Health Research W.K.Wickremainghe. 9/7/2015Dr.W.K.Wickremasinghe2 What is research ? Research can be defined as the search for knowledge, or as any systematic

Health Research

W.K.Wickremainghe

04/21/23 Dr.W.K.Wickremasinghe 2

What is research ?

Research can be defined as the search for knowledge, or as any systematic investigation, with an open mind, to establish novel facts, usually using scientific method.

Scientific research relies on the application of the scientific method.

This research provides scientific information and theories for the explanation of the nature and the properties of the world around us.


What is research ?

Research is the systematic collection, analysis, and interpretation of data to answer s certain question or solve problem,

Why we need the research?


The word research is derived from the French recherche, from rechercher, to search closely where "chercher" means "to look for or to search".


Characteristic of research

It demands a clear statement of the problem; It requires a plan (it is not aimlessly “looking” for something in the hopes that you will come across a solution);

It builds on existing data, using both and negative findings; and

New data should be collected as required and be organized in such a way that they answer the original research question(s).


Research in health serves two major purposes…

Basic research is necessary to generate new knowledge and technologies to deal with major unresolved health problems.

Applied research is necessary to identify priority problems and to design and evaluate policies and programs that will deliver the greateset health benefit, making optimal use of available resources.


Selection, analysis, and statement of the research problem

Problem identification,Prioritizing problem,Analysis,Justification


Problem identification

If the answer to the question obvious, it is a management problem.

Whether the problem needs research depends;Perceived difference between what exists and the ideal

or planned situation,The reason for the difference is unclear,There should be more than one possible answer to the

question or solution to the problem.


Criteria for prioritizing problems

Relevance,Avoidance of duplication,Feasibility,Political acceptability,Applicability,Urgency of data needed,Ethical acceptability.


Analyzing the problem

Researcher is often is not very familiar with the problem,

Health workers, managers may, but not given critical attention,

Joint analysis;Enables to pool the knowledge,Clarifies the problem and the possible factors that may

be contributing,Facilitate decisions concerning the focus and scope of

the research.


Review of available literature and information


What is literature review ?

A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic,

Most often associated with academic-oriented literature, such as thesis. Its ultimate goal is to bring the reader up to date with current literature on a topic and forms the basis for another goal, such as future research that may be needed in the area.



A well-structured literature review is characterized by a logical flow of ideas; current and relevant references with consistent, appropriate referencing style; proper use of terminology; and an unbiased and comprehensive view of the previous research on the topic.



A literature review is a description of the literature relevant to a particular field or topic. It gives an overview of what has been said, who the key writers are, what are the prevailing theories and hypotheses, what questions are being asked, and what methods and methodologies are appropriate and useful. As such, it is not in itself primary research, but rather it reports on other findings.


Why it is important ?

It prevents you from duplicating work that has been done before,

It helps you to find out what others have learned and reported on the problem,

It helps you to become more familiar with the various types of methodology,

It should provide you with convincing arguments for why your research project is needed.


Sources

Individuals, groups, and organizations,Published information Books, Articles,

indexes, and Journals),Unpublished information (other research

proposals, reports, records, and computer data bases)


Where can you find different sources

Community and district, provincial level,Clinic, hospital routine data, opinions, survey,

periodic reports, books articles, news papers,

National level,Documentation, reports and raw data from

national level ,

International level,Bilateral and multinational organizations such

as UN, USAID, ICRC etc


Also from….

First, you may want to check on the research books in the libraries. Some of these materials have a dedicated part in their structure leading to a summarized form of research results.

Second, you can look for published thesis materials of other students. Use the main documents of the research owners as your review resource. Always make sure that you reference each and every factual claim they have presented in the paper.

Lastly, try to look for a dissertation help online. There are so many custom paper services available which can give you free examples of literature research parts.


Developing a strategy..

Identify key person knowledgeable on the topic, to gather references others etc.,

Contacting librarians in deferent places and request information,

Examining the bibliography and references lists,

Looking for references in indexes, and abstract journals,

Computerized literature search.


Better to….

First be skimmed or read,Then summaries of the important

information recorded on separate index cards, or computer entries. These should be classified so that the information can easily be retrieved,

Finally a literature review can be written.


Be aware of various types of bias

If you find conflicting opinions found discuss openly and critically,

Common types of bias;Restricting references to those that support the

point of view,Drawing far reaching conclusions from

preliminary or shaky research results, or sweeping generalizations from just one case or small study,

• Ethical considerations.


Writing references..

Harvard system, Surname of author(s) or name of organization, followed

by the date of publication in round brackets. e.g. “As with any investment, working capital exposes

the business to risk” (McLaney 2003).


Writing references..

Vancouver systemThis method tends to be used in humanities

and arts publications. In the text, each reference is given a consecutive number and the list of references is then compiled in numerical order.

In the list of references, items are listed in numerical, not alphabetical order. Use the author‟s name as given on the title page. e.g. 14. Newman, W. Interactive System Design. New York: Addison Wesley, 1995, p.31


Writing references, why ?

