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Unit 2. Introduction to Quantitative & Qualitative Reseaerch.pptx

The document provides an overview of qualitative and quantitative research methods, detailing their distinctions, data types, and analysis techniques. It categorizes quantitative research into descriptive and analytical research, while exploring various forms of qualitative research. The document outlines study designs such as cohort and case-control studies, emphasizing their advantages and disadvantages in research methodology.

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Introduction to Quantitative and Qualitative Research Shakir Rahman BScN, MScN, MSc Applied Psychology, PhD Nursing (Candidate) University of Minnesota USA Principal & Assistant Professor Ayub International College of Nursing & AHS Peshawar Visiting Faculty Swabi College of Nursing & Health Sciences Swabi Nowshera College of Nursing & Health Sciences Nowshera 7/19/2023 2
Objectives At the completion of this unit learners will be able to: 1. Define the terms of qualitative and quantitative research. 2. Differentiate between qualitative and quantitative research. 3. Describe methods/approaches/types of quantitative research, i.e. Descriptive, Co- relational, Quasi-Experimental and Experimental research. 4. Describe methods/approaches/types of qualitative research i.e. Phenomenological, Grounded Theory, Ethnographical, and Historical research 5. Understand methodologies of qualitative and quantitative research. 7/19/2023 3
Quantitative Research • Attempts to explain phenomena by collecting and analysing numerical data • Tells if there is a “difference” but not necessarily why • Data collected are always numerical and analysed using statistical methods • Variables are controlled as much as possible (RCTs as the gold standard) so could eliminate interference and measure the effect of any change • Randomisation to reduce subjective bias • If there are no numbers involved, its not quantitative • Some types of research lend themselves better to quant approaches than others 4 7/19/2023
Quantitative data • Data sources include – Surveys where there are a large number of respondents (esp where you have used a Likert scale) – Questionnaires, data collection tools/ instruments – Observations (counts of numbers and/or coding data into numbers) – Secondary data (government data; SATs scores etc) • Analysis techniques include hypothesis testing, correlations and cluster analysis 7/19/2023 5
Qualitative Research • Any research that doesn’t involve numerical data • Instead uses observations, words, pictures, videos, audio recordings. Field notes, expressions, and peoples’ own words. • Tends to start with a broad question rather than a specific hypothesis • Develop theory rather than start with one • Tends to yield rich data to explore how and why things happened • Don’t need large sample sizes (in comparison to quantitative research) 7/19/2023 6
Qualitative data • Interviews (structured, semi-structured or unstructured) • Focus groups • Questionnaires or surveys • Secondary data, including diaries, self-reporting, written accounts of past events/archive data and company reports; • Direct observations – may also be recorded (video/audio) • Ethnography • Data analysis; thematic or content analysis 7/19/2023 7
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9 9 Classification of Quantitative Research Descriptive Research Analytical Research 7/19/2023
10 Descriptive Research Population based Individual based Case reporting Case series Ecological / Correlational Cross-sectional surveys 7/19/2023 10
11 Analytical Research Observational Experimental / Interventional Randomized Control Trials Cohort study Quasi- Experimental Case–control study Cross-sectional study 7/19/2023 11
12 Objectives at various levels DESCRIPTIVE STUDIES 1. Knowing the frequency of disease 2. Knowing the distribution 3. Developing the hypothesis OBSERVATIONAL ANALYTICAL 1. Testing the hypothesis 2. Establishing association EXPERIMENTAL OR INTERVENTIONAL STUDIES 1. Strength of association 2. Establishing the cause Study Types Objectives 7/19/2023 12
Study Types STUDY TYPES Descriptive ( hypothesis formulation) Individual based Case studies Case series Population based Ecological Analytical/Experimental (hypothesis testing ) Observational Case-control cohort Cross- sectional Interventional RCT’s (III) Quasi- Experimental The researcher studies, but does not alter, what occurs The researcher intervenes to change reality, then observe what happens 7/19/2023 13
14 Descriptive Studies • Describe only; do NOT examine associations between Exposure (E) and health Outcome (O). • Generally the purpose is to describe the variability in a health outcome and/or formulate hypotheses. • A descriptive study involves describing the characteristics of a particular situation event or case. • Descriptive studies can be carried out on a small or larger scale. 14 7/19/2023
Types of Descriptive Studies Individual Based Case Study A study of one diseased individual, providing a detailed description of an uncommon disease; provides timely or rare information. OR A single patient’s clinical history is described in detail, and then discussed in relation to the literature. Almost always a rare unusual, or atypical case. 7/19/2023 15
Types of Descriptive Studies Individual based Case Series : A study of multiple occurrences of unusual cases that have similar characteristics. Investigators can calculate the frequency of symptoms or characteristics of people with the disease. Results may generate causal hypotheses. Neither a case study nor a case series includes a comparison group. 7/19/2023 16
Case Report Case Series One case of unusual finding Multiple cases of finding Descriptive Study Designs 7/19/2023 17
18 Types of Descriptive Studies Individuals Based Cross sectional Surveys – Subjects or institutions are surveyed in order to describe the prevalence of health outcomes and /or characteristics of a population 18 7/19/2023
19 Descriptive Studies Population Based • Ecological – An ecological study focuses on population/ groups of people (rather than individuals) as the units of analysis. – Ecological studies are used to understand the relationship between outcome and exposure at a population level, where 'population' represents a group of individuals with a shared characteristic such as geography, ethnicity, socio-economic status of employment. – The variables include measurements taken at the group level e.g. infant mortality rates of different countries. 7/19/2023
