the relationship
between mother's smoking habit and birth weight, the mother's smoking habit is the independent
variable, while birth weight is the dependent variable.

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3) Confounding variables
A potential confounding variable is one which is associated with problem as well as the possible
cause of the problem. This variable may weaken or strengthen the apparent relationship between
a possible cause and an outcome. E.g. a study shows a relationship between mother's educational
level and malnutrition. However, family income is related to the mother's education as well as
with malnutrition. Family income is the potential confounding variable.

4) Universal variables
Variables which are so often of relevance in investigations of groups or populations, that their
inclusion should always be considered. E.g. age, sex, parity, ethnic group, religion, marital status,
social class, place of residence (rural/urban)

Defining variables

1) Conceptual definition; defines the variable as it is conceived, e.g. using social class as an
indicator of socioeconomic status or excess body weight as an indicator of obesity.

2) Operational definition; defines the characteristic which one wants to measure. It is phrased in
terms of objectively, observable facts and should be sufficiently clear and explicit to avoid
ambiguity, e.g. using occupation as an indicator of social class and the body mass index as an
indicator of obesity.

Scales of measurement

1) Nominal scale consists of two or more categories that are mutually exclusive and presented in
the form of counts, e.g. for smoking; never smoked, ex-smoker, smoker. There is no natural
order.

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2) Ordinal scale. The categories fall into a natural order and are ranked with the scale showing
positions of a ladder, e.g. social class I to V and agreement with a statement (strongly agree,
agree, neutral, disagree, strongly disagree). Each class shows the same situational relationship to
the class that follows.
3) Binary scale, refers to variable with two outcome, e.g. sex, presence or absence of a disease.

4) Continuos scale refers to variable where there is a continuum of measurements where an

infinite number of values exist, e.g. weights, heights, blood glucose readings.

5) Composite scale based on; Combinations of categories e.g. systolic and diastolic blood
pressure for hypertension. Use of formula, e.g. length of gestation, average income per capita and
obesity indices. Composite scores e.g. raw scores and weighted scores.

a) Selecting the study population

For practical purposes and due to various constraints, areas for the Community Field Visit are
usually selected in terms of accessibility. For areas with large populations, some form of sampling
have to be conducted. Each house would act as a sampling unit and a sample can be selected
using a random sampling method.

b) Sources of data

Primary using questionnaires, either self-administered or by interview. This will be discussed in

the next session.

Secondary data is existing data or data which has already been collected.

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Secondary Data
1. Publications with information on population:
2. Death certificates
3. Notifications E.g. sexually transmitted diseases, occupational diseases or injuries
4. Hospital or other records
5. Registers of diseases or people requiring special care, e.g. cancer register, register for
handicapped children
6. Personal documents; birth certificates vaccination certificates registration cards

Advantages of secondary data:

Inexpensive Uses existing sources of information Useful in cases where respondents are either
unwilling to be questioned or an unavailable. Permits examination of trends in the past.

Disadvantages:

Difficulty in access because of ethical issues pertaining to privacy. Changes in record-keeping

procedures or different criteria used. Biased or wrong information recorded, incomplete or
missing information.

Procedures for collecting secondary data

a) Determine the range of statistics available

b) Verify the definitions used
c) Determine the methods of collection and processing used
d) Investigate the reliability of the source

Primary Data
Primary data is data which is obtained by the investigator or his team using various methods.

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1. Measurement
E.g. measurement of weights, blood pressure, blood glucose levels or clinical signs.

2. Questionnaires/Survey Format
Obtaining information using interviews or self-administered (with the respondents filling in the
form).

I) Interview :
An interviews is a technique whereby one or more respondents are questioned orally. Interviews
produce soft data as opposed to hard data obtained by the various methods of observation or
measurement.

a) Unstructured Interviews

In the case of unstructured interviews, this is conducted using a list of topics. Useful as an
exploratory tool in the early stages of the survey. Also useful for obtaining the possible responses
to a question for the design of more structured questionnaires.

Advantages:
 More natural and the respondent is more likely to be himself
 Answered in more depth by the respondent and also allows for probing

Disadvantages:
 Response may be affected by interviewer
 Reliability

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b. Structured Interviews

There is complete control of questions and responses. The schedule is designed so that different
interviewers will give the same stimuli in the same order. Responses are also recorded in a
standardised way.

Advantages:
 Respondents who don't read or write
 Awareness of the difficulties respondents have in the understanding of questions
 Only the person intended responds to the questions
 Lessens number of unanswered questions and increases response rate
 Produces additional data through observation
 Opportunity to ask more interesting open-ended questions

Disadvantages:

 Characteristics or actions of the interviewer may affect responses

 Costly to administer
 Worry about anonymity by respondents
 Only record what respondents they think, believe or feel
 Biased responses

II. Self- Administered Questionnaires

Use of a form that presents written questions that are to be answered in written form by the
respondents themselves.

15
Ways of administration:
• By mail
• Gathering respondents together and giving oral and written instructions, while the forms are
filled by the respondents themselves.
• Hand delivery of questionnaires to respondents and collecting them later.

