HLTEN514 A Apply research Skills within a contemporary environment

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HLTEN514 AApply research Skills within a
contemporary environment

• DR Kithsiri Edirisinghe
• MBBS, MSc, MD ( Medical Administration)
• TAA Cert. IV ( Australia)

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What is Phenomena ?

• OH ! Factor
• Observation
• Rain / wind / infection in the ward /
  readmission of cases / increase in Dengue
  patients / Nurse turnover/ rising cost of
  healthcare

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What is a Concept ?

• An idea
• Perception
• Thought
• Theory
• Model
• Re-search model
• Conceptual model

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What is Research ?

• Why ?
• When ?
• Where ?
• Who ?
• What else ?

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What is Theory ?

• Reasoning
• Explanation
• Argument

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What is Health Research ?

• Is systematic
• collection,
• analysis,
• interpretation of data
• to answer a certain question or to solve a
  problem related to health

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Health Management Research

• Linking
• theory
• education
• practice
• to improve administrative
  practice and standards
• Health management research helps to
• Validate healthcare management practices
• Analyze effectiveness of healthcare management
  interventions
• Organize scientific base for healthcare
  management practice
• Demonstrate the accountability

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Why Health research is Important ?

• Health needs of the community---------------?Healt
  h resources
• Health Interventions
• Health resources are scarce to fulfill the health
  needs of the community
• Interventions in health have to be planned
  properly for it to be effective
• For interventions health information is vital
  to
• Prioritize the need
• Monitor the Coverage, Effectiveness
  Affordability, Efficiency, Acceptance,
  Sustainability
• Feed back
• Health research plays a major role in this
  context

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Importance of Health Research

• Demand Gap
• Effective interventions
• Coverage
• Accessibility
• Affordability
• Sustainability
• Effectiveness
• Efficiency
• Assessing need Demand
• Health Planning, Interventions, monitoring of
  health problems issues

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information

• Data
• Facts or phenomena
• Raw numbers
• Information
• Organizing numbers after scientific analysis
• Scientific results through tabulating data
• Intelligence
• Interpretation of information by using
  professional experience
• Expert knowledge

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Re search

• Solid scientific base
• Based on previous research Applied research
• Inventions Basic research

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Research concept / idea / model

• Based on the phenomena observed the snap shot
  situational analysis
• Identify issues / problems
• The identified problem should have a
• Clear gap in care current and ideal situation
• Relevance to healthcare management
• Avoidance of duplication
• Acceptability - Political / Ethical
• Applicability
• Urgency

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History of health management research

• Activity 01 group presentation next week

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Research Process

• Selection of a Problem formulation of
  objectives of the research
• Ethical consideration in research
• Literature review
• Build up on existing scientific research
• Referencing and citation
• Methodology
• Conceptual framework and hypothesis
• Study design
• Data collection
• Analysis of data
• Presentation , Interpretation and dissemination
  of results

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1. Selection of a Problem formulation of
   objectives of the research

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1. Selection of Problem

• The steps
• Selection of the problem /issue
• Situational Analysis
• Problem identification
• Prioritization of the problem
• Analysis of the problem
• Selection of a problem ( cause / effect )
• Formulation of problem statement
• Background of the problem description of the
  problem

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Hospital clinic
Let s identify issues and move on to organizing
the Research!
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• Selection of the problem
• Situational analysis of the problem
• Snap shot of the situation / issue
• Identify the problem/ problems
• Prioritize the problem from the problems
• According to the
• Relevance -Avoidance of duplication -Political
  acceptability- Applicability
• Urgency of data needed- Ethical acceptability
• The prioritized problem should have
• A clear gap, current and ideal situation
• - No clear reason to this gap -

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• Analysis of the problem
• Clarify the view points of the stakeholders
• Specify the core problem
• Analyze the problem cause and effect diagram
• Write down core problem
• Brainstorm possible factors contributing to the
  problem
• Identify further contributory factors
• Organize the related factors into similar groups
• Focus and scope of the Research
• Check information collected will be useful,
  feasible and avoid duplication
•  

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• Formulating Problem Statement
• Background
• Brief description of socio-economic and cultural
  characteristics and its importance of healthcare
  problem stated (Few illustrative statistics)
• Description of nature of problem
• Major factors contributed to the problem
• Previous studies performed in the past

