From idea to research proposal

1. From idea to research proposal <Insert Name and Centre>

2. Aim • To be able to construct a research proposal following the identification of a practice problem

3. Objectives • To be able to phrase answerable research questions • To be aware of the key differences between qualitative and quantitative research techniques

4. 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?

5. 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

6. 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)

7. 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?

8. 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.

9. 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

10. Qualitative approaches • Phenomenology • Ethnography • Grounded theory • Case study • Narrative • Considerable overlap between approaches

11. 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)

12. 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

13. 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?

14. 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

15. 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

16. 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

17. 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)

18. Research, audit or service evaluation (research)? • Confusion +++ • Generating new knowledge • Does a service meet a pre-determined standard? • What standard does a service meet?

19. Group exercise • Groups of 3-4 • 1-2 scenarios each • Feedback

20. 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?

21. 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?

22. 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

23. 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

24. 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?

25. Research paradigm: options • Qualitative • Group or 1-1 interviews • Observation • Quantitative • Survey using a questionnaire

26. 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

27. 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)

28. Survey methods • Surveys usually collect information by • postal or other self-completion questionnaire methods • diaries • personal face-to-face or telephone interviews

29. 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)

30. 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)

31. 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

32. 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

33. 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

34. 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