pdw facilitatorguide

8/13/2019 Pdw Facilitatorguide

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Putting Data to WorkEvidence-Based Health Program Planning and ManagementSUSTAINABLE MANAGEMENT DEVELOPMENT PROGRAM

FACILITATORS

GUIDE


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Sustainable Management Development ProgramDivision of Public Health Systems and Workforce Development

enter for !lobal Health

"#S# enters for Disease ontrol and Preventionhttp$%%&&cdc#gov%globalhealth%SMDP%
http://www.cdc.gov/globalhealth/SMDP/http://www.cdc.gov/globalhealth/SMDP/


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PUTTING DATA TO WORK

Putting Data to WorkCONTENTS

S"S'()*(B+E M(*(!EME*' DE,E+PME*' P.!.(M# # #/

########################################################################################################/

Putting Data to Work########################################################################i

)ntroduction####################################################################################iii

######################################################################################################iii

ourse vervie##########################################################################iv

)nstruction *otes##########################################################################viii

CONTENTS | i


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CONTENTS | ii


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)ntroduction

SUST IN BLE M N GEMENT DEVELOPMENT PROGR M

SMDP works with ministries of health, educational institutions,

nongovernmental organizations, and other partners to

strengthen leadership and management skills and systems to

improve public health in low resource countries.

Program StrategySMDP strengthens leadership and management skills and

systems through:

ntegration with country public health priorities

Strategic partnerships

!echnical assistance and training

Policy and systems development

"dvocacy and education

#valuation

$or more information, visithttp:%%www.cdc.gov%globalhealth%SMDP%.

ACKNOWLEDGEMENTS

Dr. &icholas "yebazibwe, "frican $ield #pidemiology &etwork

&orthwest 'enter for Public (ealth Practice

SUSTAINABLE MANAGEMENT DEVELOPMENT PROGRAM | iii


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ourse vervie&

ABOUT THIS COURSE

!he goal of this course is to enable participants to use data to

make decisions and recommendations. Data can be used for

planning and decision making regarding public health needs,

organizational performance and monitoring and tracking

evaluations.

!his course will focus on )uantitative data.

TARGET AUDIENCE

!his course is designed for leaders and managers of healthorganizations, programs and operations.

LEARNING OBJECTIVES

*hen participants complete this course they will be able to:

Describe how data are used in health organizations andprograms

dentify methods for summarizing data

#+plain how data analysis and interpretation can improvedecisions

Prepare and apply tables, graphs, and charts such as line

graphs, bar charts, pie charts, and spot dot- maps, forsummarizing data

COURSE OVERVIEW | iv


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MATERIALS AND EQUIPMENT

MATERIALS EQUIPMENT

For the Instructor: PowerPoint Slides

Participant *orkbooks

Summarizing Data Scenarios

'ourse #valuation $orm

#+tra Pens and Pencils

'alculators

For the Instructor:

$lip charts

/aptop

/'D Pro0ector

!ape

'opies of the PowerPoint slides should not be handed out to courseparticipants.

MATERIALS AND EQUIPMENT | v


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WORKSHOP SCHEDULE

Tasks Exp!"# Ti$

I!tr"#t$o to P"tt$g Data to Wor%&

)ntroduction

Ho& do you "se Data0

E1ercise /$ )s there a Problem0

'( m$"te!2 minutes/3 minutes/3 minutes

Data&

4inds of Data

'ypes of Data

Data ollection

E1ercise 5$ "sing a heck

Sheet

)( m$"te!/3 minutes/3 minutes

2 minutes/3 minutes

Iter*ret$g Data&

.atios

Proportions and Percentages

.ates

.ates E1ample

Why use .ates0

E1ercise 6$ alculate .atiosand .ates

+, m$"te!2 minutes

/3 minutes/2 minutes/2 minutes2 minutes

/3 minutes

S"mmar$-$g Data&

Summari7ing Data

'ables

!raphs

+ine !raphs

reating +ine !raphs

Bar harts

E1ercise 8$ Which Method doyou "se0

Pie harts

Maps

Stratification

E1ercise 2$ Summari7ing data

.(( m$"te!2 minutes

/3 minutes2 minutes2 minutes

/2 minutes/3 minutes/3 minutes

/3 minutes/2 minutes/3 minutes93 minutes

Co#/"!$o& ., m$"te!

WORKS%OP SC%EDULE | vi


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Summary

What:s *e1t

2 minutes2 minutes

!he listed times are appro+imates and should be verified during classroompreparation. 1e sure to allot time for breaks.

CLASS PREPARATION CHECKLIST

Task

2btain and test /'D pro0ector and personal computer

2btain flip charts and markers: 3 for every 456 participants

'opy participant materials. $or each participant:

Participant *orkbook

*orkshop evaluation form

"ppendi+ ": Summarizing Data #+ercise

"nswer sheet for Summarizing Data #+ercise

2btain and test PowerPoint file PD*5PP!-

Prepare flip charts

Put slide 738 on a flip chart to reference during that section

CLASSROOM SETUP

"rrive early to setup the classroom.

"rrange tables for groups of 9.

MATERIALS AND EQUIPMENT | vii


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Provide a flip chart and easel for each table of 9participants.

)nstruction *otes

!he following notes refer to slides in the PowerPointpresentation: PD*5PP!.; Suggested actions and script for theinstructor are located in the Script% is written like this.

Instructions for the facilitator to DO are written like this.

Possible answers are written like this.

ICON GLOSSAR0

SPECI1IC SLIDE 1OR USE DURING THE E2PLANATION

1LIPCHART USE

SUPPLEMENTAL IN1ORMATION TO HELP PER1ORM A TASK MORE

EASIL0

WORKS%OP SC%EDULE | viii


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SMALL GROUP E2ERCISE

QUESTIONS 1OR 1ACILITATOR TO ASK PARTICIPANTS

VIDEO PRESENTATION

MATERIALS AND EQUIPMENT | ix


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Co"r!e I!tr"#t$o

INTRODUCTION TO PUTTING DATA TO WORK

#+pected !ime: 86 minutes???????????????????????????????????????????????????????????????????????

IntroductionWORKBOOK CLOSED

!inutes

SCRI"#$KE% "OIS

Welco!e the 'artici'ants and introduce (ourself

Introduce di)nitaries *allow the! to s'eak+

E,'lain housekee'in) ite!s- such as reak ti!es-restroo! locations- etc.