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• Justification
• Type of information expected to yield from the
  project and usefulness of the information
• Definition, important concepts with relation to
  the problem
• What / when / where / what extent
• Statement of the problem the topic to the
  research

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Activity 01 . Select a problem and go trough the
process to and present in next week

• IT lab

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• 2. Ethical consideration

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Ethical Consideration

• War crimes after world war II - 1946
• Nuremberg code- 1940
• Guidelines to voluntary consent
• Withdrawal of subjects from studies
• Protection of subjects from suffering , injury,
  disability , and death
• Declaration of Helsinki 1960
• Human research after laboratory tests  
• Review of research protocols by an independent
  group
• Informed consent
• Conducted by professionals -qualified
  scientifically / medically
• Benefits must be more than Risks
• Revisions in 1975, - 1996

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Ethical ConsiderationNational Health and
Medical Research Council

• NHMRC Australia Ethical culture
  Informed consent
• Strong ethical culture should demonstrate
• honesty and interiority
• Respect for human participants , animals and the
  environment
• Good use of public resources in conducting
  research
• Acknowledgement of the others used in research
• Responsible communication of the results
• Informed consent
• Self determination
• Privacy dignity
• Anonymity confidentiality
• To fair treatment
• Protection and discomfort from harm

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Ethics in research

• Autonomy
• Beneficence
• Non-malificence
• Privacy
• Confidentiality
• Veracity
• Fidelity

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1.Principle of Autonomy

• Humans have the right to non interference when
  making decisions about themselves
• Forms the basis of ideas about privacy,
  confidentiality, veracity and consent

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2.Principle of Beneficence

• I will use treatment for the benefit of the
  sick, according to my ability and judgment
• Hippocratic Oath
• Conduct is aimed at the good and well being of
  others
• Principle requires that practitioners provide
  both appropriate treatment and an assurance that
  the treatment will not produce more harm than good

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3.Principle of Non-malificence

• Above all do no harm Hippocratic Oath
• In health care the ethical issues of
  non-malificence and beneficence are particularly
  apparent in decisions regarding the institution
  of dangerous therapy or withdrawal of therapy
  that is no longer thought to be beneficial.

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4.Privacy

• Safeguarding areas where patient does not want
  to reveal
• History
• Examinations
• Investigations

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5. Confidentiality

• Not reveling information collected from the
  patient without her / his consent
• Verbally
• Examination
• Records
• Complicated process
• Harm vs. benefit
• Individual
• Social
• Use your common sense
• Inform superiors

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6.Veracity

• Revealing truthful information to the patient
• As a professional
• Cultural /social /Medical
• Personnel Harm vs. Benefit
• Complicated process
• Experienced person needed

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7.Fidelty

• Agreement with the patient
• Verbal
• Non verbal

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3. Literature Review

• Method of gathering existing information
  regarding subject

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Usefulness of Literature review

• Avoids duplication and specify the subject
• Show different aspect of the problem and
  strengthen the problem analysis
• Provides facts to make the research efficient and
  effective
• Provides guidelines in each step, benefits and
  constrains that will occur in performing the
  study
• Provides comparative data for the research
• Sources
• Publications , web , research papers, journals

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The method of performing Literature review

• Decide on the topics to search and sources
• Organize index card, according to aspect of
  problem describe
• Index card - Key word/ summery of the article/
  important to will part .., . Etc.
• Write in the chapter
• How literature has helped the study
• Write reference, properly and a list of reference
  in alphabetical order

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Applying Ethical Considerations in research

• In research emotional or mental harm to study
  subjects
• Even as asking sensitive questions that may
  violate their privacy
• Observing without their knowledge
• Failing to respect certain cultural values,
  traditions etc.
• Remedy
• Obtaining permission before study begins
• not exploring sensitive questions before
  developing a good relationship with the informant
• Ensuring confidentiality of the data obtained.
  (name and address)
•  

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• 4. . Methodology
• Developing a conceptual framework
• Types of research designs

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Main Research categoriesQuantitative
Qualitative Research
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Qualitative / qualitative research

• In general, qualitative research generates rich,
  detailed and valid data that contribute to
  in-depth understanding of the context.
• Quantitative research generates reliable
  population based and gereralizable data and is
  well suited to establishing cause-and-effect
  relationships.