20 Types of Observational Analytical Studies 20 7/19/2023
Analytical (Non- Intervention) Studies Cross- sectional studies Case- control studies Cohort studies 7/19/2023 21
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Cross-sectional study Information is collected from each subject at one point of time Used to provide a snapshot of a population at a point in time The main out-come measure is prevalence (Prevalence study) Limited to the measurement of risk factor and out-comes at one simultaneous point in time Examples: screening surveys knowledge attitude and practice (K.A.P.) surveys 7/19/2023 24
Target Population Sample Gather Data on Exposure and Disease Exposed; Do not have Disease Not Exposed; Have Disease Not Exposed; Do not have Disease Begin with: 4 groups are possible Exposed; Have Disease Determine presence or absence of exposure & presence or absence of disease 7/19/2023 25
a b c d No disease Disease Exposed Not Exposed a b c d a b c d No disease Disease Disease No disease Exposed Exposed Not Exposed Not Exposed 7/19/2023 26
a b c d a b c d No disease Disease Disease No disease Exposed Exposed Not Exposed Not Exposed Prevalence of disease compared in exposed and non exposed a a+b vs. c c+d Prevalence of exposure compared in diseased and non diseased vs. b b+d a a+c OR 7/19/2023 27
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Advantages of cross-sectional • Outcomes and exposures measured at the same time • Uncovers associations for further study • Useful for hypothesis generation • Quick & cheap (no follow up) • Best way to determine prevalence • Questionnaire/interview based • Useful for assessing practice, attitudes, knowledge, beliefs , utilisation of services etc 7/19/2023 29
Advantages of Cross-Sectional study • Can be conducted to assess the health care needs of the population • Helpful in measuring access and utilization of health services • Provides information between disease and various variables • Provides information regarding distribution of a disease • Determines burden of the diseases in a population. So helpful for planning purposes 7/19/2023 30
Limitations of Cross-Sectional study • No temporal or time sequence so gives no information whether which comes first i.e. Cause or Disease • Gives no idea about natural history of the disease or etiology • Gives no measure of new cases occurrence • Not useful for rare exposures or rare outcomes 7/19/2023 31
CASE-CONTROL STUDY DESIGN 7/19/2023 32
Case-control studies •An analytical epidemiologic study design in which individuals who have the disease under study, also called cases, are compared to individuals free of disease (controls) regarding past exposures. •Exposure differences between cases and controls are helpful to find potential risk or protective factors. •The purpose is to determine if there are one or more factors associated with the disease under study. 7/19/2023 33
CASE-CONTROL STUDY • To examine the possible relation of an exposure to a certain disease, we identify; 1. A group of individuals with the disease (called cases) and for purpose of comparison, 2. A group of people without the disease or outcome variable (called controls ). 3. The study compares the occurrence of the possible cause in cases and in controls. 7/19/2023 34
DESIGN OF A CASE-CONTROL STUDY 7/19/2023 35
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Advantages of case-control Studies • Can be carried out quickly and quite cheaply • Useful for rare diseases and outcomes • Can study multiple exposures for a single outcome • Case control studies can be ideal for the study of rare diseases or those with a long latency • Compares odds of exposure between cases and controls 7/19/2023 40
Disadvantages of case-control studies • Selection of control population, overmatching • Information bias as exposures – similar status determined after outcome has occurred e.g. Recall • Selection bias especially regarding controls • Cannot establish sequence of events (temporal relationship) • Not good for rare exposures • Cannot usually be used to estimate incidence rates, relative risks or attributable risks 7/19/2023 41
COHORT STUDY • Cohort studies are also called “Follow-up or Incidence Studies”. • Because the data on exposure and disease refer to different points in time, cohort studies are also longitudinal. • Cohort studies have also been called “Prospective Studies”. 7/19/2023 42
Cohort studies •The observation of a cohort over time to measure outcome(s) •Synonymous terms (Last’s) ◦Follow-up ◦Longitudinal ◦Prospective 7/19/2023 43
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Cohort studies Exposure cohort: a group of individuals that potentially share a common exposure e.g. Radiation Disease cohort: a group of individuals with a specific disease. 7/19/2023 45
STEPS IN COHORT STUDY • Cohort studies are conducted in three fundamental steps: 1. Identify cohorts of exposed and unexposed individuals who are free of the disease/outcome of interest at the beginning of the study. 2. Observe each cohort over time for the development of the outcome(s) of interest. 3. Compare the risks of outcomes between the cohorts. 7/19/2023 46
COHORT STUDY DESIGN 7/19/2023 47
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Prospective Retrospective Ambidirectional Recruitment Exposure Outcome Exposure Outcome Exposure Outcome Exposure Outcome Time Cohort studies 7/19/2023 51
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COHORT STUDY DESIGN • Cohort study measure: i. Incidence rate ii. Relative Risk iii. Attributable Risk 7/19/2023 57
DESIGN OF A COHORT STUDY Disease Develop Disease Does not Develop Total Incidence Rate of Disease First Select Exposed Not Exposed a c b d a + b c + d a/a+ b c/c + d Then Follow to see whether 7/19/2023 58
INCIDENCE RATE • Incidence in exposed group = a/ a + b • Incidence in unexposed group = c/ c + d • Incidence in total (exposed + unexposed) • = a + c a + b + c + d 7/19/2023 59
RELATIVE RISK • Cohort study determine whether there is an association between exposure to a factor and development of a disease. • Relative Risk = Incidence in exposed Incidence in unexposed = a/ a + b c/ c + d 7/19/2023 60