E,'lain the workook and how the( will use it to

co!'lete e,ercises and take notes.


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/ow Do %ou 0se Data1

Workook "a)e 2

23

!inutes

SCRI"#$KE%"OIS

!hink about the many decisions that health managers make ina day.

Some of them are simple and straightforward, and some ofthem are not as simple as they may appear@

"nd then there are decisions that managers know will have

significant impact on the population they serve, on their

workforce or on the way work gets done.

"s a manager concerned with the health of your communityand the population your program serves, as well as theperformance of your organization, timely and accurate analysisof data can inform technical as well as administrativedecisions.

4sk the 'artici'ants- can you think of any ways that you usedata to make your decisionsA

Instruct the 'artici'ants to write their answers in theirworkook on 'a)e 2.

4s a lar)e )rou'- ask the 'artici'ants to share theiranswers.

*write their res'onses on the fli' chart+


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E,ercise 2: Is #here 4 "role!1Workook "a)e 5

23!inutes

SCRI"#$KE%"OIS

/etBs go through a scenario. magine that you are a medicaldirector of a district hospital and part of your 0ob is to manageresources. #ach month your employees submit receipts fortheir fuel usage.

nstead of 0ust approving the bills, you can study the data theyprovide.

'ollecting and analyzing these simple data will allow you tobetter track and understand trends in fuel usage.

'onsider the following graph which tracks fuel usage over ayear for all employees of the district hospital.

4s a lar)e )rou' discussion- ask the 'artici'ants the

followin) 6uestions. Write their res'onses on a fli'chart to 'ossil( use later durin) the stratification'ortion of this session.

; *hat is the graph telling you about fuel usageA


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4nswer: Fuel usage was lowest between April and June. Itreached its highest peaks in February, July and September.There was a sharp decline in fuel use between Februaryand April and also between September and ecember.

Fuel use continuously declined after the high peak inSeptember.

; s there a problem with usageA

4nswer: !e cannot tell if there is a problem with fuelusage because there is not enough information to answerthat "uestion. The graph shows fluctuation in fuel use butit doesn#t indicate that something is wrong. !e won#t knowanything unless we continue to monitor the trends and ask"uestions to find out what is going on.

*ithout data, you can only guess what is not working, how tocorrect it and whether your efforts at change were effective.

*hile your guesses may be informed by your e+perience, thisapproach is not likely to be successful, especially in the longterm.

2nly data can provide the guidance you will need. 1utcollecting the data is only one component of programmanagement and planning.

"ccurately analyzing and interpreting data over time will help

you identify areas that need your attention and assist toprioritize health problems.

4sk the 'artici'ants, as the medical director of this districthospital, what are some other things you would want to keeptrack of besides fuel usageA

Possible answers$ !aiting times at clinics, how often are%ehicles in the shop for repairs or maintenance

%OW DO &OU USE DATA'C (


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DATA

#+pected !ime: 6 minutes

???????????????????????????????????????????????????????????????????????

Kinds of DataWorkook "a)e 7

23!inutes

SCRI"#$KE%"OIS

>ou probably have access to more data than you realize.

f you work in a hospital or clinic, the patient admissions andmedical records can provide valuable information to help youmanage your programs.

Similarly, data that is collected about employees may beuseful for managing human resources.

Eust as in our e+ample of fuel usage, something as simple asan invoice can provide you valuable data for programmanagement and planning.

!here are different kinds of data. (ealth data, for e+ample, can

focus on individuals or entire populations.

Indi8idual:

" classic e+ample of individualized data is a patientBs medicalrecord.

#ach record is devoted e+clusively to one person and containsinformation about his or her uni)ue illnesses, in0uries,behaviors, etc.

!he data are used primarily to improve the health of that one

individual.

*e are mostly concerned with population5based data becauseit will tell us about the overall health of that population.

"nalyzing these data can inform policy and help guide publichealth programs and recommendations.

$or e+ample, if data indicated that there are fewer residents in


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our community wearing motorcycle helmets than in othercommunities, we can consider interventions to increase helmetuse.

9ana)e!ent:

!hen there are program and operation data, which are alsovaluable for making decisions and recommendations.

!hese data enable you to monitor and evaluate the use anddistribution of resources, such as staff, supplies, ande)uipment.

#+amples of management data include the fuel usage e+amplementioned earlier, as well as human resources and budgetinformation.

%OW DO &OU USE DATA'C )


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#('es of DataWorkook "a)e

23!inutes

SCRI"#$KE%"OIS

Fenerally, there are two types of data: )uantitative and)ualitative.

uantitati8e Data:

Guantitative data provide the what, who, when, and where.!hey are measurable and tangible.

Guantitative data involves the counting of people, behaviors,conditions, or other discrete eventsH classifying those eventsinto categoriesH and using math and statistics to answer)uestions.

What &umbers of deaths can be used to identify leadingcauses of death

Who &umbers of smokers and nonsmokers by gender canbe used to determine whether men are more likely to

smoke than women

When


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nterviews in a local clinic might indicate how people feel aboutthe clinicBs services.

Guantitative data and )ualitative data often interact andcomplement each other. =sing both types of data can giveyou a better picture of the situation.

Guantitative data will typically give you the numbers ormeasurable details size of population, staff turnover rates,etc.-, while )ualitative data will help you understand whysomething is happening.

$or e+ample, )uantitative data can tell us that clinic wait timesare higher in one district as compared another. (owever, it isthrough )ualitative data that we can get a betterunderstanding of why the wait times are higher.

Perhaps the clinic has very few staff serving a large population,

it double books appointments or patients are typically runninglate so they miss the appointment time and have to wait evenlonger. !his detail is not typically found through )uantitativedata.

n this course, we will focus almost entirely on )uantitativedata.

4sk the 'artici'ants to think aout that data thatcrosses (our 'ath each da(- i.e. fuel usa)e- hos'italad!issions- etc.

'an you think about any data that crosses your path each dayA*hat data are available to youA

*allow ti!e for a rief discussion and write res'onseson a fli' chart+

T&PES OF DATA | *


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Data CollectionWorkook "a)e ;

!inutes

SCRI"#$KE%"OIS

!here are many ways to collect useful data.

>ou may already be collecting data formally through asurveillance system or with a management system such asfinancial management or human resources informationsystem.