Advantages:
• Less expensive than interview
• Requires less skill to administer
• Eliminates bias introduced in terms of variations in the way interviewers question respondents
• Allows respondents to be more honest by providing anonymity

Disadvantages:
• Difficult with illiterate or semiliterate respondents
• Lower rate of response than interviews
• Little control over who answers the questions or how long they take to answer
• No way of determining whether questions are understood and interpreted in the same way by
different respondents

Pertinent questions aspects in Questionnaire Construction

I . Is the questionnaire the best method for collecting your data? Alternative methods?
2. If yes, list the major areas to be covered.
3. Each question should have a specific purpose for being included in the questionnaire. Why was
it asked? What will be done with the information?
4. Quality of information will be maximised if. wording and sequence are designed to motivate the
respondent and facilitate recall should be interesting (avoid questions which are difficult to
answer, time-consuming, embarrassing or personally threatening)
5. Logical flow; from general to specific, impersonal to personal, easy to difficult
6. Respect for respondent's dignity and privacy
7. Ensure confidentiality

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Items in questionnaire should be categorised according to the information sought. Questions can
elicit four types of responses:

1. Attitudes (what people say they want)

a. Should all abortions be outlawed?

b. How do you feel about the legalisation of abortion?
c. Do you agree or disagree with this statement "Anyone who wants an abortion should be able
to get it"?

2. Beliefs (what people think is true)

a. Do you think that breastfeeding will prevent you from becoming pregnant?

3. Behaviour/ Practice (what people do)

a. Are you currently taking birth control pills? b. Have you ever had an abortion?

4. Attribute (what people are, their current status)

a. Are currently working? b. How many children do you have?

The purpose of the study should be clearly stated in order to decide whether the questions are to
be used to tap attitudes, beliefs, behaviour or attributes.

Open-ended versus close-ended questions

• Open-ended questions: leaves respondents free to answer in any way they choose.

• Close-ended questions present respondents with a choice of possible answers.

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Advantages of open- ended questions:

• Stimulate free thoughts, solicits suggestions from respondents, probe respondent's memories,
clarifies certain issues.

• Very useful for exploratory studies to find the most salient aspects of a topic, in preparation for
developing questions in a later survey.

Disadvantages:

• Respondent must recall past experience, reorganise them and find terms to express them. For
respondents with low educational levels, they may have difficulty in answering such questions.

• Probing is often necessary to avoid incomplete, uninterpretable or irrelevant answers.

Close-ended questions with ordered choices

Here answer choices are provided, with each choice a graduation of some thought or behaviour.
The respondents has to find the most appropriate place in the spectrum for his response; e.g.;

a) How do you feel about this statement?

Strongly agree / agree / neutral / disagree / strongly disagree.

b) "No one should wait more than 15 minutes before being seen by a doctor in the emergency
unit".

c) "Do you always come to the diabetic clinic for your follow-up?" (behaviour)
Always / frequently / sometimes / rarely

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Advantages:

• Responses are suited for may forms of statistical analysis.

• Useful for determining the intensity of feeling, degree of involvement, frequency of

participation.

Disadvantage:

Limited to the specific topic to be answered in a specific way and therefore faces the risk of
missing important aspects not previously considered.

Close-ended questions with unordered responses

Here respondents must choose from a few discrete unordered categories and selecting the one
that best reflects his situation.

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Data Analysis

20
Data Analysis using SPSS

Part 1 : Constructing tables and charts using SPSS

The data on hospital service quality is used to demonstrate the procedure for
constructing tables and charts using SPSS.

In SPSS, the various types of graphs and charts are under the “Graph” command.

i) Bar Chart for categorical variable

Plotting the bar chart to show the ethnicity of the respondents
SPSS Command:- Graphs  Bar  Simple  Push the selected variable into the category axis.

Plotting the bar chart to show the ethnicity of the respondents

21
Result:

50

40

30

20

10

Percent 0
malay chinese iban bidayuh melanau others

race

ii) Multiple Bar Chart for categorical variable

Plotting the bar chart to show the ethnicity of the respondents
SPSS Command :- Graphs  Bar  Clustered  Push the main variable into the Category Axis
box and the secondary variable into Defined Clusters by box.

Plotting clustered bar chart using SPSS

22
Result:
50

40

30

20

gender
10

male
Count

0 female
malay chinese iban bidayuh melanau others

race

Graphical presentation for continous data

Histogram, Stem and Leaf, and Box plot for continuous variable are commonly used ghrapical
presentation for continous data.

Patients’ assessment on “The clinic staff behave professionally” is used in the

following illusttation.

SPSS Command :- Analyze  Descriptive Statistics  Explore  Push the selected variable into
the dependent List box  Click ‘Plot”  tick ‘Factor levels together’, ‘Stem and Leaf’, and
‘Histogram’  click ‘OK’.

