Research Methodology (COMH503)
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Course Description
• This course introduces the principal concepts• This course introduces the principal concepts
and comp...
Course Objectives
By the end of the course, students will be able:
• To Describe basic steps in undertaking health researc...
Course Contents
1. Introduction
2. Types of research
3. Components of a research
proposal
10. Sample size calculation
11. ...
Methods of Instruction and Evaluation
Methods of Instruction
• Lectures and discussions• Lectures and discussions
• In-cla...
REFERENCE
1. Shi L. Health Services Research Methods.
1997, Delmar Publishers. SPH Library.1997, Delmar Publishers. SPH Li...
What is research?
• Research - is the systematic collection, analysis
and interpretation of data to answer a certainand in...
What is research?
• Health Systems Research is concerned with
improving the health of people andimproving the health of pe...
Basic questions in health system
• What are health needs of people?
• What is the coverage of health interventions?• What ...
Basic questions---
• The major objective of HSR is to provide
health managers at all levels, as well ashealth managers at ...
Basic questions---
• Health policy makers may, for example, want
to know:to know:
– What are the prospects for voluntary
c...
Basic questions---
• Managers at district/provincial level may raise
questions such as:questions such as:
– Why is neonata...
Basic questions---
• Managers at village level may want to know:
– How can we assist women with little or no
education so ...
Characteristics of research
• It demands a clear statement of the problem.
• It requires clear objectives and a plan (it i...
Basic Vs applied research
• The classical broad divisions of research are: basic
and applied research.and applied research...
Approaches
• there are two basic approaches to research -
quantitative approach and the qualitative approach.quantitative ...
Approaches
• The purpose of inferential approach to research
is to form a data base from which to inferis to form a data b...
Approaches
• Experimental approach is characterised by much
greater control over the research environment and
in this case...
Approaches
• The term ‘simulation’ refers to “the operation of a
numerical model that represents the structure of anumeric...
Approaches
2. Qualitative approach to research is concerned with
subjective assessment of attitudes, opinions and
behaviou...
Qualitative and Quantitative Approaches…
Qualitative Quantitative
Usually Non-probability based
sample
Typically a probabi...
Mixed method
• Triangulation (Multi-method designs)
• Corroboration – (to strengthen or support with• Corroboration – (to ...
Main components of any research work
1. Preparing a research proposal
2. Fieldwork (i.e., data collection)
3. Analyzing da...
A Research Proposal
• A research proposal is a document that presents
a plan for a project to reviewers for evaluation.a p...
A Research Proposal
• Its purpose is to convince reviewers
• Can he/she handle the project?
• Is it well thought?
• Review...
A Research Proposal…
• A proposal describes the research problems and
its importance, and gives detailed account of theits...
A Research Proposal…
• The proposal has a plan for data collection and
analysis.analysis.
• It frequently includes a sched...
How do you think about a research topic?
• From personal experiences/observations• From personal experiences/observations
...
Criteria for selecting a research topic
1. Relevance: The topic chosen should be a priority
problem:problem:
• Questions t...
Criteria for selecting a research topic
2. Avoidance of duplication:
• Investigate whether the topic has been researched.•...
Criteria for selecting a research topic
3. Feasibility:
• Consider the complexity of the problem and the• Consider the com...
Criteria for selecting a research topic
4. Political acceptability:
• It is advisable to research a topic that has the
int...
Criteria for selecting a research topic
5. Applicability of possible results and
recommendationsrecommendations
• This wil...
Criteria for selecting a research topic
6. Urgency of data needed
• How urgently are the results needed for
making a decis...
Criteria for selecting a research topic
7. Ethical acceptability
• We should always consider the possibility
that we may i...
Scales for rating research topics
1. Relevance
1 = Not relevant
2 = Relevant
3 = very relevant
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Scales for rating research topics
2. Avoidance of duplication
1 = Sufficient information already available
2 = Some inform...
Scales for rating research topics
3. Feasibility
1 = Study not feasible considering available
resources
2 = Study feasible...
Scales for rating research topics
4. Political acceptability
1 = Topic not acceptable
2 = Topic somewhat acceptable
3 = To...
Scales for rating research topics
5. Applicability
1 = No chance of recommendations being1 = No chance of recommendations ...
Scales for rating research topics
6. Urgency
1 = Information not urgently needed
2 = Information could be used but a delay...
Scales for rating research topics
7. Ethical acceptability
1 = Major ethical problems
2 = Minor ethical problems
3 = No et...
Formulating the Problem Statement and
Justification of the Problems
• The first major section in a research proposal is th...
Formulating the Problem Statement and
Justification of the Problems
• Often, this can be presented in the form of research...
What is a research problem?...
A potential research situation arises when three
conditions exist:-
1. A perceived discrepa...
Why is it important to state and define
the problem well?
Because a clear statement of the problem:-
• Is the foundation (...
Why is it important to state and define
the problem well?
• Enables you to systematically point out why the
proposed resea...
What information should be included
in the problem statement?
1. A brief description of socio-economic and cultural
charac...
What information should be included
in the problem statement?
4. A brief description of any solutions to the problem that
...
How to write a Problem Statement
• The section should be precise and concise,
while not forgetting to mention essentialwhi...
Review of Literature
• For any serious study, a thorough literature review
must be accomplished. However, the questionmust...
The result of the literature review should be:
• A reaffirmation of the importance of the
theoretical rationale of the pro...
Why is a review of literature important
when preparing a proposal?
• It helps further your understanding of the
problem an...
What resources can be consulted for the
review of the literature?
• Card catalogues of books in libraries
• Indexes such a...
What resources ---?
• Computer-based literature searches such as
MEDLINE, PUBMED.MEDLINE, PUBMED.
• Bibliographies such as...
What resources ---?
• Studies conducted in the country or region.
• Responses to enquiries on ongoing research.
• Theoreti...
What resources ---?
• Responses from agencies willing to supply
reference materials for research by mail.reference materia...
• After collecting the required information the
investigator should decide in which order
he/she wants to discuss previous...
• This review should answer
– How much is known?
–What is not known?–What is not known?
–What should be done based on what...
Methods of citations in preparing
literature review:
• Information on an index card should be organized in
such a way that...
Methods of citations in preparing
literature review:
Example:Example:
• Louria DB. Emerging- and re-emerging infections: T...
Methods of citations…
• For a book the following information should
be noted:be noted:
• Author(s)’ Surname followed by in...
Vancouver Vs Harvard system
• The formats suggested above have been
adopted as standard by over 300 biomedicaladopted as s...
Vancouver Vs Harvard…
• In Harvard style, this looks as follows:
• Abramson JH (1990) 4th ed. Survey methods
in community ...
RESEARCH OBJECTIVES
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RESEARCH OBJECTIVES
• The OBJECTIVES of a research project summarise
what is to be achieved by the study.what is to be ach...
RESEARCH OBJECTIVES
• The general objective of a study states what
researchers expect to achieve by the study inresearcher...
RESEARCH OBJECTIVES
• Specific objectives should systematically address
the various aspects of the problem as defined unde...
RESEARCH OBJECTIVES
• A study into the cost and quality of home-based
care for HIV/AIDS patients and their communities inc...
RESEARCH OBJECTIVES
• It was split up in the following specific objectives:
1. To identify the full range of economic,
psy...
RESEARCH OBJECTIVES
3. To determine the economic costs of CHBC to the
patient and family as well as to the formal CHBCpati...
RESEARCH OBJECTIVES
5. To determine how improved CHBC and informal
support networks can contribute to the needs ofsupport ...
Why should research objectives be
developed?
The formulation of objectives will help you to:
1. Focus the study (narrowing...
Why should research objectives be
developed?
• Properly formulated, specific objectives will
facilitate the development of...
How should you state your objectives?
• Take care that the objectives of your study:
1. Cover the different aspects of the...
How should you state your objectives?
• Keep in mind that when the project is
evaluated, the results will be compared toev...
How should you state your objectives?
• Using the previous example on cost and quality of
CHBC, we may develop more specif...
How should you state your objectives?
3. Is the stigma attached to being HIV+ the same
strong for women as for men? Or are...
Types of objectives
1. Estimation objectives
– Estimates magnitude of an event– Estimates magnitude of an event
2. Associa...
When should the objectives of a
research project be prepared?
• The objectives should be written after the• The objectives...
What are the characteristics of good
objectives?
Objectives should be:
– Logical and coherent– Logical and coherent
– Feas...
How should objectives be stated?
• Objectives should be stated using “action verbs”
that are specific enough to be measure...
Action-verbs Vs non-action verbs
Action-verbs
To determine To compare To verifyTo determine To compare To verify
To calcul...
What formats can be used for stating
research objectives?
• Research objectives can be stated as:
– Questions: “The object...
Research hypothesis
What is a Research Hypothesis?
• A hypothesis can be defined as “a tentative
prediction or explanation...
Research hypothesis
• Based on your experience with the study
problem, it might be possible to developproblem, it might be...
Research hypothesis
• In the example concerning the cost and quality of HBC
in Ethiopia it would have been possible to for...
Research hypothesis
• Hypothesis statements are most applicable for
field intervention or evaluative studies.field interve...
What is a Research Hypothesis?...
• They indicate the major independent and
dependant variables of interest.dependant vari...
Stating Research Hypotheses:
• A hypothesis can be simple in form, predicating the
relationship between one independent an...
Stating Research Hypotheses:…
• A hypothesis can be stated in the form of “null”
(Ho)
• In the alternative form (Ha).
91Hu...
METHODS
• The methodology of a research project is the• The methodology of a research project is the
core of the study.
• ...
METHODS…
• What do I want to measure?
• How can I measure it?• How can I measure it?
• Where should I measure it?
• What w...
Components of a research design that should be
addressed in the methodology section of a
research proposal:
• Study area
•...
Variables
• What information are we going to collect in our
study to meet our objectives?
• In most studies, we must first...
Variables
• To obtain the defaulter rate we need a clear
definition of what we mean by defaultingdefinition of what we mea...
Variables
• We also want to know whether certain factors do
indeed influence the problem, and to what extent.indeed influe...
Variables
• For example, if we find that becoming a dropout of TB
treatment is strongly associated with the following
fact...
Variables
• To find these associations between problems and
contributing factors, it is essential that we carefully
define...
FORMULATING VARIABLES
• A variable is a characteristic of a person, object or
phenomenon which can take on different value...
FORMULATING VARIABLES
Other examples of variables are:
– weight (expressed in kilograms or in pounds);– weight (expressed ...
FORMULATING VARIABLES
• Because the values of all these variables are
expressed in numbers, we call them numericalexpresse...
FORMULATING VARIABLES
• Other examples are:
• Colour• Colour
– Red
– Blue
– green, etc.– green, etc.
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FORMULATING VARIABLES
• Outcome of disease
– Recovery– Recovery
– chronic illness
– death
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FORMULATING VARIABLES
• Main type of staple food eaten
– Maize– Maize
– Millet
– Rice
– cassava, etccassava, etc
• Since t...
FORMULATING VARIABLES
• Numerical variables can either be continuous
or discrete.or discrete.
Continuous.
• height in cent...
FORMULATING VARIABLES
Discrete- These are variables in which
numbers can only have full values,numbers can only have full ...
FORMULATING VARIABLES
• Categorical variables, on the other hand, can
either be ordinal or nominal.either be ordinal or no...
FORMULATING VARIABLES
• Other examples are:
• Disability: no disability, partial disability,• Disability: no disability, p...
FORMULATING VARIABLES
• Fear of leprosy: will not share food with a
patient; will not enter the house of a patient;patient...
FORMULATING VARIABLES
• If a researcher has little idea about the
distribution of a certain variable in adistribution of a...
FORMULATING VARIABLES
ii. Nominal variables. The groups in these variables do not
have an order or ranking in them.have an...
Factors rephrased as variables
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Operationalizing variables by choosing
appropriate indicators
• Operationalizing variables means that you make them
measur...
Operationalizing variables by
choosing appropriate indicators
• The variable ‘level of knowledge’ cannot be measured
as su...
Operationalizing variables by
choosing appropriate indicators
• If 10 questions were asked, you might decide
that the know...
Operationalizing variables by
choosing appropriate indicators
• Nutritional status of under-5 year olds is another
example...
Operationalizing variables by
choosing appropriate indicators
• For the classification of nutritional status,
internationa...
