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How to conduct a research
Dr. Padmal de Silva MBBS. MSc (Community Medicine), MD (Community Medicine)Consultant Community Physician
Department of Research and EvaluationWHO Collaborating Centre for Public Health Workforce Development
National Institute of Health Sciences Nagoda, Kalutara, Sri Lanka
What is Research ?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What research is
Step by step approach in conducting a ‘research’
Learning objectives?
• Research is the search for or creation of (valid) knowledge.
• Knowledge is what is believed to be true about something, what is believed to be a correct understanding of something.
• Facts are just data. Knowledge is an expert’s best interpretation of facts.
What is research?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
• Research is defines as “the systematic approach to obtaining new and reliable knowledge”.
• Notes that critical thinking is an essential element for research.
Ethridge (1995)
What is research?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
• It is the systematic investigation into and study of materials, sources, etc, in order to establish facts and reach new conclusions.
• It is an endeavour to discover new or collate old facts etc by the scientific study of a subject or by a course of critical investigation.
[Oxford Concise Dictionary]
What is research?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What is research?
Research is the Systematic
Collection, Analysis and Interpretation of data
To answer a certain question or Solve a problem
Department of Research – NIHS : Inspiring Public Health through Innovative Research
What is Health ?
Health Is a state of “complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2,
p. 100) and entered into force on 7 April 1948.
Department of Research – NIHS : Inspiring Public Health through Innovative Research
Determinants of Health
Agriculture and food
production
Education
Work environment
Living and working conditions
Unemployment
Water and sanitation
Health care
services
HousingAge, sex and
hereditary factors
Health
Human Health is a complex and a dynamic issue
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What is a health system?
• The institutional arrangements within which the behavior occurs
• A set of cultural beliefs about health and illness that forms the basis for health seeking behavior
• The socio economic / political / physical context for those beliefs and institutions.(the social determinants of health)
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Institutional arrangements within which the behavior occurs ……
1.The individual, family and community 2.Health care services
I. Public sector a) Health workers b) Health centers c) Field care
II. Private sectora) Traditional medicine b) Private practitioners c) Pharmaceuticals d) NGO
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Institutional arrangements within which the behavior occurs ……
3. Health related sectors I. Agriculture and food distribution II. Education III. Water and sanitation IV. Transport and communication
4. The international sector I. Bilateral and multilateral agencies
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Cultural beliefs about health and illness?
• What people believe (god, past deeds, planetary alignment, hot and cold, etc…)
• Actual cause of illness ?
• Pathway to cure/ wellbeing?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Why do we need to conduct research?
To see what is normal To identify the abnormal To find out what and which are associated with the abnormal To determine “causality”To test new interventions
And finally “explore strange new phenomena, seek out the truth, & to boldly go where no one has gone before”
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Evidence Based Medicine (EBM)
What is E.B.M?
Are we practicing EBM?
Is practice / treatment based on evidence ?
This evidence they are referring to is from research or studies …
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Evidence Based Medicine (EBM)In Sri Lanka
Are we conducting adequate research in Sri Lanka?
Do we have a culture of conducting research?
To both these questions the answer is
“NO”
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Some food for thought
Is evidence from other countries relevant to Sri Lanka?
Do we blindly follow them?
Is it ethical to submit our people to Evidence generated from Europe and USA?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Some more food for thought.Do we share the same potential as Americans and Europeans to use their growth standards?
When we say “our children are stunted or wasted” are they really so?
Is western medical treatment really better than “Ayurvedic treatment”
What sort of behavioral modifications do we need for the NCD problems? Are western modifications really applicable to us?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Why don’t we conduct enough “Research”?
