Formative research consists of collecting useful data for the development and implementation of intervention programs. One of the main themes of formative research is adequacy. Formative research can be used to make intervention programmes culturally and geographically appropriate. It has its roots in applied anthropology, sociology, social marketing, and educational psychology.

Formative research uses qualitative and quantitative methods to provide information to researchers to plan intervention programs. Gaps in the literature of formative research according to Young et al. (2006), include how to define objectives, implementation plans and research questions; select the methods; analyze data and develop interventions.

Formative research should combine several methods and use different sources of information to take into account different perspectives and collate the data obtained. When resources are insufficient to conduct large-scale surveys, participatory research methods can be used. For example, focus group discussions, to get basic information.

Background

Health-related behaviors have proven to be extremely difficult to change and are motivated by a number of personal, cognitive, economic, social, cultural, and structural factors. According to Kumanyika et al. (2003), understanding these factors and the processes that can be employed to develop meaningful and effective interventions at multiple levels (e.g., individual, interpersonal, organizational, environmental) is a primary purpose of formative research.

Although the number and variety of articles reporting the results of formative research have increased in recent years, there are still key gaps in the literature on formative research. These gaps include:

(a) limited information on how to develop the goals, objectives and implementation plans of formative research;

(b) the most appropriate data analysis procedures; and

(c) the process of using the results of formative research to inform subsequent interventions.

An approach to answering key questions has not been systematically developed. As an example we have the amount of formative research that must be carried out and what should be the most important questions. In the same way, how to combine and weigh the information provided by expert informants against that of regular members of the community, and what research methods to use. In addition, it is not always clear how to ensure that the results of formative research are properly used in the design of the intervention.

Methods used in Formative Research

The main methods used in formative research studies include direct observation, in-depth interviews, focus groups, structured and semi-structured surveys, and stack classifications. The use of multiple methods in formative research is considered to have several advantages, such as the convergence of information, the development of an intervention framework or matrix, guidelines for intervention planning, and understanding the cultural and ethnic diversity of the target audience.

Formative research ranges from a few focus groups to year-long efforts with multiple methods and several stages. Programs with intervention approaches and materials developed for diverse audiences (i.e., multiple ethnic groups, multiple locations) generally have greater resources dedicated to the formative research phase.

It is evident that many formative research studies have successfully employed multiple complementary methods. For example, Pathways, a trial of obesity prevention in schools, used structured and unstructured interviews. In the same way, he used focus groups and direct observations to address key issues, such as what teaching methods and approaches were most effective in communicating with American Indian schoolchildren.

Standardization in multicenter trials

A key concern in the formative research literature is the question of standardization in multicenter trials. Just as a "one size fits all" approach is not appropriate for intervention programs that are developed for diverse populations and settings. Thus, the level of standardization of formative research in multicenter trials has been debated.

Should formative research be carried out as standard in all centres to allow for easy comparison. Perhaps it should be adapted to the situation of specific centres. A related concern is that, once specific important subaudiences (i.e., segments) have been identified. So should formative research be used to explore each segment?

What does Formative Research involve?

Formative research involves a variety of qualitative and quantitative methods to help inform the recruitment and retention of study participants. In the same way, according to Higgins et al. (1996), should determine measurement procedures and acceptability, and assist in the design and implementation of the intervention.

It is the process by which researchers define and evaluate the attributes of the community or target audience that are relevant to the specific public health problem of interest. This process is carried out before an intervention is developed or applied to obtain detailed information. Specifically about the people for whom the interventions will be designed and the context in which they will be carried out.

Formative research can also help facilitate relationships between researchers and target populations. It can be applied at all levels of behavioural interventions, whether clinical (individual and group interventions), school, community or population-based.

Examples of Formative Research

Legal Change Advocacy Campaign

For example, in a campaign to advocate for legal change, the analysis of the law, the processes of law-making, the institutions involved and the ways to influence them will be key topics for formative research. In behaviour change campaigns, formative research examines the potential target audience, their behaviour and the factors that influence them. Using social marketing theory, formative research is used to determine the best way to reach the target audience.

Formative research, i.e. that carried out before and during the campaign to determine and refine the campaign planning process, provides accurate and up-to-date information to strategically develop the campaign on a solid basis. The complexity and nature of formative research depend on a number of factors, including the nature of the campaign.

