11

Introduction to the Research Process: Introduction to the Research Process: Formulating a Research QuestionFormulating a Research Question

© Fraser Health Authority, 2010

The Fraser Health Authority (“FH”) authorizes the use, reproduction and/or modification of this publication for purposes other than commercial redistribution. In consideration for this authorization, the user agrees that any unmodified reproduction of this publication shall retain all copyright and proprietary notices. If the user modifies the content of this publication, all FH copyright notices shall be removed, however FH shall be acknowledged as the author of the source publication.

Reproduction or storage of this publication in any form by any means for the purpose of commercial redistribution is strictly prohibited.

This publication is intended to provide general information only, and should not be relied on as providing specific healthcare, legal or other professional advice. The Fraser Health Authority, and every person involved in the creation of this publication, disclaims any warranty, express or implied, as to its accuracy, completeness or currency, and disclaims all liability in respect of any actions, including the results of any actions, taken or not taken in reliance on the information contained herein.

Department of Evaluation and Research Services­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Library | Education | Administration | Development

Outline & ObjectivesDERS overviewDefinition of ResearchOverview of Research Process – 9 stepsSources of Research QuestionsForming, refining and assessing research questionTools

Understand the nine major components of the research processUnderstand how to formulate your idea into a researchable questionUnderstand how to asses the feasibility and relevance of research question

Dina Shafey (604-587-4436), Research Ethics Coordinator

Susan Chunick (604-587-4681), Director

Michael Wasdell (604-587-4438), Epidemiologist

Magdalena Swanson (604-587-4637), Research and Grant Development Facilitator

Camille Viray (604-587-4628), Administrative Assistant

Michelle Purdon (604-851-4700 ext. 646832), Manager, Library Services

Department of Evaluation and Research Services­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Library | Education | Administration | Development

http://research.fraserhealth.ca

FH Research Study Database

http://researchdb.fraserhealth.ca/ersweb/

FH Health Research Intelligence Unit How can we help?

Research & Grant Development FacilitatorConducting a search for funding opportunitiesTargeted notification of new funding sources and deadlinesIdentifying a research teamPreparing letters of intentIdentifying resources required for conducting researchFormulating the research budgetFacilitating proposal development in collaboration with researchersUnderstanding FH and funding agency requirements regarding preparation of specific documentsAdministration of funding awards

FH Health Research Intelligence Unit How can we help?

EpidemiologistSpecifying the research goal, objectives and hypothesisIdentifying measurable outcomesSpecifying the variables for analysisIdentifying sources of dataDeveloping data collection tools for quantitative or qualitative studiesDeveloping the statistical analysis planUnderstanding how to use statistical software, such as SPSS

Research, Evaluation and Quality Improvement

Research: Undertaken to discover new knowledge, test theories, establish truth, and generalize across time and space

Evaluation: Undertaken to inform decisions, clarify opinions, identify improvements, and provide information about programs and policies within contextual boundaries of time, place, values, and politics

Quality Improvement: a structured approach that focuses on sequential building of knowledge, learn by doing, testing and implementation of change ideas.

Research Process1. Generate idea2. Conduct literature review3. Refine research question4. Plan research methodology5. Create research proposal6. Apply for funding7. Apply for ethics approval8. Collect and analyze data9. Draw conclusions and relate findings

Step 1: Generate research idea

Identify general area of interestFormulate a preliminary research question that you want to exploreOnce your initial research idea has been formed, it is necessary to think about research intent and previous research

What do you hope to accomplish?Has this research been done before?

Step 2: Conduct literature review

Review books, journal articles, and other peer reviewed sources such as registries of evidence based research literatureReview the references section of relevant articles to aid in the search for related articlesConducting literature reviews take time, but this is a very important step in the research process.The Fraser Health library can help you with your search.

http://fhaweb/Education+and+Research/Library/default.htm

Step 3: Refine research question

Now that you have exhausted the literature, how has your original research idea changed? Start thinking in more detail

State the problem or research questionWho will your sample include? • Who, where, when, and what

What items will be measured? How will they be measured?