>ou can start your own data collection with a simple tool.

Counts:

'ounts are the simplest measure of occurrence.

" count is 0ust the actual number of events in the population ofinterest, such as identifying how many individuals have aspecific illness such as (I.

>ou can use counts in management as well, such as countingthe number of times an employee calls in sick to work eachmonth.

'ounts are commonly used for program planning andmonitoring.

(aving a count by itself is helpful in planning things like theamount of vaccines or other medications to order, but countsalone do not provide conte+t.

'ounting events or cases does not give any indication of theproblem in relation to the size of the population.

$or e+ample, J9 cases of guinea worm in the capital city of

Faborone would be very different from J9 cases in a smallrural village in 1otswana.

Check Sheet:

2ne way to organize counts is through the use of a checksheet. " check sheet is a table or form that is used tosystematically register data as it is collected.

T&PES OF DATA < +


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E,ercise 5: 0sin) 4 Check SheetWorkook "a)e people &ho missed

appointments

9 5 59 2 9 2

'otal > appointments booked for

&eek

23 92 82 25 9/ 8? 93 6@5

Percent missed /5#3 6#/ 2=#@ ?#9 ?#@ /3#5


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A!% t3e *art$#$*at! to t"r to *age 4 $ t3e$r 5or%6oo% to

#om*/ete t3e 7o//o5$g ta!%8

=sing the check sheet, fill in the missing data for week J usingthe following information: people from 'linic ' missedappointments and 3 from 'linic D.

4nswer: tallies for clinic ' and 3 tally for clinic D, all forweek J

=se the counts from each clinic to add up the total number ofmissed appointments over the J week period.

4nswer: !he counts for total number of missed appointmentsare highlighted in yellow:

+ocation

Missed (ppointments

Week/

Week5

Week6

Week8

Week2

Week9

Week=

'otals

linic ( 9

linic B

4

linic

.+

linic D

.'

linic E ..'otals > people &ho

missed appointments

9 5 59 2 9 2 8 (:

'otal > appointments

booked for &eek

23 92 82 25 9/ 8? 93 6@5

Percent missed /5#3 6#/ 2=#@ ?#9 ?#@ /3#5

DATA COLLECTIONC -.


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INTERPRETING DATA

#+pected !ime: 9K minutes???????????????????????????????????????????????????????????????????????

RatiosWorkook "a)e =

!inutes

SCRI"#$KE%"OIS#urn to the fli' chart that dis'la(s slide >25

Measuring the fre)uency of events, such as disease or health

events, is at the heart of public health surveillance andresource allocation.

"nd measuring results is at the heart of good leadership andmanagement.

!he most commonly used measures for assessing fre)uencyare ratios, proportions, percents and rates.

!he ne+t series of slides will introduce you to these variousfre)uency measures, which are all commonly used in publichealth.

Ratios

" ratio is a comparison of two different thingsH it is a numericale+pression that indicates the relationship between two or morethings.

!he two numbers are generally separated by a colon, but canalso be e+pressed as a fraction.

$or e+ample, the ratio of missed appointments between 'linic" L- and 'linic 1 39-, is L:39 or L%39. *e can reduce this to3:8.

So for every missed appointment at 'linic ", there are 8 at'linic 1.

DATA COLLECTIONC --


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"ro'ortions and "ercentsWorkook "a)e =

23!inutes

SCRI"#$KE%"OIS

"ro'ortions

" proportion is a ratio in which the numerator is included in thedenominatorH it is a numerical e+pression where a part iscompared to the whole.

" proportion can be e+pressed as a fraction or a decimal.

$or e+ample, we can e+press the relationship of 'linic " to thetotal number of missed appointments as a proportion.

!he proportion of missed appointments in 'linic " compared

to the group is L divided by 64 or K.36.

'linic " L

K.36

!otal Missed 64

!o be more easily interpreted proportions are often multipliedby 3KK, 3KKK or 3KK,KKK, so we can also e+press this fractionas 36 per 3KK or 36K per 3KKK.

*hen multiplied by 3KK, proportions can also be reported aspercentages, so we can say that the percentage of missedappointments in 'linic " is 36N.

"s you can see, proportions and percents are essentially the

same measure.

"ercents

*hat makes a percentage different is that it standardizes thedata, which means it makes it easier to compare to similardata obtained from a different sample. Such as whencomparing the percent of missed appointments from thedifferent clinics.

DATA COLLECTIONC --


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(owever, you have to be careful when calculating andinterpreting percentages if the total number or sample size issmall.

!herefore, it is recommended that the number or count

always be given together with the percentage. /etBs illustrate this through an e+ample. n the following table

'linic " appears to have the best percentage of pregnantwomen whose partner gets tested. 1ut are they really doing aconsiderably better 0ob of getting partners testedA

f we look at that total number of pregnant women from eachclinic we see that clinic " has a much smaller population thanclinic '.

'linic N Pregnant women

whose partner gets

tested

7 of pregnant women

whose partner gets

tested

" 6KN out of 9

1 83N L out of 3L3

' 3JN 383 out of J38

INTERPRETING DATA| -(


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RatesWorkook "a)e ?

2!inutes

SCRI"#$KE%"OIS

" rate is often a proportion, with the added dimension of time.

Oates measure the fre)uency at which an event occurs over a

period of time.

n health, a rate can represent the burden of disease or other

health related outcome during a specific time period.

n management, a rate might represent the number of times apharmacy runs out of medicine or a vehicle breaks down overa period of time such as months or years.

4re (ou at risk1

1efore we go on to look at rates in more detail, letBs discuss aterm youBll often hear in assessing health: Oisk or Persons atrisk.;

Oisk is the probability or likelihood that an event will occur,such as the likelihood that an individual will become ill or die,within a stated period of time.

Persons at risk are people in the total population to whom theevent or health condition being studied could have happened.=sually this is everyone living in a specific geographic areaduring the time period of interest.

!he term persons at risk defines the denominator for the

calculation of rates. t alludes to the number of personspotentially capable of e+periencing the event or outcome ofinterest.

=nder certain conditions, however, we e+clude some personsfrom the total population. $or e+ample, when looking at thoseat risk for contracting polio, we would e+clude all those whohave had the vaccination from our population.

Oates allow us to compare the risk of health events across

INTERPRETING DATAC -)


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different groups of people, places and times.