Defining variables and indicators of variables
• To ensure that everyone (the researcher, the
data collectors, and eventua...
Defining variables and indicators of variables
• For example, to define the indicator ‘waiting
time’ it is necessary to de...
Fig. Relationship between qualitative and quantitative studies in
understanding and measuring problems
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Dependent and independent variables
• The variable that is used to describe or
measure the problem under study is calledme...
Dependent and independent variables
• For example, in a study of the relationship
between smoking and lung cancer, ‘suffer...
Dependent and independent variables
• Whether a variable is dependent or independent is
determined by the statement of the...
Dependent and independent variables
• Note that if a researcher investigates why
people smoke, ‘smoking’ is the dependentp...
• A variable that is associated with the problem and
with a possible cause of the problem is a potential
Confounding varia...
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Confounding variable
• in order to give a true picture of cause and effect,
possible confounding variables must be conside...
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Confounding variable
• In order to give a true picture of the relationship
between bottle-feeding and diarrhea of under-tw...
Background variables
• In almost every study, background variables, such as
age, sex, educational level, socioeconomic sta...
Quantitative data collection Techniques
• Interview administered questionnaire• Interview administered questionnaire
• Sel...
Quantitative data collection Techniques
• Interview administered questionnaire
• Self-administered questionnaire
• Direct ...
Qualitative data collection Techniques
• Key informant interview• Key informant interview
• In-depth interview
• Focus gro...
RESEARCH METHODS
Study designs
• A study design is the process that guides• A study design is the process that guides
rese...
• Non-intervention (Observational) studies in which
the researcher just observes and analyses
researchable objects or situ...
Non-intervention studies could be: exploratory,
descriptive or analytical
1. Exploratory studies1. Exploratory studies
• A...
For example:
• A national AIDS Control Programme wishes to
establish counselling services for HIV positive andestablish co...
• When doing exploratory studies we describe the
needs of various categories of patients and the
possibilities for action....
• In HSR, small-scale studies that compare
extreme groups are very useful for detecting
management problems.
• We could, f...
– One community with high and another with low
participation in health activities, in order to
identify factors that contr...
• Exploratory studies gain in explanatory value if we
approach the problem from different angles at the
same time. This is...
• In this manner, information from different
independent sources can be cross-checked.
• If the problem and its contributi...
2. Descriptive studies:
• A descriptive study involves describing the
characteristics of a particular situation, eventchar...
a. Small scale, descriptive case studies
• Descriptive case studies describe in-depth the
characteristics of one or a limi...
b. Large scale, cross-sectional surveys
• Cross-sectional surveys aim at describing and
quantifying the distribution of ce...
b. Large scale, cross-sectional ---
ii. Socio-economic characteristics of people such as
their age, education, marital sta...
b. Large scale, cross-sectional ---
• Cross-sectional surveys cover a selected sample of
the population.
• If a cross-sect...
b. Large scale, cross-sectional ---
• In these cases only a limited number of variables
will usually be included, in order...
3. Comparative or analytical studies
• An analytical study attempts to establish
causes or risk factors for certain proble...
There are three commonly used types of analytical studies
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1. Cross-sectional comparative studies
• Many cross-sectional surveys focus on describing as
well as comparing groups.
• F...
1. Cross-sectional comparative ---
• The researcher will not only describe these
variables but, by comparing malnourished ...
2. Case-control studies
• In a case-control study the investigator compares
one group among whom the problem that he
wishe...
Fig. Diagram of a case-control study
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• For example, in a study of the causes of neonatal
death, the investigator will first select the cases
(children who died...
• Controls should come from the same source
population.
• For example, in a hospital case-control study where• For example...
3. Cohort studies
• In a cohort study, a group of individuals that is
exposed to a risk factor (study group) is compared
t...
3. Cohort studies
• example of a cohort study - smokers and non-
smokers that is conducted among doctors tosmokers that is...
Figure: Diagram of a cohort study
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2. Intervention studies
• In intervention studies, the researcher manipulates a
situation and measures the effects of this...
1. Experimental studies
• An experimental design is a study design that gives
the most reliable proof for causation.
• ind...
Figure: Diagram of an experimental study
163Hunachew B
• A number of experimental study designs have been
developed. These are widely used in laboratory
settings and in clinical...
• For example, a researcher plans to study the effect
of a new drug. (The drug has already been tested
extensively on anim...
• He explains the study to the patients asking their
consent to be divided into two groups on a random
basis.
• One group ...
• At community level, where HSR is frequently
undertaken, we experience not only ethical but also
practical problems in ca...
2. Quasi-experimental studies
• In a quasi-experimental study, one characteristic of
a true experiment is missing, either ...
• One of the most common quasi-experimental
designs uses two (or more) groups, one of which
serves as a control group in w...
Figure : Diagram of a quasi-experimental design with two groups
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• Example of a quasi-experimental study:
• A researcher plans to study the effects of health education on the level
of par...
What are validity and reliability in research findings?
• Validity means that your scientific observations
actually measur...
• Reliability (repeatability) refers to the
possibility to replicate (repeat) the
observations and is related to the preci...
1. Neither valid nor reliable. The research methods do not hit
the heart of the research aim (not valid) and repeated
atte...
2. Reliable but not valid. The research methods do not hit
the heart of the research aim, but repeated attempts get
almost...
3. Fairly valid but not very reliable. The research
methods hit the aim of the study fairly closely, but
repeated attempts...
4. Valid and reliable. The research methods hit the
heart of the research aim, and repeated attempts all
hit in the heart ...
Sampling
What is sampling?
• Sampling is the process involving the
selection of a finite number of elements from
a given p...
What is a sample?
• A sample is a representative part of a
population.population.
• A decision is often made, therefore, t...
What are the characteristics a sample
should possess?
• A sample should possess all the
characteristics of the population ...
• Several reasons make sampling more useful
than complete enumeration.than complete enumeration.
• These include considera...
Sampling methods
a) Non-probability sampling methods
1. Convenience sampling: is a method in
which for convenience sake th...
Sampling methods
2. Quota sampling: is a method that insures that a
certain number of sample units from differentcertain n...
Sampling methods
3. Purposeful sampling strategies for qualitative
studies:
• Qualitative research methods are typically u...
Sampling methods
Random sampling strategies to collect quantitative
data:
• If the aim of a study is to measure variables
...
Sampling methods
• Then, purposeful sampling methods are
inadequate, and probability or random
sampling methods have to be...
Sampling methods
b) Probability sampling methods:
• They involve random selection procedures to• They involve random selec...
Sampling methods
1. Simple Random Sampling (SRS):This is the most basic
scheme of random sampling.
• To select a simple ra...
Sampling methods
2. Systematic Sampling:
• Individuals are chosen at regular intervals (for• Individuals are chosen at reg...
Sampling methods
• The sampling fraction is: 100/1000 = 1/10.
• The number of the first student to be included in the• The...
Sampling methods
3. Stratified sampling
• If it is important that the sample includesIf it is important that the sample in...
Sampling methods
4. Cluster sampling:
• When a list of groupings of study units is available• When a list of groupings of ...
Sampling methods
5. Multi-Stage Sampling:
• This method is appropriate when the population is• This method is appropriate ...
Sampling methods
• The secondary sampling unit is the sampling unit in
the second sampling stage, etc.
• e.g. After select...
• The nature of your research study will
determine which type of sampling you should
use.
– Large-scale descriptive studie...
Sample Size Determination
• Many handbooks contain formulae for
estimating sample size because the size ofestimating sampl...
Basic questions that should be asked
when choosing a sample.
1. How large a sample can you collect?
– The best advice that...
Basic questions…
3. What is the prevalence of the condition you are
studying?studying?
• If you are studying a condition t...
Basic questions…
5. How much time do you have for the research?
• You can only study a limited number of people in a• You ...
Sample size…
• It is generally recommended that a sample size• It is generally recommended that a sample size
of at least ...
Notice
• Finalized version of your research topic
• Group members• Group members
• send it to me at: hunachew@gmail.com
• ...
Definitions
• Target population (reference population): Is that
population about which an investigator wishes to
draw a co...
• Sampling unit: The unit of selection in the sampling
process.
• For example, in a sample of districts, the sampling
unit...
• Sample design: The scheme for selecting the
sampling units from the study population.
• Sampling frame: The list of unit...
In order to calculate the required sample size, the
following facts need to be known:
a) The reasonable estimate of the ke...
c) The confidence level required, usually specified as
95%.
d) The size of the population that the sample is to
represent....
Estimating a proportion
• Estimate how big the proportion might be (P)
• Choose the margin of error you will allow in the•...
The minimum sample size required, for a very
large population (N>10,000) is:
Sample Size to Estimate a Single Population P...
• Example 1 (Prevalence of diarrhoea)
a) p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95%
C.I.)C.I.)
• Thus, the study sho...
• Example 1 (Prevalence of diarrhoea)
a) p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95%
C.I.)C.I.)
• Thus, the study sho...
b. If the above sample is to be taken from a relatively
small population (say N = 3000), the required
minimum sample will ...
• Example 2
• A hospital administrator wishes to know what
proportion of discharged patients are unhappy with
the care rec...
Plan for data collection
• A plan for data collection should be
developed so that:developed so that:
– you will have a cle...
– you can organise both human and material
resources for data collection in the most efficient
way; and.
– you can minimis...
• It is likely that while developing a plan for data
collection you will identify problems (such as
limited manpower), whi...
• Stages in the Data Collection Process
• Three main stages can be distinguished:
• Stage 1: Permission to proceed• Stage ...
Data collection…
• Ideally, a pretest of the data collection and
data analysis procedures should be made.data analysis pro...
Points to consider while organizing the
data collection team:
• Selection of the candidates
• Salary and fringe benefits t...
Issues to consider concerning logistics support
and arrangements during data collection:
• Mode of transport needed to go ...
Planning for Data analysis
• We need to prepare a plan for analysis of data
and interpretation of the results because itan...
• Methods of data collection
• The most commonly used methods of collecting
information (quantitative data) are the use of...
1. The use of documentary sources: Clinical
records and other personal records, death
certificates, published mortality st...
Questionnaire Design
• Questions may take two general forms:
• they may be “Open ended” questions, which the
subject answe...
In questionnaire design remember to:
a) Use familiar and appropriate language
b) Avoid abbreviations, double negatives, et...
• Methods of collecting qualitative data
– Focus group discussion
– Observation
Hunachew B. 225
Plan for data processing and analysis
• Data processing and analysis should start in the
field, with checking for complete...
Plan for data processing and analysis
• When making a plan for data processing and
analysis the following issues should be...
Plan for data processing and analysis
• Data processing in both cases involves:
– categorising the data,– categorising the...
• Data analysis – quantitative data
– 1. Frequency counts
– 2. Cross-tabulations– 2. Cross-tabulations
• Processing and an...
Ethical considerations
• Ethical principles
 Autonomy- we ought to respect the right to self-
determination. In research ...
Work plan
• A work plan is a schedule, chart, or a graph
that summarizes, in a clear fashion, variousthat summarizes, in a...
Ways of presenting a work plan
A work plan could be presented in the form of:
a work schedule and GANNT charta work schedu...
Work plan…
The work schedule includes:
– the tasks to be performed;– the tasks to be performed;
– the dates each task shou...
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The GANTT Chart
• The Gantt chart is a planning tool which depicts
graphically the order in which various tasks must be
co...
The GANTT Chart
• The length of each task is shown by a bar that extends
over the number of days, weeks or months the task...
GANNTs Chart
Activities Time in months
January February March April May June
Proposal
development (PI)
XXXXXX
Ethical clea...
Preparation of a budget
There are several reasons why we need a budget:
• A detailed budget will help you to identify whic...
How should a budget be prepared?
• It is necessary to use the work plan as a
starting point. Specify, for each activity in...
Budget justification
• Make sure you give clear explanations concerning why
items that may seem questionable or that areit...
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Appendices
• Include in the appendices of your proposal
any additional information you think mightany additional informati...
Appendices
– A copy of the approval from the Institutional
Review Board.Review Board.
– Any explanatory material (such as ...
Title page and abstract
• Although the title page and abstract appear as the first
section of a research proposal, they ar...
The abstract should tell the reader:
1. The problem to be studied.
2. The main objective of the study.2. The main objectiv...
246Hunachew B
assessment of the prevalence of diarrheal
disease in addis ababa
By Group members:By Group members:
A resarh proposal subm...