Plotting histogram, stem and leaf plot, and box plot using SPSS

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Histogram

Stem-and-Leaf Plot

Frequency Stem & Leaf

1.00 Extremes (=<1.0)

6.00 2 . 000
.00 2.
15.00 3 . 0000000
.00 3.
56.00 4 . 0000000000000000000000000000
.00 4.
74.00 5 . 0000000000000000000000000000000000000
.00 5.
38.00 6 . 0000000000000000000
.00 6.
13.00 7 . 000000

Stem width: 1
Each leaf: 2 case(s)

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Box Plot

1 7

0
N= 203

rq1

Constucting frequency distribution table for categorical data

Patients’ ethnicity is used in the following illustration.

SPSS Command :- Analyze  Descriptive Statistics  Frequency  Push the selected variable
into the Variable(s) List box  click ‘OK’.

Frequency distribution table using SPSS

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Results

Ethnicity

Cumulative
Frequency Percent Valid Percent Percent
Valid malay 80 39.4 39.4 39.4
chinese 12 5.9 5.9 45.3
iban 53 26.1 26.1 71.4
bidayuh 14 6.9 6.9 78.3
melanau 13 6.4 6.4 84.7
others 31 15.3 15.3 100.0
Total 203 100.0 100.0

Constructing frequency distribution table for continuous data

The procedure involves two stages:

 Create the class interval
 Construct frequency table using class interval

Patients’ age is used in the following illustration.

The following table describes the range of the patients age.

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

age 203 18 56 25.45 7.663
Valid N (listwise) 203

Patients’ age will be renamed as age category, where the categorization is done using the
following classification

less than 25 years.

25 – less than 35 years
35 - less than 45 years
Above 45 years

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Creating class interval
SPSS Command :- Transform  Recode  Into Different Variables Push the selected variable
into the Numeric Variable(s) box  Give new name  Click ‘Old and New Values’  Define
the values  Click Continue  Click OK

Constructing frequency distribution table

Patients’ age category is used in the following illustration.

27
SPSS Command :- Analyze  Descriptive Statistics  Frequency  Push the selected variable
into the Variable(s) List box  click ‘OK’.

Results

AGE CATEGORY

Cumulative
Frequency Percent Valid Percent Percent
Valid 1.00 152 74.9 74.9 74.9
2.00 29 14.3 14.3 89.2
3.00 12 5.9 5.9 95.1
4.00 10 4.9 4.9 100.0
Total 203 100.0 100.0

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Part 2 : Inferential Statistical Test

Chi-Square Goodness of fit using SPSS

Tthe management of Kuching General Hospital would like to know whether the
proportion of female patients is about 50% of the total patient population. Based
on the data collected, the customer service department test the following
hypothesis.

The null hypothesis

H0: The percentage of female patients in Kuching General Hospital is 50% of the total number of
patients.

The alternate hypothesis

Ha: The percentage of female patients in Kuching General Hospital is NOT 50% of the total
number of patients.

SPSS Command : - Analyze  Non Parametric Test  Chi-Square  Push the selected variables
into the Test Variable(s) List box  Select “All categories equal” under expected value  Click
OK.

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Results

gender

Observed N Expected N Residual

male 92 101.5 -9.5
female 111 101.5 9.5
Total 203

Test Statistics

gender
Chi-Square a 1.778
df 1
Asymp. Sig. .182
a. 0 cells (.0%) have expected frequencies less than
5. The minimum expected cell frequency is 101.5.

Decision:
 The p-value is 0.182.

 Since the p-value is less than 0.05 (the  ), the decision is not to reject the null. Thus
there is not enough evidence to conclude that the percentage of female patients in Kuching
General hospital is not 50% of the total number of patients.

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One sample t-Test Using SPSS

The one sample t-test will be used to test the mean age of the patients getting
treatment at the Kuching General Hospital.

Step 1 The Null Hypothesis

Ho : The mean age of the patients coming for treatment at Kuching General
Hospital is at least 30. (   30)

Step 2 The Alternate Hypothesis

Ha : The mean age of the patients coming for treatment at Kuching General
Hospital is less than 30. (   30)
Note : 30 is an arbitrarily selected value.
SPSS Command :- Analyze  Compare Means One sample Test  Push the selected variables
into the Test Variable(s) List box  Define “Test Value’ as “30” Click Options  Select
Confidence Interval as “95%”  Click Continue  Click OK.

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32
Results:

One-Sample Statistics

Std. Error
N Mean Std. Deviation Mean
age 203 25.45 7.663 .538

One-Sample Test

Test Value = 30
95% Confidence
Interval of the
Mean Difference
t df Sig. (2-tailed) Difference Lower Upper
age -8.463 202 .000 -4.55 -5.61 -3.49

Decision:
 The mean age of the 203 patients is 25.45 years
 The p-value is 0.000
 Since the p-value (0.000) is less than 0.05 (the  ), the decision is to reject the null. Thus
it can be concluded that the mean age of the patients coming for treatment at Kuching
General Hospital is less than 30 years.

