Community health nursing 2

1. STUDY DESIGNS

2. Definition
• A study design is a specific plan or
protocol for conducting the study, which
allows the investigator to translate the
conceptual hypothesis into an operational
one.

3. Definition of Terms
• Case studies-An in depth examination of
groups of people.
• Phenomenological studies-Examine human
experiences through the descriptions that
are provided by the people involved.

4. Cont…
• Action research-seeks attention to improve
practice and studies the effects of the action
that was taken.
• Historical studies-concerned with the
identification, location and synthesis of
data from the past.

5. Choice of Study Design
Depends on:
–Research Questions
–Research Goals
–Researcher Beliefs and Values
–Researcher Skills
–Time and Funds

6. Cont…
It is also related to:
• Status of existent knowledge
• Occurrence of disease
• Duration of latent period
• Nature and availability of information
• Available resources

7. Types of Study Designs
• Qualitative
• Quantitative
–Observational
•Basic
•Hybrid
•Incomplete

8. Observational Designs
(Classification II)
• Preliminary (case-reports, case-series)
• Basic (cross-sectional, case-control, cohort
[prospective, retrospective] )
• Hybrid (two or more of the above, nested
case-control within cohort, etc)

9. Quantitative study design cont…
• Quasi experiment – used to estimate the causal impact of
an intervention using treatment and control groups
• Correlational – study of relationship or connection
between two variables
• Descriptive – study to depict participants in their natural
occurrence or accurately
• Survey – research that gets information from a specific
group of people and can be done on phone, face to face or email
• Experimental - controlled factor or variable is subjected
to a certain treatment or intervention to compare with a factor
kept constant
• Comparative - compares two groups of participants in an
attempt to draw a conclusion on the subject of study
• Evaluative – determines the impact of an intervention or
program mostly in a social context

10. RCT
– The “gold standard” of research designs.
They thus provide the most convincing
evidence of relationship between exposure
and effect.
– Example:
Trials of hormone replacement therapy
in menopausal women found no
protection for heart disease,
contradicting findings of prior
observational studies

11. Qualitative study designs
• The grounded theory tradition, with roots
in sociology, seeks to describe and
understand the key social psychological
processes that occur in a social setting
It was developed in the 1960s Glaser and
Strauss (1967).

12. • Phenomenology, rooted in a philosophical
tradition developed by Husserl and
Heidegger, is concerned with the lived
experiences of humans.
• Its an approach to thinking about what life
experiences of people are like and what they
mean

13. • Ethnography is the primary research tradition
within anthropology, and provides a
framework for studying the lifeways and
experiences of a defined cultural group.
• Ethnographers typically engage in
extensive fieldwork, often participating in the
life of the culture under study.

14. Historical Research
• “History is an estimate of the past from the
standpoint of the present.”
• Historical research examines the events of the
past.
• Historical research increases the nurse’s
understanding of their profession.

15. Philosophical Inquiry
• Philosophical researcher considers an idea or issue
from all perspectives through an extensive exploration
of the literature, examining conceptual meaning,
raising questions, proposing answers, and suggesting
the implications of the answers.
• The purpose of philosophical inquiry is to perform
research using intellectual analyses to clarify meanings,
make values manifest, identify ethics and study the
nature of knowledge.
• It consists of 3 types: Foundational inquiry,
Philosophical analysis and Ethical inquiry.

16. Critical Social Theory
• Critical social theory involves analysis of
systems of thought that lead to patterns of
domination and prevent personal growth of
individuals within a society.

17. Qualitative Research Techniques
• Participant observation
– Gains insight into understanding cultural patterns to
determine what’s necessary and needed in tool
development (complementary to interviews)
• Interviews/Focus groups with
stakeholders
– Explores how tools are used and could be used in a
novice programming course
– Gains insight into the meaning of tools for students for
learning to program

18. Cont…
• Data analysis
– Themes arising from data would provide insight into
current “learning to program” issues and see what is
important to students / tutors / administrators
• Survey
– Useful for verifying results on a larger scale
• User Testing
– Useful for triangulating results

19. Rigor in Qualitative Research
• Dependability
• Credibility
• Transferability
• Confirmability

20. Dependability
• Refers to the stability & trackability of the
changes in data over time & conditions
• Reflects the reality that people’s situations
change & reality differs for people
• Want to determine the extent to which
another researcher with similar training &
rapport with participants would make the
same observations
• This is determined by an audit trail

21. Credibility
• Refers to the accuracy of the description
• Enhanced by prolonged time in the field
• Repeatedly observing & interacting with
participants
• Triangulation (that facilitates validation of
data through cross verification from two or
more sources of data, methods, data type,
investigators, & theories
• Member checks-participants involved with
data analysis

