Research Application Management System

Submission Capture:

Please use the form below to submit your data. Your submission WILL NOT appear on the Research Database search results.

Research Protocol for submission to Provincial Health Research Committee

Researchers may apply on-line to have their research protocols approved.

Captured for
Please hold down CTRL to select more then one. Please note that a new submission will be created for each selected committee.

 
Title of the Applicant/Principal Investigator
Choose from drop down menu

 
First and middle names of Applicant/Principal Investigator
eg. Fred Harry

 
Surname of Applicant/Principal Investigator
eg. SMITH (In capital letters)

 
Email Address of Applicant/Principal Investigator
Details as requested

 
 
Qualifications of Applicant/Principal Investigator
Please list tertiary degrees or diplomas of the applicant/principal investigator

 
Name of Institution or affilliated Organization.
Please list the name of the institution or affiliated organization.

 
Title of the research proposal
Main title of the research protocol

 
Institution supporting the study
Institution or Organization supporting the study.

 
Associated Institutions
Partner or other institutions

 
Address
Details as requested

 
Town or City
Details as requested

 
Province
Please select which province. You can select more than one province.

District (District : Sub-District)
This list below is populated when provinces are selected above.
Post Code
Details as requested

 
Telephone
Details as requested

 
Fax
Details as requested

 
Funding institution or Donor/Sponsor
Name of donor(s) providing financial support or whether the Researcher(s), Company, Institution or Organisation will be financing the research.

 
Summary or Abstract
Brief summary or abstract outlining the aim and objectives of the study, the research methodology and data analysis.

 
Introduction
Summary of literature relevant to the proposed research problem/ problem statement.

 
Motivation
Outline of the relevance and benefits of the proposed research on Public Health.

 
Aim or Purpose
The aim or purpose must be clear and feasible.

 
Objectives
Objectives must be specific, achievable, realistic and time-bound and clearly describe the specific deliverables of the proposed study.

 
Research Area
Classify the research area e.g. TB, HIV and AIDS, etc. or other specific research areas.

 
Study Design
Specify the study design e.g. descriptive, analytical, intervention, etc.

 
Randomised Study Trial
Is this a randomised study trial?
Study Population
Clearly describe the study population that will be sampled.

 
Sampling
Specify the sampling strategy/ formulae that will be used to sample participants and include the sample size.

 
Inclusion and Exclusion criteria
Clearly state inclusion & exclusion criteria that will be used.

 
Data Collection
Specify data collection methods and instruments that will be used (if applicable) and include as appendices to the protocol.

 
Data Analysis
Please state what software and describe the techniques that will be used for data analysis.

 
Pilot Study
Indicate if a pilot study will be conducted and provide details (including the duration, sites, etc.).

 
Research Sites
Identify Health Facilities where the research will be conducted i.e. specific Hospitals, Community Health Centres or Primary Health Care Clinics.

 
Name of institution which gave Ethical Aproval
Health clearance required for health research studies involving human subjects.

 
Date of Ethical Clearance
(DD-MM-YYYY) Please provide the date of ethical clearance from a committee.

 
Ethical considerations
This section must clearly indicate what ethical issues were considered for the study including informed consent, confidentiality, etc.

 
Feedback and Dissemination of Research Findings
Clearly outline a strategy for feedback/ dissemination of results and recommendations to relevant stakeholders. Note that research reports, presentations and publications must formally acknowledge the KwaZulu-Natal Department of Health.

 
Budget
Indicate the full amount estimated for this research study.

 
Human Resources
Specify who will be involved in conducting the research including Research Assistants and Statisticians.

 
Time Frame
Provide a realistic time frame for the research i.e. specify the anticipated commencement and completion dates.

 
References and Appendices
Literature used for the development of the research proposal must be clearly referenced in full version of the protocol which should be attached. Relevant appendices must be attached to the Research Proposal including data collection instruments/ tools and any other relevant documentation referred to in the research proposal.

 
Permission from Facilities
Please indicate confirmation of written permission from District and/or Facility Managers granting permission for research to be conducted in facilities will be obtained before research begin.
Appendices

 
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