It shows the range of reading that you have done. This gains you marks.

You may support your arguments with the opinion of acknowledged experts and use data from reputable sources. This can make your own arguments more convincing.

It is a basic academic requirement to show details of the sources of your information, ideas and arguments. Doing so means that you cannot be accused of plagiarism, i.e. stealing from another person‟s work.


When to refer…

Whenever you quote someone else‟s work. This does not just include words but also tables, charts, pictures, music, etc.

When you rewrite or summaries someone else's work in your own words


FORMULATION OF RESEARCH OBJECTIVES

The objectives of a research project summarize what is to be achieved by the study,

Objectives should be closely related to the statement of the problem,

The general objective states what is expected to be achieved by the study in general terms,

Breaking down a general objective into smaller, logically connected part referred as specific objectives.


Why should research objectives be developed

Focus the study (narrowing down to essentials),

Avoid collection of unnecessary data,Organize the study in clearly defined parts

or phases.Properly formulated specific objectives will

facilitate the development of your research methodology.


SAMPLE

General objectiveTo assess the degree of client satisfaction and to

describe factors associated with satisfaction among clients attending antenatal clinics in X MOH area.

Specific objectivesTo describe the socio-demographic and economic

characteristics of clinic attendees. To assess the level of client satisfaction.To assess the factors associated with client satisfaction.To make recommendations to all concerned in improving

client satisfaction in antenatal clinics.


Methodology, variables

Variable, is a characteristic of a person, object or phenomenon that can take on different values,

Identification of variables,Operational definition of variables,Measurement,


Overview of study types

Interventional studies,Experimental studiesQuasiexperimental studies,

Non-interventional studies,Exploratory studies, (if the problem and factors are not

well defined better to do, before doing a descriptive study)

Descriptive studies,Comparative (analytical studies).


Descriptive study

A descriptive study involves the systematic collection and presentation of data to give clear picture of a particular situation,Descriptive case studies, describe one or

limited number of cases,Cross-sectional surveys aim at quantifying the

distribution of certain variables in a study population at one point of time.


Analytical studies

An analytical study attempts to establish causes or risk factors for certain problems. This is done comparing two or more groups.Cross sectional comparative studies,Case-control studies,Cohort studies.


Data collection techniques

Using available informationObservingInterviewing (face to face)Administering written questionnairesFocus group discussionsNominal group techniqueDelphi techniqueScalesEssaysCase studies


Observing

Observing is a technique that involves systematically selecting, watching, and recording behavior and characteristics of living beings, objects, or phenomena.

Participant- Observer takes part in the situation he or she observes

Nonparticipant- observer watches the situation, openly or concealed, but does not participate.

` Observation can be on human behavior, or on objects. Observations made using a defined scale called measurements(usually require additional tools- weighing scales, thermometers)


Interviewing (face to face)

An interview is a data collection technique that involves oral questioning of respondents, either individually or as a group. Answers can be recorded by writing during or after the interview or tape tape recorded. Can be conducted with varying degree of flexibility

High degree of flexibility,questions open ended respondent is unrestricted( exploratory studies, case studies)

Low degree of flexibility, using fixed list of questionnaires with fixed, pre-categorized answers. Useful when researcher know the subject and respondents are many.


Administering written questionnaires

A written questionnaire also referred as self- administered questionnaire is a data collection tool in which written questions are answered by respondents in written formCan be administered by;

Sending by mail with clear instructions and asking for mailed responses

Gathering all respondents in one place, giving oral or written instructions, and letting them fill out questionnaires

Hand-delivering questionnaires to respondents and collecting them later


Focus group discussions

A focus group discussion is a group discussion of 6-12 persons guided by a facilitator, during which group members talk freely and spontaneously about a certain topic to obtain in-depth information on concepts, perceptions, and ideas of the group.

Participants should be from the same socioeconomic group or have similar background in relation to the issue. Participants should be invited 1-2 days before and general purpose should be explained


Focus group discussions cont..

Arrange chairs in circle, quiet, adequately lighted without disturbances. Setting should be neutral.

One as a facilitator but not an expert, stimulates and support discussion another one as the recorder.


Nominal group technique

Is a group discussion technique that useful when one wants to obtain a consensus from group on a topic where decision-making can be usefully guided by the perception and opinions of the various group members.

Highly value-laden issue


Delphi technique

Delphi technique is same as NGT and has same objectives. But major difference is that in the Delphi technique, group do not meet for discussion, they communicate by mean of questionnaires.

Each time a quest. circulates, the range of permissible answers is narrowed towards the average of the answerers in the previous quest.


Scales

Are highly structured interviews: the sequence of the questions is set and highly standardized. These questionnaires are less useful in semi-literate, rural settings in developing countries.


Questionnaire

Length (20-25), Open/closed(20:80),Visual (symbols), Sequencing & layoutScale (likert) Piloting Confidentiality


Questionnaire

Open-ended - Interpretation is difficult

- very useful if qualitative studies eg. Attitude

Closed - Useful in quantitative studies

- Analysis, coding,& interpretation is easy

combination of both can be used where it is relevant


Requirement of questions..

