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Inaugural KEYSTONE Course on Health Policy and Systems Research 2015

Research Plan - 2

   

 

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Research plan - 2

Kabir Sheikh2 March 2015

   

 

KEYSTONE

Study design: from questions to

projects

IHPSR Presentation 6

www.hpsa-africa.org

@hpsa_africa

www.slideshare.net/hpsa_africa

Introduction to Health Policy and Systems Research

   

 

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Four key steps in HPSR1. Identify research focus

(problem/concern/ opportunity) and question

2. Design study 3. Ensure quality and rigour4. Apply ethical principles

   

 

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Robson, 2002

• Research design is concerned with turning research questions into projects – deals primarily with the aims, purposes,

intentions and plans within the practical constraints of location, time, money and availability of staff

   

 

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Design …. ‘… is also very much about style, the

architect’s [researcher’s] own preferences and ideas (whether

innovative or solidly traditional) and the stylistic preferences of those who pay for the work and have to live with the

finished result.’Robson, 2002

   

 

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Research questions

Purpose/s Theory

Methods Sampling strategy

Research design

Study design

   

 

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• The specific study design must be appropriate for: – the issues being investigated– the questions you want to answer; and – the underlying purpose

For example, to explore how actors’ understandings of a new policy change over time, don’t use a structured questionnaire at one time only

   

 

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Research design categories in HPSR

• Fixed designs• Flexible designs• Mixed methods designs

Terminology pause • Fixed-flexible vs quantitative-qualitative• Not about data forms!

   

 

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Fixed and flexible strategies

• ‘A fixed design calls for tight pre-specification before you reach the main data collection stage.’

• ‘A flexible design evolves during data collection. Data are typically non-numerical (usually in the form of words)’

Robson, 2002, p.87

   

 

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The image for fixed designs

   

 

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The image for flexible designs

Flexible: importance of the research spiral or cycle

Kemmis & McTaggart, 2005

   

 

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Design features Robson, 2002

Fixed• Carefully pre-planned• Focuses on ‘variables’

(defined property of person, thing, group, situation) that can be measured and compared

Data generally numerical, but could collect qualitative data

Flexible • Start with an idea or

problem and let relationships and causality emerge

• Evolving design, no predetermined ‘variables’

Data often non-numerical, but quantitative data also collected

   

 

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Study design examplesFixed• Impact evaluation• Quasi-experimental,

pragmatic RCT• Quantitative cross-

sectional (survey, record reviews)

• Discrete Choice Experiments

• Longitudinal (before and after, trend analysis)

Flexible• Process evaluation• Case study• Longitudinal case study• Qualitative cross-

sectional (key informant interviews, FGDs)

• Ethnography• History• Action research

   

 

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Mixed method design• Deliberately combines elements of fixed and

flexible design “to expand the scope of, and deepen the insights from, their studies” (Sandelowski, 2000)

• A PURPOSIVE combination, not a free for all • Combination of sampling, data collection &

analysis techniques; but not of paradigms• Benefits: e.g. allows triangulation across

datasets

   

 

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From question to study design …

Purpose Questions Study design examples

Normative • Does intervention x work? Positivist = Fixed: Quasi-experimental (adapted RCT, case control, before and after)

Exploratory • What categories of information are used in decision-making?

• What are the social processes, including power relations, influencing actors’ understandings and experiences, and shaping impacts of interventions?

Positivist= Fixed:Cross-sectional surveyRealist/Relativist = Flexible: EthnographyCase studyQualitative interviews

Descriptive • What is the quality of care in place q?

• What is the level of health worker motivation in place z?

• What are stakeholder positions on policy A?

Positivist = Fixed:Cross-sectional survey Realist = Flexible:Qualitative interviews (e.g. SHA)

   

 

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Purpose Questions Design examplesExplanatory (positivist)

• How do managers influence facility performance?

Fixed:Panel studyMulti-level modelling

Exploratory/ExplanatoryExplanatory(relativist/realist)

• How and why does management influence facility performance?

Flexible:Multiple case study (perhaps longitudinal)EthnographyHistoryTheory-based evaluation (realist)Mixed method

Emancipatory(critical)

Flexible:Action research

From question to study design (continued)

   

 

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From question to study design (continued)

Question Study designsWhat+? (who, what, where, how many, how much?) Exploratory & Descriptive

• Qualitative cross-sectional (e.g. in-depth interviews, FGDs, document review) / case study

• Surveys/archives/administrative statistics (includes longitudinal analysis)

Why + How? Impact evaluationExplanatory

• Case studies / history / ethnography• Surveys /simple modelling / experiment /

quantitative cross sectional (semi-structured interviews) (includes longitudinal studies & analysis)

What if?(includes impact studies)

• Experiment/scenarios/multi-variable modelling • Qualitative interviews & panels

   

 

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Research questions

Purpose/s Theory

Methods Sampling strategy

Research design

Study design

   

 

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Using theory in HPSR• HPSR addresses complex phenomena• Theory should play an important role within all HPSR

– e.g. conceptual frameworks = a set of concepts and their inter-linkages

– e.g. theory-driven evaluation– e.g. conceptual work

• Different disciplines have different ‘tools’ – and often utilise theory differently

   

 

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Robson, 2002Theory: a general explanation of what is going on in a situation or phenomenon

– from ‘grand theory’ to informal hunches and speculation– a theory explains why an answer is predicted (hypothesis)

Conceptual frameworks: diagram summarising theory– may not explain or predict behaviour or outcomes, but

identifies relevant elements and relationships among themHelp in investigating causality (and particularly important for complex causality)

– refine through discussion, literature review &, sometimes, through research

   

 

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HPSR (recap)• Non-hierarchical approach to study

design• Research design follows purpose,

question, and your positioning as a researcher

• HPSR makes use of theory and conceptual frameworks

   

 

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Introduction to Health Policy and Systems Research, course presentation, Presentation 6. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa

This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.

   

 

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