!he general formula for calculating rates is shown below:

&umber of persons e+periencing the event

&umber of persons at risk; of +


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$or e+ample, in city 1, we can say that the rate of disease inthis population was 8 per 3KK,KKK, or for every 3KK,KKK peoplein the population, two cases of disease were identified duringthe time period of interest.

Rates E,a!'leWorkook "a)e 23

2!inutes

SCRI"#$KE%"OIS

2n way to decide what to use as your < is to look at what youare comparing to. $or e+ample, if national data are describedin terms of per 3KK,KKKB, use this as your unit, for easiercomparison.

/etBs work through an e+ample. !he table below shows thenumber of deaths from (I%"DS among women fromFuatemala and Panama for the year of 8KK8.

Countr( /I@$4IDS Deaths Fe!ale "o'ulation

"ana!a 227 2-


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; 1ased on the rates we have calculated which country has ahigher rate of women dying from the diseaseA

4nswer: "ana!a

; *hich country has the higher number of women dying from(I%"DSA

4nswer: uate!ala. Since we are ust askin) aout a

count and not a rate- then as the tale shows- uate!ala

has !ore wo!en d(in) fro! /I@$4IDS. /owe8er- when

calculatin) the rates- we are ale to take the 'o'ulation

sie into account. "ana!a is a''ro,i!atel( G the sie of

uate!ala- so e8en thou)h the count of wo!en d(in) is

s!aller- since the 'o'ulation is so s!all the rate ishi)her.

"s you can see from the e+ample with Panama andFuatemala, the greatest benefit in using rates is that it is avalid way to make comparisons.

INTERPRETING DATAC -/


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Wh( use Rates1Workook "a)e 23

!inutes

SCRI"#$KE%"OIS

Oates allow us to make comparisons between groups ofpeople, such as different age groups, or locations that havedifferent population sizes, such as districts versus villages orurban versus rural areas.

*ith rates, you can identify groups in the community with anelevated risk of disease. *ith this information, risk factors canbe e+amined and interventions targeted to high5risk groups.

>ou can also use rates for managing operations and resources.

$or e+ample, you can calculate the rate of employee turnoveror the vaccination coverage rates across provinces in yourcountry.

>ou can also calculate rates for hospital admissions todetermine whether rates are increasing or decreasing forcertain diseases.

Oates can help play an important role in improvingorganizational performance across key indicators.


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E,ercise A: Calculate Ratios andRates

Workook "a)e 22

23!inutes

SCRI"#$KE%"OIS

&ow weBll put into practice some of the things we 0ust learned.

4sk the 'artici'ants to refer ack to the check sheet on'a)e < in (our workook to answer the followin)6uestions.

; *hat is the ratio of total missed appointments between'linic ' and 'linic DA

4nswer: #otal no. of !issed a''oint!ents at ClinicC2;#otal no. of !issed a''oint!ents at Clinic D 25Ratio 2;:25 or 7:A. For e8er( 7 !issed at Clinic C- Aare !issed at Clinic D.

; *hat is the proportion of missed appointments in *eek 6 for'linic #A

4nswer: #otal no. of !issed a''oint!ents in week at Clinic E 5. #otal no. of !issed a''oint!ents inweek ;. "ro'ortion5$;2$A or 3.AA or AAH

; *hat is the rate of missed appointments over the J weekperiodA

4nswer: Rate total no. of !issed a''oint!ents forall the clinics di8ided ( the total no. of a''oint!entsooked for the < week 'eriod of ti!e. #his nu!er isthen !ulti'lied ( so!e standard 'o'ulation unit-lets sa( 2333 for this e). #herefore the rate 7$A=5, 2333272. So there are 272 !issed a''oint!ents'er 2333 a''oint!ents ooked.


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SUMMMARI;ING DATA

#+pected !ime: 366 minutes???????????????????????????????????????????????????????????????????????

Su!!ariin) DataWorkook "a)e 25

!inutes

SCRI"#$KE%"OIS

Data represent observations that re)uire organization in orderto provide useful information.

#ach piece of data is like a puzzle piece: on its own, it doesnBttell you much, but when it is put with the rest of pieces andthey are arranged systematically, it can be part of ameaningful picture.

!o organize data and information, we can present our findingsin the form of tables, graphs, charts, and maps.

2rganization and presentation of data are essential for severalreasons.

; $irst of all, organizing data is a necessary step in the

analysis of that data. n other words, in order to make senseof the data that you have collected, you need to organizethe information in a meaningful way.

; Second, organizing and presenting data allow you to e+plorepatterns and trends in the data, as well as to be able toidentify variations in trends.

; !hird, and perhaps most importantly, organizing andpresenting data is an e+tremely useful way to communicateand share information with others.

Basic 9ethods for Su!!ariin) Data

!his section will provide a basic introduction to tables, graphs,charts and maps as a means of organizing and presentingdata.

*e will review e+amples of these figures and their use inpublic health, planning, management and evaluation.

*e will also learn how to create some of these figures.


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SUMMARI0ING DATA| 1-


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#alesWorkook "a)e 2A

23!inutes

SCRI"#$KE% "OIS

Instructor click efore readin): n the very simplestterms, a table is a set of data that is organized into rows andcolumns.

Click efore readin):!ables are very useful for organizingand displaying )uantitative data. !hey allow us todemonstrate a number of patterns or differences betweengroups, depending on what data are included in the table."lmost any )uantitative information can be organized into atable.

Click efore readin):!his is an e+ample of a 8T8 table,which is a simple way to summarize two variables, when eachvariable has two distinct values.

!his table describes the follow5up status of a group of menwith and without diabetes who were participating in a follow5up study using a medical e+amination survey between 8KK6and 8K3K.

Click efore readin): #very row and column in a tableshould have corresponding labels that are clear and concise.!he first row shows the number of diabetic men and thesecond row shows the number of non5diabetics. !he firstcolumn shows the number of deceased men and the secondcolumn shows the number of men who are still alive.

Click efore readin): Sometimes each row and column isaccompanied by totals. !he third row shows the totalnumbers for columns 3 and 8. !he third column shows thetotal numbers for rows 3 and 8.

Click efore readin): f any codes, abbreviations, symbols,or data sources are used, these should always be e+plainedby a footnote.


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" successfully and correctly structured table should be self5e+planatory, meaning that it is easily understandable andcapable of standing alone.

