Primary-Care-Research-2017 for indian university

Primary-Care-Research-2017 for indian university

1. Primary Care Research: An Primary Care Research: An
Introduction (To Some Really Introduction (To Some Really
Important Concepts)Important Concepts)
John B. Schorling, M.D., M.P.H.John B. Schorling, M.D., M.P.H.
Professor of Medicine and Public Heath SciencesProfessor of Medicine and Public Heath Sciences
James R. Martindale, Ph.D.James R. Martindale, Ph.D.
Assistant Professor of Research and Public Assistant Professor of Research and Public
Health SciencesHealth Sciences

2. Objectives:Objectives:
Be able to better formulate a research Be able to better formulate a research
questionquestion
Feel more comfortable with the clinical Feel more comfortable with the clinical
research process research process
Understand the ideas of constructs and Understand the ideas of constructs and
operationalizationoperationalization
Understand the major differences between Understand the major differences between
quantitative and qualitative approaches to quantitative and qualitative approaches to
doing educational researchdoing educational research

3. ““If we knew what we were If we knew what we were
doing, it wouldn’t be called doing, it wouldn’t be called
research, would it?”research, would it?”
Albert EinsteinAlbert Einstein

4. Developing Your QuestionDeveloping Your Question

Start with a clear purposeStart with a clear purpose

Know your literatureKnow your literature

Be iterative in your approachBe iterative in your approach

Try to specify the who, what, where and when Try to specify the who, what, where and when
of your purposeof your purpose

Ask yourself “What would the answer to this Ask yourself “What would the answer to this
question add to the literature?” and…question add to the literature?” and…

5. Developing Your QuestionDeveloping Your Question
Don’t let methodology drive the question!Don’t let methodology drive the question!

6. The Research ProcessThe Research Process
1.1.Identification of general problem/questionIdentification of general problem/question
2.2.Literature reviewLiterature review
3.3.Specify questions/hypothesesSpecify questions/hypotheses
4.4.Determination of design/methodologyDetermination of design/methodology
5.5.Data collectionData collection
6.6.Data analysis/presentationData analysis/presentation
7.7.Interpretation of findingsInterpretation of findings

7. The Right and the LeftThe Right and the Left

Quantitative research - numbers, Quantitative research - numbers,
numbers, numbersnumbers, numbers

Qualitative research - words, words, Qualitative research - words, words,
wordswords

8. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Assumptions about the WorldAssumptions about the World

Based upon the idea Based upon the idea
of “logical of “logical
positivism”, that is, positivism”, that is,
there is a singular there is a singular
reality with stable, reality with stable,
social facts that are social facts that are
separate from the separate from the
feelings and beliefs feelings and beliefs
of individuals.of individuals.
Based on the notion Based on the notion
of “constructivism”, of “constructivism”,
which assumes which assumes
multiple realities that multiple realities that
are socially are socially
constructed through constructed through
individual and individual and
collective collective
perceptions or views perceptions or views
of the same situation.of the same situation.

9. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Research PurposeResearch Purpose

Seeks to establish Seeks to establish
relationships and relationships and
explain causes of explain causes of
changes in changes in
measured variables. measured variables.
That is, the goal of That is, the goal of
science is to explain science is to explain
and predict.and predict.

Concern is with the Concern is with the
understanding of the understanding of the
social phenomenon social phenomenon
from the from the
participants’ participants’
perspectives. This perspectives. This
requires, to some requires, to some
degree, researcher degree, researcher
participation.participation.

10. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Methods and ProcessMethods and Process

The scientific The scientific
method, also known method, also known
as a priori or pre-as a priori or pre-
established design.established design.

Use of emergent Use of emergent
design utilizing design utilizing
constant constant
comparison and comparison and
revision.revision.

11. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Prototypical StudiesPrototypical Studies

Experimental or Experimental or
correlational designs correlational designs
are used to reduce are used to reduce
error, bias and the error, bias and the
influence of influence of
extraneous extraneous
variables--control of variables--control of
bias is through bias is through
design.design.
Use of ethnography, Use of ethnography,
which helps readers which helps readers
understand the understand the
multiple perspectives multiple perspectives
of the situation by the of the situation by the
persons studied. persons studied.
Subjectivity in data Subjectivity in data
analysis and analysis and
interpretation is interpretation is
acknowledged.acknowledged.

12. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Researcher RoleResearcher Role

Detachment from Detachment from
study in order to study in order to
avoid bias.avoid bias.

Immersion inImmersion in
situation and the situation and the
phenomenon being phenomenon being
studied.studied.

13. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
ContextContext

Context-free Context-free
generalizationsgeneralizations

Generalizations are Generalizations are
contextually-bound.contextually-bound.

14. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
PrecisionPrecision

Obtained through Obtained through
the use of the use of
measurement and measurement and
statisticsstatistics

Provided by detailed Provided by detailed
description of description of
phenomenonphenomenon

15. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
VerificationVerification

Results replicated Results replicated
by others.by others.

Extension of Extension of
understandings by understandings by
others.others.

16. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
ExplanationExplanation

Traditionally, Traditionally,
parsimonious parsimonious
explanations were explanations were
sought, but this may sought, but this may
be changing due to be changing due to
technology.technology.

Summary through Summary through
narrative--narrative--
importance is placed importance is placed
on reducing on reducing
complex realities to complex realities to
simple explanations.simple explanations.

17. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Logical ReasoningLogical Reasoning

DEDUCTIVE--DEDUCTIVE--
What’s the classic What’s the classic
example?example?

INDUCTIVE--INDUCTIVE--
anyone have an anyone have an
example?example?

18. Quantitative vs. Qualitative: Quantitative vs. Qualitative:
Conditional ConclusionsConditional Conclusions

Statements of Statements of
statistical statistical
probability.probability.

Tentative summary Tentative summary
interpretations.interpretations.

19. Types of Quantitative StudiesTypes of Quantitative Studies

DescriptiveDescriptive

True experimentalTrue experimental

Quasi-experimentalQuasi-experimental

CorrelationalCorrelational

PredictivePredictive

20. Research Using Primary DataResearch Using Primary Data

Cross-sectionalCross-sectional

Case ControlCase Control

CohortCohort

Randomized controlled trialRandomized controlled trial

21. Cross-sectional StudyCross-sectional Study

Data gathered at one point in timeData gathered at one point in time

Often used for surveysOften used for surveys

Can not make inferences about Can not make inferences about
causalitycausality

22. Robert Johnston’s Project
Interested in PTSD
Reviewed literature on PTSD in primary care
settings for his POM1 presentation
Decided to do a survey to determine prevalence
and associated conditions
Reviewed existing instruments
Survey includes 2 PTSD questionnaires,
AUDIT, SF-12 and PHQ-9
Obtained IRB approval June, 2010
Goal is to survey 100 patients at UMA

23. Case Control StudyCase Control Study

Start with the outcome- identify a Start with the outcome- identify a
sample with the condition of interestsample with the condition of interest

Identify a similar control groupIdentify a similar control group

Look back to determine exposureLook back to determine exposure

Calculate the risk in the cases and Calculate the risk in the cases and
controls- odds ratio used controls- odds ratio used

Can not use to establish prevalenceCan not use to establish prevalence

24. Cohort StudyCohort Study
Start with an identified groupStart with an identified group
Determine exposure in everyone at the Determine exposure in everyone at the
same timesame time
Follow the group to determine who Follow the group to determine who
develops the outcome of interestdevelops the outcome of interest
Can be used to determine prevalenceCan be used to determine prevalence
Association measured as relative risk Association measured as relative risk
(rate ratios)(rate ratios)

25. Randomized Controlled TrialRandomized Controlled Trial

Gold standard for determining Gold standard for determining
associationsassociations

Identify a groupIdentify a group

Randomly assign individuals to Randomly assign individuals to
exposureexposure

Only reliable way to control for Only reliable way to control for
confoundingconfounding

26. Research Using Secondary DataResearch Using Secondary Data

Literature reviewLiterature review

Systematic reviewSystematic review

MetanalysisMetanalysis

Analysis of existing data collected for Analysis of existing data collected for
another purposeanother purpose

27. Literature ReviewLiterature Review

Gather articles on a topic of interestGather articles on a topic of interest

Summarize the findingsSummarize the findings

28. Systematic ReviewSystematic Review

Gather articles using a pre-defined Gather articles using a pre-defined
search strategy- may include search strategy- may include
unpublished studiesunpublished studies

Develop a-priori objective criteria to Develop a-priori objective criteria to
evaluate the quality of the studiesevaluate the quality of the studies

Summarize the quality of the data and Summarize the quality of the data and
the resultsthe results

29. MetanalysisMetanalysis

Do a systematic reviewDo a systematic review

Obtain the primary data if possibleObtain the primary data if possible

Summarize the data quantitativelySummarize the data quantitatively

30. Analysis of Existing DataAnalysis of Existing Data
Use administrative data for researchUse administrative data for research

Insurance claims data- MedicareInsurance claims data- Medicare

Central Data Repository (CDR) at UVaCentral Data Repository (CDR) at UVa
Use regularly collected survey dataUse regularly collected survey data

National Center for Health Statistics National Center for Health Statistics
performs multiple surveys periodically- performs multiple surveys periodically-
NAMCS, NHIS, NMCES, NHANESNAMCS, NHIS, NMCES, NHANES
Use data collected for another studyUse data collected for another study