Teaching the Science Base of MCH

Donna Strobino, PhD

TEACHING THE SCIENCE BASE OF MCH

OBJECTIVE:To present examples of approaches to teaching the evidence base of MCH

ASSUMPTIONS OF EXAMPLES

SOLID GROUNDING IN:

• Biostatistics

• Epidemiology

• Evaluation or Study Design in the Social Sciences or Health Services Research

EXAMPLES OF APPROACHES

• Critiquing a research article• Synthesizing the literature on an

intervention/program• Translation of a study to practice or

policy• Debating the science• Choosing measures for population-

based data

CRITQUE OF A SCIENTIFIC ARTICLE: OBJECTIVE

Participants demonstrate• Knowledge of critical study methods that

affect the validity of inference

• The link of study objectives and rationale to study results and conclusion

• Objective evaluation of strengths and weaknesses of study

FOCI OF THE CRITIQUE

• Study Objectives and Rationale

• Study methods- Study design

- Sample: who, where, when, how many

- Variable Measures

FOCI OF CRITIQUE

• Study Results- Text consistent with data in tables

- Consistent with study methods

• Study Conclusions- Consistent with objectives

- Consistent with findings

EXAMPLES OF STUDIES

Study Design

• Case Control Study of Stillbirths- Stillbirths of all birth weights

- Controls: Live births > 2500 grams

• Sister pairs- Teenage mothers

- Mothers in their early 20’s

EXAMPLES OF STUDIES

Sample Restrictions• Require repeated interviews during

pregnancy of high-risk women; very low follow-up- Sample bias versus recall bias

• Reduce sample by half because of data on gestational age- Sample bias versus measurement bias

EXAMPLES OF STUDIES

• Timing of measurement of risk factors: hematocrit at delivery

• Poorly constructed measures of underlying concept: racism

• Analysis determines results: Longitudinal data on repeated births

• Text misrepresents data in tables: data

sources for measuring drug use

SYNTHESIZING THE LITERATURE: OBJECTIVES

Students learn:• How to conduct a literature search

• How to determine the most appropriate criteria for inclusions of studies in a review

• To succinctly, but comprehensively describe studies

• Evaluate the evidence

• Make conclusions about the intervention

LECTURE POINTS

• Important aspects of study methods

• Content of a study description

• Information for doing a search

• Criteria for selection of studies

• Selecting the studies to highlight

• Synthesizing/compiling the evidence

ASSIGNMENTS

• Topic and selection of studies- Criteria for selecting studies

- List of studies

• Paper presenting the evidence- Description of the intervention

- Description of studies and critique

- Conclusions about the evidence

EVALUATING LITERATURE FOR POLICY OR PRACTICE

OBJECTIVE: Students will show:

• Ability to evaluate the evidence

• Ability to determine limits of inferences

• Ability to translate study findings for

programs, practice, and policy

ARTICLE SELECTION

• Gold standard design?

• Sample exclusions

• Appropriate age range?

• Secondary prevention

• Clinical interpretations:To whom should the results be applied?

• Controversial politically

DEBATING THE SCIENCE

OBJECTIVES:Students will show:

• Understanding of the science underlying the debate

• A balance of the strengths and weaknesses of the science

• Knowledge of the reasons for policy recommendations

UNIVERSAL BREAST CANCER SCREENING: WOMEN 40-49

Debate: Pro and Con

• Hinges on interpretation of studies

• Requires additional population data

• Regardless of position, must present in writing both sites; requiring a synthesis of the literature.

BIRTH CERTIFICATE ANALYSIS: OBJECTIVES

Student will show:• Knowledge of the vital statistics system

and its uses• Knowledge of data for surveillance and

research• Knowledge of the constraints in

collecting population-based data• Knowledge of measurement of items on

the certificate

APPROACH TO PAPER

• Geopolitical area• VS System in that area• Content of current certificate• Recommendations for changes

- System of data acquisition- Format of form- Content/measurement of items

TESTING PREPARATION TO UNDERTAKE RESEARCH

Take-home exam: Objective: To test student’s ability to:

• Critically analyze research in their area of interest

• Synthesize and integrate both concepts and methods learned in course work

Exam: Using 1-2 Research Articles

Focus of questions about articles:

• Conceptual basis of the research

- Conceptual framework

- Variables and their conceptualization

• Study methods

- Study design

- Sampling plan

- Statistical analysis

DrPH versus PhD Students

• DrPH students:

- Program, policy or practice implications of the study

• PhD students:

- Research implications of the study