HEALTHCARE RESEARCH METHODS: the Research Question, the team and the study approaches

PHC215

By Dr. Khaled Ouanes Ph.D.

E-mail: k.ouanes@seu.edu.sa

Twitter: @khaled_ouanes

INTRODUCTION TO

HEALTHCARE RESEARCH

METHODS

Focusing on the Research

Question

Primary, Secondary, and Tertiary

Research

Key Considerations

Study Goals & Specific Objectives

The literature review and consideration of a study

approach should lead to the selection of one very

specific study topic that can be stated in terms of a

single overarching study goal or study question.

A study goal often includes the specific exposure,

disease, and population that will be the focus of the

study

Examples of Study Goals

After finalizing the overarching study goal, the researcher

should identify three or more specific objectives (also

called specific aims or specific hypotheses) that stem from

the main study goal.

Each of these specific objectives should take the form of

a measurable question or a “to” statement.

Each should represent a logical step toward answering

the main study question.

Example

Study goal: “to assess the impact of lead

poisoning on school performance in

kindergarten students in USA.”

Specific objective #1:

1. To measure the prevalence of high blood lead levels in a

random sample of kindergarten students in USA.

Example

Study goal: “to assess the impact of lead

poisoning on school performance in

kindergarten students in USA.”

Specific objective #2:

2. To determine whether children in that sample with high

blood lead levels have lower scores on academic tests

than children with lower blood lead levels.

Example

Study goal: “to assess the impact of lead

poisoning on school performance in

kindergarten students in USA.”

Specific objective #3:

3. To estimate the total impact of high blood lead levels on

kindergarten performance in USA by applying the rates in

the sample population to the total population of the

region / Country.

Example

Note that all three of these

specific objectives relate to the

overall study goal and provide a

clear pathway for achieving the

main goal.

ESSENTIAL QUESTIONS TO THE

SUCCESS OF THE PROJECT

ESSENTIAL QUESTIONS TO THE

SUCCESS OF THE PROJECT

Assembling a Support

Team

Research projects benefit from the

input of technical and cultural experts.

A team of collaborators should be

assembled early in the research

process.

Members of the Team

Although some papers in the health

sciences have solo authors, most

papers have about four coauthors,

and some have dozens of coauthors.

All of what we have seen until now in the

previous presentations is about the 1st step:

Identifying a Study Question

Selecting a Study

Approach

The 2nd step: Selecting a Study Approach

Overview

The 2nd step in the research process is to select a general study approach.

This section provides an overview of 8 common study designs.

1. Reviews / meta-analyses

2. Correlational (ecological)

studies

3. Case series

4. Cross-sectional surveys

5. Case control studies

6. Cohort studies

7. Experimental studies

8. Qualitative studies

The Studies Approaches

Prim

ary

, Se

co

nd

ary

,

an

d Te

rtiary

Stu

dy

Ap

pro

ac

he

s

Study duration

Primary Studies:

Study duration

Secondary & Tertiary Studies:

The study duration is dependent on how existing data & articles will be acquired.

Population Selection for Each

Study Approach

REVIEWS

A review article or meta-analysis carefully gathersall prior publications on a specific topic andsummarizes them to provide a big-pictureanalysis.

Meta: meaning "after", or "beyond") is a prefix used inEnglish to indicate a concept which is an abstraction from

another concept, used to complete or add to the latter.

The required Steps:

1. An extensive search of the literature

2. Extraction of key information from relevant

articles

3. Clear and concise presentation of this

information

The benefits:

A literature review is an effective way to become an

expert in the literature on a well-defined topic

A literature review is a helpful step in preparing for future

primary or secondary analyses

Review articles are often cited more often than reports

of individual field studies

The limitations and drawbacks:

Not all journals publish review articles (especially reviews

that the editors do not solicit)

Reviews are sometimes perceived to be a less rigorous

form of research than projects that collect new data

and/or involve statistical analysis

Selecting a Topic

The most important decision is to select a topic

that is narrow enough that all the relevant

publications can be acquired.

The topic may need to be modified after a

preliminary search, depending on the number of

articles available.Example:

9 = too few expand the scope

100+ = too many narrow the scope

Library Access

The full text of every relevant article must be identified and obtained.

Check with a university librarian about the library’s policies and the fees that may be charged for the use of interlibrary loan services.

Maintain a meticulous system for tracking articles that have already been acquired, those that have been requested but not yet received, and those that need to be requested.

Narrative Reviews

Narrative reviews tell a “story” about a well-

defined topic using evidence from the literature

to support the “plot”

Narrative reviews must be carefully organized

by theme, methodology, chronology, or some

other guiding principle

The absence of a systematic search strategy

must be justified by the researcher

Systematic Reviews

Systematic reviews are designed to minimize the bias that might occur when review article authors handpick the articles they want to highlight

After the identification of the study question, the most important decision in a systematic review is the selection of keywords and inclusion criteria

The goal is to craft a search strategy that identifies all the articles ever published on the narrow, well-defined area covered by the review

Once the articles are identified from one or more abstract databases, each article is screened to see whether it is eligible for inclusion.

Relevant information is extracted from all eligible articles and presented in table form.

Then the trends and key observations are summarized.

Systematic Reviews

Sy

stem

atic

Re

vie

ws

Meta-Analysis

The goal of a meta-analysis is to combine the results of several high-quality articles that used similar methods to collect and analyze data into one summary statistic.

Meta-analysis usually begins with a comprehensive systematic review of the literature to identify every single possibly relevant article.

The steps of a meta-analysis are to:

Conduct a systematic review

Assess the quality and comparability of each eligible study

Extract statistical results from each study that meets all

inclusion criteria

Combine these statistical results into one summary statistic

Meta-Analysis

Key Characteristics of Reviews and Meta-

Analyses

Key

Characteristics

of Reviews and

Meta-Analyses

PHC215

By Dr. Khaled Ouanes Ph.D.

E-mail: k.ouanes@seu.edu.sa

Twitter: @khaled_ouanes

HEALTHCARE RESEARCH METHODS

Based on the textbook of introduction to health research methods – K.H. Jacobsen