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Quantitative research

• Quantitative research refers to counts and
  measures of things, simply its about numbers,
  objective hard data.
• Quantitative research is research involving the
  use of structured questions where the response
  options have been predetermined and a large
  number of respondents is involved.
• By definition, measurement must be objective,
  quantitative and statistically valid.
• The sample size for a survey is calculated by
  statisticians using formulas.

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Quantitative Research

• Systematic and objective process
• To gather analyze information
• Information converted to numbers statistics
• Uses numerical picture look at similarities and
  differences
• Take decision on the relationship of the things
  measured
• This is a very LOGICAL approach
• It begins with a hypothesis / argument / educated
  guess about the concept and formulate research
  questions

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Classification of Quantitative Research
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Classification of Quantitative Research
Classification based on

• Reasons for conducting the research
• Basic find new knowledge
• Applied .find answers to day to day problems
• Time span
• Cross sectional ..point of time
• Longitudinal spread over time
• Point of collection
• Retrospective - ..Past lt-------- Present
• Prospective . Present -------- gtfuture

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Classification of Quantitative Research
Classification based on

• 5. Purpose and aim
• Descriptive
• Exploratory
• Explanatory
• Predictive
• 6. Research design
• Experimental .. Interventional
• Non experimental non interventional/
  observation

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Description of the Quantitative studies
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1. Basic and Applied

• This is classified according to the reasons for
  conducting the research
• Basic
• Basic find new knowledge
• Vaccine for Malaria / AIDS
• Applied
• Applied .find answers to day to day problems
• Health needs/ wants

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2. Cross sectional longitudinal

• This is categorized as per the time span
• Cross sectional
• One point of time
• Snap shot
• Maximum Months
• Longitudinal
• Spread over time
• long term
• Years

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Cross sectional studies

• Quantify the distribution of certain variables in
  a study population at one point of time
  (snap shot)
• It will include
• Physical characteristics of people, environment
  prevent survey of leprosy, evaluation coverage
  (immunization, ..)
• Socio-economic characteristics of people age,
  education, marital status, no. of children and
  income.
• Behaviour of people .. and opinion, that may
  help to explain the behaviours (.. studies)
• Events that occur in population death, birth,
  marital, migration
• example census cross sectional survey
  covering total population
• Disease and distribution prevalence survey
• Health programmes
•  

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3.Retrospective Prospective

• Categorized according to a point of collection
• Retrospective - ..Past lt-------- Present
• Collect a group of patients with lung cancer and
  see the their exposure to smoking
• Prospective . Present -------- gtfuture
• Collect a group of people who are smoking and
  asses the development of lung cancer over period
  of time

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4. Descriptive Exploratory

• This is categorizes as per the purpose
• Descriptive
• describe the subjects / situation
• Questions asked and answers are need
• Exploratory
• Explore the situation
• Case studies
• Limited scope

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Descriptive studies

• They describe relevant situation, people,
  programme or events
• Majority of the studies performed are descriptive
  studies
• Systematic collection and presentation of data to
  give a clear picture of a particular problem or
  situation
• Questions are asked to find out answers on the
  above mentioned situations
• who, when, where, why , what to do

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Descriptive studies

• Questions asked answers sought
• Who? -Personal characteristics
• Why?-Reason/association
• Where - Distribution
• What to do?-Suspect action
• When -Time/season or future studies

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Exploratory studies

• This is a small scale study performed to clarify
  a problem or situation.
• Mostly performed in management problems to
  analyze a situation.
• Rapid appraisal method for management.
• Interviews and comparison of a problem is
  performed.
• Ex. Needs of HIV AID patients of various gender
  groups and to prioritize resources allocating
  (here the various needs are compared, a rapid
  appraisal is performed)

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6. Experimental non-experimental studies

• This is categorized as per the research design
• Experimental .. Interventional
• Non experimental non interventional/
  observation
• Majority are non experimental

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Experimental studies

• Randomly select to two groups.
• One is subjected to intervention (or experiment)
  and the other without intervention. The outcome
  of intervention is obtained by comparing two
  groups
• (the outcome effect of the intervention on the
  problem or the dependent variable)
• These studies actually prove causation

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Experimental studies

• Classical experimental studies have 3
  characteristics
• Manipulation - Researcher does something to one
  group of subjects in the study.
• Control -The researcher introduce one or more
  control groups to compare with the experimental
  group
• Randomization -The researcher randomly assign
  subjects to control and experimental groups
  (given equal chance for selection to either
  group)

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Quantitative Research process

1. Conceiving
2. Designing
3. Conducting
4. Analyzing
5. Using

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1. Conceiving the study

• Research problem identification phase
• Research development phase
• What to study ?
• What is the problem
• What frame work ?
• What are the variables ?

