Reserch PPT by Bisrat 2

WOLKITE UNIVERSITY
COLLEGE OF HEALTH SCINCES

DEPARTEMNT OF NURSING
NURSING RESERCH METHEDOLOGY
By
Bisrat Zeleke (Bsc.N, Msc.N Ass’t prof)
Course outline
– Course title: Nursing Research Methodology
– Program: Nursing
– Course code: Nurs 2103
– Degree Program: BSc Nursing
– Module Name: Health system research
– ECTS credits: 3 ECTS
– Contact hours: 32 hrs
– Target Group: BSC nursing students
– Year: III
– Status of the course: Major
– Pre-requisite: Biostatistics and epidemiology
Reserch Methedology By:- Bisrat Zeleke
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Course outline…..
Course description
– This course is intended to equip the health officer

students with a basic working knowledge of health
research methods. It also gives the trainee an
acquaintance with research proposal writing,
critical appraisal of scientific paper and application
of common statistical packages.

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Course outline…..
Course objectives:
At the end of the course the students will be able to:
– Define research in general and health systems research in
particular
– List the major types of study designs
– Describe the main issues in the design, conduct and presentation of
a research
– Describe the major components of research proposal and thesis
– Prepare a research protocol and conduct a simple research
– List the major elements that need to be examined when making a
critical assessment of a research paper.
– Demonstrate how to deal with each of these elements with
reference to a published paper
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Course outline…..
Content
Chapter 1 …….. Introduction
Chapter 2 ……….Selecting a research topic
Chapter 3 ……….Problem statement
Chapter 4 ……….Literature review
Chapter 5 ……….Research objectives
Chapter 6 ……….Research methods
Chapter 7 ……….Work plan & Budget
Chapter 8 …….. Research Report Writing & Promoting
Utilization of the Findings
Chapter 9 …….. Critical appraisal of scientific paper

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Course outline…..
Teaching Methods
– Lecture and discussion
– Case study
– Assignments
– Seminar presentation

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Course outline…..
Assessment Methods
– Quizzes -------------------------------------------#1 -------------------- 10 points
– Test ---------------------------------------------- #1---------------------- 20 points
– Individual assignment --------------------------#1 ---------------------- 10 points Submission
Date…… 30/06/13
– Group assignment ----------- # 1-----------10 points
Submission date…… 10/07/13
– Final ------------------------------------50%(Covering all portions)----------- Exam
date 25/06/13
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Course outline…..
Course Policy
• Attendance: It is compulsory to come to class on time and every time. The students
are allowed to attend the class 100%. If you are going to miss one class during the
term without valid reason, you aren’t allowed to seat in the final examination.
• Assignments: You must do your assignment on time. No late assignment will be

accepted.
• Quiz: Quiz will be given randomly at any time in the class room
• Final exam : Will include all portion
• Cheating/plagiarism: Students must do their own work and not copy and get
answers from someone else. Any sort of cheating/plagiarism will result in
disqualification that work and disciplinary measures as per the university’s
legislation
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Course outline…..
References:
Title Author
1. Research methodology for HSS Getu D., Tegbar Y., 2006
2. Research strategies for health WHO, 1992
3. Writing research papers Nelissa walker, 1984
4. Principles and practice of Epidemiology M.Fletcher, 1992
5. Survey research methods Earl R. Babbie, 1973

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Chapter One
Introduction to Research
Methodology
Chapter One
Learning Objectives
After completing this chapter, the student should be able
to:
1. Define research in general and health systems research
in particular
2. Enumerate the characteristics of research
3. Identify the different types of research
4. List the essential features of health systems research
5. Describe the broad divisions (steps) involved in the
research process
6. Explain the roles of research in development
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Chapter One
– Research is a systematic collection, analysis and
interpretation of data to generate new knowledge
and answer a certain question or solve a problem.
– Research is a systematic inquiry that uses

disciplined methods to answer questions or solve
problems.
– The ultimate goal of research is to develop, refine,

and expand a body of knowledge.
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Chapter One….
– Research is the systematic collection, analysis and
interpretation of data to answer a certain question
or solve a problem or add body of knowledge.
– Research is the systematic investigation into and

study of materials, sources, etc, in order to
establish facts and reach new conclusions.

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Chapter One….
Therefore, Research is
An approach in obtaining a solution for a problem.
Necessary to generate new knowledge and technologies

to solve problems.
Essential for guiding action.
Necessary to identify priority problems, design and

evaluate policies and programs

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Chapter One….
– Research is what we do when we have a question or a problem we
want to resolve
– We may already think we know the answer to our question already
– We may think the answer is obvious, common sense even But until
we have subjected our problem to rigorous scientific scrutiny, our
'knowledge' remains little more than guess work or at best
intuition.

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Chapter One….
Characteristics of research
– Originates with a question or problem.
– Requires clear articulation of a goal.
– Follows a specific plan or procedure.
– Often divides main problem into sub problems.
– Guided by specific problem, question, or hypothesis.
– Accepts certain critical assumptions.
– Requires collection and interpretation of data.
– Cyclical in nature.
Research must be: Purposeful, Targeted,

Credible and Timely
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Chapter One….
It demands a clear statement of the problem
 It requires a plan
 It builds on existing data, using both positive and
negative findings
 New data collected as required and be organized so
that they answer the original research question(s)

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Research = Identifying Problems & Designing
Appropriate Action
Established methods must be used in both!!

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Chapter One….
Health Research
– Health research is the application of principles of
research on health
– Health research has been broadly defined as the

generation of new knowledge using the scientific method
to identify and deal with health problems
– Health Research is a systematic collection, analysis and

interpretation of data to solve a health problem.

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Chapter One….
Research that supports health development is known
as Health Systems Research.
Health system Includes :
1. The individual, family and the community with its socio-
cultural context
2. Health care services - private and Public (governmental)
sector - Health workers, health institutions, etc.
3.Health related sectors : education, agriculture,
etc.
4.The international sector (bilateral) and multilateral
donor agencies,
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Chapter One….
The ultimate goal of research in health is
– To modify the natural history of disease
– To prevent or delay, death or disability and
– To improve the health of a patient population or

the community

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Chapter One….
Types of Health Research
1. Based on Functions:
– Basic/fundamental…………..(building knowledge)
undertaken to extend the base of knowledge in a
discipline, or to formulate or refine a theory.
– Applied /action/operational……..(solution to
problems) Applied research focuses on finding
solutions to existing problems.

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Chapter One….
2. Based on population:
Biomedical, clinical…………….individual
Epidemiologic, health services research

….population

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Chapter One….
3. Based on philosophical approach:
Empirical : based upon observation and

experience
Theoretical: based upon theory and abstraction
• Empirical research in the health sciences can be qualitative or

quantitative in nature.

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Chapter One….
Quantitative research:
– Is based on the measurement of quantity.
– Involves the generation of data in quantitative form
• E.g: prevalence of smoking
Qualitative research:
– Is concerned with subjective assessment of attitudes,
opinions and behavior.
– Is concerned with qualitative phenomenon, a phenomena

relating to or involving quality or kind.
• Eg. What people think, feel, about health effects of smoking…
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Chapter One….
Essential Features for successful HSR
– Focus on priority problems.
– Action oriented -aimed at developing solutions.
– Multidisciplinary approach (from many disciplines)
– Participatory in nature (from policy makers to community members)
– Must be timely.
– Simple, short-term designs.

– Cost-effectiveness
– Results presented in formats most useful for administrators, decision-

makers and the community.

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Chapter One….
Nursing research
– Is systematic inquiry designed to develop knowledge about
issues of importance to the nursing profession, including
nursing practice, education, administration, and informatics.
– Is systematic inquiry to develop knowledge about issues of

importance to nurses.
– Nurses are increasingly engaged in disciplined studies that

benefit the profession and its patients, and that contribute
to improvements in the entire health care system.

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Chapter One….
The Importance of Research in Nursing
– To adopt an evidence-based practice (EBP), which
is broadly defined as the use of the best clinical
evidence in making patient care decisions.
– Help to eliminate nursing actions that do not

achieve desired outcomes.
– Help nurses to identify practices that improve

health care outcomes and contain costs as well.
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Chapter One….
Enables nurses to
– Describe the characteristics of a particular nursing
situation about which little is known;
– To explain phenomena that must be considered in

planning nursing care;
– To predict the probable outcomes of certain nursing

decisions;
– To control the occurrence of undesired outcomes; and to

initiate activities to promote desired client behavior.
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Chapter One….
– Nursing research began with Florence Nightingale but
developed slowly until its rapid acceleration in the 1950s.
– Since the 1970s, nursing research has focused on problems

relating to clinical practice.
– The National Institute of Nursing Research (NINR), established

at the U.S. National Institutes of Health in 1993, affirms the
stature of nursing research in the United States.
– Future emphases of nursing research are likely to include

outcomes research, research utilization projects, replications of
research, multisite studies, and expanded dissemination efforts.
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Chapter One….
Users of Research
The users of the research outputs fall broadly into 3 groups with
– Operational research being predominantly, but not

exclusively, of use to health care providers;
– Implementation research predominantly of use to

managers of programmes scaling up an intervention
– Health systems research of most use to those who

manage or need to make policy for the health system.

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Chapter One….
Steps involved in the research process
– Identifying a problem
– Preparing a research proposal
– Fieldwork (i.e., data collection)

– Analyzing data and preparing a research report
– Dissemination and
– Application of results
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Planning
Problem research
identification
Implementing
research
Applicati
on
Disseminatin
g
findings
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Chapter One….
Components of a Research Proposal
1. Preliminary part
– Cover page/ Title pages (2)
– Acknowledgement
– Table of Contents
– List of Tables
– List of Figures
– Acronym/ Abbreviation
– Abstract / Summary (background, objective/aim, method, key words,
budget summary )
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Chapter One….
2. Body of the report
Chapter one
INTRODUCTION
 Background information
 Statement of the problem
Chapter two
 Literature review
 Conceptual/theorotical framework
 Justification of the study / Significance of the study
Chapter Three
OBJECTIVES/ Hypothesis
 General objective
 Specific objectives
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Chapter One….
Chapter Four
METHODOLOGY/ Method and Materials
 Study area and period
 Study design/ type
 Population (source population, study population, study unit)
 Inclusion and exclusion criteria
 sample size determination
 sampling techniques/sampling procedure
 Plan for Data collection procedures (instrument, personnel, data quality
control)
 Plan for data processing and analysis
 variables of the study
 Operational definition (if any)
 Data quality control management/ techniques
 Ethical consideration
 Dissemination plan
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Chapter One….
Chapter Five
WORK PLAN
Chapter Six
BUDGET
References

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Chapter One….
3. Supplementary part
Annex
- Data collection instruments (questionnaire, interview guide)
- Written consent form
- Standard procedures (if applicable)
- Case definition or staging/diagnostic criteria (if applicable)

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Chapter One….
Components of a Research Thesis
1. Preliminary part
– Cover page/ Title pages (2)
– Abstract / Summary (background, objective/aim, method, result,

conclusion & recommendation, key words, budget summary)
– Table of Contents
– List of Figures
– List of Tables
– Acknowledgement

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Chapter One….
Chapter one
INTRODUCTION
 Background information
 Statement of the problem
Chapter two
 Literature review
 Justification of the study / Significance of the study
Chapter Three
OBJECTIVES/ Hypothesis
 General objective
 Specific objectives
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Chapter One….
Chapter Four
METHODOLOGY/Method and Materials

 Study area and period
 Study type/design
 Population (source population, study population, study unit)
 Inclusion and exclusion criteria
 Sample size determination
 Sampling techniques/sampling procedure
 Data collection procedures (instrument, personnel, data quality control)
 Data processing and analysis
 Variables of the study
 Operational definition (if any)
 Data quality management
 Ethical consideration
 Dissemination plan

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Chapter One….
Chapter Five
Results
Chapter Six
Discussion
Chapter Seven
Conclusion and Recommendation
References
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Chapter One….
3. Supplementary part
Annex
 Data collection instruments (questionnaire, interview guide)
 Written consent form
 Standard procedures (if applicable)
 Case definition or staging/diagnostic criteria (if applicable)
Declaration
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Chapter Two
Selecting a research topic

Chapter Two
Learning objectives
After completing this chapter, the student should be able to:
1. Examine the cyclical nature of the development of a research
proposal
2. Describe the principles underlying whether a problem situation is

researchable.
3. List the criteria for selecting a research topic.
4. Identify and select his/her own topic (health problem) for research
based on certain guidelines.
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Chapter two….
– The development of a health project goes through a
number of stages.
– Formulation of the research proposal is the major

task in the process of developing a research project.
– The proposal draws on all the preparatory steps of

the research process and pulls them together in a
document describing the rationale and the
methodology proposed for research.
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Chapter two….
– If the answer to the research question is obvious,
we are dealing with a management problem that
may be solved without further research.
– A number of research questions could be

presented that may be posed at the various levels
of the health system.