• Summary of the major components of a
research proposal
– Title and cover page
– Abstract– Abstract
– Table of contents
–...
III) Materials and methods
• Type of study (study design)
• Study population• Study population
– Describe the study areas ...
• Type of data (defining each variable to be collected
and methods for collecting them
– Operational definitions
– Some el...
• What characteristics will be measured? How will
the variables be defined? What scales of
measurement will be used etc.
–...
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
Proposal writing revised
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Proposal writing revised

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Proposal writing revised

  1. 1. Research Methodology (COMH503) 1Hunachew B
  2. 2. Course Description • This course introduces the principal concepts• This course introduces the principal concepts and components of research. • It deals with the ways how to define research questions, formulate problem statement, develop a research project proposal, how to collect research data and analyze and interpretcollect research data and analyze and interpret data. 2Hunachew B
  3. 3. Course Objectives By the end of the course, students will be able: • To Describe basic steps in undertaking health research • To exercise how to search and review literatures• To exercise how to search and review literatures • To demonstrate how to formulate problem statement and research questions • To determine how to develop a research proposal • To determine the sample size required for a study • To explain how to collect research data and analyze it• To explain how to collect research data and analyze it • To describe ethics in health research • To formulate how to write and disseminate research findings 3Hunachew B
  4. 4. Course Contents 1. Introduction 2. Types of research 3. Components of a research proposal 10. Sample size calculation 11. Overview of sampling methods 12. Types of variablesproposal 4. Research questions and problem statement 5. Literature search and review 6. Formulating research hypothesis 7. Formulation of research 12. Types of variables 13. Data collection techniques 14. Designing research questionnaire 15. Bias in data collection 16. Data management and analysis 17. Health research ethics7. Formulation of research objectives 8. Study designs 9. Quantitative and qualitative research methods 17. Health research ethics 18. Scientific report writing 19. Dissemination of research findings 4Hunachew B
  5. 5. Methods of Instruction and Evaluation Methods of Instruction • Lectures and discussions• Lectures and discussions • In-class exercises • Take-home assignments Evaluation • Evaluation methods – 10% Progressive assessment (class participation and attendance)attendance) – 40% Preparation of a mini-research proposal on a given topic – 50% Final examination 5Hunachew B
  6. 6. REFERENCE 1. Shi L. Health Services Research Methods. 1997, Delmar Publishers. SPH Library.1997, Delmar Publishers. SPH Library. 6Hunachew B
  7. 7. What is research? • Research - is the systematic collection, analysis and interpretation of data to answer a certainand interpretation of data to answer a certain question or solve a problem. • Health research - is the application of principles of research on health. • It is the generation of new knowledge using scientific method to identify and deal withscientific method to identify and deal with health problems and come up with better solutions to mitigate the prevailing problem. 7Hunachew B
  8. 8. What is research? • Health Systems Research is concerned with improving the health of people andimproving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socio- economic development, with full involvement of all partners. economic development, with full involvement of all partners. 8Hunachew B
  9. 9. Basic questions in health system • What are health needs of people? • What is the coverage of health interventions?• What is the coverage of health interventions? • How can we use resources cost-effectively? • How can we control environmental factors? N.B. Without research answering these questions is unthinkable 9Hunachew B
  10. 10. Basic questions--- • The major objective of HSR is to provide health managers at all levels, as well ashealth managers at all levels, as well as community members, with the relevant information they need to make decisions on health-related problems they are facing. 10Hunachew B
  11. 11. Basic questions--- • Health policy makers may, for example, want to know:to know: – What are the prospects for voluntary community-based insurance? What would acceptable contributions for different income groups? Should the pooling of resources take place on a community or national basis?place on a community or national basis? – How can user-fees be used as an instrument to direct demands for care to the appropriate level? 11Hunachew B
  12. 12. Basic questions--- • Managers at district/provincial level may raise questions such as:questions such as: – Why is neonatal mortality in certain districts much higher than in other districts? • Hospital directors may ask: – Why do we have such a high rate of complications– Why do we have such a high rate of complications during child birth? Are the first-line services available and adequate? Are our own services adequate? Are mothers coming late for delivery and, if so, why? 12Hunachew B
  13. 13. Basic questions--- • Managers at village level may want to know: – How can we assist women with little or no education so that they can effectively recognise the symptoms of pneumonia and go in time to the health centre with their children? – How much community labour will be required toHow much community labour will be required to manage the new water system? 13Hunachew B
  14. 14. Characteristics of research • It demands a clear statement of the problem. • It requires clear objectives and a plan (it is not aimlessly looking for something in the hope that you will come across a solution). • It builds on existing data, using both positive and negative findings.and negative findings. • New data should be systematically collected and analyzed to answer the original research objectives. 14Hunachew B
  15. 15. Basic Vs applied research • The classical broad divisions of research are: basic and applied research.and applied research. • Basic Research - is designed to extend the bases of knowledge in a discipline, for the sake of understanding itself. (E.g. cloning, satellite researches ).researches ). • Applied Research - concentrates on finding solutions to immediate problems of practical nature. 15Hunachew B
  16. 16. Approaches • there are two basic approaches to research - quantitative approach and the qualitative approach.quantitative approach and the qualitative approach. 1. The quantitative approach involves the generation of data in quantitative form which can be subjected to rigorous quantitative analysis. • This approach can be further sub-classified into• This approach can be further sub-classified into inferential, experimental and simulation approaches to research. 16Hunachew B
  17. 17. Approaches • The purpose of inferential approach to research is to form a data base from which to inferis to form a data base from which to infer characteristics or relationships of population. • This usually means survey research where a sample of population is studied (questioned or observed) to determine its characteristics, and itobserved) to determine its characteristics, and it is then inferred that the population has the same characteristics. 17Hunachew B
  18. 18. Approaches • Experimental approach is characterised by much greater control over the research environment and in this case some variables are manipulated toin this case some variables are manipulated to observe their effect on other variables. • Simulation approach involves the construction of an artificial environment within which relevant information and data can be generated. • This permits an observation of the dynamic behaviour of a system (or its sub-system) under controlled conditions. 18Hunachew B
  19. 19. Approaches • The term ‘simulation’ refers to “the operation of a numerical model that represents the structure of anumerical model that represents the structure of a dynamic process. • Given the values of initial conditions, parameters and exogenous variables, a simulation is run to represent the behaviour of the process over time.represent the behaviour of the process over time. • Simulation approach can also be useful in building models for understanding future conditions. 19Hunachew B
  20. 20. Approaches 2. Qualitative approach to research is concerned with subjective assessment of attitudes, opinions and behaviour.behaviour. • Research in such a situation is a function of researcher’s insights and impressions. • Such an approach to research generates results either in non-quantitative form or in the form which are notin non-quantitative form or in the form which are not subjected to rigorous quantitative analysis. • Generally, the techniques of focus group interviews, projective techniques and depth interviews are used. 20Hunachew B
  21. 21. Qualitative and Quantitative Approaches… Qualitative Quantitative Usually Non-probability based sample Typically a probability-based samplesample sample Non-generalizable Exploratory Generalizable Explanatory Answers Why? How? Answers How many? When? Where? Generate hypothesis Process is inductive Tests hypotheses Process is deductiveProcess is inductive Process is deductive Data are “rich” and time- consuming to analyze Data are more efficient, but may miss contextual detail Design may emerge as study unfolds Design decided in advance Researcher IS the instrument Various tools, instruments employed 21Hunachew B
  22. 22. Mixed method • Triangulation (Multi-method designs) • Corroboration – (to strengthen or support with• Corroboration – (to strengthen or support with other evidence; make more certain)-(superior evidence if the result from triangulation is the same) • Here is a metaphor for thinking about mixed research:research: “Construct one fish net out of several fish nets that have holes in them by laying them on top of one another. The "new" net will not have any holes in it. The use of multiple methods or approaches to research works the same way.” 22Hunachew B
  23. 23. Main components of any research work 1. Preparing a research proposal 2. Fieldwork (i.e., data collection) 3. Analyzing data and preparing a research report Hunachew B 23
  24. 24. A Research Proposal • A research proposal is a document that presents a plan for a project to reviewers for evaluation.a plan for a project to reviewers for evaluation. – It can be a supervised project submitted to instructors – it can present a project proposed to a fundingit can present a project proposed to a funding agency. 24Hunachew B
  25. 25. A Research Proposal • Its purpose is to convince reviewers • Can he/she handle the project? • Is it well thought? • Reviewers have more confidence that planned project will be successfully completed if theproject will be successfully completed if the proposal is well written and organized, and if you demonstrate careful planning. 25Hunachew B
  26. 26. A Research Proposal… • A proposal describes the research problems and its importance, and gives detailed account of theits importance, and gives detailed account of the methods that will be used and why they are appropriate. • The proposal for quantitative research has most of the parts of the research report: a title, anof the parts of the research report: a title, an abstract, a problem statement, a literature review, a method or design section, and a bibliography. 26Hunachew B
  27. 27. A Research Proposal… • The proposal has a plan for data collection and analysis.analysis. • It frequently includes a schedule of the steps to be undertaken and estimates of the time and budget required to carry out each step of the research. 27Hunachew B
  28. 28. How do you think about a research topic? • From personal experiences/observations• From personal experiences/observations • By discussion with community/health workers • By contacting researchers/experts on the topic • By reading journals/articles’ recommendations • From formal advertisement by organizations• From formal advertisement by organizations 28Hunachew B
  29. 29. Criteria for selecting a research topic 1. Relevance: The topic chosen should be a priority problem:problem: • Questions to be asked include: – How large or widespread is the problem? – Who is affected? – How severe is the problem?– How severe is the problem? Hunachew B 29
  30. 30. Criteria for selecting a research topic 2. Avoidance of duplication: • Investigate whether the topic has been researched.• Investigate whether the topic has been researched. • If the topic has been researched, the results should be reviewed to explore whether major questions that deserve further investigation remain unanswered. • If not, another topic should be chosen.• If not, another topic should be chosen. Hunachew B 30
  31. 31. Criteria for selecting a research topic 3. Feasibility: • Consider the complexity of the problem and the• Consider the complexity of the problem and the resources you will require to carry out the study. • Thought should be given first to personnel, time, equipment and money that are locally available. Hunachew B 31
  32. 32. Criteria for selecting a research topic 4. Political acceptability: • It is advisable to research a topic that has the interest and support of the authorities. • This will facilitate the smooth conduct of the research and increases the chance that the results of the study will be implemented.results of the study will be implemented. Hunachew B 32
  33. 33. Criteria for selecting a research topic 5. Applicability of possible results and recommendationsrecommendations • This will depend not only on the blessing of the authorities but also on the availability of resources for implementing the recommendations.recommendations. Hunachew B 33
  34. 34. Criteria for selecting a research topic 6. Urgency of data needed • How urgently are the results needed for making a decision? • Which research should be done first and which can be done late?which can be done late? Hunachew B 34
  35. 35. Criteria for selecting a research topic 7. Ethical acceptability • We should always consider the possibility that we may inflict harm on others while carrying out research. • Therefore, it will be useful to review the• Therefore, it will be useful to review the proposed study. Hunachew B 35
  36. 36. Scales for rating research topics 1. Relevance 1 = Not relevant 2 = Relevant 3 = very relevant Hunachew B 36
  37. 37. Scales for rating research topics 2. Avoidance of duplication 1 = Sufficient information already available 2 = Some information available but major issues not covered 3 = No sound information available on which to base problem-solvingto base problem-solving Hunachew B 37
  38. 38. Scales for rating research topics 3. Feasibility 1 = Study not feasible considering available resources 2 = Study feasible considering available resourcesresources 3 = Study very feasible considering available resources Hunachew B 38
  39. 39. Scales for rating research topics 4. Political acceptability 1 = Topic not acceptable 2 = Topic somewhat acceptable 3 = Topic fully acceptable Hunachew B 39
  40. 40. Scales for rating research topics 5. Applicability 1 = No chance of recommendations being1 = No chance of recommendations being implemented 2 = Some chance of recommendations being implemented 3 = Good chance of recommendations being3 = Good chance of recommendations being implemented Hunachew B 40
