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Primary Care Research: An Primary Care Research: An Introduction (To Some Really Introduction (To Some Really
Important Concepts)Important Concepts)
John B. Schorling, M.D., M.P.H.John B. Schorling, M.D., M.P.H.Professor of Medicine and Public Heath SciencesProfessor of Medicine and Public Heath Sciences
James R. Martindale, Ph.D.James R. Martindale, Ph.D.Assistant Professor of Research and Public Assistant Professor of Research and Public Health SciencesHealth Sciences
Objectives:Objectives:
Be able to better formulate a research Be able to better formulate a research questionquestion
Feel more comfortable with the clinical Feel more comfortable with the clinical research process research process
Understand the ideas of constructs and Understand the ideas of constructs and operationalizationoperationalization
Understand the major differences between Understand the major differences between quantitative and qualitative approaches to quantitative and qualitative approaches to doing educational researchdoing educational research
““If we knew what we were If we knew what we were doing, it wouldn’t be called doing, it wouldn’t be called research, would it?”research, would it?”
Albert EinsteinAlbert Einstein
Developing Your QuestionDeveloping Your Question
Start with a clear purposeStart with a clear purpose Know your literatureKnow your literature Be iterative in your approachBe iterative in your approach Try to specify the who, what, where and when Try to specify the who, what, where and when
of your purposeof your purpose Ask yourself “What would the answer to this Ask yourself “What would the answer to this
question add to the literature?” and…question add to the literature?” and…
Developing Your QuestionDeveloping Your Question
Don’t let methodology drive the question!Don’t let methodology drive the question!
The Research ProcessThe Research Process
1.1. Identification of general problem/questionIdentification of general problem/question
2.2. Literature reviewLiterature review
3.3. Specify questions/hypothesesSpecify questions/hypotheses
4.4. Determination of design/methodologyDetermination of design/methodology
5.5. Data collectionData collection
6.6. Data analysis/presentationData analysis/presentation
7.7. Interpretation of findingsInterpretation of findings
The Right and the LeftThe Right and the Left
Quantitative research - numbers, Quantitative research - numbers, numbers, numbersnumbers, numbers
Qualitative research - words, words, Qualitative research - words, words, wordswords
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Assumptions about the WorldAssumptions about the World
Based upon the idea Based upon the idea of “logical of “logical positivism”, that is, positivism”, that is, there is a singular there is a singular reality with stable, reality with stable, social facts that are social facts that are separate from the separate from the feelings and beliefs feelings and beliefs of individuals.of individuals.
Based on the notion Based on the notion of “constructivism”, of “constructivism”, which assumes which assumes multiple realities that multiple realities that are socially are socially constructed through constructed through individual and individual and collective collective perceptions or views perceptions or views of the same of the same situation.situation.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Research PurposeResearch Purpose
Seeks to establish Seeks to establish relationships and relationships and explain causes of explain causes of changes in changes in measured variables. measured variables. That is, the goal of That is, the goal of science is to explain science is to explain and predict.and predict.
Concern is with the Concern is with the understanding of the understanding of the social phenomenon social phenomenon from the from the participants’ participants’ perspectives. This perspectives. This requires, to some requires, to some degree, researcher degree, researcher participation.participation.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Methods and ProcessMethods and Process
The scientific The scientific method, also known method, also known as a priori or pre-as a priori or pre-established design.established design.
Use of emergent Use of emergent design utilizing design utilizing constant constant comparison and comparison and revision.revision.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Prototypical StudiesPrototypical Studies
Experimental or Experimental or correlational designs correlational designs are used to reduce are used to reduce error, bias and the error, bias and the influence of influence of extraneous extraneous variables--control of variables--control of bias is through bias is through design.design.
Use of ethnography, Use of ethnography, which helps readers which helps readers understand the understand the multiple perspectives multiple perspectives of the situation by of the situation by the persons studied. the persons studied. Subjectivity in data Subjectivity in data analysis and analysis and interpretation is interpretation is acknowledged.acknowledged.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Researcher RoleResearcher Role
Detachment from Detachment from study in order to study in order to avoid bias.avoid bias.
Immersion inImmersion in situation and the situation and the phenomenon being phenomenon being studied.studied.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: ContextContext
Context-free Context-free generalizationsgeneralizations
Generalizations are Generalizations are contextually-bound.contextually-bound.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: PrecisionPrecision
Obtained through Obtained through the use of the use of measurement and measurement and statisticsstatistics
Provided by detailed Provided by detailed description of description of phenomenonphenomenon
Quantitative vs. Qualitative: Quantitative vs. Qualitative: VerificationVerification
Results replicated Results replicated by others.by others.
Extension of Extension of understandings by understandings by others.others.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: ExplanationExplanation
Traditionally, Traditionally, parsimonious parsimonious explanations were explanations were sought, but this may sought, but this may be changing due to be changing due to technology.technology.
