From idea to research proposal

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Aim

To be able to construct a research proposal following the identification of a practice problem

Objectives

To be able to phrase answerable research questions

To be aware of the key differences between qualitative and quantitative research techniques

Phrasing the question Defining the research question

– All research begins with a question – Directs all aspects of the research study– Will need refining in the planning stages– Should be realistic and not over-ambitious– Should be specific and precise– Should be important

Initial steps– Get it down on paper– Can it broken down to bite size pieces?

Research paradigms Qualitative

– Aims to understand people’s experiences of the world

– ‘what does it feel like’ or ‘what is important to you’? – Develops theory

Quantitative– Quantifies phenomena– ‘How long’ or ‘how many’?– Tests theory

Qualitative or quantitative? Why do people not take their medicines?

Does a community-based education programme improve compliance in cardiac patients?

PICO (Population, Intervention, Comparision, Outcome)

Qualitative or quantitative?

Why do patients engage with alternative healthcare practitioners?

Does aloe vera gel improve the quality of life in patients with psoriasis compared to placebo?

Goal of qualitative research

Development of concepts which help us to understand phenomena in natural settings, giving due emphasis to the meanings, experiences, and views of participants (Mays and Pope 1997, p.4)

Therefore it aims to discover meanings, understand actions, generate theory.

Qualitative research Natural setting vs. experimental Sample

– small numbers, purposive, informative cases, not randomly selected

– how many is enough? Data

– Interview transcripts, quotations, descriptions, not numeric

Analysis – theory may emerge from the data

Qualitative approaches

Phenomenology Ethnography Grounded theory Case study Narrative

Considerable overlap between approaches

Collecting qualitative data

Depends upon approach Research instrument = researcher Observations

– overt vs. covert and the Hawthorne Effect– recorded in field diaries

Open and semi-structured interviews– 1-1, group or ‘focus group’

Documents Audio-visual (e.g video)

Analysing data

Depends upon approach– Approach-specific frameworks

General tips– Transcribe data – Code the data (e.g highlight similar ideas in same

colour)– Look for emerging themes– From these themes, try to generalise about the

phenomenon in question

Quality in qualitative research

Debate – the nature of knowledge produced by qualitative research

CASP tool– Rigour - has a thorough and appropriate approach

been applied to key research methods in the study? Reflexivity.

– Credibility - are the findings well presented and meaningful?

– Relevance - how useful are the findings to you and your organisation? Context?

Quantitative research Many study designs (e.g. RCT, case control,

cohort) Experimental setting Sample

– Statistically informed– Sample randomly selected from population

Data – Numeric

Analysis - generally testing theory but not always

Collecting and analysing data

Data collected by validated instruments (e.g QoL scales, diagnostic criteria, questionnaires)

Analysed using descriptive or inferential statistics

Quality in quantitative studies

Service evaluation research

‘Are we doing the right things with the right people at the right time?’

Service evaluation research may …– Determine whether the programme addresses the

problem– Examine what resources are needed or how

effectively they are being used– Measure service achievement– Improve service delivery

Service evaluation research

Formative (before intervention) vs. summative (after intervention)

Often use ‘mixed methods’

Process measures of effectiveness (e.g. timely answer) vs. outcome measures (e.g patient outcome)

Research, audit or service evaluation (research)? Confusion +++

Generating new knowledge

Does a service meet a pre-determined standard?

What standard does a service meet?

Group exercise

Groups of 3-4 1-2 scenarios each Feedback

Service evaluation: case study

Research strategy top 5 questions:

What impact does the UKMi enquiry answering service have on patient care?

What economic impact do UKMi services and products have for the NHS? What are the costs and benefits?

Are UKMi internet resources (e.g. new product reviews, news) used by healthcare professionals in the care of individual patients?

How can UKMi best support 24/7 NHS services? What can UKMi contribute to the management and maintenance

of electronic prescribing systems?

How can UKMi best support 24/7 NHS services?

How would you answer this question? Where would you start?

What are the possible methods? Qualitative or quantitative? What have other researchers done?

Literature review

Identifies what has been done before

Helps to form the research question and the study objectives

Clear objectives will guide the entire research study

Rationale

MI services available 9-5 Debate around hospital pharmacy 24/7 Deaths due to medication errors rising Majority of errors occur when pharmacy

is shut Inadequate access to information

repeatedly proposed as a cause of error

Literature review: unanswered questions What medicines information do UK

healthcare professionals need ooh? How do they currently access it? Are there any barriers during this time? How would they prefer to access it? (Has it led to an error in their practice?) Does UKMi service need to develop to

support them further?

Research paradigm: options

Qualitative– Group or 1-1

interviews– Observation

Quantitative– Survey using a

questionnaire

Research paradigm

Quantitative paradigm suitable as– Pre-existing knowledge

exists– Nature of data is

straightforward– BUT relevant issues may

be overlooked

Enables efficient data collection and analysis

Survey methods Survey methods used to describe

– Events (accessing information) – Behaviour (how information is accessed)– Attitudes (how professionals would prefer to access

information)

Data extrapolated from a sample to the whole population

Hypotheses developed that can be tested (e.g. nurses are more likely to require information about IV medicines ooh)

Survey methods

Surveys usually collect information by– postal or other self-

completion questionnaire methods

– diaries– personal face-to-face or

telephone interviews

Developing the research instrument Research instrument

must be validated (e.g. questionnaire, quality of life scale, thermometer, clock)

It must measure what it is intended to measure (valid) and be repeatable over time (reliable)

Sampling frame

Study population: All NHS doctors and nurses that work outside the hours of 9am to 5pm Monday to Friday, or anytime at weekends

Proposed study sampling frame – all FY1, FY2s and nurses that work ooh

Accessing staff names (ethics, data protection)

Key results

Low response rate Average need; 1 to 5 time per shift Questions were most likely to relate to;

– adverse effects– drug interactions– dose – practical aspects of drug administration

including intravenous compatibility

Key results

Tendency to use paper-based resources and their peers

Majority did not perceive there to be barriers Questions that are more difficult to answer

– Chemotherapy, IV medicines

Wants – Extended hour MI, links to validated online

sources, Q&As

Conclusions

NHS health professionals need reliable, relevant advice that can be accessed quickly and with minimal effort out-of-hours to help them make decisions beside the patient

Examples of opportunities for UKMi;– Change to current nine to five pattern– Increased training of on-call teams– Development of NeLM including ooh-specific Q&As– Increased training of nursing and medical staff with

information and evaluation skills– Links to validated websites from Trust intranets

Learning outcomes

By the end of the session you will

– Be able to phrase answerable research questions

– Be aware of the key differences between qualitative and quantitative research techniques