Practical Class Instructions:

This document contains a series of interactive scenarios designed for group work in social medicine and public health workshops. The instructor will choose a scenario for each group (or pair of groups) to solve using the principles of sociological research methods.

Reference Material

This assignment is based on the reading material: Sociological Research Methods in Medicine. All methodological justifications and critiques must reference concepts from this text.

General Instructions for Students

Each group will independently solve a distinct research problem. Your task is to:

Analyze the Research Question: Determine which sociological method (survey, observation, interview or documentary analysis) best addresses it.
Design the Instrument: Create a concrete data collection tool with 10-15 specific items - questionnaire, observation protocol, interview guide, or document analysis framework.
Justify Your Approach: Explain why your method is appropriate, addressing research purpose, validity threats, and practical constraints.
The Battle (Debate): Prepare to defend your choice and critique alternative methods using evidence-based reasoning.

Scenario: “The Healthcare Worker Burnout Crisis”

Context and Background:

University Hospital Plovdiv has experienced a 40% increase in physician resignations. Emergency and ICU physicians account for 67% of these. Exit interviews mention “moral injury,” “administrative burden,” and “lack of institutional support,” but these brief 12-minute conversations lack the depth needed for intervention planning. The hospital director needs to know: What specific factors drive departure? Which interventions would work? Do drivers vary by department?

Your Research Task:

Primary Question: What are the multilayered factors (workload, compensation, culture, moral distress) driving resignations, and which are most amenable to intervention?

Option A: Structured Survey Approach

Method: Standardized questionnaire distributed to all current and recently departed physicians.

Hints for your design:

Burnout Scales: How will you measure the severity of burnout?
Stressor Categories: Group items into workload, administrative tasks, and social support.
Anonymity: How will you ensure doctors feel safe enough to criticize their superiors?
Logic: Think about statistical power and the ability to compare different departments.

Option B: In-Depth Interview Approach

Method: Semi-structured interviews with a purposive sample of 30 current and former physicians.

Hints for your design:

Rapport: How do you start the conversation to make a stressed doctor open up?
The “Why”: Use probes to move past phrases like “I was tired” to actual causal events.
Moral Injury: Design questions that explore the gap between clinical ideals and hospital reality.
Logic: Think about “thick description” and capturing the temporal sequence of the decision to quit.

Option C: Documentary Analysis

Method: Systematic audit of administrative records, shift rosters, and resignation letters.

Hints for your design:

Objective Data: How do HR records on overtime and sick leave correlate with resignation dates?
The “Official” Reason: Compare resignation letters with exit interview notes—where are the gaps?
Incident Reports: Track if departments with the most “near-misses” also have the highest turnover.
Logic: Explain how document analysis provides a baseline of “hard facts” to compare with subjective reports.

Option D: Ethnographic Observation

Method: Researcher immersion in the ICU and ER environments over a 4-week period.

Hints for your design:

Micro-stressors: Capture things doctors don’t report (e.g., noise levels, broken equipment, interruptions).
Communication Flow: Observe how hierarchy affects interactions between departments.
“Invisible Work”: Note time spent on administrative “scut work” versus patient care.
Logic: Address the value of seeing stressors in real-time rather than relying on memory.

Scenario: “Hospital Hand Hygiene Compliance”

Context and Background:

Surgical site infections (SSIs) have increased by 35%, potentially costing the hospital 180,000 EUR in penalties. Administration claims 80% compliance based on alcohol gel consumption, but the Infection Control nurse disputes this, noting that consumption doesn’t reveal who is washing their hands or if they are doing it at the right clinical moments.

Your Research Task:

Primary Question: What is the actual hand hygiene compliance rate among different healthcare worker categories (surgeons, nurses, students) across different clinical settings (ICU, Wards)?

Option A: Structured Survey Approach

Method: Anonymous questionnaire on self-reported compliance and perceived barriers.

Hints for your design:

Social Desirability Bias: How do you ask “do you wash your hands” without everyone just saying “yes”?
Barrier Identification: Design items to rank reasons for non-compliance (lack of time, skin irritation, sink distance).
Knowledge vs. Action: Test their knowledge of the “5 Moments” vs. their reported behavior.
Logic: Explain how surveys can reach the entire hospital staff quickly to identify cultural norms.

Option B: Focus Group Approach

Method: Facilitated discussions with groups of surgeons, nurses, and residents.

Hints for your design:

Hierarchy: Should you mix surgeons and students in the same group? Why or why not?
Peer Pressure: How do you explore “unspoken rules” (e.g., “we only wash when the Chief is watching”)?
System Fixes: Ask staff to design their “ideal” hygiene station to identify structural flaws.
Logic: Focus on how group dynamics reveal collective attitudes that individual observations might miss.

Option C: Documentary Analysis

Method: Audit of alcohol-based hand rub (ABHR) procurement vs. clinical activity logs.

Hints for your design:

Proxy Measures: Can you calculate “liters per patient-day” across different wards?
Temporal Trends: Does compliance (gel use) drop during night shifts or high-admission periods?
Correlation: Link infection rate spikes in specific wards to their ABHR consumption records.
Logic: Address the “Gel consumption vs. true compliance” debate—is more gel always better?

Option D: Hybrid Observation (Overt/Covert)

Method: Trained observers using standardized checklists in clinical areas.