• Don’t know how to conduct Research • Don’t have the time• Don’t have adequate facilities • Don’t see a need to conduct research • Conduct research but don’t publish it • Research evidence not taken up for action • No culture for “research”
THERE IS LACK OF RESEARCH
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Components of a research
• Statement of the problem • Literature review • Aims• Design of study • Study setting• Study population• Study sample and sample size calculation• Sampling Methods• Data collection methods and study instruments• Data collectors • Analysis of data and presentation of results• Ethical issues• Discussion• Conclusions
Department of Research– NIHS : Inspiring Public Health through Innovative Research
A researcher needs to develop capabilities in
• Conducting a literature review - Pub med / HINARI • Referencing and bibliography - Endnote / Mendally / cite fast• Calculating of sample size - Open epi or Win pepi • Developing instruments • Adhering to ethics and getting ERC approval • Preparation of a research proposal • Data base development using Epidata • Data quality assessment • Performing simple analysis SpSS OR Epi Info• Writing a research report
– Abstracts – Policy briefs – Short report
Department of Research– NIHS : Inspiring Public Health through Innovative Research
CONDUCTING RESEARCH
Department of Research– NIHS : Inspiring Public Health through Innovative Research
• It demands a clear statement of the problem.
• It requires clear objectives and a plan (it is not aimlessly looking for something in the hopes that you will come across a solution).
• It builds on existing data, using both positive and negative findings.
• New data should be systematically collected and analyzed to answer the original research objectives.
Characteristics of a research
Department of Research– NIHS : Inspiring Public Health through Innovative Research
• First priority is to formulate your research question
• Then figure out how you are going to answer it– How have others answered it?– How does your proposal fit in with what others
have done?– How will you know when you have answered it?
• Then you can present your answer
Department of Research– NIHS : Inspiring Public Health through Innovative Research
From where do I begin?
Steps of Scientific Research
Selection of area
Selection of topic
Crude research question no answer
Refined research question
Research hypothesis, goals and objectives
Study design
Population & sampling
Variables confounding bias
Research tools
Pilot study
Work plan
Collection of data
Data management
Interpretation
Reporting
no need for study
answers found
Literature review
Ethical issues
Is based on criteria such as:1. Relevance
2. Avoidance of duplication
3. Urgency of data need
4. Political acceptability of the study
5. Feasibility of the study
6. Applicability of results
7. Ethical considerations
Criteria for selecting a research topic
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Problem analysis
Department of Research– NIHS : Inspiring Public Health through Innovative Research
A useful link @ http://www.wikimindmap.org/
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Literature review
It need not be so………….
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Why do it?
• Identify/focus topic
• Enhance knowledge about the problem
• Identify study variables
• Formulate hypothesis
• Interpret results
• Identify research method
– Including data analysis, sample size
determination
Department of Research– NIHS : Inspiring Public Health through Innovative Research
When do you do it?
• Start reading/reviewing early– What you are planning may already have been done
• Continue throughout the project
• Drawback of an early exhaustive review– May inhibit originality
Department of Research– NIHS : Inspiring Public Health through Innovative Research
How to start?
• Talk to: experts, colleagues, librarian• Read a textbook, bibliography• Identify key original papers and review articles• Key words and MeSH words (Medical Subject
Headings)• Medline/PubMed• Google scholar
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Published Material
• Books
• Journal articles (original research, review)
• Conference proceedings/abstracts
• Reports
• Dissertations
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Sources of Published Material
• Libraries – PGIM, Ministry of Health, Universities, SLMA, SLAAS, etc.
• Private collections
• Internet/ web resources
Pubmed
http://www.ncbi.nlm.nih.gov/entrez/
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Sources of Unpublished Material
• Experts
• Teachers
• Colleagues
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@ www.pubmed.com
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Learning PubMed is easy as A, B, C…………..
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Demonstration videos @ http://www.nlm.nih.gov/bsd/disted/pubmed.html#qt
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Identify researchable areas in the problem
State Objectives
General Objective Specific Objectives
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Once the research topic is identified
We can proceed with….
Literature review
Identifying/clarifying methodology
Identifying ethical issues etc….
