The document discusses the challenges facing the field of Health Policy and Systems Research (HPSR), particularly the risk of "disciplinary capture" where a particular knowledge framework dominates. It argues this risk stems from clashes between positivist paradigms in clinical/biomedical research and relativist paradigms in social sciences. To develop HPSR, the field needs to recognize diverse disciplinary perspectives and engage across disciplines. Understanding health policies and systems demands multi- and inter-disciplinary inquiry.
Scientific Research And Ethics by Manu ShreshthaManu Shreshtha
This document presents an overview of ethics with respect to science and research. It begins with definitions of ethics and discusses ethical theories like deontology, teleology, and utilitarianism. It then examines important historical events that shaped modern research ethics like the Nazi medical experiments and the Nuremberg Code. The document outlines principles for ethical research like informed consent and protecting vulnerable subjects. It discusses ethical concerns in qualitative and quantitative research and emphasizes the importance of ethics in protecting participants and ensuring research is conducted safely and for the benefit of all.
1) The document discusses the appropriate uses of qualitative methods in health economics.
2) It outlines the constructivist philosophy often associated with qualitative research and contrasts this with the positivist approach commonly used in neoclassical economics.
3) The document examines the potential roles of qualitative methods in explanatory and normative research conducted by health economists working within different philosophical frameworks.
Invited presentation made at the 13th International Conference on Nanomedicine and Pharmaceutical Nanotechnology at Aurelio, Rome, Italy, during July 24-25, 2017.
This document proposes the Movement Continuum Theory as a broad theory of physical therapy to provide a theoretical framework for the profession. Currently, physical therapy only has narrow, middle-range theories focused on specific treatment approaches or body parts. The Movement Continuum Theory describes physical therapists' unique holistic approach to movement rehabilitation by incorporating knowledge of pathology with consideration of physical, social, and psychological influences on movement. It consists of eight principles of movement, three shared with other movement sciences and five specific to physical therapy. The theory aims to distinguish physical therapy from other fields and apply to education, research, and clinical practice.
The document summarizes The Belmont Report, which established ethical principles for protecting human subjects in research. It was created in 1979 by a commission in response to unethical human subject research studies. The Belmont Report outlines three basic ethical principles - respect for persons, beneficence, and justice. It also distinguishes between research and practice, and provides guidelines for informed consent, risk-benefit assessments, and subject selection to help apply these principles. While not formally adopted, The Belmont Report has become the primary framework for research ethics in the United States.
The document discusses the Brain Activity Map (BAM) and Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiatives which aim to achieve unprecedented knowledge of neural substrates through neuroscience techniques. It argues that such advances could profoundly impact many areas but also raises ethical concerns that must be addressed through neuroethics to help guide responsible research and oversight. Specifically, neuroethics should take a pragmatic approach to appraising both benefits and risks of specific neuroscience undertakings to help ensure their safe and responsible development and application.
Scientific Research And Ethics by Manu ShreshthaManu Shreshtha
This document presents an overview of ethics with respect to science and research. It begins with definitions of ethics and discusses ethical theories like deontology, teleology, and utilitarianism. It then examines important historical events that shaped modern research ethics like the Nazi medical experiments and the Nuremberg Code. The document outlines principles for ethical research like informed consent and protecting vulnerable subjects. It discusses ethical concerns in qualitative and quantitative research and emphasizes the importance of ethics in protecting participants and ensuring research is conducted safely and for the benefit of all.
1) The document discusses the appropriate uses of qualitative methods in health economics.
2) It outlines the constructivist philosophy often associated with qualitative research and contrasts this with the positivist approach commonly used in neoclassical economics.
3) The document examines the potential roles of qualitative methods in explanatory and normative research conducted by health economists working within different philosophical frameworks.
Invited presentation made at the 13th International Conference on Nanomedicine and Pharmaceutical Nanotechnology at Aurelio, Rome, Italy, during July 24-25, 2017.
This document proposes the Movement Continuum Theory as a broad theory of physical therapy to provide a theoretical framework for the profession. Currently, physical therapy only has narrow, middle-range theories focused on specific treatment approaches or body parts. The Movement Continuum Theory describes physical therapists' unique holistic approach to movement rehabilitation by incorporating knowledge of pathology with consideration of physical, social, and psychological influences on movement. It consists of eight principles of movement, three shared with other movement sciences and five specific to physical therapy. The theory aims to distinguish physical therapy from other fields and apply to education, research, and clinical practice.
The document summarizes The Belmont Report, which established ethical principles for protecting human subjects in research. It was created in 1979 by a commission in response to unethical human subject research studies. The Belmont Report outlines three basic ethical principles - respect for persons, beneficence, and justice. It also distinguishes between research and practice, and provides guidelines for informed consent, risk-benefit assessments, and subject selection to help apply these principles. While not formally adopted, The Belmont Report has become the primary framework for research ethics in the United States.
The document discusses the Brain Activity Map (BAM) and Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiatives which aim to achieve unprecedented knowledge of neural substrates through neuroscience techniques. It argues that such advances could profoundly impact many areas but also raises ethical concerns that must be addressed through neuroethics to help guide responsible research and oversight. Specifically, neuroethics should take a pragmatic approach to appraising both benefits and risks of specific neuroscience undertakings to help ensure their safe and responsible development and application.
Evolution of the biopsychosocial model: prospects and challenges for health p...ellen1066
The document discusses the evolution and current state of the biopsychosocial model in health psychology. It finds that while advances have been made in specifying connections between biological, psychological, and social processes, more can be done to understand and utilize linkages among these variables. Specifically, the biopsychosocial model has not been fully embraced by the medical establishment or implemented in all health psychology research. The document recommends initiatives to better facilitate a multisystem, multilevel approach as envisioned by the biopsychosocial perspective.
Here is a research tip We write the theory into a separate sectioSusanaFurman449
Here is a research tip: We write the theory into a separate section in a research proposal so that readers can clearly identify the theory from other components. Such a separate passage provides a complete explication of the theory section, its use, and how it relates to the study.
Writing a Quantitative Theoretical Perspective
Using these ideas, the following presents a model for writing a quantitative theoretical perspective section into a research plan. Assume that the task is to identify a theory that explains the relationship between independent and dependent variables.
Look in the discipline-based literature for a theory. If the unit of analysis for variables is an individual, look in the psychology literature; to study groups or organizations, look in the sociological literature. If the project examines individuals and groups, consider the social psychology literature. Of course, theories from other disciplines may be useful, too (e.g., to study an economic issue, the theory may be found in economics).
Examine also prior studies that address the topic or a closely related topic. What theories did the authors use? Limit the number of theories and try to identify one overarching theory that explains the central hypothesis or major research question.
