research definitions, types, problems and objectives

8/2/2019 Research Definitions, Types, Problems and Objectives

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Research Methodologyfor MSc Students

Berihun Megabiaw (MD,MPH)

April, 2012Epid & Biostat Dep`t, UoG


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Learning Objectives

At the end of this session the student will beable to:

Define health research, research design,and research methods

Understand the differences betweenresearch and audit

Understand the different types of research

Develop research objectives of differentforms


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3

Research?

The systematic collection, analysis, andinterpretation of data to answer acertain question or solve a problem


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Health Research?

Health research is the process of obtainingsystematic knowledge and technology which canbe used for the improvement of the health ofindividual groups. It provides the basic

information on the state of health and diseasesof the population; it aims to develop tools toprevent and cure illness and mitigate its effectsand it attempts to devise better approaches tohealth care for the individual and community

(Davies 1991)


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What is Health Research?Cont..

Health Research is a systematic

collection, analysis and interpretationof data to solve a health problem.


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Purpose of Health Research

- To generate knowledge essential toeffectively promote the health of

the population.

- Without that knowledge, effective

action is impossible because it hasno logical or empirical basis.


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Research must be:

Purposeful: what do you want to be able tocontribute?

Targeted: Who are the audiences?

Credible: consider sources information, method ofdata collection, personnel involved

Timely: Is the information needed?

Research is done to find solutions to health problems.


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2) Research and audit

Although research and audit have a great dealto offer each other and should be inextricablylinked, it is important to recognise their distinctroles. Otherwise there is a danger of auditmasquerading as research but without thenecessary rigour, or research pretending to beaudit, but without any attempts to improve thequality of care given. (Black, 1992)


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Research and audit cont..

Research

aims to find the value of health care (Is anintervention effective/humane/cost-effective?)

should be generalizable to other placesand times (if properly carried out)

4


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Audit Audit consists of reviewing and monitoring

current practice, and evaluation (comparison ofperformance) against agreed predefined

standards

Audit is directed at the maintenance andachievement of quality in health care.


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Audit- aims to assess and monitor the provision

of health care to ensure its quality (Quality

= effectiveness, humanity, equity,efficiency)- is an ongoing activity to monitor, institute

changes then reassess

- is essentially a local activity, results beingof primary value at the specific time andplace


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Ways in which Research and Audit are linked

Research as a basis for audit Research often makes a vital contribution to audit by:

defining good quality care(Treatment of malaria by coartem)

produce accurate outcome measures

Audit as a basis for research Audit data can be used as a non-experimental basis for

evaluating health care by:

detecting dramatic effects of an intervention or rareside effects

investigating differences in use of and access toservices (equity)

optimal approach is to collect together audit data withlarge audit databases


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Criteria for undertaking audit

The issue should be a common, significant orserious problem

Any changes following audit should be likely to

benefit patients and to lead to greatereffectiveness

The issue is relevant to professional practiceand development

There is realistic potential for improvement

The end result is likely to justify the investmentof time and effort involved


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Types of research

Level of Analysis Object of Analysis

Conditions Responses

Individual and

subindividual

Biomedical Research

(Basic biological processes,structure and function of the

human body, pathologicalmechanisms)

Clinical Research

(Efficacy of preventive,diagnostic, and therapeutic

procedures, natural history ofdiseases)

Population Epidemiologic Research(Frequency, distribution, anddeterminants of health)

Health Systems research

(Effectiveness, quality, andcosts of services: developmentand distribution of resources forcare )


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Types of research cont

Biomedical Research

Example: Experiments in cell culture andin vivo demonstrate that treatment with

statins reduces production of Abeta, themain component of senile plaques, afeature of Alzheimers Disease.

Epidemiological Research

Example: Prevalence and risk factors ofcigarette smoking and khat chewing


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Types of research cont

Clinical Research

Example: studying the effectiveness ofcoartem in treating malaria

Health Systems Research

Example: Study of the underlying reasonsfor emergency hospital admission ofpatients with diabetes.


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Basic Vs Applied Research

Basic research (also called fundamentalorpureresearch) -has as its primaryobjective the advancement of knowledge

and the theoretical understanding of therelations among variables

The terms basic or fundamental

indicate that, through theory generation,basic research provides the foundation forfurther, sometimes applied research.
http://en.wikipedia.org/wiki/Basic_researchhttp://en.wikipedia.org/wiki/Knowledgehttp://en.wikipedia.org/wiki/Knowledgehttp://en.wikipedia.org/wiki/Basic_research


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Basic Vs Applied Researchcont..

It consists of pure basic research andstrategic basic research.

Pure basic research is carried out withoutlooking for long-term benefits other thanthe advancement of knowledge.


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Strategic basic research - is directed tospecified broad areas in the expectation ofuseful discoveries.

