Health Research & Methods

A foreword

JOSEPH MARIA ADAIKALAM, M.D. (Siddha)., M.Sc. (Epid.)., THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY

Research - Definition
Research is a quest for knowledge through diligent search or investigation or experimentation aimed at the discovery and interpretation of new knowledge WHO

Research what is it all about?

Central to the scientific enquiry. Seeing what others see and finding what others don t.

Purpose: to add to knowledge that will better the lives of people

Research is a scientific process

There is a need to demystify the scientific process. Scientific Inquiry is basically a potentiation of common sense ,which is one of the most equitably distributed human gifts. As Einstein said The whole of science is nothing more than a refinement of everyday thinking. In a sense ,most of us conduct some research in our daily life. (e.g) ,if we want to buy a car in a proper way, we collect information about the models and dealers,analyse it then try to reach the scientific conclusion on which one to buy.

Health Research
Health most vital part of human life Health research & Medical research Cornerstone of all the advancements Health for all or Millennium Development Goals only through proper research

Health Research what is it all about ?

Increase understanding of causal association both etiologic agents and risk factors to disease. To improve methods of diagnosis To optimize therapy and management of the sick.

What health research has achieved so far

Small pox Rheumatic fever & Rheumatic heart disease Iodine deficiency Tobacco use & cancer HIV/AIDS SARS/Avian flu/Swine flu

Is Health Research a luxury?

Should Countries with scarce resources do research ? Yes Because we are a poor country , we cannot afford not to do research . (Jawaharlal Nehru) India cannot wait indefinitely for development of new technologies for health that are urgently required for tackling various diseases effecting the people of country Gulam Nabi Azad Health research A vital investment

Research provides the reliable evidence

Definition of levels of evidence and grading of recommendation

Level Ia Ib IIa IIb III IV Type of evidence available from Meta-analysis of RCTs MetaA At least one RCT At least one well-designed controlled study without wellrandomization At least one other type of well-designed quasiwellquasiexperimental study Well-designed non-experimental descriptive Wellnonstudies Expert committee reports or opinions and/or clinical experience of respected authorities C B Grade

Research

Health research in India

Since more than 2000 years 1911 to 2011 (IRFA to ICMR) DHR - 2007 For mariginalized communities - priority Health research in India is poor: The Lancet *
Research to achieve healthcare for all in India 0.4% in 1988 to 1.8% in 2008
*The Hindu, 04.04.2011

Research in CCRAS
Basic research Clinical research Drug research Literature research New drug development Collaborative research

Research in CCRH
Survey, collection and cultivation of medicinal plants Drug standardisation Drug proving Clinical verification Clinical research

Tools for health research

Epidemiology
Measures of disease frequency Causations & Associations Validity & reliability Study designs etc.,

Biostatistics
Descriptive statistics Sample size Tests of significance etc.,

Types of health research

Basic and applied Empirical and theoretical Qualitative and quantitative Health research triangle
Biomedical Behavioral Health research

Types of Research Studies

Research studies can be classified as:
Causation type Disease type Prognosis type

Steps in research
1.Formulation of problems 2.Setting research objectives 3.Designing the study 4.Methods of data collection 5.Statistical analysis 6.Interpretation of the results 7.Dissemination

Choosing a Research Topic



FINER *
Feasible Interesting Novel Ethical Relevant
* Hulley et al, 2001

Research question spells out the local public health problem

Problem in district X among the population reached level during

Note: The statement specifies: What How much Who Where When

The Research Question Should be clearly stated Should be specific Primary and secondary objectives

Study designs
1. Different questions require different types of Study Designs. 2. It is essential to understand the structure of different Study Designs 3. Choosing the correct study design is crucial to the success of the Research

Types of research studies

STUDIES

QUALITATIVE

QUANTITATIVE
OBSERVATIONAL OBSERVATIONAL

EXPERIMENTAL

FORMATIVE

CROSS SECTIONAL
CASE CONTROL

FIELDTRIALS

VACCINE TRIALS CLINICAL TRIALS

COHORT

Choosing a study design as per the objective

Epidemiologic Study Designs

Research cycle

The life cycle of epidemiological investigations: The never ending story

Identifying data needs Spelling out the research question Formulating the study objectives Planning the analysis Preparing data collection instruments
Here we go again

Involving the programme Formulating recommendations Drawing conclusions

Analysing data

Collecting data

Good research & Bad research

 There is only one type of research - good research .  Bad research does not deserve the name Research  Badly done research is utter waste of time , money and effort; it is unethical as it exposes research subjects to the inherent risk of experimentation with no reward to them ,to others or communities

Poor medical research is a SCANDAL!*

Due to ignorance or willingly! Fear of Epidemiology / Biostatistics Unprofessional, unethical & unacceptable Very common!? *BMJ, 1994;308:283-284

 To lose ones health renders science null, art inglorious, strength unavailing, wealth useless and eloquence powerless Herophilus, 300 BC Lets take up the challenge & RESPONSIBILITY!