ATTRIBUTABLE RISK • This is determined by the “Attributable Risk”, which is defined as “the amount or proportion of diseases incidence (or disease risk) that can be attributed to a specific exposure”. • Attributable Risk is calculated as follow: • Risk Difference = (Incidence in exposed group ) – (Incidence in non-exposed group [Background risk] 7/19/2023 61
Advantages of cohort studies • Useful for rare exposures • Useful for more than one outcome • Incidence of the outcome (and incidence rates) • Temporal relationship between exposure and outcome is clear as exposure status defined at start of study • If prospective, minimises bias in measurement of exposure • Sometimes the only ethical or legal way to do study 7/19/2023 62
Disadvantages of cohort studies • Not good for study of rare outcomes • If retrospective they rely on the adequacy of records • Exposed may be followed more closely than unexposed • If prospective they can be very expensive and slow • As they are follow up studies, the validity of results is highly sensitive to losses to follow up (migration, withdrawal, lack of participation, death) 7/19/2023 63
EXPERIMENTAL STUDY DESIGN 7/19/2023 64
Randomized Controlled Trial (RCT) ”An epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called interventional and control groups to receive and not receive an experimental preventive or therapetuic procedure, or interventition” 7/19/2023 65
Randomized Control Trials (R.C.T) Randomization: Allocation of participants to various groups in random fashion Intervention: The group of participants which receives intervention/ treatment. Control: The group of participants which receives placebo. Trials: An experiment conduction. 66 7/19/2023
Taraget population Sample Random Allocation Intervention group Control group Outcome measure Changed group during study Loss to follow up Loss to follow up RCT Reference population 7/19/2023 67
RANDOMIZED CONTROLLED TRIAL • The true experimental study design (RCT) has three characteristics: 1. RANDOMIZATION - the researcher takes care to randomly assign subjects to the control and experimental groups. • (Each subject is given an equal chance of being assigned to either group.) 7/19/2023 68
RANDOMIZED CONTROLLED TRIAL 2. CONTROL - the researcher introduces one or more control group(s) to compare with the experimental group. 3. MANIPULATION - the researcher does something to one group of subjects in the study. • Note: The strength of experimental studies is that by randomization of confounding variables. 7/19/2023 69
RANDOMIZED CONTROLLED TRIAL • In Randomized Controlled Trial (RCT), we begin with a defined population. • Subjects in the study population are randomly allocated to intervention and control groups, and the results are assessed by comparing outcomes. • The basic design of RCT is given below; 7/19/2023 70
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Allocation of study subjects - randomization •Random = governed by chance •Randomization = allocation of individuals to groups by chance •Each sampling unit has the same chance of selection 7/19/2023 72
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76 TYPES OF BLINDING • Single Blind – The subjects are not knowing the group to which they are belonging . • Double blind trials – Neither the subject nor care giver is aware about the groups • Triple blind trials – The subject, the care giver (nurse or doctor) and the person doing the analysis are not aware about the groups in. 76 7/19/2023
Advantages of RCT • Exposure in under control. • Due to randomization both intervention and control groups have similar characteristics. • By blinding the study, the observer and selection bias can be eliminated. • If properly designed & conducted, it can reduce the confounding. • Can confirm or refute etiological hypothesis. • Can evaluate the efficacy / effectiveness / efficiency of health services. • Best method for studying causal relationship. 77 7/19/2023
Disadvantages of RCT • Ethical problems Due to adverse effects Due to benefits of intervention in the treated group Provision of Placebo • Relatively expensive 78 7/19/2023
QUASI EXPERIMENTAL STUDY • In a Quasi Experimental Study, at least one characteristic of a true experiment is missing, either randomization or the use of a separate control group. • A quasi experimental study, however, always includes manipulation of an independent variable that serves as the intervention. 7/19/2023 79
QUASI EXPERIMENTAL STUDY • One of the most common quasi experimental designs uses two (or more) groups, one of which serves as a control group in which no intervention takes place. • Both groups are observed before as well as after the intervention, to test if the intervention has made any difference. • The subjects in the two groups (study and control groups) have not been randomly assigned. 7/19/2023 80
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QUASI EXPERIMENTAL STUDY • Another type of design that is often chosen because it is quite easy to set up uses only one group in which an intervention is carried out. • The situation is analyzed before and after the intervention to test if there is any difference in the observed problem. This is called a "Before- After" study/ Pre – Post Study. 7/19/2023 82
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STUDY TYPES & STRENGTH OF EVIDENCE • Analytic Study involves the systematic evaluation of suspected relationships, for example, between an exposure and a health outcome. • Analytic studies typically provide stronger evidence concerning particular relationships. • An experimental design is the only type of study design that can actually prove causation. 7/19/2023 84
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Qualitative Research Methods 7/19/2023 86
Phenomenological Studies • Phenomenological studies examine human experiences through the descriptions provided by the people involved. • These experiences are called lived experiences. • The goal of phenomenological studies is to describe the meaning that experiences hold for each subject. • This type of research is used to study areas in which there is little knowledge (Donalek, 2004). • In phenomenological research, respondents are asked to describe their experiences as they perceive them. • They may write about their experiences, but information is generally obtained through interviews. • To understand the lived experience from the vantage point of the subject, the researcher must take into account her or his own beliefs and feeling.
