West Nile Virus - Research Paper Example

? TOPIC: FINAL PAPER WEST NILE VIRUS LECTURER: FINAL PAPER WEST NILE VIRUS INTRODUCTION West Nile virus, a disease that was onceidentified to be associated with only few places around the world is today considered an epidemic because it has had a very wide scope of areas that it has spread to. In the United States, current studies show that the disease is in over 85% of states, which is a course for great worry. With symptoms similar to malaria and other fever related diseases, West Nile virus remains a disease with no specific curative treatment. This has led to a situation where prevention strategies have been embraced in both literature and practice. For affected people however, various forms of management interventions are often used. In the current research work, the approach to what exists in literature is not much different. This is because the researcher seeks to use a population that is made up of patients of the disease who have been hospitalized in an identified health facility. There shall also be a group of respondents who are directly affected by the disease but stand the risk of being affected. For the former group, a more curative approach to intervention shall be sought, whiles a preventive intervention shall be prescribed for the latter group. The population is made up of people of both sexes, most of whom are in their 20s. Since only one hospital was used, it is expected that all the respondents will belong to the same cultural setting and from the state from which the study was conducted. The study is conducted using a quantitative research method. This means that there will be the use of primary data collection, which will involve the collection of specific numeric index outcomes about the population and the effect of the intervention on the population (Bernard and Kramer, 2001). The quantitative research method has been used in several instances, especially in cases where the approach to intervention is for curative management among people who have already been affected by the disease. In this study, the researcher combines the preventive intervention with curative management and so expects that the quantitative research will aid in achieving this 2-tier goal. The research shall be approached by first identifying a population of people who are both affected by the disease and at risk to contracting the disease, due to their exposure to risk factors associated with the disease. After identifying the population, the researcher shall make maximum use of available interventional solutions that exists for these people. The difference in approach for this study shall however be the introduction and use of best practices in the use of existing intervention. The rationale for this approach is that preliminary review conducted have showed that most of the existing interventions are effective in managing cases of West Nile virus but have failed in achieving desired solutions because best practice principles have not been followed in their application (Eldridge, 1987). At the end of the study, it is expected that a 2-tier outcome is going to be produced. The first of this would aid in enhancing the prevention of West Nile virus, while the second will focus on ways of reducing the effect of the disease on affected people. The researcher is also highly optimistic that existing gaps in literature; especially those that have to do with the application of best practices will be adequately filled at the end of this study. LITERATURE REVIEW Health Topic Through the review of existing literature, two major interventions were found as what has already been done in an attempt to addressing the issue of West Nile virus. These interventions can be categorized into preventive interventions and curative interventions (Asnis, 2002). A typical example of a preventive intervention was used by Wittich (2007), who is credited for the environmental predictive model for West Nile virus. In this model, specific risk factors that expose a group of people belonging to a particular population is found and mitigated. The Roll-Out Model is an example of curative intervention, even though this intervention is yet to be aligned with any specific treatment or cure for the disease (Bernard and Kramer, 2001). There have been different outcomes with the two existing approaches interventions. The first is that the preventive approach has been found to result in long term control of the disease, instead of short term control (Hubalek and Halouzka, 1999). According to Hubalek (2000), the reason this is so is that the preventive interventions rely exclusively on behavioral changes, which take very long time in taking place. The curative interventions on the other hand have resulted in outcomes that have to do with short term management or control of the disease. This notwithstanding, there still exists no known cure for the disease even though the curative interventions have ensured that patients gain improved health. One other trend with the outcomes of the author’s conclusions on their interventions is that preventive models have been found to be effective for use in smaller populations while the curative interventions are easily replicated into a nationwide program (Asnis, 2002). Critiquing the various forms of interventions, Gruszynski (2006) observed that each of these have their weaknesses, which needs to be improved for the achievement of effective primary health care. In the first place, the preventive approach has been identified to have the weakness of being highly delimited in terms of applicability. Because of this, people who benefit from the preventive intervention have always been very little, leading to continual widespread of the disease. The curative intervention has also been criticized for its absence of total control, whereby patients who receive the intervention cannot be guaranteed against reoccurrence. As a way of improving on these two interventions, it is recommended that an approach that is similar to what the researcher is seeking to do in the current study be adopted. This entails the combination of the two interventions in a manner that ensures that whiles the curative intervention improves the health of affected people, then the preventive intervention be used to ensure that reoccurrences are done