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Chi Square test comparing two groups using SPSS

The respondents for the survey consist of both male and female patients while their
scorings on ‘knowledge of hospital staff’ were grouped into two categories, 4 and
below and greater than 4. The administrator of the hospital would like to know who
gave better rating, male or female patients.

The null hypothesis

H0: The percentage of female patients that gave a minimum score of 4 for hospital staff’s
knowledge is the same as the proportion of male patients that gave similar scores.

The alternate hypothesis

Ha: The percentage of female patients that gave a minimum score of 4 for hospital staff’s
knowledge is NOT the same as the proportion of male patients that gave similar scores.

To test this hypothesis a two tailed test is required. Both the null and
alternate hypothesis does not specify any ‘direction’ (eg greater or less
than).

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SPSS Command :-Analyze  Descriptive  Cross Tab  Push the selected variables into the
“rows” and “Column” List box  Click Cells  Tick “Observed” for counts and “Column” for
Percentages  Click Continue  Click Statistics  Select “Chi-Square”  Click Continue 
Click OK.

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Results:

gender * Knowledge of Hospital Staff Crosstabulation

Knowledge of Hospital
Staff
Minimum Score of
score of 4 above 4 Total
gender male Count 29 63 92
% within Knowledge There is a difference
43.9% 46.0% 45.3% in the proportion in
of Hospital Staff
the sample
female Count 37 74 111
% within Knowledge
56.1% 54.0% 54.7%
of Hospital Staff
Total Count 66 137 203
% within Knowledge
100.0% 100.0% 100.0%
of Hospital Staff

Chi-Square Tests

Asymp. Sig. Exact Sig. Exact Sig.

Value df (2-sided) (2-sided) (1-sided)
Pearson Chi-Square .075b 1 .784
Continuity Correctiona .015 1 .901
Likelihood Ratio .075 1 .784
Fisher's Exact Test .881 .451
Linear-by-Linear
.075 1 .784
Association
N of Valid Cases 203
a. Computed only for a 2x2 table
b. 0 cells (.0%) have expected count less than 5. The minimum expected count is
29.91.

 P-value is 0.784
 Since the p-value is greater than 0.05, there is not enough evidence to conclude that the
percentage of female patients that gave a minimum score of 4 for hospital staff’s
knowledge is different from the proportion of male patients that gave similar scores.
 Thus it can be concluded that both the assessment by the male and female patients are
similar.

36
Chi Square test for comparing more than two groups using SPSS

Referring to the scenario in 15.2.1, if the administrator of the hospital would like to
know who gave better rating, Government servants, private sector employees, or
students, the following hypothesis need to be tested

The null hypothesis

Ho : There is no association between patients’ assessment on “Hospital staff’s knowledge” and
their employment..

The alternate hypothesis

Ha: There is a significant association between patients’ assessment on “Hospital staff’s
knowledge” and their employment.

SPSS Command:- Analyze  Descriptive  Cross Tab  Push the selected variables into the
“rows” and “Column” List box  Click Cells  Tick “Observed” for counts and “Row” for
Percentages  Click Continue  Click Statistics  Select “Chi-Square”  Click Continue 
Click OK.

37
Results
Employment * Employees are knowledgable Crosstabulation

Employees are
knowledgable
Not Satisfied Satisfied Total
Employment Goverment Count 5 13 18
% within Employment 27.8% 72.2% 100.0%
Private Count 12 29 41
% within Employment 29.3% 70.7% 100.0%
Students Count 49 95 144
% within Employment 34.0% 66.0% 100.0%
Total Count 66 137 203
% within Employment 32.5% 67.5% 100.0%

Chi-Square Tests

Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square .531a 2 .767
Likelihood Ratio .539 2 .764
Linear-by-Linear
.498 1 .480
Association
N of Valid Cases 203
a. 0 cells (.0%) have expected count less than 5. The
minimum expected count is 5.85.

 P-value is 0.767
 Since the p-value is greater than 0.05, there is not enough evidence to conclude that the
patients’ assessment on “Hospital staff’s knowledge” and their employment are
associated.

38
Independent sample t-test using SPSS

The independent sample t-test is used to compare the difference between two distinct groups’ (eg
male and female) rating on particular phenomena.

The following table provides the mean score and standard deviation of respondents’
assessment on the knowledge of the hospital staff according to gender.

Knowledge of hospital staff

N Mean Std. Deviation Minimum Maximum

Male 92 4.87 1.233 1 7
Female 111 4.88 1.068 2 7

The null hypothesis

Ho : There is no difference between the male and female respondents’ assessment on hospital
staff knowledge.

The alternate hypothesis

Ha: There is a significant difference between the male and female respondents’ assessment on
hospital staff knowledge..

SPSS Command :- Analyze  Compare Mean  Independent Sample T-Test  Push the
selected variables into the Test Variable List box Push “gender” into the Grouping variable box
 Define Group (1 and 2 in this case)  Click OK.