Example • Daly (2005) studied the lived experiences of mothers of suicidal adolescents. She contended that, unfortunately, the mother’s experience is often the hidden dimension in the family. • Unstructured interviews were conducted with 6 mothers living with suicidal adolescents. • Six themes were identified: • failure as a good mother, the ultimate rejection, feeling alone in the struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance.
Ethnographic Studies • Ethnographic studies involve the collection and analysis of data about cultural groups. • Cameron (1990) wrote that ethnography means “learning from people” (p. 5). • According to Leininger (1985), ethnography can be defined as “the systematic process of observing, detailing, describing, documenting, and analyzing the lifeways or particular patterns of a culture (or subculture) in order to grasp the lifeways or patterns of the people in their familiar environment” • In ethnographic research, the researcher frequently lives with the people and becomes a part of their culture. The researcher explores with the people their rituals and customs.
Example • Gance-Cleveland (2004) examined the features, critical attributes, processes, and benefits of school based support groups for adolescents with an addicted parent. Ethnographic methods were used to gather data. • Participant observations were conducted weekly at two high schools over one semester. • Interviews were conducted with program administrators, school administrators, group co-facilitators, and participants. • School-based support group participation was found to enhance self- knowledge and led to self-care and self-healing.
Grounded Theory Studies • Grounded theory is a qualitative research approach developed by two sociologists, Glaser and Strauss (1967). • Grounded theory studies are studies in which data are collected and analyzed and then a theory is developed that is grounded in the data. • The grounded theory method uses both an inductive and a deductive approach to theory development.
Example • The grounded theory qualitative method was used by Williams and Irurita (2005) to study the personal control and emotional comfort of hospitalized patients. Interviews were conducted with 40 patients, and 75 hours of field observations were conducted. • The basic psychological process identified by the researchers was labeled “optimizing personal control to facilitate emotional comfort.” • Personal control referred to the ability of patients to influence their environment; emotional comfort was defined as a state of relaxation that affected the physical status of the patient. • Personal control was found to be a central feature of emotional comfort.
Historical Studies • Historical studies concern the identification, location, evaluation, and synthesis of data from the past. • Historical research seeks not only to discover the events of the past but to relate these past happenings to the present and to the future. • Although there is a need for historical research in nursing, a limited number of nurse researchers have chosen it. • But the process of historical research is basically the same as in many other types of scientific research. • The problem area or area of interest is clearly identified and the literature is reviewed. Research questions are formulated. • Finally, the data are collected and analyzed.
Example • Oral histories were gathered from 8 nurses who were employed between 1951 and 1965 in a Virginia state hospital (Harmon, 2005). • These nurses were now retired and had between 12 and 46 years of psychiatric nursing experience. • The researcher wanted to describe the experiences of these nurses who practiced in a state mental hospital before and during the introduction of antipsychotic medications. • They expressed resignation and frustration while trying to provide care despite crowded wards and inadequate personnel and supplies. The nurses indicated that they focused on the patient’s body instead of on the patient’s mind. • The camaraderie they experienced with other nurses helped them continue in their positions, despite what they felt to be a “thankless job.”
Action Research Studies • Action research is a type of qualitative research that seeks action to improve practice and study the effects of the action that was taken (Streubert & Carpenter, 2002). Solutions are sought to practice problems in one particular hospital or health care settings. • There is no goal of trying to generalize the findings of the study, as is the case in quantitative research studies. In action research, the implementation of solutions occurs as an actual part of the research process. There is no delay in implementation of the solutions.
Example • Action research was used with staff in one hospice and one nursing home setting in London (Dunckley, Aspinal,Addington-Hall, Hughes, & Higginson, 2005).The purpose of the study was to identify facilitators and barriers to the use of the Palliative Care Outcome Scale (POS). • Staff took part in semi structured interviews, completed diaries, and participated in monthly meetings to give their opinions of what they thought were the facilitators and barriers to the implementation of the POS.
References • Principles of Epidemiology in Public Health Practice, Third Edition An Introduction to Applied Epidemiology and Biostatistics • http://www.cdc.gov/ • Jhonhopkin university epidemiology lectures 7/19/2023 98
Unit 2. Introduction to Quantitative & Qualitative Reseaerch.pptx

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Unit 2. Introduction to Quantitative & Qualitative Reseaerch.pptx

  • 2.