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Why do we need objectives for a research
• To verify the extent of research
• To have a clear guidance on the research
• To focus the research topic to achievable targets
• To build necessary skills and experiences needed for the research
• To prepare the research plan ……
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Research objectives should be
• S -Specific
• M -Measurable
• A -Achievable
• R -Realistic/ reliable
• T -Time bound
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Specific
In both meaning and focus
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Measurable
Outcome of the research should be measurable
Need to identify indicators for measuringDepartment of Research– NIHS : Inspiring Public Health through Innovative Research
Achievable
Does your resources and capacity allow you to reach the target
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Reliable/Relevance/Realistic
are the resources available reliable to carryout the research
Are the planed methods correct and appropriate for the study
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Time bound
Am I able to finish this within the target time
Department of Research– NIHS : Inspiring Public Health through Innovative Research
An “objective” starts with
Action verbs
As we are trying to solve a problem or clear up a situation
Verb is combined with “To”
To describe To recommend
To develop To analyze
To identify To design
To assess To compare Department of Research– NIHS : Inspiring Public Health through Innovative Research
An “objective” includes
What you are going to do specifically
Where you are going to do this OR for whom you are going to do this for
When you are going to do this
Why you are going to do this is not included here Department of Research– NIHS : Inspiring Public Health through Innovative Research
Some examples
To describe the patient profile treated at PCU - BH Panadura during first quarter of 2014.
To estimate the prevalence and selected risk factors for DM in Hambantota district for 2014.
To describe the knowledge on breast feeding technique among the pregnant primiparas females in the MOH area of Hambantota in 2014.
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Study Designs
Descriptive studies Analytical studies
Case report
Case serialreports
Cross-sectionalstudies
Ecological studies
Observational studies
Experimentalstudies
Case-controlstudies
Cohort studies
Prospective Retrospective(historical)
RandomizedControlled Clinical
trials
RandomizedControlled field
trials
Non-randomizedexperiments
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Ra
nd
om
ize
d C
on
tro
l Tri
als
Ob
se
rva
tio
na
l stu
die
s
Sys
tem
atic
Re
vie
ws
Qu
alit
ati
ve
stu
die
s
General population, study population and the sample
Department of Research– NIHS : Inspiring Public Health through Innovative Research
The sampling process…
POPULATION
SAMPLE
INFERENCE
Department of Research– NIHS : Inspiring Public Health through Innovative Research
The sampling process…
POPULATION
SAMPLE
INFERENCE
Is this sample representative?
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Sample Size Calculation
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What is the measure of interest?
What is the underlying probability distribution of thecharacteristic of interest?
What is the sampling distribution of the measure? (i.e., type of study design and how the samples were obtained)
How accurate do the results want to be?
Department of Research– NIHS : Inspiring Public Health through Innovative Research
The accuracy of the estimate depends on two
quantities:
1. how narrow the width of interval
2. how confident the results to be(e.g. 95%).
Department of Research– NIHS : Inspiring Public Health through Innovative Research
S – Sample size for infinite population
Z 1-α/2 – Percentile of the standard normal distribution determined by the
specified confidence level (1.96 for 95% confidence level)
p – Estimated proportion in study population
d – Acceptable margin of error (width of interval)
Formula to calculate sample size for a cross sectional study having a binomial distribution for the characteristics of interest (i.e., to calculate a proportion of a certain event)
Department of Research– NIHS : Inspiring Public Health through Innovative Research
@ http://www.openepi.com/Menu/OE_Menu.htm
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Problem identification Problem identification & Prioritization& Prioritization
Problem analysisProblem analysis
Literature ReviewLiterature Review
Developing ObjectivesDeveloping Objectives
Study DesignsStudy Designs
Selecting study populationSelecting study populationSample size calculationSample size calculation
Data Collection TechniquesData Collection Techniques
What is data collection?
• Systematic collection of information about the Objects of the study and about the settings in which they occur
• Objects– People– Phenomena (Occurrences, Happenings) – Objects (Things)
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What is data collection?