Summary through Summary through narrative--narrative--importance is placed importance is placed on reducing on reducing complex realities to complex realities to simple explanations.simple explanations.
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Logical ReasoningLogical Reasoning
DEDUCTIVE--DEDUCTIVE--What’s the classic What’s the classic example?example?
INDUCTIVE--INDUCTIVE--anyone have an anyone have an example?example?
Quantitative vs. Qualitative: Quantitative vs. Qualitative: Conditional ConclusionsConditional Conclusions
Statements of Statements of statistical statistical probability.probability.
Tentative summary Tentative summary interpretations.interpretations.
Types of Quantitative StudiesTypes of Quantitative Studies
DescriptiveDescriptive True experimentalTrue experimental Quasi-experimentalQuasi-experimental CorrelationalCorrelational PredictivePredictive
Research Using Primary DataResearch Using Primary Data
Cross-sectionalCross-sectional
Case ControlCase Control
CohortCohort
Randomized controlled trialRandomized controlled trial
Cross-sectional StudyCross-sectional Study
Data gathered at one point in timeData gathered at one point in time
Often used for surveysOften used for surveys
Can not make inferences about Can not make inferences about causalitycausality
Robert Johnston’s Project
Interested in PTSD Reviewed literature on PTSD in primary care
settings for his POM1 presentation Decided to do a survey to determine prevalence
and associated conditions Reviewed existing instruments Survey includes 2 PTSD questionnaires,
AUDIT, SF-12 and PHQ-9 Obtained IRB approval June, 2010 Goal is to survey 100 patients at UMA
Case Control StudyCase Control Study
Start with the outcome- identify a Start with the outcome- identify a sample with the condition of interestsample with the condition of interest
Identify a similar control groupIdentify a similar control group Look back to determine exposureLook back to determine exposure Calculate the risk in the cases and Calculate the risk in the cases and
controls- odds ratio used controls- odds ratio used Can not use to establish prevalenceCan not use to establish prevalence
Cohort StudyCohort Study
Start with an identified groupStart with an identified group Determine exposure in everyone at the Determine exposure in everyone at the
same timesame time Follow the group to determine who Follow the group to determine who
develops the outcome of interestdevelops the outcome of interest Can be used to determine prevalenceCan be used to determine prevalence Association measured as relative risk Association measured as relative risk
(rate ratios)(rate ratios)
Randomized Controlled TrialRandomized Controlled Trial
Gold standard for determining Gold standard for determining associationsassociations
Identify a groupIdentify a group Randomly assign individuals to Randomly assign individuals to
exposureexposure Only reliable way to control for Only reliable way to control for
confoundingconfounding
Research Using Secondary DataResearch Using Secondary Data
Literature reviewLiterature review
Systematic reviewSystematic review
MetanalysisMetanalysis
Analysis of existing data collected for Analysis of existing data collected for another purposeanother purpose
Literature ReviewLiterature Review
Gather articles on a topic of interestGather articles on a topic of interest
Summarize the findingsSummarize the findings
Systematic ReviewSystematic Review
Gather articles using a pre-defined Gather articles using a pre-defined search strategy- may include search strategy- may include unpublished studiesunpublished studies
Develop a-priori objective criteria to Develop a-priori objective criteria to evaluate the quality of the studiesevaluate the quality of the studies
Summarize the quality of the data and Summarize the quality of the data and the resultsthe results
MetanalysisMetanalysis
Do a systematic reviewDo a systematic review
Obtain the primary data if possibleObtain the primary data if possible
Summarize the data quantitativelySummarize the data quantitatively
Analysis of Existing DataAnalysis of Existing Data
Use administrative data for researchUse administrative data for research Insurance claims data- MedicareInsurance claims data- Medicare Central Data Repository (CDR) at UVaCentral Data Repository (CDR) at UVa
Use regularly collected survey dataUse regularly collected survey data National Center for Health Statistics National Center for Health Statistics
performs multiple surveys periodically- performs multiple surveys periodically- NAMCS, NHIS, NMCES, NHANESNAMCS, NHIS, NMCES, NHANES
Use data collected for another studyUse data collected for another study
Timeline for GSP Research ProjectTimeline for GSP Research Project
Fall 2010- develop a research ideaFall 2010- develop a research idea Spring 2011Spring 2011
Work with mentor on developing your ideaWork with mentor on developing your idea Put together a protocol for IRB approvalPut together a protocol for IRB approval
Summer 2011- MSSRP, collect dataSummer 2011- MSSRP, collect data Fall 2011- medical student research dayFall 2011- medical student research day Fall 2013- research elective to finish Fall 2013- research elective to finish
project project Spring 2013- GSP thesis + presentationSpring 2013- GSP thesis + presentation
THANK YOU!THANK YOU!
Contact: [email protected]: [email protected]