Lect. 6- Understanding Research

7/28/2019 Lect. 6- Understanding Research

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Mixed Method Research

- Integration of qualitative and quantitative datain a study or clustered study

- an emergent trend, using Pragmatism as themost common paradigm


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Advantage

1. Complementarity

2. Incrementality- qualitative findings can generate

hypothesis to be tested quantitatively

3. Enhanced validity- hypothesis is supported by multiple

and complementary types of data


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Application

1. Instrumentation

- gathering of qualitative data as the basis ofgenerating questions for quantitativeanalysis

2. Hypothesis generation and testing- qualitative studies provide insights about

constructs or relationship which could beconfirmed by quantitative study


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3. Explication

- qualitative data used to explicate meaning

of quantitative description or relationshipand statistical findings

4. Theory building, testing and Refinement

- use of multiple methods provides greatopportunity for potential disconfirmationwhich results to theory rejection


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5. Intervention Development

- Intervention research is increasinglylikely to be mixed method research

Design and Strategies (continually evoking)

1. Component Design

- qualitative and quantitative aspects areImplemented as discrete component ofover-all inquiry including Data collectionand analysis


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2. Integrated Design

- greater Integration of the methods at allphases of the study, from Research questions

development to Analysis

- offers the possibility of yielding more Insightfulunderstanding of the phenomenon under study


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Research that Involve Interventions

1. Clinical Trials

- assess the effectiveness of clinicalInterventions

- develop for medical and Epidemiologicalstudies

- e.g. - Therapeutic measures/modality- effectiveness of certain drugs or new

drugs available


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Full Clinical trial ( 4 phases)Phase I

- occurs after initial development of drugs

or therapy- done to develop the best possiblestrength of treatment

Phase II- done to seek preliminary evidence of

effectiveness- considered as pilot test- look for signs of possible side-effects


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Phase III

- full experimentation involving randomsamples

- randomized clinical trial using largepopulation from various settings (multi-siteclinical trial)

- sequential trial maybe adopted- done to develop evidence about efficacy

compared to standard and monitoring ofadverse effect


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Phase IV

- design for long term consequence in cases

ere the drug or therapy had been adopted- studies the effectiveness in general

population

- include post-approval safety surveillance

- cost-effectiveness and clinical utility of thetreatment


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2. Sequential Clinical Trials- alternative to standard or Phase III of

clinical trial

- experimental data are continuously analyzedas they become available in a series of miniexperiment

- results accumulates overtime and experimentis terminated as soon as the evidence isstrong enough to support theconclusion


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3. Practical Clinical trial- address practical questions about benefits,

risk and cost of Intervention for application

in real life situation

4. Evaluation Research- designed for the assessment of program,

practice, program of procedure or policies- aid in the decision making of the concernedauthorities


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- sometimes clinical trial is a form of evaluationresearch

- considered in Evaluation Research1. should the program be replaced with a

new one

2. Do it need modification3. should it be abandoned

4. Do Implementation cost outweighthe benefits


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5. Implementation/Process Analysis

- describing the process by which the program

gets Implemented and how it function

- does the program operates the way it isIntended to be

- aim is to Improve the present program


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- Considered in Process Analysis

1. Strength and weaknesses

2. Difficulties in Implementation

3. How the clients and staff feel about theprogram

6. Impact Analysis- attempt to Identify the net impact of the

program above the standard

- relative efficiency of the program


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7. Outcome Analysis

- focus whether a program or policy ismeeting its objectives

- also known as summative evaluation due toits assessment of the worth of the program

- aim is to decide whether the program will

be discarded, continued, modified,replaced or replicated

- descriptive in nature rather than rigorousexperimental design


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8. Cost Analysis

- determine whether the benefits of the programoutweigh the cost of Implementation

a. Cost-effectiveness analysis- compare health outcomes and resource

cost of alternative Intervention


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b. Cost-benefit Analysis

- monetary estimation on the cost ofImplementing the program and thebenefits that may gained