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2. Designing the study

• Select a type of design
• Study design
• Identify the sample
• Sample selection
• Decide how to collect data
• Data collation method

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3. Conducting the study

• Ethical clearance
• Requite subjects
• Collect data
• Analyzing the study

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4. Analyzing the study

• Describe the sample
• Answer the research question
• Interpret results

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4. Using the study

• Recommend further study
• Dissemination of results and how to do

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1. Conceiving the study
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Selection of Problem

• The steps
• Selection of the issue ?? Phenomena
• Situational Analysis Snap shot
• Clear problem identification
• Prioritization of the problem
• Analysis of the problem ( find -cause / effect
  ) optional
• Brain storming
• Formulation of problem statement
• Background of the problem description of the
  problem

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Phenomena on Hospital clinic
Let s identify issues and move on to organizing
the Research!
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• Selection of the issue
• Stagnation at the medical clinics
• Frequent complains conflicts
• Situational Analysis
• stagnation , inconvenience , disorganized process
  
• poor seating facilities , unsatisfied patients ,
  no proper treatment and high risk to patients
• poor administration , poor number of staff
• Clear problem identification
• Overcrowding of the Medical Clinics at Teaching
  hospital Ragama, 2011.

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Analyze the problem - Cause effect analysis

• Causes - reasons for the problem
• Infrastructure ventilation , light , seating ,
  small waiting and clinic area
• Human resources low number , lazy staff ,
  untrained staff
• Methods no method , ineffective method , old
  method
• Patients lack of compliance and patience
• Effects results of the problem
• inconvenience, poor quality , image of the
  hospital , risk for the patients
• Problem overcrowding of the medical clinics

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Cause effect diagram problem tree
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Study Frame work
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Selection of Variables

• Variable
• Characteristic of a person, object or a
  phenomena that takes different forms or that
  varies.
• Variable two main types
• Numerical variables - takes Number form
• Weight , height ( 23 kg . and 100 cm)
• Categorical variables - category form
• Color , Race ( black , white and Sinhalese ,
  Tamils , Muslims )
• Uses of variables
• To construct questions
• To improve the validation of data and form
  tables
• To indicate variables in statistical form
  treatment

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Classification of Variables

• According to the type, epidemiological,
  statistical variety
• Type
• Biological , physical, socio- economic ,events
  service delivery
• Epidemiological
• Dependent
• Independent
• Confounding
• Background

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Problem Dependent
Main factors Independent
Effect Lung Cancer
Main Causative factor Smoking
Other factors Alcohol , occupation
Background factors Age, sex , race
Confounding effect both
Background no direct effect
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• Dependent
• Describe the problem of the study
• Waiting time
• Independent
• Describe the direct causative factors
• Availability of staff
• Efficiency of the staff
• Confounding
• These affects both dependent and independent
  variables
• They either weaken or strengthen them
• poor infrastructure
• Background
• Old age
• Language barrier

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• Formulation of Variables
• Find contributory factors
• Rephrase
• Making variable neutral
• Long waiting time waiting time
• Operationailize
• making variables measurable through indicators
• 1 hour - good
• gt 1 hour to 2 hours- reasonable
• gt 2 hours - poor
• Define
• To ensure consistency and remove confusion and
  bias
• The time patient enters to the OPD clinic, up to
  seen by the consultant doctor
• Scales measurement
• Mnts. , Hours ,

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Variables

• The factors that have identified in problem
  analysis may be negative. By rephrasing it has to
  be made as neutral variable where it can take
  both negative and positive forms
•  
• Long waiting time (-) - Waiting time
• Absent of D (-) -Availability FD
• Lack of supervision - Frequency
  of supervisory visit
• Poor knowledge of signs, causes and -Knowledge
  of sign, cause and Consequences TB
  
  consequence

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b. Operationalizing Variable