22. Transferability
• Concerned with generalizability or
fittingness of findings to other settings,
populations, & contexts
• Lack of transferability is often viewed as a
weakness of qualitative methods

23. Confirmability
• Neutrality is the focus
• Do conclusions depend upon the subjects &
conditions of inquiry rather than on the
researcher
• Would 2 independent researchers agree about
the meanings emerging from the data
• An audit trail is used
• Researcher must explicate how personal biases
may have come into play and consider
alternative explanations

24. Advantages of Qualitative
• Helps explain
relationships in detail;
individualistic
• Can help validate
quantitative findings by
further investigation
• Can help close gap
between research and
practice
– Needs of individuals in
institutions
– Study problems more
relevant to policy makers
• Less dependent on
instrument
• Can bring change in
institutions and society
– In-depth
– Personalized
– Examines specific issues

25. Disadvantages of Qualitative
• Strong dependency on
sample population
– Access
– Honest and valid
information
• Time and resources
needed for collection and
analysis is intensive
• Lack of objectivity and
bias by researcher
– Inferences made
– Incorrect conclusions
• Convenience sampling
• Lack of training or
knowledge about
methodology
• Lack of ability to
produce and
comprehend research

26. Study populations
• Cross-sectional: where only ONE set of
observations is collected for every unit in the
study, at a certain point in time, disregarding
the length of time of the study as a whole.
• Longitudinal: where TWO or MORE sets of
observations are collected for every unit in the
study, i.e. follow-up is involved in order to
allow monitoring of a certain population
(cohort) over a specified period of time. Such
populations are AT RISK (disease-free) at the
start of the study.

27. Case-series:
Clinical case series
• Clinical case-series: usually a coherent and
consecutive set of cases of a disease (or similar
problem) which derive from either the practice of
one or more health care professionals or a defined
health care setting, e.g. a hospital or family
practice.
• A case-series is, effectively, a register of cases.
• Analyse cases together to learn about the disease.
• Clinical case-series are of value for:
– Studying symptoms and signs
– Creating case definitions
– Clinical education, audit and research

28. Case series:
Population based
• When a clinical case-series is complete for a
defined geographical area for which the
population is known, it is, effectively, a
population based case-series consisting of a
population register of cases.
• The most important case-series are registers
of serious diseases or deaths, and of health
service utilisation, e.g. hospital
admissions.
• Usually compiled for administrative and legal
reasons.

29. Cross-sectional Studies
(Community health studies,
surveys)
• Characteristics: detects point prevalence; relative
conditions; allows for stratification
• Merits: feasible; quick; economic; allows study of
several diseases / exposures; useful for estimation of
the population burden, health planning and priority
setting of health problems
• Limitations: temporal ambiguity (cannot
determine whether the exposure preceded
outcome); possible measurement error; not suitable
for rare conditions; liable to survivor bias
• Effect measure: Odds Ratio

30. Cohort Studies
• Characteristics: follow-up period
(prospective; retrospective)
• Merits: no temporal ambiguity; several
outcomes could be studied at the same
time; suitable for incidence estimation
• Limitations (of prospective type):
expensive; time-consuming; inefficient for
rare diseases; may not be feasible
• Effect measure: Risk Ratio (Relative Risk)

31. Advantages of Quantitative
• Observations are used
throughout studies
• Formulating hypotheses
allows for speculation
about outcomes;
applicable instrument
• Safeguards used to
minimize or eliminate
bias
• Predicts correlation
between objects
• Systematic data
collection and analysis
• Generalizable to other
institutions for further
research
• Recognized criteria for
assessment and validity
• More research
conducted by this
method

32. Disadvantages of Quantitative
• Should only be used if
data can be measured by
numbers, results
quantified
• Instrument or method
chosen is subjective and
research is dependent
upon tool chosen
• Lack of independent
thought by researcher
when dependent on
instrument or
mathematics used to
extract or evaluate data
• Individuals’ decisions not
evaluated based on their
culture or social interactions
• Decisions made without regard
to individual human thought or
choice to predict behavior
• All individuals are measured
same way
– Experiences
– Backgrounds
– Intelligence
– Ability to change decisions at
any given point in time
– Independent though

33. Comparison
Qualitative
• Understanding
• Interview/observation
• Discovering frameworks
• Textual (words)
• Theory generating
• Quality of informant more
important than sample size
• Subjective
• Embedded knowledge
• Models of analysis: fidelity to
text or words of interviewees
Quantitative
• Prediction
• Survey/questionnaires
• Existing frameworks
• Numerical
• Theory testing
(experimental)
• Sample size core issue in
reliability of data
• Objective
• Public
• Model of analysis:
parametric, non-parametric