- long term and short term benefitsshould be considered

- Problem: difficult to give monetaryvalue on the benefits in terms ofhealth services


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Nursing Intervention Research

- studies either questioning existing carepractices or testing innovations in carepractice

- guided by a strong theoretical basis

- Informed by recent advances in science

- designed to improve the quality care andhealth of individuals, families, communityand society

- requires collaborative planning at all steps


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- Involve 4 phases

1. Phase I: Developmental Phase

- brainstorming about the problem andconceptualization

- collaborative discussions andconsultation with experts

- critical literature review

2. Phase II: Pilot testing

- Testing the Intervention developed


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- Control mechanisms

1. secure preliminary evidence ofInterventions benefits

2. refine the Intervention theory and theIntervention

3. Finalize the Intervention protocol

4. Assess the feasibility of rigorous test


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3. Phase III: Classical Clinical Trial- undertake the full experimental test

4. Phase IV- assess the effectiveness and utility of

Intervention in real world clinical setting- establishing standard for using the

Intervention- Identify possible markets and crating

demands for the Intervention


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Research that does not Involve Interventions

1. Outcome Research

- design to document the effectiveness ofhealthcare services or nursing services

- Involve quality assurance and qualityassessment

- involve the following strategies: Healthmodel, Nursing process, Patient's Risk

Adjustment


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Health Modela. Structure

- size, location, range of services, type offacilities, technology and organizationalstructure and climate

b. Process- aspects of clinical management, decision

making and clinical Interventionsc. Outcomes

- specific clinical and results of patient care


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Nursing Process- demonstrate nurses effects on health

outcome

- careful description and documentation ofnurses clinical actions and behavior

- involve the following nursing actions:1. problem solving skills

2. Clinical decision making3. Clinical competence and leadership4. other specific activities/Interventions


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Patients Risk Adjustment- Involve the use of global measures of

patients risk activity

- adverse outcome can occur no matter whatnursing Intervention, variation in patientsoutcome depends not only the care theyreceived but also differences in patientsconditions and co-morbidities

- controls and take into account the patientsrisk to poor outcome


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2. Secondary Analysis- involve the use of data gathered in previous

study to test new hypothesis or explore newrelationships

- focuses on a particular sub-group of the fullorganized sample

a. Qualitative

- provides opportunities to exploit richdata sets- problems: voluminous data, difficult to

store, problem in accessing data


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b. Quantitative- consider the appropriateness and

adequacy of data and technical usability

3. Survey Research- designed to obtain Information about

prevalence, distribution and Interrelationsof variables within the population

- Involve the following strategiesa. self-reportb. case study


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c. Interviews

- personal Interview, TelephoneInterview, computer assisted self-Interview (Audio-CASI)

d. Questionnaire

- Self-administered Questionnaire

(SAQ)e. Longitudinal and Trend analysis

f. Mixed mode strategy


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Other Non-Intervention Research

1. Needs-assessment

- determine if there is a need for specialintervention or outreach effort or if aprogram is meeting the needs of those

who are supposed to benefit it

- researchers collect the data to estimatethe needs of a group, community ororganization


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Strategies:1. Key-Informant approach

- people who are in key position to

know the needs2. Survey approach- sample population whose needs are

being assessed

2. Delphi survey- several rounds of questionnaire are given

to panel of experts- developed for short-term forecasting


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3. Replication Studies

- to determine if findings obtained in anoriginal piece of research could beduplicated in another Independent study

- Strategies:

a. Operational/virtual replication

- methodology was replicatedb. Identical/Literal replication

- same everything except setting


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c. Systematic extension replication orconstructive: methods are not replicated

4. Methologic Research

- address the development, validation andevaluation of research tools or methods

- focus on Instrument development andtesting

- to develop high quality Instrument that couldbe used by others


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5. Meta-Analysis

- application of statistical procedures

to findings from research report- method of Integrating the findings of prior

research using statistical procedures

- treating findings of a study as a single data

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Documents

Lect. 6- Understanding Research