ENH 522 Research Methods PDF

ENH 522 RESEARCH METHODS Course introduction Prof intro, D2L tour,& other course info A little about me My name is Sabrina Chiodo PhD Epidemiology student at the Dalla Lana School of Public Health (DLSPH), University...

ENH 522 RESEARCH METHODS Course introduction Prof intro, D2L tour,& other course info A little about me My name is Sabrina Chiodo PhD Epidemiology student at the Dalla Lana School of Public Health (DLSPH), University of Toronto Hold an MPH in Epidemiology from DLSPH Over 6 years of research experience in epidemiology, population health, and health equity Worked at institutions including UofT, Trillium Health Partners, Princess Margaret Cancer Research Centre, and SickKids Thesis: Prediction of adverse pregnancy outcomes in Canada, focusing on how social determinants of health influence risk Syllabus & D2L Tour INTRO TO RESEARCH METHODS How do we know what we know? Experiences shape how we know about the world Through observations: allows us to make hypotheses, gather evidence Through trial and error: powerful tool in research b/c allows us to refine our understanding over time How do we know that lung cancer is caused by smoking? Articles, research Patterns emerged through observations – people who smoke are more likely to get lung cancer compared to those who do not Deductive reasoning- overtime through what we know about chemicals and carcinogens  Tenacity: Based largely on ideas of superstitions (e.g., Ghosts, curses) Intuition: A “hunch”; Can Metho help create a hypothesis ds of Authority: Taught by someone in a position of Knowi authority ng Rationalism: Deductive reasoning and logic Empiricism: Based on experiences and observations Methods of Knowing Tenacity- long standing traditions regardless of evidence, ideas that have persisted trough cultures universally but no scientific evidence. Ex: 19th century fi someone got sick they’re cursed Intuition- may not always be based on concrete evidence- important for forming ideas Authority- involved expertise of the person and the trustworthiness of source Rationalism- using principles of logic to arrive at a conclusion- powerful and construct arguments and theories Empiricism- cornerstone of scientific research- what is research methods is about, gathering data through science and forming and testing hypothesis  What is Research? Systematic investigation to increase human knowledge Establishes or confirms facts. In this course: empirical scientific research Collection of evidence related to the mechanisms and causes of disease, injury and health disciplined source High degree of accuracy and precision Empirical: gathering evidence Essential for advancing understanding  Epidemiological Research Porta. 2014. Dictionary of Epidemiology. Oxford. Involves applying knowledge to control and prevent health problems. Ex: looking at masks and vaccines during COVID-19 rather than just looking at ”droplets are the cause of the virus”- looking at how to prevent it  2. Select study 1. Identify approach study Come up with a question way to test the data The 3. Design Researc study and collect data 4. Analyze data h (e.g., Watch out for bias questionnaires and other threats to validity , interviews) Process 6. Report findings (peer review, 5. Interpret academic results publication, news article, website) Study Validity Internal validity: extent to which a study is free from bias or systematic error. (Accuracy in representing some fundamental truth) External validity: extent to which study results may apply to populations or people who did not directly participate in the study (relates to generalizability) Please review concepts here: http://sphweb.bumc.bu.edu/otlt/mph-modules/Pro gramEvaluation/ProgramEvaluation6.html Study Validity Internal: ex: during COVID clinical trials for vaccines. b/c people in the lab (experimenter) controlling aspects of that environment Observational have less internal validity because experimenter cant control External: - asks the question can these findings be applied beyond the specific conditions of the study. Ex: across different locations and times Ex: doing study on 60 year old men can it be used in women or children Bias From “slant” or “angle” In common use, typically means “unfair” or “one- sided”, a deliberate distortion In science, can refer to issues with methods that distort results, without any deliberate intention Epidemiologists love to talk about bias! Some biases are cognitive – Key example: confirmation bias: Distortion of facts to fit a certain way – : cognitive- stems from the way the brain processes info. Ex: confirmation- people tend to favour evidence that is based on preexisting beliefs or hypothesis and will unconsciously ignore evidence that is contrary to their belief. Ex: docs who smoked didn’t believe smoking caused factor WHO Defines Health 1948: 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease.’ 1984: 'Health is a resource of everyday life, not the objective of living: it is a positive concept emphasizing social and personal resources as well as physical capacities.' Health ebbs and flows; think of health in broad ways. What is Health Research? 