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Chapter two….
Problem identification
Whether a problem requires research depends on
three conditions:
 There should be a perceived difference or discrepancy
between what it is and what it should be;
 The reason(s) for this difference should be unclear; and
 There should be more than one possible and plausible

answer to the question (or solution to the problem).

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Chapter two….
Example1:
– Problem situation: In district “ Y “ there are 1 hospital, 2 health centers and 10

health stations but only 2 health stations were functioning and a report showed
that in the first month there were 500 children under one year old who started
immunization, but at the end of the year it was found out that there were only 25
children who completed their vaccination.
– Discrepancy: All the 500 children at district “Y “should have completed their
vaccination but only 5% out of those who started vaccination have completed.
– Problem (research) question: why only 5% of the children completed their

vaccination?
– Definite answer: Out of the 1 hospital, 2 health centers and 10 health stations
found in district “Y” only 2 health stations were functioning, the rest were
closed
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Chapter two….
– Is it researchable or not??????
– In the above example, assuming that all the given

facts are true, there is no need of undertaking a
research, since definite answer is obtained to the
problem situation.

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Chapter two….
Example 2:
– Problem situation: In district “Z” (population 150,000)
there are 2 health centers, 1 hospital and 15 health stations
and all of them function smoothly. However, at the end of
the year it was found that the EPI coverage was only 25%.
– Discrepancy: Although district “Z” had 100% availability of

health services and at least 80% of the children should have
had full vaccinations the EPI coverage was only 25% as seen
above.
– Problem question: What factors influence the low EPI

coverage in district “Z”?
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Chapter two….
– Possible answers:
 Mothers might have problems for not attending in the EPI
sessions.
 The MCH, EPI, OPD etc… programmes might not have

been integrated; hence children might have missed
opportunities in getting immunization.
 The follow up of defaulting children might not be effective

– Is it researchable or not???
– Thus, the above problem situation is researchable.

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Chapter two….
Criteria for selecting a research topic
1. Relevance: The topic you choose should be a priority
problem: e.g. Magnitude, severity, who is affected???
2. Avoidance of duplication: Investigate whether the topic
has been researched
3. Feasibility: Consider the complexity of the problem and
the resources you will require to carry out the study
4. Political acceptability: It is advisable to research a topic
that has the interest and support of the authorities.
5. Applicability of possible results and recommendations
6. Urgency of data needed
7. Ethical acceptability
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SCALES FOR RATING RESEARCH TOPICS
Relevance Political acceptability

1= Not relevant 1= Topic not acceptable to high level policymakers
2= Topic more or less acceptable
2= Relevant 3= Topic fully acceptable
3= Very relevant Feasibility
Avoidance of duplication 1= Study not feasible, considering available
1= Sufficient information already resources
available 2= Study feasible, considering available resources
2= Some information available but major 3= Study very feasible, considering available
resources
issues not covered Applicability
3= No sound information available on 1= No chance of recommendations being
which to base problem-solving implemented
Urgency 2= Some chance of recommendations being
implemented
1= Information not urgently needed
3= Good chance of recommendations being
2= Information could be used right away implemented
but a delay of some months would Ethical acceptability
be acceptable 1= Major ethical problems
3= Data very urgently needed for 2= Minor ethical problems
decision-making 3= No ethical problems
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Chapter two….
Research Title
• The research title should be specific and clear.
• The topic should clearly indicate the WHO/WHAT, WHEN, WHY,
WHERE and HOW.
• It is the focus of your research.
– A good title is usually a compromise between conciseness and
explicitness.
– Titles should be comprehensive enough to indicate the nature

of the research.
– One good way to cut the length of titles is to avoid words that
add nothing to a reader's understanding, such as "Studies
on...," "Investigations...," or "Research on Some Problems in...."
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Chapter two….
Title:
 The title should be written in a way that:
 Indicate study subjects, study design, study area, objective of the study
and study period
 Word length on average (5-14)
Have two title pages
 First title page contains
 The tile of the study, name of the researcher(s) with his/her title, name of
Department to be submitted/institution with date of submission
Second title page
 In addition to those things in the 1 st page, name of the advisors and examiners will also
included here.
 Not more than 20 word
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Chapter two….
Exercises
1. In a certain district (population, 150,000), sanitary
conditions are very poor (only 5% of households have
latrines) and diseases connected with poor sanitation,
such as, gastroenteritis and worms are very common.
The Ministry of Health has initiated a sanitation project
that aims at increasing the number of households with
latrines by 20% each year. The project provides materials
and the population should provide labour. Two years
later, less than half of the target has been reached.
– State the discrepancy, research question and the possible
answers.
– Is this problem situation researchable?
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Chapter two….
2. Walk around and identify three health problems in the
university compound. Discuss about these health
problems and rate them based on the selection
criteria.
3. Write a research topic/title for the priority problem

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Rating scale: 1 = low, 2 = medium, 3 = high
Criteria for selecting a Research Topic

Proposed topic
Health problem I Health problem II Health problem III
Relevance
Avoidance of duplication
Feasibility
Political acceptability
Applicability
Urgency of data needed
Ethical acceptability
Total

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Chapter Three
Problem statement
Chapter Three
Learning objectives
After completing this chapter, the student should be able to:
1. Describe the advantages of a systematic analysis of a
problem
2. Describe the importance of a clear statement of a problem
3. Enumerate the points that should be included in the

statement of a problem

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Chapter three…..
Analyzing the problem
 A systematic analysis of the problem, completed
jointly by the researchers, health workers, managers,
and community representatives is a very crucial step
in designing the research because it:
 Enables those concerned to bring together their knowledge
 Clarifies the problem and the possible factors that may be

contributing
 Facilitates decisions concerning the focus and scope of the

research.
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Chapter three…..
Formulating the problem statement
After identifying, selecting and analyzing the

problem, the next major section in a research
proposal is “statement of the problem”
The overall objective of statement of the problem

is to justify why we are doing study

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Chapter three…..
Why is it important to state and define the problem
well?
Because a clear statement of the problem:
Is the foundation for the further development of the research
proposal (research objectives, methodology, work plan, etc);
Makes it easier to find information and reports of similar

studies
Enables the researcher to systematically point out why the

proposed research on the problem should be undertaken
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Chapter three…..
A health problem selected to be studied has to be justified in
terms of its:
Being a current and existing problem which needs solution
Being a widely spread problem affecting a target population
Effects on the health service programmes
 Being a problem which concerns the planners, policy

makers and the communities at large

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Chapter three…..
Information included in the statement of a
problem
A brief description of socioeconomic and cultural
characteristics and an overview of health status.
A more detailed description of the nature of the
problem
• Basic description of the research problem
• The discrepancy between what is and what should be
• Its size, distribution, and severity (who is affected,
where, since when, etc.)

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Chapter three…..
• An analysis of the major factors that may influence the problem and a
convincing argument that available knowledge is insufficient to answer a
certain question and to update the previous knowledge.
• A brief description of any solutions that have been tried in the past, how
well they have worked, and why further research is needed.
• A description of the type of information expected to result from the

project and how this information will be used to help solve the problem
• Why further research is needed
• If necessary, a short list of definitions of crucial concepts used in the

statement of the problem.
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Chapter Four
Literature Review
Literature Review
Learning objectives
– After completing this chapter, the student should be able to:
1. Describe the reasons for reviewing available literature
and other information during the preparation of a
research proposal.
2. Describe the resources that are available for carrying out

such a review.
3. Record (organize) information obtained from literature on

an index card.

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Literature Review…..
 A literature review is a systematic ,explicit & reproducible
method for identifying, evaluating & synthesizing the
existing body of completed & recorded work produced by
researchers, scholars & practitioners.
 It discusses published information in a particular subject

area.
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 A literature review is the effective evaluation of selected
documents on a research topic.
 In the context of a research paper or thesis the literature

review is a critical synthesis of previous research.
 The evaluation of the literature leads logically to the research

question.
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A .‘good’ literature review….. A ‘poor’ literature review is…
….. is a synthesis of available research …..an annotated bibliography
….. is a critical evaluation ….. confined to description

….. has appropriate breadth and depth
….. narrow and shallow
….. has clarity and conciseness
….. confusing and longwinded
….. uses rigorous and consistent methods
….. constructed in an arbitrary
way
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Purpose
 Provide you with a handy guide to a particular topic.
 Provide a solid background for a research paper's investigation.
 It prevents you from duplicating work that has been done before.
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 It increases your knowledge on the problem you want to study and
this may assist you in refining your "statement of the problem".
 It gives you confidence why your particular research project is

needed.
 To be familiar with different research methods
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 The purpose of a literature review is for you to take a critical

look at the literature (facts and views) that already exists in
the area you are researching.
 A literature review is not a shopping list of everything that

exists, but a critical analysis that shows an evaluation of the
existing literature and a relationship between the different
works.
 It demonstrates the relevance of the research.
LR by Ayele S 76
In a broader context Hart (1998) lists the following
purposes of a review:
– Distinguishing what has been done from what needs to be
done;
– Discovering important variables relevant to the topic;
– Synthesizing and gaining a new perspective;
– Identifying relationships between ideas and practice;
– Establishing the context of the topic or problem;
77
– Rationalizing the significance of the problem;
– Enhancing and acquiring the subject vocabulary;
– Understanding the structure of the subject;
– Relating ideas and theory to applications;
– Identifying methodologies and techniques that have been used.
78
– Describe the relationship of each work to the others under
consideration
– Identify new ways to interpret, and shed light on any gaps in,
previous research
– Resolve conflicts amongst seemingly contradictory previous

studies
– Identify areas of prior scholarship to prevent duplication of effort

79
Some examples of resources where information could be
obtained are:
 Clinic and hospital based data from routine activity statistics
 Local surveys, annual reports
 Scientific conferences
 Statistics issued at region and district levels
 Articles from national and international journals (e.g., The
Ethiopian Journal of Health Development, The Ethiopian
Medical Journal, The East African Medical journal, The Lancet,
etc.)
 Internet
 Documentation, reports, and raw data from the Ministry of
Health, Central Statistical Offices, Nongovernmental
organizations, etc.
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Sources of information
 Journal articles: these are good especially for up-to-
date information.
 Books: books tend to be less up-to-date as it takes

longer for a book to be published than for a journal
article.
N.B Text books are unlikely to be useful for

including in your literature review as they are
intended for teaching.
81
 Conference proceedings:
 These can be useful in providing the latest research, or
research that has not been published.
 They are also helpful in providing information on which

people are currently involved in which research areas.
82
 Newspapers/Magazines:
Since they are intended for a general (not specialized)
audience, the information they provide will be of very limited
use for your literature review.
Often they are more helpful as providers of information about
recent trends, discoveries or changes.
 Government/corporate reports:
Their published findings can provide a useful source of
information, depending on your field of study.
83
 Theses and dissertations:
 Can be useful sources of information. However there are
disadvantages:
 They can be difficult to obtain since they are not

published.
 The student who carried out the research may not be

an experienced researcher and therefore you might
have to treat their findings.
84
Internet:
 The fastest-growing source
 It is impossible to characterize the information available
but here are some hints about using electronic sources:
Internet Search tools
Gateways
Databases eg. PubMed (database)
Search Engines eg.www.scholar.google.com,
Yahoo
Search widely: Library, Electronic search engines, Grey literature
85
TYPES OF LITERATURE REVIEW