• Making variable measurable
• Some variables can be measured easily but some
  cannot be categorized easily. Measurable
• categorization of variable presents as
  Indicators
• Poor knowledge of pregnant mother mother
  - Factor
• Rephrase the Variable- Level of knowledge of
  pregnant mother
• Operationalize
  Indicator
• Correct answer to lt 3Q poor
  4-6 -reasonable
• gt 7 good
• Weight/age gt80 std - Well nourished
  I
• 0-80 std - moderate
  malnutrition
• gt 60 std - severely
  malnutrition

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c. Defining Variables Indicators

• To ensure everyone understand the exactly what
  has been measured and to ensure consistency in
  the measurement, definition of variable and
  indicators are need.
• Ex. Waiting time when patient enters the
  front door of OPD until it is seen and a doctor
  or register or \ obtain a card
• Experts comments previous study variable
  and logical variable should be considered here.

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The process of quantitative study

• 2. Designing the study
• Select a type of design
• Study design
• Identify the sample
• Sample selection
• Decide how to collect data
• Data collation method

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The process of quantitative study

• 3. Conducting the study
• Ethical clearance
• Requite subjects
• Collect data
• Analyzing the study

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The process of quantitative study

• 4. Analyzing the study
• Describe the sample
• designing the study
• Answer the research question
• Interpret results

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Quantitative Research

• Ideal for studies which
• Can be countered
• Not many numerous factors
• Very structured/ organized
• Objective / purpose
• Results tend to be clearly defend
• Easily interpreted

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Qualitative Quantitative Research
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Qualitative research

• Qualitative Research is collecting, analyzing,
  and interpreting data by observing what people do
  and say.
• Qualitative research refers to the meanings,
  concepts, definitions, characteristics,
  metaphors, symbols, and descriptions of things.
• More subjective than quantitative research
• Uses different methods of collecting
  information,
• Mainly individual, in-depth interviews and focus
  groups.
• The nature of this type of research is
  exploratory and open-ended. Small numbers of
  people are interviewed in-depth and/or a
  relatively small number of focus groups are
  conducted.

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• Quantitative
• Objective
• Research questions How many? Strength of
  association?
• "Hard" science
• Literature review must be done early in study
• Test theory
• One reality focus is concise and narrow
• Facts are value-free and unbiased
• Reduction, control, precision
• Measurable
• Mechanistic parts equal the whole
• Report statistical analysis.

• Qualitative
• Subjective
• Research questions What? Why?
• "Soft" science
• Literature review may be done as study progresses
  or afterwards
• Develops theory
• Multiple realities focus is complex and broad
• Facts are value-laden and biased
• Discovery, description, understanding, shared
  interpretation
• Interpretive
• Organismic whole is greater than the parts

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• Quantitative
• Basic element of analysis is numbers
• Researcher is separate
• Subjects
• Context free
• Hypothesis
• Reasoning is logistic and deductive
• Establishes relationships, causation
• Uses instruments
• Strives for generalization
• Generalizations leading to prediction,
  explanation, and understanding
• Highly controlled setting experimental setting
  (outcome oriented)
• Sample size n
• "Counts the beans"

• Qualitative
• Report rich narrative, individual
  interpretation. Basic element of analysis is
  words/ideas.
• Researcher is part of process
• Participants
• Context dependent
• Research questions
• Reasoning is dialectic and inductive
• Describes meaning, discovery
• Uses communications and observation
• Strives for uniqueness
• Patterns and theories developed for understanding
• Flexible approach natural setting (process
  oriented)
• Sample size is not a concern seeks "informal
  rich" sample
• Provides information as to "which beans are worth
  counting"

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Selection

• The decision of whether to choose a quantitative
  or a qualitative design is a philosophical
  question.
• Which methods to choose will depend on the
• Nature of the project,
• The type of information needed the context of the
  study
• The availability of recourses (time, money, and
  human).

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Combination of both

• It is a combination of two types of research. It
  is also called pluralistic research.
• Advantages of combining both types of research
  include
• Research development (one approach is used to
  inform the other, such as using qualitative
  research to develop an instrument to be used in
  quantitative research)
• Increased validity (confirmation of results by
  means of different data sources)
• Compleme ntarity (adding information, i.e. words
  to numbers and vice versa)
• Creating new lines of thinking by the emergence
  of fresh perspectives and contradictions.

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