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Research Methods in Health
Chapter 2. Structure of Research Paper
Colin Binns1, Mi Kyung Lee
1, Young Moon Chae
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1. Curtin University, Australia
2. School of Public Health, Yonsei University, Korea
Table of Contents
1. Abstract
2. Introduction
3. Methods and ethics
4. Results
5. Discussion
6. Conclusion
7. Acknowledgements
8. Reference
9. Review paper
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Abstract
• Abstract 200 words
• Usually write after article is completed.
• The use of a structured abstract is becoming more common.
• Common headings are:
- Objectives or Issue(s) addressed:
- Methods:
- Results:
- Conclusions:
• You cannot include a table in the abstract, but you must include some results – enough to make people want to read the full article.
• Make sure the results are the same as in the article.
• Make sure objectives and conclusions are the same as in the article.
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(cont.)
Keywords:
• Usually 4-5 words, sometimes up to 10.
• Remember these will become the key search words in the databases.
• Keywords will determine if your paper is cited.
• Check keywords for similar articles. (articles you have used in your references)
• Check keywords used in your chosen journal.
• Use terms from the MeSH list of Index Medicus)
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Introduction
• This is the most difficult part of your paper to write. If the editor (or reader) doesn’t like the introduction he/she won’t read the rest of it.
• Set the scene for your paper.
− History
− Importance
− Gaps in our knowledge
− Why is this a problem?
• Important definitions are included here.
e.g. Exclusive breastfeeding, full breastfeeding, any breastfeeding.
• Conclude with objectives or research questions.
• Tell your audience exactly what they can expect from this paper.
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Introduction (cont.)
Background - literature review
• Information about the problem.
• Remember science builds on previous science.
- Historical papers
- Key studies
- Reviews
• You must mention enough studies to be representative of previous studies.
• Always write a critical review
• Include references to methods.
• Describe methods used in past studies and how they have evolved.
• Describe scientific significances of this research based on literature review
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Introduction (cont.)
Objectives or research questions:
• Preferable to have one good general objective and 3 – 4 specific objectives (sub-problems) in order to provide clear direction for research
• Each sub-objective is a researchable unit
• Do not confuse with expected benefits
• Preferable to include policy implication objective for health services researches
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Methods
Structure of Methods
• Subjects
− Number of subjects
− Sampling design
• Methods
− Research design
− Research framework
− Analytic methods
− Questionnaire
• Ethical issues
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Methods (cont.)
Subjects
• How did you choose your sample?
− Random
− Systematic
− Convenience
− Other
• Which population does the sample represent?
• How was bias controlled?
• How did you calculate sample size?
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Methods (cont.)
Types of Research Design
• The degree of formulation of problem
a. Exploratory or Formulated
b. Descriptive, Diagnostic, Analytical
•The topical scope
a. Historical study b. Survey, Delphi Study c. Case study (History, Material),
Accounts, Episodes, Story of experience d. Statistical study
•The search environment, I.e., the field or lab setting
a. survey b. lab experiment
•The time dimension
a. Cross Sectional (One time) b. Longitudinal, Trend, Cohort
•Qualitative or Quantitative Research
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Methods (cont.) Research Framework
• Need to specify dependent and independent variables
• Need to include statistical methods between variables
• Example of research framework for the factors influencing blood pressure
Blood Pressure
Demographic characteristics
(Age, Sex, Location, etc.)
Lifestyle
(Exercise, Eating habit, Smoking, Drinking, etc.)
Medical Status
(Family history, other disease)
Multiple regression
T test or ANOVA (Relation between BP and influencing factors)
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Methods (cont.)
Analytic Methods
• Describe the method(s) you used in your study.
• Several references to where the method has been used previously.
• Why is this method the best?
• Sometimes you cannot use the latest method (cost, lack of equipment, etc).
• You must justify your decision.
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Methods (cont.)
Questionnaire Design
• List the questionnaires you will use.
− Are they standard?
− How were they validated?
− Are they based on literatures?
− Are key independent and dependent variable included?
− If you used your own questionnaire, how was it developed and validated?
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Methods (cont.)
Ethics
• Which ethics committee gave approval? (If none, then state that the research conforms to the NHMRC standards and the Helsinki declaration)
• Keep your letter of approval – some journals require a copy of it.
• How did you gain consent to participate?
• Usually written consent is required, even for questionnaires. (Is this the case in all cultures?)
• Confidentiality and storage of data must be mentioned.
• Caution– Children, students, aboriginals (Dependent relationships)
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An example of an ethics section in a paper:
The project was approved by the Curtin Human Ethics Research Committee and the ethics committees of each individual hospital. An information sheet was given to each person selected to participate. The sheet was read out to each mother to save them from embarrassment if they could not read. Informed consent was then requested. Mothers who declined to participate were reassured that they would not be discriminated against in their treatment or association with the health service in any way. All data was kept confidential and no identifiable data will be released to anyone.
