Cross-sectional Study

Definition
• A cross-sectional studies
– a type of observational study
– the investigator has no control over the exposure of
interest (e.q. diet).
• It involves
– identifying a defined population at a particular point in
time
– measuring a range of variables on an individual basis
• e.g. include past and current dietary intake
– At the same time measuring outcome of interest
• e. g. obesity

PRD-2
 Definition
• Measurement of exposure of interest and
outcome of interest is carried out at the same
time (e.g. Obesity and Hypertension)
• There is no in-built directionality as both
exposure and outcome are present in the
study subject for quite some time

PRD-3
 Cross-sectional studies
• Deals with the situation existing at a given time (or during a
given period) in a group or population
• These may be concerned with:
– The presence of disorders such as diseases, disabilities and symptoms
of ill health
– Dimensions of positive health, such as physical fitness
– Other attributes relevant to health such as blood pressure and body
measurements
– Factors a/w health & disease such as exposure to specific
environmental exposure or defined social & behavioral attributes and
demographic attributes
– Determining the workload of personnel in a health program as given
by prevalence

PRD-4
Which came first?

?? Causality

PRD-5
PRD-6
 Cross-sectional studies
• May be
– Descriptive
– Analytical or
– Both
• At descriptive level, it yields information about a
single variable, or about each of number of separate
variables in a study population
• At analytic level, it provides information about the
presence and strength of associations between
variables, permitting testing of hypothesis

PRD-7
Steps in cross-sectional studies

PRD-9
PRD-10
 Chose the problem & analyze it
• Important steps:
– Problem identification
– Prioritize the problem
– Analyze the problem to convert it in “Research
Question”
• Specific
• Measurable
• Realistic
• Time bound
• Questions to ask:
– What is the problem?
– Why should it be studied? PRD-11
 Literature review
• What information is already available?
• Helps you understand and analyze the
problem
– Is it the same thing which is bothering me?
– Uncertainty about a health issue that the
investigator wants to resolve
• Helps you to frame SMART research question

PRD-12
 SMART research question: Example
• What is the distribution of hemoglobin in
adolescent girls of Anji PHC?
• What is the prevalence of anemia among
adolescent girls of Anji PHC?
• Is the prevalence of anemia among non-
school going adolescent girls higher as
compared to that of school going adolescent
girls of Anji PHC?

PRD-13
 Other attributes of SMART RQ
• Feasible
– Adequate number of subjects
– Adequate technical expertise
– Adequate resources (time & money)
• Interesting to investigator
• Novel
– Confirms or refutes previous findings
– Extends previous findings
– Provides new findings
• Ethical
• Relevant
– For scientific knowledge
– For policy implications
– For future research directions

PRD-14
 Research Methodology
• Questions to be asked:
– What data do we need to meet our objectives?
– How will I get this?
– How will it be collected?
• Elements:
– Study population
– Study subjects – Sampling & Sample size
– Variables
– Data collection instruments & techniques & plan
– Data management – data processing & analysis
– Ethical clearance
– Piloting

PRD-15
 Choosing the study subjects
• Good choice of study subjects serves the vital
purpose of assuring that the findings in the study
accurately represent what is going on in the
population
– Sample of subjects which are affordable in time & money,
– yet it is large enough to control random error in
generalizing the study findings to the population
– and representative enough to control systematic error in
these inferences

PRD-16
• External
• &
• Internal validity
 Sampling methods
• Probability sampling
– Simple random sampling
– Systematic sampling
– Stratified random sampling
– Cluster sampling
• Non-probability sampling
– Consecutive sampling
– Convenience sampling
– Purposive (Judgmental) sampling

PRD-18
 Sample size
• One sample situation:
– A. Proportion
• Estimating a population proportion with specified precision
– Absolute
– Relative
• Hypothesis test for population proportion
– B. Mean
• Estimating a population mean with specified precision
• Estimating sample size with unknown mean
• Hypothesis test for population mean
• Two sample situation
– A. Proportions
• Estimating difference between two population proportions with specified
precision
• Hypothesis test for two population proportions
– B. Means
• Estimating difference between two population means with specified
precision
• Hypothesis test for two population means
PRD-19
 Variables
• What characteristics will be studied- variable
• Depends on objective of study
• Variables
– Outcome variable (dependent variable)
– Predictor variable (independent variable)
– Continuous & Categorical variables
• Literature search:
– you have not left out any important predictor variable
– How other people have defined these variables
– How other people have measured these variables
• Biological rationale

PRD-20
 Variables
• Defining variable
– Clear & explicit definition
– Operational definition
– Obesity as defined by body fat content more than
33% Vs BMI > 25

PRD-21
 Data collection
• Data collection instrument
• Data collection plan
• Quality check plan

PRD-22
 Data collection instrument:
Questionnaire/Interview schedule
• General:
– Brief description of purpose of study
– Instructions specifying how to fill
– Group the questions concerning major subject area under a short
heading
– Warm-up questions
• Open-ended & close-ended questions
• Instrument format
– Format should make it as easy as possible for filling and avoiding data
entry confusions
• Wording
– Clarity, simplicity, neutrality, double-barreled questions, time frame
• Codes, scores and scales

PRD-23
 Steps in designing questionnaire
• Make a list of variables
• Borrow from other instruments
• Write a draft
• Revise
• Pretest
• Shorten and revise again
• Precode

PRD-24
 Precision & Accuracy

Good precision Poor precision Good precision Poor precision

Poor accuracy Good accuracyGood accuracyPoor accuracy

PRD-25
 Data collection

• Quality Checks
• Capture-recapture

PRD-26
 Data management
• Recording data in schedule
• Choice of software
• Duplicate data entry
• Missing data
• Data cleaning
• Data storage

PRD-27
 Analysis- Descriptive CS study
• Objective:
– To describe the disease in time, place and person
– To generate hypothesis
• Analysis
– Means & SD
– Median & percentile
– Proportions – Prevalence
– Ratios
– Age, sex or other group specific analysis

PRD-28