As mentioned earlier, ask the rainbow question that bridges the independent and dependent variables: What explains why the independent variable(s) would influence the dependent variables?
Script out the theory section. Follow these lead sentences: “The theory that I will use is _____ (name the theory). It was developed by _____ (identify the origin, source, or developer of the theory), and it was used to study _____ (identify the topics where one finds the theory being applied). This theory indicates that _____ (identify the propositions or hypotheses in the theory). As applied to my study, this theory holds that I would expect my independent variable(s) _____ (state independent variables) to influence or explain the dependent variable(s) _____ (state dependent variables) because _____ (provide a rationale based on the logic of the theory).”
Thus, the topics to include in a quantitative theory discussion are the theory to be used, its central hypotheses or propositions, information about past use of the theory and its application, and statements that reflect how it relates to a proposed study. Example 3.1, which contains a passage by Crutchfield (1986) from her dissertation, illustrates the use of this model.
Theory
at a
Glance
A Guide For Health Promotion Practice
(Second Edition)
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Foreword
A
decade ago, the first edition of Theory at a Glance was published. The guide was
a welcome resource for public health practitioners seeking a single, concise
summary of health behavior theories that was neither overwhelming nor superficial.
As a government publication in the public domain, it also prov ...
The author provides an overview of the emerging field of bioethics and criticisms that have been leveled against it. The field arose over the past decade to address moral dilemmas in medicine and healthcare. While now established with practitioners, literature, and university courses, bioethics draws from many disciplines and lacks clear standards. It has faced criticism for not being a legitimate academic pursuit, having no practical benefits, and pursuing unanswerable questions. The author aims to evaluate these criticisms, define reasonable expectations for bioethics, and recommend future directions for the field.
This document discusses ethics in social science and health research. It defines key terms like research, social science research, and health research. It outlines the symbiotic relationship between health and social science research, noting that social factors must be considered in health research and vice versa. The document also examines debates around ethical issues in social science research, such as power dynamics and risks to participants. It provides an overview of different types of ethics review for research protocols and discusses navigating ethics through principles like those in the Belmont Report.
The document outlines the history and basic principles of the Declaration of Helsinki, which provides ethical guidelines for medical research involving human subjects. It discusses how the Declaration was first adopted in 1964 and has since undergone revisions to regulate research. The key principles outlined include protecting subjects' lives, health, dignity and privacy, ensuring proper scientific conduct and qualifications of researchers, registering clinical trials, obtaining consent, and assessing risks and benefits to populations involved in research.
The Belmont Report summarizes the basic ethical principles identified by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. It discusses three principles that should guide research with human subjects: respect for persons, beneficence, and justice. The report was created to identify ethical standards for research and outline how risks and benefits, informed consent, and subject selection should be handled.
This document provides a summary of a research study that explored the concept of phronesis (practical wisdom) in medical decision-making through interviews and observations with 131 doctors. The study found 15 virtue continua that capture the collective practical wisdom conveyed by participants, which can help support ethical decision-making. This contributes a theoretical framework of "collective practical wisdom" that captures the various virtues considered important by medical practitioners. The findings have implications for improving ethical decision-making in medical education, policy, and research.
The document discusses the benefits of undergraduate research experiences. It outlines how research experience benefits the student's education by allowing them to practice problem-solving skills, immerse themselves in a field of study, and build relationships. Research is also beneficial for gaining admission to graduate programs, as it is often a required experience. The document also notes that research helps develop important skills for medical students such as analytical thinking and self-directed learning.
THE BELMONT REPORT Office of the Secretary Ethical Princip.docxtodd541
THE BELMONT REPORT
Office of the Secretary
Ethical Principles and Guidelines for the Protection of Human
Subjects of Research
The National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research
April 18, 1979
AGENCY: Department of Health, Education, and Welfare.
ACTION: Notice of Report for Public Comment.
SUMMARY: On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law, there-by creating the
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the
charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical
and behavioral research involving human subjects and to develop guidelines which should be followed to assure that
such research is conducted in accordance with those principles. In carrying out the above, the Commission was
directed to consider: (i) the boundaries between biomedical and behavioral research and the accepted and routine
practice of medicine, (ii) the role of assessment of risk-benefit criteria in the determination of the appropriateness of
research involving human subjects, (iii) appropriate guidelines for the selection of human subjects for participation in
such research and (iv) the nature and definition of informed consent in various research settings.
The Belmont Report attempts to summarize the basic ethical principles identified by the Commission in the course of
its deliberations. It is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at
the Smithsonian Institution's Belmont Conference Center supplemented by the monthly deliberations of the
Commission that were held over a period of nearly four years. It is a statement of basic ethical principles and
guidelines that should assist in resolving the ethical problems that surround the conduct of research with human
subjects. By publishing the Report in the Federal Register, and providing reprints upon request, the Secretary intends
that it may be made readily available to scientists, members of Institutional Review Boards, and Federal employees.
The two-volume Appendix, containing the lengthy reports of experts and specialists who assisted the Commission in
fulfilling this part of its charge, is available as DHEW Publication No. (OS) 78-0013 and No. (OS) 78-0014, for sale by
the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.
Unlike most other reports of the Commission, the Belmont Report does not make specific recommendations for
administrative action by the Secretary of Health, Education, and Welfare. Rather, the Commission recommended that
the Belmont Report be adopted in its entirety, as a statement of the Department's policy. The Department requests
public comment on this recommendation.
National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Resea.
Strengthening health systems in Sub-Saharan Africa requires health policy and systems research and analysis (HPSR+A). HPSR+A takes a multidisciplinary approach to understand how health systems function and how to improve them. It also examines how to influence health policies and implement policies effectively to strengthen systems. Some priorities for HPSR+A include conducting mixed-method longitudinal studies, using theory, and thinking outside disease-specific approaches to consider the broader health system issues. Several HPSR+A studies provided examples of how health systems can be strengthened by taking a systems perspective rather than just focusing on individual programs or diseases.
This document provides an introduction to research methodology. It defines research as the systematic collection and analysis of data to answer questions or solve problems. The document then discusses the importance of research in advancing knowledge and development, particularly in the medical field. It outlines four key benefits of research: guiding action, developing new tools, multiplying benefits through more efficient use of resources, and contributing to the development process. The document also describes the key characteristics and purposes of research, and explains the typical stages involved in the research process, including identifying a problem, developing a hypothesis, conducting research design and measurement, collecting and analyzing data, and generating conclusions.