    Introduction to Quantitativeand Qualitative Research Shakir Rahman BScN, MScN, MSc Applied Psychology, PhD Nursing (Candidate) University of Minnesota USA Principal & Assistant Professor Ayub International College of Nursing & AHS Peshawar Visiting Faculty Swabi College of Nursing & Health Sciences Swabi Nowshera College of Nursing & Health Sciences Nowshera 7/19/2023 2
  • 3.
    Objectives At the completionof this unit learners will be able to: 1. Define the terms of qualitative and quantitative research. 2. Differentiate between qualitative and quantitative research. 3. Describe methods/approaches/types of quantitative research, i.e. Descriptive, Co- relational, Quasi-Experimental and Experimental research. 4. Describe methods/approaches/types of qualitative research i.e. Phenomenological, Grounded Theory, Ethnographical, and Historical research 5. Understand methodologies of qualitative and quantitative research. 7/19/2023 3
  • 4.
    Quantitative Research • Attemptsto explain phenomena by collecting and analysing numerical data • Tells if there is a “difference” but not necessarily why • Data collected are always numerical and analysed using statistical methods • Variables are controlled as much as possible (RCTs as the gold standard) so could eliminate interference and measure the effect of any change • Randomisation to reduce subjective bias • If there are no numbers involved, its not quantitative • Some types of research lend themselves better to quant approaches than others 4 7/19/2023
  • 5.
    Quantitative data • Datasources include – Surveys where there are a large number of respondents (esp where you have used a Likert scale) – Questionnaires, data collection tools/ instruments – Observations (counts of numbers and/or coding data into numbers) – Secondary data (government data; SATs scores etc) • Analysis techniques include hypothesis testing, correlations and cluster analysis 7/19/2023 5
  • 6.
    Qualitative Research • Anyresearch that doesn’t involve numerical data • Instead uses observations, words, pictures, videos, audio recordings. Field notes, expressions, and peoples’ own words. • Tends to start with a broad question rather than a specific hypothesis • Develop theory rather than start with one • Tends to yield rich data to explore how and why things happened • Don’t need large sample sizes (in comparison to quantitative research) 7/19/2023 6
  • 7.
    Qualitative data • Interviews(structured, semi-structured or unstructured) • Focus groups • Questionnaires or surveys • Secondary data, including diaries, self-reporting, written accounts of past events/archive data and company reports; • Direct observations – may also be recorded (video/audio) • Ethnography • Data analysis; thematic or content analysis 7/19/2023 7
  • 8.
  • 9.
    9 9 Classification of QuantitativeResearch Descriptive Research Analytical Research 7/19/2023
  • 10.
    10 Descriptive Research Population based Individualbased Case reporting Case series Ecological / Correlational Cross-sectional surveys 7/19/2023 10
  • 11.
    11 Analytical Research Observational Experimental/ Interventional Randomized Control Trials Cohort study Quasi- Experimental Case–control study Cross-sectional study 7/19/2023 11
  • 12.
    12 Objectives at variouslevels DESCRIPTIVE STUDIES 1. Knowing the frequency of disease 2. Knowing the distribution 3. Developing the hypothesis OBSERVATIONAL ANALYTICAL 1. Testing the hypothesis 2. Establishing association EXPERIMENTAL OR INTERVENTIONAL STUDIES 1. Strength of association 2. Establishing the cause Study Types Objectives 7/19/2023 12
  • 13.
    Study Types STUDY TYPES Descriptive (hypothesis formulation) Individual based Case studies Case series Population based Ecological Analytical/Experimental (hypothesis testing ) Observational Case-control cohort Cross- sectional Interventional RCT’s (III) Quasi- Experimental The researcher studies, but does not alter, what occurs The researcher intervenes to change reality, then observe what happens 7/19/2023 13
  • 14.
    14 Descriptive Studies • Describeonly; do NOT examine associations between Exposure (E) and health Outcome (O). • Generally the purpose is to describe the variability in a health outcome and/or formulate hypotheses. • A descriptive study involves describing the characteristics of a particular situation event or case. • Descriptive studies can be carried out on a small or larger scale. 14 7/19/2023
  • 15.
    Types of DescriptiveStudies Individual Based Case Study A study of one diseased individual, providing a detailed description of an uncommon disease; provides timely or rare information. OR A single patient’s clinical history is described in detail, and then discussed in relation to the literature. Almost always a rare unusual, or atypical case. 7/19/2023 15
  • 16.
    Types of DescriptiveStudies Individual based Case Series : A study of multiple occurrences of unusual cases that have similar characteristics. Investigators can calculate the frequency of symptoms or characteristics of people with the disease. Results may generate causal hypotheses. Neither a case study nor a case series includes a comparison group. 7/19/2023 16
  • 17.
    Case Report Case Series Onecase of unusual finding Multiple cases of finding Descriptive Study Designs 7/19/2023 17
  • 18.
    18 Types of DescriptiveStudies Individuals Based Cross sectional Surveys – Subjects or institutions are surveyed in order to describe the prevalence of health outcomes and /or characteristics of a population 18 7/19/2023
  • 19.
    19 Descriptive Studies Population Based •Ecological – An ecological study focuses on population/ groups of people (rather than individuals) as the units of analysis. – Ecological studies are used to understand the relationship between outcome and exposure at a population level, where 'population' represents a group of individuals with a shared characteristic such as geography, ethnicity, socio-economic status of employment. – The variables include measurements taken at the group level e.g. infant mortality rates of different countries. 7/19/2023
  • 20.