away with. Population Research The search through literature has showed that the population that has been used for various researches has largely been determined by approach to intervention used. Where curative interventions are used, the populations have been widened to a nationwide perspective. In instances like the roll out program, the Ministry of Health, which has been the major financier of researches, has used nationwide population by engaging hospitals from almost each of the states of the country (Hubalek and Halouzka, 1999). This has been done to ensure that at the end of the research works, the interventions will serve as a centralized approach to tackling the problem of West Nile virus. Where preventive interventions are used, the researchers have often used smaller population such as single hospitals. The rationale for this is that the preventive approach deals with behavioral changes, which is difficult to manage on a large scale basis (Shortridge, Oya, Kobayashi and Duggan, 2010). In modern times, there has been a trend in the population of existing research, where researchers have included and focused studies on animal populations. A typical example of such works has been done by Wittich (2007) and Gruszynski (2006) who used birds as their population. The animal population was used with the intention of finding the relationship between risk factors in animals and those of humans (Klenk and Komar, 2003). These trends have also been necessary as a way of finding out if there are ways in which the presence of the virus in the birds could be a factor of cause in humans. According to Eldridge (1987), this new trend has been very useful because it has expanded knowledge and understanding on risk factors on the West Nile virus. Whether researchers use human population or animal population, a common denominator that is used for their research is to have two groups of sample members. The first group has been marked as the test or experimental group who has often received the interventions of the researcher. The other group has been the control group that does not receive the intervention. Variables in both groups have however been the same, including reported diagnosis of West Nile virus or diagnosis as possessing risk factors. At the end of the research, outcomes in test group are compared with control group to find the level of impact of the intervention on the test group (Shortridge, Oya, Kobayashi and Duggan, 2010). Common Methodology used for like programs Two major research methods have been used in existing literature. These are the qualitative research method and quantitative research method. In qualitative research method, researchers focus on the use of behavioral changes as a way of achieving either the prevention or management of West Nile virus. In such cases, ethnographic research designs are employed as a way of studying the cultural perspectives of people in relation to how a change in these perspectives can bring about a guaranteed the prevention of diseases. The quantitative research method has on the other hand focused on the immediate effect of curative interventions on patients. The quantitative research method has thus been used for its ability to give off immediate results for decision making. Between the quantitative and qualitative research methods however, it will be noted that the qualitative research method is more common and popular among practitioners and researchers. There are a number of factors that can be attributed to this situation. In the first place, most of the research that has been conducted has taken place among smaller populations where the preventive approach has been employed (Hubalek, 2000). Meanwhile, it has been said that the preventive approach is more suitable with qualitative research it focuses directly on behavioral changes. In the second place, qualitative research has been preferred by most researchers as it ensures active participation of respondents rather than a passive involvement of respondents. When different methodologies are used for the search for interventions for West Nile virus, different outcomes are often produced. In the first place, qualitative research methods help in producing respondents who gain experiences of the research as a personal part of their lives. In effect, researchers can be assured that respondents can on their own replicate the interventions that were used on them in a qualitative manner so that the outcome of the research can be realized to very long time frames. It is not surprising that qualitative research methods are used ethnographically to achieve prevention of disease. The quantitative research methods on the other hand can be said to produce passive, though immediate and effective outcomes. METHODOLOGY The research is targeting to use a total of 20 respondents from an identified hospital (name withdrawn for ethical reasons). All 20 respondents are expected to have been on treatment of West Nile virus using doctor recommended interventions and medications. The respondents will be found by use of a purposive sampling technique. In such purposive sampling techniques, researchers prepare their own inclusive and exclusion criteria with which they select respondents for the study (Shilite, 2003). A similar approach was thus repeated in this instance, where the researcher shall prepare an inclusion and exclusion criteria and present to authorities of the hospital. Largely, the respondents must have a medical record that has authenticated the contraction of West Nile virus. Patients must not be suffering from any other known chronic history as this may interfere with measuring results for the post-test. It is also expected that patients to be included must be those on admission and have been scheduled to be there for at least three days. This is needed to ensure that the researcher can extensively deliver the intervention on the respondents to the letter. The respondents must also live within the vicinity of the hospital so that follow up processes can be undertaken. Once the respondents are selected, they will be expected to partake in the study by accepting to receive the researcher’s intervention and going ahead to stick to instructions given to them on the administration of the intervention. The respondents are also expected to give accurate data