These study notes are examinable in the Assessment 1 quiz

and the Assessment 4 final examination

In research reports, many technical words are used to describe

research designs, methodologies and projects. These study notes
summarise many of the important terms. All of these ideas belong in
your information supermarket trolley.

Knowledge goals
Commonly used terms for research methodologies, methods and
study designs.

Relevance to healthcare practice and policy

Modern healthcare practice and policy depend on research.

There are many ways of going about research. These include:

The reason for the research.

The type of research question.

The entire approach to doing the research the methodology.

How the research is actually done the research design and method.

To understand what they are reading, healthcare practitioners and policymakers

need to know the technical terms used to describe research.

1
Research designs can be classified by words that refer to different approaches.

For Western Sydney University classes taught by John Bidewell 1

 Terms for describing research

1.1 Basic and applied research

A research project can be considered as either basic or applied.

Basic research seeks knowledge for the sake of it, without looking for practical
applications. A project investigating the biochemistry of metabolism in muscles
would be basic research.

Applied research aims for practical outcomes directly from the research. An
example of applied research in sports medicine might be to show how controlling
metabolic by-

basic research is
important because it brings new insights that may have unexpected future applications.
The technology we use today, including computers, all started with basic research.
Early discoveries about electricity were done hundreds of years before electric lighting,
generators and motors were developed. In 1953, Watson and Crick reported the
double-helix, ladder structure of deoxyribose nucleic acid (DNA), the molecule used to
record and transmit genetic information.1 That finding was basic research yet it
revolutionised modern biology, giving rise to genetic research as we now know it, with
all of its practical applications in healthcare and agriculture.

The emphasis for this unit and evidence-based practice in general is applied
research, although the importance of basic research is acknowledged. Without basic
research, applied research runs dry.

1.2 Exploratory and confirmatory research

Exploratory research is open-
about what will happen in the data. These predictions are known as hypotheses,
and they do not occur in exploratory research. An example of exploratory
research might be to ask people what makes them happy. At the outset the
researcher has no definite idea about how people will answer the question.
Qualitative research is exploratory.

Confirmatory research does test hypotheses. An example of confirmatory

research might be to find out whether rich people are happier than less wealthy
people. At the outset the researcher predicts that rich people will rate themselves
earch seeks

1 Check the reference list for these study notes and see that one of the most important scientific
journal articles of the 20th century was only two pages long.

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 Terms for describing research

to test that prediction. The results will either support (i.e., confirm) or disconfirm
the prediction.

Confirmatory research is often preferred to exploratory because the researcher must

show better understanding of the issues before starting the research. However, there
are many situations where exploratory research is appropriate, for example, if existing
knowledge gives no clue about what the findings will be. Exploratory research becomes
the only option.

2
As discussed in the Week 1 lecture, there are several ways of setting up a research
study. Here is a summary, based on NHMRC (2009) with some extras:

2.1 Intervention studies

The researcher sets up treatments or conditions that the participants experience.

Experimental designs are intervention studies in which there is at least one

treatment group and a control or placebo group, and consisting of:

Randomised controlled trials (NHMRC Level II). Participants are randomly

allocated to treatment, control or placebo conditions.

Pseudo-randomised, including so-called quasi-experiments

(NHMRC Level III-1). The allocation is not truly
random but approximat -of random.

Comparative studies with the control or placebo condition happening at the

same time as the intervention (i.e., concurrent controls, NMRC Level III-2).
There is no true randomisation or anything resembling random allocation
(pseudo-randomisation), so the risk of uncontrolled background factors
affecting the results (allocation bias) is increased.

time as the intervention (i.e., non-concurrent controls, NHMRC Level III-3).

Non-experimental designs:

Cases series designs, where there is an intervention but no control group

(NHMRC Level IV).

Some authors, such as Salkind (2012), would class any intervention study with a
control group as experimental. The term experiment is not defined precisely nor used
consistently. Examination questions in this unit will avoid these difficulties.

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 Terms for describing research

2.2 Observational studies

The researchers observe events as they occur naturally, without setting up artificial
conditions. These designs are non-experimental. They include these epidemiological
study designs:

Cohort study

Case control.

See p. 7 for more about epidemiological designs, and also the epidemiology lecture.

Observational studies include case studies and case reports about individual
patients or small groups of patients. The haphazard approach to sampling, the
anecdotal nature of the evidence, sample-specific conclusions from case reports that its
reliability and validity cannot be trusted for evidence-based practice. Case studies and
case reports do not even have an NMRMC evidence level. Do not confuse case studies
and case reports with case series and case-control studies. They are different.

2.3 Qualitative research

Qualitative research covers a range of methodologies that look in-
personal experiences. Unlike the intervention and observational designs shown above,
- Qualitative research has no NHMRC
evidence level.

3
Where research looks forwards or backwards across time there are two approaches.

3.1 Prospective and retrospective studies

A prospective study plans to look at what will happen. It is a planned analysis of
future events. The researcher collects information that was not available when
the study was planned. For example:

A randomised controlled trial testing the effects of a new treatment that has
not yet been used with the sample of patients.

what will happen to the patient.