• Data collection need to be Systematic• Haphazard data collection will not answer the
research question well
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Different data collection techniques
• Using available information• Observing• Interviewing• Administering questionnaires• Observational check list • Focus Group Discussions / In depth interview• Other methods
Department of Research– NIHS : Inspiring Public Health through Innovative Research
MEASUREMENT
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Measurement is
essentially assigning
numbers according to
certain rules
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Anything that can
be measured and is
observed to vary is
called a variable
Variable
Department of Research– NIHS : Inspiring Public Health through Innovative Research
MEASUREMENT ERROR
When ever we make
measurements we must be
aware of the possibility of
errorDepartment of Research– NIHS : Inspiring Public Health through Innovative Research
Two kinds of errors
Systematic error Random error
Department of Research– NIHS : Inspiring Public Health through Innovative Research
How to minimize Subject variation
•Planning data collection in almost similar settings, environments
•Training data collectors on questioning (tone, mood, time of the date etc)
Department of Research– NIHS : Inspiring Public Health through Innovative Research
How to minimize observer error
Training observers or data collectors (Inter observer variation)
Repeat measurements and take the average (Intra observer variation)
Department of Research– NIHS : Inspiring Public Health through Innovative Research
How to minimized Instrumental errors
•Standardizing instruments and procedures•Instruments has to standardize/ calibrate repeatedly
•Procedures or techniques has to be cross check during the study
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Characteristics of an indicator
• Valid • Reliable• Sensitive • Specific
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Validity
Validity is the ability of a
instrument/ questionnaire
to measure what it suppose
to measure
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Reliable
Reliability / Repeatability is the level of agreement between two replicate measurements
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Valid
& reliable
Valid
Not as reliable
Not valid
Repeatable
Not valid
Not reliable
Data collection flow
The following needs to be thought of and decided upon……
1.Who is going to collect the data ?2.From whom ?3.Where ?4.How ?5.Using what?6.How is information given to the participants?7.How are they recruited to the study?8.How is consent to be obtained?9.How to conclude the data collection?10.What to do with positive cases?11.Checking for quality of the collected data? Who? When ? Where ? How ?12.Entering the data?13.Analysis of the data
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Ethical considerations
– Do no harm – Do good – Voluntary participation – Informed consent – Conflict of interest – Scientific validity
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@ https://phrp.nihtraining.com/users/login.php
Getting Ethics clearance
Very Very Very importantNo publisher is going to publish your work without ERC approval Essential for getting your research allowance
Forum for Ethics Review Committees of Sri Lanka (FERCSL)ERC you submit needs to be accredited from FERCSLElse your proposal will be re channeled for review by MoH
Some of the FERCSL accredited review committees
1. University ERCs2. NIHS 3. MRI4. SLMA5. NHSL
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ERU - NIHS: Centre of Excellence in Public Health Research
Time series chart – GANTT ChartItem description MAR AP
RMAY JU
NJUL
AUG
SEP
OCT
NOV
DEC
Initial discussion XLiterature review X XFinalizing methodology X XEthical clearance XPre testing X XData collection proper X XData entry X XInitial analysis X XDraft report XFinal report submission XPresentation of findings X
ERU - NIHS: Centre of Excellence in Public Health Research
Preparing a budget Steps in preparing a budget
1.Perform a task analysis and list out the tasks for the study2.Define the cost categories for each identified task
1. Manpower 2. Machinery 3. Materials 4. Time
3.Decide on the time requirement for each activity 4.Decide who is going to perform each activity and how much it is going to cost / person / time unit 5.Perform cost estimation for each activity / task 6.Sum cost of activities to get the total cost for the study
ERU - NIHS: Centre of Excellence in Public Health Research
Preparing a budget Steps in preparing a budget
7.Don’t forget to cost for….• Travelling, food and accommodation of data
collectors• Refreshments for discussions / meetings • Translation and typesetting of questionnaires• Printing of data collection formats• Data entry and analysis • Dissemination of results • Publication of data • Licensed software
Plan of analysis
Descriptive statistics
Measures of central tendency
Measures of dispersion
Inferential statistics
Statistical significance
Population parameter estimation
Testing of hypothesis
Statistical modeling
What statistical software is going to be used?