to the researcher on their state of health to make quantitative measurement of these data possible. Data shall be collected by the use of a health record checklist. This will be a quantitative checklist that contains basic close ended questions on the health state of the respondents. The health record checklist is the major research instrument that will be used for the evaluation of the study. The approach to evaluation shall be a formative approach, which means that the researcher shall not wait till the end of the whole program before assessing the impact of the program (Petersen and Roehrig, 2001). Rather, measurement of the impact of the program shall be done as and when the program proceeds. Due to this approach, there shall be three major levels of evaluation, which are pre-intervention evaluation, intervention evaluation and post-intervention evaluation. Pre-intervention evaluation shall involve collection of data on the current state health state of respondents in terms of the West Nile virus. Thereafter, the respondents shall be divided into two, one group forming the test group, and the other forming the control group. The test group shall then receive the intervention, which shall be a combined intervention. There shall be measurement of health improvement among the test group as and when the intervention goes on. After this, the last evaluation shall be taken at the end of the intervention period to compare improvements in the health status of test group to control group. PROGRAM DESIGN AND DESCRIPTION As part of primary data collection, the researcher plans to identify two existing interventions, one of which is a preventive intervention and the other a curative intervention. Thereafter, two major sample sizes shall be formed. The first shall be made up of patients of the West Nile virus who will form the test group, and the second sample size shall be made up of patients who shall form the control group. The research shall be approached using the proceed-precede design, such that two major tests shall be conducted on the sample sizes. The first test termed as pretest shall be conducted to identify the current state of patients as far as the West Nile virus is concerned. Thereafter, the intervention, which is a 2-tier or combined intervention, shall be introduced to the test group. The second test, which is termed post-test, shall then be introduced to measure any possible changes in terms of health improvements in the test group and the control group. This means that what is specifically involved in the program is an action research that seeks to identify a problem within a localized setting and solving the problem with the support of people who are directly affected by the problem. In this case, the researcher shall not be concerned with only improving the health status of affected people but ensuring the prevention of reoccurrence also. As far as the population and sample is concerned, the researcher is going to use a purposive sampling technique to identify a group patients affected by the West Nile virus at a hospital with a proximity that can ensure that the researcher can constantly monitor respondents. The purposive sampling is preferred in this instance over the use of random sampling because if random sampling is used, the possibility of getting respondents whose variables correspond with the research problem may not be realized. The two groups of respondents will be required to play different roles for their participation in the program. As far as the test group is concerned, respondents are expected to adhere to interventional instructions and measures put forth by the researcher. Because the study is a quantitative study, not much will be expected from the respondents in terms of active participation. Their role shall therefore focus primarily on reporting. Participation of respondents in the study is not expected to attract any stipulated incentive or reward. However, the researcher shall present some honorariums to the respondents as a way of saying thank you to them for their participation. The honorarium is expected to take the form of free drugs, transportation and free medical tests. The main incentive would perhaps be the fact that due to the involvement of the respondents, a permanent intervention for West Nile virus will be devised. Action research of this nature have been noted for their time consumption due to the fact that they involve several stages and processes involving pretest, intervention and post-test (Shilite, 2003). Due to this, the researcher plans on using a total of 15 weeks for the entire program. Within the period, the intervention stage is expected to take the lengthiest time, followed by the post-test and then the pretest. After the post-test, it is expected that there will a follow up program to test the sustainability of the study. The sustainability plan will be determined mainly outcome of the follow up program that will be undertaken. What this means is that depending on the progress that the respondents make with their health situation, the researcher will choose to either modify the intervention for future usage or to maintain the intervention. But in order to ensure that the intervention is consistent with time and thus sustainable, the researcher shall ensure that there is a periodic developmental research conducted to test the rigidity of the intervention with time. In relation to academic and professional provisions, the researcher shall ensure that ethical considerations are made for the study. In the first place, the research setting, which is the hospital, shall be used with all necessary permission sought. Participation in the study shall also take place from a voluntary will instead of out of compulsory. All these shall be ensured by designing a consent form, which shall spell out the objectives of the study to stakeholders and respondents. The roles that are to be performed by respondents shall be clearly stated in the consent form as well as any risks and incentives. More importantly, the consent form shall assure the participants that their identities and responses shall be kept anonymous and confidential. The study shall be completed with the support of the researcher’s supervisor, a group of research assistants and health professionals from the hospital. Supplies including