I. Integrative - draw conclusions from past studies to present
state of knowledge concerning the topic.
II. Theoretical - summarizes all the existing theories used to

explain a particular topic and examine them in terms of
major content areas, similarities, differences, and accuracy
in prediction.
86
III. Methodological - aims to identify the strengths and weakness

of different study designs for a particular topic and explain to
which extent differences in findings are the results differences
in designs.
IV. Policy-oriented - summarizes current knowledge of a topic so

as to draw out policy implications of study findings.
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CARRYING OUT A LITERATURE SEARCH
 It outlines good practice in how to undertake a
literature search i.e., how to:
o Set search parameters
o Identify appropriate databases
o Write the search strategy and
o Record the results.
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CARRYING OUT LR
• After collecting the required information, the
investigator should decide in which order he/she
wants to discuss previous research findings:
 From global to local

 From broader to focused
 From past to current
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First, cover the basic categories
 Just like most academic papers, literature reviews must contain

at least three basic elements:
a) An introduction or background information section.
b. Body of the review containing the discussion of sources and
c. Conclusion and/or recommendations section to end the paper.
90
Steps for Writing a Literature Review
1. Planning: What Type of Literature Review am I Writing?
Focus, type, scope, Academic Discipline, etc
2. Reading & Research: What Materials am I Going to Use?
Collect and read material,
Summarize sources
Select only relevant books and articles.
3. Analyzing: How Do I Assess Existing Research?
A literature review is never just a list of studies—it always
offers an argument about a body of research.
Four Analysis Tasks: Summarize, Synthesize, Critique,
compare
4. Drafting: What Am I Going to Write? Organizing
 Five common approaches to organize: Topical/Thematic,
Distant to close, Debate, Chronological, Seminal Study
5. Revising: How Can I modify My Draft?
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Ethical considerations
• Careless presentation and interpretation of data may put readers
who want to use the study’s findings on the wrong track
• The presentation of research results or scientific publications

from other writers without quoting the author may take to court
• Therefore, appropriate referencing procedures should always be

followed in research proposals as well as in research reports.
92
Conceptual Maps
• A conceptual map is simply a diagram of the concepts

and relationships expressed in a theoretical/conceptual
framework.
• A conceptual map is an efficient way to communicate

what is known about a phenomenon more clearly than
a verbal description
Saturday, May 22, 2021 93
Conceptual Maps …
– Conceptual maps contain all the concepts of a theory.
– Arrows indicate the proposed direction of the

relationships among the concepts.
– Conceptual maps should be supported with references

from the literature.

Conceptual map….
Example
– Health Workers Job Satisfaction and Factors affecting
their Satisfaction Level (title)
– Dependant and independent variables are identified as

job satisfaction level and (Socio-demographic
characteristics, Motivation factors, Management
condition, Staff relationship, and Resource &
material) Respectively.
– Conceptual framework relates these two variables

diagrammatically as follows:
Conceptual frame work
Motivation factors
Socio-demographic House
characteristics Incentives (top up)
Sex Free health care
Age Farther education
Marital status Training
Service year
Professional category
Job satisfaction level

Management
condition Resource &
Staff involvement in material
decision making Medical
Recognition for task instruments
well done Medical reagents
Co-operation between Staff relationship Essential drug s
managers &staff Working relation ship Infrastructures
Job description. Colleagues support Salary
Theoretical frameworks
– Are brief descriptions of a theory, or portions of a theory, to
be tested in a research project.
– Theoretical framework describes the basic structure of ideas

(i.e., theories, concepts, propositions) within which the
study is to be conducted and the results interpreted (Diers,
1979).
– It is description of existing theory relevant to the

phenomena under investigation, based on a review of the
literature
Theoretical frameworks.…
• Serves as a guide to systematically identify

precisely defined relationships among variables.
• Theoretical framework provides a rationale for

predictions about the relationships among
variables of a research study

Chapter Five
Research Objectives
Chapter Five….
Learning objectives
After completing this chapter, the student
should be able to:
1.Describe the need for the development of
research objectives
2. Differentiate between general and specific
objectives
3. Formulate specific objectives and hypotheses

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Chapter Five
General objectives:
 Is the aim of the study in general terms
 Summarizes what is to be achieved by the study
 Should be clearly related to the statement of the problem.
Eg. “To assess missed opportunities for EPI in Addis Ababa”.
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Chapter Five….
Specific objectives:
Logically connected parts of the general objective
Focus the study on the essentials
Direct the design of the investigation
Orient collection, analysis and interpretation of

the data

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Chapter Five….
Example:
– To find out the magnitude of missed opportunities
for children who attend OPD, MCH, CDD, etc. in
Addis Ababa,
– To examine the reasons for children not being

immunized while attending the OPD, MCH, CDD,
etc. services.

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Chapter Five….
Criteria for setting research objectives
 Focused, each covering a single point
 Ordered in a logical sequence
 Realistic and feasible to answer
 Operational, using action verbs such as:
– determine - verify -identify
– describe - assess - compare
– calculate - establish -explore
 Measurable outcomes at the end of the research

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Chapter Five….
Avoid the use of vague non-action verbs such as;
– To appreciate
– To understand
– To study
– To believe

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Chapter Five….
Importance of developing objectives
– Focus the study
– Avoid the collection of data which are not strictly
necessary
– Properly formulated specific objectives facilitate
the development of research methodology and
help to orient the collection, analysis,
interpretation and utilization of data.
– Helps for evaluating the project
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Hypothesis Vs Research questions
• A hypothesis requires sufficient knowledge of the problem to

be able to predict relationships among factors which then can
be explicitly tested.
• Research questions are formulated when the investigators do

not have enough insight into the problem being studied.
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Chapter Six
Research Report Writing and

Promoting Utilization of the
Findings
Chapter Six
Objective of the Session
At the end of this session we hope that students will be able to:
 Understand and explain what a research report is
 Know how to write research report in the actual setting
 Identifying the components and formats of research report
writing
 Identifying the barriers for research finding utilization
 How to promote research finding for utilization
 Knowing ways of research dissemination to target audiences
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Chapter Six….
Research communication:
 The process of sharing research findings to the target
audiences with appropriate channels to influence
decision makers and to boost up the existing knowledge.
 There are two types research communications

 Written communication/report writing
 Oral communication/presentation
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Chapter Six….
Research Report:
 A written document that communicates the purpose, rational

of the study , objective(s), hypotheses, methodology, findings,
limitations and finally, conclusion and recommendations of a
research project to others in written document
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Chapter Six….
Why research report is needed?
• To share Knowledge and innovative findings
• To provide input for decision makers during
 Policy formulation
 Planning and assessment
 Intervention or implementation
 Monitoring and Evaluation
• To get comments and improve our work
• To show gaps that need further investigation
• To convince others about the issue of interest
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Chapter Six….
Types of research repot
 The basic orientation of a research report depends on its
audience.
 Before writing the report the researcher must know his or her
audience.
 The researcher may have to make assumptions about the

composition, background and interests of the target audience .
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Chapter Six….
• Based on our audience there are two major research reports:
A. Technical report
B. Management report
A) Technical report:
 Written for an audience of research community.
 Technical reports has two types:
1. Long technical reports
2. Short technical report
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Chapter Six….
A long technical report
 A long technical report include a full presentation and analysis of

the data and details.
 This includes introduction , objective ,sources of data, study design

research procedures, sampling design, sampling techniques ,data-
gathering methods and instruments, analysis methods, results
conclusion ,recommendation ,index …
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Chapter Six….
Short technical report

 It is an abbreviated form of long technical reports.
 The purpose of this type of report is to distribute information

quickly in an easy-to-use format
 At the beginning, there should be a brief statement about the

purpose the study, the problem examined, and its depth
followed by major findings, conclusions and recommendations
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Chapter Six….
B. Management reports
– Designed for a non- technical audiences such as policy makers, study
communities etc
– Readers are less concerned with methodological details
– But they are more interested in learning quickly the major findings and
conclusions.
– The style of the report should encourage rapid reading and quick
comprehension of major findings
– Sentences and paragraphs should be short and direct.
– use of visual displays more sound and simplify
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Chapter Six….
Steps of research report writing
• Before we began to start writing of our report we have think over about
the research in terms of the papers objective, our audience and the over
all logical flow of the writing process.
• In general it is better to follow the following steps to write a good report
1. Planning the report writing
2. The actual Report writing
2.1. First draft
2.2. Second draft
2.3. Final draft
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Chapter Six….
 Planning the report writing:
 For whom the research is written, materials needed, what is
the purpose of the report? what is the expected format of the
report? etc…
 First draft:
 Finding, discussion & conclusions has been completed.
Working group members and facilitators should read
critically & forward comments.
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Chapter Six….
 Second draft:
 The authors may prepared a second draft taking in to
considerations all comments that have been made.
 Final draft:
 The facilitators & different groups read the 2nd draft again, then
the final version of the report will be prepared after
incorporating comments.

