What is research : The nature, role and context of research in health and social care

1. What isresearch: The nature,role andcontextof
researchin health andsocial care
Dr.NouraAlMadani, RN,BSN,CI,MSN, PhD
DirectorofProjectManagement &Transformation,General DirectorateofNursing
noura.almadani123@gmail.com
nalmadani@moh.gov.sa
www.linkedin.com/in/noura-almadani2020
@noura_almadani

2. Knowledge and basic characteristics
What is researchand why dowe need it?
Theresearchprocess
Wheredo ideas originate
Different approaches to research
Example researchprojects
Outlines

4. Fundamentalto humannatureto ask the question
“why”?
Use thescientific methodto make discoveries
Coherentframework to explain world around us.
Focus on theperson
Basic science/applied research
HSC focus on applied research

5. Why should I be interested in theresearch process?
• Systematically build knowledge and test
treatment efficacy
• Impact health policy and service
delivery
• Participate in research activities
• Enhance understanding of daily practice
• Become critical consumer of research
literature

6. Howdo weknowwhat weknow?
Informal knowledge
Authority
Hearsay
Pastexperiences
Beliefs & intuition
Research must be based on
systematic thought
processes & methodological
investigation involving
documentation, analysis &
drawing conclusions

7. Threebasic characteristics
of HSC research
 Logical – set of reasoning
methods that involve defined
ways of thinking, for example
 Deductive reasoning
 Inductive reasoning

8. Threebasic characteristics
of HSC research
 Understandable – the process
followed, logic employed and
conclusions drawn must be
understandable by others

9. Threebasic characteristics
of HSC research
 Useful – knowledge could
inform professional practice
and/or improve health
outcomes.

10. The research process
 Identifya philosophicalfoundation&frameyour research
problem
 Determinethe supportingknowledge& theorybase
 Developa specificresearch question
 Select a designstrategyand setstudy boundaries
 Consider ethicalissues &obtain information
 Analyseinformationand draw conclusions
 Share anduse research knowledge

11. Research Philosophy
Ontology is the sum of beliefs that
reflect an individual’s interpretation
about what constitutesa fact
(Phillimore& Goodson, 2004). It is
associated withthecentral questionof
whethersocial entitiesneed to be
perceived as objective or subjective.
Objectivism / Realism
Constructivism / Idealism

12. Ontology

13. Epistemology
Epistemology explores the interconnectionbetween
theresearcher and theexistence of facts (Phillimore &
Goodson, 2004), or the way in whichit is acquired or
established. Epistemology is the study of thefact and
scope of existingknowledge(Reimer-Kirkhamet al.,
2009)

14. Positivist Paradigm
 Emphasizes thathumanreason is supreme and that
there is a single objective truththatcan be
discovered by science
 Encourages us to stress the functionof objects,
celebrate technologyand to regard the world as a
rational, ordered place with a clearly defined past,
present and future

15. Non-Positivist Paradigm
 Questions theassumptionsofthepositivistparadigm
 Argues thatour societyplaces toomuch emphasison
science andtechnology
 Argues thatthis ordered,rationalviewofconsumers
deniesthe complexityofthe socialand culturalworld
we livein
 Stresses theimportanceof symbolic,subjective
experience

16. Threeconditions must be considered whendetermining
the appropriate research method:
1. The type of research question posed;
2. The extentof control the investigator has over
actualbehavioural events; and
3. The degree of focus on contemporary as opposed
to historical events.
The relationship betweenthethree conditions and the
related research methods

17. The different approaches to research
• Quantitative methodology
• Qualitative methodology
• Mixed methods: combination of both approaches

18. Bellenger,Bernhardt and Goldstucker, Qualitative Research in Marketing, American Marketing Association
Qualitative
Research
‘QualitativeResearch…involves
findingout whatpeople think,and
how theyfeel- or at any rate, what
they say they thinkand how they say
they feel. This kind of informationis
subjective. It involves feelingsand
impressions, rather thannumbers’

19. What is Qualitative Research?
 Qualitativeresearch is multimethodin focus, involving an
interpretative, naturalisticapproach to its subject matter.
 QualitativeResearchers study “things”(people and their
thoughts)in theirnaturalsettings, attemptingto makesense
of, or interpret, phenomenain terms of themeanings people
bring to them.

20. Qualitative questions
 What is it like to have a certain condition?
 What does it meanto the patient?
 What has the experiencebeen like?
 How has thisexperience made you feel?
 What do you thinkhelped you through this
experience?
 Has anythingmade the experience worse?

21. Boyd,pp.67-68 in Munhall, 2001
Qualitative Research
 There is typically a highlevel of researcher involvement
withsubjects; strategies of participant observation and in-
depth, unstructuredinterviews are often used.
 The data produced provide a description, usually
narrative, of people living throughevents insituations.

22. Examples of Qualitative Research
• Exploring the experience of
person-centred care of people
with chronic back pain
• Understanding the challenges
associated with frequent
medication changes for older
people...

