HLTEN514 A Apply research Skills within a contemporary environment

1. HLTEN514 AApply research Skills within a contemporary environment DR Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration) TAA Cert. IV ( Australia)

2. What is Phenomena ? OH ! Factor Observation Rain / wind / infection in the ward / readmission of cases / increase in Dengue patients / Nurse turnover/ rising cost of healthcare

3. What is a Concept ? An idea Perception Thought Theory Model Re-search model Conceptual model

4. What is Research ? Why ? When ? Where ? Who ? What else ?

5. What is Theory ? Reasoning Explanation Argument

6. What is Health Research ? • Is systematic; • collection, • analysis, • interpretation of data • to answer a certain question or to solve a problem related to health

7. Health Management Research • “Linking • theory • education • practice to improve administrative practice and standards “ • Health management research helps to : • Validate healthcare management practices • Analyze effectiveness of healthcare management interventions • Organize scientific base for healthcare management practice • Demonstrate the accountability

8. Why Health research is Important ? • Health needs of the community---------------Health resources • Health Interventions • Health resources are scarce to fulfill the health needs of the community • Interventions in health have to be planned properly for it to be effective • For interventions health information is vital to : • Prioritize the need • Monitor the Coverage, Effectiveness Affordability, Efficiency, Acceptance, Sustainability • Feed back Health research plays a major role in this context

9. Importance of Health Research • Demand Gap • Effective interventions • Coverage • Accessibility • Affordability • Sustainability • Effectiveness • Efficiency • Assessing need & Demand • Health Planning, Interventions, monitoring of health problems & issues

10. information • Data • Facts or phenomena • Raw numbers • Information • Organizing numbers after scientific analysis • Scientific results through tabulating data • Intelligence • Interpretation of information by using professional experience • Expert knowledge

11. Re – search • Solid scientific base • Based on previous research – Applied research • Inventions – Basic research

12. Research concept / idea / model • Based on the phenomena observed – the snap shot – situational analysis • Identify issues / problems • The identified problem should have a : • Clear gap in care current and ideal situation • Relevance to healthcare management • Avoidance of duplication • Acceptability - Political / Ethical • Applicability • Urgency

13. History of health management research • Activity 01 – group presentation next week

14. Research Process • Selection of a Problem & formulation of objectives of the research • Ethical consideration in research • Literature review • Build up on existing scientific research • Referencing and citation • Methodology • Conceptual framework and hypothesis • Study design • Data collection • Analysis of data • Presentation , Interpretation and dissemination of results

15. Selection of a Problem & formulation of objectives of the research

16. 1. Selection of Problem The steps : • Selection of the problem /issue • Situational Analysis • Problem identification • Prioritization of the problem • Analysis of the problem • Selection of a problem ( cause / effect ) • Formulation of problem statement • Background of the problem & description of the problem

17. Hospital clinic Let s identify issues and move on to organizing the Research!

18. Selection of the problem • Situational analysis of the problem • Snap shot of the situation / issue • Identify the problem/ problems • Prioritize the problem from the problems • According to the : • Relevance -Avoidance of duplication -Political acceptability- Applicability • Urgency of data needed- Ethical acceptability • The prioritized problem should have: • A clear gap, current and ideal situation - No clear reason to this gap -

19. Analysis of the problem • Clarify the view points of the stakeholders • Specify the core problem • Analyze the problem – cause and effect diagram • Write down core problem • Brainstorm possible factors contributing to the problem • Identify further contributory factors • Organize the related factors into similar groups Focus and scope of the Research • Check information collected will be useful, feasible and avoid duplication

20. Formulating Problem Statement • Background • Brief description of socio-economic and cultural characteristics and its importance of healthcare problem stated (Few illustrative statistics) • Description of nature of problem • Major factors contributed to the problem • Previous studies performed in the past

21. Justification • Type of information expected to yield from the project and usefulness of the information • Definition, important concepts with relation to the problem • What / when / where / what extent • Statement of the problem the topic to the research

22. Activity 01 . Select a problem and go trough the process to and present in next week IT lab

23. 2. Ethical consideration

24. Ethical Consideration • War crimes after world war II - 1946 • Nuremberg code- 1940 • Guidelines to voluntary consent • Withdrawal of subjects from studies • Protection of subjects from suffering , injury, disability , and death • Declaration of Helsinki – 1960 • Human research after laboratory tests   • Review of research protocols by an independent group • Informed consent • Conducted by professionals -qualified scientifically / medically • Benefits must be more than Risks • Revisions in 1975, - 1996

25. Ethical ConsiderationNational Health and Medical Research Council • NHMRC – Australia – “Ethical culture” & “Informed consent” • Strong ethical culture should demonstrate • honesty and interiority • Respect for human participants , animals and the environment • Good use of public resources in conducting research • Acknowledgement of the others used in research • Responsible communication of the results • Informed consent • Self determination • Privacy & dignity • Anonymity & confidentiality • To fair treatment • Protection and discomfort from harm

26. Ethics in research • Autonomy • Beneficence • Non-malificence • Privacy • Confidentiality • Veracity • Fidelity

27. 1.Principle of Autonomy • Humans have the right to non – interference when making decisions about themselves • Forms the basis of ideas about privacy, confidentiality, veracity and consent

28. 2.Principle of Beneficence • “I will use treatment for the benefit of the sick, according to my ability and judgment” Hippocratic Oath • Conduct is aimed at the good and well being of others • Principle requires that practitioners provide both appropriate treatment and an assurance that the treatment will not produce more harm than good

29. 3.Principle of Non-malificence • “Above all do no harm” Hippocratic Oath • In health care the ethical issues of non-malificence and beneficence are particularly apparent in decisions regarding the institution of dangerous therapy or withdrawal of therapy that is no longer thought to be beneficial.