39
Results

Independent Samples Test

Levene's Test for

Equality of Variances t-test for Equality of Means

Mean
F Sig. t df Sig. (2-tailed) Difference
Knowledge of Equal variances
1.127 .290 -.082 201 .934 -.01
hospital staff assumed
Equal variances
-.081 181.322 .935 -.01
not assumed

Note: The independent sample t-test requires the assumption of equality of variance.
However in the event this assumption cannot be fulfilled SPSS will perform some
correction and compute the test value and associated probability value based on this
correction.

In this example, the Levene Test provides evidence that the assumption of equality of variance is
met. Thus the p-value of the first row will be used to test the research hypothesis.

Decision:
 The p-value is greater than 0.05, do not reject the null, there is not enough evidence to
conclude the alternate
 There is no difference in the male and female respondents’ assessment on hospital staff
knowledge.

40
Paired T-Test using SPSS

As an initiative to create awareness regarding the services provided by the Kuching

Genaral Hospital, the management organizes seminars to educate the public on the
different types of services as well as the constrains faced by the hospital. Prior to
the seminar a group of randomly selected patients were asked to assess the quality
of services on 25 specific items among which knowledge of the staff is one of
them. The same group of people were asked to assess again the service quality of
the Kuching Hospital after attending the seminar. The following table provide the
mean score and standard deviation of respondents, assessment on the knowledge
of the hospital staff before and after attending the seminar.

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

Knowledge of staff
(assessment before 203 1 7 4.88 1.143
attending seminar)
Knowledge of staff
(assessment after 203 4.00 7.00 6.1724 .67106
attending seminar)
Valid N (listwise) 203

The null hypothesis

Ho : There is no difference in the assessment on hospital staff knowledge before and after
attending seminar.

The alternate hypothesis

Ha: There is a significant difference in the assessment on hospital staff knowledge before and
after attending seminar.

41
SPSS Command :- Analyze  Compare Means  Paired Sample T Test  Push the selected
variables into the Test Pair(s) List box Click OK.

Results
Paired Samples Statistics

Mean N Std. Deviation

Knowledge of staff
4.88 203 1.143
(assessment before attending seminar)
Knowledge of staff
6.17 203 0.671
(assessment after attending seminar)

Paired Samples Test

Paired Differences

Mean Std. Deviation t df Sig. (2-tailed)

Knowledge of staff (assessment
before attending seminar) -
-1.2956 1.27500 -14.480 202 .000
Knowledge of staff (assessment after
attending seminar)

Decision:
 The p-value is smaller than 0.025, reject the null and conclude the alternate hypothesis.
 There is a difference in the assessment on hospital staff knowledge before and after
attending seminar.

42
REPORT WRITING
AND
PRESENTATION

43
Introduction

Communicating the results of the survey is important. A useful survey that is not communicated is
equal to incomplete work no matter how impressive the findings are. As far as a research work is
concern, the research result is, and has to be communicated in a detail written report and
presentation. Written report and presentation differs. In written report students are required to
report every evidences and findings with discussions, an oral presentation stresses on the main
concern providing information that clearly reveal what the audience wants to know at the end of
the presentation.

The following diagram is a guidance to writing a proper research report and for presentation
preparations.

Problem definition,
Approach, Research
Design and Field work
Data Analysis

Interpretations,
Conclusions,
and
Recommendation
Report Preparation

Oral Presentation

Figure 1: The report preparation and presentation

44
Report Format
For better organization of the report, it is suggested that the content is divided into 3 parts that
are the preliminary pages, the contents and finally the references. For better understanding, please
refer as follows:

PART I – The preliminary pages

i. Title Page
ii. Acknowledgements
iii. Letter of transmittal
iv. Letter of authorization
v. Table of contents
vi. List of tables
vii. List of graphs
viii. List of appendices
ix. List of exhibits
x. Executive summary
a. Major findings
b. Conclusions
c. Recommendations

In this first part of the report, the contents are as listed above. Each of the elements in this part
must be paid equal attention as the actual content of the result because these few front pages are
the pages which audience flips through before they concentrate on the other content. Particular
clients may analyze these elements seriously as it plays role to elicit a good first impression of the
whole research done.

Cover page. The title page should indicate what the study is all about besides including the
information such as name, address and telephone about the researcher or organization conducting
the research, the name that it is prepared for, and the date of the release.

Acknowledgements. Throughout the process, there are many parties who involved directly and
indirectly contributing success to the research effort. These parties need to be acknowledged to
appreciate their contributions apart as a motivation factor to gain their cooperation for future
research.

45
Table of contents. This page shows the list of the contents with reference pages. Table of content
is necessary to inform of the topics covered in the whole research done. List of tables, List of
graphs, List of appendices, List of exhibits are included in the table contents to help audience to
refer to desired references as they go through the report.

Executive Summary. Executive summary must include the major finding, conclusion and
recommendation, must be based on the whole report without any new material added and ideal
length suggested by Ghauri and Gronhoug (2002) is three pages or 5 percent of the whole report.
Executive summary is necessary to help busy managers to read through the report with
comprehensive explanation of the overall findings.