Step 4: Plan research methodology

Select research methods which will allow you to answer your research question

Consider:Who are the subjects and how will they be recruitedWhat measures do you intend to useWhat will be the procedure for recruiting subjects or accessing dataWhat will be the procedure for interventionsJustification for the sample sizePlans for statistical or qualitative analysisPlans for dissemination of results

Step 5: Create research proposal

Create a research proposal that will enable people who are not involved in the study to understand exactly what you plan to do A proposal will be required when seeking departmental approval, applying for grant funding, and for ethics review

Step 5: Create research proposal

Your proposal should include: Abstract background information goals & objectives & hypotheses justification & relevance research design, subjects, measures, data collection procedure, sample size justification, data analysis plan KT plan (may include budget + other sections)

Step 6: Applying for grant funding

It is often possible to gain funding to assist in carrying out your research study Funders will require a detailed research proposal Consult with the FH Health Research Intelligence Unit early in the process to help identify potential grants as well as help prepare applicationsContact Magdalena Swanson, Research and Grant Development Facilitator for further information regarding grant writing magdalena.swanson@fraserhealth.ca

Step 7: Ethics approval

Ethics consideration is an essential component of the research process Most studies require ethics approval when dealing with human subjects or health dataThe Fraser Health Research Ethics Board (REB) reviews submissions on a regular basis See the Fraser Health Research homepage for more information and guidelines

http://research.fraserhealth.ca

Step 8: Collect and analyze data

Collecting data for your study is exciting because you are close to finding out the answer to your research question or hypothesis Remember to be diligent and follow your research plan for collecting data Exercise care in the collecting, coding and documentation of data Analysis of data should follow the plan outlined in your proposal

Step 9: Draw conclusions and relate findings

Summarize your findings and formulate conclusions Was your research question answered? Why do you think this was the case? What were the limitations of your study? What new information was gained that would inform future research?Prepare presentation, poster and / or manuscripts, liaise with stakeholders, etc.

Research Process1. Generate idea2. Conduct literature review3. Refine research question4. Plan research methodology5. Create research proposal6. Apply for funding7. Apply for ethics approval8. Collect and analyze data9. Draw conclusions and relate findings

Generating, Assessing and Refining the Research Question

“You can tell whether a man is clever by his answers. You can tell whether a man is wise by his questions."Naguib Mahfouz

Generate Research Idea

Research begins with the identification of a problem/knowledge gap and formulation of a research question

Identifying this problem can be the hardest part of researchThe problem or question does not have to be complex

Generate Research Idea

Where to obtain a research ideaExperience in your area of specialtyKnowledge of the relevant literature and issuesPractice guidelinesJournal editorials and review articlesDepartment strategic prioritiesPeers

Group Exercise 1: Generating the research question

Working in small groups, come up with 2 research questions or topics of interest to you.

Assessing the Goal

What is your primary goal?Describe – when little is known about the characteristics of a problem, patient group, health care providers or a health service/system.Associate – when you want to asses if certain factors might go hand in hand with a well described problem.

Assessing the GoalWhat is your primary goal?

Predict – when you want to understand the extent to which certain factors contribute to or cause a problem.Compare – when you wish assess the impact of an intervention or to determine if there are differences between interventions or characteristics of various groups (e.g., differences between patients or health services).

Building a Program of ResearchState of Knowledge

Type of Research Question

Examples

Problem is new or characteristics of problem not well defined.

Describe What are the characteristics? To what extent is this observed? What are the experiences?

Possible linkages between problem and other relevant factors.

Associate Is there an association?What are the correlates?

Determine the extent to which other characteristics influences the problem.

Predict What are the predictors?What are possible causes?

Identify differences between groups.Determine effects of interventions.

Compare Do differences exist?Is the treatment effective?Does the condition change over time?

Group Exercise 2: Assessing the goal

Working in your groups, examine your list of research ideas/questions and assess how they fit with the four main goals of describe, associate, predict and compare.

