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Health research methodology

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  • 1. Dr Rajeev Kashyap B.Sc, B.D.S.,M.Sc Dental Public Health
  • 2.  Research can be defined as the systematic collection, description, analysis and interpretation of data to answer a certain question or solve a problem.  Health research can also be defined as the process for systematic collection, description, analysis and interpretation of data that can be used to improve the health of individuals or groups. Dr Rajeev Kashyap
  • 3.  Health research has been broadly defined as the generation of new knowledge using the scientific method to identify and deal with health problems. (Commission on Health Research for Development, 1991)  Health research is thus not limited to the biomedical field. Other fields of science can contribute much to the improvement of our understanding about health issues. Dr Rajeev Kashyap
  • 4. Key attributes of good research are  Planning,  accuracy in data collection and  ProPer unbiased interPretation. Policy-makers and funders of research, on the other hand, would like to see research targeted to respond to priority health needs. Dr Rajeev Kashyap
  • 5.  Concerns about ethics in health research, general ethical principles.  Responsibility for maintaining ethical standards. And  The duties of ethics committees which review and approve research. Dr Rajeev Kashyap
  • 6.  Beneficence  Non-maleficence  Respect and justice Ethics are principles of right conduct. since they represent basic human values. There can , however, be differences on how they are interpreted and implemented in specific cases. Dr Rajeev Kashyap
  • 7. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation International Covenant on Civil and Political Rights, Article 7, 1966 Dr Rajeev Kashyap
  • 8. • Biomedical sciences: These include all biological, medical and clinical research, and biomedical product development and evaluation. • Population sciences: These include epidemiology, demography and the sociobehavioural sciences. • Health policy sciences: These include health policy research, health systems research and health services research. Economic analysis studies are now an important subcategory of health policy research. Under each category, there are a growing number of specialties and sub-specialties. Dr Rajeev Kashyap
  • 9. Dr Rajeev Kashyap
  • 10.  In many types of biomedical research, discovery is the prize in the research game. But hunting for discovery is not a straightforward undertaking.  Many of the drugs we use today have been discovered in research programmes designed for other purposes. Minoxidil (the drug for male baldness) was originally developed and tested for the treatment of hypertension. Sildenafil (Viagra), used for the treatment of erectile dysfunction, was discovered in a cardiovascular research programme. Dr Rajeev Kashyap
  • 11. In 1889 in Strasbourg, while studying the function of the pancreas in digestion, Joseph von Mering and Oscar Minkowski removed the pancreas from a dog. One day later, a laboratory assistant called their attention to a swarm of flies around the urine from this dog. Curious about why the flies were attracted to the urine, they analysed it and found it was loaded with sugar, a common sign of diabetes. But it was only in 1921 that Canadian researchers Fredrick Banting (a young medical doctor), Charles Best (a medical student), and John Macleod (a professor) could extract the secretion from the pancreas of dogs, inject it into dogs rendered diabetic, and prove its effectiveness (Roberts, 1989). Dr Rajeev Kashyap
  • 12.  Health policy-makers at the national and international level would like to see research driven by the health needs, with a return on the investment that can decrease the disease burden on their people.  The relative magnitude of a health problem is determined by its prevalence and its seriousness. A health problem may be prevalent but not serious, and may be serious but not widely prevalent. The tradition in the past has been to consider mortality as the measure for the seriousness of a health problem. Dr Rajeev Kashyap
  • 13.  Mortality does not always go with morbidity. Some disease conditions leave the patient seriously morbid but do not kill. Conversely, some diseases either kill or leave no long-term impairment in health.  The burden of disease as a result of any health problem is commonly expressed as the disability- adjusted life years (DALYs) lost. This measure expresses both time lost through premature death and time lived with a disability. Dr Rajeev Kashyap
  • 14.  A health problem is of high magnitude does not necessarily mean that it should be a priority for research. The know-how to deal with the problem may be already available, but it is not applied and made available. The need may be for action and not for research.  Research should not be an excuse for delaying action. Dr Rajeev Kashyap
  • 15.  Industry has become a major actor in health research. The research and development share of sales revenues varies among pharmaceutical companies, but is estimated on average to be 13%. In the 1990s, seven countries—United States of America, Japan,United Kingdom, Germany, Switzerland, France and Italy (in decreasing order)—conducted 97% of all worldwide pharmaceutical research and development (Murray et,al. 1994).  Pharmaceutical industry investments in research and development surpassed public investments in four of the countries (France, Japan, Switzerland and United Kingdom). Dr Rajeev Kashyap
  • 16.  The direction for research and development in industry is pushed by the new developments in technology, which provide new leads for developing new drugs. The market pull impacts, however, on the technology push, and thus on the opportunities for research. For example, in the industrialized countries people over 65 years old spend the most on drugs. This aging population is driving new and expanding markets. New drugs are targeting age-related disorders and enhancing quality of life for the elderly (Burrill,1998).  The recent top-selling drugs were mostly in this category, for example Eli Lilly’s Evista for osteoporosis, Merck’s Propecia for male pattern baldness, Pfizer’s erectile dysfunction pill Viagra (with estimated sales of US$ 2 billion by 2000), and Monasto’s Celebra for arthritic pain. Dr Rajeev Kashyap