In Part II of the report, the contents are presented into five main chapters. The second part of the
report includes the elements as follows;

PART II – The Contents

Chapter 1: Introduction
The Problem Definition
Problem Statement
Research Questions & Research Objectives
Significance of the study
Definition of terms
Limitation of the Study

Chapter 2: Literature Review

Literature review on past research

Chapter 3: Methods and Material

Research Design
Measurement
Instrumentation
Sampling

46
 Chapter 4: Data Analysis and Findings
Results
Interpretations of data

Chapter 5: Conclusions and Recommendations

Discussions on the findings
Recommendation

Chapter One: Introduction

The first chapter is basically the introductory part of the report. Here, the problem is defined,
followed by the problem statement. The problem should be clearly defined as the clear problem
statement tells researcher what to do next. Research questions should be address followed by
research objectives. Without objectives, researcher will not have a clear direction of what the want
to achieve towards the end of the day. It also serves as a measure to indicate if the research has
been successfully conducted and proven to achieve the objectives stated. Significance of the study
stresses the importance of the study. Definition of terms lists the terms and short explanation to
familiarize with the terms used in the report. Limitation of the study can also be included here.

Chapter Two: Literature Review

In this chapter, the theoretical background of the problem area as well as the study is presented
with reference to the related literature. There has to be proper reasoning on the findings with the
help of prior studies and findings.

47
Chapter Three: Methods and Material
Here, the researcher is informing the reader of research design, measurement, instrumentation and
the sampling used in the research. The research designs, exploratory, descriptive or causal would
suggest whether to use qualitative or quantitative methods for data collections and analysis.
Instrumentations is another important element to inform the sources where the measurement is
obtained or data adopted from. The number of respondents and who are the respondents is also
explained in this chapter.

Chapter Four: Data Analysis and Finding

Among all, this is the integral part of the report as in this chapter the researcher or writer will be
revealing the results with the interpretations of the findings. Data can be analyzed using the
suitable software such as SPSS. Data can be presented in many forms. Tables and charts are
among the most frequently used tools to present the results. The results will be properly and
meaningfully interpreted to yield interesting findings. The findings are discussed in relation to
theories and past research findings.

Chapter Five: Conclusions and Recommendations

Chapter five is the final chapter. Discussions of findings are usually done here, either is supporting
the findings of previous study or otherwise before the writer can come up with a conclusion. The
writer’s biases and desires should not influence the conclusions. Recommendations are usually
provided as well. These recommendations may come from the researchers’ idea on how the
decision maker should address the problem and make their decisions to overcome the problem at
hand.

The final part, Part III, of the report is the references. This section normally includes the list of
references, a sample of questionnaire and other supportive documents for the reader’s reference.
Many have problems writing the references using the right format following the types of sources;
journals, periodicals, books or articles. One may choose to use the common referencing format
such as APA and Harvard system.

48
PART III – References

i. Appendices (list of references)

ii. Sample of questionnaire

Principles of Report Writing

Report writing process is done based on a few principles and guidelines. Report is written to
provide clear understanding of the problem an organization is facing. The following criteria should
be emphasized when writing a good report:

i. Audience
The best reports are those that are written with particular audiences in mind. First, it must be in
consideration that who will read the report and it highlights the importance of the executive
summary.

ii. Clarity
Without clarity, the report can be meaningless and a waste of effort. Research are conducted for
various purposes and if the written report by researchers are not clear to tell the story of the
actual situation, decision makers may end up making wrong decisions.

iii. Simplicity
Language used should be kept simple but comprehensive. Using difficult words or specific jargons
should be avoided to ensure the report is well understood by all. Avoid including unnecessary
information. In fact, reports are not judged according to their length. The quality counts.

49
iv. Organized
The report format must be in sequence to show the direction of the research conducted. Each
element must be organized and discussed accordingly. Tables and graphs should be used to
visualize the result. The appearance should also be presentable and shows professionalism in the
work.

v. Tenses
Wrong usage of tenses can be confusing as well. The tenses should be consistent throughout
where record of the past should be written in past tense. Present tense is used in the discussions of
the general truth or referring readers to the tables or figures.

vi. Check
A good written report needs to be read through and re-check by other persons to avoid mistakes
that might be overlooked by the writers. Re-checking is useful as the content of the report is
understood as the way it is intended. For example, if the reader interprets the discussions in the
report wrongly, it shows that the discussions or words use might not be suitable to reflect the
actual meaning that the author trying to convey to the audience.

Oral Presentation
One of the most satisfying things in research is completing a proper research work using good
methodology, correct analysis of data, valid findings and proper conclusions. Oral presentation of
the report is not of less importance as presentation help to highlight the results of the lengthy
report. Normally, the presentation of good report will take up to fifteen to twenty minutes. The
time is just enough to cover important findings and results. Presenting the research results might
be very challenging, especially between keeping the audience to listen attentively and delivering
the right results and facts. Presenter tend to get carried away if he or she gets too excited and lose
focus of the actual purpose why oral presentation of the research report is done. Great ideas have
no value unless it is communicated well to its audience.