It provides the broad base of knowledgenecessary for the solution of recognizedpractical problems.


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Basic research is conducted to

address fundamental questions about

the biological, Behavioral, and

social mechanisms,

which underlie wellness and disease


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Applied research

Is original work undertaken in order toacquire new knowledge with a specificapplication in view.

Is a research that seeks to solve practicalproblems


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Research Methods

Refers to: The practices and techniques used to collect,

process and analyze the data (e.g What type ofexperiment or survey);

The sample size and methods of sampling In the case of experiments and analytical

studies, of assignment to experimental andcontrol groups

The research proposal will need to present andjustify the appropriateness of the chosenresearch methods


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Overview of research process

What is the problem?

Define your initial objective

Search literature

Modify your objective based on the

information you get from literatureWrite the full proposal guided by the objective


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2424

Where

are we?

Youre 30metres

above the

ground in aballoon.

You mustbe a

researcher

Yes.How

did you

know?


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2525

Because whatyou told us is

absolutely

correct but itis completely

useless.

You must

be policy-makers.

Yes, weare. How

did youknow?

Because you dont

know where youare, you dont know

where youre going,

and now youre

blaming me foranswering your

question precisely.


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What is A Problem?

What is What should be!

Exist

Ideal


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Situation:In District X (pop. 145,000) sanitary conditions are poor

(5% of households have latrines) and diseasesconnected with poor sanitation, such as hepatitis,gastroenteritis and worms, are very common. TheMinistry of Health has therefore initiated a sanitation

project which aims at increasing the percentage ofhouseholds with latrines by 15% each year. The projectprovides materials, and the population should providelabour. Two years later, less than half of the target hasbeen reached.


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Discrepancy:

35% of the households should have latrines,but only 15% do have them.

Possible answers????

Research Problem or not?


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Problem situation: District A: 125 HIV-positive adultswere coming to the hospital every day as part of aDOTS programme to take medication for TB; last

month for one entire week, none of the 125patients received any medication

Discrepancy?

Problem question? What are the factors responsible for125 patients failing to receive any treatment?

Possible answer: During the week a very heavy

rainstorm caused flooding that washed out several roads a resupply truck could not reach the hospital for oneweek

Research Problem or not?


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The reasons for this difference is unclear

More than one possible answerto the question

or solution to the problem

Whether a problem requires research or not

?

? ?


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7 Criteria for selection of a researchproblem

Relevance (widespread, who is affected, severity)

Avoidance of duplication

Feasibility (available resources)

Political acceptabilityApplicability

Urgency

Ethical applicability

Prioritization: 1= LOW ; 2= MEDIUM; 3= HIGH


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1. Relevance

How large or widespread is the problem?

Who is affected?

How severe is the problem?

2. Avoidance of duplication

find out whether the suggested topic has been

investigated before

either within the proposed study area or in

another area with similar conditions


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3. Urgency of data needed (timeliness)

How urgently are the results needed for making a decision

or developing interventions at various levels (from

community to policy)?

Consider which research should be done first and which

can be done later

4. Political acceptability

research a topic which has the interest and support of the

local/national authorities


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5. Feasibility

Think about the resources required to conduct the study

manpower, time, equipment and money that are locally

available

possibility of obtaining technical and financial assistance

from external sources

6. Applicability of possible results/recommendations

Is it likely that the recommendations from the study will

be applied?

7.Ethical acceptability

the possibility that we may inflict harm on others while

carrying out research


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Problem Analysis

Identify factors that may have contributed to the problem

Clarify the relationship between problem and the

contributory factors

PROBLEM

FACTOR

FACTOR


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Delay intreatment

Delay indiagnosis

Prolongedduration for

culture &sensitivity

(6-10 weeks)

Failure of anti TB drugsto control TB in recent

years

Attempts todevelop

rapiddiagnosisprocedure

X Ray orsmear

microscopy

is inadequatefor use in D& T

Growing resistance ofMycobacterium species to anti TB

drugs

Poor compliance of patients

Patients take care at GP

Not providing HE

Self medication

Misuse of anti-TB drugs

Availability of anti-TB drugs in market

Problem statement


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Constitutes the scientific justification for thestudy;

Gives an empirical basis to describe thesituationClearly specifies the gaps (in existing

knowledge and/orcontroversy and inconclusive evidence)

Defines the objective of study and conveys the

questions orbroader issues

Problem statement


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A logical sequence for presenting the statementMagnitude, frequency and distribution: Affected

geographicalareas & population groups affected by the problemProbable causes of the problem: What is the currentknowledge

of the problem and its causes? Is there consensus?controversy? conclusive evidence?Possible solutions: In what ways have solutions to theproblembeen attempted? What has been proposed? What are theresults?Unanswered questions: What remains to be answered?What areas have not been possible to understand,determine, verify, or test?