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Chapter Six….
Generally address the following issues while writing your report:
• Present your finding with logical order
• Editorial aspects-(font size, type, style, indentation etc.)
• Each new section with new page
• Use present tense to report well accepted facts
• Use past tense to describe specific results
• Consider issue of quotations and headings
• Consider capitalization, block, italics
• Put the reference if it is not your finding and idea
Pay attention and do it accordingly throughout the whole document
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Chapter Six….
Components and Formats of Research Report Document
• Generally the components of a formal research report can
be summarized in to three parts:
1. Preliminary parts
3. Supplementary parts
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Chapter Six….
Title:
 The title should be written in a way that:
 Indicate study subjects, study design, study area, objective of
the study and study period
 word length on average (5-10)
 Have two title pages
First title page contains
 The tile of the study, name of the researcher(s) with his/her
title, name of Department to be submitted/institution with
date of submission
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Chapter Six….
 Second title page

 In addition to those things in the 1st page, name of the
advisors and examiners will also included here.
 Not more than 20 word
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Chapter Six….
Acknowledgement:
• We should acknowledge individuals, communities and organization

such as study participants, funding agents, advisors, data sources and
others accordingly
• Acknowledge in the order of General to Specific (community to

individual)
• Acknowledgement shouldn’t exceed 100 words

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Chapter Six….
Contents:
• Includes table of content , list of figures and tables
Table of content:
• Should include all content of the document with their respective
pages and sequential order
• Formatting with heading and sub heading
List of figures and tables:
 Put them with full tile and page numbers in different pages with
order of list of table followed by list of figures
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Chapter Six….
Acronym and abbreviation:

• Mention all the abbreviations and acronyms that you have in your
document
• List them in alphabetical order
• When you write abbreviation or acronyms first you have state the
full form
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Chapter Six….
Abstract
 A short and precise summary of the whole document that contents
introduction (description about the problem) ,objective ,
methods( area, design, sampling technique), pertinent result,
conclusion and recommendation.
 Word length on average 250-400,but it differ from journal to
journal.
 The title abstract should be mentioned at the top
 It’s contents can be written in subheading format or in a full
narration without heading.
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Chapter Six….
Background
• Present general facts, truth and trends in your topic
• Clarify how your work adds important findings
• Try to briefly discuss what is known in the area and the gap that
should be filled by your research.
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Chapter Six….
Statement of the problem:

• It describes the context of the study and identify the general analysis
approach of study
• The overall objective of this part is to justify why we are doing study
We have to address the following issues when we write this section
 Brief description of the socio-economic & cultural characteristics
 Overview of health status and health care system
 Size, distribution, and severity of the problem
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Chapter Six….
 Major factors that influence the problem
 Solutions that have been tried in the past
 How well the solutions worked
 Why further research is needed
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Chapter Six….
Literature review:
 Search widely which are most relevant and recent literates
 Put reference for all reviewed literature
 Include information directly relevant to your study
 There should be logical sequence in writing literature review
 Put in the order of global to local context of the condition in
precise manner
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Chapter Six….
Conceptual Maps
• A conceptual map is simply a diagram of the concepts and
relationships expressed in a theoretical/conceptual framework.
• A conceptual map is an efficient way to communicate what is

known about a phenomenon more clearly than a verbal
description

Chapter Six….
– Conceptual maps contain all the concepts of a theory.
– Arrows indicate the proposed direction of the

relationships among the concepts.
– Conceptual maps should be supported with references

from the literature.

Chapter Six….
Significance of the Study:

• It indicate how your research will refine, revise, or extend
existing knowledge in the area under investigation.
• Talk about implications, how results of the study may

affect scholarly research, theory, practice, educational
interventions, curricula, counseling, policy.

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Chapter Six….
Objective
• We have to state the general and specific objectives clearly
• Should orient the collection, analysis and interpretation of the data
• They should be SMART
 Specific:
 An objective must be specific with a single key result.
 Measurable:
 Allows monitoring and Evaluation
 Action verbs are observable and better communicate
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Chapter Six….
 State by action verbs
– To determine …, To compare…, To verify…, To calculate…,
To describe… etc.
– Do not use vague non-action verbs such as: “To appreciate …
To understand… To believe…”
Attainable
– An objective must be attainable with the resources that are available.
 Result-oriented/Realistic
– The objective should be central to the goals of the system.
 Time specific (bound)
– The objective should be traceable in time period.
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Chapter Six….
Example:
 General objective:
 To identify determinates of institutional delivery service
utilization among reproductive age group women in Jimma
town from February (10-30)/2004 E. c.
 Specific objective
 To identify socio demographical factors that affect intuitional
delivery serve in the above specified period
 To determine the attitude of mothers towards institutional
delivery service in the above specified period
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Chapter Six….
Methods
Study period and area
 Should indicate location of the study area, socio demographic
information, the system under study etc
Study design
 Clearly state(qualitative, quantitative, or both)
 Which specific type from each design should be stated
 Source and study population
 Define the source population where you haven taken study population
 Who are included in your sample to provide data should be specified
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Chapter Six….
 Inclusion and exclusion

 State the parameters for the inclusion and exclusion of study
subjects
 Sample size determination and Sampling procedure
 What type of sample size determination method used(single ,two
population proportion formula…)
 Write the formula and describe each notation in the formula
 Possible assumption if there state them explicitly
 The type of sampling technique and how you apply it during data
collection
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Chapter Six….
 Study Variable
 The dependent(outcome of interest) and independent
variables should be identified and stated clearly
 Data collection methods and tools
 Consider both qualitative and quantitative data collection
techniques based on our design and objective.
 Describe about data collectors, procedures, number of days,
data collection tools and technique.
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Chapter Six….
 Data processing and analysis:

– It is essential that the statistical methods to be used in the investigation are
outlined in detail.
– State the types of analysis procedure that you used
– It is not sufficient to merely state the names of the tests to be used; you
should describe the rationale for your choice of statistical software package
 Quality assurance
 Mentioning the way of quality assuring means such as data training of
data collector, pretesting, ongoing supervision of data collector, cross
checking etc.
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Chapter Six….
Operational definitions
 Define the variable to be observed in the context of your research
 It indicates what specific variables to be observed and interest how they are
interpreted
Ethical consideration
 Ethical committees or institutional review board have to give approval before
research can be undertaken.
 There are four fundamental moral principles: autonomy, non-maleficence,
benefices and justice.
 Plan for Dissemination and Utilization of the findings
 State the way of communication to the respective audience and the way for
utilization of the findings
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Chapter Six….
Result
• Logical description and presentation of the research findings in
relation with our objective.
• It should provide a good combination or triangulation of data from
qualitative(if there is) and quantitative components of the study.
• Different way of data presentation such a tables, graphs, charts should
be used and their legends/keys should be labeled appropriately.
• The data presentation should be self explanatory(answer what, where
and when).
• Consider sub-sections and grouping
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Chapter Six….
Issue that what we have to consider:

 Logical Sequence of presentation of finding
 Start with response rate and socio demographic character
 Information of the problem who, where, when(descriptive)
 Analytical results(cause –effect relations: OR,RR,CI,P
value)
 Tables & figures for individual values & trends
 Make sure numbers consistent with table results.
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Chapter Six….
Discussion
• The research finding should be discussed in relation to our objective which
leads to conclusion.
• Focus on the main result & emphasize on the new findings
• Restate & interpret in comparison with the context of literature review.
• Logical explanation of discrepancies between our findings and what

literatures says.
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Chapter Six….
Limitation of the Study
• State the limitation of your study design and other problems that
encounter during your study
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Chapter Six….
Conclusion and Recommendation

– Based on the findings and our discussion conclusions and
recommendations will be forwarded accordingly
– The recommendation have to consider for whom, by whom

and what will be done, and it should be feasible.
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Chapter Six….
Reference:
– Those references used in the study should be included here
– Be consistent while putting references throughout the
whole document(don’t mix different styles in one
document)
– There are two style of writing references commonly used
1. Vancouver system.
2. Harvard system
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Chapter Six….
Vancouver system
 The most commonly used style/system in writing references
 References are indicated by number consecutively in the order they

are first mentioned in the document
 Each reference number placed in parenthesis, throughout the text
 The sources can be authors, books, journals, Internet references etc
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Chapter Six….
Authors:
 Author(s)’Surname followed by initials. Title of article. Name of
Journal. Year, Volume,(number): the first and last page numbers of
the article.
Example :
 Deressa W, Hailemariam D, Ali A. Economic costs of epidemic
malaria to households in rural Ethiopia. Tropical Medicine and
International Health;2007;12(10):1148-1156.
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Chapter Six….
 List all authors, but if the number exceeds six, give the
first six followed by “et al” (but can vary from journal to
journal)
Example :
 Rose ME, Huerbin MB, Melick J, Marion DW, Palmer AM,
Schiding JK, et al. Regulation of interstitial excitatory amino
acid concentrations after cortical contusion injury.
International journal of Health; 2002;935(2):40-6.
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Chapter Six….
For books with chapters written by individual authors:
 Author(s) of chapter (Surname(s) followed by initials).
Chapter title. In: Editor(s) of book, (Surname(s) followed by
initials) (eds). Title of book. Place, Publisher, Year, Page
numbers of chapter.
Example:
• Gebreyesus AT, Deressa W, Witten KH, Getachew A & SeboxaT.
Malaria. In: BerhaneY, Hailemariam D & Kloos H (eds).
Epidemiology and Ecology of Health and Disease in Ethiopia.
Addis Ababa, Shama Books, 2006, 556–576.
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Chapter Six….
Book titles or and chapter titles:
 Capitalize the first letter of the first word in the title. The rest of
the title is in lower-case.
 Surname and initial of author(s),full title of the book,
place(town)of publication, publisher, year of edition (publication)
and number of edition.
Example:
• Abramson JH. Survey methods in community medicine.
Edinburgh: Churchill Livingstone, 1990, 4th ed.
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Chapter Six….
Journal citations:
• Author(s) last name first. Title of article. Name of journal, year;
volume number: page numbers of article
Example:
 Fantahun M. Factors affecting ANC attendance and
preference of delivery by pregnant women in Gulele woreda.
Ethiop J Health Dev 1992 ; vol 6 (2): 17-22
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Chapter Six….
Internet Sources:
• Author, initials, title, date retrieved (accessed), retrieved from, full
website address.
Example:
• WHO and UNAIDS. Guidance on provider-initiated HIV testing
and counseling in health facilities. Geneva, World Health
Organization,2007 (http://www.who.int/hiv/pub/vct/pitc2007/en,
accessed 1 September 2009).
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Chapter Six….
Harvard(author-date) System.
• This system uses the author's name and date of publication in the
body of the text, and it is listed alphabetically by author name on
the reference page.
• Last name of the author, year of publication and number (s) of

page(s) referred to between brackets
Example :
(Kebede 1988: 15-17).
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Chapter Six….
Appendices:
• For those who needs details of our research
• Placed following the reference section and it can contain
• Data collection tools(original and local version)
• Ethical review clearance
• Consent form of study subjects
• Map of the study area
• Biographical data of (CV) of the PI and collaborative
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Chapter Six….
Research utilization:
 The stage where by research findings are used for decisions
making during policy formulation, resource allocation,
planning and management, program systems development and
strengthening and adaption of science and technology.
 Needs multi desplenary efforts and coordination's to change
findings in to practice .
 Despite its indispensable role for decision making, many
researches remains on the shelf due to several reasons.
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Chapter Six….
Disseminations of Research Findings
• Communication of research findings to the concerned community
members through the available and appropriate channels.
• Dissemination strategies must be incorporated into the earliest

planning stages of a research study.
• Since dissemination of key findings upon project completion is
a crucial step in research process.
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Chapter Six….
Importance of Dissemination
– Advancement of scientific knowledge.
– Developing evidence-based practice
– Increase the access for research
– Planning for change and innovation
– Promote research finding implementation
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Chapter Six….
Dissemination Plan
• Developing a dissemination plan will facilitate the translation of your
research into practice,
• The researchers should consider issues such as:
 Specify research findings
 Identifying end user/audiences
 Knowing dissemination partners
 Assess available communication channels
 Setting monitoring and evaluation means
Develop dissemination work plan
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Chapter Six….
Dissemination Channels
 Dissemination channels depends on the target audiences
 Potential target audiences can be divided into three
1. Research community:
 Includes scientists or who share similar research interest and experience.
 Technical aspects such as research design, sampling methods, statistical
details etc. gives due attention
 Appropriate dissemination channels :
o Journals articles
o Conference presentation at different levels
o Books ,internet etc.
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Chapter Six….
2. Stakeholders
 Are those who provide funding for research or have a key role to play in
implementing research finding.
 Less technical terms, but more details and explanation on the result,
discussion, conclusion and recommendation.
 Appropriate dissemination channels:
o Research proposal
o Lectures, seminars, and workshops
o Direct mail in the form of letters to local authorities, and policymakers.
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Chapter Six….
3. Public
 Are those who are neither researcher nor stakeholder.
 They are encompasses study participants, source population in the
study area
 The first priority in any dissemination plan is returning results to
study participants.
 Appropriate dissemination channels:
 Posters ,flyers, Brochures
 Presentations at community meetings.
 Press Releases, news paper ,radio ,TV etc.
 Exhibits in popular community venues.
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One
●
Researchers tell the Truth, so
●
Don't Fabricate
data's/findings
Two Policy makers don’t make

●
decision Without evidence
Three Research is an Engine

●
for development !!!

