About the World Health Survey:

Floating Doctors has developed a survey program and World Health Survey to: compile baseline information on the general health of the populations and communities visited and the outcomes associated with the investment in health systems; gather baseline evidence on the way health systems are currently functioning; identify disease trends in different geographic areas; and identify the people’s health system paradigms. The overall goal of the Floating Doctors World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of communities and its people, the responsiveness of health systems and measurement of health-related parameters.

Background:

Health Access Survey research has a long and revered history (Berk & Schur, 1997). In the early 1930s, the Falk Commission of the Coast of medical Care, a group of private health care stake holders, commissioned the 1st modern American survey of health services use and cost. Since that time, health survey research has developed into complex endeavors for many scientists and researchers as it spans internationally.

With all of the health care survey resources available, there are still many questions unanswered. The Floating Doctors World Health Survey aims to explore more than just the demographic, disease and healthcare access data of the countries visited, but also the perceptual and cultural behaviors, attitudes and beliefs of the communities that significantly impact their health. Many studies have been done in Central America and the Eastern Pacific Islands, however, large population surveys do not account for small local areas, all unique with their own local problems and barriers to health. The Floating Doctors will be visiting small, isolated, coastal villages and tribes, mostly only accessible by boat. Utilizing surveys tailored to small, local communities, Floating Doctors will ask questions about local institutions, infrastructure and community practices to meet and identify the needs of local populations. The surveys will ask about individual preferences and expectations of health that are usually not included in standard access to care surveys.

The failure of developing countries to support health practices and combat epidemic disease is due to the fundamental inadequacies in their health care delivery systems. The world’s poorest nations are crippled by limited resources, poor infrastructure, malnutrition, cultural attitudes and practices, inexperience, and inadequate public health systems (source: World Health Organization). The Floating Doctors survey seeks to identify the many local factors and conditions that inhibit communities to practicing preventive health and combating disease. The lack of basic infrastructure prevents the delivery of basic health care services, including medicine and preventative efforts in the developing world. Cultural beliefs, attitudes and practices often complicate this further. Weak transportation systems block patients, providers and medicines from reaching health facilities and failures (or lack of) local public health systems create problems in everyday health maintenance. There is a grossly inadequate ratio of medical professionals, as in most developing nations there is 1 doctor to every 10,000 people, and most health facilities are located in busy urban areas, inaccessible to many small tribes and villages (source: World Health Organization).

Fundamental social and cultural beliefs and practices in many developing nations have made it extremely difficult to change behavior and convince populations to take advantage of health care services and medicines available, as well as practice every day preventative care. This is an important factor that the Floating Doctors World Health Survey hopes to explore and understand, as to develop better interventional strategies for combating and preventing disease.

Objectives:

• Develop low-cost, valid, reliable and comparable information
• Monitor whether the health systems in those areas are achieving the desired goals
• Identify barriers and restrictions to good health
• provide evidence to adjust current policies, strategies and programs as necessary.
• Identify health expectations of the communities and how their health institutions respond to their needs.
• Examine the way populations report their health and how they value health
• Identify various areas of health care such as adult mortality, child/infant mortality, various risk factors for disease, assessment of main chronic health conditions and the coverage of health interventions and preventative care.

Survey Administration:

The Floating Doctors World Health Survey will be conducted in clinic to better assess the health care infrastructure, access to health care services and the perceptual attitudes and health beliefs of the countries visited. These surveys will be administered by a Floating Doctors volunteer in conjunction with a translator for accuracy in the health information. One patient may be assigned more than one survey. A general health survey will be conducted upon arrival of the patient, and information will be gathered about their overall health status and demographic information by the clinical workers through our Patient Intake Form. This will serve as a baseline of the patient’s current and past health concerns, as well as give vital information to the physician for treatment. After the patient is treated, they will be directed to the Survey Administration table, where they will be asked to participate in two surveys: “Access to Care” and “Perceptions and Health Beliefs”. Three other surveys (“Respiratory Health”, “Nutrition” and “Women’s Health”) will be administered in countries where severe problems exist or further research is needed.  All surveys will be filled out on a volunteer basis. Data will be collected and stored through tablet computers connected to an in-clinic intranet server.

Population Sample:

• Target Population- The target population includes any adult, male or female; and any children treated in one of the Floating Doctors mobile clinics. Patients will be interviewed at the end of their consultation and treatment in the mobile clinic and will be asked to participate in our World Health Survey at a separate table, where they will be provided with a translator and trained interviewer.
• Interview of Respondents-The interviews will be conducted face-to-face with the respondents in their local language with the use of a translator. The interview is expected to last approximately 30-60 minutes, but the length of the interview will depend on the comprehension and literacy level of the respondent.
• Informed Consent- Participation in the survey is voluntary and the respondent can refuse to be interviewed. The interviewer is responsible for explaining what the survey is about, providing all the necessary information, and make sure that the respondent understands the implications of their participation before giving his/her consent.  Consents will be documented by asking the respondents to sign and informed consent form before doing the interview. The interviewee much check off that the respondent has read and understood the form before signing, and should offer to go over it with him/her emphasizing any parts that are unclear.

Countries Survey will conducted in:

*Countries subject to change based on sailing schedule.

1. Haiti

2. Belize

3. Livingston, Guatemala

4. La Cieba, Honduras

5. Isla Providencia, Columbia

6. Corn Islands, Nicaragua

7. Bocos del Toro, Panama

8. Portobello, Panama

9. El Porvenir, Panama

10. San Blas Islands, Panama

11. Cocos Islands

12. Hiva

13. Tonga

14. Fiji

Survey Topics:

1. Access to Health Care: Where do they go to receive health advice, treatment? What delays are there is receiving care? How does cost play into getting treated? How far do they have to travel to get to a hospital/doctor/etc? Emergency care, home visits, vaccine upkeep, general health problems, barriers to health care. What services/organizations are in place already? What is useful for maintaining good health?
2. Perceptual Attitudes and Health Beliefs: What do they perceive to be the biggest health problems? How could health care/services improve? Who do they see for health care? Why seek treatment from healers, shamans, etc?
3. Respiratory Care: Identify risk factors for respiratory problems (ie: do they live in polluted area/smoke/ work with pesticides) what care do/would they seek if they had trouble breathing/asthma attack?
4. Gynecological/Women’s Health: How many times pregnant? How many times miscarried/aborted? Regular gynecological check ups (PAP), how often?
5. Nutrition/Obesity: Physical activity/exercise level? Have they tried to gain/lose weight recently? Why? Reduction of fat or calories in diet? What is the diet mostly comprised of? Do they consider themselves obese/underweight/average? Who cooks/prepares meals in the household? Where do they get their food sources?