  41. 41. Scales for rating research topics 6. Urgency 1 = Information not urgently needed 2 = Information could be used but a delay of some months would be acceptable 3 = Data very urgently needed for decision-3 = Data very urgently needed for decision- making Hunachew B 41
  42. 42. Scales for rating research topics 7. Ethical acceptability 1 = Major ethical problems 2 = Minor ethical problems 3 = No ethical problems N.B. The above rating should be based on the existingN.B. The above rating should be based on the existing data and not on mere assumptions. Hunachew B 42
  43. 43. Formulating the Problem Statement and Justification of the Problems • The first major section in a research proposal is the ‘statement of the problem’.‘statement of the problem’. • It should describe the problem that is to be investigated and the questions that will guide the research process. • Note that proper justification of the importance of the research questions to be addressed requires some senseresearch questions to be addressed requires some sense of the likely contribution to knowledge that the research will make and its place in current debate or technological advance. 43Hunachew B
  44. 44. Formulating the Problem Statement and Justification of the Problems • Often, this can be presented in the form of research hypotheses to be tested.hypotheses to be tested. • All research is set in motion by the existence of a problem. • A problem is a perceived difficulty, a feeling of discomfort about the way things are, or a discrepancy between what someone believes should be the situationbetween what someone believes should be the situation and what the situation is in reality. • While problems are the initiating force behind research, not all problems require research. 44Hunachew B
  45. 45. What is a research problem?... A potential research situation arises when three conditions exist:- 1. A perceived discrepancy exists between what is and1. A perceived discrepancy exists between what is and what should be (e.g. malaria in highlanders and lowlanders). 2. A question exists about why there is a discrepancy. 3. At least two possible and plausible answers exist to the3. At least two possible and plausible answers exist to the question. N.B. If there is only one possible and plausible answer to the question about the discrepancy, then a research situation does not exist. 45Hunachew B
  46. 46. Why is it important to state and define the problem well? Because a clear statement of the problem:- • Is the foundation (blue print) for further development of the research proposal (research objectives, methodology, work plan, budget, etc). • Makes it easier to find information and reports of similar studies from which your own study design can benefit. 46Hunachew B
  47. 47. Why is it important to state and define the problem well? • Enables you to systematically point out why the proposed research on the problem should beproposed research on the problem should be undertaken and what you hope to achieve with the study results. • This is important to highlight when you present your project to community members, health staff, relevant ministries and donor agencies who need to support your study or give their consent. 47Hunachew B
  48. 48. What information should be included in the problem statement? 1. A brief description of socio-economic and cultural characteristics and an overview of health status and thecharacteristics and an overview of health status and the health-care system in the country/district and Include a few illustrative statistics. 2. A concise description of the nature of the problem, the size, distribution and severity of the problem. 3. An analysis of the major factors that may influence the problem and a discussion of why certain factors need more investigation if the problem is to be fully understood. 48Hunachew B
  49. 49. What information should be included in the problem statement? 4. A brief description of any solutions to the problem that have been tried in the past, how well they havehave been tried in the past, how well they have worked, and why further research is needed (justification for your study). 5. A description of the type of information expected to result from the project and how this information will beresult from the project and how this information will be used to help solve the problem. 6. If necessary, a short list of definitions of crucial concepts used in the statement of the problem. 49Hunachew B
  50. 50. How to write a Problem Statement • The section should be precise and concise, while not forgetting to mention essentialwhile not forgetting to mention essential points. • Information concerning the problem should be summarized, so the reader is not “drowned” in detail. • An outline listing the major points to be• An outline listing the major points to be covered could be prepared before any writing is done, so the section will be logical and well organized. 50Hunachew B
  51. 51. Review of Literature • For any serious study, a thorough literature review must be accomplished. However, the questionmust be accomplished. However, the question remains: Why Review? • To which point in the theoretical agenda of that body of knowledge does your project relate to most directly? • What are the major controversies that are• What are the major controversies that are important for your project? --you need to do a comprehensive and focused literature review on your particular topic. 51Hunachew B
  52. 52. The result of the literature review should be: • A reaffirmation of the importance of the theoretical rationale of the project in the lighttheoretical rationale of the project in the light of the work of others in the same area, and; • An emphasis on the contribution which the project is likely to make to the ongoing task of building and improving theory in a given area of knowledge.knowledge. • The later should be your target! 52Hunachew B
  53. 53. Why is a review of literature important when preparing a proposal? • It helps further your understanding of the problem and may lead to refining of theproblem and may lead to refining of the “Statement of the problem”. • It helps you find out what others have learned and reported on your topic, and take account of this in the design of your study.this in the design of your study. • It gives you a familiarity with the various types of methodology that might be used in your study. 53Hunachew B
  54. 54. What resources can be consulted for the review of the literature? • Card catalogues of books in libraries • Indexes such as INDEX MEDICUS, INTERNATIONAL NURSING INDEX etc. that identify journal articles by subject, author and title. • Summaries of abstracts of books and articles• Summaries of abstracts of books and articles 54Hunachew B
  55. 55. What resources ---? • Computer-based literature searches such as MEDLINE, PUBMED.MEDLINE, PUBMED. • Bibliographies such as those found at the end of books, articles, theses, etc. or prepared as separate documents. • Statistics collected at the national, provincial• Statistics collected at the national, provincial and/or departmental levels. 55Hunachew B
  56. 56. What resources ---? • Studies conducted in the country or region. • Responses to enquiries on ongoing research. • Theoretical works related to the topic. • Works on methodology and descriptions of methodologies used in other studiesmethodologies used in other studies 56Hunachew B
  57. 57. What resources ---? • Responses from agencies willing to supply reference materials for research by mail.reference materials for research by mail. • Opinions, beliefs, points-of-view. • Anecdote, clinical observations, reports of incidents • Gray literature etc. 57Hunachew B
  58. 58. • After collecting the required information the investigator should decide in which order he/she wants to discuss previous researchhe/she wants to discuss previous research findings: –from global to local –from broader to focused –from past to current Hunachew B 58
  59. 59. • This review should answer – How much is known? –What is not known?–What is not known? –What should be done based on what is lacking? Hunachew B 59
  60. 60. Methods of citations in preparing literature review: • Information on an index card should be organized in such a way that you can easily find all the data you willsuch a way that you can easily find all the data you will need for your report: • For an article the following information should be noted: • Author(s)’ Surname followed by initials. Title of article. Name of Journal. Year, Volume, (number): pageName of Journal. Year, Volume, (number): page numbers of article. 60Hunachew B
  61. 61. Methods of citations in preparing literature review: Example:Example: • Louria DB. Emerging- and re-emerging infections: The societal variables. International Journal of Infectious Disease. 1996, 1(2):59-62. 61Hunachew B
  62. 62. Methods of citations… • For a book the following information should be noted:be noted: • Author(s)’ Surname followed by initials. Title of book. Place: Publisher, Year, Edition Example: • Abramson JH. Survey methods in community• Abramson JH. Survey methods in community medicine. Edinburgh: Churchill Livingstone, 1990, 4th ed. 62Hunachew B
  63. 63. Vancouver Vs Harvard system • The formats suggested above have been adopted as standard by over 300 biomedicaladopted as standard by over 300 biomedical journals and are referred to as the Vancouver System. • In other journals and books it is common to put the year, between brackets, straight afterput the year, between brackets, straight after the name of the author(s). • This is called the Harvard System. 63Hunachew B
  64. 64. Vancouver Vs Harvard… • In Harvard style, this looks as follows: • Abramson JH (1990) 4th ed. Survey methods in community medicine. Edinburgh: Churchill Livingstone. • N.B. Alphabetical referencing 64Hunachew B
  65. 65. RESEARCH OBJECTIVES 65Hunachew B
  66. 66. RESEARCH OBJECTIVES • The OBJECTIVES of a research project summarise what is to be achieved by the study.what is to be achieved by the study. • Objectives should be closely related to the statement of the problem. • For example, if the problem identified is low utilisation of child welfare clinics, the generalutilisation of child welfare clinics, the general objective of the study could be to identify the reasons for this low utilisation, in order to find solutions. 66Hunachew B
  67. 67. RESEARCH OBJECTIVES • The general objective of a study states what researchers expect to achieve by the study inresearchers expect to achieve by the study in general terms. Specific objectives • It is possible (and advisable) the break down a• It is possible (and advisable) the break down a general objective into smaller, logically connected parts. 67Hunachew B
  68. 68. RESEARCH OBJECTIVES • Specific objectives should systematically address the various aspects of the problem as defined underthe various aspects of the problem as defined under Statement of the Problem and the key factors that are assumed to influence or cause the problem. • They should specify what you will do in your study, where and for what purpose.where and for what purpose. 68Hunachew B
  69. 69. RESEARCH OBJECTIVES • A study into the cost and quality of home-based care for HIV/AIDS patients and their communities incare for HIV/AIDS patients and their communities in Ethiopia, for example, has as its general objective: “To explore to what extent community home- based care (CHBC) projects in Ethiopia provide adequate, affordable and sustainable care of good quality to people with HIV/AIDS, and togood quality to people with HIV/AIDS, and to identify ways in which these services can be improved”. 69Hunachew B
  70. 70. RESEARCH OBJECTIVES • It was split up in the following specific objectives: 1. To identify the full range of economic, psychosocial, health/nursing care and other needs of patients and their families affected by AIDS. 2. To determine the extent to which formal and informal support systems address these needsinformal support systems address these needs from the viewpoint of service providers as well as patients. 70Hunachew B
  71. 71. RESEARCH OBJECTIVES 3. To determine the economic costs of CHBC to the patient and family as well as to the formal CHBCpatient and family as well as to the formal CHBC programmes themselves. 4. To relate the calculated costs to the quality of care provided to the patient by the family and to the family/patient by the CHBC programme. 71Hunachew B
  72. 72. RESEARCH OBJECTIVES 5. To determine how improved CHBC and informal support networks can contribute to the needs ofsupport networks can contribute to the needs of persons with AIDS and other chronically and terminally ill patients. 6. To use the findings to make recommendations on the improvement of CHBC to home care providers, donors and other concerned organisations,donors and other concerned organisations, including government. 72Hunachew B
  73. 73. Why should research objectives be developed? The formulation of objectives will help you to: 1. Focus the study (narrowing it down to essentials); 2. Avoid the collection of data which are not strictly necessary for understanding and solving the problem you have identified; andthe problem you have identified; and 3. Organise the study in clearly defined parts or phases. 73Hunachew B
  74. 74. Why should research objectives be developed? • Properly formulated, specific objectives will facilitate the development of your researchfacilitate the development of your research methodology and will help to orient the collection, analysis, interpretation and utilisation of data. 74Hunachew B
  75. 75. How should you state your objectives? • Take care that the objectives of your study: 1. Cover the different aspects of the problem and its1. Cover the different aspects of the problem and its contributing factors in a coherent way and in a logical sequence; 2. Are clearly phrased in operational terms, specifying exactly what you are going to do, where, and for what purpose;what purpose; 3. Are realistic considering local conditions; and 4. Use action verbs that are specific enough to be evaluated. 75Hunachew B
  76. 76. How should you state your objectives? • Keep in mind that when the project is evaluated, the results will be compared toevaluated, the results will be compared to the objectives. • If the objectives have not been spelled out clearly, the project cannot be evaluated. 76Hunachew B
  77. 77. How should you state your objectives? • Using the previous example on cost and quality of CHBC, we may develop more specific research questions for the different objectives, such as:questions for the different objectives, such as: 1. Do rural and urban CHBC projects differ with respect to the adequacy, quality, affordability and sustainability of HBC provided? 2. How satisfied are AIDS patients, relatives and2. How satisfied are AIDS patients, relatives and service providers with the care provided? Are there differences in perceptions between those groups? 77Hunachew B
  78. 78. How should you state your objectives? 3. Is the stigma attached to being HIV+ the same strong for women as for men? Or are there gender differences in stigma?differences in stigma? 4. What impact does the care provided to AIDS patients have on the economy of the homestead? Is there competition with other basic needs (e.g. schooling of children, purchases of food)? 78Hunachew B
  79. 79. Types of objectives 1. Estimation objectives – Estimates magnitude of an event– Estimates magnitude of an event 2. Association objectives – Analyses factors associated with an event 3. Evaluation objectives Evaluates associations– Evaluates associations 79Hunachew B
