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Teaching the Science Base of MCH
Donna Strobino, PhD
TEACHING THE SCIENCE BASE OF MCH
OBJECTIVE:To present examples of approaches to teaching the evidence base of MCH
ASSUMPTIONS OF EXAMPLES
SOLID GROUNDING IN:
• Biostatistics
• Epidemiology
• Evaluation or Study Design in the Social Sciences or Health Services Research
EXAMPLES OF APPROACHES
• Critiquing a research article• Synthesizing the literature on an
intervention/program• Translation of a study to practice or
policy• Debating the science• Choosing measures for population-
based data
CRITQUE OF A SCIENTIFIC ARTICLE: OBJECTIVE
Participants demonstrate• Knowledge of critical study methods that
affect the validity of inference
• The link of study objectives and rationale to study results and conclusion
• Objective evaluation of strengths and weaknesses of study
FOCI OF THE CRITIQUE
• Study Objectives and Rationale
• Study methods- Study design
- Sample: who, where, when, how many
- Variable Measures
FOCI OF CRITIQUE
• Study Results- Text consistent with data in tables
- Consistent with study methods
• Study Conclusions- Consistent with objectives
- Consistent with findings
EXAMPLES OF STUDIES
Study Design
• Case Control Study of Stillbirths- Stillbirths of all birth weights
- Controls: Live births > 2500 grams
• Sister pairs- Teenage mothers
- Mothers in their early 20’s
EXAMPLES OF STUDIES
Sample Restrictions• Require repeated interviews during
pregnancy of high-risk women; very low follow-up- Sample bias versus recall bias
• Reduce sample by half because of data on gestational age- Sample bias versus measurement bias
EXAMPLES OF STUDIES
• Timing of measurement of risk factors: hematocrit at delivery
• Poorly constructed measures of underlying concept: racism
• Analysis determines results: Longitudinal data on repeated births
• Text misrepresents data in tables: data
sources for measuring drug use
SYNTHESIZING THE LITERATURE: OBJECTIVES
Students learn:• How to conduct a literature search
• How to determine the most appropriate criteria for inclusions of studies in a review
• To succinctly, but comprehensively describe studies
• Evaluate the evidence
• Make conclusions about the intervention
LECTURE POINTS
• Important aspects of study methods
• Content of a study description
• Information for doing a search
• Criteria for selection of studies
• Selecting the studies to highlight
• Synthesizing/compiling the evidence
ASSIGNMENTS
• Topic and selection of studies- Criteria for selecting studies
- List of studies
• Paper presenting the evidence- Description of the intervention
- Description of studies and critique
- Conclusions about the evidence
EVALUATING LITERATURE FOR POLICY OR PRACTICE
OBJECTIVE: Students will show:
• Ability to evaluate the evidence
• Ability to determine limits of inferences
• Ability to translate study findings for
programs, practice, and policy
ARTICLE SELECTION
• Gold standard design?
• Sample exclusions
• Appropriate age range?
• Secondary prevention
• Clinical interpretations:To whom should the results be applied?
• Controversial politically
DEBATING THE SCIENCE
OBJECTIVES:Students will show:
• Understanding of the science underlying the debate
• A balance of the strengths and weaknesses of the science
• Knowledge of the reasons for policy recommendations
UNIVERSAL BREAST CANCER SCREENING: WOMEN 40-49
Debate: Pro and Con
• Hinges on interpretation of studies
• Requires additional population data
• Regardless of position, must present in writing both sites; requiring a synthesis of the literature.
BIRTH CERTIFICATE ANALYSIS: OBJECTIVES
Student will show:• Knowledge of the vital statistics system
and its uses• Knowledge of data for surveillance and
research• Knowledge of the constraints in
collecting population-based data• Knowledge of measurement of items on
the certificate
APPROACH TO PAPER
• Geopolitical area• VS System in that area• Content of current certificate• Recommendations for changes
- System of data acquisition- Format of form- Content/measurement of items
TESTING PREPARATION TO UNDERTAKE RESEARCH
Take-home exam: Objective: To test student’s ability to:
• Critically analyze research in their area of interest
• Synthesize and integrate both concepts and methods learned in course work
Exam: Using 1-2 Research Articles
Focus of questions about articles:
• Conceptual basis of the research
- Conceptual framework
- Variables and their conceptualization
• Study methods
- Study design
- Sampling plan
- Statistical analysis
DrPH versus PhD Students
• DrPH students:
- Program, policy or practice implications of the study
• PhD students:
- Research implications of the study