23. Quantitative research
• Quantitative research - ‘Explaining concepts/issues by collecting numerical
data that are analysed using mathematically based methods (statistics)’
• Variable – ‘a feature that is liable to vary or change’
– Dependent – ‘depends on other factors e.g. blood pressure’
– Independent - ‘stands alone and isn't changed by the other variables you are
trying to measure e.g. age’
– Confounding – 3rd type and can affect the relationship between the independent
and dependent variable.
• Hypothesis – ‘proposed explanation made on the basis of limited evidence
as a starting point for further investigation’

24. Approaches to Quantitative Research
• Classification based around how we control the
variables.
• Four main types
– Descriptive
– Correlational
– Causal-comparative
– Experimental

25. Descriptive research
• Describe current status of identified variable.
• Provide systematic evidence.
• Generally no hypothesis.
• Requires:-
– 1) Careful participant selection
– 2) Careful measurement of each variable
• Often used to generate an hypothesis

26. Correlational research
• Determine relationship between ≥ 2 variables
• Uses statistics
• Seeks to identify trends or patterns
• Does not prove causation
• Data, relationships and distributions of variables studies ONLY
• Similarity – descriptive research

27. Causal-comparative research
• Establish cause-effective relationships
• Independent variable identified BUT NOT changed
• Natural groups form around variable studied
e.g. sun exposure
• Dependent variable measured.
• Careful consideration of unknowns.

28. Experimental research
• True experimentation (lab study)
• Scientific approach to test cause-effect
• Identify and control all variables (except one)
• Independent variable manipulated to understand effects
on dependent variables
• Subjects randomly assigned into test condition groups
(not natural)

29. What is Quantitative Research?
 Singlereality
 Establish ultimaterules
 Determinerelationships and
make predictions

30. What is Quantitative Research?
 Suggest& develop theories
 Deductive reasoning to
generatespecific hypothesis
 Hypothesis testingused to
refinetheory

31. What is Quantitative Research?
 Factsobtainedthrough objective
observation
 Measurementindependentof
observer
 Allobservations reducedtoa
number

32. What is Quantitative Research?
 Test hypotheses with statistics
 Controlled conditions
 Oftenmanipulateone variable
whilstmeasuringanother

33. Quantitative Research
 Hypothesis testing used to refine theory
 Theories must be general statements
which are consistent
 Ultimateaim is to bring together
observations findings into meaningful
pattern
 Ability to make predictions
 Quantitative research proceeds
sequentially

34. Examples of quantitative research
• Epidemiological study of type
II diabetes
• RCT: strategies for reducing
medication errors amongst
nurses

35. How does Qualitative
Research differ from
Quantitative?

36. How does Qualitative Research differ from
Quantitative?

37. How does Qualitative Researchdiffer from Quantitative?
 A systematic,subjective approach used to describe
life experiencesand give themmeaning
 Useful in understandinghumanexperiences such as
pain, caring,powerlessness, and comfort
 Focuses on understandingthe whole
 Consistentwith holisticphilosophy of nursing

38. A Comparison of Qualitative and Quantitative
Methodological Approaches
Research component Quantitative Qualitative
1. Primary purpose Determine outcomes Understand phenomenon
2. Research question ‘‘What’’ questions; eg, ‘‘What is the
impact of a new
educational intervention in
professionalism?’’
‘‘How’’ and ‘‘why’’ questions;
eg, ‘‘Why is a new program
in professionalism effective or
not?’’ ‘‘How is it effective?’’
3. Selection of
participants
Intervention and comparison groups;
groups selected to
be equal or randomized
(generalizability
Purposive to ensure
representation of important
elements of the research
question; include outliers
4. Sample size Determined a priori by power
calculation
Determined when data
saturation is achieved (through
data collection and analysis)
5. Analysis Statistical, numeric Interpretive, narrative
6. Research quality and
rigor
Ensure quality of the data (validity)
and of the data
analysis (reliability)
Ensure quality of the data
(authenticity) and data
analysis (trustworthiness

39. Watch this Video
https://youtu.be/uF-9MEaiud4

40. Mixed method research– combining both approaches
Nowincreasingpractice of integratingbothapproaches.
 Mixedmethodsapproach allows potentialshortcomings ofeach
approach tobeaddressed,e.g.
 Oversimplificationofindividualperceptionswithexperimental-type
research.
 Lackofconsistencyinqualitativeresearch
 Allowstheresearchertoseethewhole
 Differentapproachestocombiningmethods,e.g.firstqualitativeresearch
thenexperimental-typeapproach.

41. Selecting your approach
• Which area of health/healthcare are you interested in?
• What research output could influence thinking in your field?
• How do you think as an individual, does experimental-type
research of qualitative research make more sense to you?
• Consider what is already known in your particular topic area.
• Consider qualitative research if nothing known
• Large experimental-type study to investigate a current
treatment

42. Characteristics of a good researcher
• Open mindedness: Questions to ask, strategies to use,
possible explanations
• Knowledge of a specific subject: Know field so can ask
pose appropriate research questions
• Intellectual curiosity: Desire to read and develop in-
depth understanding of one field
• Perseverance: The research process is time consuming
and often laborious
• Honesty: Possible to alter data or to plagiarise work

43. Frame your research problem - Where do
ideas originate
• Topic identification:
• Personal interest
• Relevance
• Need
• How you think as an individual
• Purpose
• Resources
• Often easy to identify problem area but more
difficult to formulate exact question

44. Frame your research problem - Where do
ideas originate
• Professional experience/practice
• Own observations, patient feedback
• Societal trends
• Reflected in government policy,
eg obesity related illness, aging, participation in sport
• Look at priorities of research councils, MRC, NIHR or
local calls for research

45. Frame your research problem - Where do
ideas originate
• Research studies
– Reading research papers
– Attending profession meetings
– /conferences
– Recent topical review or
– meta-analyses
• Existing theory
– Do you want to challenge exist theory?
– New theory - Is there unexplained phenomena in your field?

