research Methodology by Saiprasad Bhavsar

1. Designing and methodology of a study Pg guide: dr s r suryawanshi student: dr saiprasad bhavsar

2. Researchis a topic that many find intimidating This issue of Research methodology will look at theconcept of research, as well as the related concepts of evaluation and quality improvement, study design and analysis activities which many health workers are familiar with through their current work.

3. Basic classification Various issues in any of the research methodology can be conveniently divided into six steps for the better understanding of the process. Defining what is research Defining what is evaluation How to formulate a research question.

4. 4. Reviewing the literature 5. Study design 6. Quantitative data analysis.

5. What is research A broad definition of research is any activity which is undertaken to increase the knowledge. In the health field research can be defined as the systematic investigation of a problem, issue or question, which increases the knowledge and understanding of health and the provision of care.

6. Evaluation:- People who work In the health area are involved in the implementation of projects, which aim to improve the health or health service delivery. Evaluation is the integral part of this implementation. It can be defined as the process of value of an intervention by systematically gathering information to make more informed decisions.

7. Quality improvement(QI):- QI provides a framework for monitoring and improving performance, by systematically reviewing care provided, or outcomes achieved, against explicit criteria. Thus it can be stated in short that, Research questions aim to discover new knowledge; evaluation questions aim to judge the worth of an intervention QI questions aim to examine how well something is done and improve performance

8. What is evaluation? Evaluation is the process of judging the worth of something. It can determine if an intervention worked, help decide if it should continue, and provide evidence of effectiveness to obtain additional funding.

10. how well it has contributed to the goal, met the objectives and undertaken the strategies;

11. what worked well and what didn’t, and why;

12. whether there were any unintended outcomes; and

15. assessing the results;

17. selecting the scale and scope;

18. determining the methodology;

19. organising how the evaluationwill be conducted.

21. Process, impact and outcome evaluation Process evaluation: -focuses on how the program has been implemented; -assesses whether activities were conducted as planned. 2) Impact evaluation: -focuses on the immediate effects of the program; -judges how well the objectives were met. 3) Outcome evaluation: -focuses on the longer term effects of the program; -judges how well the goal has been achieved

22. How to formulate a research question Research originates with an idea about some general problem or question. This problem or question is narrowed down to a more specific research question, which then represents the central issue being addressed. First, it is important to distinguish between descriptive and analytical studies.

23. Descriptive studies ask simpler questions about what is going on. For example, .How many or what proportion of patients admitted to hospital are with a fractured neck of femur?. Analytical studies compare one or more interventions or exposures. For example, Is it more effective to educate GPs about depression guidelines with group education sessions or practice visits?. or .Is lung cancer associated with cigarette smoking?.

26. Interesting to the investigator

27. Novel (confirms or refutes previous findings, provides new findings)

28. Ethical

30. Identifies past relevant studies as well as the methods used

31. Assists in refining your research question

32. Puts the project and methodology into a relevant context

33. Adds valuable background to the study or formal report

34. Suggests areas requiring further investigation

37. What are the results?

39. Descriptive and analytical studies One way of classifying study design is to divide them into descriptive studies that describe a situation or analytical studies that try to explain a situation by formulating and testing hypotheses Non-experimental and experimental studies Studies can also be categorised as non-experimental (or observational) with no intervention or experimental where the researcher intervenes, e.g. by introducing a new treatment

41. Intervention trials

42. Longitudinal studies

43. Cross-sectional studies

44. Cohort studies

45. Case-control studies

47. Heart of this control trial is Randomization

48. Randomization is the statistical procedure by which the participants are allocated in the groups usually ‘study’ and ‘control’ groups. To receive or not to receive the intervention.