'A broad spectrum of biological, socioeconomic, environmental, and other factors that contribute to physical, mental, and social health and well-being.' (Jacobsen 2017) Essentially examines wide range of factors Asks the question “how do all these factors play together to contribute to our well being?” Population health research involves humans as the unit of investigation. Distinction between routine practices and health research.  Population health: distinct from other research that focuses on genetics, looking population as a whole to see factors affecting population level health- still has implication for critical care. Ex: does pop. live Evidence- Based Medicine Requires that researchers or health practitioners follow a series of steps to arrive at a sound decision. Recently includes evidence- based practice and evidence-based behavioral practice. Involves emphasizing using the best research we have available with clinical expertise and patient values Use resrarch to shift prac  Best research evidence is the foundation that provides up to date research for practice  Most reliable way physicians can achieve better patient outcomes 1. Asking a 2. Accessing focused clinical question the clinical research Steps in Evidenc 3. Appraising the best 4. Applying the evidence e-Based evidence found to the problem at hand Decisio 5. Assessing the n- effectiveness of care based Making on this evidence Health Research Milestones in Canada 1920s 1940s The Discovery of Insulin Canada contributes to Fredrick Banton the polio vaccine and Charles west- insulin Treating seizures in Development in cancer Montreal radiation treatment 1930s 1950s Canadian Institutes of Health Research Four pillars of research: – 1. Biomedical- research on biological mechanisms: genetic research, molecular cancer – 2. Clinical- study patients to improve diagnoses, treatment in prevention of diseases – 3. Health services and policy- how health care services are delivered and how different policies can improve health outcomes at the population level – 4. Social, cultural, environmental, and population health- broader social determinants of health, and environmental factors and how they influence population health Health Research Purposes To describe, to explain, to predict, and to control (Young 2004; Bassil & Zabkiewicz 2014) Common reasons for initiating a health research study: Needs Risk Applied Outcomes assessme assessme practice evaluation nt nt (1) Needs What is the health status of the population?- Evaluate the health Assessme status of a pop nt Major health concerns of members in population- identify the major health concerns and areas that are not being adequality addressed Ask critical questions: Which health-related concerns are not being addressed? The systematic approach to ensure health services improve the population's health efficiently. Ex: low-income area have no access to urgent care, conduct a study and ask how is that lack of access to health, affect the population, “What does the pop need to improve health outcomes” (2) Risk Assessme ntThreats to health – For example, COVID-19 Risk factors for morbidity, mortality, disability, and other health issues. Ex: covid- wanted to understand risk factors from dying from covid, such as existing conditions and age. “who was the most at risk” and by assessing, we can better prepare for next pandemic and (3) Applied Practice How well are we preventing, diagnosing, and treating health concerns in populations?- Evaluate how effectively are we preventing, diagnosing and treating health conditions within the pop. Applies to a variety of health professions: medicine, nursing, public health, and others- Crucial for health care professionals, and goal is to ensure clinical practice is leading to better health outcomes (4) Outcomes Evaluation Was this intervention successful at improving health status in this population?