The nature and sources of information for study and research in healthcare:

The nature and sources of information for study and research in healthcare: the research process

Aims • To establish what we mean by “the research process” • To understand the role of research evidence, in its various guises, in allowing us to formulate knowledge and information • To relate the knowledge and information we’ve gained to the research process

Objectives • To articulate the respective steps in the research process • To comment on the ways in which evidence can be gathered, assessed and the results disseminated • To understand the constraints associated with knowledge and information

Straight to the point… In clinical situations, we talk about “evidence-based research” and “evidence-based practice”. What do we mean by these expressions and why do they relate the current module?

The research process… • Identify the research question • Conduct a comprehensive literature review • Given the question, plan the methodology (quantitative, qualitative, more likely an admixture of the two) • Obtain the required consent inc. ethical approval • Perform the study • Analyse the results • Come to a conclusion • Share your findings with the research community and healthcare practitioners

We want to give our patients… • The best available care...but • How do we know what “best” means… • Where do we find out? • How do we know if what claims to be “best” really is best? • What sources could we investigate?

The starting point… • The research question… For example, a contemporary concern for parents is whether or not to have their children inoculated using the MMR vaccine

The question for parents might be… “Is there a link between receiving the MMR vaccine and the development of autism in children?”

As part of the literature search, we could investigate prior research in this field and look in… • Books from the University library e.g. Fitzpatrick M (2004) MMR and autism: what parents need to know London: Routledge

Or we could investigate… • Learned/professional journals e.g. The British Medical Journal (BMJ). A search for MMR revealed, amongst many others, a review of the MMR website by… Muminovic M (2002) MMR British Medical Journal 325, 604

Or we could investigate… • Databases e.g. Medline and, amongst 213 hits, was the paper… Andreae MC, Freed GL and Katz SL (2004) Safety concerns regarding combination vaccines: the experience in Japan Vaccine 22, 29-30, 3911-3916

Or we could look in… • Websites e.g. The National Electronic Library for Health (NELH). A search for MMR revealed, amongst many others, HTA record 20030454-MMR vaccine and autism: no evidence of association

Or we could investigate… • Policy statements from the Department of Health e.g. “Statement on the safety of the MMR vaccination programme attachment to press notice from Department of Health”

Or we could check out… • Quality agencies e.g. The National Institute of Clinical Excellence (NICE), where amongst many others was, New study injects fresh evidence into the MMR-autism debate

Or we could find out from… • Approved Centres of Excellence e.g. The Health Protection Agency where we would find… Why is MMR preferable to single vaccines?

We could have investigated “The Sun “ But we won’t… Why not?

What is research evidence? • Facts, events, transactions that have been recorded as a result of rigorous methodologies e.g. observations, counts, measures, weights, survey questionnaires, interviews • The raw material from which knowledge and information are formed • In essence, groups of studies reported in reputable journals or in peer-reviewed books

Why not just one study? • Consider the work of Andrew Wakefield et al (1994: 1998: 2001)… • You won’t find it in the NELH, nor on the Department of Health website because it was considered to be “bad science” • However, following the sensational reporting of his work, MMR vaccine rates fell sharply and the consequence is…?

Classification of research evidence? • By source (trustworthiness) • By level (operational, technical, strategic) • By time (historical, contemporary, predictive) • By use, repetition and acceptance by the research community

Good research information is… • Relevant • Accurate • Complete • Reliable

So now… • We have the basis of carrying out research… • Choosing a topic of interest • Deciding what the research question is • Conducting a comprehensive literature review • Selecting the best way of answering the research question

This gives rise to academic debate Considering the alternative views, approaches etc to a topic and, from your understanding, choosing a position that you can defend

EBR/P …and this takes us full circle! “evidence-based research” and “evidence-based practice” That’s why “Information for Study and Research” is so important to you!

Objectives • To articulate the respective steps in the research process • To comment on the ways in which evidence can be gathered, assessed and disseminated • To understand the constraints associated with knowledge and information

The nature and sources of information for study and research in healthcare: