DESIGNING A STUDY TO OBTAIN ACCURATE WOUND SURVEY DATA. IN RURAL AREAS OF ... rural clinic in northern Ghana were presented, via email, to five. Ghanaians who are ... _05_12/en/index.html. Case Studies to Guide Interviews ...
DESIGNING A STUDY TO OBTAIN ACCURATE WOUND SURVEY DATA IN RURAL AREAS OF DEVELOPING COUNTRIES Linda L. Benskin, BSN, RN, SRN (Ghana), CWCN, CWS; UTMB Doctoral Nursing Student, Galveston, TX This mini-study was unsponsored. The investigator retained full independence in the conduct of this research. Background: Unrelenting heat, poor sanitation, ignorance, and poverty all contribute to a disabling wound prevalence which can exceed 20% in rural areas of tropical developing nations. Wound experts from the USA, Europe, and Australia are creating programs to decrease this suffering by instructing traditional health providers and village health workers in modern moist wound management practices. (Health care professionals are rarely available in rural areas of developing nations.) Research to discover the current usual wound management practices in rural villages is needed before effective, culturallyacceptable wound management educational programs can be designed. Establishing the ecological validity of proposed new interventions will require comparison studies. An extensive literature search revealed few studies involving wound care in rural areas of tropical developing countries, and no published descriptions of current usual wound management practices in this setting. A sound, culturally-appropriate study design is needed to elicit this baseline information. The investigator proposes interviewing village health workers, traditional health providers and villagers performing wound selfcare in 25 villages (75 participants in all) to elicit this important data as her dissertation research. The investigator gained familiarity with the challenges of working in this setting while practicing wound care and teaching village health workers for five years in a remote area of northern Ghana, West Africa. Barriers to obtaining accurate survey data in this setting are formidable, and 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 cultural predisposition towards providing pleasing answers, in preference to accurate answers 4. the possibility of the survey focusing upon wound problems that are not commonly encountered in villages The investigator will situate culturally-appropriate open-ended questions within case study discussions to address barriers 1 – 3. This mini-study was conducted prior to these case study discussions (dissertation research) to eliminate barrier 4.
Objective: This mini-study was designed to determine which of thirty wound cases are most representative of wounds treated by traditional health providers and village health workers in rural areas of tropical developing countries. Methods: Thirty actual wound cases (photos and brief patient histories) taken from the investigator’s portfolio of wounds managed in a rural clinic in northern Ghana were presented, via email, to five Ghanaians who are experienced in wound care and familiar with village life. These experts each responded to twenty questions about the wound cases (below). Wound Case Studies presented to five Ghanaian wound experts via email:
Case Studies to Guide Interviews on Wound Management Abscess: A young man has come to you with a painful, very swollen hand. The problem began a few days ago, but it is getting worse. He has not treated it in any way. He can no longer farm because of the pain and swelling. The young man does not remember anything that may have caused the problem – he says, “It came on its own.” Burn: A small child walked into a burn pit that still had hot items in it under the ashes and burned his feet a few days ago. The child refuses to walk and cries all the time, so the mother is bringing the child to you for help. The larger blisters have been burst, but there are a few small intact blisters on the toes of the right foot.
Schoolchild with leg ulcers: A school child developed a leg ulcer that is so painful that it is becoming difficult to walk. The wound is producing small amounts of thick yellow foul-smelling drainage. The child does not remember how long ago the ulcer came.
The photos were digitally compressed into a