  80. 80. When should the objectives of a research project be prepared? • The objectives should be written after the• The objectives should be written after the statement of the problem is developed, i.e following the literature review, and before the methodology for the study is planned. • Because the objectives show the precise goal of the study, help guide the development of thethe study, help guide the development of the research methodology, and orient the collection, analysis and interpretation of data. 80Hunachew B
  81. 81. What are the characteristics of good objectives? Objectives should be: – Logical and coherent– Logical and coherent – Feasible (few objectives) – Realistic, considering local conditions – Defined in operational terms that can be measuredmeasured – Phrased to clearly meet the purpose of the study 81Hunachew B
  82. 82. How should objectives be stated? • Objectives should be stated using “action verbs” that are specific enough to be measured:that are specific enough to be measured: Examples: • To determine …, To compare…, To verify…, To calculate…, To describe…, etc.calculate…, To describe…, etc. • Do not use vague non-action verbs such as: – To appreciate … To understand… To believe 82Hunachew B
  83. 83. Action-verbs Vs non-action verbs Action-verbs To determine To compare To verifyTo determine To compare To verify To calculate To describe To asses To explore To test To establish To identify Non-action verbs To appreciate To understand To show To share To believe to study 83Hunachew B
  84. 84. What formats can be used for stating research objectives? • Research objectives can be stated as: – Questions: “The objectives of this study are to answer the following questions …” – Positive sentence: “The objectives of this study are to determine …” – Hypothesis: “The objective of this study is to verify the following hypothesis...” 84Hunachew B
  85. 85. Research hypothesis What is a Research Hypothesis? • A hypothesis can be defined as “a tentative prediction or explanation of the relationship between two or more variables and the problem under study that can be tested. • A hypothesis, in other words, translates the problem statement into a precise, unambiguous predication of expected outcomes.” 85Hunachew B
  86. 86. Research hypothesis • Based on your experience with the study problem, it might be possible to developproblem, it might be possible to develop explanations for the problem, which can then be tested. • If so, you can formulate hypotheses in addition to the study objectives.addition to the study objectives. 86Hunachew B
  87. 87. Research hypothesis • In the example concerning the cost and quality of HBC in Ethiopia it would have been possible to formulate and test the following hypotheses:and test the following hypotheses: 1. The role of first-line relatives in the provision of care to AIDS patients is more substantial in rural than in urban areas. 2. The silence and stigma surrounding AIDS makes the2. The silence and stigma surrounding AIDS makes the formation of self-help groups of AIDS patients and their relatives next to impossible, which in turn maintains the high level of stigma on HIV/AIDS. 87Hunachew B
  88. 88. Research hypothesis • Hypothesis statements are most applicable for field intervention or evaluative studies.field intervention or evaluative studies. • Diagnostic or exploratory studies do not normally require hypothesis statements because they generally do not test relationships between variables.between variables. 88Hunachew B
  89. 89. What is a Research Hypothesis?... • They indicate the major independent and dependant variables of interest.dependant variables of interest. • They suggest the type of data that must be collected and the type of analysis that must be conducted in order to measure the relationship among the variables.relationship among the variables. 89Hunachew B
  90. 90. Stating Research Hypotheses: • A hypothesis can be simple in form, predicating the relationship between one independent and onerelationship between one independent and one dependant variable. • “Health education involving active participation by mothers will produce more positive changes in child feeding than health education based on lectures.” • Independent variable: Type of health education • Dependant variable: Changes in child feeding 90Hunachew B
  91. 91. Stating Research Hypotheses:… • A hypothesis can be stated in the form of “null” (Ho) • In the alternative form (Ha). 91Hunachew B
  92. 92. METHODS • The methodology of a research project is the• The methodology of a research project is the core of the study. • The following are important questions to consider when beginning to prepare a research design for a research proposal:---------design for a research proposal:--------- 92Hunachew B
  93. 93. METHODS… • What do I want to measure? • How can I measure it?• How can I measure it? • Where should I measure it? • What will I do with the answers collected? • How can I check whether my methods for measuring are correct before beginning a large study? • What professional and non-professional staff do I need to carry out this study?carry out this study? • What types of logistical support do I need? • Are there any ethical problems related to the study? • How can I avoid introducing biases into the study? • What constraints may affect this study? 93Hunachew B
  94. 94. Components of a research design that should be addressed in the methodology section of a research proposal: • Study area • Research designs• Research designs • Variables • Sampling method • Plan for data collection • Plan for analysis of data and interpretation of the resultsresults • Staffing, supplies and equipment (covered in detail in ‘Budget and plan for data collection and analysis’ section). • Ethical considerations 94Hunachew B
  95. 95. Variables • What information are we going to collect in our study to meet our objectives? • In most studies, we must first describe the problem itself more precisely. • For example, in a study that is investigating why so many tuberculosis (TB) patients default from out-patient treatment, we first want to knowout-patient treatment, we first want to know how high the defaulter rate is: is it 10%, 30%, 50%? 95Hunachew B
  96. 96. Variables • To obtain the defaulter rate we need a clear definition of what we mean by defaultingdefinition of what we mean by defaulting (how many times treatment was missed). 96Hunachew B
  97. 97. Variables • We also want to know whether certain factors do indeed influence the problem, and to what extent.indeed influence the problem, and to what extent. • If we know the extent to which a certain factor influences the problem, we are much more likely to be able to convince ourselves (and relevant others) to take action.to take action. 97Hunachew B
  98. 98. Variables • For example, if we find that becoming a dropout of TB treatment is strongly associated with the following factors, we have clues that will help us to solve thefactors, we have clues that will help us to solve the problem: • The patient’s lack of knowledge concerning the actual duration of treatment and the danger of relapse or death when the full course is not completed; • Living more than 8 km away from the clinic where the• Living more than 8 km away from the clinic where the drugs have to be collected monthly; and • Being between 15 and 30 years of age. 98Hunachew B
  99. 99. Variables • To find these associations between problems and contributing factors, it is essential that we carefully define the problem itself, as well as each of thedefine the problem itself, as well as each of the factors identified when analysing the problem . • We do this by formulating variables. 99Hunachew B
  100. 100. FORMULATING VARIABLES • A variable is a characteristic of a person, object or phenomenon which can take on different values. • These may be in the form of numbers (e.g., age) or non-numerical characteristics (e.g., sex). • A simple example of a variable in the form of numbers is ‘a person’s age’. • The variable ‘age’ can take on different values since a person can be 20 years old, 35 years old and so on. 100Hunachew B
  101. 101. FORMULATING VARIABLES Other examples of variables are: – weight (expressed in kilograms or in pounds);– weight (expressed in kilograms or in pounds); – home - clinic distance (expressed in kilometres or in minutes walking distance); – monthly income (expressed birr); and – number of children (1, 2, etc.). 101Hunachew B
  102. 102. FORMULATING VARIABLES • Because the values of all these variables are expressed in numbers, we call them numericalexpressed in numbers, we call them numerical variables. • Some variables may also be expressed in categories. • For example, the variable sex has two districts categories, groups - male and female. 102Hunachew B
  103. 103. FORMULATING VARIABLES • Other examples are: • Colour• Colour – Red – Blue – green, etc.– green, etc. 103Hunachew B
  104. 104. FORMULATING VARIABLES • Outcome of disease – Recovery– Recovery – chronic illness – death 104Hunachew B
  105. 105. FORMULATING VARIABLES • Main type of staple food eaten – Maize– Maize – Millet – Rice – cassava, etccassava, etc • Since these variables are expressed in categories, we call them categorical variables. 105Hunachew B
  106. 106. FORMULATING VARIABLES • Numerical variables can either be continuous or discrete.or discrete. Continuous. • height in centimetres (2.5 cm or 2.546 cm or 2.543216 cm) • temperature in degrees Celsius (37.2 0 C or 37.19999 0 C etc.) 106Hunachew B
  107. 107. FORMULATING VARIABLES Discrete- These are variables in which numbers can only have full values,numbers can only have full values, • number of visits to a clinic (0, 1, 2, 3, 4, etc). • number of sexual partners (0, 1, 2, 3, 4, 5, etc.)etc.) 107Hunachew B
  108. 108. FORMULATING VARIABLES • Categorical variables, on the other hand, can either be ordinal or nominal.either be ordinal or nominal. i. Ordinal variables. These are grouped variables that are ordered or ranked in increasing or decreasing order: • High income (above 300 per month);• High income (above 300 per month); • Middle income (100-300 per month); and • Low income (less than 100 per month). 108Hunachew B
  109. 109. FORMULATING VARIABLES • Other examples are: • Disability: no disability, partial disability,• Disability: no disability, partial disability, serious or total disability • Seriousness of a disease: severe, moderate, mildmild • Agreement with a statement: fully agree, partially agree, fully disagree 109Hunachew B
  110. 110. FORMULATING VARIABLES • Fear of leprosy: will not share food with a patient; will not enter the house of a patient;patient; will not enter the house of a patient; will not allow patient to live in the community. • Note: Fear of leprosy is an attitude, and• Note: Fear of leprosy is an attitude, and attitudes are often scaled (you make them into ordinal variables). 110Hunachew B
  111. 111. FORMULATING VARIABLES • If a researcher has little idea about the distribution of a certain variable in adistribution of a certain variable in a population (for example, if you don’t know whether 30%, 50%, or 95% are below the poverty line of 100 per month), it is advisable to categorise numerical data only after the pre-test, or even after data collection. to categorise numerical data only after the pre-test, or even after data collection. 111Hunachew B
  112. 112. FORMULATING VARIABLES ii. Nominal variables. The groups in these variables do not have an order or ranking in them.have an order or ranking in them. For example: • Sex: male, female • Main food crops: maize, millet, rice, etc. • Religion: Christian, Moslem, Hindu, Buddhism, etc.• Religion: Christian, Moslem, Hindu, Buddhism, etc. • For examples of scales of measurement, as continuous, discrete, ordinal and nominal data require different statistical tests. 112Hunachew B
  113. 113. Factors rephrased as variables 113Hunachew B
  114. 114. Operationalizing variables by choosing appropriate indicators • Operationalizing variables means that you make them measurable:measurable: • For example: • In many HSR studies, you want to determine the level of knowledge concerning a specific issue in order to find out to what extent the factor ‘poor knowledge’find out to what extent the factor ‘poor knowledge’ influences the problem under study (for example low utilisation of pre-natal care by pregnant women). 114Hunachew B
  115. 115. Operationalizing variables by choosing appropriate indicators • The variable ‘level of knowledge’ cannot be measured as such.as such. • You would need to develop a series of questions to assess a woman’s knowledge, for example on pre- natal care and risk factors related to pregnancy. • The answers to these questions form an indicator of• The answers to these questions form an indicator of someone’s knowledge on this issue, which can then be categorised. 115Hunachew B
  116. 116. Operationalizing variables by choosing appropriate indicators • If 10 questions were asked, you might decide that the knowledge of those with:that the knowledge of those with: – 0 to 3 correct answers is poor, – 4 to 6 correct answers is reasonable, and – 7 to 10 correct answers is good. 116Hunachew B
  117. 117. Operationalizing variables by choosing appropriate indicators • Nutritional status of under-5 year olds is another example of a variable that cannot be measuredexample of a variable that cannot be measured directly and for which you would need to choose appropriate indicators. • Widely used indicators for nutritional status include: – Weight in relation to age (W/A) – Weight in relation to height (W/H)– Weight in relation to height (W/H) – Height in relation to age (H/A) – Upper-arm circumference (UAC) 117Hunachew B
  118. 118. Operationalizing variables by choosing appropriate indicators • For the classification of nutritional status, internationally accepted categories already exist,internationally accepted categories already exist, which are based on so-called standard growth curves. • For the indicator ‘Weight/Age’, for example, children are: – well-nourished if they are above 80% of the standard, – moderately malnourished if they are between 60% and 80%, and – severely malnourished if they are below 60%. 118Hunachew B
  119. 119. Defining variables and indicators of variables • To ensure that everyone (the researcher, the data collectors, and eventually, the reader ofdata collectors, and eventually, the reader of the research report) understands exactly what has been measured and to ensure that there will be consistency in the measurement, it is necessary to clearlymeasurement, it is necessary to clearly define the variables (and indicators of variables). 119Hunachew B
  120. 120. Defining variables and indicators of variables • For example, to define the indicator ‘waiting time’ it is necessary to decide what will betime’ it is necessary to decide what will be considered the starting point of the ‘waiting period’ e.g., is it when the patient enters the front door, or when he has been registered and obtained his card? 120Hunachew B
  121. 121. Fig. Relationship between qualitative and quantitative studies in understanding and measuring problems 121Hunachew B
  122. 122. Dependent and independent variables • The variable that is used to describe or measure the problem under study is calledmeasure the problem under study is called the dependent variable. • The variables that are used to describe or measure the factors that are assumed to cause or at least to influence the problem are called the independent variables. 122Hunachew B
  123. 123. Dependent and independent variables • For example, in a study of the relationship between smoking and lung cancer, ‘sufferingbetween smoking and lung cancer, ‘suffering from lung cancer’ (with the values yes, no) would be the dependent variable and ‘smoking’ (varying from not smoking to smoking more than three packets a day) the independent variable. 123Hunachew B
