Chapter 11

1. Chapter 11 Reporting Results

2. Learning Objectives • Summarize research results • Distinguish statements that are and are not supported by the results • Draft all sections of a research report • Prepare correct citations and references • Create meaningful data tables and graphs • Write with brevity as the goal

3. Research Report/Journal Manuscript • This presentation discusses the elements of the report or manuscript • Specific requirements can vary by journal, funding agency, or graduate school • A few suggestions concerning elements are personal preference of the authors • Investigators are encouraged to consult the recipient of the report to determine specific requirements

4. Make the Point • All statements about results MUST be supported by results that are presented • Speculation MUST be identified as such • Avoid tangents • The shorter and more concise the better

5. Common Page and Font Requirements • 10 pages, excluding abstract, acknowledgements, tables, figures, and references • Double spaced • Times New Roman • Font size 11 • BUT be sure to check specific requirements for your report or manuscript

6. The Shape of the Report Statement of the Problem Specific Topic Review of Studies Research Question Methods Results Summary Limitations Implications

7. Illustration of the Shape Heart disease is the leading cause of death in the U.S. Cholesterol level is strongly associated with heart disease Studies suggest that cholesterol levels can be modified through diet and exercise This study presents the results of a 4-arm clinical trial: No change Exercise Diet Both Random Sample Of 1000 adults In 4 U.S. cities The exercise and diet arm showed the greatest reduction in LDL and increase in HDL cholesterol This study tested the effects of a diet and exercise intervention Cardiologists should work with exercise physiologists and dieticians to create and customize combined diet and exercise programs for patients at risk for heart disease

8. Introduction and Literature Review • Importance of the broad issue • Introduce the general health problem or issue • Emphasize the magnitude of importance • Review large-scale study or surveillance results to support the importance • Use appropriate citation style • Limit to about a half double-spaced page

9. Introduction and Literature Review (cont.) • Statement of the specific aspect of the issue • Introduce the focus of the research question or hypothesis • Link the specific focus to the broader issue • Discuss at a level specific enough that can be operationalized—anything broader is misleading in terms of promising too much • Limit to about one or two sentences

10. Introduction and Literature Review (cont.) • Literature Review • Review only relevant studies—similar target population, similar exposure, similar outcome, similar intervention design, and so on • Limit specificity to the research focus—do not slip back to the general issue or get side-tracked to prior study results that are not directly relevant • Discuss prior studies in a logical order that builds in a meaningful way to the research question • Use appropriate citation style • Limit to about 2 pages

11. Introduction and Literature Review (cont.) • Research Question or Hypothesis • State the question or hypothesis in a testable manner—refer to a hypothesis in the context of the alternative relevant to the null • Emphasize that this is the purpose of the present study • Discuss how the test of this research question or hypothesis will extend what is currently known about the specific focus • Limit to about half a page

12. Methods • Sample • Mention, again, the target population • Discuss the sampling frame—how it was constructed • Describe the sampling procedure—probability or non-probability procedures, hybrid • Indicate the target and actual sample size • Indicate the response rate • Describe the key characteristics of the sample—person, place, time, unit of analysis • Present descriptive statistics about demographic characteristics of the final sample (either here or in the results section) • If cohort, present the retention rate and descriptive statistics of demographic characteristics of those lost to the study • Limit to about one paragraph

13. Methods (cont.) • Data Collection Procedures • Identify the data collection method(s) used (e.g., survey, medical tests, open-ended interview, record review, and so on) • Describe the initial contact with potential subjects • Explain the recruitment procedure (e.g., mail, phone, email, in-person) • Address the issue of IRB approval for human subjects studies • Limit to one paragraph

14. Methods (cont.) • Measures • Focus primarily (or only) on the measures analyzed in the current report • Identify the type(s) of measures to be analyzed (e.g., survey items, biological tests, diagnoses) • Briefly describe the key measurement procedures (e.g., assumptions, criteria, equipment, definitions, methods) • Indicate the proportion of subjects with missing data on key measures • Limit to half a paragraph

15. Methods (cont.) • Analysis Procedures • Indicate the analytic methods used in the report (e.g., measures of association, regression, survival) • Mention the statistical analysis package used (if appropriate) • Limit to half a paragraph

16. Results • Typically the shortest section of the document • Generic ingredients • 1) present the numeric results, and • 2) summarize and highlight them • Summarized NOT interpreted • Results should be edited to those that address the research question or hypothesis • Present results in tabular or graphic form • One or two sentences for each table or graph

17. Results (cont.) • Text should “put into words” the numbers presented in tables or figures • Tables and figures should be “called out” in the text where they are summarized • Table 3 about here— • Each table or graph should be typed on its own page • All tables and graphs are included in order at the very end of the document

18. Example Table Table 1. Relative Frequency Distribution of the Social Support Scale, Chicago 1989 Note: Social support is an additive scale of 6 items measuring contact with and reliance on family, friends, and school colleagues. It has been recoded into 33.3% groups based on the distribution of the raw scale.

19. Example Figure Figure 1. Relative Frequency Distribution of Social Support, Chicago 1989 (n=118)

20. Important Note • Do not present the same data in both a table and a graph • Choose one or the other

21. Discussion • Should include the most information • Tie results back to reviewed studies • Emphasize the importance, relevance, implications, and limitations of the results • Really think about them • Make something (appropriately) of them • As usual, don’t overreach • Why is this important for the reader?