4sk the 'artici'ants:looking at the table, can you tell mehow many diabetic men are livingAAnswer$ &'.

!he check sheet that we saw in the previous e+ercise isanother e+ample of a table.

*e can use the information in a table to create a line graph,bar chart, pie chart or map. *e will practice how to do so in

this section. 1ecause large complicated tables can be overwhelming for the

reader, when summarizing a large number of variables trycreating two or three small tables instead.

SUMMARI0ING DATAC 11


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Continuous 8s. Discrete !inutes

SCRI"#$KE%"OIS

1efore we talk about the ne+t method for organizing and

presenting data, letBs talk a little bit about the data we are

using.

!he numerical data we will be talking about for our graphs

and charts falls into 3 of 8 categories: continuous and

discrete.

'ontinuous data can assume any value within a range, such

as height, weight, temperature or even time.

2ne general way to tell if data are continuous is to ask

yourself if it is possible for the data to take on values that are

fractions or decimals. f your answer is yes, this is usually

continuous data.

Discretedata have a fi+ed number of possible values, such as

gender, race, marital status and trained and untrained staff.

Discrete data usually occurs when we are counting something,

using whole numbers. $or e+ample we canBt have half a

person.


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ra'hsWorkook "a)e 27

!inutes

SCRI"#$KE%"OIS

" second popular means of organizing and presenting data isthrough the use of graphs.

n essence, a graph is a way to show numerical data visually byusing a system of coordinates.

/ike tables, graphs are capable of showing patterns, trends,similarities and differences in the data.

n general, creating a graph re)uires that a very specific formatbe followed.

!his is an e+ample of a basic line graph. !he graph shows the

number of reported cases of measles in the =nited Statesbetween the 3U6K and the 3UUK.

Instructor click efore readin).!he +5a+is, the horizontalline, is used to show the values of the method of classification.!he method of classification is the criteria that you are using toorder the information. $or e+ample, if you want to e+aminerates of a disease over time, you would use the +5a+is to showunits of time e.g. days, months or years-.


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"long the +5a+is of this graph, you see that the intervals aredivided up by years, beginning with 3U6K, and then moving at65year intervals through time, all the way to 3UUK. So, in thisgraph, time is the method of classification.

Instructor click efore readin).!he y5a+is, the vertical line,is used to show a fre)uency measureVhow much or how many.

n this graph the y5a+is depicts the number of reported cases ofmeasles per 3,KKK people, with a range from K5UKK. !henumber of reported cases, therefore, represents the fre)uencymeasure.

Click efore readin). n creating a line graph, we plot usinga set of two coordinates, an + coordinate and a y coordinate. nthis graph the +5coordinate is the year and the y5coordinate isthe number of reported cases measles per 3,KKK people that

occurred during that particular year. 4sk the 'artici'ants- in looking at our graph, what

observation can you make about the reported case of measlesover the 4K year periodA

4nswer: $rom the 3U6Ks through the early 3U9Ks, reportedcases of measles in the =nited States occurred in largenumbers. (owever, as you can see from the graph, when avaccine was licensed in 3U9, the number of reported cases ofmeasles%3,KKK people began to decline on a steady basis,falling off to almost K reported cases by the late 3ULKs.

t can be easier to understand and remember the details of aparticular data set from looking at a graph as opposed toreviewing a table. "lso, grid lines are optional. $or a clean lookuse a faint color or delete the lines completely.

SUMMARI0ING DATAC 1/


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Creatin) Line ra'hsWorkook "a)e 2

2!inutes

SCRI"#$KE%"OIS

/ine graphs are useful for showing patterns or trends oversome variable, usually time. !hey are used to representcontinuous data.

Oemember, continuous data can assume any value within arange, such as height, weight, temperature or time.

/ine graphs are also useful for comparing two or more sets ofdata in the same graph.

&ow, letBs go through some general tips for creating a linegraph.

!hese tips are also useful when creating other types of graphsand charts, so you may want to keep them handy.

E,a!'le:

n our e+ample, we would like to track the number of staff

members who have been hired to work at district healthfacilities from 3UJ6 to 8K3K.

*hen creating a line graph, you first mark off each a+is ate)ual intervals.

(ere you see the T and > a+es, without any intervals marked.

Instructor, click to show the intervals:"ll we do is markoff e)ual intervals along the T and the > a+es.

1efore you start marking though, you will need to take intoaccount some of the tips covered on the ne+t few slides.

/etBs think about a reasonable interval. >ou should use a scaleon the +5a+is that matches the intervals used when collecting

the data, e.g. days, weeks, months, or years-. $or e+ample, if

you collected the data over days, then use an +5a+is scale that

is also based on da s.

n our e+ample, we would like to graph data from 3UJ6 to8K3K. *hile weekly or monthly reporting may have occurred,it is reasonable since the information spans such a long time


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period to present these data in years. /etBs think about areasonable interval.

4sk the audience- do you want to show each year on thegraph over the 6 year period 35year5intervals-A 2r mark aninterval every certain number of yearsA

A Mark off each a+is at e)ual intervals

>5a+is

T5a+is

Discuss with the 'artici'ants that e8er( (ear fro!2?


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>ou can see that the +5a+is, which represents time, has beenclearly divided into J e)ual intervals of 6 years each,beginning in 3UJ6 and ending in 8K3K. !his is easy to readand understand.

o to the ne,t slide: t is a smart idea to make the +5a+islonger than the y5a+isVthis helps to ensure that the linegraph appears to be positioned horizontally. n addition, youshould always start your y5a+is with K.

A Make the +5a+is longer than the y5a+is

A "lways start y5a+is with K

T5a+is longer than >5a+is

.


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larger.

!his way your range of values on the y5a+is will be slightlyhigher than the largest value you will be plotting.

n our e+ample, the lowest number of staff members reported

in one year during the time period is about 6KK, and thehighest number reported during one year is about LKK.

"fter rounding off, our range of values can e+tend from eitherK to L6KK or from K to UKKK.

1efore we decide our ma+imum value we should decide whichinterval we want to use. !he interval used can help determinethe ma+imum value displayed. $or e+ample, if we use aninterval of 6KK, the ma+imum value could be L6KKH but if weuse an interval of 3KKK, the ma+imum value would be UKKK.

n this case, the easiest way of showing staff members wouldbe to display the y5a+is going from K to U,KKK staff, byintervals of 3KKK. ntervals of 6KK could work, but may makethe a+is too crowded.