Ideally, this evaluation should be carried out in the early planning phases of the campaign, long before the campaign activities are carried out. The baseline study provides a critical benchmark for assessing changes and impact, as it establishes a basis for comparing the situation before and after an intervention, and for making inferences about the effectiveness of the campaign.

Campaigns for Political - Institutional Change

In campaigns for political/institutional change, research on legislation, policies and their implementation are the most common data needed for baselines. In behaviour change campaigns, a baseline typically collects data on the knowledge, attitudes and practices (KAP) of the target audience regarding the campaign theme.

Freedom from Fear

Freedom from Fear is a 10-year advocacy educational campaign in Australia. It focused on perpetrators of domestic violence and the men at risk of perpetrating it. The formative research included qualitative research with the main target group to investigate awareness, attitudes and beliefs about domestic violence, and to explore possible communication messages regarding its acceptability, credibility and potential to change attitudes and behaviours. Based on the results, those responsible for the campaign decided on two types of messages:

(1) A message of "consequences" focused on the harmful impact of domestic violence on children, taking into account that all participants of the target audience in the formative research expressed a strong attachment to their children. Very few expressed feelings of affection towards their partners. In addition, many of the respondents were able to relate their own feelings from their childhood, when they witnessed or experienced domestic violence.

(2) A message of "help" that extends a helping hand to aggressors willing to change their way of acting. The majority of offenders surveyed expressed the need to be provided with sources of formal help, such as counselling and treatment programmes.

Theories for carrying out formative research

Several researchers have used specific theoretical frameworks to develop formative research approaches and questions. Some based their formative research on the ecological model and focused their information collection on specific levels of the model that they considered most susceptible to intervention. Others used social cognitive theory for formative research in Caminos.

This approach led to an intervention focused on individual behaviors for modification, as well as environmental and personal factors. Other authors based their formative research on Girls Health Enrichment's multisite studies of social cognitive theory and developed a matrix that explained the levels and types of cultural influences on weight status.

One of the most used frameworks for formative research has been social marketing, in which emphasis has been placed on audience segmentation, channel identification and the development of appropriate messages on research topics as diverse as malaria prevention and nutrition education. The use of theory provides guidance in the overall process of formative research.

Uses of formative research

Most of the literature on formative research shows its use mainly to develop intervention strategies and materials and instruments. The literature has many examples of the uses of formative research for the development of intervention.

These include identifying salient themes and social norms for message development and identifying key behaviors for intervention. In the same way, it includes the evaluation of the level of knowledge or knowledge gaps in a specific educational area and the determination of appropriate channels for communication and understanding of local concepts of health and disease. This as a means to establish relationships and as a means to direct, segment and test messages and approaches. This diversity of potential uses demonstrates how formative research can be an important strategy for developing effective health interventions.

Less frequent uses

Another less frequent use of formative research is the development of instruments. One example is a recent paper by Nichter, Thompson, Shiffman, and Moscicki (2002) describing a seven-stage formative research process for developing a survey on nicotine dependence in adolescents.

This process, which included in-depth interviews and focus groups at different stages, was used to modify or remove existing questions and develop new questions. Cognitive interview approaches, in which respondents complete and review a survey and discuss their thoughts and feelings about it and suggest alternative wording, is another approach. In addition, formative research has been used to develop a bibliography of fundamental cultural topics useful for the development of surveys appropriate to the target audience.

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Bibliographic References

Higgins DL, O'Reilly K, Tashima N, Crain C, Beeker C, Goldbaum G, et al. Using formative research to lay the foundation for community level HIV prevention efforts: An example from the AIDS community demonstration projects. Public Health Rep. 1996;111(Suppl 1):28–35.

Kumanyika SK, Story M, Beech BM, Sherwood NE, Baranowski JC, Powell TM, et al. Collaborative planning for formative research and cultural appropriateness in the Girls Health Enrichment Multi-site Studies (GEMS): A retrospection. Ethnicity and Disease. 2003;13:S15–S29.

Young DR, Johnson CC, Steckler A, Gittelsohn J, Saunders RP, Saksvig BI, et al. Data to action: Using formative research to develop intervention programs to increase physical activity in adolescent girls. Health Education & Behavior. 2006;33:97–111.

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