Welcome to the WightmanBerris Academy DOCH 2 ILP Mission: Possible

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Welcome to theWightman-Berris AcademyDOCH 2
ILP Mission Possible

• Dr. Joyce Nyhof-Young
• November 14, 2006

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Feeling overwhelmed?A little under fire?Dont
know where to turn?
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Advice Assistance

• Course Director
• Academy Coordinator
• Academy Research Coordinator
• Research Advisors (see list)
• Your Research Team
• Other/Former Students

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Session Goals and Objectives

• WHAT DO YOU EXPECT TO LEARN TODAY?
• THE GOAL IS TO ANSWER
• YOUR QUESTIONS!!

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Session Goals and Objectives

• By the end of this workshop, you should
• Know the types of projects available
• Understand the nature of interactions between
  health problems, DOHs and research questions
• Understand how to develop a research question
• Know how to find appropriate outcome measures and
  project support

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Types of Projects

• Needs Assessment
• Assessment of the health needs of a community
  group wrt a health concern and its DOH
• Barrier Assessment
• Assessment of a barrier to health for a community
  group wrt a specific health or social issue

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Types of Projects

• Instrument/Resource Development
• Development of a new instrument/resource using
  sound evidence evaluation plan
• Evaluation
• Evaluation of an existing program, intervention
  or resource

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Types of Projects

• Clearly describe the type of project and the
  rationale for choosing it
• Include this in the study title
• Is it a pilot study? Preliminary investigation?

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Develop a Research Question

• DOCH 2 Challenge
• Linking your agencys concern with a determinant
  of health

DOCH 2
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Agency Issues

• My evaluation project is with endocrinologists at
  TEGH assessing the effectiveness of the
  in-hospital insulin teaching of patients
  diagnosed with Diabetes.
• The Manual states that we MUST have a
  community-based agency. The endocrinologists
  arent exactly an agency.
• What do I do about the requirement?

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Determinants of Health

• Physical Environment
• Shelter
• Peace
• Stable Ecosystem
• Sustainable Environment
• Social Environment
• - Income - Education
• - Social Security - Social Relations
• Equity - Social Justice
• Respect for Human Rights - Access

Biological Behavioural - Genetic factors -
Lifestyle factors
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Choosing a Determinant of Health

• Questions to consider
• How is the DOH a relevant variable?
• How broad or narrow is your DOH?
• How do you operationalize a DOH (e.g.
• socioeconomic status, social support)?
• How will the data relate back to a DOH?
• Show the reader your thinking and
  understanding of issues around your DOH.

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Do I include the DOH in my research question?

• My project is to determine the effectiveness of a
  patient education discharge tool and its
  companion video.
• For the 'Research Question' part of the ILP, does
  our main question have to incorporate the
  determinant of health being studied or can the
  determinant of health be addressed in one of the
  subsidiary questions?

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What KIND of DOH am I investigating?

• My project will evaluate whether travel distance
  to the nearest eye care service provider acts as
  a barrier to retinopathy screening in the Ontario
  diabetic population.
• Would travel distance be considered a physical
  barrier or a social barrier (access to care)?

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How broad or narrow is your DOH?

• Tease out the issues involved in your DOH. Start
  broad and go narrow.
• E.g., what does education/SES involve in your
  context?
• What questions will you ask (and how) to get at
  the components?
• Justify your approach

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Evaluating the Quality of a Research Question

• http//www.esc.edu/esconline/across_esc/writerscom
  plex.nsf/0/f87fd7182f0ff21c852569c2005a47b7questi
  on

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Your Research Question

• Is the question researchable?
• What type of information do you need to answer
  the question?
• Is the scope of information reasonable?
• Is your question too broad, too narrow?
• Are there sources available to answer the
  question?
• Can you access the sources?
• Will you be able to answer question by April?

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Narrowing your question

• "How does Determinant of Health
• affect stroke patient satisfaction with
• an aerobic training program included
• as part of stroke rehabilitation a
• program evaluation."
• Do you think this is a clear research question?
  Would I be penalized for discussing multiple
  DOHs? I like SES (do Education, Diet, Physical
  Activity fall under the umbrella of SES or must I
  strictly talk about SES alone?)

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Which of these questions can be researched?

• Are pamphlets or CDROMs
• better tools for educating
• patients?
• Is Prozac a good way to
• treat clinical depression in
• certain cases?

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Is the research question too broad or too narrow?