CLICK to show the (Ja,is drawn ( inter8als of 2333and with a !a,i!u! 8alue of ?333.

.


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Infor! the 'artici'ants that the( !a( ha8e so!e ackJandJforth in this 'rocess. So!eti!es after (ou ha8echosen (our !a,i!u! 8alue and inter8als- (ou need to)o ack and 'la( with the nu!er of inter8als or thes'acin).

E,'lain to the 'artici'ants that ecause of the lar)eran)e- the detail for the e,act nu!er of staff!e!ers cannot e shown. Instead- the reader willha8e a sense of aout how !an( staff !e!ers were'resent each (ear- and the 'attern *increasin) ordecreasin)+. enerall( ha8in) =J2 inter8als on the (Ja,is is a''ro'riate.

So, after all that work, you can plot the data on your linegraph. (ere is the completed graph of number of staffmembers hired to work in district health facilities from 3UJ6 to

8K3K.

&ow that you have a better understanding of how to create aline graph, letBs review what this graph is telling us.

4sk the 'artici'ants the followin) 6uestion and ask for

8olunteers to answer.

; *hat does the data tell youA

Suggested answer$ (etween )'*+ and )'', the numberof staff members remained between - and withthe lowest peaks between )'*' and )''. There was asharp rise in the number of staff members in )'') with thehighest number seen around /).


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SUMMARI0ING DATAC 1*


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bottom to top. !he bars in a bar chart may be organizedhorizontally or verticallyVit depends on how you want tocommunicate the data.

!he horizontal a+is of the graph represents the amount of timepatients had to wait in minutes and is divided up in increments

of 3K with the range being K to JK. !he vertical a+is representsthe various districts: &algonda, "dilabad, and so on. !hisgraph tells the observer that, in 8KKL, the average wait timewas the longest in clinics in the &algonda district.

&ote that similar to a line graph, in a bar chart, one a+is isused to show the method of classification, or how you areordering the data, and the other a+is is used for the fre)uencymeasure. (owever, with a bar chart it does not matter whicha+is shows which55it 0ust depends on how you would like yourchart to look, i.e. vertically5oriented, horizontally5oriented, etc.

&ow that you have mastered the line graph, letBs move on tothe simple bar chart.

!he bars that comprise bar charts have several importantcharacteristics. $irstly, the bars in a bar chart may beorganized horizontally or verticallyVitBs up to you.

"ll bars in a simple bar chart should be of e)ual width, andseparated from one another visually.

#ach individual bar in a bar chart represents one value of thevariable being displayed. $or e+ample, letBs imagine that you

collect data on the occurrence of 6 different diseases over a 6year period and then construct a chart to display your data. nyour bar chart, there would be 6 bars, and each individual barwould correspond to a different disease.

!he length and%or height of each bar in your chart isproportional to the fre)uency of the event in that particularcategory. So, in a vertical bar chart, for e+ample, if there weremore observed cases of Disease " as opposed to Disease 1 inthe 6 year time period, the bar representing Disease " wouldbe taller than the bar representing Disease 1.

E,a!'les:

Click to show. (ere is an e+ample of a vertical bar chart.!his chart shows the number of reported polio cases worldwidefrom 3UUK to 3UU6.

SUMMARI0ING DATAC (1


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#ach individual bar represents one value of the variable beingdisplayed. So for this bar chart, the variable is the year. !hereare 9 bars, and each individual bar corresponds to a differentyear.

!he length and%or height of each bar in a bar chart isproportional to the number of reported polio cases.

"ccording to this bar chart, the highest amount of reportedpolio cases occurred in 3UUK and has steadily declined sincethen.

#i':Some people refer to bar charts as bar graphs.


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E,ercise 7: Which 9ethod Do %ou0se1

Workook "a)e 2ou can use this process to obtain the percentages for all the

other causes of death among children.

=se different colors or different patterns to represent eachcomponent of the pie. !his makes it easier to read anddistinguish one component from another.

SUMMARI0ING DATAC (*


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9a'sWorkook "a)e 2?

2!inutes

SCRI"#$KE%"OIS

Maps are a way to visually display data, in this casegeographic, or spatial, data.

2f course, you could display the same data on a table or barchart, but maps are a much easier way of taking in spatial orgeographic patterns.

!hey are also a better alternative in cases when you may havetoo many geographic units to easily display on a chart.

Mapping your data can provide a )uick visual overview. t is aparticularly powerful tool for looking at clusters of diseases orevents to determine where the health outcome is occurringmost fre)uently.

Different geographic levels are used to answer that )uestion:province, district, or village. !hese geographic areas can begrouped by specific characteristics, such as rural and urban.

Mapping can also be used for management purposes. $ore+ample, you can use a map to show the distribution of healthlaboratories in a certain city.

!here are many types of maps that can be used to organizeand present data.

!he more common ones include spot maps, area maps, andmaps created through use of geographic information systemsor FS. *e will focus on spot maps.

Spot maps are created by placing a dot or some other symbol

on a geographic site where some event occurred. 2ne of the most famous spot maps was Dr. Eohn SnowBs

tracking of cholera deaths in /ondon in September 3L64.

>ou can also use spot maps to track operations information,such as location of ambulances in a district or the location ofI'! centers in a certain district or province.

/etBs look at an e+ample. !he following spot map shows a


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region in South "frica. !he circles represent the clinics that

offer (I%"DS counseling and testing. !he triangles represent

persons that have been recently diagnosed with (I%"DS. *e

can look at the distribution of patients across the regionin

relation to the number and location of clinics. !his helps

provide a visual representation of where resources are and

helps us analyze whether we need to makes changes.

"n important point about spot maps is that they D2 &2! takeinto account the size of the population at risk. n other words,they do not show the risk of the event occurring in a particular

place. " heavy clustering of dots in one particular geographic area

may simply mean that more people are living in that area, notnecessarily that there is a higher rate.

$or e+ample, in our spot map there is a heavy clustering of

patients in the central part of the region. !hat could mean

that there is a higher rate of newly diagnoses patients, or it

SUMMARI0ING DATAC (,

'linics that offer(I%"DS counseling

Persons with (I%"DS


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!his particular map was taken from the *orld (ealth

2rganization, and uses a darker blue color to depict those

countries that reported at least one outbreak of yellow fever

between 3UL6 and 3UUU. !he lighter shade of blue is used to

identify those countries considered to be at risk of

e+periencing yellow fever in their population.