This document discusses different research paradigms and methodologies in health research. It begins by outlining the positivist and interpretivist paradigms, which represent different epistemological approaches to knowledge and ways of knowing about the world. The positivist paradigm is linked to quantitative research methods and aims to produce objective evidence through scientific principles. The interpretivist paradigm is based on the principle that knowledge derives from human perception, and thus qualitative research methods are used that consider how human subjects understand the world. The document then discusses advantages and disadvantages of quantitative and qualitative research methods. It also introduces mixed methods research, which combines both approaches. Finally, it outlines some specific qualitative research methods commonly used in health research, including using documents, interviews,
A SWOT Analysis Of The Physiotherapy Profession In KuwaitJim Webb
This research article conducted a SWOT analysis of the physiotherapy profession in Kuwait through 17 key informant interviews. The interviews identified strengths like funding for services and motivated professionals, as well as weaknesses such as lack of education, resources, marketing, and standardized practices. Opportunities mentioned were untapped demand, development of the physiotherapy association, and collaboration. Threats included low public awareness, challenges with interprofessional practice, and cultural views on health. The analysis concluded that opportunities exist to advance the profession through the physiotherapy association advocating for standards, research, and collaboration.
An Introduction To Reading And Appraising Qualitative ResearchBryce Nelson
This article introduces readers to qualitative research methods through a six-part series. It discusses key differences between qualitative and quantitative research, including their approaches to knowledge. Qualitative research focuses on understanding experiences and behaviors through tools like interviews and observations, while quantitative research aims to discover objective truths through measures and statistics. The number of qualitative studies in medical journals is rising, but clinicians lack resources to properly evaluate them. This series aims to help readers critically appraise qualitative research by explaining different methodologies, theories, and quality standards.
This document provides an introduction and overview of Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). It discusses the importance and role of theory in health promotion practice. The document is intended to help public health workers and practitioners design effective programs by applying relevant behavioral theories. It contains three parts, with Part 1 providing foundations on the use of theory in health promotion. Theories can help explain health behaviors, identify factors that influence behavior and how they may be changed, and guide the development and evaluation of health interventions and programs. Both explanatory and change theories are important. The document emphasizes that no single theory is suitable for all cases and that practitioners should select theories appropriate for the issue, population, and context.
Peer 1 World Medical Association Declaration of Ethical Principles.docx4934bk
The document discusses several research articles that address ethical issues in various types of medical research involving human subjects. Some of the key ethical principles discussed across multiple articles include respecting participant autonomy, minimizing harm, and beneficence. The articles examine ethical considerations for research topics such as genetics, children as subjects, and the use of deception. Maintaining high scientific standards while protecting participants is emphasized.
This document discusses the case study approach to research. It begins by defining a case study as an in-depth exploration of a complex issue within its real-world context. The document then discusses different types of case studies, how they are conducted, and common challenges. Key points include: 1) Case studies can explore issues, events, or phenomena, 2) They use multiple data sources to provide a nuanced understanding, 3) Challenges include maintaining objectivity and generalizing from a single case.
La urgencialización de la atención primaria en la comuna de Talcahuano, 2011-...Jorge Pacheco
El documento analiza el efecto de la implementación de los Servicios de Atención Primaria de Urgencias (SAPU) en las consultas médicas en la comuna de Talcahuano entre 2011-2015. Los resultados mostraron que el número de consultas anuales en SAPU aumentó un 53%, mientras que las consultas de morbilidad en centros de salud familiar y postas rurales disminuyeron un 28,5%. Las consultas de urgencias en el hospital también disminuyeron un 15,5%. La mayor disminución en consultas de morbilidad ocurrió en
Indicadores comunales de salud. Talcahuano, 2016.Jorge Pacheco
Este informe preliminar presenta indicadores comunales de salud de la comuna de Talcahuano para el año 2016. Incluye 13 indicadores de salud divididos en tópicos como pobreza, educación, empleo, envejecimiento poblacional, mortalidad y fecundidad. Los indicadores muestran tendencias de mejoría en algunas áreas como reducción de la pobreza y aumento del nivel educativo, pero también desafíos como el envejecimiento poblacional y brechas de género en indicadores como sobremortalidad masculina.
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Evolution of the biopsychosocial model: prospects and challenges for health p...ellen1066
The document discusses the evolution and current state of the biopsychosocial model in health psychology. It finds that while advances have been made in specifying connections between biological, psychological, and social processes, more can be done to understand and utilize linkages among these variables. Specifically, the biopsychosocial model has not been fully embraced by the medical establishment or implemented in all health psychology research. The document recommends initiatives to better facilitate a multisystem, multilevel approach as envisioned by the biopsychosocial perspective.
Here is a research tip We write the theory into a separate sectioSusanaFurman449
Here is a research tip: We write the theory into a separate section in a research proposal so that readers can clearly identify the theory from other components. Such a separate passage provides a complete explication of the theory section, its use, and how it relates to the study.
Writing a Quantitative Theoretical Perspective
Using these ideas, the following presents a model for writing a quantitative theoretical perspective section into a research plan. Assume that the task is to identify a theory that explains the relationship between independent and dependent variables.
Look in the discipline-based literature for a theory. If the unit of analysis for variables is an individual, look in the psychology literature; to study groups or organizations, look in the sociological literature. If the project examines individuals and groups, consider the social psychology literature. Of course, theories from other disciplines may be useful, too (e.g., to study an economic issue, the theory may be found in economics).
Examine also prior studies that address the topic or a closely related topic. What theories did the authors use? Limit the number of theories and try to identify one overarching theory that explains the central hypothesis or major research question.
As mentioned earlier, ask the rainbow question that bridges the independent and dependent variables: What explains why the independent variable(s) would influence the dependent variables?
Script out the theory section. Follow these lead sentences: “The theory that I will use is _____ (name the theory). It was developed by _____ (identify the origin, source, or developer of the theory), and it was used to study _____ (identify the topics where one finds the theory being applied). This theory indicates that _____ (identify the propositions or hypotheses in the theory). As applied to my study, this theory holds that I would expect my independent variable(s) _____ (state independent variables) to influence or explain the dependent variable(s) _____ (state dependent variables) because _____ (provide a rationale based on the logic of the theory).”
Thus, the topics to include in a quantitative theory discussion are the theory to be used, its central hypotheses or propositions, information about past use of the theory and its application, and statements that reflect how it relates to a proposed study. Example 3.1, which contains a passage by Crutchfield (1986) from her dissertation, illustrates the use of this model.
Theory
at a
Glance
A Guide For Health Promotion Practice
(Second Edition)
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Foreword
A
decade ago, the first edition of Theory at a Glance was published. The guide was
a welcome resource for public health practitioners seeking a single, concise
summary of health behavior theories that was neither overwhelming nor superficial.
As a government publication in the public domain, it also prov ...
