This chapter discusses defining the research question and performing a literature review. It outlines strategies for developing well-formulated research questions like FINER and PICO(TS) and defines key components of the research process such as the problem statement and hypothesis. The chapter also covers the purposes, sources, and steps of conducting a literature review, including searching literature databases, collecting and analyzing information, and synthesizing findings.

1. © 2017 American Health Information Management Association
© 2017 American Health Information Management Association
Health Informatics Research Methods:
Principles and Practice, Second Edition
Chapter 10: Defining the
Research Question and
Performing a Literature Review

2. © 2017 American Health Information Management Association
Learning Objectives
• Formulate research questions for topics in health
informatics and HIM
• Articulate clear hypotheses related to research
questions
• Search knowledge bases such as bibliographic
databases
• Extract essential information from information
sources
• Use key terms associated with research
questions, hypotheses, and literature reviews
appropriately

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Six Components of Systematic
Research Process
• Defining the research question*
• Performing a literature review*
• Selecting a research design and method
• Collecting data
• Analyzing the data
• Presenting results
*Components discussed in this chapter; Items 3–6 covered in subsequent
chapters

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Importance of Purpose
• Knowing the research’s purpose is critical
• Purpose
– Answer a significant question
– Solve a meaningful problem
– Contribute to body of knowledge
• Drives six components of systematic
research process

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Development of a Research
Question: Using FINER
• Feasible Interesting Novel Ethical
Relevant
• A research question is a clear statement in
the form of a question of the specific issue
within a topic that a researcher wishes to
study
• Important to write well-developed research
questions because they guide the literature
review and the selection of the research
design

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Quantitative Process Vs.
Qualitative Process
Quantitative process
• Generate objective
information
• Linear
• Researchable and
specific
• Clearly defined at onset
of research project is
clearly defined
Qualitative process
• Interpret or understand
phenomena
• Iterative or cyclical
• Initial preliminary question
is refined during research
project
• Can be ambiguous at onset
of research project

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Sources of Research Questions
• Research models
• Recommendations of previous
researchers
• Gaps in the body of knowledge
• Problematic areas
• Organizations’ problems

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Refinement of the Research
Question
• Refinement: Narrowing to a manageable scope
and researchable question
– Feasibility
– Additional details learned during literature review
• Scope: Breadth of the question
– Wide scope is unmanageable
– Narrow to an aspect
• Researchable question: Observable phenomena
that can be empirically studied
• Scale: Extent or pervasiveness

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PICO(TS)
• Acronym for a well-developed and manageable research
question
– Patient, Population, or Problem of interest includes the condition,
subpopulation, and other characteristics and demographics
– Intervention is broadly defined as treatment, program, or other
independent variable manipulated in study
– Comparison or Control against which intervention’s effect is
compared
– Outcome is specific result of interest, the dependent variable;
should be measurable
– Timing is the time frame or duration of interest (optional)
– Setting is context, such home or primary care clinic (optional)
• Researchers also refer to PICO, PICOS, or PICOT depending
upon the elements they use

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PICO(TS) (cont.)
• In states with higher levels of managed care
penetration, how does health information exchange,
compared to states with lower levels of managed care,
affect Medicaid costs?
– Population: States with high levels of managed care
– Intervention: Health information exchange
– Comparison: States with lower levels of managed care
– Outcome: Medicaid costs
• Timing and Setting are omitted; however, Timing could
be added as 2010 through 2015 and Setting could be
inpatient hospital

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Problem Statement
• Quantitative research
– Operationalizes
– Operational definitions
• Qualitative research
– Tentative supposition
– Guides initial data collection
and is revised during the
study based on the data
obtained
• Single sentence with an action verb that specifically and
succinctly states what the researcher will be doing to
investigate the research question
• Limits study’s scope by setting boundaries
• Action verb indicates study’s research design

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Hypothesis
Quantitative
• Explicit, testable statement
that describes research
question in operational
definitions and measurable
terms and is written a priori
– Operationalized variables
– Prediction of association or
difference
– Computable measurement
– Study’s intention
Qualitative
• Tentative or working supposition
– Revised during data collection
– Iterative and cyclical
• Statement of the researchers’ predictions on the study’s
outcome
• Based on theory, model, observation, or expectation from
analysis and interpretation of studies in the literature