&otice that this map does not show individual cases of disease

as a dot map does. nstead, it illustrates the differences in riskin different geographic areas.

SUMMARI0ING DATAC (,


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StratificationWorkook "a)e 53

23!inutes

SCRI"#$KE%"OIS

"nother way to organize or present data is to stratify it. *henlooking at the data you have collected, sometimes it is helpfulto break it down into smaller groups. !his is calledstratification.

Stratification is a techni)ue used to divide a set of data into

meaningful subgroups strata- of data. !hink about what kind of subgroups might have a meaningful

influence on the data results. !hey could include, for e+ample,age, gender, time, or geographical location.

/etBs think back to our check sheet on page J of yourworkbook. !he following bar chart shows the weeklypercentage of people missing "O! appointments from all theclinics combined.

4sk the 'artici'ants, would it be helpful to know thepercentages from each clinic separatelyA

2nce we stratify the percent of people missing appointments we

can analyze the data and ask more specific )uestions to


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determine if there is aproblem.

4s a lar)e )rou'- ask the 'artici'ants the followin)6uestions.

n this case stratification by clinic helps get more informationfrom the data. t allows you to ask )uestions such as

5 *hy does clinic 1 have 3KKN attendance, e+cept during weekA

5 *hy has clinic " improved in week , while all others areworseA

5 *hy did clinics 1, D and # e+perience higher non5attendancein week threeA "re they in a similar geographic locationA*hat else could link themA

In Su!!ar(:

!he purpose of organizing and presenting data is to analyze it,to e+plore patterns and trends, and to communicateinformation to others

Data can be organized through the creation of tables, graphs,charts, and maps

85variable tables can illustrate the number of people who sharea certain characteristic%set of characteristics which can providevaluable information about possible or probable relationshipsbetween two variables

/ine graphs are useful for showing patterns or trends over

SUMMARI0ING DATAC )(


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some variable, usually time

1ar charts are used to display countable or discrete data, suchas race or gender, and make it easy to see differences amongthe categories

Pie charts are useful for showing the component parts of asingle group or variable

Maps are an e+cellent way to display geographic information,and make it easier to identify geographical patterns in data

Spot dot- maps use dots or other symbols to show geographicdistribution of an events or a disease%condition


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E,ercise : Su!!ariin) DataWorkook "a)e 55

;3!inutes

SCRI"#$KE%"OIS

S'lit the 'artici'ants into s!all )rou's.

i8e each )rou' a scenario *located in the 4''endi, on

'a)es 2J;+- fli' chart sheet and !arkers to use.

Infor! the )rou's that the( will e usin) the )i8enscenarios toM

; Determine which data summary method to use.

; Summarize the data using your recommended method.

; Present your results to the class. a''ro,i!atel( A!inutes$'resentation-

Derief: 4llow each )rou' to share their answer with

the class- sa(in) what their dia)ra! re'resents andholdin) it u' for others to see.

4lternati8e O'tion: 4llow each )rou' to han) their

dia)ra!s on the oard$walls to allow class!ates towalk around and 8iew the!.

4t the end of the e,ercise hand out the answer ke(.


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CONCLUSION

#+pected !ime: 3K minutes???????????????????????????????????????????????????????????????????????

Su!!ar(Workook "a)e 5A

!inutes

SCRI"#$KE%"OIS


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Whats &e,tWorkook "a)e 57

!inutes

SCRI"#$KE%"OIS

!hink about the data you have available to you. (ow can ithelp you make stronger management and public health policydecisionsA

Practice data analysis and presentation and share your reportswith colleagues.

!o continue to improve your skills in using data for decisionmaking, research these additional training topics:

; Ialues 1ased Decision Making

; ntroduction to 1iostatistics

; Program Planning

; Process mprovement

; Pro0ect Management

; #mployee Performance Management


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RESOURCES

$or more information about Putting Data to *ork, consult these referencematerials:

'enters for Disease 'ontrol and Prevention 'D'- 2ffice of *orkforceand 'areer Development Principles of 2pidemiology in Public 3ealthPractice 45rded.6. "tlanta.

Page OM, 'ole F#, !immreck O'. 3UU6-. 2rganizing #pidemiologic Data.n E. 1urns #d.-. 1asic #pidemiological Methods and 1iostatistics5"Practical Fuidebook;. 1oston: Eones and 1artlett Publishers.

PowerPoint presentation5!ables, graphs and diagrams, 1arbaraSchimmer, 8KK9 based on #P#! material-. "vailable at:

http:%%www.epinorth.org%dav%'J6L#D#9.ppt

$2'=S Iolume , ssue 9. Data "nalysis: Simple Statistical !ests."vailable at: http:%%nccphp.sph.unc.edu%focus%vol%issue9%59Data!ests?issue.pdf


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APPENDICES

"ppendi+ ": Summarizing Data Scenarios.....................................63

"ppendi+ 1: Flossary of !erms......................................................6J

"ppendi+ ': 'ourse #valuation $orm............................................9K


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APPENDI2 A& SUMMARI;ING DATA SCENARIOS

Group1

Lets refer to the check sheet that we used to show missing appointments over a 7week period in the previous section. A portion of the table has been reproduced

here for your convenience.

Week 1 Week Week ! Week " Week # Week $ Week 7

%linic %

%linic &

%linic '

(ow can you graphically represent this information to show the number of missed

appointments for clinics %) & and ' over the 7 week period* Which clinic had the

highest number of missed appointments* %an you draw any other conclusions*


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Group

+he table below shows the (,- status for patients who visit clinics in a certain

region. ,ndividuals with an unknown (,- status cannot remember their status or

their records cannot be found.

ame of

clinic

(,- status

/ositive egative 0nknown

2! #

3 1 "7 11

4 15# $1 !

(ow can you graphically represent this data to show the number of positive)

negative and unknown (,- statuses of individuals at each clinic* 0sing your

graphical representation) which clinic has the highest numbers of (,- positive

individuals* %an you draw any other conclusions*


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Group !