Implementing an improvement program and then monitoring changes.

A retrospective study looks at what did happen, what has already happened.
Retrospective research analyses past events. Outcomes have already occurred,
but they still need to be measured.

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 Terms for describing research

Both approaches have their value. Where possible, a prospective study is superior
scientifically because predicting what will happen requires greater insight than
explaining what did happen. Notice how the weather bureau is better at explaining why

You have to know a lot about the weather to predict

report the temperature now.

In clinical settings it may be possible to think of plausible explanations about why

somethi
social support etc.)
was going on, we could have predicted these events before they happened, but that
t

In the BBC documentary series The Story of Science shown on SBS television,
presenter Michael Mosley describes a classic example of shonky retrospective thinking.
The ancient Roman physician, Galen (130-200 AD), dissected animals and claimed that
the thigh bone (i.e., femur) was curved. For about 1,500 years after Galen, people
believed that the human thigh bone was also curved because everyone believed
anything that Galen wrote. This was not evidence-based practice. It was Galen-based
practice. Several hundred years ago people were finally forced by observation to accept
that human femurs are actually

plausible (or maybe not) because perhaps people were wearing tight pants at the time.
However, the explanation happens to be just plain wrong.

With a prospective study involving hypotheses (predictions) you really are putting

you do that) makes it easier to pick the

winner choose the horse that s
already run. Celebrity baseball player, Yogi Berra, is alleged to have said,

3.2 Longitudinal and cross-sectional studies

Where research compares two different events separated in time there are two
approaches.

A longitudinal study follows or tracks a group of people over time and records
what happens to them. Longitudinal studies are typically prospective but they can
be retrospective. With a longitudinal study, data are collected at least twice, at

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 Terms for describing research

different times from same one group. In that way, changes in people are
observed while time progresses.

Advantage of longitudinal studies: Study participants share the same history at

different points in time. They are the same people now as they were then.

Disadvantage of longitudinal studies: Because they collect data over time,

which could be many years, longitudinal studies are time-consuming and
expensive. With very long-
during the research as people move away, die, or opt out. Losing participants
from a sample is known as attrition. Attrition can cause sampling biases if
certain types of people are lost from the study.

A cross-
example, by comparing old and young people now. With a cross-sectional study,
data are collected once at the same time from at least two different groups that
have a built-in time difference. The cross-section study compares two groups at

with new graduates today, in order to measure the effect of experience. By

contrast, a longitudinal study would sample new graduates and return to them
years later after they gained experience. Cross-sectional studies are always
retrospective.

Advantage of cross-sectional studies: Quicker, cheaper, usually easier, and

with less risk of attrition and associated biases.

Disadvantage of cross-sectional studies: Two groups may not share the same
history. Factors linked to time but not relevant to the research question may
affect the results. This problem is similar to the non-equivalent treatment and
control groups that threaten the validity of non-randomised experimental
studies. Cross-sectional studies reveal group differences that may have
something to do with time, or they may relate to other, background factors.

Longitudinal studies are scientifically preferable to cross-sectional studies but can be

impractical. Where there is a choice between the two approaches, the longitudinal study
-sectional study may differ

conservative in their political views than younger people. We might conclude that people
become more conservative as they get older. A longitudinal study could show this by

time. A cross-sectional study could give the same result by comparing old and young
ey age.

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 Terms for describing research

The older people may always have been more conservative, even when they were
young, compared with young people now, who may always be conservative, even when
they become older.

Cross- sequent,
delayed data collection. However, longitudinal studies really do reveal change over
time, which is the aim of the exercise.

4
This unit devotes an entire week these study designs. Two of the main designs are
summarised below. The aim of epidemiological research is to see whether (or by how
much) exposure to a hazard increases the later risk of a disease or any other change in
health. Alternatively, exposure to a protective measure may reduce the risk of a
disorder. Simple examples include:
Whether regular, prolonged exposure to UVA and UVB radiation in sunlight
increases the risk of premature skin ageing or skin cancers.

Whether the use of sunscreen lotions during exposure to sunlight protects

against premature skin ageing or skin cancers. In this case, exposure reduces
risk. With either approach we are still relating exposure and risk. In this case the
protection could be considered a treatment. Sunscreen lotion is a healthcare
treatment. Treatments are intended to reduce the risk or severity of health
disorders.

There are two main study designs for epidemiological research:

Studies relating exposure to risk the cohort study.

Studies relating risk to exposure the case-control study.

These two designs answer the same fundamental research question (i.e., what is the
relationship between exposure to risk or protection, and subsequent health condition) in
different ways.

4.1 Cohort studies

A cohort study relates exposure to risk. A cohort study looks at whether exposure
relates to subsequent health outcomes. The cohort studies starts by identifying two
groups according to their exposure to a hazard or a protective event:

1. Exposed to treatment or hazard.

2. Not exposed to treatment or hazard.

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 Terms for describing research

Then the research compares the rates or severity of disease for the two groups. The
researcher predicts that hazard exposure, protection or treatment relates to disease.