• Select the best research question
• What impact have wait times had on medical care?
• What percentage of hospital deaths at UHN were
  traced to poor infection control during the last
  10 years?
• What impact has SARS had on hospital infection
  control?

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Select the best question

• What marketing strategies does GlaxoSmithKline
  currently apply?
• What is GlaxoSmithKlines future marketing plan?
• What marketing strategies has GlaxoSmithKline
  used in the past?

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Refining the Research Question 1

• We intend to conduct a needs assessment
  cross-sectional study to assess if adult (gt 18
  years of age) HIV() individuals seen at the TGH
  Immunodeficiency Clinic have adequate levels of
  education self-reported HIV-specific health
  literacy consisting of an understanding of 1)
  medication compliance, 2) prevention of disease
  transmission, 3) an understanding of how
  medications maintain immune function, examined by
  a survey employing both a quantitative (29
  questions) qualitative (1 question) strategy at
  clinic visits from Jan Feb 07. This study
  should provide insight into this group of HIV()
  individuals HIV health literacy and therefore
  ability to self manage their care.

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Refining the Research Question 2

• Do HIV() patients of the TGH Immunodeficiency
  clinic surveyed with both quantitative and
  qualitative questions, at single clinic visits
  during January till February 2007, have the
  formal education and HIV specific health literacy
  to meet their needs of understanding medication
  use and prevention of disease transmission?

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Refining the Research Question 3

• In what ways does the level of formal and
  informal education amongst HIV() patients of the
  TGH Immunodeficiency clinic impact HIV specific
  health literacy pertaining to anti-retroviral use
  and prevention of virus transmission?

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Refining the Research Question 4

• In what ways does the level of education amongst
  HIV() patients of the TGH Immunodeficiency
  clinic impact their HIV specific health literacy?

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Research Study Title

• A good research question can be adapted slightly
  to become an informative study title.
• The title should include
• DOH
• Population and context
• Type of project
• Health concern

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Research Study Title

• RQ In what ways does the level of education
  amongst HIV() patients of the TGH
  Immunodeficiency clinic impact their HIV specific
  health literacy?
• Title Investigating the relationship between
  education and health literacy among HIV ()
  patients at the TGH Immunodeficiency Clinic A
  pilot needs assessment

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Methods

• Mixed methods (Ql and QN) can strengthen a study
• Allow the researcher to triangulate data

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Triangulation

• Triangulation Method used by qualitative
  researchers to check and establish the validity
  of their studies
• Data triangulation
• Investigator triangulation
• Theory triangulation
• Methodological triangulation
• Environmental triangulation

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Mixing Methods

• How does social support in primary hip
  replacement patients affect their perceived level
  of anxiety prior to discharge from inpatient
  rehabilitation?
• This question will be evaluated using
  quantitative methods (surveys). Would a
  qualitative component constitute a
  secondary/minor research question?
• Should it be included in the research question?

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Methods I am developing a survey

• I have noted where I have obtained the surveys
  and that I have modified portions.
• Do I have to list every change that I made to the
  survey, and why I made the changes?
• For example Questions 12 and 13 were taken out
  since they were demographic questions specific to
  United States residents.

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Participatory Design

• Try to involve members of the subject group in
  the design of your research tools
• Pilot test your instruments, especially if they
  are not validated or not validated with your
  population.

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Help - ethics is due, Im not done!!!

• Submit an early draft
• The REB will evaluate
• the sensitivity of the questions, the
  vulnerability of the participants, and your
  delivery methods
• Tentative approval will likely be granted
• Submit final document later

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Developing Appropriate Outcome Measures
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What are Outcomes?

• Benefits or changes for individuals or
  populations during or after participation in an
  intervention
• Relate to behaviour, skills, knowledge,
  attitudes, values, condition or other attributes

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Outcome Measures

• Metric In-depth Reviews of Instruments
• http//www.measurementexperts.org/instrument/inst
  rument.asp
• Patient-Assessed Health Instruments
• http//phi.uhce.ox.ac.uk/
• Ottawa Health Research Health Institute A-Z
  Inventory of Decision Aids
• http//decisionaid.ohri.ca/Azinvent.php

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Summary Key Points

• Clearly outline
• Your research question ( rationale)
• DOH
• Type of project
• Study design
• Population (sample)
• Methods
• Data Analysis

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DOCH 2 ILPMission PossibleYou will reach your
DOCH 2 goals
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Thank you for attending!PLEASE GIVE US
YOUR FEEDBACK!
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