As a top official in 4imbabwes 6() you are responsible for allocating funds for

(,-8A,&9 prevention) treatment and care to districts across the country. 3ou wish

to account for the various sources of e:ternal funding that you have received;

/'/!#)555)555

9afe ?lood for Africa @9?A #)##5)555

Gates "5)555)555

+he Global 1)555)555

?ristolB6yers 9Cuibb @?69 7)#55)555

+otal amount of money >155)5#5)555

(ow can you graphically represent this information* Which organiDation provided

the greatest percentage of funds to the country* %an you draw any other

conclusions*


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Group "

+he data below shows the number of staff members in various departments of a

district hospital. 0sing a graphical representation) which department has thehighest percentage of staff members* %an you draw any other conclusions*

&epartment E of staff

,ntensive %are 0nit 1"

(uman =esources 15

/ediatrics 5

General surgery 2

+otal 7


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Group #

+he following table shows the number of vehicles available at health facilities in

the romia region of 'thiopia. (ow would you graphically represent this data toshow the number of vehicles at each facility* 0se that representation to identify

which health facility has the highest number of vehicles available for office use.

ame of health facility umber of vehicles available

Adama (ealth %enter !


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Group $

+he data below shows the daily summaries of malaria cases in health centers in the

Western &istrict of Fenya. (ow will you display this information to show thedistribution of cases* %an you draw any conclusions*

Dail( su!!aries of !alaria cases in health centers in the Western District

&ay umber of cases of malaria

1 1$

1$

! 12

" 1

# 1$

$ 1

7 #

2 2

2

15 !

11 1

1 1

1! 1

1" 1$


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APPENDI2 B& GLOSSAR0 O1 TERMS

1ar chart " visual display in which each category of a variable is

represented by a bar or columnH bar charts are used to

illustrate variations in size among categories.

'ase5fatality rate 7 of deaths due to a disease

7 of people with the disease

'luster "n aggregation of cases of a disease, in0ury or other

health condition particularly cancer and birth defects- in a

circumscribed area during a particular period without

regard to whether the number of cases is more than

e+pected often the e+pected number is not known-

'ontinuous variable " variable that has the potential for having an infinite

number of values along a continuum e.g., height and

weight-

Demographic

information

Personal characteristics of a person or group e.g., age,

se+, race%ethnicity, residence, and occupation-H

demographic information is used to characterize patients

or populations

Denominator !he lower portion of a fractionH used in calculating a ratio,

proportion, or rate.

Dependent variable " variable whose values are a function of one or more

other variables

Discrete variable " variable that is limited to a finite number of values

#pidemiology !he study of the distribution and determinants of health

conditions or events among populations and the

application of that study to control health problems.

#valuation Systematic and ob0ective e+amination of activities to

determine their relevance, effectiveness and impact.

$re)uency !he amount or number of occurrences of an attribute or

health outcome among a population

Fraph " visual display of )uantitative data arranged on a system


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of coordinates

(istogram " visual representation of the fre)uency distribution of a

continuous variable.

ncidence Oate " measure of the fre)uency with which new cases ofillness, in0ury, or other health condition occur among a

population during a specified period.

7 of new cases over a specified period

average population or cumulative person5time the

population was at risk

ndependent variable "n e+posure, risk factor, or other characteristic being

observed or measured that is hypothesized to influence an

event or manifestation the dependent variable-

nfant Mortality Oate 7 of deaths due to pregnancy%childbirth

7 of live births in the same population

/ine graph " graph that displays patterns or trends by plotting the

fre)uency e.g., number, proportion, or rate- of a

characteristic or event during some variable, usually time.

Maternal Mortality

Oate

7 of deaths due to pregnancy%childbirth

7 of live births in the same population

Morbidity "ny departure, sub0ective or ob0ective, from a state of

physiological or psychological health and well5being.

Mortality Oate " measure of fre)uency of occurrence of death among adefined population during a specified time interval.

7 of deaths

population

&umerator !he upper portion of a fraction

APPENDI2 B GLOSSAR&C /*


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Pie chart " circular graph of a fre)uency distribution in which each

segment of the pie is proportional in size to the fre)uency

of corresponding category

Population !he total number of inhabitants of a geographic area of

the total number of persons in a particular group e.g., the

number of persons engaged in a certain occupation-

Prevalence !he number or proportion of cases or events or attributes

among a given population

Proportion " ratio in which the numerator is included in the

denominatorH the ratio of a part to the whole, e+pressed

as a decimal fraction e.g., K.8-, a fraction 3%6- or a

percentage 8KN-

Oate "n e+pression of the relative fre)uency with which an

event occurs among a defined population per unit of time,

calculated as the number of new cases or deaths during a

specified period divided by either person5time or the

average population

Oatio !he relative size of two )uantities, calculated by dividing

one )uantity by the other

Oisk !he probability that an event will occur e.g., that a personwill be affected by, or die from, an illness, in0ury or other

health condition within a specified time or age span

Spot map " visual display of the geographic pattern of a health

problem or event, in which a marker is placed on a map to

indicate where each affected person lives, works or might

have been e+posed.

!able "n arrangement of data in rows and columnsH the data are

usually summaries of the fre)uency of occurrence of anevent or characteristic occurring among different groups

Iariable " characteristic that may assume more than one set of

values to which a numerical measure can be assigned

e.g., income, age and weight-.


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+5a+is !he horizontal a+is of a rectangular graph, usually

displaying the independent variable

y5a+is !he vertical a+is of a rectangular graph, usually displaying

the dependent variable e.g., fre)uencyVnumber,

proportion, or rate-

APPENDI2 C& COURSE EVALUATION 1ORM

"uttin) Data to Work E8aluation

Please help us improve the workshop by responding candidly to the following

statements:

'ourse ob0ectives were well communicated 3 8 4 6!he training was built to match the way need to do my 0ob 3 8 4 6

"de)uate time was allotted for e+planations%practice 3 8 4 6

!he training materials were well written 3 8 4 6

Eob aids are available to support what learned 3 8 4 6

know where to get assistance when return to my 0ob 3 8 4 6

2verall the class was satisfactory 3 8 4 6

*hat did you like most about the classA

(ow can we improve the classA

Do you have any additional )uestions regarding this topicA

APPENDI2 B GLOSSAR&C /*


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If (ou wish us to contact (ou- 'lease 'ro8ide the followin)

infor!ation:

&ame #mail !elephone &umber

pdw facilitatorguide

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