- What is the effectiveness on this item in improving pop health Can ask about the effectiveness of procedure, process, project, program, policy, and other activity. Ex: is this physical activity program actually improving the health of this pop. Empirical research Gather all data and observations to ensure that we are delivering best care, identifying risk factors and preventing disease- all comes down to using empirical research COLLECT DATA PUT YOUR PET THEORIES, HYPOTHESES OR WAYS OF THINKING AT RISK OF FALSIFICATION WITH DATA COLLECTION HISTORICAL EXAMPLE OF EMPIRICAL SCIENCE: PREVENTING INFECTION Ignác Semmelweis and Childbed Fever  Ignác Semmelwe is 1818-1865 Physician Work was important for preventing childbed fever, cause of infant mortality Research he produced shaped the way clinical practice works on hand hygiene Reduce deathrates of mothers Hand hygiene  Hospital in Vienna Issue: high Maternal mortality rate- didn’t know why it was happening The Young Mother by Charles West Cope, 1845. Valerie McGlinchey, CC BY-SA 2.0 uk, https://common s.wikimedia.org/ w/index.php? curid=9977581  Puerperal/ childbed fever Severe abdominal pain, fever, Mothers pass Became epidemic heartbeat away 1-3 days in Europe in abnormalities, post childbirth ~1700s digestive and urinary problems Devastating “Sporadic” (non- mortality in epidemic) form epidemic form: had lower 70-80% mortality Hallett, C. (2005). The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries: The Influence of Inflammation Theory. Medical History, 49(1), 1-28. doi:10.1017/S0025727300000119 First Division Second Division Births by physicians Births by midwives 3000-3500 births per year 3000-3500 births/year 600-800 deaths from ~60 deaths from puerperal fever per year puerperal fever per year 800 < his findings 700 Asked what is going Typical deaths from childbed fever on Started to collect 600 500 data through 2 400 divisions Strange b/c men 300 were allowed to be 200 doctors and they 100 went to school 0 rather than First clinic Second Clinic midwives Why? Theories: Thought first division was cursed, or bad air (miasma), blamed women being depressed- entering birth sad youre gonna die No theories made sense, so he made 6 observations  Semmelweis’s 6 observations: The fever raging in First Division had First Division was not Decades of hospital ~10x the fever general to Vienna. In- records of fever deaths of Second home and even deaths showed no Division, with key unexpected alleyway connection to difference being births rarely had weather, unlike other doctors vs. midwives puerperal fever epidemics deaths. Closing down the Infants born to Greater physical ward stopped women who later died trauma during birth mortality—if delivered of puerperal fever seemed to increase elsewhere, risk goes sometimes also died risk of fever away in a similar way Adapted from Nuland. The Doctors’ Plague. 2003. Norton. p 97-98  Jakob Kolletschk a (1803- 1847) Pointing turn in his research: Friend Jakob passed away- physician at hospital overseeing autopsy and med student pricked him with scalpel Száva, István (1967) Ein Artz besiegt den Tod, Budapest, Hungary: and Corvina Verlag he page 48 passed away later and in his autopsy it was very similar w women who died of childbed fever  He then realized physicans performed autopsy and when women die they autopsy these women, and then they Rembrandt attend new patients, and he then - The Anatomy Lesson of Dr. Nicolaes Tulp , 1632 realized physicians were attending autopsies, not washing hands and then attending new women  Said all physicians need to wash hands and scrub under nails with chlorine solutions after this practice, dramatically reduced deathrate in clinic Hand-hygiene basin at the Lying-In Women's Hospital in Vienna, 1847. Source: https://doi.org/10.1016/S1473-3099(09)70295-6  https://doi.org/10.1016/S1473-3099(09)70295-6 0 death in 1847 when it was impleme (on D2L under Resources>Library E-reading  Issue: boss did not believe him, he believed it was miasma It means that physicians cased the plague and they did not want to admit to their faults and so nobody believed him and so the head doctor fired him Did not report his findings (most important part of research- have to publish your findings)  Moved to a Budapest hospital and was rageful because nobody believed and he spent his entire career doing research on this  Final attempt to share his findings he wrote a book and calls everyone out for not hand washing and believing him  Sent him to asylum and he later died At his death, his autopsy found signs of childbed fever and neuro problems  Today, we know he was right Introduced in bloodstream through childbirth We can learn that we need to publish our findings Strepcoccus was apart of the fever Streptococcus pyoge HOW TO READ AND LEARN RESEARCH How to learn about research It is important to Critically appraise articles and study Scientists communicate Ever Emerging in peer- changing issues reviewed journals Reading current scientific articles Where to find articles: RU library search everything, google scholar, pubmed, web of science, others? For this class: readings provided on D2L (look under resources, one stop course readings). Refer to syllabus for which to read for which weeks. BUT, I NEED TO UNDERSTAND A TOPIC BEFORE I CAN READ A SCIENTIFIC ARTICLE ABOUT IT! How to read