The author provides an overview of the emerging field of bioethics and criticisms that have been leveled against it. The field arose over the past decade to address moral dilemmas in medicine and healthcare. While now established with practitioners, literature, and university courses, bioethics draws from many disciplines and lacks clear standards. It has faced criticism for not being a legitimate academic pursuit, having no practical benefits, and pursuing unanswerable questions. The author aims to evaluate these criticisms, define reasonable expectations for bioethics, and recommend future directions for the field.
This document discusses ethics in social science and health research. It defines key terms like research, social science research, and health research. It outlines the symbiotic relationship between health and social science research, noting that social factors must be considered in health research and vice versa. The document also examines debates around ethical issues in social science research, such as power dynamics and risks to participants. It provides an overview of different types of ethics review for research protocols and discusses navigating ethics through principles like those in the Belmont Report.
The document outlines the history and basic principles of the Declaration of Helsinki, which provides ethical guidelines for medical research involving human subjects. It discusses how the Declaration was first adopted in 1964 and has since undergone revisions to regulate research. The key principles outlined include protecting subjects' lives, health, dignity and privacy, ensuring proper scientific conduct and qualifications of researchers, registering clinical trials, obtaining consent, and assessing risks and benefits to populations involved in research.
The Belmont Report summarizes the basic ethical principles identified by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. It discusses three principles that should guide research with human subjects: respect for persons, beneficence, and justice. The report was created to identify ethical standards for research and outline how risks and benefits, informed consent, and subject selection should be handled.
This document provides a summary of a research study that explored the concept of phronesis (practical wisdom) in medical decision-making through interviews and observations with 131 doctors. The study found 15 virtue continua that capture the collective practical wisdom conveyed by participants, which can help support ethical decision-making. This contributes a theoretical framework of "collective practical wisdom" that captures the various virtues considered important by medical practitioners. The findings have implications for improving ethical decision-making in medical education, policy, and research.
The document discusses the benefits of undergraduate research experiences. It outlines how research experience benefits the student's education by allowing them to practice problem-solving skills, immerse themselves in a field of study, and build relationships. Research is also beneficial for gaining admission to graduate programs, as it is often a required experience. The document also notes that research helps develop important skills for medical students such as analytical thinking and self-directed learning.
THE BELMONT REPORT Office of the Secretary Ethical Princip.docxtodd541
THE BELMONT REPORT
Office of the Secretary
Ethical Principles and Guidelines for the Protection of Human
Subjects of Research
The National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research
April 18, 1979
AGENCY: Department of Health, Education, and Welfare.
ACTION: Notice of Report for Public Comment.
SUMMARY: On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law, there-by creating the
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the
charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical
and behavioral research involving human subjects and to develop guidelines which should be followed to assure that
such research is conducted in accordance with those principles. In carrying out the above, the Commission was
directed to consider: (i) the boundaries between biomedical and behavioral research and the accepted and routine
practice of medicine, (ii) the role of assessment of risk-benefit criteria in the determination of the appropriateness of
research involving human subjects, (iii) appropriate guidelines for the selection of human subjects for participation in
such research and (iv) the nature and definition of informed consent in various research settings.
The Belmont Report attempts to summarize the basic ethical principles identified by the Commission in the course of
its deliberations. It is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at
the Smithsonian Institution's Belmont Conference Center supplemented by the monthly deliberations of the
Commission that were held over a period of nearly four years. It is a statement of basic ethical principles and
guidelines that should assist in resolving the ethical problems that surround the conduct of research with human
subjects. By publishing the Report in the Federal Register, and providing reprints upon request, the Secretary intends
that it may be made readily available to scientists, members of Institutional Review Boards, and Federal employees.
The two-volume Appendix, containing the lengthy reports of experts and specialists who assisted the Commission in
fulfilling this part of its charge, is available as DHEW Publication No. (OS) 78-0013 and No. (OS) 78-0014, for sale by
the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.
Unlike most other reports of the Commission, the Belmont Report does not make specific recommendations for
administrative action by the Secretary of Health, Education, and Welfare. Rather, the Commission recommended that
the Belmont Report be adopted in its entirety, as a statement of the Department's policy. The Department requests
public comment on this recommendation.
National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Resea.
Strengthening health systems in Sub-Saharan Africa requires health policy and systems research and analysis (HPSR+A). HPSR+A takes a multidisciplinary approach to understand how health systems function and how to improve them. It also examines how to influence health policies and implement policies effectively to strengthen systems. Some priorities for HPSR+A include conducting mixed-method longitudinal studies, using theory, and thinking outside disease-specific approaches to consider the broader health system issues. Several HPSR+A studies provided examples of how health systems can be strengthened by taking a systems perspective rather than just focusing on individual programs or diseases.
This document provides an introduction to research methodology. It defines research as the systematic collection and analysis of data to answer questions or solve problems. The document then discusses the importance of research in advancing knowledge and development, particularly in the medical field. It outlines four key benefits of research: guiding action, developing new tools, multiplying benefits through more efficient use of resources, and contributing to the development process. The document also describes the key characteristics and purposes of research, and explains the typical stages involved in the research process, including identifying a problem, developing a hypothesis, conducting research design and measurement, collecting and analyzing data, and generating conclusions.
This document discusses different research paradigms and methodologies in health research. It begins by outlining the positivist and interpretivist paradigms, which represent different epistemological approaches to knowledge and ways of knowing about the world. The positivist paradigm is linked to quantitative research methods and aims to produce objective evidence through scientific principles. The interpretivist paradigm is based on the principle that knowledge derives from human perception, and thus qualitative research methods are used that consider how human subjects understand the world. The document then discusses advantages and disadvantages of quantitative and qualitative research methods. It also introduces mixed methods research, which combines both approaches. Finally, it outlines some specific qualitative research methods commonly used in health research, including using documents, interviews,
A SWOT Analysis Of The Physiotherapy Profession In KuwaitJim Webb
This research article conducted a SWOT analysis of the physiotherapy profession in Kuwait through 17 key informant interviews. The interviews identified strengths like funding for services and motivated professionals, as well as weaknesses such as lack of education, resources, marketing, and standardized practices. Opportunities mentioned were untapped demand, development of the physiotherapy association, and collaboration. Threats included low public awareness, challenges with interprofessional practice, and cultural views on health. The analysis concluded that opportunities exist to advance the profession through the physiotherapy association advocating for standards, research, and collaboration.
An Introduction To Reading And Appraising Qualitative ResearchBryce Nelson
This article introduces readers to qualitative research methods through a six-part series. It discusses key differences between qualitative and quantitative research, including their approaches to knowledge. Qualitative research focuses on understanding experiences and behaviors through tools like interviews and observations, while quantitative research aims to discover objective truths through measures and statistics. The number of qualitative studies in medical journals is rising, but clinicians lack resources to properly evaluate them. This series aims to help readers critically appraise qualitative research by explaining different methodologies, theories, and quality standards.