basic experimental instruments, stationery and printing materials are expected to be incurred. In all, the researcher hopes to use an amount of $800 on the study. At the end of the study, success shall be measured by using the health outcome of respondents. DISCUSSION There have been several factors put in place to ensure that the research is successfully implemented. Part of the structures that have been put in place is the setting up of a research assistance team made up of colleague students who will offer academic advice and counsel towards the successful implementation of the study. The researcher shall also liaise harmoniously with the supervisor and stakeholders at the research setting. All these factors notwithstanding, there could be the possibility that the program implementation may be affected or limited. One of such factors is the assurance of consent from the targeted research setting or population. Currently, much of the research has been planned around the hospital and its patients. However, since participation is voluntary, the researcher cannot be adequately assured of participation of the needed number of respondents. Again, because action research is time consuming, not all intended components of the intervention may be executed before the required time for the study may be up. Should this limitation with the full implementation of the intervention take place, the risk is that the program outcome may be affected negatively. This is because if due to time the researcher is not able to implement the combined intervention, only the curative intervention shall be implemented, meaning that the possible of reoccurrence with the disease will be higher (Luanda, 2010). Another factor or condition that is likely to affect the program outcome has to do with the authenticity of results and data that the respondents give to the researcher. It will be noted that the quantitative study will rely largely on the outcome of variables and demographic data collected from respondents. Any inaccuracies will therefore affect the program outcome. On the whole, the validity and the reliability of the study is a very important requirement for academic studies of this nature. In line with this, the major determining factor that will influence the need for there to be a revision on the program or a total elimination of it will be dependent on the level of validity and reliability of the study. In the first place, the validity of the study shall be determined by the level to which the research instrument collects the kind of data that the research problem seeks to collect (Petersen and Roehrig, 2001). In line with this, the validity of the study shall first be tested by having a mock research among the research assistants. Because of the academic knowledge of these assistants, it is expected that the level of information or data collected with them will be relatively the same as what is collected from the actual population. Where there exist a very wide margin of error then there will be a revision or elimination of the procedure. The reliability of the study on the other hand is expected to affect the sustainability of the study directly. The reliability of the study will be guaranteed with the same results can be produced if the research is replicated in different settings with the same variable holding as constant. To this end, factors that will be put in place to ensure the reliability of the study will go a long way to also promote the program sustainability. One important measure that the researcher shall put in place to ensure the reliability of the study is to promote fairness in respondent participation by ensuring that the researcher does not influence the outcome of results in anyway (Klenk and Komar, 2003). CONCLUSION At the end of the whole study, it is expected that changes in health and wellness will be positively affected. On the whole, this is expected to be done as the combined intervention used by the researcher is adopted and replicated in various health practices, especially at the national level of rolling out West Nile virus. Currently, a major gap that exists in research and with programs to finding interventions to West Nile virus is that the curative interventions, which are the most common form of intervention used at the national level, have failed to effectively roll back West Nile virus. This is because after improving the health of affected people, there are no measures to prevent recurrence of the disease. This study is therefore expected to bring a paradigm shift that ensures that whiles affected people are supported they are also protected against reoccurrences. Luanda (2010) found that most people that exhibit symptoms of the West Nile virus do so with the same risk factors and health variables. The implication of this to the study is that the interventions and findings of the program, if they turn out to be effective, can be replicated in other communities other than the research setting where the current study was conducted. Having said this, sight will not be lost of the fact that the researcher has a responsibility of guaranteeing the reliability of the study to attain success with the ability to replicate the study in other populations. On a final note, it would be said that the way forward for effective prevention and management of West Nile virus is a paradigm shift in existing approaches. The time has come to try a shift from the use of single interventions to the use of combined approaches that are backed by the application of best practices in health studies. References Asnis D. (2002). West Nile Infection in the United States: A Review and Update. Inf Med. 19(6):266-78, Bernard KA, Kramer LD. (2001). West Nile virus activity in the United States, 2001. Eldridge BF. (1987). Strategies for surveillance, prevention, and control of arbovirus diseases in western North America. Am J Trop Med Hyg. 37(3):77S-86S. Gruszynski K. R. (2006). The epidemiology of West Nile virus in Louisiana. 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Japanese encephalitis virus antibody in cold blooded animals. Trans R Soc Trop Med Hyg. 1977;71(3):261- 2. Wittich A. C. (2007). Spatial analysis of West Nile virus and predictors of Hyperendemicity in the Texas equine industry. Emergency Infectious Diseases. 11(10):1633-5 Read More