Hints for your design:

WHO 5 Moments: How will you code “before touching a patient” vs. “after”?
The Hawthorne Effect: How do you handle the fact that people act differently when they see you with a clipboard?
Ethics: If using covert observation, how do you justify it? Think about “Deferred Consent.”
Logic: Explain why seeing “real behavior” is the gold standard for clinical compliance research.

Scenario: “Improving Maternal Health Clinic Attendance”

Context and Background

Roma women in suburban Plovdiv attend prenatal care at much lower rates (43%) than the general population (87%). Administrators blame “culture,” while community workers suspect “discrimination” and “structural barriers.” Late presentation leads to higher rates of preventable complications and maternal mortality.

Your Research Task

Primary Question: What are the real barriers (economic, social, health system-related) preventing attendance, and how do they interact?

Option A: Structured Survey Approach

Method: Community-wide survey targeting Roma households in selected districts.

Hints for your design:

Language and Literacy: How will you administer the survey if participants have varying literacy levels?
Perception Items: Design Likert scales to measure trust in the healthcare system and perceived discrimination.
Accessibility: Include items on distance, cost of transport, and “opportunity cost” (lost work time).
Logic: Explain how representative sampling can prove that barriers are structural, not just “cultural.”

Option B: Focus Group Method

Method: Facilitated discussions with Roma women and community health mediators.

Hints for your design:

Homogeneity: Should the group be all women? Should the moderator be from the community?
Sensitive Topics: How do you ask about discrimination without “putting words in their mouths”?
Social Norms: Design prompts that explore what the community thinks about clinics, not just the individual.
Logistics: Think about childcare, transportation, and incentives to attend the session.

Option C: Documentary Analysis

Method: Systematic audit of medical records, appointment logs, and staff communications.

Hints for your design:

Patterns: What variables in a medical record show “differential treatment” (e.g., fewer labs, late initiation)?
Structural Barriers: Can you prove wait times are longer for certain districts through the database?
Sanitization: Address the fact that doctors don’t write “I was rude” in the medical notes.
Objectivity: Explain how an audit trail provides “hard evidence” that interviews might miss.

Option D: Environmental Observation

Method: “Mystery Shopper” or waiting room observation at the maternal clinics.

Hints for your design:

Atmosphere: How does the clinic staff treat patients who arrive late or without documents?
Visual Cues: Are there signs in Romani? Is the waiting room welcoming or intimidating?
The “Welcome”: Observe the first 120 seconds of the interaction—what is the non-verbal communication?
Logic: Justify how observing the setting explains why women might choose not to return.

Scenario: “Tuberculosis Treatment Adherence”

Context and Background

28% of TB patients in Plovdiv stop their 6-month treatment early, leading to multi-drug resistant TB. Many stop around Week 11. Brief exit interviews suggest “work conflicts” or “feeling better,” but the dispensary needs a deeper understanding of why patients take the risk of stopping.

Your Research Task

Primary Question: What are the multilayered barriers preventing completion, and why do they become critical at specific time points (like Week 11)?

Option A: Structured Survey Approach

Method: Standardized adherence screening tool (e.g., MMAS-8) applied to all current patients.

Hints for your design:

Timing: At what Week (1, 4, 8, 11) do you administer the survey to catch “early warnings”?
Psychosocial Items: Include scales for depression, social support, and TB-related stigma.
Self-Report Accuracy: How do you design questions to reduce “faking good” (social desirability)?
Logic: Focus on identifying statistical “at-risk” profiles across a large population.

Option B: Individual In-Depth Interviews

Method: Narrative interviews with both “Completers” and “Discontinuers.”

Hints for your design:

Temporal Sequence: Map the journey from diagnosis to the moment they decided to stop.
Stigma: How do you explore if the fear of neighbors finding out affects clinic visits?
Side Effects: Move past “I felt sick” to how side effects interfered with their specific life (work, parenting).
Comparison: What did the “Completers” have that the others didn’t (Support? Better education?)?

Option C: Documentary Analysis

Method: Analysis of treatment cards, side effect reports, and social work assessments.

Hints for your design:

Predictors: Can you find a “red flag” in the early notes that predicts who will quit later?
Documentation Gaps: If a patient quit, did the staff actually record any follow-up attempts?
Side Effect Mapping: Track the correlation between documented nausea/hepatitis and the date of discontinuation.
Power: Explain how analyzing the entire 2024 cohort (150 patients) is stronger than small samples.

Option D: Direct Observation (DOT) Session Analysis

Method: Observation of “Directly Observed Therapy” interactions at the dispensary.

Hints for your design:

Interaction Quality: Does the nurse just “watch them swallow” or do they ask about side effects?
Patient Burden: Observe the time it takes for a patient to travel, wait, and get their dose.
Verbal vs. Non-verbal: Do patients look hesitant or rushed during the interaction?
Logic: Justify how observing the delivery of the drug helps explain the decision to quit.

Evaluation Criteria:

Methodological Precision (30%): Instrument design follows the logic of the chosen method.
Conceptual Application (30%): Arguments explicitly reference the 15-minute reading material.
Critical Reasoning (20%): Groups identify and address valid threats (Recall Bias, Hawthorne Effect, Ecological Fallacy).
Communication (20%): Ability to defend and critique professionally.