Refining the Research Question

P Population/PatientI InterventionC ComparisonO Outcome

Define the key components of the question

PICO – Population/Patient

GenderAgeSocio-demographicDiagnostic categoryMedical historyInpatient or outpatient

Example: Adults in BC with diabetes

PICO – Intervention/Exposure

ProphylacticTherapeuticDiagnostic testExposurePrognostic factorHealth servicePolicy change

Example: Lifestyle education and fitness training

PICO – Comparisons

Alternative Population/Patient/Problem or Intervention to compare with the intervention being assessed

PlaceboAlternate medication, dose, timing of interventionUnexposed groupDifferent patient groupDifferent service, structure or policy

Example: Medication for obesity

PICO – Outcome (quantitative)Concept

Symptoms, adverse events, functioning, quality of lifeMeasure

Categorical - eg) yes/no, occupations, body systemsOrdinal - implied order eg) income categories of low, medium, highInterval - Equal distance between each value eg) age, quantitative lab values, heart rate

Direction/ThresholdImprove, reduce, meet diagnostic cut-off

Example: Decrease in obesity in BC

PICO and Research Question Type

Population/Patient

Intervention Comparison Outcome

Describe Always Sometimes Sometimes Sometimes

Associate Always Sometimes Sometimes Sometimes

Predict Always Sometimes Sometimes Always

Compare Always Sometimes Always Sometimes

Qualitative Research

Qualitative account of:Experiences, perceptions, feelings, observationsFocus on what, how, why and when rather than how many or how much

May need to adapt PICO to account for qualitative outcomes

Example: How do patients with diabetes feel about interactions with clinical nutritionists?

SPICE

For qualitative research SPICE may be more useful: S ETTING P ERSPECTIVE I NTERVENTION/INTEREST C OMPARISON E VALUATION

http://www.jbiconnect.org/connect/info/about/jbi_ebhc_approach.php

SPICESETTING – In acute care PERSPECTIVE – Patients with diabetes INTERVENTION/INTEREST – recommendations for weight management from cliniciansCOMPARISON – Not Applicable EVALUATION – perceptions

Example: What are the perceptions of patients with diabetes in acute care about information they receive from clinicians about managing their weight?

Group Exercise 3: Refining the Research Question

P Population/PatientI InterventionC ComparisonO Outcome

S SettingP PerspectiveI Intervention/InterestC ComparisonE Evaluation

Choose one research question and refine using PICO or SPICE

Assessing Your Research Question

Make it FINER

Confirmed through literature search and review

Just for Fun – Is this FINER?Ig Nobel prize winner:MEDICINE: Donald L. Unger, of Thousand

Oaks, California, USA, for investigating a possible cause of arthritis of the fingers, by diligently cracking the knuckles of his left hand — but never cracking the knuckles of his right hand — every day for more than sixty (60) years.

REFERENCE: "Does Knuckle Cracking Lead to Arthritis of the Fingers?", Donald L. Unger, Arthritis and Rheumatism, vol. 41, no. 5, 1998, pp. 949-50.

http://improbable.com/ig/ig-pastwinners.hthttp://improbable.com/ig/winners/#ig2010ml

MEDICINE: Brian Witcombe of Gloucester, UK, and Dan Meyer of Antioch, Tennessee, USA, for their penetrating medical report "Sword Swallowing and Its Side Effects."

REFERENCE: "Sword Swallowing and Its Side Effects," Brian Witcombeand Dan Meyer, British Medical Journal, December 23, 2006, vol. 333, pp. 1285-7

Group Exercise 4 – Assessing your research question

Assess your research question according to FINER criteria.

Obtain Feedback

Write down your research questionPrepare a 1 or 2 page summary of the rationale and draft research planObtain feedback from peers, colleagues, decision makersSeek consultation with Evaluation and Research Services

Plan research methodology

Inappropriate research design and method

Invalid results

Create research proposal

Not feasibleNot innovativeNot novel

Apply for funding Research budgets are determined by method

Does not pass expert peer review

Consequences of Poorly Formed or Poorly Informed Research Question

Apply for ethics approval

Lack of equipoiseInappropriate methodsLack of confidentialityNeed for informed consent

Collect and analyze data

Collect incorrect dataMiscode dataChoose wrong analysis

Draw conclusions and relate findings

Conclusions invalidNot publishableNot useable

Consequences of Poorly Formed or Poorly Informed Research Question

“The question being asked determines the appropriate research architecture, strategy

and tactics to be used - not tradition, authority, experts, paradigms or schools of

thought”

Sackett DL and Wennberg JE. Choosing the best researchdesign for each question. BMJ 1997; 315: 1636.

Questions