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From idea to research proposal
<Insert Name and Centre>
Aim
To be able to construct a research proposal following the identification of a practice problem
Objectives
To be able to phrase answerable research questions
To be aware of the key differences between qualitative and quantitative research techniques
Phrasing the question Defining the research question
– All research begins with a question – Directs all aspects of the research study– Will need refining in the planning stages– Should be realistic and not over-ambitious– Should be specific and precise– Should be important
Initial steps– Get it down on paper– Can it broken down to bite size pieces?
Research paradigms Qualitative
– Aims to understand people’s experiences of the world
– ‘what does it feel like’ or ‘what is important to you’? – Develops theory
Quantitative– Quantifies phenomena– ‘How long’ or ‘how many’?– Tests theory
Qualitative or quantitative? Why do people not take their medicines?
Does a community-based education programme improve compliance in cardiac patients?
PICO (Population, Intervention, Comparision, Outcome)
Qualitative or quantitative?
Why do patients engage with alternative healthcare practitioners?
Does aloe vera gel improve the quality of life in patients with psoriasis compared to placebo?
Goal of qualitative research
Development of concepts which help us to understand phenomena in natural settings, giving due emphasis to the meanings, experiences, and views of participants (Mays and Pope 1997, p.4)
Therefore it aims to discover meanings, understand actions, generate theory.
Qualitative research Natural setting vs. experimental Sample
– small numbers, purposive, informative cases, not randomly selected
– how many is enough? Data
– Interview transcripts, quotations, descriptions, not numeric
Analysis – theory may emerge from the data
Qualitative approaches
Phenomenology Ethnography Grounded theory Case study Narrative
Considerable overlap between approaches
Collecting qualitative data
Depends upon approach Research instrument = researcher Observations
– overt vs. covert and the Hawthorne Effect– recorded in field diaries
Open and semi-structured interviews– 1-1, group or ‘focus group’
Documents Audio-visual (e.g video)
Analysing data
Depends upon approach– Approach-specific frameworks
General tips– Transcribe data – Code the data (e.g highlight similar ideas in same
colour)– Look for emerging themes– From these themes, try to generalise about the
phenomenon in question
Quality in qualitative research
Debate – the nature of knowledge produced by qualitative research
CASP tool– Rigour - has a thorough and appropriate approach
been applied to key research methods in the study? Reflexivity.
– Credibility - are the findings well presented and meaningful?
– Relevance - how useful are the findings to you and your organisation? Context?
Quantitative research Many study designs (e.g. RCT, case control,
cohort) Experimental setting Sample
– Statistically informed– Sample randomly selected from population
Data – Numeric
Analysis - generally testing theory but not always
Collecting and analysing data
Data collected by validated instruments (e.g QoL scales, diagnostic criteria, questionnaires)
Analysed using descriptive or inferential statistics
Quality in quantitative studies
Service evaluation research
‘Are we doing the right things with the right people at the right time?’
Service evaluation research may …– Determine whether the programme addresses the
problem– Examine what resources are needed or how
effectively they are being used– Measure service achievement– Improve service delivery
Service evaluation research
Formative (before intervention) vs. summative (after intervention)
Often use ‘mixed methods’
Process measures of effectiveness (e.g. timely answer) vs. outcome measures (e.g patient outcome)
Research, audit or service evaluation (research)? Confusion +++
Generating new knowledge
Does a service meet a pre-determined standard?
What standard does a service meet?
Group exercise
Groups of 3-4 1-2 scenarios each Feedback
Service evaluation: case study
Research strategy top 5 questions:
What impact does the UKMi enquiry answering service have on patient care?
What economic impact do UKMi services and products have for the NHS? What are the costs and benefits?
Are UKMi internet resources (e.g. new product reviews, news) used by healthcare professionals in the care of individual patients?
How can UKMi best support 24/7 NHS services? What can UKMi contribute to the management and maintenance
of electronic prescribing systems?
How can UKMi best support 24/7 NHS services?
How would you answer this question? Where would you start?
What are the possible methods? Qualitative or quantitative? What have other researchers done?
Literature review
Identifies what has been done before
Helps to form the research question and the study objectives
Clear objectives will guide the entire research study
Rationale
MI services available 9-5 Debate around hospital pharmacy 24/7 Deaths due to medication errors rising Majority of errors occur when pharmacy
is shut Inadequate access to information
repeatedly proposed as a cause of error
Literature review: unanswered questions What medicines information do UK
healthcare professionals need ooh? How do they currently access it? Are there any barriers during this time? How would they prefer to access it? (Has it led to an error in their practice?) Does UKMi service need to develop to
support them further?
Research paradigm: options
Qualitative– Group or 1-1
interviews– Observation
Quantitative– Survey using a
questionnaire
Research paradigm
Quantitative paradigm suitable as– Pre-existing knowledge
exists– Nature of data is
straightforward– BUT relevant issues may
be overlooked
Enables efficient data collection and analysis
Survey methods Survey methods used to describe
– Events (accessing information) – Behaviour (how information is accessed)– Attitudes (how professionals would prefer to access
information)
Data extrapolated from a sample to the whole population
Hypotheses developed that can be tested (e.g. nurses are more likely to require information about IV medicines ooh)
Survey methods
Surveys usually collect information by– postal or other self-
completion questionnaire methods
– diaries– personal face-to-face or
telephone interviews
Developing the research instrument Research instrument
must be validated (e.g. questionnaire, quality of life scale, thermometer, clock)
It must measure what it is intended to measure (valid) and be repeatable over time (reliable)
Sampling frame
Study population: All NHS doctors and nurses that work outside the hours of 9am to 5pm Monday to Friday, or anytime at weekends
Proposed study sampling frame – all FY1, FY2s and nurses that work ooh
Accessing staff names (ethics, data protection)
Key results
Low response rate Average need; 1 to 5 time per shift Questions were most likely to relate to;
– adverse effects– drug interactions– dose – practical aspects of drug administration
including intravenous compatibility
Key results
Tendency to use paper-based resources and their peers
Majority did not perceive there to be barriers Questions that are more difficult to answer
– Chemotherapy, IV medicines
Wants – Extended hour MI, links to validated online
sources, Q&As
Conclusions
NHS health professionals need reliable, relevant advice that can be accessed quickly and with minimal effort out-of-hours to help them make decisions beside the patient
Examples of opportunities for UKMi;– Change to current nine to five pattern– Increased training of on-call teams– Development of NeLM including ooh-specific Q&As– Increased training of nursing and medical staff with
information and evaluation skills– Links to validated websites from Trust intranets
Learning outcomes
By the end of the session you will
– Be able to phrase answerable research questions
– Be aware of the key differences between qualitative and quantitative research techniques