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ERU - NIHS: Centre of Excellence in Public Health Research
Disseminating research evidence into policy and practice
1. Research reports 2. Abstract presentation: poster or oral 3. Journal articles 4. Advocacy briefs 5. Policy briefs
ERU - NIHS: Centre of Excellence in Public Health Research
Report writing 1. Abstracts and key words 2. An introduction including a justification 3. Appropriate review of literature 4. Objectives and methodology 5. Results 6. Discussion 7. Conclusions and recommendations 8. References 9. Annexures
Quiz
• Please complete this short quiz to test and increase your knowledge of referencing.
…Good Luck !!
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Why do we need to reference material that we use?
1. Avoid accusations of plagiarism
2. Acknowledge others work
3. Support academic arguments
4. Prove that you have researched a topic
5. All of the above10
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No. 5 is correct
It is crucial in academic writing to acknowledge the work of others in support of your argument. Plagiarism is a growing problem and there are disciplinary procedures for anyone caught plagiarising other people’s work.
Department of Research– NIHS : Inspiring Public Health through Innovative Research
In which case would you need to reference the source of information?
1. When you copy word for word a paragraph from a journal article/book
2. When you copy word for word a paragraph from a web site
3. When you write in your own words ideas from a journal article/book
4. When you write in your own words ideas from a web site
5. None of these6. All of the above 10
Department of Research– NIHS : Inspiring Public Health through Innovative Research
No. 6 is correct
• It is important to acknowledge any other person’s ideas/words that you include in your work, either directly or indirectly. If you do not make reference to someone else’s ideas/work you may be accused of passing it off as your own (plagiarism).
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Which style of referencing is usually followed?
1. Harvard
2. Vancouver
3. Endnotes
4. Reference footnotes
5. Don’t know10
Department of Research– NIHS : Inspiring Public Health through Innovative Research
No. 1 is correct
• Harvard style of referencing, which is the author/date style is frequently used. Some journals and publishers continues to use the Vancouver, or number, style of referencing.
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What are the essential elements of a book reference?
1. Author’s name and title2. Author’s name, title
and date 3. Title, date and
publisher4. Author name,
publication date, title, place of publication and publisher
5. Don’t know 10
Department of Research– NIHS : Inspiring Public Health through Innovative Research
No. 4 is correct
• It is important that you give these required elements about the books we use as this makes it easier for someone to find the edition of the book that you have used.
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What are the essential elements of a journal article reference?
1. Author name and article title
2. Author name and journal title
3. Author name, article title and publication date
4. Author name, article title, journal title, publication date, volume and issue number, inclusive page numbers
5. Don’t know
10
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No. 4 is correct
• It is important to include all of these elements so that someone else can find the article that you have referred to.
NB. If you are adding a reference to an electronic journal please refer to the ‘Quoting and Preparing References’ guidelines.
Department of Research– NIHS : Inspiring Public Health through Innovative Research
What must you include in a web site reference that is different from other references? (Please choose two
options.)
1. Web site author
2. Date accessed
3. Full URL
4. Don’t know10
Department of Research– NIHS : Inspiring Public Health through Innovative Research
No. 2 & 3 are correct
• Materials on the web may be removed. Including the date that you looked at the website tells other people when the material was available.
• Including the full URL will direct other people to the correct web site.
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@: www.nihsknowledgehub.comDepartment of Research– NIHS : Inspiring Public Health through Innovative Research
@ http://wwwn.cdc.gov/epiinfo/7/
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@ http://www.mendeley.com/
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RESEARCH TEAM
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Putting together a team
Department of Research– NIHS : Inspiring Public Health through Innovative Research
A research team needs persons capable of………
• Conducting a literature review - Pub med / HINARI • Referencing and bibliography - Endnote / Mendally / cite fast• Calculating of sample size - Open epi or Win pepi • Developing instruments • Adhering to ethics and getting ERC approval • Preparation of a research proposal • Data base development using Epidata • Data quality assessment • Performing simple analysis SpSS OR Epi Info• Writing a research report
– Abstracts – Policy briefs – Short report
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Together Everyone Achieves More
Department of Research– NIHS : Inspiring Public Health through Innovative Research
Thank you