Deciding on a Research Topic: Your First Challenge

Research Week 2014UKM Health Cluster

Easiest way – ask your supervisor

• Your supervisor may have a grant or a specific field of interest that he wish to pursue.

• If so, then you’re in luck. Just make sure that you are really clear what he/she wish to achieve.

• Otherwise ………

Choose a research that you are interested in!• Think of the who, what, when, where and why questions:– WHY did you choose the topic? What interests you about

it? Do you have an interest in the outcome? The research process is more relevant if you care about your topic.

– WHO are going to benefit if you do a research on this topic? What is the prevalence of the disease? Will it help many people? Do you know of organisations or institutions affiliated with the disease that can help you in having access to either the patients or the required resources?

– WHAT are the major current issues for this disease? Is there a debate about the possible major risk factors? Are there new ideas or new modes of treatment that you would like to try out?

Choose a research that you are interested in!– WHERE is your research topic important: at the local, national or

international level? Are there specific places affected by the research topic? i.e. iodine deficiency among the Orang Asli.

– WHEN is/was your research topic important? Is it a current event or an historical issue? Do you want to compare your research topic by time periods? i.e. the prevalence of diabetes mellitus over time, 1996 to 2011, and it’s relationship with prevalence of overweight and obesity in Malaysia.

– Hot current issue would be the current Ebola outbreak, if you can think of a suitable topic/approach to do a research on related to Ebola. For example; is our A&E/outpatient dept capable of detecting and managing a yet to be diagnosed case of Ebola? What are the chances of those treating the Ebola patient of being infected by the disease? What are the chance of the Ebola patient infecting others in the waiting room? Amacam Sebastian? Is our ED ready?

– America has shown that they were not ready with the recent fiasco in Dallas.

Remember!

• Narrow your topic to something manageable.– If your topic is too broad, you will find too much

information and not be able to focus.– Background reading can help you choose and limit

the scope of your topic. – Start by deciding “what is the outcome of

interest”?

Example 1 – MDR TB

• Let’s say that you were previously attached to the chest clinic and you’re interested in the prevalence of MDR TB in Malaysia and factors causing MDR TB in Malaysia.

• First clearly define the outcome of interest using globally accepted definition;i.e. MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other first-line drugs (FLD). (WHO. Guidelines for the programmatic management of drug-resistant tuberculosis. 2011 Update. WHO/HTM/TB/2011.6. Geneva, Switzerland: WHO, 2011.)

MDR-TB Definition

Read up on the Risk Factors of MDR TB

Risk factors of MDR TB

• Carefully select risk factors which are relevant with our own local settings.

• Get a clear definition for each one of the risk factors, then look up for references on each one of them in relation with our outcome of interest, at least 3 references per risk factor, to see how the risk factor affect the outcome of interest.

• Come out with a conceptual framework of your study.

Conceptual framework

Example 2 – Intervention Study

• This is the most popular mode of study amongst clinical post-grad students.

• Let us take a simple example, the use of fish-oil supplements to improve the blood lipid profile of patients in the Hypertension Clinic.

• First clearly define the outcome of interest of abnormal lipid level, using globally accepted definition;– HDL <1.20mmol/L– TC >5.70mmol/L– LDL >3.80mmol/L– TG >1.40mmol/L

Effect of intervention on lipid level

• Identify the seminal paper which created the interest on fish oil and its effect on lipid level.

• Look up for review papers and recent findings on the effectiveness of fish oil on modifying lipid levels.

• Identify and define factors which can affect the effectiveness of the intervention and how it can be controlled in your study.

• Identify a suitable control/placebo.• Define clearly what is the end outcome that you are

looking for at the end of the study, i.e. lipid level become normal is the definition of success.

Reminder

• If the outcome of interest is easily defined, such as diabetic/hypertensive/etc.; then you should be okay.

• Problem usually arises when the outcome of interest is calculated based on scales or certain scores such as SF36 or QOL studies. If you plan to utilise such methods, make sure that the scales/questionnaire has been validated for your population and the cut-off points has been clearly defined.

• Otherwise you will end up making fatal error like in the following example;

PPUKM Study done using Patient Satisfaction Questionnaire II (PSQ II)

• The complete PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests.

PSQ II explanation from the PPUKM study

• Data was collected by interviewing patients (face to face interview) using Patient Satisfaction Questionnaire II (PSQ II). The questionnaire contains of 41 items which related to eight dimensions of the patients’ satisfaction such as interpersonal aspect, technical quality, accessibility, efficacy, convenience, availability, financial aspect and continuity of care. Likert Scale was used to score the satisfaction questionnaire with four response categories (strongly agree, agree, disagree, and strongly disagree). Scaling decision for the questionnaire is by using cut of point 50% or by using formula: (Total Highest Score - Total Lowest Score) / 2????????????????????????????????????????????????????

Wrong formula used in PPUKM study (Total Highest Score - Total Lowest Score) / 2

• If coded as strongly agree (1), agree (2), disagree (3), and strongly disagree (4)

• Therefore if data coded as above, best cut-off point would be 2.5. If 10 questions, then it would be 25, since lowest score would be 10, highest score would be 40.

• If using above formula, (40-10)/2 = 15. Then the avg cut-off of 1.5 would be between strongly agree and agree. Doesn’t make sense.

Correct formula ((Total Highest Score - Total Lowest Score) / 2) + Total Lowest Score

• If coded as strongly agree (1), agree (2), disagree (3), and strongly disagree (4)

• If for 10 questions, then the cut-off would be 25, since lowest score would be 10, highest score would be 40.

• If using correct formula, ((40-10)/2 )+10= 25. Then the average cut-off of 2.5 would be between agree and disagree. Now it will make more sense.

Problems Identified

• The author calculated the wrong cut-off point for all the domains and the overall score. This will lead to an increase in the number of those not satisfied. So wrong conclusion was made.

• So be careful if you are using scales such as this. Check the cut-off points.

Next

Choosing the appropriate study design.