47. An introduction
to qualitative
methods

48. Objectives: that you will start to...
• consider a range of approaches to qualitative research that can be applied to a
variety of research situations
• be able to select, apply and critically appraise applied research techniques that can
be used in qualitative studies
– be able to critically appraise the purpose, process and products of research activity
– have an increased ability to critically evaluate current research and to evaluate
research methods used by others
– have critically reflected on your developing competence as a researcher and the
implications for the development of this part of your role
Aim:To enhance your understanding of the process of qualitative research

49. What is Qualitative Research?
 A holistic approach to questions--arecognition that
humanrealitiesare complex. Broad questions.
 The focus is on humanexperience
 The research strategies used generallyfeature
sustainedcontact withpeople in settingswherethose
people normally spend their time. Contextsof Human
Behavior.

50. Goals of Social Researchthat are primarily answered
using qualitative strategies
 Giving voice
 Interpreting cultural and historical phenomena
 Due to the fact thatthere are often many aspects involved in historical
research, and because many of the materials are not specifically
quantitative in nature
 Advancing new theories
 “Inductive logic”; it goes from a specific case to a general case
 qualitative cases are often more in-depth, and give a fuller picture of
phenomena than quantitative cases

51. Features of Qualitative Research
 Exploratorypurpose
 Focus on naturalbehavior
 Emphasisonsubjectiveexperience
 Examinationofcontext,environment
 Inductivemethods
 Idiographic explanation
 Awarenessofresearcher’s role

52. Describe Understand Explain
Identify Develop Generate
Qualitative Research Purpose

53. Qualitative Research Methods
 Multiplerealities
 Natural settingfor data collection
 Researchers and participants
interact
 Resultsare rich descriptions

54. Phenomenological
Grounded Theory
Ethnography
NarrativeResearch
Historical
Approaches to Qualitative Research

57. PurposeType
Understanding culture,values, or perceptionsEthnographic
Conducting research without anypreconceived ideas or theories; using it
to develop new theories.
Grounded Theory
Understanding how women areoppressed in societyFeminist
Understanding how people assign meaning totheir life stories. Thisis also
used to analyzetranscripts of therapy sessions
Narrative
Understanding how orwhyan individual, group, organization, or
communityhas experienced a problem orintervention
Case Studies
Bringinggroups of people (including clients) together to conduct research.
Thepurpose is to use researchto document social problems andbring
forth social change.
Participatory ActionResearch
Summary of Qualitative Approaches

59. Qualitative
Research Process
Justify thesignificance ofthe
study
Select topic and problem
Design study
Identify and gain accessto
subjects
Select study subjects and
data
Interpretresults
1
2
3
4
5
6

61. Role ofResearcher in qualitative method
 Monitoringand Reducing Bias
 Developing Competence inMethods
 Collectingand Analyzing Data
 Presentingthe Finding

64. Validity and rigour
• Data analysis is a subjective process undertaken
by the researcher
• Role and bias of the researcher must be taken
into account (reflective diary/field notes)
• Validity can be improved by:
– Sound methodology and methods
– Transparency of method
– Respondent validation
– Triangulation
– Reflexivity

65. Validity and rigour
• Aim is to tell a credible ‘story’ about
how the new knowledge has been
created
• Strong links between ontology –
epistemology – data collection
methods – data analysis –
presentation of findings

66. Assessing trustworthiness
(Lincoln & Guba, 1986)
• Credibility: extent to which the findings represent reality
– Appropriate methods to answer the research question (link between
epistemology and methods)
– Triangulation
• Transferability: extent to which the findings can be applied to other situations
– Appropriate, transparent sampling technique
• Dependability: extent to which the study could be repeated in another setting
– Clear and transparent reporting of data collection and analysis methods
• Confirmability: extent to which the findings represent the participants’
viewpoints
– Member checking

67. (Probyn et al, 2015)

71. Interpretation/ Analysis

74. Reading
• Creswell J.W. (2007) Qualitative inquiry and research
design: choosing among five approaches. Sage, UK
• Holloway I. (2008) A-Z of qualitative research in health
care, Blackwell publishing, UK
• Silverman D. (2000) Doing qualitative research: a practical
handbook, Sage,UK
• Silverman D.(2004) Qualitative research: theory, method
and practice, Sage,UK
• Speziale H.J.S. and Carpenter D.R. (2007) Qualitative
research in nursing: Advancing the humanistic
perspective Lippincott, Williams and Wilkins, USA

75. Thank You