50
There are many other factors to consider in making the presentation impressive while to keep
audience interested includes the presenter dressing, voicing projection and tone variations,
selection of words, speed of talking, eye contact, and use of visual aids. In fact, most oral
presentations are graded on content and its delivery. Content refers to the quality, logical flow of
the presentation, appropriateness, avoidance of generalities, and absence of mistakes. Delivery on
the other hand concerns on the audience attentiveness, clarity of visual aids, appropriate
appearance, persuasiveness of arguments and body language. Audience “rejects” psychologically
presentations whose presenter with monotonous voice like as if he or she is reading out the text.
Due to that, being spontaneous without losing focus requires a very good preparation and
rehearsals before the presentation takes place. The following are some tips for effective
presentation.

Principles of Oral Presentation

i. Preparation
Nothing comes perfect and that highlights the need of preparations of the oral presentation.
Preparation helps presenter to plan what to say, when to speak, when to answer questions, how to
control the situation, how to use the visual aids and how to attract attention of the audience.
Planning the whole presentation not only will make the presentation to run smooth. Good
planners always have a back up plan. For example, if the slide projector is not working, the back
up plan is to refer on the hand outs or transparencies to enable the presenter to proceed with the
presentation despite the failure of the technical support.

51
ii. Organizing the content
The presenter should introduce themselves and appropriately address the audience when starting
the presentation. It will be useful to provide a clear outline of what is going to be presented in the
following 15 or 20 minutes. Not only it will make the presentation more directional, it helps
audience to have the idea of the presentation is all about. Keep it short and simple as the purpose
is to only provide a brief idea of the whole presentation.

iii. Voice
Voice projection must be reasonably clear but shouting have to be avoided. If microphone is
provided, the amount of sound have to be controlled where the presenter need not to speak too
loud. Voice variation is necessary when stressing the important points. The speeds of the words
uttered have to be in control as well. If people speaks too fast and tend to repeat words, it shows
that they are nervous and the voice projection can be a disaster.

iv. Body Language

Body language speaks louder than what a person is saying. Therefore, showing positive posture
will show off confidence during the presentation. The gestures should be appropriate according to
the purpose. For example, a descriptive gesture is used to clarify or enhance verbal
communication whereas an emphatic gesture is suitable when emphasizing what have been said.
On the other hand, a prompting gesture is essential for eliciting a desired response from the
audience.

Having a good eye contact is extremely important. This is one of the best ways to persuade
the audience. Maintaining good eye contact is believed to be useful for the presenter to gain
continual commitment from audience for the whole session of the presentation. Above all, the
sense of humor is helpful to keep the boredom away.

52
v. Language
Terms and terminologies are sometimes necessary to be used though avoiding research jargons are
recommended. Therefore, if these terms and difficult words need to be used, it must then be
explained. Avoid using short forms and filler words. Simple words should be used to ensure the
delivery of information is free of confusion and misunderstanding.

vi. Time management

Presentation that takes too long may distract audience interest and have the high tendency of
unnecessary contents. Presenters should manage their presentation time by allocating periods of
each topic presented. For example, the allocation of time for a 20-minutes presentation can be as
follows:
 Objective and research question with relation to past studies and importance – 3 minutes
 How the study is carried out, sources and arguments – 2 minutes
 Findings and conclusion – 10 minutes
 Questions and answers – 5 minutes

vii. Visual aids

Visual aids facilitate good understanding. Tables and graphs should be used to help listeners to see
the whole picture and make quick comparisons and evaluations. Evaluating the result themselves
during the presentation and make direct comparison is harder if they were to do it themselves,
given the short time.

53
Rules and Regulation

54
 GUIDELINE ON
PORTFOLIO WRITING &
ASSESSMENT

55
1. A copy of the report of the portfolio shall be submitted to the Department of Community
Medicine within FOUR weeks of completion of the fieldwork.
2. Use the format given BELOW in preparing the portfolio.

SECTION 1 – Clinic Visit

 Introduction to the Health Care System in Malaysia.

 Description of the health clinic (Organisational
Structure etc).
 Roles and responsibilities of the staff at the clinic.
 Primary and extended health care provided at the
clinic.
 Reflection on the clinic visit (what did you learn, etc)

SECTION 2 – Household Survey

 Introduction to the ‘kampung’ or village the survey

done.
 Desription of the household survey (Purpose, Research
Objectives, Significance etc)
 Methods and Material
 Findings
 Discussion
 Conclusion &Limitation

SECTION 3 – Research Project

 Introduction .
 Literature review
 Methods and Material
 Findings
 Discussion
 Conclusion &Limitation

56
Example : Front Cover Format

60 mm

COMMUNITY HEALTH VISIT

HULU BERNAM

SELANGOR

Date :