  • 17.  Selection of a topic for research may be driven by opportunity. The opportunity comes with the availability of funding, the chance to participate in collaborative international research, and working with the pharmaceutical industry.  Availability of funding :Funding for health research basically comes from either public sources, including governments and intergovernmental organizations, or private sources including for- profit pharmaceutical industry and not-for-profit agencies, Dr Rajeev Kashyap
  • 18. • Role of health research in improving health and stimulating national economic growth is now well established. • Health research supports health systems in the delivery of better, fairer and more equitable health care to people. • It does so by identifying challenges and providing best solutions, monitoring how health systems perform and producing new knowledge for better technologies and improved approaches to public health.  Basic research provides the pool of knowledge from which leads for applied research Dr Rajeev Kashyap
  • 19. All nAtionAl And provinciAl heAlth policies should be bAsed on vAlid scientific evidence.such evidence requires reseArch; And the ApplicAtion of the knowledge, informAtion And technology Dr Rajeev Kashyap
  • 20. good reseArch ideAs come from the knowledge, work And Attitudes of reseArchers. Dr Rajeev Kashyap
  • 21. Dr Rajeev Kashyap
  • 22. • Health research must serve as a driver for health policy and practice • The literature on research methodologies is vast. Researchers and scientists worldwide nowadays have access to enormous, and growing, information resources which provide in-depth knowledge, training and education to enhance and improve research. • Inadequacy in capacities for research and development remains a major impediment for the developing world Dr Rajeev Kashyap
  • 23. It does so by  Identifying challenges and providing best solutions,  Monitoring how health systems perform and producing new knowledge for better technologies and improved approaches to public health,  Health research supports health systems in the delivery of better, fairer and more equitable health care to people. Dr Rajeev Kashyap
  • 24.  However, in the field of health research, and science in general, the “pure” (basic) versus “applied” debate has raged for decades and shows no signs of abating.  There has been a move to emphasize and promote research that has the potential to improve health or quality of life, i.e. applied research. Dr Rajeev Kashyap
  • 25.  Clinicians are trained to think mechanistically, and clinicians are therefore most familiar with quantitative research.  However, medicine is not only a mechanistic and quantitative science.  Patients are not broken down machines or malfunctioning biological systems. Doctors do not treat diseases; doctors treat patients Dr Rajeev Kashyap
  • 26. Health is more in the hands of people than in the hands of health professionals.  Qualitative research is needed to provide insights into people’s lifestyle behaviour, their knowledge, their feelings and attitudes, their opinions and values and their experience. Having a good health system structure in place is not enough to ensure good quality health care. Dr Rajeev Kashyap
  • 27. How the system functions and the attitudes of health care providers can make all the difference.  Quantitative research gives adequate results about the anatomy of the system.  A quantitative study may be complemented with a qualitative study to provide further insights into the findings Dr Rajeev Kashyap
  • 28.  Qualitative research can help in closing the gap between the science of discovery and the implementation of results.  Qualitative research is often needed to find out why research results are often not translated into practice.  Incorporating qualitative research methodologies into research thinking ensures that the right methodology is brought to bear on the right question. Dr Rajeev Kashyap
  • 29.  Action research is a style of research, rather than a specific methodology. In action research, the researchers work with the people and for the people, rather than undertake research on them.  The focus of action research is on generating solutions to problems identified by the people who are going to use the results of research.  Action research is not synonymous with qualitative research. But it typically draws on qualitative methods such as interviews and observations. Dr Rajeev Kashyap
  • 30. A common misconception is that health economics is about cutting costs. In economic evaluation, costs are regarded as opportunity costs.  Health economics is a logic framework which allows us to reach conclusions about the best way that resources can be allocated.  As resources are scarce, each decision to use resources in one way implies a sacrifice of another opportunity to use the resources in an alternative way Dr Rajeev Kashyap
  • 31.  A scientific approach is essential for health professionals. As the practice of medicine is advancing rapidly, the need for critical evaluation of new developments becomes more urgent.  Research helps to develop a scientific critical attitude. A clinician will find that the faculties developed by doing research are those most needed in clinical diagnosis.  Health policy-makers, particularly in developing countries, may not appreciate the contribution which research can make. There is still a divide between the universe of research and the universe of policy-making. Dr Rajeev Kashyap
  • 32.  Pharmaceutical companies in the past to do most of their research and development in- house. Nowadays, a growing number of pharmaceutical companies commission their research to reputable centres in universities. Many companies today outsource more than 30% of their research and development budget and all or part of their clinical research and development (Burrill, 1998). Dr Rajeev Kashyap
  • 33. A Practical Guide for Health Researchers Mahmoud F. Fathalla Dr Rajeev Kashyap