This document provides an introduction and overview of Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). It discusses the importance and role of theory in health promotion practice. The document is intended to help public health workers and practitioners design effective programs by applying relevant behavioral theories. It contains three parts, with Part 1 providing foundations on the use of theory in health promotion. Theories can help explain health behaviors, identify factors that influence behavior and how they may be changed, and guide the development and evaluation of health interventions and programs. Both explanatory and change theories are important. The document emphasizes that no single theory is suitable for all cases and that practitioners should select theories appropriate for the issue, population, and context.
Peer 1 World Medical Association Declaration of Ethical Principles.docx4934bk
The document discusses several research articles that address ethical issues in various types of medical research involving human subjects. Some of the key ethical principles discussed across multiple articles include respecting participant autonomy, minimizing harm, and beneficence. The articles examine ethical considerations for research topics such as genetics, children as subjects, and the use of deception. Maintaining high scientific standards while protecting participants is emphasized.
This document discusses the case study approach to research. It begins by defining a case study as an in-depth exploration of a complex issue within its real-world context. The document then discusses different types of case studies, how they are conducted, and common challenges. Key points include: 1) Case studies can explore issues, events, or phenomena, 2) They use multiple data sources to provide a nuanced understanding, 3) Challenges include maintaining objectivity and generalizing from a single case.
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La urgencialización de la atención primaria en la comuna de Talcahuano, 2011-...Jorge Pacheco
El documento analiza el efecto de la implementación de los Servicios de Atención Primaria de Urgencias (SAPU) en las consultas médicas en la comuna de Talcahuano entre 2011-2015. Los resultados mostraron que el número de consultas anuales en SAPU aumentó un 53%, mientras que las consultas de morbilidad en centros de salud familiar y postas rurales disminuyeron un 28,5%. Las consultas de urgencias en el hospital también disminuyeron un 15,5%. La mayor disminución en consultas de morbilidad ocurrió en
Indicadores comunales de salud. Talcahuano, 2016.Jorge Pacheco
Este informe preliminar presenta indicadores comunales de salud de la comuna de Talcahuano para el año 2016. Incluye 13 indicadores de salud divididos en tópicos como pobreza, educación, empleo, envejecimiento poblacional, mortalidad y fecundidad. Los indicadores muestran tendencias de mejoría en algunas áreas como reducción de la pobreza y aumento del nivel educativo, pero también desafíos como el envejecimiento poblacional y brechas de género en indicadores como sobremortalidad masculina.
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Este documento describe los cuidados integrales para adultos mayores en la atención primaria de salud en Chile. Señala que Chile está experimentando un rápido envejecimiento poblacional que aumentará la carga en el sistema de salud. Describe el Examen de Medicina Preventiva del Adulto Mayor, el cual evalúa la salud e identifica factores de riesgo. También discute problemas comunes como la multimorbilidad, polimedicación y prescripciones potencialmente inapropiadas, las cuales son frecuentes debido al envejecimiento y requ
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Este documento analiza cómo la baja escolaridad y la edad avanzada de adultos mayores evaluados en Chile con el test Minimental abreviado pueden llevar a un sobrediagnóstico de demencia. Los resultados mostraron que una proporción mayor de adultos mayores con baja escolaridad y mayor edad obtuvieron puntajes indicativos de alteración cognitiva en el test, pero al aplicar también el test de funcionalidad de Pfeffer, más de la mitad de esos casos no mostraron discapacidad real. Esto sugiere que el Min
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Building the field of health policy and system research: social science matters
1. Policy Forum
Building the Field of Health Policy and Systems Research:
Social Science Matters
Lucy Gilson1,2*, Kara Hanson2, Kabir Sheikh3, Irene Akua Agyepong4, Freddie Ssengooba5, Sara
Bennett6
1 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa, 2 Department of Global Health and Development, London School of
Hygiene and Tropical Medicine, London, United Kingdom, 3 Public Health Foundation of India, New Delhi, India, 4 Ghana Health Service/School of Public Health,
University of Ghana, Accra, Ghana, 5 School of Public Health, Makerere University, Kampala, Uganda, 6 Health Systems Programme, Johns Hopkins Bloomberg School of
Public Health, Baltimore, Maryland, United States of America
Introduction tives, as well as shared concerns. Richer
PLoS Medicine Series on HPSR methodologies for addressing these con-
The first paper in this series on building cerns must then be developed. And, as
the field of Health Policy and Systems Following the First Global Sympo-
sium on Health Systems Research in health policies and systems are themselves
Research (HPSR) in low- and middle- social and political constructions, it is
income countries (LMICs) [1] outlined the Montreux in November 2010, PLoS
Medicine commissioned three arti- important to acknowledge the particular
scope and questions of the field and value of social science perspectives in the
cles on the state-of-the-art in Health
highlighted the key challenges and oppor- field. Each of these issues is addressed in
Policy and Systems Research (HPSR).
tunities it is currently facing. This paper Three Policy Forum articles, au- the following sections, and they are
examines more closely one key challenge, thored by a diverse group of global considered further in paper three of the
the risk of disciplinary capture—the im- health academics, critically examine series [4].
position of a particular knowledge frame the current challenges to the field
on the field, privileging some questions and lay out what is needed to build Knowledge Paradigms
and methodologies above others. In capacity in HPSR and support local
HPSR the risk of disciplinary capture policy development and health sys- Figure 1 characterises key areas of
can be seen in the current methodological tems strengthening, especially in difference between the dominant knowl-
critique of the field, with consequences for low- and middle-income countries. edge paradigms that underpin the disci-
its status and development (especially plines applied within HPSR. The figure
when expressed by research leaders). Paper 1. Kabir Sheikh and col- deliberately polarises the paradigms to
The main criticisms are reported to be: leagues. Building the Field of Health spark debate. Some disciplines are domi-
that the context specificity of the research Policy and Systems Research: Fram- nated by a particular paradigm and some
makes generalisation from its findings ing the Questions. are spread across paradigms.
difficult; lack of sufficiently clear conclu- The positivist worldview is reflected in
Paper 2. Lucy Gilson and colleagues.
sions for policy makers; and questionable much clinical, biomedical, and epidemio-
Building the Field of Health Policy
quality and rigour [2]. Some critique is and Systems Research: Social Sci- logical, and some social science, research.
certainly warranted and has come from ence Matters. This view starts from the same position as
HPS researchers themselves. However, the natural and physical sciences. The
this critique also reflects a clash of Paper 3. Sara Bennett and col- phenomena being investigated comprise a
knowledge paradigms, between some of leagues. Building the Field of Health set of facts, a single reality that can
those with clinical, biomedical, and epide- Policy and Systems Research: An be observed and measured by the
miological backgrounds and those with Agenda for Action. researcher without disturbing them. The
social science backgrounds. Yet, as HPSR central aim of research is to detect causal
is defined by the topics and questions it mechanisms through the deductive process
considers rather than a particular disci- of testing hypotheses derived from
plinary approach, it requires engagement
across disciplines; indeed, understanding
Citation: Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, et al. (2011) Building the Field of Health
the complexity of health policy and Policy and Systems Research: Social Science Matters. PLoS Med 8(8): e1001079. doi:10.1371/jour-
systems demands multi- and inter-disci- nal.pmed.1001079
plinary inquiry [3]. Published August 23, 2011
To develop the science of HPSR it is,
Copyright: ß 2011 Gilson et al. This is an open-access article distributed under the terms of the Creative
therefore, important to start by recognis- Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
ing the diversity of disciplinary perspec- provided the original author and source are credited.
