Agency staff may have a lot of questions about their programs. Why don’t more people come to our workshops? How can we prepare our kids to make responsible decisions about drugs and sex? Are clients happy with our services? Before beginning to do research, it’s important to understand and refine questions as much as possible. The questions may start out wide-reaching, but can be modified to reflect concerns for various target audiences, such as youth, substance abusers, MSM of color, as well as for geographic differences (rural, urban, suburban).

Consider the case of a program manager of a drug abuse treatment program who is concerned that her agency’s clients aren’t getting HIV antibody tested, despite the fact that they are at considerable risk of HIV infection and that if they find out that they are HIV positive, they can access early intervention services. Her first question is:

Why don’t our clients get HIV tested?

After further reflection she realizes that her primary reason for wanting her high risk clients to be HIV tested is to enable those who test positive to obtain early intervention services for HIV infection. Her question then becomes:

Why don’t our clients get HIV tested, so those who are seropositive can start early intervention treatments for HIV?

The program manager decides to ask her case managers and outreach workers this question. She brings it up at a monthly staff meeting (informal focus group) and finds out from her staff that there may be a number of reasons why certain clients have been unable or unwilling to be tested. The actual process required for HIV testing is just one of a number of barriers. One of the outreach workers also notes that barriers are different among persons who believe they might be HIV+ as compared with those who believe they are HIV-. They agree to focus on clients who believe they might be HIV+. Her question then changes to:

Among clients who believe they are HIV+, what are the barriers to getting tested and to subsequently obtaining early intervention treatment?

The program manager then asks her outreach workers to conduct brief interviews with clients to try to learn more about barriers and how the agency can help overcome them. She develops a brief series of questions for them to ask, leaving room for discussion.

At the suggestion of one of her case managers, she also sets up interviews with managers from other public health agencies, such as the local clinic where many HIV+ persons are treated, the family planning clinic, the local chapter of AA and the HIV specialist at the Department of Public Health.At the next staff meeting, they discuss the results of their interviews and agree that barriers to HIV testing are very different for men than for women who believe they are HIV+, that women who inject heroin are less likely to seek out services of any kind, and that anecdotally, more women seem to be seroconverting than men. Her question then evolves into:

What are the barriers to HIV testing and early intervention for needle-using women who believe they are seropositive?

And

What kind of intervention can best serve the needs of needle-using women who believe they are seropositive to help them access HIV testing and counseling services and subsequent early intervention treatment?

From here, the program manager puts together an intervention development team that may include: staff from her agency and outside agencies, staff from the DPH, a researcher from a local university, volunteers, and selected clients. Using the formative research already conducted, they develop and pilot test an intervention.

Good Questions, Better Answers --  � 1998 California Department of Health Services and Northern California Grantmakers AIDS Task Force  -- http://www.goodquestions.com