Lecture 1: Introduction to health

research
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!! Online!!
Assessments
[3 Assignments and online Quizzes + 50% written final
paper]
 Housekeeping
• Online = Computer & Internet needed
• All course content delivered online
• Continuous assessments online
• Communication online
Housekeeping
Learning Reshuffle:
• Week 1:
Online orientation
• Week 2:
Introduction to research & health research
• Week 3:
Research process & Selecting a problem
• Week 4:
Literature search & Literature Review
What is research?
Root = French = “to search”
“the systematic collection, description, analysis
and interpretation of data to answer a certain
question or solve a problem” (WHO, 2004)
“organized curiosity”

“a quest for knowledge”

Health research

• “ process for systematic collection,

description, analysis and interpretation of
data that can be used to
improve the health of individuals or
groups” (WHO, 2004)
Why research?
• Advance understanding of health and
disease
• Inform policies and decision making in
health systems
• Develop critical thinking skills

Prevent death and disease & improve

health outcomes for individuals &
populations
Why you need to know
• 1) To stay on top of
advances in health
knowledge

• 2) The need to stay up to

date with best practice
Why you need to know
• 3) The need to understand
and practice according to
clinical guidelines

• 4) Growth in
patients/consumers
knowledge
Why you need to know
• 5) Advanced professional training-
research requirements
Categories of research

• By philosophical approach: empirical /

theoretical
• By application: basic (theoretical) / applied
• By primary focus: preventive /therapeutic
• By level: laboratory/ bedside / population
Research philosophy
• = how knowledge is developed and what the
nature of that knowledge is
• Has certain assumptions about how you view
knowledge and the process by which it is
attained
• Determines your research process & methods
• Eg:
• What is the best method for diagnosing cancer?
– Diagnostic accuracy

– Patient preference
Research philosophy
Empirical vs theoretical
Empirical: Knowledge is gained by direct or
indirect observation of events and analysis
of data (statistical analysis) to confirm
whether a hypothesis is true or not
-most health research lives here
-practical, factual, objective
-quantitative vs qualitative
 Table 1:
Element of research Associated with Associated with Qualitative
Quantitative research research
Your research philosophy: Objectivism: things exist in Constructionism: everything
what knowledge is and how an objective reality. The way is relative and depends on
to get it they exist does not have context. The way things are
anything to do with the way is just a construct of the way
we think about them or we make sense of them. It’s
experience them. Research just our own personal
tries to observe and theory. Research tries to
measure this objective truth capture this context and
personal meaning.
Your theoretical Positivism: information is not Critical inquiry: reality is
perspective: how you scientific unless it can be constantly changing. Every
explain what things mean proven right or wrong by action changes the context.
through research observation and experiment We must constantly be
critical of our assumptions
when we do research.
Research philosophy
• Theoretical: suggests theories from
hypothetical examples, not actual
observations.
• Theories range from explicit
hypotheses to working models and
frameworks of thinking about reality
• Give meaning in understanding
health and health related problems
Examples of theories
• Social construction: relationships and
social contexts are socially constructed
and are part of people’s identity
• Critical theory: some groups are more
powerful than others, and they all
compete for resources like trees in a
crowded forest
• Functionalism: society is or should be
united, functioning as efficiently as a
beehive to everyone’s benefit
Categories of research
• Basic vs applied
• Basic –search for knowledge with
no defined purpose or use for
that knowledge
• Applied- research that is oriented
towards answering a specific
question in order to solve a
problem. Where health research
exists.
 Categories of research
• Health research triangle- looks at
research from an operational point of
view:
• Biomedical-examines processes at a
cellular level
• Health services-examines factors that
influence access to and quality of health
care
• Behavioural- interaction of man & the
environment in relation to their beliefs,
attitudes & practices
Scientific method
• Most health research is empirical
• Objective observations and hypothesis testing
• Scientific thought grew over centuries
• Developed systematic methods for describing,
explaining and controlling health related
events (or phenomena)
Scientific method-Order
Order:
• conclusions must be made after using a
systematic (often objective) approach
• organized observations made on
phenomena/events of interest.
• theories based on data/facts that have
been systematically collected and
analyzed (not ‘common sense notions’
Scientific method-Inference
Infer = to deduce or
Inference and chance conclude based on
evidence or reasoning
• Testing hypotheses
• Eg : CT scan is better at diagnosing breast
cancer than breast biopsy
• Systematically try to prove or disprove
hypotheses
• Make inferences based on observations
 Scientific method-Making inferences
• Inductive approach:
• Moves from specific general conclusions
• Always considers possibility of chance (coincidence) in producing
results seen
• Conclusions not definite, don’t always follow the premises or facts.
• Uses the laws of probability and is used in quantitative health
research (which is why we use statistics-known as biostatistics).
• Conclusions such as
-The probability of A occurring given B and C is…
-Therefore it might be that these factors influence whether or
not A occurs
 Scientific method-Making inferences
• Deductive approach: premises are made from
which conclusions are drawn, Reading 1 gives a
good example of this kind of approach:
• All A is B
• All B is C
• Therefore All A is C
• Moves from general  specific conclusions
• NO element of uncertainty or chance in the
conclusions.
 Scientific method-Probability
• Recall: Probability= measure of uncertainty or
variability of a characteristic among
individuals in a population
• Using probabilities allows measurement of
uncertainty more validity in findings
• Using samples of populations requires use of
laws of probability
 Scientific method-Hypotheses
• = carefully constructed statements about a
phenomenon (or event ) occurring in a population
• “educated guesses” put into a statement about
possible relationships that exist
• based on observations
• Guide the research process (determine what we’re
trying to prove)
• How do we come up with hypotheses?
– Use Mills Canon of inductive reasoning
Scientific method-Hypotheses
• Mills canon
• Method of difference:
• When you observe that the amount of a disease is
very different in two different circumstances say in
two groups of people, or under two different
conditions