As a researcher you should be genuine where ever when ever whatever the
case you have!
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Chapter seven
Methodology
Chapter seven
Methodology
– Indicates the methodological steps you will take

to answer every question or to test every
hypothesis or problem stated in your study.
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Chapter seven….
Study design
– A study design is a specific plan or protocol for conducting the
study, which allows the investigator to translate the conceptual
hypothesis into an operational one.
– A study design is the model that guides researchers on how to

collect, analyze and interpret studies.
– It is a logical model that guides the investigator in the various

stages of the research.
– Several classifications of study types are possible, depending on

what research strategies are used.
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Types of epidemiological study designs
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Types of Epidemiological Studies
Populations Ecologic
Descriptive Case-series
Individuals
Cross-sectional
Case-control
Observational
Prospective
Cohort
Analytical
Retrospective
Intervention Clinical trials

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Hierarchy of Epidemiologic Study Design
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Descriptive studies:
Case reports and case series, Ecological studies, Cross-sectional(Prevalence)

– They are studies that describe the patterns of disease occurrence and other
health-related conditions by person, place and time.
– Personal variables include: basic demographic factors, such as age, sex,

marital status , as well as the consumption of various types of food or
medication use.
– Place variables refer to the geographic distribution of disease, including

variation among countries or within countries, such as between urban and
rural areas.
– With regard to time, descriptive studies may examine seasonal patterns in

disease onset and other classifications of period of time.
Chapter seven….
Advantages of descriptive studies
They can be done fairly quickly and easily,
Important for hypothesis generation
 Allow planners and administrators to allocate

resources
Provide the first important clues about possible

determinants of a disease or health problems

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Types of descriptive studies
I.Case reports and case series
– Detailed report of a single patient (case report) or a group of

patients (case series) with a given disease
– Document unusual medical occurrences
– Gives the first clues in the identification of new disease and

adverse effects of exposures
– An important link between clinical medicine and epidemiology
– Most common types of studies

Chapter seven….
Case reports and case series played a role in the early

recognition of AIDS
– In 1980 and 1981, five cases of Pneumocystis carini
were reported among young homosexual men in Los
Angeles. Previously it occurred in older cancer patients
with compromised immunity
– In 1981, large number of cases of Kaposi’s sarcoma

happened in young homosexual men. Previously this
exclusively occurred in elderly men and women equally

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Chapter seven….
Advantages
– Important link between clinical medicine and epidemiology.
– One of the first steps in outbreak investigation.
– Often useful for hypothesis generating and examining new
diseases.
Disadvantages
–Can’t be used to test hypotheses
–Based on the experience of one or few people
–Lacks comparison group

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Chapter seven….
II. Ecological / correlational studies

– The unit of observation is the entire population to compare
disease frequency between different groups during the
same period of time or in the same population at different
points in time.
– Comparison of rates (morbidity or mortality) across

geographical areas (or regions).
– Example: Countries with low cigarette consumption have

lower lung cancer
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Chapter seven….
Limitations of Ecological studies
Since it refer to whole populations rather than to

individuals, it is not possible to link an exposure to
occurrence of disease in the same person/Ecological
fallacy.

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Chapter seven….
Advantages:
– Useful for the formulation of hypotheses
– Quick and inexpensive
– Often use already available information
Disadvantages:
– Based on averages and may miss actual contributing
factors
– Unable to link exposure with disease at individual level
– Lack of ability to control for potential confounders
– Presence or absence of correlation does not imply
valid statistical association
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III. Cross-sectional(Prevalence) studies
– It provides information concerning the situation at a given

time.
– The status of an individual with respect to the presence or
absence of both exposure and disease is assessed at the same
point in time.
– Usually involve collection of new data.
– In general, measure prevalence rather than incidence
– Presence or absence of both exposure and disease is assessed
– Provide “snapshot” of health experience
Chapter seven….
Limitations of cross-sectional study
– Not good for studying rare diseases or diseases with short

duration
– Also not ideal for studying rare exposures.
– “Chicken and egg dilemma” /temporal inference problem

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Cross-sectional study can be either analytical or descriptive.
– If data are collected both on exposures and outcomes of

interest, and analyzed demonstrate differences, then this is
an analytical cross-sectional study.
– If the data collected are purely of a descriptive nature,

without comparison of groups formed on the basis of
exposure or outcome status, then this is a descriptive cross-
sectional study.
Summary

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Summary
Descriptive Studies
• Describe the general characteristics of the occurrence and distribution
of a disease:
– Person
– Place
– Time
• Not aimed to test hypothesis
• Frequently encountered approach
• Person
“Who is getting the disease?” Age, race, sex
• Place
“Where are the rates of disease highest/ lowest?”
• Time
“When does the disease occur commonly/ rarely?”
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Analytic studies
– They are studies used to test hypotheses concerning the

relationship between a suspected risk factor and
an outcome and to measure the magnitude of the
association and its statistical significance.
 Focus on the determinants (causes) of diseases.

 Used to test hypothesis
 Major distinguishing feature of analytic studies is the use
of controls.
Chapter seven….
– Focus on determinants of cause

– Search for cause and effect.
– Answer questions like: Why? How?
– To test whether certain factors are associated or
not
– Test hypothesis about causal relationship
• Proof
– Quantify the association between exposure and
outcome

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Chapter seven….
Observational (Non-intervention) studies:

 The researcher just observes and analyses
researchable objects or situations but does not
intervene
Intervention/experimental studies:
 The researcher manipulates objects or situations
and measures the outcome of manipulations.

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Types of Analytic studies
I. Observational studies
– No human intervention involved in assigning study groups
– Simply observe the relationship between exposure and

disease.
– Subject to many potential biases, but by careful design

and analysis, many of these biases can be minimized.
• Examples of observational studies: cohort and case- control

studies.
Chapter seven….
I. Case-control studies:
• Group of subjects with the disease (cases) and group of subjects without the
disease (controls) are identified.
• Information, about previous exposures are obtained for cases and controls, and
frequency of exposure compared for the two groups.
Strengths and limitations of the case-control study design
Strengths:
• Is relatively quick and inexpensive
• Is optimal for the evaluation of rare diseases.
• Can examine multiple etiologic factors for a single disease.
Limitations:
• Is inefficient for the evaluation of rare exposures
• Cannot directly compute incidence of disease in the groups.
• Is particularly prone to bias compared to other analytic designs, in particular,
selection and recall bias.
Case-control =
Both the exposure and disease have already occurred at the time of the study

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Chapter seven….

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Chapter seven….

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Chapter seven….
Selection of cases
• Subjects selected on the basis of disease
• A case should be clearly defined with regard to specific characteristic of
disease
• Needs appropriate diagnostic criteria
• Can be identified from:
• hospital setting = hospital-based case-control
• defined general population = population-based
• disease registries with complete records
Selection of Controls
• Be comparable to the cases: as similar to a case as possible but without the
disease in question
• Must have the same opportunity for exposure as a case
• Must be subject to the same inclusion and exclusion criteria as cases
• Involves consideration of a number of issues: Scientific, economic and
practical considerations
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II. Cohort studies:
 Study groups identified by exposure status prior to
ascertainment of their disease status
 Both exposed and unexposed groups followed in identical

manner until they develop the disease under study, they die,
the study ends, or they are lost to follow-up
 Disease free exposed and non-exposed people are followed

up and then outcome events are picked up when they occur
 Measure and compare the incidence of disease in two or

more study cohorts
Chapter seven….
What is a cohort?
• A group of persons
– sharing the same experience
– followed for a specified period of time
• Examples
– birth cohort
– workers at a chemical plant
– graduating university class
– Attendants of this course
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Chapter seven….

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Chapter seven….

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Chapter seven….
Types of Cohort Studies
 Based on the starting point of the study
 Prospective
 Retrospective (historical)

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Prospective

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Retrospective

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Chapter seven….
Strengths and limitations of the cohort study design

Strengths:
• Is of particular value when the exposure is rare
• Can examine multiple effects of a single exposure
• Allows direct measurement of incidence of disease in the
exposed and non-exposed groups.
Limitations:
• Is inefficient for the evaluation of rare diseases
• Expensive and time consuming
• Validity of the results can be seriously affected by losses to
follow-up
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Chapter seven….
II. Intervention studies

– The researcher manipulates a situation and
measures the effects of this manipulation.
– Usually (but not always) two groups are compared
– The two categories of intervention studies are:

 Experimental studies and
 Quasi-experimental studies
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Chapter seven….
I.Experimental studies
– Is a study design that gives the most reliable proof for causation.
– In this study, individuals are randomly allocated to at least two groups.
– One group is subject to an intervention, or experiment, while the other

group(s) is not.
– The outcome of the intervention (effect of the intervention on the

dependent variable) is obtained by comparing the two groups.
– For ethical reasons, the opportunities for experiments involving human

subjects are restricted.
Chapter seven….

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Chapter seven….
– However, randomized control trials of new drugs are

common.
– At community level, where health research is frequently

undertaken, we experience not only ethical but also practical
problems in carrying out experimental studies.
– In real life settings, it is often impossible to assign persons at

random to two groups.
– Therefore, experimental research designs may have to be

replaced by quasi-experimental designs.

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• Intervention (experimental) studies can also be considered either
therapeutic or preventive.
– Therapeutic trials are conducted among patients with
a particular disease to determine the ability of an
agent or procedure to diminish symptoms, prevent
recurrence, or decrease risk of death from that
disease.
– A preventive trial (community trial) involves the
evaluation of whether an agent or procedure reduces
the risk of developing disease among those free from
that condition at enrolment.
• Thus, preventive trials can be conducted among individuals at
usual risk (e.g. vaccine trials)
Design choice
• A particular research question may be addressed using different approaches.
• The choice of study design for investigation is influenced by:
– Particular features of the exposure and disease occurrence.
– Logistic considerations of available resources, time, fund
– Results from previous studies and gaps in knowledge that
remain to be filled.
– Ingenuity and creativity of the researcher
– Expertise of researcher/ knowledge & skill
– Research Questions, Research Goals, Researcher Beliefs and
Values
It is also related to:
• Status of existent knowledge
• Duration of latent period
• Nature and availability of information
Group work
 Suppose you are interested to study whether consumption of high
amount of salt causes hypertension.
 How do you conduct ecological study to assess this
association.
 How do you conduct cross sectional study to assess whether
Cigarette Smoking causes Lung Cancer?
 Suppose you are interested to investigate the association between
cigarette smoking and lung cancer.
 How do you conduct case control study
 What are the problems in conducting this case control study
 Suppose you want to assess the association between Smoking and Lung
cancer.
 How do you conduct cohort study to investigate this
association
 What are the possible problems in conducting this study
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Chapter seven….
SAMPLING
What is sampling?
– Sampling involves+
– the selection of a number of study units from a defined
study population.
– The population is too large for collecting information from

all its members.
– Instead we select a sample of individuals hoping that the

sample is representative of the population.
Chapter seven….
When taking a sample, we will be confronted with the
following questions:
a) What is the group of people from which we want
to draw a sample?
b) How many people do we need in our sample?
c) How will these people be selected?