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Formulation of the Problem Statement

Context Socio-economic and cultural characteristics

and an overview of health status and the health care

system

Nature of the problem

An analysis of major factors and convincing argument

Any solution that have been tried in the past, how well

they have worked, and why further research is needed.

Type of information expected to result from the project

and how this information will be used to solve problem.


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4/25/2012 Berihun M. 41


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Formulation of Research

ObjectivesBerihun Megabiaw (MD, MPH)

Dep`t of Epid and BiostatUoG

March 2012


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A Research QuestionUncertainty about something in the

hospital/treatment procedure/populationthat theinvestigator wants to resolve by makingmeasurements on his/her study subjects

MedicalArticles

Conferences

Observations

Applyingnew

concepts toold issues

ResearchQuestion


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Research questions:

- Formulated when insight intothe problem being studied is notsufficient.


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5 CRITERIA for A Good Research Question

Feasible : Adequate no. of subjects, adequate technicalexpertise; afford in time and moneyF

I

N

E

R

Interesting to the investigator

Novel : Previous findings - confirm or refute, extend New

findings

Ethical : Autonomy, Benefits and Risks, Justice

Relevant : To scientific knowledge, clinical & health policyfuture research directions

E l f R h Q ti


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Examples of Research Questions(Articles, Research Reports, Congress Abstracts)

What are the patterns of anti-malarial prescriptions at referral

Hospitals?

What are the socioeconomic background

and behavior of adolescent pregnancy?

What are the traditional birth practices of

rural Ethiopian women?

Wh t f t b d f


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What formats can be used forstating research objectives?

Research objectives can be stated as:

A) Questions: The objectives of this studyare to answer the following questions

B) Positive sentence: The objectives of thisstudy are to assess

C) Hypothesis: The objective of this study is

to verify the following hypothesis...


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Formulating Objectives cont..

A good question includes the following elements:-

The patient or client in question (the Problem)

The Intervention (or exposure) being considered

A Comparison - an alternative intervention orgroup

The Outcome of interest

This format (PICO) does not fit with all questions


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Formulating Objectives

Example: Imagine you are a member of NationalCigarette Smoking Cessation Group.

One issue that the group considers is nicotinereplacement therapy for people who want to stop

smoking.

The other group says advising people to stopsmoking will suffice.

The debate continued but they couldnt agree.

Formulate a research question for the aboveproblem


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Formulating Objectives cont..

Answer

Problem Intervention Comparison Outcome

For smokers

who want togive upsmoking,

does nicotine

replacementtherapy,

when

comparedwithindividualsrelying on

advice only,

increase their

chance ofgiving upsmoking?


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It summarizes what is to be achieved

by the research / study


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To focus the study (Narrow the scope)

To avoid collection of unnecessary data

Facilitate the development of research

methodology Help to orient the collection, analysis,

interpretation and utilization of data.


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WHERE AREYOU GOING?

If you are not

certain of where youare going, you may

well end up

somewhere else

(and not even know

it!).

Set objectiveEvaluate performance


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General Objective

What is expected to be achieved by

the study ingeneral terms

Specific Objectives

Breaking down the general objectiveinto smaller, logically connected

parts


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Objective should be closely related toproblem statement

Example problem:

Low utilization of Antenatal Care(ANC) General Objective:

To assess the reasons for low utilization of

ANC services in District X.


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PROBLEM IDENTIFICATION,ANALYSIS AND STATEMENT OF

THE PROBLEM

CHOOSING OF RESEARCH AREA


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Should address various aspect of problemand factors influencing/associatedwith/determining the problems.

The first specific objective usually focuseson quantifying or specifying the problem

Should specify-

What will do in the study Where

For what purposes


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1. Determine the level of utilization of ANC inDistrict X over the years 1998 and 1999.

2. Identify whether there are variations inutilization of ANC service, related to the seasonand type of clinic.

3. Identify socioeconomic & cultural factors thatmay influence the mothers' utilization of ANCservices


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Cover the different aspects of problem and itscontributing factors in acoherent way and logicalsequence

Clearly phrased in operational terms by specifyingwhat you are going to do, where and for whatpurpose

Considering local conditions to berealistic

Useaction verbs


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-determine -verify -identify-describe - find - compare

calculate - establish - explore To compare: the level of utilization of ANC

services among various S.E groups.

To establish: the pattern of utilization of ANC

services in various seasons of the year.


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Avoid use of non-action verbs

Vague

Examples:

to appreciate

to study

to understandto know


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Specific

Measurable

Achievable

Realistic

Time bound


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Clear and comprehensive objective is

critical

To the dev`t of all other components of a

research design, subsequent datacollection, analysis, reporting & utilizationof data.


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Group work!


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pResearch Question and Objectives

1. Formulate research questions (03)

2. Write general and specificobjectives for them


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research definitions, types, problems and objectives

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