MBBS
PHASE 1
DEPARTMENT OF COMMUNITY MEDICINE
INTERNATIONAL MEDICAL UNIVERSITY

60 mm

57
Evaluation

A Field Visit

Name : _________________________________ Student ID : _________________________

Group Leader Rating

Criteria 1 2 3 4 5 Total Score

Attendance

Participation

Motivation

Communication Skills

Teamwork

Leadership

58
B Portfolio

Criteria Marks Score Remarks

Clinic Visit
Introduction to the Health Care System in Malaysia. 10
Description of the health clinic (Organisational Structure etc). 20
Roles and responsibilities of the staff at the clinic. 20
Primary and extended health care provided at the clinic. 30
Reflection on the clinic visit (what did you learn, etc) 20
Total 100
Household Survey
Introduction to the ‘kampung’ or village the survey done. 10
Desription of the household survey (Purpose, Research 20
Objectives, Significance etc)
Methods and Material 10
Survey Findings 20
Discussion 20
Conslusion &Limitation 10
Reflection 10
Total 100
Research Project
Introduction (Purpose, Research Objectives, Significance etc) 10
Methods and Material 20
Survey Findings 30
Discussion 20
Conslusion &Limitation 10
Reflection 10
Total 100

59
C Presentation

Criteria Marks Score Remarks

Presentation
Planning of Presentation 10
Sequance 20
Communication 20
Discussion 30
Audio and Visual Aids 20
Total 100

Overall Evaluation Marks Distribution

i) Participation in the Field Visit : 30%
ii) Portfolio and presentation : 70%

Areas of assessment Weight Score Remarks

Presentation
Clinic Visit 20
House Hold Survey 30
Mini Health Research 30
Presentation 20
Total 100

60
Appendix 2 : Example of Instrument for Health Related Research

1) Research on Hypertension

1 Id No.:

2 Place Data Collected:

A. Socio Demographic Data

3 Age:

4 Gender:

5 Ethnicity:

6 Education Level:

7 Household Income:

8 Marital Status:

9 Occupation:

10 Smoking Status:

11 Alcohol Intake:

B. Examination Results

12 BP reading: First: Month/Year Reading

Latest: Month/Year Reading

13 Height:

14 Weight:

15 BMI:

61
16 Waist circumference:

17 Fundoscopy:

C. Laboratory Test Results

18 FBC:

19 Urinalysis:

20 Lipid Profile:

D. Management

21 (a) Non Pharmacological

Yes No
Weight reduction
Decrease sodium intake
Reduce alcohol intake
Stop Smoking
Healthy Eating
Increase Physical exercise

22 (b) Phramacological

Yes No
Diuretics
ß blockers
ACE Inhibitors
Others

62
2 Research on Pap Smear

1 Id No.:

2 Place Data Collected:

A. Socio Demographic Data

3 Age:

4 Ethnicity:

5 Education Level:

6 Occupation:

7 Household Income:

8 Marital Status:

9 Smoking Status:

10 Alcohol Intake:

11 OCP Usage:

12 No. of Pregnancies:

13 FH of Cx Cancer:

B. Pap Smear Result

14 First pap smear taken:

14(a
) Year Result

15 Latest pap smear taken:

15(a
) Year Result

16 Total no. of pap smears taken:

63
 C. Physical Examination

17 Height:

18 Weight:

19 BMI:

3 Research on Breastfeeding

1 Id No.:

2 Place Data Collected:

3 Age of Infant:

A. Socio Demographic Data

4 Date of Birth:

5 Ethnicity:

6 Education Level:

7 Occupation:

8 Household Income:

9 Marital Status:

B. Obstetric History

10 Place of Delivery:

11 Parity:

12 Mode of delivery:

13 Attend B/F Class:

64
 14 Intention to B/F:

C. Infant History

15 Gender:

16 Birth Weight:

17 Gestational Age:

D. Breastfeeding Practice

18 Ever breastfed:

19 Exclusive breastfed for 1 month:

20 Exclusive breastfed for 3 months:

21 Exclusive breastfed for 6 months:

4 Research on Child Disability

1 Id No.:

2 Place Data Collected:

A. Type of Disability

3 Type of Disability

4 Age of Diagnosis

B. Data on Child

3 Date of Birth:

4 Ethnicity:

5 No. of Children in Family:

6 Order of Child in Family:

65
C. Data on Father

7 Ethnicity:

8 Education Level:

9 Occupation:

10 Household Income:

11 Smoking Status:

12 Alcohol Intake:

D. Data on Mother

13 Ethnicity:

14 Education Level:

15 Occupation:

16 Smoking Status:

17 Alcohol Intake:

E. Management of Child

18 Was Denver Chart Used:

19 Was Reassessment Done:

Was Child Referred to

20 Hospital:

66
5 Research on Child Disability

1 Id No.:

2 Place Data Collected:

A. Socio Demographic Data

3 Age:

4 Gender:

5 Ethnicity:

6 Education Level:

7 Occupation:

8 Household Income:

9 Marital Status:

10 Alcohol Intake:

B. Smoking History

14 Years of Smoking:

15 Cig. Smoked per Day:

16 Ever Tried to Quit Smoking:

C. Physical Examination

17 Height:

18 Weight:

19 BMI:

67