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Population
 Target population (reference population): Is that population
about which an investigator wishes to draw a conclusion.
 Study population (population sampled): Population from which

the sample actually was drawn and about which a conclusion can
be made.
• For Practical reasons the study population is often more limited

than the target population.
Chapter seven….
 Study unit: The unit on which the observations will be

collected. For example, persons in a study of disease
prevalence, or households, in a study of family size.
 Sampling unit: The unit of selection in the sampling

process. For example, in a sample of districts, the sampling
unit is a district; in a sample of persons, the sampling unit
is a person.
 Sampling frame: The list of all units from which the

sample is to be taken.
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Chapter seven….
• Eligibility (inclusion) criteria: Criteria that specify

population characteristics
• Exclusion criteria: Sometimes, a population is defined in
terms of characteristics that people must not possess.
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Chapter seven….
 This criteria often reflect considerations other than
substantive or theoretical interests, such as:
 Costs
 Practical concerns
 People’s ability to participate in a study
 Design considerations
 Criteria used to define a population have implications for

both interpretation and generalizablity of the findings.
05/22/2021 By Abebe 215

Sampling methods
– An important issue influencing the choice of
the most appropriate sampling method is
whether a sampling frame is available.
– There are two broad categories of sampling

methods.
I. Probability sampling method

II. Non probability sampling method
I. Probability sampling methods
– They involve random selection procedures to

ensure that each unit of the sample is chosen on
the basis of chance.
– All units of the study population should have an

equal or at least a known chance of being
included in the sample.

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Chapter seven….
1.Simple Random Sampling (SRS):
• This is the most basic scheme of random sampling.

• To select a simple random sample you need to:
– Make a numbered list of all the units in the population.
– Each unit on the list should be numbered in sequence
from 1 to N
– Decide on the size of the sample
– Select the required number of sampling units, using a
“lottery” method or a table of random numbers.

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Chapter seven….
Example:
• You want to carry out a survey of 100 voters in a small
town with a population of 1,000 eligible voters. We could
write the names of all voters on a piece of paper, put all
pieces of paper into a box and draw 100 tickets at random.
You shake the box, draw a piece of paper and set it aside,
shake again, draw another, set it aside, etc. until you had
100 slips of paper. These 100 form your sample. And this
sample would be drawn through a SRS procedure - at each
draw, every name in the box had the same probability of
being chosen.
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2. Systematic random Sampling:
 Individuals are chosen at regular intervals from the sampling frame.

 We randomly select a number to tell us where to start selecting
individuals from the list.
Technique:
• Desired sample size is established at some number (n).
• The size of population must be known or estimated (N).

• Divide N by n, to get sampling interval (width) - (k)
• Select every Kth unit after the 1st number (random start).
Chapter seven….
For example
• A systematic sample is to be selected from 1000 students
of a school. The sample size is decided to be 100. The
sampling fraction is: 1000/100 = 10. The number of the
first student to be included in the sample is chosen
randomly by picking one out of the first ten pieces of
paper, numbered 1 to 10. If number 5 is picked, every
tenth student will be included in the sample, starting
with student number 5, until 100 students are selected.
Students with the following numbers will be included in
the sample: 5,15, 25, 35,45, . . . , 985, 995.

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Systematic rand…
222
Chapter seven….
– Systematic Sampling is less time consuming to perform
than SRS.
– It provides a good approximation to SRS.
– Should not be used if there is any sort of cyclic pattern in
the ordering of the subjects on the list.

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3 . Stratified sampling:
–If it is important that the sample includes representative

groups of study units with specific characteristics (E. g, sex,
area of residence, and etc.) then the sampling frame must be
divided into groups.
– Random or systematic samples of a predetermined size will

then have to be obtained from each group (stratum).
– This is called stratified sampling.

Chapter seven….
• It is appropriate when the distribution of the
characteristic to be studied is heterogeneous.
• The population is divided into groups called strata having
similar characteristics.
• These strata are non-overlapping and together they
comprise the whole population.
• A separate sample is then taken from each stratum by
random sampling
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Example
 Suppose that in a Wolkite university nursing department

there are the following Students:
 male, Regular : 100
 male, Extension : 50
 female, Regular : 120
 female, Extension: 30
 Total: 300
 To take a sample of 50 students, stratified according to

the above categories (nj=(n/N) x Nj), where j = 1,2…k is
the number of strata.
226
Example cont…
• The first step is to find the total number of students (300) and
calculate the percentage in each group.
• Male, Regular = (50 / 300) x 100 =17
• Male, Extension =( 50 / 300 ) x50 = 8
• Female, Regular = (50 / 300 ) x 120 = 20
• Female, Extension = (50 / 300) x 30 = 5
Total = 50
By Proportionate stratified sampling
227
Chapter seven….
Some of the reasons for stratifying the population may

be:
– Different sampling schemes may be used in different strata,
e.g. Urban and rural
– Conditions may suggest that prevalence rates will vary

between strata: the overall estimate for the whole
population will be more precise if stratification is used.
– Administrative reasons may make it easier to carry out the

survey through an organization with a regional structure.
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4. Cluster sampling:
When a list of groupings of study units is available a number
of these groupings can be randomly selected.
The selection of groups of study units (clusters) instead of the

selection of study units individually is called cluster sampling.
Is a sampling technique used when "natural" groupings are

evident in a statistical population.
Clusters are often geographic units (e.g. districts) or

organizational units (e.g. clinics).
Chapter seven….
Example:
• To draw a sample of nursing students, we
might first draw a random sample of nursing
schools and then draw a sample of students
from the selected schools.

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Example: Cluster sampling...
Section 1 Section 2
Section 3
Section 5
Section 4
231
Chapter seven….
5. Multi-Stage Sampling:
 Is appropriate when the population is large and widely
scattered.
 The number of stages of sampling is the number of times a

sampling procedure is carried out.
 The primary sampling unit (PSU) is the sampling unit in

the first sampling stage;
 The secondary sampling unit (SSU) is the sampling unit in

the second sampling stage, etc.
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Chapter seven….
Example:
• After selection of a sample of clusters (e.g.
household), further sampling of individuals
may be carried out within each household
selected. This constitutes two-stage sampling,
with the PSU being households and the SSU
being individuals

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Chapter seven….
Advantages:
– less costly, we only need to draw up a list of
individuals in the clusters actually selected, and
we can do that when we arrive there.
Disadvantage:
– less precise than SRS.

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II. Non probability sampling
• A type of sampling where each study unit has an unknown
probability of inclusion in the sample.
• It is less likely than probability sampling to produce accurate and

representative samples.
• Subjects are usually selected on the basis of their accessibility or
by the purposive personal judgment of the researcher (subjective).
235
Chapter seven….
When to use Non probability Sampling

• If group that represents target population already exists.
• If it is difficult or impossible to obtain the list of names for
sampling (e.g. Homeless, IV Drug user).
• If all cases of interest may not be identified ahead of time.
• For small/rare population.
• when the researcher aims to do qualitative, pilot or
exploratory study. 236
II. Non probability sampling
Types of Non probability Sampling

1. Voluntary/self selection sampling
2. Judgmental /Purposive sampling
3. Convenience / haphazard sampling
4. Quota sampling
5. Snow ball sampling
237
Chapter seven….
1. Volunteer/self selection Sampling
– Selected subjects are volunteers who show interest to participate in the
study.
– Common in trials demanding long duration.
– Payments for subjects some times be involved.
Example: call-in radio shows that solicit audience participation in

surveys on controversial topics (abortion, affirmative action, etc.).
– The resulting sample tends to over-represent individuals who have
strong opinions.
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Chapter seven….
2. Purposive/Judgemental Sampling
• The researchers choose the sample based on who they think would be
appropriate for the study.
• Primarily used when there is a limited number of people that have expertise
in the area being researched
• Qualitative research methods are typically used when focusing on a limited

number of informants, whom we select strategically so that their in-depth
information will give optimal insight into an issue about which little is known.
This is called purposeful sampling.
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Chapter seven….
3. Convenience/Haphazard/ accidental
 Convenience sampling entails using the most conveniently available & accessible
people as study participants.
 The study units that happen to be available at the time of data

collection are selected.
Examples :
 A faculty member who distributes questionnaires to nursing students in a class is
using a convenience sample.
 The nurse who conducts an observational study of women delivering twins at the
local hospital is also relying on a convenience sample.
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Chapter seven….
4. Quota sampling
• Is a method that ensures a certain number of sample from different
categories with specific characteristics appear in the sample so that all these
characteristics are represented.
• The population is first segmented into mutually exclusive sub-groups as in
stratified sampling.
• Stratification should be based on one or more variables that would reflect
important differences in the dependent variable under study like (age,
gender, ethnicity, educational attainment, medical diagnosis etc).
• Convenience is used to select subjects until a specific number of units/quota/
for various sub-groups has been filled.
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Chapter seven….
5. Snowball
– Is usually done when there is very small population size.
– Involves a process of “chain referrals”
– Start with one or two key informants and ask them if they know
persons who know a lot about the topic of interest.
– Used when trying to interview hard to reach groups.
– The downside of using a snowball sample is that it is hardly

representative of the population
242
Errors in sampling procedures
•When taking a sample, the results will not exactly equal to results for the population. i.e. it will
be subject to error.
•This error has two components: sampling and non-sampling errors.
a) Sampling error (i.e., random error)
•Random error, consists of random deviations from the true value, which can occur
in any direction.
•Sampling error (random error) can be minimized by increasing sample size.
•Opposite of random error is reliability.
Reliability (or precision): : This refers to the repeatability of a measurement.
•Is about degree of closeness between repeated measurement of the same value.
•Reliability addresses the question, if the same thing is measured several times, how close are
the measurements to each other?
The sources of variation resulting in poor reliability include:
-Variation in the characteristic of the subject being measured. E.g.: blood pressure
-The measuring instruments, e.g. questionnaires
-The persons collecting the information (observer variation)
Inter-observer variation: differences between observers in measuring the same observation
Intra-observer variation: differences in measuring the same observation by the same observer
on different occasions.
b) Non Sampling error (i.e., bias)
•Bias, consists of systematic deviations from the true value, always in the
same direction.
•It is possible to eliminate or reduce the non-sampling error (bias)
by careful design of the study procedures.
•The opposite of bias is validity.
Validity: This refers to the degree of closeness between a measurement
and the true value of what is being measured.
• Validity addresses the question, how close is the measured value to
the true value?
•To be accurate, a measuring device must be both valid and reliable.
•However, if one cannot have both:-
– validity is more important in situations when we are interested in the
absolute value of what is being measured.
– Reliability on the other hand is more important when it is not essential to
know the absolute value, but rather we are interested in finding out if
there is a trend, or to rank values.
Examples of types of bias in sampling include:
• Bias resulting from incompleteness of the sampling frame, accessibility bias,
seasonality bias, self-reporting bias, volunteer bias, non-response bias etc.
Non-response bias: is failure to obtain information on some of the study subjects. It
results in significant bias when the following two situations are both fulfilled.
– When non-respondents constitute a significant proportion of the sample.
– When non-respondents differ significantly from respondents
A). Non-response should be considered during the planning stage of the study and
Non-response should be kept to a minimum. E.g. below 15%.
Methods that may help in maintaining non-response at a low level could be:
• Subjects should be contacted in a respectful way and convinced about the study
• Incentives to encourage participation. but, consider potential problems in the
future.
• making repeated attempts to contact study subjects who were absent at initial
visit.
B).The number of non-responses should be documented according to type, so as to
facilitate an assessment of the extent of bias introduced by non-response.
C). As much information as possible should be collected on non-respondents, so as
to see in what ways they may differ from respondents.
alid
Neither Valid
nor Reliable
not V
e but
bl
Relia
Validity and Reliability
Fairly Valid but

