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Oral Health Research (lecture 2)


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Lecture 2 - for dentistry undergrads years 1/2

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Oral Health Research (lecture 2)

  1. 1. ORAL HEALTH RESEARCH DENT-125/225 – part 2 Martin Morris |
  2. 2. Objectives By the end of this session you will have a better understanding of: • the detailed differences between qualitative and quantitative research; • how these can be combined in Mixed Methods Research; • the connection between patient-centred care and oral health research; • tools to help you decide what to research; 2
  3. 3. Firstly, a reassurance… Remember Hippocrates, Galen, Avicenna, Vesalius etc from the previous time we met? Good! Now feel free to forget them (unless you’re interested in medical history!). 3
  4. 4. The Scientific Method 4 Question Lit Search Hypothesis Method Data Collection Observations Conclusion What do we want to learn more about? Gathering of information A suggested explanation based on limited evidence A carefully planned and followed experiment to test the hypothesis Information collected during the experiment A record of what was noticed during the experiment Does the hypothesis still hold, or not? Possible new question?
  5. 5. Quantitative vs Qualitative: A brief refresher
  6. 6. Inductive, deductive research 7 Theory Test, experiment, intervention Results, outcomes Observations Context Hypothetico-deductive Inductive From: Allen, A.K., (2012) Research Skills for Medical Students, London: Learning Matters, SAGE. p.10
  7. 7. Inductive, deductive research • Deductive approaches aim to test existing hypotheses/theories • Inductive approaches aim to create new theory from existing data 8
  8. 8. Hypothetico-deductive model Checking whether or not a hypothesis is compatible with experimental data, in order to potentially disprove it. Hypotheses cannot be proven, only disproven. Why? 9
  9. 9. Quantitative is all about the numbers
  10. 10. No amount of experimentation can ever prove me right; a single experiment can prove me wrong. Albert EINSTEIN “ ”
  11. 11. Inductive Model Attempts draw conclusions/induce a hypothesis from observations. Generates new theory/hypotheses. Example 100% of biological life forms that we know of depend on liquid water to exist. Therefore, if we discover a new biological life form it will probably depend on liquid water to exist. 12
  12. 12. Qualitative Methodologies Some terms to look out for: Ethnography Phenomenology Narrative Research Case Studies Grounded Theory Culture of groups Individuals Processes, activities 13
  13. 13. Qual/Quan: Why? Quantitative Qualitative • Tests hypothesis through observations • Focussed on cause and effect • Quantifies data • Generates theory through observations • Oriented to exploration and discovery • Aims to discover/better understand reasons and motivations 14
  14. 14. Qual/Quan: How? Quantitative Qualitative • Predetermined • First collect/code data, then analyse • Sample: usually large, aims to represent wider population • Data: Structured techniques (e.g. RCT’s, questionnaires) • Statistical analysis • Outcome: to provide convincing evidence for e.g. a course of action • Emergent design • Merges data collection with ongoing analysis • Sample: Usually a small number, non-representative • Data: in-depth, semi-structured interviews common • Constant comparison/thematic analysis • Outcome: to develop understanding 15
  15. 15. Qual/Quan: Objectivity Quantitative Qualitative • Results do not depend on researcher’s beliefs • Measurement is stressed • Researcher is detached and distanced from data • Standardised protocols are used • Seeks to understand other’s motivations and perceptions • Emphasises meaning and interpretation • Researcher is the research instrument • Importance of immersion in the data 16
  16. 16. A final comparison 17 Quantitative: universality/generalizabilit y • Emphasises generalisation and replication • Analyses variables • Experimental and statistical controls • Uses large number of cases Qualitative: importance of context • Emphasises depth and detail • Analyses holistic systems • Naturalistic approach • Relies on a few carefully chosen cases
  17. 17. A final comparison QUALITATIVE Descriptive Interpretative Oriented towards reasons, emotions Numbers not the primary focus QUANTITATIVE About numbers Statistical Oriented towards cause and effect Quantifies data, attempts to generalise it 18
  18. 18. …but what about this? 19 Kate wants to learn more about what stresses dental students. So she designs a study to look at this. Sources of Data 1. She asks students to grade (1-5) different sources of stress twice in the year in a questionnaire, and to give more information if they wish. 2. She then picks students where she needs more information, and interviews them.