a scientific article http://www.owlnet.rice.edu/~ca inproj/courses/HowToReadSciAr ticle.pdf  Journal source: is it peer-reviewed? Authors: where are they? Could this be of interest? Do they go to a university Timeline of research and article- if it took to long to review it means there were issues in checking their info Check article structure, does it follow IMRD? – Introduction – Methods – Results – Discussion Article abstract Your starting point Summarizes the article: most readers look at this first. Should contain info on: – Purpose or rationale of study (why they did it) – Methodology (how they did it) – Results (what they found) – Conclusions (what it means) Missing info: we don’t know sample size, why did they do the study, methodology- we do not know they analyzed data  Creates interest in subject Summarizes relevant background – What is already known? – What is not yet known? (forms justification or rationale for the study) Introducti Previous work by the team and by others that support on the current approach A good place to learn new terms and make note of those to look up to define for yourself (can read past unknown terms in some cases) The research question/hypotheses should become apparent  What new terms did you read in the introduction? From How did they justify the need Sana et for their current al. 2013 study? What else did you learn from the introduction? Methods Terms you may find: study population, participants, sampling, design, materials, procedure, measurement Key words to look for: random, statistics, sampling, control- hints that a statistical analysis was performed In theory: enough detail for another scientist to repeat the methods- that is how much detail should be there Likely the most challenging section to read without technical knowledge. Try reading without fully understanding all detail…can you follow the gist of what was done  The methods for two distinct experiments are described, what were the different goals of each? Who were the From participants in this study? Sana et What was the key explanatory variable? al. 2013 Laptop multitasking What was the key response variable? Learning/comprehensio n Does multitasking on a laptop affect learning?  What was Look for charts found? and figures Results Normally does not reference any other work, just the current study findings  What are the key results? Sana et al. 2013 Where are these results most effectively communicated? No- they could have included chart in results section From Sana et al 2013 Bars mean confidence interval Shows that multitasking affects performance  Results are placed in context of the broader field What did we find in the study and how Discussio does it relate to what other people have studied- compare with what people have n found and what is known Answers the question posed in the Introduction Provides extensions for further study- “this is what we found but couldn’t expand on and this is what our future work will do” Perhaps draws a conclusion relevant to practice- have a conclusion that will have a recommendation Highlights study strengths and limitations- what they could do and could not What did we find in the study and how  A new finding and a replicated finding, what were these? What strengths of the current approach are highlighted? Sana et What future studies are al 2013 suggested? Did this study compare what people believe to some objective measure of truth? How? What suggestions or recommendations are made for implementing the findings in practice? Sana et al 2013 Answers Strengths: easily replicable, able to control environment Future studies: look at subject difficulty Did this study compare: yes because they used deductive reasoning- “laptop does hinder learning” “this gives sense knowing what we know from before” Recommendations: teachers discuss consequences of laptop multitasking and suggest that they explicitly discourage laptop use in courses Reading a Scientific Article: tips Read actively: take notes on what you read! Ask yourself questions before reading: – Who are the authors? – What journal is this? – Do I understand enough terminology to proceed? – Am I getting bogged down/spending too much time on less important details? – Where can I go for clarity or help with definitions? Ask questions after reading What specific problem does the research address? Why is the problem important? Is the method a good one? Is it the best one? What are the specific findings? Can I summarize these in 1- 2 sentences? Is the evidence for the findings persuasive? Is there another way to interpret the data that the authors did not consider? How are the findings unique/new/unusual or supportive of previous findings? How can the ideas be applied in practice? What further experiments or data could help answer remaining questions?