    20 Types of ObservationalAnalytical Studies 20 7/19/2023
  • 21.
  • 22.
  • 23.
  • 24.
    Cross-sectional study Information iscollected from each subject at one point of time Used to provide a snapshot of a population at a point in time The main out-come measure is prevalence (Prevalence study) Limited to the measurement of risk factor and out-comes at one simultaneous point in time Examples: screening surveys knowledge attitude and practice (K.A.P.) surveys 7/19/2023 24
  • 25.
    Target Population Sample Gather Dataon Exposure and Disease Exposed; Do not have Disease Not Exposed; Have Disease Not Exposed; Do not have Disease Begin with: 4 groups are possible Exposed; Have Disease Determine presence or absence of exposure & presence or absence of disease 7/19/2023 25
  • 26.
    a b c d Nodisease Disease Exposed Not Exposed a b c d a b c d No disease Disease Disease No disease Exposed Exposed Not Exposed Not Exposed 7/19/2023 26
  • 27.
    a b c d ab c d No disease Disease Disease No disease Exposed Exposed Not Exposed Not Exposed Prevalence of disease compared in exposed and non exposed a a+b vs. c c+d Prevalence of exposure compared in diseased and non diseased vs. b b+d a a+c OR 7/19/2023 27
  • 28.
  • 29.
    Advantages of cross-sectional •Outcomes and exposures measured at the same time • Uncovers associations for further study • Useful for hypothesis generation • Quick & cheap (no follow up) • Best way to determine prevalence • Questionnaire/interview based • Useful for assessing practice, attitudes, knowledge, beliefs , utilisation of services etc 7/19/2023 29
  • 30.
    Advantages of Cross-Sectionalstudy • Can be conducted to assess the health care needs of the population • Helpful in measuring access and utilization of health services • Provides information between disease and various variables • Provides information regarding distribution of a disease • Determines burden of the diseases in a population. So helpful for planning purposes 7/19/2023 30
  • 31.
    Limitations of Cross-Sectionalstudy • No temporal or time sequence so gives no information whether which comes first i.e. Cause or Disease • Gives no idea about natural history of the disease or etiology • Gives no measure of new cases occurrence • Not useful for rare exposures or rare outcomes 7/19/2023 31
  • 32.
  • 33.
    Case-control studies •An analyticalepidemiologic study design in which individuals who have the disease under study, also called cases, are compared to individuals free of disease (controls) regarding past exposures. •Exposure differences between cases and controls are helpful to find potential risk or protective factors. •The purpose is to determine if there are one or more factors associated with the disease under study. 7/19/2023 33
  • 34.
    CASE-CONTROL STUDY • Toexamine the possible relation of an exposure to a certain disease, we identify; 1. A group of individuals with the disease (called cases) and for purpose of comparison, 2. A group of people without the disease or outcome variable (called controls ). 3. The study compares the occurrence of the possible cause in cases and in controls. 7/19/2023 34
  • 35.
    DESIGN OF ACASE-CONTROL STUDY 7/19/2023 35
  • 39.
  • 40.
    Advantages of case-controlStudies • Can be carried out quickly and quite cheaply • Useful for rare diseases and outcomes • Can study multiple exposures for a single outcome • Case control studies can be ideal for the study of rare diseases or those with a long latency • Compares odds of exposure between cases and controls 7/19/2023 40
  • 41.
    Disadvantages of case-controlstudies • Selection of control population, overmatching • Information bias as exposures – similar status determined after outcome has occurred e.g. Recall • Selection bias especially regarding controls • Cannot establish sequence of events (temporal relationship) • Not good for rare exposures • Cannot usually be used to estimate incidence rates, relative risks or attributable risks 7/19/2023 41
  • 42.
    COHORT STUDY • Cohortstudies are also called “Follow-up or Incidence Studies”. • Because the data on exposure and disease refer to different points in time, cohort studies are also longitudinal. • Cohort studies have also been called “Prospective Studies”. 7/19/2023 42
  • 43.
    Cohort studies •The observationof a cohort over time to measure outcome(s) •Synonymous terms (Last’s) ◦Follow-up ◦Longitudinal ◦Prospective 7/19/2023 43
  • 44.
  • 45.
    Cohort studies Exposure cohort:a group of individuals that potentially share a common exposure e.g. Radiation Disease cohort: a group of individuals with a specific disease. 7/19/2023 45
  • 46.
    STEPS IN COHORTSTUDY • Cohort studies are conducted in three fundamental steps: 1. Identify cohorts of exposed and unexposed individuals who are free of the disease/outcome of interest at the beginning of the study. 2. Observe each cohort over time for the development of the outcome(s) of interest. 3. Compare the risks of outcomes between the cohorts. 7/19/2023 46
  • 47.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57.
    COHORT STUDY DESIGN •Cohort study measure: i. Incidence rate ii. Relative Risk iii. Attributable Risk 7/19/2023 57
  • 58.
    DESIGN OF ACOHORT STUDY Disease Develop Disease Does not Develop Total Incidence Rate of Disease First Select Exposed Not Exposed a c b d a + b c + d a/a+ b c/c + d Then Follow to see whether 7/19/2023 58
  • 59.