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Quantitative Alternative Hypothesis
and Null Hypothesis

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Direction of Hypothesis
• One-tailed hypothesis
(test)—predicts
direction
• Two-tailed hypothesis
(test)—no prediction of
direction
• Choice depends upon
– Theory or model
– Previous results in
literature
– Type of study

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Purpose Statement
• Declarative sentence that summarizes the
specific topic and goals of the research study
– Clearly states what the researchers are trying to
achieve
– Is near beginning of article or research proposal
– Explains reason for study, engages the reader, or
both
– Makes clear how the research will advance the
goals of the reader, audience, or funding agency
– Other terms: Aims, objectives, goals, dependent
upon journal and funding agency

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Literature Review
• Literature review is
the systematic
acquisition, analytical
examination, critical
evaluation, and
synthesis of
important information
about a topic
– Comprehensive
– Relevant
• Literature review has
three meanings
– 1. Process of identifying,
reading, summarizing,
analyzing, and synthesizing
– 2. Dependent product, which
is introduction to manuscript
or literature review explaining
background of research
question
– 3. Independent product
,which is an expansion of
dependent product into an
entire article, book chapter, or
book

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Purposes and Process of Literature
Reviews
Purposes
• Orient readers and
persuade them of necessity
of research study
• Assure reader that
researcher has conducted
thorough review of the topic
• Build the researcher’s
knowledge of topic resulting
in competencies
Process
1. Identify sources of
information for the
literature review
2. Seek and retrieve the
literature
3. Collect and record
information
4. Analyze and synthesize
the information obtained in
step 3

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Sources of Information
• Printed works
– Peer-reviewed
journal articles
– Books and book
chapters
– Conference papers
– Government
documents
• Audiovisual media
and electronic media
• Others
• Credibility
– Peer review
– AACODS (Authority,
Accuracy, Coverage,
Objectivity, Date,
Significance)
• Grey literature
• Primary sources and
secondary sources

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Search and Retrieval of Information
Sources
• Knowledge bases,
such as bibliographic
databases and digital
collections
• Systematic plan to
identify
– Databases and
collections
– Search terms
• Search multiple and
variety of databases
– Health informatics and
HIM are
multidisciplinary
– All relevant works not
in one bibliographic
database

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Collection and Recording of Information
Sources
•Use reference management software
•Capture complete citation data at first access to source
•Record key information in summary table

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Analysis, Evaluation, and
Synthesis of Information
Sources
• Step 4 takes the most time
• Summary table can be analytical and evaluative tool by identifying
and emphasizing
– Key features
– Common characteristics
– Trends
– Gaps
• Chronicling a series of descriptions is inadequate
• Synthesizing is required and makes sense of all the information that
has been captured
– Comparing similarities and contrasting differences
– Critically evaluating studies methods and tools
– Interpreting findings
– Drawing conclusions

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Development of the Literature Review
•Characteristics
– Comprehensiveness that is
relevant and focused
– Concise statement of what is
known and unknown
– Logical and succinct summary
from mostly primary sources
– Critical analysis and evaluation
including strengths,
weaknesses, limitations, and
gaps
– Synthesis
•Conventions
• Transparency
• Organizational structure
• Progression
• Equitable coverage
• Pertinence
• Style
•Good literature reviews deliver concentrated knowledge to the
reader

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Review
• Research question: Clear statement, in form of a question, of a specific
issue within the topic the researcher wishes to study
• Development of a quantitative research question results in a researchable
and specific question at onset of study; development of qualitative research
question results in initial preliminary question refined during study
• Acronyms FINER and PICO(TS) represent strategies to refine research
questions
• Problem statement: Single sentence with action verb that specifically and
succinctly states what will be done to investigate the research question
• Hypothesis: Statement of researchers’ predictions on study’s outcome.
Quantitative versions are null and alternative and can be one-tailed or two-
tailed
• Literature review: Systematic acquisition, analytical examination, critical
evaluation, and synthesis of important information about a topic