  124. 124. Dependent and independent variables • Whether a variable is dependent or independent is determined by the statement of the problem anddetermined by the statement of the problem and the objectives of the study. • It is therefore important when designing an analytical study to clearly state which variable is the dependent and which are the independent ones.dependent and which are the independent ones. 124Hunachew B
  125. 125. Dependent and independent variables • Note that if a researcher investigates why people smoke, ‘smoking’ is the dependentpeople smoke, ‘smoking’ is the dependent variable, and ‘pressure from peers to smoke’ could be an independent variable. • In the lung cancer study ‘smoking’ was the• In the lung cancer study ‘smoking’ was the independent variable. 125Hunachew B
  126. 126. • A variable that is associated with the problem and with a possible cause of the problem is a potential Confounding variable with a possible cause of the problem is a potential confounding variable. • A confounding variable may either strengthen or weaken the apparent relationship between the problem and a possible cause. 126Hunachew B
  127. 127. 127Hunachew B
  128. 128. Confounding variable • in order to give a true picture of cause and effect, possible confounding variables must be considered,possible confounding variables must be considered, either at planning stage or while doing data analysis. For example: • A relationship is shown between bottle-feeding and diarrhea in under-twos.diarrhea in under-twos. • However, mother’s education may be related to bottle-feeding as well as to diarrhea. 128Hunachew B
  129. 129. 129Hunachew B
  130. 130. Confounding variable • In order to give a true picture of the relationship between bottle-feeding and diarrhea of under-twos,between bottle-feeding and diarrhea of under-twos, the influence of mother’s education should be controlled. • This could either be addressed in the research design, e.g., by selecting only mothers with a specific level of education, or it could be taken into account duringeducation, or it could be taken into account during the analysis of the findings by analysing the relation between bottle-feeding and diarrhea separately for mothers with different levels of education. 130Hunachew B
  131. 131. Background variables • In almost every study, background variables, such as age, sex, educational level, socioeconomic status, marital status and religion, should be considered.marital status and religion, should be considered. • These background variables are often related to a number of independent variables, so that they influence the problem indirectly (hence they are called background variables). • Only background variables important to the study should be measured. • Background variables are notorious ‘confounders’. 131Hunachew B
  132. 132. Quantitative data collection Techniques • Interview administered questionnaire• Interview administered questionnaire • Self-administered questionnaire • Direct measurement• Direct measurement • Review of record 132Hunachew B
  133. 133. Quantitative data collection Techniques • Interview administered questionnaire • Self-administered questionnaire • Direct measurement • Review of record 133Hunachew B
  134. 134. Qualitative data collection Techniques • Key informant interview• Key informant interview • In-depth interview • Focus group discussions• Focus group discussions • Observations (direct, participant) 134Hunachew B
  135. 135. RESEARCH METHODS Study designs • A study design is the process that guides• A study design is the process that guides researchers on how to collect, analyze and interpret observations. • It is a logical model that guides the investigator in the various stages of the research. • Several classifications of study types are possible, depending on what research strategies are used. Hunachew B 135
  136. 136. • Non-intervention (Observational) studies in which the researcher just observes and analyses researchable objects or situations but does not intervene; and • Intervention studies in which the researcher manipulates objects or situations and measures the outcome of his manipulations (e.g., by implementing intensive health education and measuring the improvement in immunisationmeasuring the improvement in immunisation rates.) Hunachew B 136
  137. 137. Non-intervention studies could be: exploratory, descriptive or analytical 1. Exploratory studies1. Exploratory studies • An exploratory study is a small-scale study of relatively short duration, which is carried out when little is known about a situation or a problem. • It may include description as well as comparison. Hunachew B 137
  138. 138. For example: • A national AIDS Control Programme wishes to establish counselling services for HIV positive andestablish counselling services for HIV positive and AIDS patients, but lacks information on specific needs patients have for support. • To explore these needs, a number of in-depth interviews are held with various categories of patients (males, females, married and single) andpatients (males, females, married and single) and with some counsellors working on a programme that is already under way. Hunachew B 138
  139. 139. • When doing exploratory studies we describe the needs of various categories of patients and the possibilities for action. • We may want to go further and try to explain the• We may want to go further and try to explain the differences we observe (e.g., in the needs of male and female AIDS patients) or to identify causes of problems. • Then we will need to compare groups. • Comparison is a fundamental research strategy to identify variables that help explain why one group of persons or objects differs from another. Hunachew B 139
  140. 140. • In HSR, small-scale studies that compare extreme groups are very useful for detecting management problems. • We could, for example, compare: – Two district health teams that are functioning well and two that do not function satisfactorily, in order to detect the possible reasons for bottlenecks in the functioning of the districtbottlenecks in the functioning of the district health teams; Hunachew B 140
  141. 141. – One community with high and another with low participation in health activities, in order to identify factors that contribute to community participation;participation; – 20 mothers who delivered in a maternity and 20 who delivered at home, in order to identify possible reasons for the low percentage of supervised deliveries.supervised deliveries. Hunachew B 141
  142. 142. • Exploratory studies gain in explanatory value if we approach the problem from different angles at the same time. This is called triangulation. • In a study that is looking for causes of the low percentage of supervised deliveries, it may be very useful to include observations and interviews with health staff in the maternity centres that should serve the mothers in question and interviews withserve the mothers in question and interviews with their supervisors, as well as with the mothers themselves. Hunachew B 142
  143. 143. • In this manner, information from different independent sources can be cross-checked. • If the problem and its contributing factors are• If the problem and its contributing factors are not well defined it is always advisable to do an exploratory study before embarking on a large-scale descriptive or comparative study. Hunachew B 143
  144. 144. 2. Descriptive studies: • A descriptive study involves describing the characteristics of a particular situation, eventcharacteristics of a particular situation, event or case. • Descriptive studies can be carried out on a small or larger scale. Hunachew B 144
  145. 145. a. Small scale, descriptive case studies • Descriptive case studies describe in-depth the characteristics of one or a limited number ofcharacteristics of one or a limited number of cases. • A case may be, for example, a patient, a health centre, or a village. • Such a study can provide quite useful insight• Such a study can provide quite useful insight into a problem. • Case studies are common in clinical medicine. 145Hunachew B
  146. 146. b. Large scale, cross-sectional surveys • Cross-sectional surveys aim at describing and quantifying the distribution of certain variables in a study population at one point of time.study population at one point of time. They may cover, for example: i. Physical characteristics of people, materials or the environment, as in – prevalence surveys (of bilharzia, leprosy, HIV), or– prevalence surveys (of bilharzia, leprosy, HIV), or – evaluation of coverage (of immunisation, latrines, etc.), 146Hunachew B
  147. 147. b. Large scale, cross-sectional --- ii. Socio-economic characteristics of people such as their age, education, marital status, number of children and income, iii. The behaviour or practices of people and the knowledge, attitudes, beliefs, opinions which may help to explain that behaviour (KAP studies), or iv. Events that occurred in the population. 147Hunachew B
  148. 148. b. Large scale, cross-sectional --- • Cross-sectional surveys cover a selected sample of the population. • If a cross-sectional study covers the total population it is called a census. • A cross-sectional survey may be repeated in order to measure changes over time in the characteristics that were studied.that were studied. • The surveys may be very large, with hundreds or even thousands of study units. 148Hunachew B
  149. 149. b. Large scale, cross-sectional --- • In these cases only a limited number of variables will usually be included, in order to avoid problems with analysis and report writing. If cross-sectional surveys are smaller they can be more complex. • Small surveys can reveal interesting associations between certain variables, such as between having tuberculosis and socioeconomic status, sex, and ways of coping. 149Hunachew B
  150. 150. 3. Comparative or analytical studies • An analytical study attempts to establish causes or risk factors for certain problems.causes or risk factors for certain problems. • This is done by comparing two or more groups, some of which have or develop the problem and some of which have not. 150Hunachew B
  151. 151. There are three commonly used types of analytical studies 151Hunachew B
  152. 152. 1. Cross-sectional comparative studies • Many cross-sectional surveys focus on describing as well as comparing groups. • For example, a survey on malnutrition may wish to• For example, a survey on malnutrition may wish to establish: – The percentage of malnourished children in a certain population; – Socio-economic, physical, political variables that– Socio-economic, physical, political variables that influence the availability of food; – Feeding practices; and the knowledge, beliefs, opinions that influence these practices. 152Hunachew B
  153. 153. 1. Cross-sectional comparative --- • The researcher will not only describe these variables but, by comparing malnourished and well nourished children, he will try to determine which socio-economic, behavioural and other independent variables may have contributed to malnutrition. • In any comparative study, one has to watch out for confounding or intervening variables. 153Hunachew B
  154. 154. 2. Case-control studies • In a case-control study the investigator compares one group among whom the problem that he wishes to investigate is present (e.g. malnutrition)wishes to investigate is present (e.g. malnutrition) and another group called a control or comparison group, where the problem is absent, in order to find out what factors have contributed to the problem. 154Hunachew B
  155. 155. Fig. Diagram of a case-control study 155Hunachew B
  156. 156. • For example, in a study of the causes of neonatal death, the investigator will first select the cases (children who died within the first month of life) and controls (children who survived their firstand controls (children who survived their first month of life). • (S)he then interviews their mothers to compare the history of these two groups of children, to determine whether certain risk factors are more prevalent among the children who died than amongprevalent among the children who died than among those who survived. 156Hunachew B
  157. 157. • Controls should come from the same source population. • For example, in a hospital case-control study where• For example, in a hospital case-control study where cases are being sought in the hospital, control should normally be selected from patients attending at the same hospital. • If controls are selected from another hospital, they might not be from the same source populationmight not be from the same source population because the referral pathways may be different, and therefore they would not really be comparable to the cases. 157Hunachew B
  158. 158. 3. Cohort studies • In a cohort study, a group of individuals that is exposed to a risk factor (study group) is compared to a group of individuals not exposed to the risk factor (control group). • The researcher follows both groups over time and compares the occurrence of the problem that he expects to be related to the risk factor in the twoexpects to be related to the risk factor in the two groups to determine whether a greater proportion of those with the risk factor are indeed affected. 158Hunachew B
  159. 159. 3. Cohort studies • example of a cohort study - smokers and non- smokers that is conducted among doctors tosmokers that is conducted among doctors to determine the importance of smoking as a risk factor for developing lung-cancer. 159Hunachew B
  160. 160. Figure: Diagram of a cohort study 160Hunachew B
  161. 161. 2. Intervention studies • In intervention studies, the researcher manipulates a situation and measures the effects of this manipulation. • Usually (but not always) two groups are compared, one• Usually (but not always) two groups are compared, one group in which the intervention takes place (e.g. treatment with a certain drug) and another group that remains untouched (e.g. treatment with a placebo). • The two categories of intervention studies are: a. experimental studies and b. quasi-experimental studies 161Hunachew B
  162. 162. 1. Experimental studies • An experimental design is a study design that gives the most reliable proof for causation. • individuals are randomly allocated to at least two• individuals are randomly allocated to at least two groups. • One group is subject to an intervention, or experiment, while the other group(s) is not. • The outcome of the intervention (effect of the intervention on the dependent variable/problem) is obtained by comparing the two groups. Hunachew B 162
  163. 163. Figure: Diagram of an experimental study 163Hunachew B
  164. 164. • A number of experimental study designs have been developed. These are widely used in laboratory settings and in clinical settings. • For ethical reasons, the opportunities for experiments involving human subjects are restricted. • However, randomised control trials of new drugs are common. 164Hunachew B
  165. 165. • For example, a researcher plans to study the effect of a new drug. (The drug has already been tested extensively on animals and has been approved for trial use.)trial use.) • He plans to include 300 patients in the study who are currently receiving the standard treatment for the same condition for which the new drug has been designed.been designed. 165Hunachew B
