Are we in the right path ?

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Are we in the right path ?Are we in the right path ? the data have been collected… collated… validated… analyzed… presented… the indicators have been calculated…

NOW…….

What is the meaning of the “stuff” we have?

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Interpretation Interpretation - making sense of - making sense of

informationinformation

April 16, 2007

TOPIC 6

MED-INF 5200

Humberto Muquingue

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Learning outcomesLearning outcomes

At the end of this topic, you should be able to:

Define what is interpretation of information Describe the requirements for interpretation Understand the practical issues involved in

interpretation List some problems related to interpretation

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InterpretationInterpretation(making sense of information)(making sense of information)

Is about UNDERTANDING … Is about UNDERTANDING … constructing meaning with:

I. Old information – to find known patternsII. New information – to place a new look at known

patternsIII. Rational and logical approaches:

Mix new information with old Put new information into the context Link up different pieces of new information Link up different pieces of new and old information

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How is How is Information Information Interpreted ?Interpreted ?

Understanding implies:

Appropriate interpretations make many linkages possible (correct, logical, sensible) may answer important questions may result in action Possible interpretations are context dependent (population, health, service status) depend on data quality rely on data definitions

Therefore: discuss, explore and consult discuss different interpretations and explore different views this allows improved understanding

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Preparing for interpretationPreparing for interpretation- - The essential ingredientsThe essential ingredients

Accuracy checks – 3 C’s and 1 T, includes:

Routine validation and trends checked over time

Data checked per month, per facility, per district

Local / contextual knowledge on:

Population data: ethnicity, lifestyle, occupation

Health data: common diseases

Service data: types of facilities, proficiency of staff

Effective interpretation needs a minimum of 6 months worth of data

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Garbage in ? Garbage in ? Garbage Garbage out !!!!out !!!!

one cannot effectively analyse data that is of poor quality,

one cannot interpret information that is of poor and suspect quality…

…with any hope of relevance, appropriateness and usefulness !!!

ASK: Is this data measuring what it is required to measure?

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Practical questions in interpretation

1. Why have you produced this information/ indicator? 2. What does the indicator measure?3. What is the actual measurement unit?4. Has the indicator been accurately measured?5. What is the target value OR action trigger value?

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Practical questions in interpretation

6. What is the normal range?In your country:

- urban- rural

In the world:- best in the world- worst in the world

7. How does it fit in with other information?8. What is the local context?9. What should you do about the situation?10. How could you implement that?

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DIFFERENT INFORMATION

REQUIRE DIFFERENT INTERPRETATION

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TRESPASSERS WILL BE SHOT !

SURVIVORS WILL BE SHOT AGAIN !!

NO TRESPASSING

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The manager of a clinic in a peri-urban area was surprised by the very low numbers of male patients attending the OPD with urethral discharge. She was sure that the facility reporting system worked well. What could be the cause?

EXERCISE

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Use of MUDs1 as data element for prevalence of STI…

Is problematic because it only relates to males of whom few go to health facilities… due to the dominance of women and children in

PHC facilities and a perceived lack of privacy? STIs not very stigmatizing in a male-dominated

environment… …but embarrassing vis-à-vis female neighbors! many males prefer to go to a private GP!

1MUD = male urethral discharge

Example of reasoning on infoExample of reasoning on info

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EXERCISE

You are presented with a graph for a district in Uganda showing 3 indicators on the Overall TB Cure Rate, Overall TB Success Rate and DOTS (Directly Observed Treatment Shortcourse) for each quarter of 2006.

How would YOU interpret the information contained in the graph?

TB INDICATORS FOR AN UGANDAN DISTRICT, 2003

4540

70

40

53

6571

6163

50

80 80

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4

%

Overall TB Cure Rate Overall TB Success Rate % Patients on DOTS

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To interpret this information YOU would ask the following questions.

What are the definitions of the indicators that are used?

What does the graph show? What else do you need to know? Is it enough to make a decision? Is this the best way to present this information?

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Matching information to Matching information to realityreality

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USE = Assessing USE = Assessing coverage and quality of coverage and quality of

health serviceshealth servicesWHO GETS SICK ?

WHAT HEALTH SERVICES EXIST ?

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Assessment of coverageAssessment of coveragewho gets sick?who gets sick?

Description of people who attend health services:

• age and gender breakdown

• community distribution

Use of individual patient data to construct aggregated routine data

Definition of population• catchment• target for specific services• at risk

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Assessment of qualityAssessment of qualitywhat services exist ?what services exist ?

For whom? Accessibility

Catchment population Target population Utilization

What? Appropriateness

Type and range Continuity

Why? Political vs functional

When? Acceptability

Convenience to clients and staff

Where? Distribution Integration

How ? Affordability Resources

Staff Materials Money

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Applying the “systems model” to data Applying the “systems model” to data and indicatorsand indicators

Inputs…. resources Processes …. activities Outputs …. results Outcomes … impacts

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The path from Data to InformationThe path from Data to InformationInput ….Raw Data

quantity and quality of data elements (MDS !)

data collection tools (tally sheets, registers, client cards)

Process …Analysis

turning raw data into useful information

planning tools (targets, indicators)

Output …Information

used for effective decision-making

assessment tools (aggregation, graphs, reports)

Outcome …Coverage and quality of health services

management

planning (strategic & operational)

monitoring & evaluation Impact: Health status