    INCIDENCE RATE • Incidencein exposed group = a/ a + b • Incidence in unexposed group = c/ c + d • Incidence in total (exposed + unexposed) • = a + c a + b + c + d 7/19/2023 59
  • 60.
    RELATIVE RISK • Cohortstudy determine whether there is an association between exposure to a factor and development of a disease. • Relative Risk = Incidence in exposed Incidence in unexposed = a/ a + b c/ c + d 7/19/2023 60
  • 61.
    ATTRIBUTABLE RISK • Thisis determined by the “Attributable Risk”, which is defined as “the amount or proportion of diseases incidence (or disease risk) that can be attributed to a specific exposure”. • Attributable Risk is calculated as follow: • Risk Difference = (Incidence in exposed group ) – (Incidence in non-exposed group [Background risk] 7/19/2023 61
  • 62.
    Advantages of cohortstudies • Useful for rare exposures • Useful for more than one outcome • Incidence of the outcome (and incidence rates) • Temporal relationship between exposure and outcome is clear as exposure status defined at start of study • If prospective, minimises bias in measurement of exposure • Sometimes the only ethical or legal way to do study 7/19/2023 62
  • 63.
    Disadvantages of cohortstudies • Not good for study of rare outcomes • If retrospective they rely on the adequacy of records • Exposed may be followed more closely than unexposed • If prospective they can be very expensive and slow • As they are follow up studies, the validity of results is highly sensitive to losses to follow up (migration, withdrawal, lack of participation, death) 7/19/2023 63
  • 64.
  • 65.
    Randomized Controlled Trial(RCT) ”An epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called interventional and control groups to receive and not receive an experimental preventive or therapetuic procedure, or interventition” 7/19/2023 65
  • 66.
    Randomized Control Trials(R.C.T) Randomization: Allocation of participants to various groups in random fashion Intervention: The group of participants which receives intervention/ treatment. Control: The group of participants which receives placebo. Trials: An experiment conduction. 66 7/19/2023
  • 67.
    Taraget population Sample Random Allocation Interventiongroup Control group Outcome measure Changed group during study Loss to follow up Loss to follow up RCT Reference population 7/19/2023 67
  • 68.
    RANDOMIZED CONTROLLED TRIAL •The true experimental study design (RCT) has three characteristics: 1. RANDOMIZATION - the researcher takes care to randomly assign subjects to the control and experimental groups. • (Each subject is given an equal chance of being assigned to either group.) 7/19/2023 68
  • 69.
    RANDOMIZED CONTROLLED TRIAL 2.CONTROL - the researcher introduces one or more control group(s) to compare with the experimental group. 3. MANIPULATION - the researcher does something to one group of subjects in the study. • Note: The strength of experimental studies is that by randomization of confounding variables. 7/19/2023 69
  • 70.
    RANDOMIZED CONTROLLED TRIAL •In Randomized Controlled Trial (RCT), we begin with a defined population. • Subjects in the study population are randomly allocated to intervention and control groups, and the results are assessed by comparing outcomes. • The basic design of RCT is given below; 7/19/2023 70
  • 71.
  • 72.
    Allocation of studysubjects - randomization •Random = governed by chance •Randomization = allocation of individuals to groups by chance •Each sampling unit has the same chance of selection 7/19/2023 72
  • 73.
  • 74.
  • 75.
  • 76.
    76 TYPES OF BLINDING •Single Blind – The subjects are not knowing the group to which they are belonging . • Double blind trials – Neither the subject nor care giver is aware about the groups • Triple blind trials – The subject, the care giver (nurse or doctor) and the person doing the analysis are not aware about the groups in. 76 7/19/2023
  • 77.
    Advantages of RCT •Exposure in under control. • Due to randomization both intervention and control groups have similar characteristics. • By blinding the study, the observer and selection bias can be eliminated. • If properly designed & conducted, it can reduce the confounding. • Can confirm or refute etiological hypothesis. • Can evaluate the efficacy / effectiveness / efficiency of health services. • Best method for studying causal relationship. 77 7/19/2023
  • 78.
    Disadvantages of RCT •Ethical problems Due to adverse effects Due to benefits of intervention in the treated group Provision of Placebo • Relatively expensive 78 7/19/2023
  • 79.
    QUASI EXPERIMENTAL STUDY •In a Quasi Experimental Study, at least one characteristic of a true experiment is missing, either randomization or the use of a separate control group. • A quasi experimental study, however, always includes manipulation of an independent variable that serves as the intervention. 7/19/2023 79
  • 80.
    QUASI EXPERIMENTAL STUDY •One of the most common quasi experimental designs uses two (or more) groups, one of which serves as a control group in which no intervention takes place. • Both groups are observed before as well as after the intervention, to test if the intervention has made any difference. • The subjects in the two groups (study and control groups) have not been randomly assigned. 7/19/2023 80
  • 81.
  • 82.
    QUASI EXPERIMENTAL STUDY •Another type of design that is often chosen because it is quite easy to set up uses only one group in which an intervention is carried out. • The situation is analyzed before and after the intervention to test if there is any difference in the observed problem. This is called a "Before- After" study/ Pre – Post Study. 7/19/2023 82
  • 83.