Face validity- birth weight of the baby can be taken from records or ask from mother, later one has less face validity than first

Expected to know the answer- minor injury which was taken placed one year back

Clear & unambiguous- all respondents will understand in the same way ( family planning, saving money for vacation)

User friendly- double-barrelNot be offensive or embarrassingBe fairSimple- avoiding jargon , not too long, single

issue


Why do you want a sample ? Reasons for sampling

Complete coverage is not possible Complete coverage may not offer

substantial advantage over sampleSample require less time Sample need less resourcesSample study is more economicalSample offer more details high degree

accuracy because deal with only smaller numbers


Sampling

S1 S2

S3

Study population

Sample 1

Total population

Element/unitSampling frame


Total population - All children bellow 5 year in Sri LankaStudy population – Children < 5 who are registered in birth & immunization

register( what is available to us )Sample -3500 children selected from above register using sample technique Sample frame- List of children of B&I Sample unit / element- Individuals


Major characteristics Well chosen- representative of the parent

population- selection bias Sufficiently large - findings of the several

samples of the parent population are different - sampling variation

Adequate coverage unless information in fact obtained all or almost all members of the sample , individual studied may not be representative of study population- selection bias


Methods of samplings

Probability sampling

Non-probability sampling

•No place in community medicine•Use in exploratory/ obtained feel of the situation •Useful in Some qualitative studies

•“Accidental” •Quota sampling •Purposive sampling•Snowball sampling

•Simple random•Systematic sample•Stratified sample•Cluster sample •Multi-stage sample

•Known probability of being selected•Generalization can be made with the precision and the confidence


Probability sampling

Random sampling -each sampling unit has the same probability of being

selected -Prepare sampling frame (list showing all the units)

-Decide size of the sample-Select the number at random (lots or random table)

Systematic sampling - List of sampling unit (Not necessarily numbered)

- Decide sampling interval (K=N/n)-Start with random

OR where there is no list Every 3rd client comes to the service


Probability sampling cont..Cluster sampling - Group or cluster of individual is selected using random

method School, classes, hospitals etc..- all individuals or selected number using simple random- large number of small clusters are preferable

Stratified sampling - Population first divided in to sub group (strata)

according to one or more characteristics age, sex, - Random or systematic sampling will apply to each stratum-Proportional (same proportion), Disproportional(different proportion)


Non-probability sampling Purposive sampling Investigator presume that they are typical of the study population.

Subjects are purposely selected not in order to represent the population but they will express beliefs, practices or experience- Very useful in qualitative studies

Snowball sampling People who meet the criteria for inclusion in the study are ask to

name the others who meet these criteria useful in hard to find individuals e.g. illegal behavior

Accidental sampling interviewer position at the super market ask to address 50 women passing with relatively full shopping trolley

Quota sampling In terms of age, sex, and social class decided in advance; Only

requirement is to get the right number of people to fill the these quotas


Errors

Total error

Random error

Systematic error

Administrative error

Respondent error

Non-response error

Response error

Data processing error

Sample selection error

Interviewer error

Interviewer cheating

Acquiescence bias

Extremity bias

Interviewer bias

Auspices bias

Social desirability bias


Random error Different sample givesdifferent results in same population

Systematic errors (Bias)Any trends in collection,analysis, Interpretation, and publication that can lead to that are systematically different from truth

Selection biasError due to a systematic difference of the characteristics of the individuals studied and not studied

Information biasShort comings in collection,recording, coding or processingOrigins include the people who collect the data

Non-response

Dropout

Berksonian

Self selection

Observer

Interviewer

Instrument


Calculation of sample-margin of error

What margin of error can you accept?5% is a common choice The margin of error is the amount of error that

you can tolerate. If 90% of respondents answer yes, while 10% answer no, you may be able to tolerate a larger amount of error than if the respondents are split 50-50 or 45-55. Lower margin of error requires a larger sample size.


Confidence level

What confidence level do you need?Typical choices are 90%, 95%, or 99%The confidence level is the amount of uncertainty you

can tolerate. Suppose that you have 20 yes-no questions in your survey. With a confidence level of 95%, you would expect that for one of the questions (1 in 20), the percentage of people who answer yes would be more than the margin of error away from the true answer. The true answer is the percentage you would get if you exhaustively interviewed everyone.

Higher confidence level requires a larger sample size.


Population size

What is the population size? If you don't know, use 20000 How many people are there to choose

your random sample from? The sample size doesn't change much for populations larger than 20,000.


Response distribution

What is the response distribution? Leave this as 50% For each question, what do you expect

the results will be? If the sample is skewed highly one way or the other, the population probably is, too. If you don't know, use 50%, which gives the largest sample size.

Raosoft –sample size calculator.


What else?

MethodologyBudgetWork planEthical issues

Data analysisDiscussionConclusionsRecommendationsAnnexes

Documents

Health Research W.K.Wickremainghe. 9/7/2015Dr.W.K.Wickremasinghe2 What is research ? Research can be defined as the search for knowledge, or as any systematic