30. 4.Privacy • Safeguarding areas where patient does not want to reveal : • History • Examinations • Investigations

31. 5. Confidentiality • Not reveling information collected from the patient without her / his consent : • Verbally • Examination • Records • Complicated process • Harm vs. benefit • Individual • Social • Use your common sense • Inform superiors

32. 6.Veracity • Revealing truthful information to the patient: • As a professional • Cultural /social /Medical • Personnel Harm vs. Benefit • Complicated process • Experienced person needed

33. 7.Fidelty • Agreement with the patient • Verbal • Non verbal

34. 3. Literature Review ‘Method of gathering existing information regarding subject’

35. Usefulness of Literature review • Avoids duplication and specify the subject • Show different aspect of the problem and strengthen the problem analysis • Provides facts to make the research efficient and effective • Provides guidelines in each step, benefits and constrains that will occur in performing the study • Provides comparative data for the research • Sources • Publications , web , research papers, journals

36. The method of performing Literature review • Decide on the topics to search and sources • Organize index card, according to aspect of problem describe • Index card - Key word/ summery of the article/ important to will part – …….., …. Etc. • Write in the chapter • How literature has helped the study • Write reference, properly and a list of reference in alphabetical order

37. Applying Ethical Considerations in research • In research emotional or mental harm to study subjects • Even as asking sensitive questions that may violate their privacy • Observing without their knowledge • Failing to respect certain cultural values, traditions etc. • Remedy : • Obtaining permission before study begins • not exploring sensitive questions before developing a good relationship with the informant • Ensuring confidentiality of the data obtained. (name and address)

38. 4. . Methodology • Developing a conceptual framework • Types of research designs

39. Main Research categoriesQuantitative Qualitative Research

40. Qualitative / qualitative research • In general, qualitative research generates rich, detailed and valid data that contribute to in-depth understanding of the context. • Quantitative research generates reliable population based and gereralizable data and is well suited to establishing cause-and-effect relationships.

41. Quantitative research • Quantitative research refers to counts and measures of things, simply it’s about numbers, objective hard data. • Quantitative research is research involving the use of structured questions where the response options have been predetermined and a large number of respondents is involved. • By definition, measurement must be objective, quantitative and statistically valid. • The sample size for a survey is calculated by statisticians using formulas.

42. Quantitative Research • Systematic and objective process • To gather & analyze information • Information converted to numbers – statistics • Uses numerical picture look at similarities and differences • Take decision on the relationship of the things measured • This is a very LOGICAL approach • It begins with a hypothesis / argument / educated guess about the concept and formulate research questions

43. Classification of Quantitative Research

44. Classification of Quantitative Research Classification based on : • Reasons for conducting the research • Basic ………………find new knowledge • Applied ………….find answers to day to day problems • Time span • Cross sectional ……..point of time • Longitudinal …………spread over time • Point of collection • Retrospective - ………..Past <-------- Present • Prospective ……………. Present -------- >future

45. Classification of Quantitative Research Classification based on : 5. Purpose and aim • Descriptive • Exploratory • Explanatory • Predictive 6. Research design • Experimental …….. Interventional • Non experimental …………non interventional/ observation

46. Description of the Quantitative studies

47. 1. Basic and Applied This is classified according to the reasons for conducting the research • Basic • Basic ………………find new knowledge • Vaccine for Malaria / AIDS • Applied • Applied ………….find answers to day to day problems • Health needs/ wants

48. 2. Cross sectional & longitudinal This is categorized as per the time span • Cross sectional • One point of time • Snap shot • Maximum Months • Longitudinal • Spread over time • long term • Years

49. Cross sectional studies • Quantify the distribution of certain variables in a study population at one point of time ………………(snap shot) • It will include • Physical characteristics of people, environment; prevent survey of leprosy, evaluation coverage (immunization, ……..) • Socio-economic characteristics of people; age, education, marital status, no. of children and income. • Behaviour of people ….. and opinion, that may help to explain the behaviours (….. studies) • Events that occur in population – death, birth, marital, migration example : census – cross sectional survey covering total population • Disease and distribution – prevalence survey • Health programmes

50. 3.Retrospective & Prospective Categorized according to a point of collection • Retrospective - ………..Past <-------- Present • Collect a group of patients with lung cancer and see the their exposure to smoking • Prospective ……………. Present -------- >future • Collect a group of people who are smoking and asses the development of lung cancer over period of time