  166. 166. • He explains the study to the patients asking their consent to be divided into two groups on a random basis. • One group will receive the experimental drug while• One group will receive the experimental drug while the other group will continue to receive the standard treatment. • He makes sure that the medications are disguised and labelled in such a manner that neither the research assistant administering them nor theresearch assistant administering them nor the patient know which drug is used. (This is called a double blind experiment.) 166Hunachew B
  167. 167. • At community level, where HSR is frequently undertaken, we experience not only ethical but also practical problems in carrying out experimental studies.studies. • In real life settings, it is often impossible to assign persons at random to two groups, or to maintain a control group. • Therefore, experimental research designs may have to be replaced by quasi-experimental designs.to be replaced by quasi-experimental designs. Hunachew B 167
  168. 168. 2. Quasi-experimental studies • In a quasi-experimental study, one characteristic of a true experiment is missing, either randomisationa true experiment is missing, either randomisation or the use of a separate control group. • A quasi-experimental study, however, always includes the manipulation of an independent variable which is the intervention.variable which is the intervention. Hunachew B 168
  169. 169. • One of the most common quasi-experimental designs uses two (or more) groups, one of which serves as a control group in which no intervention takes place.takes place. • Both groups are observed before as well as after the intervention, to test if the intervention has made any difference. • (This quasi-experimental design is called the ‘non-• (This quasi-experimental design is called the ‘non- equivalent control group design’ because the subjects in the two groups (study and control groups) have not been randomly assigned.) Hunachew B 169
  170. 170. Figure : Diagram of a quasi-experimental design with two groups 170Hunachew B
  171. 171. • Example of a quasi-experimental study: • A researcher plans to study the effects of health education on the level of participation of a village population in an immunisation campaign. She decides to select one village in which health education sessions on immunisation will be given and another village which will not receiveimmunisation will be given and another village which will not receive health education and serves as a control. The immunisation campaign will be carried out in the same manner in both villages. A survey will then be undertaken to determine if the immunisation coverage in the village where health education was introduced before the campaign is significantly different from the coverage in the control village which did not receive health education. • Note: The study is quasi-experimental because the subjects were not• Note: The study is quasi-experimental because the subjects were not assigned to the control or experimental groups on a random basis. 171Hunachew B
  172. 172. What are validity and reliability in research findings? • Validity means that your scientific observations actually measure what they intend to measure (your conclusions are true). • Reliability means that someone else using the same method in the same circumstances should be able to obtain the same findings (your findings are repeatable). 172Hunachew B
  173. 173. • Reliability (repeatability) refers to the possibility to replicate (repeat) the observations and is related to the precision of the instrument used for scientific observations. • Validity refers to the soundness of the observations and to the accurateness of theobservations and to the accurateness of the data collected by the research method/instrument. 173Hunachew B
  174. 174. 1. Neither valid nor reliable. The research methods do not hit the heart of the research aim (not valid) and repeated attempts are unfocussed 174Hunachew B
  175. 175. 2. Reliable but not valid. The research methods do not hit the heart of the research aim, but repeated attempts get almost the same (but wrong) results 175Hunachew B
  176. 176. 3. Fairly valid but not very reliable. The research methods hit the aim of the study fairly closely, but repeated attempts have very scattered results (not reliable) 176Hunachew B
  177. 177. 4. Valid and reliable. The research methods hit the heart of the research aim, and repeated attempts all hit in the heart (similar results) 177Hunachew B
  178. 178. Sampling What is sampling? • Sampling is the process involving the selection of a finite number of elements from a given population of interest, for purposes of inquiry.of inquiry. 178Hunachew B
  179. 179. What is a sample? • A sample is a representative part of a population.population. • A decision is often made, therefore, to study only a small fraction of the population, or a “sample” of it, from which conclusions can be“sample” of it, from which conclusions can be drawn about the whole population. 179Hunachew B
  180. 180. What are the characteristics a sample should possess? • A sample should possess all the characteristics of the population from whichcharacteristics of the population from which it is drawn, if possible, so that is fully representative of the population. • The method of sample selection usually• The method of sample selection usually determines its representative nature. 180Hunachew B
  181. 181. • Several reasons make sampling more useful than complete enumeration.than complete enumeration. • These include considerations regarding: –Time –Costs and available resources, and – Practicability.– Practicability. 181Hunachew B
  182. 182. Sampling methods a) Non-probability sampling methods 1. Convenience sampling: is a method in which for convenience sake the study units that happen to be available at the time of data collection are selected.data collection are selected. Hunachew B 182
  183. 183. Sampling methods 2. Quota sampling: is a method that insures that a certain number of sample units from differentcertain number of sample units from different categories with specific characteristics appear in the sample so that all these characteristics are represented. In this method the investigator interviews as manyIn this method the investigator interviews as many people in each category of study unit as he can find until he has filled his quota. Hunachew B 183
  184. 184. Sampling methods 3. Purposeful sampling strategies for qualitative studies: • Qualitative research methods are typically used when focusing on a limited number of informants, whom we select strategically so that their in-depth information will give optimal insight into an issue about which little is known.about which little is known. • The above sampling methods do not claim to be representative of the entire population. Hunachew B 184
  185. 185. Sampling methods Random sampling strategies to collect quantitative data: • If the aim of a study is to measure variables distributed in a population (e.g., diseases) or to test hypotheses about which factors are contributing significantly to a certain problem, we have to be sure that we can generalise thewe have to be sure that we can generalise the findings obtained from a sample to the total study population. Hunachew B 185
  186. 186. Sampling methods • Then, purposeful sampling methods are inadequate, and probability or random sampling methods have to be used. Hunachew B 186
  187. 187. Sampling methods b) Probability sampling methods: • They involve random selection procedures to• They involve random selection procedures to ensure that each unit of the sample is chosen on the basis of chance. • All units of the study population should have an equal or at least a known chance of being includedequal or at least a known chance of being included in the sample. Hunachew B 187
  188. 188. Sampling methods 1. Simple Random Sampling (SRS):This is the most basic scheme of random sampling. • To select a simple random sample you need to: – Make a numbered list of all the units in the population from which you want to draw a sample. – Each unit on the list should be numbered in sequence from 1 to N (Where N is the Size of the population).from 1 to N (Where N is the Size of the population). – Decide on the size of the sample – Select the required number of sampling units, using a “lottery” method or a table of random numbers. Hunachew B 188
  189. 189. Sampling methods 2. Systematic Sampling: • Individuals are chosen at regular intervals (for• Individuals are chosen at regular intervals (for example, every 5th, 10th, etc.) from the sampling frame. • Ideally we randomly select a number to tell us where to start selecting individuals from the list.where to start selecting individuals from the list. • For example, a systematic sample is to be selected from 1000 students of a school. The sample size is decided to be 100. Hunachew B 189
  190. 190. Sampling methods • The sampling fraction is: 100/1000 = 1/10. • The number of the first student to be included in the• The number of the first student to be included in the sample is chosen randomly by picking one out of the first ten pieces of paper, numbered 1 to 10. • If number 5 is picked, every tenth student will be included in the sample, starting with student number 5, until 100 students are selected.5, until 100 students are selected. • Students with the following numbers will be included in the sample: 5,15, 25, 35,45, . . . , 985, 995. Hunachew B 190
  191. 191. Sampling methods 3. Stratified sampling • If it is important that the sample includesIf it is important that the sample includes representative groups of study units with specific characteristics – for example, residents from urban and rural areas, then the sampling frame must be divided into groups, or strata, according to these characteristics. • Random or systematic samples of a predetermined• Random or systematic samples of a predetermined size will then have to be obtained from each group (stratum). Hunachew B 191
  192. 192. Sampling methods 4. Cluster sampling: • When a list of groupings of study units is available• When a list of groupings of study units is available (e.g. villages, etc.) or can be easily compiled, a number of these groupings can be randomly selected. • The selection of groups of study units (clusters) instead of the selection of study units individually isinstead of the selection of study units individually is called cluster sampling. • Clusters are often geographic units (e.g. districts, villages) or organizational units (e.g. clinics). Hunachew B 192
  193. 193. Sampling methods 5. Multi-Stage Sampling: • This method is appropriate when the population is• This method is appropriate when the population is large and widely scattered. • The number of stages of sampling is the number of times a sampling procedure is carried out. • The primary sampling unit is the sampling unit (or unit of selection in the sampling procedure) in theunit of selection in the sampling procedure) in the first sampling stage; Hunachew B 193
  194. 194. Sampling methods • The secondary sampling unit is the sampling unit in the second sampling stage, etc. • e.g. After selection of a sample of clusters (e.g. household), further sampling of individuals may be carried out within each household selected. • This constitutes two stage sampling, with the PSU being households and the SSU being individuals.being households and the SSU being individuals. Hunachew B 194
  195. 195. • The nature of your research study will determine which type of sampling you should use. – Large-scale descriptive studies almost always use– Large-scale descriptive studies almost always use probability-sampling techniques. – Intervention studies sometimes use probability sampling but also frequently use non-probability sampling. – Qualitative studies almost always use non-– Qualitative studies almost always use non- probability samples. 195Hunachew B
  196. 196. Sample Size Determination • Many handbooks contain formulae for estimating sample size because the size ofestimating sample size because the size of the sample is one of the most important determinates of the accuracy of survey estimates. 196Hunachew B
  197. 197. Basic questions that should be asked when choosing a sample. 1. How large a sample can you collect? – The best advice that can usually be given to a new– The best advice that can usually be given to a new researcher is that as large a sample as possible should be used. – The larger the sample the smaller the chance that the sample will be markedly different from the population it should represent (Minimize sampling error).error). 2. What level of budget do you have for the study? – The safest procedure is to select as large as your fund can support, within reason. 197Hunachew B
  198. 198. Basic questions… 3. What is the prevalence of the condition you are studying?studying? • If you are studying a condition that appears quite often in a population, you can take a smaller sample than if the condition is quite rare. 4. What staff are available to gather the sample?4. What staff are available to gather the sample? • Limited human resources may be a constraint on sample size. 198Hunachew B
  199. 199. Basic questions… 5. How much time do you have for the research? • You can only study a limited number of people in a• You can only study a limited number of people in a certain time. 6. Into how many cells or categories are you going to divide your data for analytical purposes? • The more categories planned for analysis, the larger the sample must be.sample must be. 7. What is the general rule concerning minimum sample size? 199Hunachew B
  200. 200. Sample size… • It is generally recommended that a sample size• It is generally recommended that a sample size of at least 10, or preferably 20 to 30, be selected for each sub-part of data or cell of the design that will be analyzed. • A smaller sample can be used if the population• A smaller sample can be used if the population is relatively homogenous 200Hunachew B
  201. 201. Notice • Finalized version of your research topic • Group members• Group members • send it to me at: hunachew@gmail.com • +251911833015 Hunachew B 201
  202. 202. Definitions • Target population (reference population): Is that population about which an investigator wishes to draw a conclusion. • Study population (population sampled): Population from which the sample actually was drawn and about which a conclusion can be made. • For Practical reasons the study population is often more limited than the target population.more limited than the target population. • In some instances, the target population and the population sampled are identical. Hunachew B. 202
  203. 203. • Sampling unit: The unit of selection in the sampling process. • For example, in a sample of districts, the sampling unit is a district; in a sample of persons, a person,unit is a district; in a sample of persons, a person, etc. • Study unit: The unit on which the observations will be collected. For example, persons in a study of disease prevalence, or households, in a study of family size.family size. • N.B. The sampling unit is not necessarily the same as the study unit. Hunachew B. 203
  204. 204. • Sample design: The scheme for selecting the sampling units from the study population. • Sampling frame: The list of units from which the sample is to be selected.sample is to be selected. • The existence of an adequate and up-to-date sampling frame often defines the study population. Hunachew B. 204
  205. 205. In order to calculate the required sample size, the following facts need to be known: a) The reasonable estimate of the key proportion toa) The reasonable estimate of the key proportion to be studied. If you cannot guess the proportion, take it as 50%. b) The degree of accuracy required. - the allowed deviation from the true proportion in- the allowed deviation from the true proportion in the population as a whole. • It can be within 1% or 5%, etc. Hunachew B. 205