Methods (cont.)
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Results
• The results are the heart of the paper.
• You must provide enough information (but only objective information) to allow others to reach the same conclusions as you have and to understand if bias and errors have been accounted for.
• Make sure research questions (objectives) are addressed.
• In the results section report your most interesting and important results.
• Include tables and figures (less than 20)
• Do not simply repeat in textual form the same information that is in the tables.
• Do not cite references
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Results (cont.)
• Descriptive statistics
Include the simple statistics as well as the complex in order to describe subjects
• Inference statistics
Multivariate models
Include confidence intervals and p-values in tables
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Discussion
Structure of Discussion Sections
• Statement of principal findings
• Strengths and weaknesses of the study
• Strengths and weaknesses in relation to other studies, discussing particularly any differences in results
• Meaning of the study: possible mechanisms and implications for clinicians or policymakers
• Unanswered questions and limitations
• Future research
(Reference: Docherty M, Smith R. The case for structuring the discussion of scientific papers. BMJ, 1999;318:1224-5)
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• This is the second most difficult section: it requires a high degree of abstraction in writing.
• What have you found out?- Make sure each of your research questions is addressed.
• Do your results differ from or confirm previous studies? In what ways? (use literature review)
• Why are your results different – sample selection or size, different method of measurement, etc?
• How does your study add to our knowledge?
• What wider groups can the study be generalized too?
• How does your study change practices in this area?
Discussion (cont.)
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Discussion (cont.)
• What further research is now needed?
• Add some interesting descriptions (color) – but these must be limited in size.
• Limitations of this study.
Be honest – all studies have limitations of sample selection.etc But don’t give such a long list that you make the editor think that the paper is not worth publishing.
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Limitations of this study
Be honest – all studies have limitations of sample selection etc. (But don’t give such a long list that you make the editor think that the paper is not worth publishing.)
An example of a limitations section:(There are a number of limitations that need to be considered when interpreting the results of this study. The study populations were mothers delivering at two Perth hospitals, which are generally representative of public patients. The results may not be applicable to private patients who are often in the upper income brackets. The study was based on the results of a questionnaire and some of the mothers may not have been aware of the addition of folate to foods or beverages that they consumed. However it is unlikely that mothers consuming folate tablets each day for a period of months would not be aware of what they were taking.)
Discussion (cont.)
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Conclusion
• Quick summary of most important findings.
• Don’t add anything new.
• Include your most important statistic.
• Perhaps recommend change in public health practice.
• Almost always you will recommend more research.
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Example of a conclusion
It does not include recommendations for further research, but does include a policy recommendation.
Conclusion.This study updates previous studies of the use of folate in Australia. While the percentage of mothers taking folate appears to have increased, in this study there were a significant proportion of mothers who did not take folic acid periconceptually. The mothers who are not taking folic are less educated, are from lower socioeconomic
groups and are not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.
Conclusion (cont.)
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• Thank your
funders,
co-workers,
hospitals and participants (patients)
• Funding agencies often require you to mention the grant number.
• Don’t go overboard
• Mention any conflicts of interest. (e.g. industry funding)
• Disclaimer may be required.
Acknowledgements
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References
• Make sure you follow your journals instructions accurately.
• Usually number is limited (e.g. 25-30)
• Include:
- 1 or 2 classic references
- Several references from this year to show you are
- up to date
- References from the journal you are intending to publish in.
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Number of References (Maximum 20-30 unless writing a review or Social Science & Medicine)
• Introduction 2-3
• Why is this a problem? 1-2
• Literature Review 10-15
• Methods 5
• Results 0
• Ethics 2 (Helsinki, NHMRC)
• Discussion 5-10
• Conclusion 0
References (cont.)
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• Same major headings.
• Remember to write a “critical review”.
A critical review means that you do not believe that just because something is in print that it is true. Every paper or idea you include must be evaluated to assess its “truth” or “evidence”
• Methods
Include databases and keywords used for searching. How each article assessed?
• Results
As part of a critical review include levels of evidence
• Conclusion
How does this alter current practice?
Further research?
Review Paper
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Review Paper (cont.)
• Details of each paper included:
− Type of study
− Aim
− Sample size (n), details
− Country, animal or human
− How measured?
• Check every paper you intend to include in Science Citations.
• Include some assessment of the quality of each paper.
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References
Polgar S, Thomas, S.A. (1991). Introduction to research in thehealth sciences. Churchill Livingston.
Dane FC (1990). Research methods. Brooks/Cole PublishingCompany.
Docherty M, Smith R. The case for structuring the discussion ofscientific papers. BMJ, 1999;318:1224-5