not very Reliable
b le
Relia
id &
Val
Tadesse, Chanyalew & Yeshitila 246
Sample size determination
 In planning any investigation we must decide how many people need

to be studied in order to answer the study objectives.
If the study is too small we may fail to detect important effects, or may
estimate effects too imprecisely.
If the study is too large then we will waste resources.
In general, it is much better to increase the accuracy of data collection
than to increase the sample size after a certain point.
The final sample size is usually a compromise between what is
desirable and what is feasible.
The feasible sample size is determined by the availability of resources.
In order to calculate the required sample size, you need to know the following
facts:
A. The reasonable estimate of the key proportion to be studied. If you cannot
guess the proportion, take it as 50%.
B. The degree of accuracy required. That is, the allowed deviation from the true
proportion in the population as a whole. It can be within 1% or 5%, etc.
C. The confidence level required, usually specified as 95%.
D. The size of the population that the sample is to represent.
–If it is more than 10,000 the precise magnitude is not likely to be very
important.
–but if the population is less than 10,000 then a smaller sample size may be
required.
E). The difference between the two sub-groups and the value of the likelihood
or the power that helps in finding a statistically significant difference.
Note that ‘E’ is required when there are two population groups and the interest
is to compare between two means or proportions.
Sample size for estimating single proportion:
• Estimate how big the proportion might be (P)
Steps:
• Choose the margin of error allowable in the estimate of the proportion (say ± w)
• Choose the level of confidence that the proportion in the whole population is
indeed between (p-w) and (p+w). We can never be 100% sure. Do you want to be
95% sure?
Then the minimum sample size, will be as follow depending on population size.
I. The minimum sample size required, for a very large population (N>10,000) is:
n = Z² p(1-p) / w²
Where,
n= required minimum sample size
Z= z-score value corresponding to a given level of confidence
p= estimated population proportion
w= allowable margins of error
II. Minimum sample size required, if population size is lessor equal to 10,000 is:
n= no / (1+ (no/N))
Where,
n= minimum required sample size
no= minimum sample if population size was more 10,000
N= total population size
Example 1 (Prevalence of diarrhea)

Given: p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95% C.I.), N>10,000
solution:
n = (1.96) ² (.26 × .74) / (.03) ² = 821.25 ≈ 822 subjects
 If the above sample is to be taken from a relatively small population (say N =
3000), the required minimum sample will be:
n= 821.25 / (1+ (821.25/3000)) = 644.7 ≈ 645 subjects
Example 2
• A hospital administrator wishes to know what proportion of discharged
patients are unhappy with the care received during hospitalization. If 95%
Confidence interval is desired to estimate the proportion within 5%, how
large a sample should be drawn?
Given: z=1.96, w=0.05 , p=0.5(If you don’t have any information about P, take it
as 50% and get the maximum sample size)
Solution:
• n = Z² p(1-p)/w² =(1.96) ²(.5×.5)/(.05) ² =384.2 ≈ 385patients
Sample size for estimating single mean:
•The required minimum sample size is given by :
n = Z² σ² / w²
Where,
n= required minimum sample size
Z= z-score corresponding to a given level of confidence
σ= standard deviation
W= allowable margin of error.
Example: A health officer wishes to estimate the mean serum cholesterol in a
population of men. From previous similar studies a standard deviation of 40
mg/100ml was reported. If he is willing to tolerate a marginal error of up to 5
mg/100ml in his estimate, how many subjects should be included in his study?
Given: z=1.96, σ= 40mg/100ml, w=5mg/ml
Solution:
n = (1.96) ² (40) ² / (5) ² = 245.86 ≈ 246 persons
•σ can be estimated from previous similar studies or could be obtained by

conducting a small pilot study
Sample size for Comparison of two proportions:
n (in each Group) = (p1q1 + p2q2) (z1-α +z1-β) ²/ ((p1 - p2)²
Where,
α = type I error (level of significance)
β = type II error
1-β = power of the study, power = the probability of getting a significant result
• Type I error (α) = The probability of rejecting Ho when it is true
• Type II error () = The probability of not rejecting Ho when it is false
• Power (1-) = the probability H0 is rejected
given that it is false
Ho = There is no difference between the
two groups
Ho: µ1 - µ2 = 0
P1 - P2 = 0
HA = There is a difference between the
two groups
HA: µ1 - µ2 ≠ 0
P1 - P2 ≠ 0
Sampling by G-V 254
• Type I error
– α( commonly 5%)
– Rejecting a true hypothesis
– Acceptable risk of rejecting a H0
• Type II error
– β (20%,10%)
– Failing to reject false H0
• Power
– 1-β =80%, 90%
– Probability we will reject false H0
255
Example: The proportion of nurses leaving the health service is compared
between two regions. In one region 30% of nurses is estimated to leave the
service. In other region it is probably 15%. The required sample to show, with
a 90% likelihood (power), that the percentage of nurses is different in these
two regions would be:
Given: α= 5% (assume a confidence level of 95%) ,β= 90%, P1= 0.3, q1= 0.7,
p2= 0.15 q2=0.85
Solution: n = (1.28+1.96) ² ((.3×.7) +(.15 ×.85)) / (.30 - .15) ² = 158
• 158 nurses are required in each region
Sample size for comparison of two means (sample size in each group):
n = (s1² + s2² ) (z1-α +z1-β) ² / (m1 - m2)²
Where, m1 and s1 are mean and standard deviation of group 1 respectively.
• m2 and s2 are mean and standard deviation of group 2 respectively

05/22/2021 256
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Reading assignment
Sample size calculation for:

• Case control studies
• Cohort studies
• Experimental studies
Methods of data collection
•Having decided on how to design the research study, the next is how to
collect information.
The choice of methods of data collection is based on:

•The accuracy of information they will yield
•Practical and resource considerations, such as, the need for personnel,
time, equipment and other facilities, in relation to what is available.
–Accuracy and “practicability” are often inversely correlated.

–A method providing more satisfactory information will often be a more
expensive or inconvenient one.
–Therefore, accuracy must be balanced against practical considerations
(resources and other practical limitations)
Quantitative data collection methods
•The most commonly used methods of collecting quantitative data are the use of
documentary sources, interviews and self-administered questionnaires.
1. The use of documentary sources
•It include clinical records and other personal records, death certificates, published mortality
statistics, census publications, etc
Advantages:
•Documents can provide ready made information relatively easily.
•The best means of studying past events.
Disadvantages:
•Problems of reliability and validity.
–because the information is collected by a number of different persons who may have
used different definitions or methods of obtaining data.
•Errors may occur when the information is extracted from the records.
–This may be an important source of unreliability if handwritings are difficult to read.
•Incompleteness
–Since the records are maintained not for research purposes, but for clinical, administrative
or other ends, the information required may not be recorded at all, or only partly
recorded.
2. Interviews and self-administered questionnaires
Interviews:
•Interviews may be less or more structured.
•A person conducting interviews may come with a checklist of topics, but may
not decide in advance precisely what questions he will ask.
•If his approach is flexible; the content, wording and order of his questions
vary from interview to interview. Hence, his interviews are
relatively unstructured.
•On the other hand, if a more standardized technique where the wording and
order of the questions being decided in advance is used, it may take the form
of a highly structured interview
Self-administered questionnaire:
•the respondents read the questions and fills in the answers by themselves
• sometimes interviewer may be present, who stands by to give assistance if
necessary.
•The use of self-administered questionnaires is simpler and cheaper
•such questionnaires can be administered to many persons simultaneously.
Questionnaire Design
•Questions may take two general forms:

–Open ended questions: which the subject answers in his own words, or
–Closed questions: answered by choosing from a number of fixed alternative responses.
In questionnaire design remember to:
Use familiar and appropriate language
Avoid abbreviations, double negatives, double barreled questions, etc.
Avoid two elements to be collected through one question
Pre-code the responses to facilitate data processing
Avoid embarrassing and painful questions
Watch out for ambiguous wording
Avoid language that suggests a response
Start with simpler questions
Provide the unit of measurement for continuous variables (years, months, kgs, etc.)
For open ended questions, provide sufficient space for the response
Arrange questions in logical sequence
Group questions by topic, and place a few sentences of transition between topics
Pretest the questionnaire on 20-50 respondents in actual field situation
Include “thank you” after the last question
Qualitative data collection methods
• Qualitative approaches to data collection usually involve direct interaction
with individuals on a one to one basis or in a group setting.
• Data collection methods are time consuming
• data is collected from smaller numbers of people than would usually be the
case in quantitative approaches.
• The benefits include richness of data and deeper insight into the
phenomena under study.
• Unlike quantitative data, raw qualitative data cannot be analyzed statistically.
• Samples of qualitative study are usually smaller than with quantitative one.
• Data collected are not usually aimed at drawing generalization.
• Data analysis is also time consuming and consequently expensive.
• The main methods of collecting qualitative data are: individual in-depth
interviews, focus groups discussions and observations.
Qualitative interviews(in-depth interview)
• Qualitative interviews are semi structured or unstructured.

• Semi structured interviews (sometimes referred to as focused interviews):
involve a series of open ended questions based on the topic areas the
researcher wants to cover.
• The open ended nature of the question defines the topic under investigation
but provides opportunities to discuss some topics in more detail.
• Unstructured interviews: are interviews where the interviewer wants to find
out about a specific topic but has no structure or preconceived plan or
expectation as to how they will deal with the topic.
• Qualitative interviews should be fairly informal. Interviewees should feel as
though they are participating in a conversation or discussion rather than in a
formal question and answer situation.
Focus group discussion
• A focus group discussion (FGD) is a group discussion of 6-12 persons guided by

a facilitator
• It is a method which brings together a small homogenous group to discuss on
topic of interest.
• It capitalizes on group dynamics(interaction) to stimulate participants to
reveal underlying opinions, attitudes and reasons for their behavior.
• The group need to be guided by a skilled moderator into increasing levels of
focus and depth on the issue.
• Group members should talk freely and spontaneously about a certain topic.
• The purpose of an FGD is to obtain in-depth information on concepts,
perceptions, and ideas of the group.
• It aims to be more than a question-answer interaction
• The discussion should be conducted in
– a relaxed atmosphere and
– Non threatening environment and without any personal inhibitions.
Observation
• To fully understand the complexities of social phenomena, merely relying

on what people say is limited;
• because people may be unwilling to share important details especially if
they are sensitive.
• Direct observation is critical
• Observation: is systematic watching and recording of what people do and
say in naturally occurring setting and careful recording of what occurs.
• There are two types of observation:-
– Non-participant observation
– Participant Observation
• In both cases The researcher can record observations of people, a situation