• the two groups differ by a certain factor for example

one group smokes and the other doesn’t or one
group lives in a particular suburb and the other
doesn’t.

• You might then make a hypothesis that the factor by

which they are different is the cause of the disease.
Scientific method-Hypotheses
• Method of agreement
If a factor by its presence or absence is common
in a number of circumstances which then lead to
the outcome occurring then that factor may be a
cause or risk factor for that outcome.
Scientific method-Hypotheses
• Method of concomitant variation
or the dose response effect
An increase in dose of a possible
exposure leads to an increase in the
effect and similarly when the
exposure decreases, the outcome
decreases, when you see this
happening you might hypothesize
that the exposure causes the effect.
Scientific method-Hypotheses
• Method of analogy:
The distribution of a disease or effect is similar
to that of another disease-this may lead you to
hypothesize that the two diseases share a
common cause:
Hep B  Hepatitis, Hep B  Liver cancer, It is
possible that Hep B virus is a cause or risk factor
not only for hepatitis but for liver cancer too.
Study design
• Once we have a hypothesis:
– Smoking is a risk factor for lung cancer
– Treatment with Drug B reduces heart
attacks
• Find a strategy to prove whether
the hypothesis is true or not.
• Design a study which can to prove /
disprove hypotheses using a valid
scientific approach
Study Design

Health
research

Qualitative Quantitative
Study design
• Quantitative studies- measure relationship
between two factors or variables, one being a
possible cause and the other a possible effect
of that cause.
• Quantitative study designs: experimental and
observational (non- experimental) studies
 QUANTITATIVE STUDIES
Did investigator assign the
intervention/exposure?

Experimental Observational
Random allocation? Comparison group?

Randomized Analytical study

Descriptive study
controlled trial (RCT)

Non randomized Direction? Case reports/

controlled trial Series
Cohort
(Exposure Outcome) Cross- sectional/
ecological
Case-control
(Outcome  Exposure)

Cross-sectional study
(Exposure – Outcome)
Quantitative studies
Experimental Observational
Controlled factors-assign • ‘Natural experiment’
exposure/ possible cause
The “perfect” study 1
Question  Hypothesis
• 1.choose population of interest
• 2.give intervention/exposure
• 3.assess outcomes after specified period of
time
The “perfect” study 2
THEN
Take the SAME population back in time
Withhold intervention/exposure
Assess outcomes after same period of
time

COMPARE Outcomes:
with intervention vs without
intervention
Next best thing….
• Assess 2 groups of subjects who are as similar
as possible
• Give one group factor of
interest(exposure/intervention)
• Observe and measure outcomes in the 2
groups
• Quantitative studies
usually have 2 (or more)
comparison groups:
• Cases vs non cases
(controls)
• Treatment vs control
(placebo)
• Exception: Descriptive
studies
Study designs
• Hypothesis generating (descriptive)
• Case series

• Cross sectional
Study designs
• Hypothesis testing (analytical)
• Case control
• Cohort
• RCT
Study Designs

Health
research

Qualitative Quantitative
Qualitative studies
• answer the why and how
questions
• use theoretical approach
• add richness to understanding
• methods include interviews,
surveys, focus group discussions
• conclusions based on themes not
quantitative analysis