  19. 19. …but what about this? What kind of study is this? It uses both quantitative and qualitative methods within the study design. It is therefore mixed methods research. 20
  20. 20. Mixed Methods Research • Allows us to tackle a research question from any given angle • Gives us the best of both worlds: – In-depth insights of qualitative work – Predictive power of quantitative work • Various strategies exist to blend the data in these studies 21
  21. 21. Combining QN and QL QUAN QUAL QUAL QUAN Sequential Explanatory Uses qualitative data to help explain the results of a quantitative study. Sequential Exploratory To explore a phenomenon. Useful when e.g. developing a new instrument. 22
  22. 22. Combining QN and QL Concurrent Triangulation Use of both methods at same time, one method overcoming weaknesses in the other. QUAN QUAL Quan Data Analysis Qual Data Analysis Comparison of results 23
  23. 23. Mixed Methods Research BUT: downsides to consider • Can be hard to combine the data from the QN and QL sides • Time required • You may get unequal evidence from the two sides of the study 24
  24. 24. Patient-centred care and research
  25. 25. Evidence-Based Dentistry 26 American Dental Association: “…an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences American Dental Association (2008). ADA Policy on Evidence Based Dentistry. Viewed: Oct. 1, 2012 Clinical Expertise Patient‘s Preference Research Evidence (including Resources) EB D
  26. 26. What is Patient-centred care? According to the American Dental Association, it is: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”
  27. 27. EBD + Patient-centred care Patient Preferences = PATIENT-CENTRED CARE 28 The practice of EBD, and the practice of Patient-Centred Care, both require an understanding of patient preferences.
  28. 28. ‘SHAPERS’ • Cultural norms and societal expectations • Socioeconomic background • Formal and informal learning (e.g. media) • Personal experience • Medical training and clinical experience (dentist) PATIENT FACTORS • Attitudes and Expectations • Knowledge • Personality • Gender • Age • Ethnicity • Nature of problem • Knowledge of dentist CONSULTATION-LEVEL INFLUENCES • Communication barriers • Physical barriers • Interruptions • Presence of third parties • Time limitations • Workload pressures DENTIST FACTORS • Attitudes • Values • Knowledge • Personality • Gender • Age • Ethnicity • Knowledge of patient PROFESSIONAL CONTEXT INFLUENCES • Professional norms • Performance incentives and targets • Accreditation • Government policy initiatives FIVE DIMENSIONS OF PATIENT-CENTREDNESS Dentist behaviour Patient behaviour 29 Time
  29. 29. ACTIVITY Looking at the Patient-Centred Care chart, consider a possible: • Quantitative; • Qualitative; or • Mixed Methods research question. …and maybe share it (if that’s OK). 30
  30. 30. My example If a dentist learns basic ASL/LSQ does this improve their ability to provide patient-centred care to their Deaf patients? CONSULTATION-LEVEL INFLUENCES • Communication barriers • Physical barriers • Interruptions • Presence of third parties • Time limitations • Workload pressures 31
  31. 31. PCC – Actual projects • Measuring patient-centredness: a comparison of three observation-based instruments • Correlation between a patient-centred outcome score and surgical skill in oral surgery • An Australian survey of audiologists' preferences for patient-centredness. 32
  32. 32. How do I decide what to research?
  33. 33. Sources of research ideas Lectures Research Ideas 34
  34. 34. Concept Mapping 35
  35. 35. caused by caused by solved by DENTAL CARIES Sugar Poor dental hygiene Flossing Mouthwashes Reduced sugar in diet Fluoridation solved by solved by 36 Toothbrushing Education
  36. 36. Conclusions • Qualitative and quantitative methodologies are both good approaches depending on your question • You may get a better answer by combining the two in a mixed-methods study • Patient-centred care can be complicated. Up-to-date research can inform our understanding of this area. • Remember the variety of information sources available to you, your colleagues, and the library, when seeking research ideas • Consider mind-mapping as a tool when thinking. 37
  37. 37. Any questions?
  38. 38. References • Cartoon (c) Sheldon Comics • Various icons from the Noun Project ( • Patient-centred care diagram from Mead N & Bower P, Patient-centredness: a conceptual framework and review of the empirical literature, Soc Sci Med, 2000: 51, pp 1087–110, Qualitative Methods in Dentistry – further reading: • Stewart K, Gill P, Chadwick B, Treasure E. Qualitative Research in Dentistry. British Dental Journal, 2008. 204: 235-9 39