Investigating health

1. Investigating health

2. Session aims • To increase your understanding of the philosophical and methodological foundations of health-related research • To encourage you to consider which methodology/s, design and methods are appropriate to answer different types of research questions and so be familiar with all of the stages of the research process and therefore be able to undertake a research project • To analyse the nature of evidence and evidence based practice

3. What is research? • Research is an active and systematic process of inquiry in order to discover, interpret or revise facts, events, behaviours, or theories. • Part of the research process is also making practical applications with the help of the information gathered through the research process. • So research is a process by which questions can be both explored and answered. • Research is therefore a tool to explore, describe, understand, explain, predict, intervene (change), evaluate and assess impact.

4. Philosophical frameworks in research • Research is underpinned by models of understanding known as paradigms. • A paradigm is a perspective and a way of examining and understanding (therefore researching) reality (Hennick et al 2011). • There are two distinct paradigms and philosophical traditions that underpin research. • Positivism is associated with quantitative research whilst interpretivism is used within qualitative approaches (Seale, 2004).

5. Research paradigms

6. Key points about the philosophy of research • Researchers can use a specific paradigm and therefore apply its associated techniques in practice. If you are trained in a positivist position then you will use quantitative methods. Comparatively, if you are trained in an interpretivist tradition then you will apply qualitative tools of data collection. • So there are different views of what social reality looks like. The term to describe this is ontology. Ontology is defined as “the study of the nature of reality” (Broom and Willis, 2007 p 25). There are a range of ontological understandings each discussing the nature of the social world in a different way. • There are also different views about what represents knowledge, how it is produced and how it can therefore be measured. These are epistemological considerations, or “the study of the nature of knowledge” (Schwandt, 2001, p. 71).

7. The research question • All research starts with a question/s and this is an essential part of the research process, with the aims and purpose of the research needing to be clearly defined at the outset of the process. • Research question/s help the researcher to clarify what they are investigating and guides the researcher towards the most appropriate methods to address the question. • Questions arise in a variety of ways. • Questions can be addressed using quantitative methods, qualitative methods or a combination of both approaches.

8. Quantitative Methods • Experiments. • RCTs. • Surveys.

9. Quantitative sampling • Sampling is the process of selecting units (e.g., people, organizations) from a population of interest. • Generalisability is the most common goal in quantitative sampling. • There are different types of quantitative sampling strategies. • Steps in quantitative sampling include • Identifying the population of interest. • Deciding what types of sampling strategy is possible • Considering if there will be difficulties in gaining access and recruitment of participants • Considering how to improve response rates

10. Quantitative analysis • Quantitative data involves the analysis of numerical data and is best undertaken using statistical packages e.g. PASW (formerly SPSS) • Quantitative research is concerned with measurement. Measurement is simply assigning values to outcomes. • There are different levels and scales of measurement which help researchers to decide upon the most appropriate mathematical manipulations to undertake on their data and to choose appropriate statistical tests. • Quantitative analysis involves working with statistics – descriptive and inferential.

11. The value of quantitative health research • Quantitative approaches have provided large data sets which document changing health trends across the UK and further afield, demonstrating which areas should be of priority for practitioners. • For example, the Health Survey for England (2008) shows changing UK trends such as increasing rates of obesity and rates of death from alcohol associated diseases.

12. Qualitative methods • Interviews. • Focus groups. • Observations.

13. Qualitative sampling • Qualitative samples are mostly made up of people, characteristics, experiences, documents, images and settings (Mason 1996). • Unlike quantitative research there is no set rule for having a specific sample size within qualitative research - the nature of the research question, the scope of the study and the length of time available will influence the size of any qualitative sample. • Qualitative samples do not aim to be representative. • Qualitative samples can be convenience samples, quota samples, purposive samples, snowball/network samples.

14. Qualitative analysis • As a result of the data being in the form of words, qualitative researchers do not have a specific set of formulae to analyse their data. • Can involve thematic analysis, which starts with data being coded. • Miles and Huberman’s (1994) framework for qualitative analysis is that data is reduced, then displayed and finally the researcher draws and verifies conclusions.

15. The value of qualitative health research • Health related qualitative research has provided a wealth of data about people’s experiences, how people experience pain, how they feel about treatment and what is important from a patient’s perspective. • Qualitative approaches have enabled the voices of social actors to be heard so that they can articulate their own stories and narratives in relation to their health. • Research has provided insights into interactions between health care professionals and patients, so demonstrating the process and power within them. • Qualitative approaches have also been used to empower participants for example, getting patients to think positively about cancer whilst allowing researchers to explore patients’ talk (Wilkinson and Kitzinger 2000).

16. Differences between quantitative and qualitative research

17. Combining qualitative and quantitative approaches • Despite the differences between these approaches, there are also some similarities. • It is possible to combine these different forms of research within a single study in a mixed method approach. • Accessing multiple sources of information, using a range of different tools is likely to provide the researcher with a much more comprehensive picture of the area that they are investigating. • Mixed methods are generally used to compare different findings, to investigate different perspectives on issues and to generate different types of data from both methodological traditions, quantitative and qualitative. • Combining research techniques in this way is commonly called methodological triangulation.

18. Research ethics • There are key principles relating to ethics that should underpin all research projects. • Research projects often require ethical approval and are expected to adhere to specific codes of ethics. • Principles of research ethics include • Protection from harm - harm to both participants and researchers should • Informed consent - participants should be fully aware of the research process and be able to consent freely. This is achieved by the use of information sheets and consent forms. • Anonymity – participants should not be able to be identified. • Confidentiality – participants should be aware what happens to the data they provide and who will see it. • Right to withdraw - from the research process up to a clearly identified point if they choose to.

19. Evidence based practice • Research is essential within the field of health for practitioners to acquire an evidence base. • Evidence based practice is simply the application of research findings to practice situations. • Research has helped develop and improve practice in a number of ways: • By evaluating services and their effectiveness. • By evaluating the clinical effectiveness of interventions and treatments. • By determining the cost effectiveness of treatments. • By examining improvements for patients undergoing treatment using quality of life measures. • Gray (1997) suggests three stages that practitioners and students will need to go through in order to draw on evidence to inform their practice. • Finding evidence • Appraising evidence • Applying the evidence to practice

20. Summary • Research is a systematic process drawing on philosophical and theoretical concepts about design and methods. • In order to provide a rich understanding of health related issues both quantitative and qualitative research methodologies need to be utilised. • Different research questions can be addressed by differing research designs and methods.