22. Discussion (cont.) • The Research Question or Hypothesis • Begin with a phrase like “The purpose of this study was to…” • Very briefly describe the important details of the study (usually the sample and data collection method) • Restate the research question or hypothesis • Generally indicate whether the hypothesis was supported or the question answered • Limit to one paragraph

23. Discussion (cont.) • Summary and Interpretation of Results • Summarize the results that are directly relevant to the question or hypothesis • Avoid too much detail and repetition of the results section • No need to repeat the specific numeric results • Focus on the meaning not the numbers of the results • This is the place to speculate about what the results mean in the broader context of the area of the study • It is also appropriate to speculate about the reason(s) for unexpected results • Limit to about one page

24. Discussion (cont.) • Limitations of the Study • Here is the place to meet one aspect of our ethical duty • All important study weaknesses should be revealed or emphasized • Examples include low response rate, selection bias, insufficient statistical power, and so on • Efforts to address the effect of the limitations on the results should be made • For example, characteristics of subjects lost to follow-up should be included in models predicting the outcome • Informed speculations about the effect of the limitations should be made • Limit to about three quarters of a page

25. Discussion (cont.) • Implications of the Results • Describe the implication of the results for the field of study • Suggest future studies that overcome this study’s limitations • If relevant, describe the practical implications of the results for public health practice (treatment or prevention)

26. Citations and References • When should information be cited? • Not common knowledge (with audience in mind) • Results of specific studies • How to avoid plagiarism • Verbatim wording should be avoided and minimized, but if used should be enclosed in quotations and the page number where it can be found in the source included in the citation • Even paraphrasing can be plagiarism • Presenting someone’s original idea as one’s own (without citing) is plagiarism • Plagiarism is a violation of the researcher’s ethical responsibility, and any questions about “gray areas” should be pursued and resolved • If there is a question, cite it

27. Citations • Formatting depends on the specific required style [American Medical Association (AMA), American Psychological Association (APA), etc.] • AMA: HIV/AIDS remains as a significant problem in the African-American community1-4 • APA: HIV/AIDS remains as a significant problem in the African-American community (Anderson & Bartlett, 2010; Carson et al., 2009; Dugan, Ellis, & Fenton, 2011)

28. Citations (cont.) • If it is a statement that has a great deal of support • Present the study results as a simple statement of fact • The prevalence of obesity among youth in the U.S. has been increasing since the 1970s (Authors, years) • If it is a summary of more specific results with limited support • Say a few things about the study with the summary of results • In a small cross-sectional study of young people with certain genetic abnormalities, Zelenski and colleagues (2011) found a higher than expected prevalence of obesity.

29. References • List at the end of the document that presents the detailed information about each citation in the text • AMA: List and number the references in the same order they are called out in the text 2. Buse J, Smith B. Combining insulin and oral agents. Am J Med. April 2000;108 (suppl):23S-32S. • APA: List but don’t number references in alphabetical order by first author’s last name Wegener, D. T., & Petty, R. E. (1994). Mood management across affective states: The hedonic contingency hypothesis. Journal of Personality and Social Psychology, 66, 1034-1048.

30. References (cont.) • Other specific requirements depending on the type of publication (e.g., book, periodical, electronic site) and number of authors • Other styles may be used by other journals or schools • International Committee of Medical Journal Editors (ICMJE) • National Library of Medicine (NLM) • Use a package available on University library web pages that will format automatically into common styles • EndNote, RefWorks

31. Title and Abstract • Can only be written after the analysis is complete, and maybe even the document is completely drafted • Wording is very important because it is the “hook” to attract a reader’s interest and it provides keywords that may be used in a literature search

32. Title • Limit to 10-12 words • Indicate the general study design and, ideally, key results • Defining characteristics of the sample • Study design • “Efficacy of a trial…” “X is risk factor for Y…” “X is not associated with Y…” • Include important keywords that readers might use in literature search engines

33. Abstract • Limit to about 120-180 words • Either structured (with headings) or unstructured (no headings) • With or without headings, should include: • Purpose of the study • Methods • Results – key results; include p-value for significant associations • Conclusions – most attention • Focus on including important keywords

34. Acknowledgements • Important part of the work • Usually included at the end of journal articles or beginning of theses, books, etc. • Thank the people who really made this possible – by name or by group • Funders • Reviewers • Original investigators if secondary analysis • Project directors, interviewers, subjects, etc.

35. CONSORT and STROBE • Initiatives to standardize and improve/maintain the quality of publications in public health • Developed by committees of investigators and practitioners in the field • CONSORT – Consolidated Standards of Reporting Trials • Established in 1996, revised in 2001 and 2010 • Outlines criteria for reporting the results of clinical trials

36. CONSORT and STROBE (cont.) • STROBE - Strengthening the Reports of Observational Studies in Epidemiology • Established in 2004 • Outlines criteria for reporting the results of cohort, case-control, and cross-sectional studies • CONSORT and STROBE provide checklists of information to include in each section of a high-quality report

37. STROBE Example Title and Abstract indicate the study’s design Introduction Background/rationale explain the scientific background Objectives include hypotheses Methods Study design present key elements of the design early in the paper Participants depending on the design, give eligibility criteria etc. Variables clearly define all Data sources/measurement give sources of data for each variable Bias describe any efforts to address sources of bias Etc….

38. Final Words • Just the facts • Brief and concise • Ethical • Thoughtful