4.1.1 Prospective cohort study

Both groups (i.e., exposed and not-exposed) are followed over time. Future
outcomes such as disease or death are measured. The design is longitudinal, so the
researcher must wait for results, which can take a long time.

4.1.2 Retrospective cohort study

Exposed and not-exposed groups are compared on the outcomes now. There is no
waiting for outcomes to happen. the person already has the disease or does not, and
they already have been exposed or they have not. Therefore, the retrospective cohort
study is quicker than the prospective study. It is a historical study.

4.2 Case-control studies

Case-control studies relate outcomes to earlier exposure. As with the cohort study,
two groups are identified, only this time by outcomes rather than exposure.

1. Has the disease.

2. Does not have the disease.

The researcher then compares the two groups for their earlier exposure to the
hazard, protection or treatment. The researcher expects that people with the disease
are more likely to have been exposed to the hazard, or less likely to have received
treatment or protection.

The case-control study is retrospective by design; it is the only way possible.

Because of its retrospective design, the case-control study is scientifically weaker than
the prospective cohort study. With retrospective studies there are risks of bias in
selecting the same and recalling information about earlier exposure or protection. (How
much sunscreen did you use when you were 5 years old?). As well, people without the
disease must not be selected on the basis of earlier exposure.

5
Action research is a different category of research compared to what we have seen
above in these study notes.
highly practical approach to research in which the practitioners (who could be managers
or clinicians, but always workers) change the way things are done and use research
methods to evaluate the effect.

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 Terms for describing research

requirement for action research is that the researchers have the freedom to implement
change and the desire to evaluate whether the change works.

Action research starts with critical reflection about current work practices.
Practitioners attempt and test changes to workplace practices and evaluate the effects
of those changes. They use research methods and small-scale studies to do it. Action
researchers aim for a continuous process of change to bring improvement. Every time a
change is attempted and evaluated it gives ideas for further change which is evaluated
in turn. The process is cyclical.

Action research is highly practical research. It aims to solve real-world problems in

organisational settings. Practitioners become researchers, so they are more involved in
their work and empowered.

Examples of action research include:

Health professionals introducing new patient care methods (Glasson et al., 2008;
Glasson et al., 2006).

Lea et al. (2012) using action research to reduce falls.

Any workplace situation where participants take charge of the processes in which

changes and feed results of evaluation into further development and testing
through by doing their own research.

Action research is something you, as a future healthcare practitioner can do. You
- esearch in
healthcare is relevant to clinical practice because real-world health practitioners do it.
Whatever remember anything from these evidence-based practice units, be sure to
include action research.

6
For now, it is enough to remember that systematic reviews are studies of studies
combining data from at least two eligible studies to arrive at an overall conclusion. An
example might be a systematic review of clinical trials on the effectiveness of nicotine
replacement therapy to assist tobacco smokers to quit. See the Cochrane Library for
access to any number of published systematic reviews.

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7
Qualitative research refers to several methodologies that seek in-depth information

ique subjective reality; they reject the notion of a

as it is for them. Conclusions from qualitative research are specific to a time and place;
they are context-dependent. W here and now may not be
true for everybody, everywhere and forever.

Qualitative methodologies are intentionally non-scientific and non-experimental.

Instead, they are observational, exploratory studies, almost always retrospective or
cross-sectional. They could also investigate immediate experience. For qualitative
researchers, knowledge is about understanding how people makes sense of their
experiences. Later in this semester we shall look further at the reasoning behind
qualitative methodologies and how data from qualitative studies are analysed.

Glasson, J. B., Chang, E. M., & Bidewell, J. W. (2008). The value of participatory action
research in clinical nursing practice. International Journal of Nursing Practice, 14, 34-39.
doi: 10.1111/j.1440-172X.2007.00665.x

Glasson, J., Chang, E., Chenoweth, L., Hancock, K., Hall, T., Hill-Murray, F., & Collier, L. (2006)
Evaluation of a model of nursing care for older patients using participatory action research in
an acute medical ward. Journal of Clinical Nursing, 15, 588-598. doi: 10.1111/j.1365-
2702.2006.01371.x

Lea, E., Andrews, S., Hill, K., Haines, T.; Nitz, J., Haralambous, B., Moore, K., & Robinson, A.
(2012). Beyond the 'tick and flick': Facilitating best practice falls prevention through an action
research approach. Journal of Clinical Nursing, 13/14, 1896-1905.
doi: http://dx.doi.org/10.1111/j.1365-2702.2012.04121.x

NMRMC (2009). NHMRC additional levels of evidence and grades for recommendations for
developers of guidelines: Stage 2 consultation. Retrieved 21 February, 2013 from
http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/stage_2_consultation_levels_and_grad
es.pdf

Salkind, N. J. (2012). Exploring research. Boston: Pearson.

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