50. This can be done by Blinding

51. There are three typesSingle Blinding Double Blinding Triple Blinding

52. Types of Randomized trials are as follows Clinical trials:- E.g., The evaluation of beta-blockers in reducing the cardiovascular mortality in patients surviving the acute phase of myocardial infarction. Preventive trials:- E.g., Vaccination trial

53. C) Risk factor trial:- E.g., four main intervention to reduce the CHD are reduction in the blood cholesterol, cessation of smoking, control of hypertension, and promotion of regular physical exercise. d) Cessation experiments:- E.g., decreased incidence of lung cancer in the group who have given up the smoking.

54. e) Trial of etiological agent:- E.g., Retrolental fibroplasia as a cause of the blindness in premature babies exposed of high concentration continuous supply of oxygen than the control group who have been given oxygen only on emergency basis. f) Evaluation of health service:- E.g., Excellent example is that of chemotherapy of tuberculosis in India which showed ‘Domiciliary treatment’ of TB was as effective as much costlier hospital or sanatorium treatment.

56. Known as prospective study, longitudinal study, incidence study, forward looking study.

57. Distinguishing features are-Cohorts are identified prior to the appearance of the disease Study group so defined are observed over a period of time to determine the frequency of the disease Study proceeds forwards from cause to effect.

58. Advantages are- Incidence can be calculated Several possible outcomes Direct estimation of relative risk and Attributable risk Dose response ratio can be calculated Bias like misclassification of groups into diseased and non diseased is minimized

59. CASE CONTROL STUDY Often called “retrospective Study” is a common first approach to test the causal hypothesis. Case Control study has three distinct features Both exposure and outcome have occurred prior to the start of the study The study proceeds backwards from effect to cause It uses control or comparison group to support or refute the study. This is basically a comparison study

60. e) Estimation of the relative risk and odds ratio is the main distinguishing feature of case control study

61. Quantitative data analysis Type of variables An item of data that can be observed or measured is called a variable. There are two main types of variables. 1) Numerical variables can be: -Discrete variables - values that are separate and distinct e.g. number of GP visits; or -Continuous variables - when all values are possible e.g. blood pressure, weight.

62. 2 )Categorical variables represent membership of a particular category. They can be: -Ordinal variables – several categories where order is relevant e.g. physical activity measured as minimal, moderate or vigorous; - Nominal variables - no natural order e.g. area of residence; or -Dichotomous variables – only two responses e.g. yes/no.

64. Mode - most frequently occurring count or measure across a group of individuals;

65. Median - middle observation in a sample of individuals;

66. Range - difference between the maximum and minimum observations; and

68. In summarising categorical data, counts are used. They can also be expressed as proportions or percentages by dividing the count by the total number of individuals. While categorical variables may be coded using numbers, it is important not to summarise them as numerical data. e.g.average coded numbers in Likert scales as below: Very dissatisfied very satisfied

69. The relationship between categorical variables is usually presented in a contingency table and tested using chi-square test . Statistical tests:- There are many statistical tests available. Two of the most common tests are the t-test for numerical data and the chi-square test for categorical data.

70. Inferential statistics In inferential statistics you are trying to reach conclusions about a population, based on a sample of individuals from the population. In hypothesis testing, statistical methods are used to determine the probability of obtaining the observed effect by chance. The p value of your chosen statistical test is compared to the level of significance (usually set at 0.05 or 0.01). For example, a t-test with a p-value of 0.03 (and level of significance of 0.05) indicates that the results are not due to chance and are statistically significant.

71. Confidence intervals can also be used. Based on a sample, they are estimations of a range of values (confidence interval) within which the population parameter is likely to lie. With a level of significance set at 95%, you can say that based on your sample, you are 95% confident that the population value lies within your confidence interval.

72. REMEMBER The many steps as explained earlierin planning, implementing and completing research Among these, it is essential to choose the appropriate study design Plan carefully before implementing your study

73. Choice of a Good Study Design is very important because A badly designed study can NEVER be RETRIEVED…….

74. THAT’S ALL FOR THE DAY…. THANK YOU VERY MUCH…..