Funding: No specific funding was provided for writing this article.
The Policy Forum allows health policy makers Competing Interests: The authors have declared that no competing interests exist.
around the world to discuss challenges and Abbreviations: HPSR, Health Policy and Systems Research; LMIC, low- and middle-income country.
opportunities for improving health care in their
societies. * E-mail: lucy.gilson@uct.ac.za
Provenance: Commissioned; externally peer reviewed.
PLoS Medicine | www.plosmedicine.org 1 August 2011 | Volume 8 | Issue 8 | e1001079
2. Summary Points how to strengthen health systems to
benefit those being served by them. The
N All researchers hold a knowledge paradigm that frames their understanding of complexity of the phenomena being in-
vestigated may also generate a willingness
reality and of the functions and nature of research. Some disciplines are
dominated by a particular paradigm and some are spread across paradigms. to think creatively about how to investigate
issues. Therefore, HPS researchers tend
N The criticisms that Health Policy and Systems Research (HPSR) is too context
not to fall at the extreme ends of the
specific, does not offer clear lessons for policy makers, and is not rigorous are
partly a reflection of differences in knowledge paradigms between those with spectrum outlined in Figure 1—and this
predominantly clinical, biomedical, and epidemiological backgrounds, under- makes multi- and inter-disciplinary work
pinned by a positivist paradigm, and those with social science backgrounds more possible.
underpinned by a relativist paradigm. Review of existing HPSR work demon-
N Health policies and systems are complex social and political phenomena, strates, moreover, that bringing together
research from different traditions gener-
constructed by human action rather than naturally occurring. Relativist social
science perspectives are, therefore, of particular relevance to HPSR as they ates broader and deeper understanding on
recognise that all phenomena are in essence constructed through human the issues of focus. Box 1, for example,
behaviour and interpretation. shows the breadth of questions that have
N Social science insights that can advance the science of HPSR include been addressed around one critical HPS
issue for LMICs, user fees; and the
approaches to generalising from rich understanding of context; supporting
policy learning; and enhancing research rigour and quality. different papers examining the household
level impacts of out of pocket payments
together provide deeper and richer in-
theory and past experience against empir- researchers study human behaviour in sights on these experiences than would
ical facts. At their simplest, such mecha- everyday or natural settings, gener- come from one perspective alone.
nisms represent the prediction that ‘‘x will ating qualitative data that are primarily
cause y’’ in any other setting. Simple analysed inductively to generate categories Learning from Relativist Social
HPSR hypotheses might include, for and explanations of experience. Such Science Perspectives
example, ‘‘limited financial incentives analysis also involves interpretation by
cause low motivation’’ or ‘‘a lack of health the researcher, in interaction with Health policies and systems are funda-
facilities undermines access to health respondents. It may be guided by, and/ mentally shaped by political decision-
services.’’ Sometimes such hypotheses are or generate, what is called middle range making, whilst the routines of health
tested through statistical analysis of sec- theory, i.e., ideas about how the world systems are brought alive through the
ondary data [5]; sometimes studies are works, comprising categories and concepts relationships among the actors involved in
designed to allow hypotheses to be tested derived from analysis, and suggestions managing, delivering, and accessing health
[6]. Indeed, the positivist perspective about how they are linked together. care, and engaged in wider action to
underpins the recent rise of experimen- Middle range theory may be tested against promote health, including researchers
tal methodology in impact evaluation. evidence through the process of analysis or [11]. In essence, therefore, health policies
As the emphasis in such studies is on highlights questions and ideas to be and systems are constructed through
measuring the magnitude of an interven- considered in future studies. human behaviour and interpretation,
tion’s impact, and ensuring that this Relativist HPSR studies focus, for rather than existing independently of
estimate is unbiased, careful attention is example, on how health system actors them. As relativist social science perspec-
paid to selecting an appropriate control understand and experience particular ser- tives see all phenomena as at least partially
group (randomized or otherwise) and vices or policies [7], and what social and constructed in this way, they have partic-
controlling the influence of possible con- political processes, including power rela- ular value in building the methodological
founding factors. Much less emphasis is tions, influence them [8,9]. The develop- foundations of HPSR. Three contributions
placed on understanding how the inter- ment and testing of middle range theory is are discussed here: generalising from rich
vention works and which contextual or also supported by studies that adopt a contextual understanding; supporting pol-
other factors mediate its impact. critical realist position. This knowledge icy learning; and approaches to ensuring
Much social science work that is paradigm falls somewhere in the spectrum research rigour.
qualitative is located at the relativist end between positivism and relativism, and is
of the spectrum. Such research is essen- of growing interest in HPSR [10] (see Taking Account of Context in
tially based on the understanding that the FEMhealth, http://www.abdn.ac.uk/fem- Drawing out Generalisations
world around us is subject to human health/). However, these sorts of questions Multiple contextual factors influence the
interpretation. Health policies and systems are still only quite rarely addressed in the working of health systems. Health worker
are, therefore, understood to be con- wider HPSR literature [1]. motivation, for example, reflects a range of
structed and brought alive by social personal, organisational, and societal fac-
actors through the meaning they attach to Shared Concerns and the Value tors, including relationships with others,
(their interpretations of) their experiences. of Multiple Perspectives and itself influences many aspects of the
Whereas positivist researchers focus on provision of health care. Similarly, pa-
facts and regularities (that is, causes and Although HPS researchers from differ- tients’ decisions to use services, or adhere
effects), relativist researchers see inter- ent disciplinary traditions have some to treatment advice, are responses to many
pretations as the primary subject of difficulty understanding each other’s per- contextual factors: their own understand-
inquiry, proposing that different interpre- spectives, they also have some shared ings of illness, and how best to treat it;
tations of the same experience represent starting points: a common focus, health advice received from friends and family;
multiple realities. In this tradition, policies and systems, and a concern about past experience of health providers; the
PLoS Medicine | www.plosmedicine.org 2 August 2011 | Volume 8 | Issue 8 | e1001079