or an environment by making note or video recording of what has been
observed.
Bias in data Collection
•Bias in data collection is a distortion in the collected data so that it does not
represent reality.
Possible sources of bias during data collection:
1. Defective instruments, such as:
•Questionnaires with:
– fixed or closed questions on topics about which little is known
– open-ended questions without guidelines on how to ask (or to answer) them
– vaguely phrased questions
– leading questions’ that cause the respondent to believe one answer would be
preferred over another
– questions placed in an illogical order.
•Weighing scales or other measuring equipment that are not standardized
/calibrated.
These sources of bias can be prevented by carefully planning the data
collection process and by pre-testing the data collection tools
2. Observer bias:
• Observer bias can easily occur when conducting observations or utilizing loosely
structured interviews.
• There is a risk that the data collector will only see or hear things in which (s)he is
interested or will miss information that is critical to the research.
Mitigation measures
Observation protocols and guidelines for conducting loosely structured
interviews should be prepared, and training and practice should be provided to data
collectors in using both these tools.
Moreover it is highly recommended that data collectors work in pairs when using
flexible research techniques and discuss and interpret the data immediately after
collecting it.
Another possibility is using a tape recorder and transcribing the tape word by word.
3. Effect of the interview on the informant:
• This is a possible factor in all interview situations.
• The informant may mistrust the intention of the interview and dodge certain
questions or give misleading answers.
• For example: in a survey on alcoholism you ask school children: ‘Does your father
sometimes get drunk?’ Many will probably deny that he does, even if it is true.
Such bias can be reduced by
– adequately introducing the purpose of the study to informants
– phrasing questions on sensitive issues in a positive way
– taking sufficient time for the interview, and
– assuring informants that the data collected will be confidential.
4. Information bias:
• Sometimes the information itself has weaknesses.
• Medical records may have many blanks or be unreadable. This tells something
about the quality of the data and has to be recorded.
• Another common information bias is due to gaps in people’s memory; this is
called memory or recall bias.
– E.g. A mother may not remember all details of her child’s last diarrhoea
episode and of the treatment she gave two or three months ago.
Data processing and analysis
• Data processing and analysis should start in the field, with checking for
completeness of the data and performing quality control
• Data of small samples may even be processed and analyzed as soon as
collected.
• a data processing and analysis issues should include the following :
– Sorting data
– Performing quality-control checks
– Data processing and
– Data analysis
Sorting data:
• Sorting the data is important for facilitating subsequent processing and
analysis.
• If you have different study populations (for example village health workers,
village health committees and the general population), you obviously would
number the questionnaires separately.
• In a comparative study it is best to sort the data right after collection into the
two or three groups that will be compared.
Performing quality control checks
• Usually the data have already been checked that all information has been
properly collected and recorded.
• Before and during data processing, the information should be checked again
for completeness and internal consistency.
• If a questionnaire has not been filled in completely you will have MISSING
DATA for some of your variables.
• If there are many missing data in a particular questionnaire, you may decide to
exclude the whole questionnaire from further analysis.
• If an inconsistency is clearly due to a mistake made by the researcher/research
assistant it may still be possible to check with the person who conducted the
interview
• If the inconsistency is less clearly a mistake in recording, it may be possible (in
a small scale study) to return to the respondent and ask for clarification.
• If it is not possible to correct information that is clearly inconsistent
• If a certain question produces ambiguous or vague answers throughout, the
whole question should be excluded from further analysis.
• For computer data analysis, quality control checks of data must also include a
verification of how the data has been transformed into codes
Data processing – quantitative data
• Decide whether to process and analyze the data from questionnaires:

– manually, using data master sheets or manual compilation of the
questionnaires, or
– by computer, for example, using a micro-computer and existing software or
self- written program for data analysis.
• Data processing in both cases involves:
– categorizing the data,
– coding, and
– summarizing the data in data master sheets, manual compilation without
master sheets, or data entry and verification by computer.
1. Categorizing:
• Decisions have to be made concerning how to categorize responses.
• For categorical variables that are investigated through closed questions
or observation, the categories have been decided upon beforehand.
• In interviews the answers to open-ended questions (for example, ‘Why
do you visit the health Centre?’) can be pre-categorized to a certain
extent, depending on the knowledge of possible answers that may be
given. However, there should always be a category called ‘Others,
specify . . .’, which can only be categorized afterwards.
• These responses should be listed and placed in categories that are a
logical continuation of the categories you already have.
• Answers that are difficult or impossible to categorize may be put in a
separate residual category called ‘others’, but this category should not
contain more than 5% of the answers obtained.
• For numerical variables, the data are often better collected without
any pre-categorisation.
2. Coding
• If the data will be entered in a computer for subsequent processing and
analysis, it is essential to develop a CODING SYSTEM.
• For computer analysis, each category of a variable can be coded with a letter,
group of letters or word, or be given a number.
For example the answer for question “did you get vaccine?”
– ‘yes’ may be coded as _______ “Y’ or 1;
– ‘no’ as ____ ‘N’ or 2 and
– ‘no response’ or ‘unknown’ as ___‘U’ or 9.
Codes for open-ended questions:
• can be done only after examining a sample questionnaires.
• You may group similar types of responses into single categories, so as to limit
their number to at most 6 or 7.
• If there are too many categories it is difficult to analyze the data.
3. Computer compilation
•Before you decide to use a computer, you have to be sure that it will
save time or that the quality of the analysis will benefit from it.
•feeding data into a computer costs time and money.
•The computer should not be used if your sample is small and/or the
data is mainly generated by open questions (qualitative data).
•The larger the sample, the more beneficial in general the use of a
computer will be.
Computer compilation consists of the following steps:

1.Choosing an appropriate computer program
2. Data entry
3. Verification or validation of the data
4. Programming (if necessary)
5. Computer outputs/prints
Data analysis – quantitative data
• Analysis of quantitative data involves the production and interpretation of
frequencies, tables, graphs, etc., that describe the data
1. Frequency counts:
• simple tables can be made with frequency counts for each variable. A
frequency count is an enumeration of how often a certain measurement or a
certain answer to a specific question occurs. For example,
• If numbers are large enough it is better to calculate the relative frequencies.

This makes it easier to compare groups than when only absolute numbers are
given.
2. Cross-tabulations
• Further analysis of the data usually requires the combination of information
on two or more variables in order to describe the problem or to arrive at
possible explanations for it.
• For this purpose it is necessary to design CROSS-TABULATIONS.
• Depending on the objectives and the type of study, two major kinds of cross-
tabulations may be required:
– Descriptive cross-tabulations that aim at describing the problem under
study.
– Analytic cross-tabulations in which groups are compared in order to
determine differences, or which focus on exploring relationships between
variables.
Chapter Eight
Work plan and Budget

Chapter Eight…..
Work Plan
• A WORK PLAN is a schedule, chart or graph that summarizes the different
components of a research project and how they will be implemented in a
coherent way within a specific time span.
• It may include:
• The tasks to be performed;
• When and where the tasks will be performed; and
• Who will perform the tasks and the time
• Work plan could be presented in different forms, such as work schedule and
GANTT chart.
• A GANTT chart is a planning tool that depicts graphically the order in which
various tasks must be completed and the duration of each activity. The length of
each task is shown by a bar that extends over the number of days, weeks or
months the task is expected to take.

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Chapter Eight…..
How can a work plan be used?
A work plan can serve as:
• A tool for planning the details of the project activities and drafting a
budget.
• A visual outline or illustration of the sequence of project operations. It can

facilitate presentations and negotiations concerning the project with
government authorities and other funding agencies.
• A management tool for the Team Leader and members of the research
team, showing what tasks and activities are planned, their timing, and
when various staff members will be involved in various tasks.
• A tool for monitoring and evaluation, when the current status of the
project is compared to what had been foreseen in the work plan.
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Chapter Eight…..
Budget
Why do we need to design a budget?
• A detailed budget will help you to identify which
resources are already locally available and which
additional resources may be required.
• The process of budget design will encourage you to

consider aspects of the work plan you have not thought
about before and will serve as a useful reminder of
activities planned, as your research gets underway.
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Chapter Eight…..
How should a budget be prepared?
• It is necessary to use the work plan as a starting point. Specify, for
each activity in the work plan, what resources are required.
Determine for each resource needed the unit cost and the total
cost.
• The budget for the fieldwork component of the work plan will
include funds for personnel, transport and supplies.
• Note that UNIT COST (e.g., per diem or cost of petrol per km), the
MULTIPLYING FACTOR (number of days), and TOTAL COST are
required for all budget categories.
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Chapter Eight…..
Budget justification
• It is not sufficient to present a budget without explanation.
• The budget justification follows the budget as an explanatory note

justifying briefly, in the context of the proposal, why the various items in
the budget are required.
• Make sure you give clear explanations concerning why items that may
seem questionable or that are particularly costly are needed and discuss
how complicated expenses have been calculated.
• If a strong budget justification has been prepared, it is less likely that

essential items will be cut during proposal review.
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WOLKITE UNIVERSITY

COLLEGE OF HEALTH SCINCES

NURSING RESERCH METHEDOLOGY

– This course is intended to equip the health officer

Reserch Methedology By:- Bisrat Zeleke

Reserch Methedology By:- Bisrat Zeleke

– Test ---------------------------------------------- #1---------------------- 20 points

– Individual assignment --------------------------#1 ---------------------- 10 points Submission

– Group assignment ----------- # 1-----------10 points

Submission date…… 10/07/13

– Final ------------------------------------50%(Covering all portions)----------- Exam

• Assignments: You must do your assignment on time. No late assignment will be

• Final exam : Will include all portion

Reserch Methedology By:- Bisrat Zeleke

– Research is a systematic inquiry that uses

– The ultimate goal of research is to develop, refine,

– Research is the systematic investigation into and

Reserch Methedology By:- Bisrat Zeleke

An approach in obtaining a solution for a problem.

Necessary to generate new knowledge and technologies

Essential for guiding action.

Necessary to identify priority problems, design and

Reserch Methedology By:- Bisrat Zeleke

– We may already think we know the answer to our question already

Reserch Methedology By:- Bisrat Zeleke

Research must be: Purposeful, Targeted,

 It builds on existing data, using both positive and

 New data collected as required and be organized so

that they answer the original research question(s)

Established methods must be used in both!!

– Health research has been broadly defined as the

– Health Research is a systematic collection, analysis and

Reserch Methedology By:- Bisrat Zeleke

– To modify the natural history of disease

– To prevent or delay, death or disability and

– To improve the health of a patient population or

Reserch Methedology By:- Bisrat Zeleke

Reserch Methedology By:- Bisrat Zeleke

Epidemiologic, health services research

Reserch Methedology By:- Bisrat Zeleke

Empirical : based upon observation and

Theoretical: based upon theory and abstraction

• Empirical research in the health sciences can be qualitative or

Reserch Methedology By:- Bisrat Zeleke

– Is concerned with qualitative phenomenon, a phenomena

– Action oriented -aimed at developing solutions.

– Multidisciplinary approach (from many disciplines)

– Participatory in nature (from policy makers to community members)

– Simple, short-term designs.

– Results presented in formats most useful for administrators, decision-

Reserch Methedology By:- Bisrat Zeleke

– Is systematic inquiry to develop knowledge about issues of

– Nurses are increasingly engaged in disciplined studies that

Reserch Methedology By:- Bisrat Zeleke

– Help to eliminate nursing actions that do not

– Help nurses to identify practices that improve

– To explain phenomena that must be considered in

– To predict the probable outcomes of certain nursing

– To control the occurrence of undesired outcomes; and to

– Since the 1970s, nursing research has focused on problems

– The National Institute of Nursing Research (NINR), established

– Future emphases of nursing research are likely to include

– Operational research being predominantly, but not