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.

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: Overt Observation

Method: Visible observers in clinical areas using standardized checklists.

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?
Inter-rater Reliability: How do you ensure two different observers count the same way?
Checklist: Design a grid that captures the who, the when, and the how well.

Option B: Covert/Hybrid Observation

Method: Disguised observers or hidden cameras to capture baseline behavior.

Hints for your design:

Ethics: How do you justify observing staff without their immediate knowledge? Think about “Deferred Consent.”
Camera Placement: Where would you put a camera to see the sink but respect privacy?
Technical Detail: Can a camera see if they used enough soap and rubbed for 20 seconds?
The “Ground Truth”: Explain why seeing “real behavior” outweighs the ethical complexity.

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: Focus Group Method

Method: Facilitated discussions with Roma women who attended few or no visits.

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 B: 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.

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: 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 B: 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 or social assessments?
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 interview samples.

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.