3. Figure 1. Core differences between knowledge paradigms.
doi:10.1371/journal.pmed.1001079.g001
availability of cash to cover costs; and the particular experiences situated within their tion (Box 2). The aim in such analysis is
gender dynamics influencing household context that allow understanding and not to draw conclusions that can be
decision-making. There are also multiple explanations of the phenomena of focus statistically generalised to a wider study
interpretations of the same experience as by reference to that context [12]. For population, or that will hold across time
different people bring different contexts to example, a study of Brazilian health and place. Instead, analytic generalisation
bear on its interpretation. Health workers, system decentralisation, involving anthro- entails the development of general conclu-
for example, respond differently to the pological work in three case study areas, sions that, although derived from a limited
same financial incentive, and patients vary investigated the factors shaping the extent number of particular experiences, provide
in their response to treatment advice. The of local decision-making actually achieved, theoretical insights that can be put forward
causal mechanisms underpinning the with consequences for quality of care for consideration, and testing, in other,
changes brought about by new health improvement possibilities. A range of similar situations. This includes middle
policies or health system interventions are, contextual factors were influential, includ- range theory, as outlined earlier, and
thus, complex. ing political relationships among layers of theory that offers ideas about the causal
As a result, investigation of HPS issues government, the potential of generating mechanisms likely to underpin interven-
demands research that seeks to understand tax revenue at the local level, differences tions that achieve their goals.
and explain experiences by reference to between rural and urban areas in the
the many layers of their context, whilst opportunities for community participation
acknowledging the often quite different in decision-making, and existing patterns Active Support for Policy Learning
interpretations of experience across peo- of political patronage; and these also Health research has traditionally seen
ple. Reducing relevant contextual factors combined with individual management knowledge generation as essentially a
to a set of simple quantifiable measures for styles and health worker commitment to process of adding to the existing stock of
statistical analysis is, simply, difficult. On the local area [13]. facts and predictions, with researchers
the other hand, case study research, widely In studies with multiple cases, system- acting largely as disinterested scientists
used in organisational and political science atic and deliberate cross-case comparison feeding evidence into the decision-making
work, supports the ‘‘thick descriptions’’ of supports, moreover, analytic generalisa- process [14]. Learning from that knowl-
PLoS Medicine | www.plosmedicine.org 3 August 2011 | Volume 8 | Issue 8 | e1001079
4. Box 1. Drawing on Different Perspectives to Understand and tacit knowledge in active debate with
Explain Experiences of User Fee Policy Change in Low- and policy makers [15]. Thus, some social
Middle-Income Countries scientists argue that in addressing prob-
lems that matter in their own communi-
Assessing household level impacts ties, researchers should pay particular
attention to the ways in which values and
Positivist perspectives: power shape those problems and responses
N What is the impact of out of pocket payments on household poverty levels to them [17], assisting policy actors to
negotiate mutually acceptable solutions to
across countries?
problems, and ensuring that underrepre-
# Cross-national statistical analysis [5] (health economics) sented groups are heard [18]. For others,
N What is the impact of user fee removal on aggregate patient utilisation and building the possibility of such action into
research design is an ethical requirement
across different patient socioeconomic groups within one country?
and key hallmark of good quality research
# Before and after statistical analysis [24] (health economics) [19].
Relativist perspectives: Social science perspectives, therefore,
challenge the HPSR community to think
N How do pocket payments combine with other influences over health-seeking more deeply about how to support policy
behaviour to impact on the dynamics of household poverty? and system change through their research,
# Mixed method study involving longitudinal household case studies [22] including how to address the thorny issue
(development sociology, health economics) of the boundary between researcher and
advocate. For example, what sorts of
Explaining policy implementation experiences
participatory and action research with
Critical realist and relativist perspectives: citizens, health managers, and health
workers can support the reflective enquiry
N What political forces led to user fee introduction/removal, and why was equity that generates positive change in current
neglected as a policy goal? practices? And should and can we initiate
# Qualitative study [25] (social anthropology, policy analysis) processes that stimulate public debate
about research findings—such as active
N How does the process of implementing user fee removal influence health media engagement, debates on public
worker morale?
platforms, or engagement with civil society
# Multiple method study within overarching qualitative approach [26] organisations?
(sociology, policy analysis)
N How is the process of implementing user fees, in interaction with other policies, Ensuring Research Rigour
influenced by wider societal forces? For some traditions of health research,
validity and reliability are the hallmarks of
# Ethnographic study [27] (anthropology) rigorous research, and are ensured through
careful study design, appropriate tool devel-
edge then entails the simple transfer of lation sometimes see this process as quite opment and data collection, and correct
knowledge from one setting to another linear [16]. approaches to statistical analysis. In contrast,
[15]. Even current HPSR debates about However, for a relativist, researchers relativist (qualitative) social science research
the importance of getting research into contribute to the process of learning as is premised on the understanding that there
policy and practice and knowledge trans- active participants, using both formal and are multiple realities, reflecting actors’
different understandings of common expe-
riences (Figure 1). These understandings are
Box 2. An Example of Analytic Generalisation [28] either seen to have significant influence over
A study of the factors underpinning successful family planning programmes the issues of focus or to be the focus of
involved work in eight country cases. In each country a rich description of the inquiry. Researchers from this tradition,
evolution of programme development over time was developed, based on moreover, aim not just to identify and report
qualitative interviews with policy elites and documentary data analysis. such understandings, but instead, through
analysis and engagement, to produce their
The countries were paired on the basis of similar socioeconomic development, own interpretations of them, explaining why
but in each pair one country had a strong and one a weak, family planning and how actors behave and think as they do.