  • 84.
    STUDY TYPES &STRENGTH OF EVIDENCE • Analytic Study involves the systematic evaluation of suspected relationships, for example, between an exposure and a health outcome. • Analytic studies typically provide stronger evidence concerning particular relationships. • An experimental design is the only type of study design that can actually prove causation. 7/19/2023 84
  • 85.
  • 86.
  • 87.
    Phenomenological Studies • Phenomenologicalstudies examine human experiences through the descriptions provided by the people involved. • These experiences are called lived experiences. • The goal of phenomenological studies is to describe the meaning that experiences hold for each subject. • This type of research is used to study areas in which there is little knowledge (Donalek, 2004). • In phenomenological research, respondents are asked to describe their experiences as they perceive them. • They may write about their experiences, but information is generally obtained through interviews. • To understand the lived experience from the vantage point of the subject, the researcher must take into account her or his own beliefs and feeling.
  • 88.
    Example • Daly (2005)studied the lived experiences of mothers of suicidal adolescents. She contended that, unfortunately, the mother’s experience is often the hidden dimension in the family. • Unstructured interviews were conducted with 6 mothers living with suicidal adolescents. • Six themes were identified: • failure as a good mother, the ultimate rejection, feeling alone in the struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance.
  • 89.
    Ethnographic Studies • Ethnographicstudies involve the collection and analysis of data about cultural groups. • Cameron (1990) wrote that ethnography means “learning from people” (p. 5). • According to Leininger (1985), ethnography can be defined as “the systematic process of observing, detailing, describing, documenting, and analyzing the lifeways or particular patterns of a culture (or subculture) in order to grasp the lifeways or patterns of the people in their familiar environment” • In ethnographic research, the researcher frequently lives with the people and becomes a part of their culture. The researcher explores with the people their rituals and customs.
  • 90.
    Example • Gance-Cleveland (2004)examined the features, critical attributes, processes, and benefits of school based support groups for adolescents with an addicted parent. Ethnographic methods were used to gather data. • Participant observations were conducted weekly at two high schools over one semester. • Interviews were conducted with program administrators, school administrators, group co-facilitators, and participants. • School-based support group participation was found to enhance self- knowledge and led to self-care and self-healing.
  • 91.
    Grounded Theory Studies •Grounded theory is a qualitative research approach developed by two sociologists, Glaser and Strauss (1967). • Grounded theory studies are studies in which data are collected and analyzed and then a theory is developed that is grounded in the data. • The grounded theory method uses both an inductive and a deductive approach to theory development.
  • 92.
    Example • The groundedtheory qualitative method was used by Williams and Irurita (2005) to study the personal control and emotional comfort of hospitalized patients. Interviews were conducted with 40 patients, and 75 hours of field observations were conducted. • The basic psychological process identified by the researchers was labeled “optimizing personal control to facilitate emotional comfort.” • Personal control referred to the ability of patients to influence their environment; emotional comfort was defined as a state of relaxation that affected the physical status of the patient. • Personal control was found to be a central feature of emotional comfort.
  • 93.
    Historical Studies • Historicalstudies concern the identification, location, evaluation, and synthesis of data from the past. • Historical research seeks not only to discover the events of the past but to relate these past happenings to the present and to the future. • Although there is a need for historical research in nursing, a limited number of nurse researchers have chosen it. • But the process of historical research is basically the same as in many other types of scientific research. • The problem area or area of interest is clearly identified and the literature is reviewed. Research questions are formulated. • Finally, the data are collected and analyzed.
  • 94.
    Example • Oral historieswere gathered from 8 nurses who were employed between 1951 and 1965 in a Virginia state hospital (Harmon, 2005). • These nurses were now retired and had between 12 and 46 years of psychiatric nursing experience. • The researcher wanted to describe the experiences of these nurses who practiced in a state mental hospital before and during the introduction of antipsychotic medications. • They expressed resignation and frustration while trying to provide care despite crowded wards and inadequate personnel and supplies. The nurses indicated that they focused on the patient’s body instead of on the patient’s mind. • The camaraderie they experienced with other nurses helped them continue in their positions, despite what they felt to be a “thankless job.”
  • 95.
    Action Research Studies •Action research is a type of qualitative research that seeks action to improve practice and study the effects of the action that was taken (Streubert & Carpenter, 2002). Solutions are sought to practice problems in one particular hospital or health care settings. • There is no goal of trying to generalize the findings of the study, as is the case in quantitative research studies. In action research, the implementation of solutions occurs as an actual part of the research process. There is no delay in implementation of the solutions.
  • 96.
    Example • Action researchwas used with staff in one hospice and one nursing home setting in London (Dunckley, Aspinal,Addington-Hall, Hughes, & Higginson, 2005).The purpose of the study was to identify facilitators and barriers to the use of the Palliative Care Outcome Scale (POS). • Staff took part in semi structured interviews, completed diaries, and participated in monthly meetings to give their opinions of what they thought were the facilitators and barriers to the implementation of the POS.
  • 98.
    References • Principles ofEpidemiology in Public Health Practice, Third Edition An Introduction to Applied Epidemiology and Biostatistics • http://www.cdc.gov/ • Jhonhopkin university epidemiology lectures 7/19/2023 98