  206. 206. c) The confidence level required, usually specified as 95%. d) The size of the population that the sample is to represent.represent. e) The difference between the two sub-groups and the value of the likelihood or the power that helps in finding a statistically significant difference. Hunachew B. 206
  207. 207. Estimating a proportion • Estimate how big the proportion might be (P) • Choose the margin of error you will allow in the• Choose the margin of error you will allow in the estimate of the proportion (say ± w) • Choose the level of confidence that the proportion in the whole population is indeed between (p-w) and (p+w).and (p+w). • We can never be 100% sure. • Do you want to be 95% sure? Hunachew B. 207
  208. 208. The minimum sample size required, for a very large population (N>10,000) is: Sample Size to Estimate a Single Population Proportion The minimum sample size required, for a population (N<10,000) is: Hunachew B. 208
  209. 209. • Example 1 (Prevalence of diarrhoea) a) p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95% C.I.)C.I.) • Thus, the study should include at least 822• Thus, the study should include at least 822 subjects. Hunachew B. 209
  210. 210. • Example 1 (Prevalence of diarrhoea) a) p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95% C.I.)C.I.) • Thus, the study should include at least 822• Thus, the study should include at least 822 subjects. Hunachew B 210
  211. 211. b. If the above sample is to be taken from a relatively small population (say N = 3000), the required minimum sample will be obtained from the aboveminimum sample will be obtained from the above estimate by making some adjustment. 821.25 / (1+ (821.25/3000)) = 644.7 ≈ 645 subjects Hunachew B 211
  212. 212. • Example 2 • A hospital administrator wishes to know what proportion of discharged patients are unhappy with the care received during hospitalization. If 95%the care received during hospitalization. If 95% Confidence interval is desired to estimate the proportion within 5%, how large a sample should be drawn? n = Z2 p(1-p)/w2 =(1.96)2(.5×.5)/(.05)2 =384.2 ≈ 385 patientspatients • N.B. If you don’t have any information about P, take it as 50% and get the maximum value of PQ which is 1/4 (i.e., 25%). Hunachew B 212
  213. 213. Plan for data collection • A plan for data collection should be developed so that:developed so that: – you will have a clear overview of what tasks have to be carried out, who should perform them, and the duration of these tasks; Hunachew B. 213
  214. 214. – you can organise both human and material resources for data collection in the most efficient way; and. – you can minimise errors and delays which may result from lack of planning (for example, the population not being available or data forms being misplaced). Hunachew B. 214
  215. 215. • It is likely that while developing a plan for data collection you will identify problems (such as limited manpower), which will require modification of the proposal.of the proposal. • Such modifications might include adjustment of the sample size or extension of the period for data collection. Hunachew B. 215
  216. 216. • Stages in the Data Collection Process • Three main stages can be distinguished: • Stage 1: Permission to proceed• Stage 1: Permission to proceed • Stage 2: Data collection • Stage 3: Data handling Hunachew B. 216
  217. 217. Data collection… • Ideally, a pretest of the data collection and data analysis procedures should be made.data analysis procedures should be made. • The advantages of a pretest:- • we can draft the work plan and budget based on realistic estimates, • revise the data collection tools before we• revise the data collection tools before we submit the proposal for approval. 217Hunachew B
  218. 218. Points to consider while organizing the data collection team: • Selection of the candidates • Salary and fringe benefits to be given to the staff (team• Salary and fringe benefits to be given to the staff (team members) • Training • Planning from the beginning, for possible dropouts • Additional training sessions for new members to fill for dropouts,dropouts, • What will happen to members hired, at the end of their work with the project? (Training or certification for future jobs, location of future employment possibilities) 218Hunachew B
  219. 219. Issues to consider concerning logistics support and arrangements during data collection: • Mode of transport needed to go to the field Mode of transport needed when working in the• Mode of transport needed when working in the field, repairs • Number of days in the field • Number of days of holiday (personal, weekly and national) during data collection • Food and lodging for data collection team • Meeting place for the team • Recreational facilities (if needed) 219Hunachew B
  220. 220. Planning for Data analysis • We need to prepare a plan for analysis of data and interpretation of the results because itand interpretation of the results because it helps the researcher avoid becoming aware at the end of the study, that: – Needed information has not been collected – Certain information collected has not been analyzedanalyzed – Certain information collected has not been gathered in a form appropriate for statistical analysis 220Hunachew B
  221. 221. • Methods of data collection • The most commonly used methods of collecting information (quantitative data) are the use of – documentary sources, – interviews and – self-administered questionnaires. Hunachew B. 221
  222. 222. 1. The use of documentary sources: Clinical records and other personal records, death certificates, published mortality statistics, census publications, etc.census publications, etc. 2. Interviews and self-administered questionnaires Hunachew B. 222
  223. 223. Questionnaire Design • Questions may take two general forms: • they may be “Open ended” questions, which the subject answers in his own words, orsubject answers in his own words, or • “closed” questions, which are answered by choosing from a number of fixed alternative responses. Hunachew B. 223
  224. 224. In questionnaire design remember to: a) Use familiar and appropriate language b) Avoid abbreviations, double negatives, etc. c) Avoid two elements to be collected through one questionc) Avoid two elements to be collected through one question d) Pre-code the responses to facilitate data processing e) Avoid embarrassing and painful questions f) Watch out for ambiguous wording g) Avoid language that suggests a responseg) Avoid language that suggests a response h) Start with simpler questions i) Ask the same question to all respondents Hunachew B. 224
  225. 225. • Methods of collecting qualitative data – Focus group discussion – Observation Hunachew B. 225
  226. 226. Plan for data processing and analysis • Data processing and analysis should start in the field, with checking for completeness of the datafield, with checking for completeness of the data and performing quality control checks, while sorting the data by instrument used and by group of informants. • Data of small samples may even be processed and• Data of small samples may even be processed and analyzed as soon as it is collected. Hunachew B. 226
  227. 227. Plan for data processing and analysis • When making a plan for data processing and analysis the following issues should be considered:analysis the following issues should be considered: – Sorting data, – Performing quality-control checks, – Data processing, and – Data analysis. Hunachew B. 227
  228. 228. Plan for data processing and analysis • Data processing in both cases involves: – categorising the data,– categorising the data, – coding, and – summarising the data in data master sheets, manual compilation without master sheets, or data entry and verification by computer. Hunachew B. 228
  229. 229. • Data analysis – quantitative data – 1. Frequency counts – 2. Cross-tabulations– 2. Cross-tabulations • Processing and analysis of qualitative data Hunachew B. 229
  230. 230. Ethical considerations • Ethical principles  Autonomy- we ought to respect the right to self- determination. In research autonomy is protected bydetermination. In research autonomy is protected by ensuring that any consent to participate in the study is informed or real.  Non-Maleficence- we ought not to inflict evil or harm.  Beneficence – we ought to further others’ legitimate Beneficence – we ought to further others’ legitimate interests.  Justice-we ought to ensure fair entitlement to resources. Hunachew B. 230
  231. 231. Work plan • A work plan is a schedule, chart, or a graph that summarizes, in a clear fashion, variousthat summarizes, in a clear fashion, various components of the research project and how they fit together. A work plan may include: – The tasks to be performed (activity) – When the tasks will be performed (time)– When the tasks will be performed (time) – Who will perform the tasks and the time each person will spend on them (person) – The relationship of the tasks to each other. 231Hunachew B
  232. 232. Ways of presenting a work plan A work plan could be presented in the form of: a work schedule and GANNT charta work schedule and GANNT chart The Work Schedule • A work schedule is a table that summarizes the tasks/activities to be performed in the research project, the duration of eachresearch project, the duration of each activity, and the staff responsible. 232Hunachew B
  233. 233. Work plan… The work schedule includes: – the tasks to be performed;– the tasks to be performed; – the dates each task should begin and end – research team, research assistants, and support staff (drivers and typists) assigned to the tasks; and – person-days required by the research team members, research assistants, and support staff (the number of person-days equals the number of working days perperson-days equals the number of working days per person). – The work schedule shows the tasks to be completed, how long they take, and who is to be assigned to each one. 233Hunachew B
  234. 234. 234Hunachew B
  235. 235. The GANTT Chart • The Gantt chart is a planning tool which depicts graphically the order in which various tasks must be completed and their duration of activity.completed and their duration of activity. • A typical Gantt chart includes the following information: – The tasks to be performed – Who is responsible for each task; and – The time each task is expected to take. 235Hunachew B
  236. 236. The GANTT Chart • The length of each task is shown by a bar that extends over the number of days, weeks or months the task is expected to take.expected to take. • The Gantt chart shows the tasks to be completed and illustrates visually how long they will take. 236Hunachew B
  237. 237. GANNTs Chart Activities Time in months January February March April May June Proposal development (PI) XXXXXX Ethical clearance XXXXX Field work XXXXXField work XXXXX Data entry XXXXX Data analysis XXXXX XXXXX 237Hunachew B
  238. 238. Preparation of a budget There are several reasons why we need a budget: • A detailed budget will help you to identify which resources are already locally available and which additional resources may be required. • The process of budget preparation will encourage you to consider aspects of the work plan you haveyou to consider aspects of the work plan you have not thought about before and will serve as a useful reminder of activities planned, as your research gets underway 238Hunachew B
  239. 239. How should a budget be prepared? • It is necessary to use the work plan as a starting point. Specify, for each activity in thestarting point. Specify, for each activity in the work plan, what resources are required. • Determine for each resource needed the unit cost and the total cost.cost and the total cost. 239Hunachew B
  240. 240. Budget justification • Make sure you give clear explanations concerning why items that may seem questionable or that areitems that may seem questionable or that are particularly costly are needed and discuss how complicated expenses have been calculated. • If a strong budget justification has been prepared, it is less likely that essential items will be cut during proposal review.proposal review. 240Hunachew B
  241. 241. 241Hunachew B
  242. 242. Appendices • Include in the appendices of your proposal any additional information you think mightany additional information you think might be helpful to a proposal reviewer. For example, include: – Biographical data of the principal investigator – The study questionnaire if you have it. – The consent form. 242Hunachew B
  243. 243. Appendices – A copy of the approval from the Institutional Review Board.Review Board. – Any explanatory material (such as annual report) about your institution or the origination under whose name the study will be conducted. – A list of references if you have cited literature in the proposal. 243Hunachew B
  244. 244. Title page and abstract • Although the title page and abstract appear as the first section of a research proposal, they are the last to be written.written. • The title page gives the essential information about the proposal. Immediately following the title page you should include an abstract. • The abstract is a summary of the basic information contained in all the other sections of your proposal.contained in all the other sections of your proposal. • Do not overload an abstract with unnecessary information. Keep it short (no longer than one or two pages), precise, and to the point. 244Hunachew B
  245. 245. The abstract should tell the reader: 1. The problem to be studied. 2. The main objective of the study.2. The main objective of the study. 3. The major expected implications of the study. 4. Who will conduct the study 5. When the study will be conducted. 6. Where the study will be conducted.6. Where the study will be conducted. 7. What methods will be used to conduct the study. 8. What resources are required for the study. 245Hunachew B
  246. 246. 246Hunachew B
  247. 247. assessment of the prevalence of diarrheal disease in addis ababa By Group members:By Group members: A resarh proposal submited for partial fulfilment of the degree of medicine, addis ababa universityuniversity June 2012 Hunachew B 247
  248. 248. • Summary of the major components of a research proposal – Title and cover page – Abstract– Abstract – Table of contents – I) Introduction – Statement of the research problem – State of knowledge: knowledge pertinent to subject under studysubject under study – Significance of the proposed work – II) Objective of the study Hunachew B. 248
  249. 249. III) Materials and methods • Type of study (study design) • Study population• Study population – Describe the study areas and populations – Mapping and numbering of the study area – Appropriateness of the study – Accessibility (provide background information,– Accessibility (provide background information, travel, time, etc...) – Cooperation and stability of the population Hunachew B. 249
  250. 250. • Type of data (defining each variable to be collected and methods for collecting them – Operational definitions – Some elements of the variables to be studied: Hunachew B. 250
  251. 251. • What characteristics will be measured? How will the variables be defined? What scales of measurement will be used etc. – Inclusion/ exclusion criteria– Inclusion/ exclusion criteria – Sampling procedure to be used and sample size and power calculation. – Data collection and management • Data collection and coding forms should be• Data collection and coding forms should be appended to protocol • Data analysis Hunachew B. 251
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