programme. Comparison of experience within and across pairs, suggested that For relativist research, the ‘‘trustworthiness
governments’ commitment to family planning programmes was influenced by of researchers’’’ interpretations is the key
the process of their development and implementation. hallmark of research rigour, implying that
the interpretation is widely recognised to
More specifically, three factors were identified as likely to underpin successful have value beyond the particular examples
family planning programmes: coalitions among elite groups with influence over
considered. Such trustworthiness is, in
health policy, that support effective programme development; spreading the risk
essence, negotiated between researchers
associated with the sensitive issue of family planning among groups and over
time; and having a clear and stable organisational structure in charge of and research users on the basis of transpar-
implementation, as well as adequate funding. These conclusions were the general ent information on study design and the
insights put forward for consideration and testing in other settings. processes of data collection, analysis, and
interpretation. Table 1 summarises the
PLoS Medicine | www.plosmedicine.org 4 August 2011 | Volume 8 | Issue 8 | e1001079
5. Table 1. Processes for ensuring rigour in case study and qualitative data collection and analysis [20,29].
Principle Example:
A study of the influence of trust in workplace relationships over health worker
motivation and performance, involving in-depth inquiry in four case studies [30]
Prolonged engagement with the subject of inquiry Case study:
Although ethnographers may spend years in the field, HPSR tends A period of three to four weeks spent in each case study facility
to draw on lengthy and perhaps repeated interviews with respondents, Respondents
and/or days and weeks of engagement within a case study site Informal engagement & repeated formal interviews
Use of theory Conceptual framework derived from previous work
To guide sample selection, data collection and analysis, and to draw into Case study selection based on assumptions drawn from framework (see below)
interpretive analysis Theory used in triangulation and negative case analysis (see below)
Case selection Four primary health care facilities: two pairs of facility types, & in each pair one well
Purposive selection to allow prior theory and initial assumptions and one poorly performing as judged by managers using data on utilization and
to be tested or to examine ‘‘average’’ or unusual experience tacit knowledge (to test assumptions that staff in ‘‘well performing’’ facilities have
higher levels of motivation and workplace trust)
Sampling In small case study facilities, interviewed all available staff; in larger facilities,
Of people, places, times, etc., initially, to include as many as possible interviewed a purposive sample of staff from each of the staff groups within the
of the factors that might influence the behavior of those people central facility (considering e.g., age, sex, length of time in facility); interviewed random
to the topic of focus (subsequently extend in the light of early findings) sample of patients visiting each facility; interviewed all facility supervisors and area
Gather views from wide range of perspectives and respondents rather manager
than letting one viewpoint dominate
Multiple methods (case studies) For each case study site:
Two sets of formal interviews with all sampled staff
Researcher observation & informal discussion
Interviews with patients
Interviews with facility supervisors and area managers
Triangulation Within cases:
Looking for patterns of convergence and divergence by comparing results Initial case reports based on triangulation across all data sets for that case (and
across multiple sources of evidence (e.g., across interviewees, and between across analysts in terms of individual staff members’ experience), generating overall
interview and other data), between researchers, across methodological judgments about facility-wide experience as well as noting variation in individual
approaches, with theory health worker experience
Cross-cases:
Initial case reports compared with each other to look for common and different
experiences across cases, and also compared with theory to look for convergence or
divergence
Negative case analysis Within cases:
Looking for evidence that contradicts your explanations and theory, Triangulation across data identified experiences that contradicted initial
and refining them in response to this evidence assumptions (e.g., about the influence of community interactions over motivation,
and about the association between low motivation and poor caring behaviour), and
identified unexpected influences (e.g., a general sense of powerlessness among
health workers)
Cross-cases:
Cross-site analysis identified facility-level experience that contradicted the initial
assumptions underpinning the study (e.g., about the link between high levels of
workplace trust, strong health worker motivation, and positive caring behaviour),
and identified unexpected conclusions (e.g., about the critical importance of facility-
level management over trust and motivation)
Report notes weak evidence to support links between levels of workplace trust and
client perceptions, but also stronger evidence of links between levels of workplace
trust and motivation
Peer debriefing and support Preliminary case study reports initially reviewed by other members of the research
Review of findings and reports by other researchers team
Respondent validation (member checking) Preliminary cross-case analysis fed back for review and comment to study
Review of findings and reports by respondents respondents; feedback incorporated into final reports
Clear report of methods of data collection and analysis (audit trail) Report provides clear outline of methods and analysis steps as implemented in
Keeping a full record of activities that can be opened to others practice (although on reflection, could be fuller and more reflexive)
and presenting a full account of how methods evolved to the
research audience
doi:10.1371/journal.pmed.1001079.t001
critical steps researchers must take to ensure particular approaches to research rigour stages of research must always be con-
that their analysis is both based on rich relevant to the specific paradigm of ducted with caution. Rigorous investiga-
insight into the experience examined and knowledge underpinning any study. How- tion involves the following [19–21]:
has been subject to challenge, and to offer a ever, because of the complexity of the
transparent account of their research process
to the user.
issues investigated, social science perspec-
tives on rigour offer valuable insights for
N an active process of questioning and
checking in inquiry—asking how and
At a minimum, improving the quality of all empirical HPSR. As HPSR is often why things happened and not only
HPSR requires paying due attention to the more investigation than observation, all what happened, checking answers to
PLoS Medicine | www.plosmedicine.org 5 August 2011 | Volume 8 | Issue 8 | e1001079
6. questions to identify further issues that Finally, although currently rarely con- HPSR, thus, demands we take steps to
need to be followed up to deepen ducted in HPSR, mixed-method research build understanding across disciplinary
understanding of the experience; in which qualitative and quantitative boundaries, for example, by ensuring that
N a constant process of conceptualising analyses are undertaken sequentially, with
one stage of work deliberately feeding into
we can speak each other’s languages
around generalisability and knowledge
and reconceptualising—using ideas and
theory to develop an initial understand- the next [22], offer important opportuni- generation; sharing experience of support-
ing of the problem or situation of focus ties for the triangulation across methods ing policy learning; and clarifying expec-
to guide data collection, but using the and knowledge paradigms that can broad- tations of each other’s disciplinary culture.
data collected to challenge those ideas en and deepen investigation of health Valuing social science perspectives and
and assumptions and when necessary, to policy and systems issues [23]. building interdisciplinary understanding
revise your ideas in response to the both represents the cutting edge of HPSR
evidence; Conclusions and demonstrates that the field is at a
N crafted, interpretative judgements—
The current interest in HPSR provides
scientific cutting edge.
based on enough evidence, particularly
about context, to justify the conclu- exciting opportunities for the field, but also Author Contributions
sions drawn, as well as deliberate brings the threat of ‘‘disciplinary capture’’
by the clinical, biomedical, and epidemi- Wrote the first draft of the manuscript: LG KH
consideration of contradictory evi- KS IA FS SB. Contributed to the writing of the
dence (negative case analysis) and ological disciplinary perspectives domi-
manuscript: LG KH KS IA FS SB. ICMJE
review of initial interpretations by nant in wider health research. Yet, social criteria for authorship read and met: LG KH
respondents (member checking); science perspectives are vital to HPSR. KS IA FS SB. Agree with manuscript’s results
Health policies and systems are complex
N researcher reflexivity—being explicit
social and political phenomena, construct-
and conclusions: LG KH KS IA FS SB.
about how your own assumptions
may influence your interpretation, ed by human action rather than naturally
and testing them in analysis. occurring. Advancing the science of
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