Mixed Methods/Other Research & Systematic Reviews PDF

Mixed Methods/Other Research & Systematic Reviews NURS/HSCI 3092 Week 9: December 2nd , 2024  Part 1: Mixed Methods/Other Research  Mixed Method Research Many areas of inquiry Research that can be enriched by integr...

Mixed Methods/Other Research & Systematic Reviews NURS/HSCI 3092 Week 9: December 2nd , 2024  Part 1: Mixed Methods/Other Research  Mixed Method Research Many areas of inquiry Research that can be enriched by integrates QUANT & triangulating Advantages: QUAL data and complementarity; quantitative and practicality; enhanced strategies in a single qualitative data; some study validity questions require mixed methods: pragmatism (Woo, 2018)  Mixed Method Designs Bringing together of two Notation system: Consists of components: methods, usually occurs QUAL/quant; during data analysis OR QUAN/qual during narrative of results Core component: can stand Concurrent approach: quant Core component provides along if necessary and qual data collected at theoretical base same time Supplemental component Core component is always Qual and quant are collected the complete and rigorous in phases method and addresses research question (Woo, 2018)  Mixed Method Designs Obtain different, but complementary, data about the central phenomenon under study—i.e., to Convergent parallel design triangulate data sources Sequential designs with quantitative data collected in phase 1, followed by qualitative data Explanatory design collected in phase 2 Sequential MM designs, with qualitative data being collected first Exploratory design (Woo, 2018) Other Special Types of Research Health services Interventio Survey Secondary Delphi and n Research research analysis surveys outcomes research (Woo, 2018)  Clinical Trials ◦ Phase I: designed to establish safety, tolerance, and dose ◦ Phase II: seeks preliminary evidence of effectiveness—a pilot test often using a quasi-experimental design ◦ Phase III: fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often in multiple sites; sometimes called an efficacy study ◦ Phase IV: focuses on external validity of an intervention in the general population; emphasis on generalizability (Woo, 2018)  Practical Clinical Trials ◦ Emphasis on EBP has led to call for studies that bridge gap between tightly controlled efficacy studies and subsequent effectiveness studies ◦ Practical clinical trials (or pragmatic clinical trials) help in making decisions in real-world applications ◦ Pragmatism is a paradigm often associated with MM research (Woo, 2018)  Evaluation Research Process analysis Economic analysis Often undertaken to obtain descriptive information about the Assess whether program process by which a benefits outweigh program gets monetary costs implemented and how it functions (Woo, 2018)  Basic Nursing development Intervention al research Research Describes an approach Effectivene Pilot distinguished by a distinctive ss research research process of planning, developing, and testing interventions—especially complex interventions Efficacy research (Woo, 2018)  Health Services Research ◦ Designed to document quality and effectiveness of health care and services ◦ Often focuses on parts of a health care quality model developed by Donabedian; key concepts: Structure of care Processes (e.g., Outcomes (end (e.g., nursing clinical decision results of patient skill mix) making) care) (Woo, 2018)  Outcome Research Subset of health services research Comprises efforts to understand end results of health care practices and assess effectiveness of health care services Represents response to increasing demand from policy makers and public to justify care practices for improved patient outcomes and costs (Woo, 2018)  Survey Research Obtains Secures quantitative Used information information primarily in about on correlational people’s May be prevalence, studies and actions, cross- distribution, to gather intentions, sectional or & information knowledge, longitudinal interrelation from characteristi s of nonclinical cs, opinions, variables in populations and a population attitudes (Woo, 2018) Modes of Collecting Survey Data Self- Personal administere (face-to- Telephone d face) interviews questionnai interviews res (Woo, 2018)  Secondary Analysis Study uses Cost-effective; Can be May not be aware previously data collection undertaken with of data quality gathered data to can be expensive qualitative or problems & face address new and time- quantitative data “if only” issues questions consuming (Woo, 2018)  Delphi Surveys Technique involves panel of experts who complete several Multiple iterations are Developed as a tool for rounds of used to achieve short-term forecasting questionnaires focusing consensus on their judgments about topic of interest (Woo, 2018)  Methodologic Research Studies that focus on development, validation, and evaluation of research tools and instruments Can involve qualitative or quantitative data Example: Developing and testing new data collection instrument (Woo, 2018)  Part 2: Systematic Reviews  What is a Systematic Review? ◦ Comprehensive, unbiased synthesis of many relevant studies in single document using rigorous and transparent methods (Aromataris & Pearson, 2014) ◦ Impossible to develop “best practice” guidelines, protocols, and procedures without organizing and evaluating research evidence through a systematic review  Starting point for clinical practice guidelines and protocols ◦ Secondary versus primary research (Woo, 2018)  History Archie Cochrane (1909-1988) ◦ Failure of medicine to use body of available evidence in appropriate way ◦ 1993 Cochrane Collaboration ◦ 1995 Cochrane Database of Systematic Reviews 1970s & 80s systematic reviews and meta-analyses in health fields ◦ Difference between systematic review and meta-analysis ◦ Suggest meta-analysis is process of statistical synthesis ◦ Groups globally expanded systematic reviews ◦ Methodology continually evolving (Woo, 2018)  Why are Systematic Reviews Important? ◦ Uncover international evidence ◦ Confirm current practice/ address variations ◦ Identify areas future research ◦ Investigate conflicting results ◦ Produce statements to guide decision-making (Woo, 2018) Types of Systematic Reviews Meta- Meta- analysis synthesis (Woo, 2018)  Remember: Quality depends on methods to minimize risk of error / bias Explicit and exhaustive reporting of methods necessary Rigor distinguishes them from traditional literature reviews Influence healthcare decisions and should be conducted with same rigor expected of all research (Woo, 2018) Traditional Literature Review Systematic Review Choices for inclusion of studies is Informed by an a priori protocol subjective Structured research process Conducted with no stated methodology Steps taken to reduce bias Leads to risk of bias / systematic Systematic and often exhaustive error searching for information Limited searching Transparent and reproducible methods Unreproducible and not transparent Cannot be done by one person (Woo, 2018)  Standards for Systematic Reviews ◦ Quality depends on extent methods are followed to minimize error / bias ◦ Require explicit and exhaustive report of methods ◦ Reporting standards exist to guide reports JBI Reviewer’s Cochrane PRISMA Manual Handbook (Woo, 2018) PRISMA Diagram The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed100009 7 High Quality Systematic Reviews Articulated objectives and questions Inclusion and exclusion criteria outlined in protocol Search for all published & unpublished studies Critical appraisal & analysis of included studies Presentation and synthesis of the findings extracted Transparent reporting of methodology and methods (Aromataris & Pearson, 2014)  Planning a Systematic Review Statistical support Library support Methodolog ical Topic expertise expertise At least 2 reviewers - relevant training (Woo, 2018)  Meta-Analysis Advantages Objectivity - statistical integration eliminates Increased power— Despite these bias in drawing reduces the risk of a advantages, meta- conclusions when type II error compared analysis is not always results in different to a single study appropriate studies are at odds (Woo, 2018)  Using Meta-Analysis ◦ Must decide whether statistical integration is suitable ◦ Research question / hypothesis should be same across studies ◦ Avoid the “fruit” problem - don’t combine apples and oranges! ◦ Must have sufficient knowledge base - must be enough studies of acceptable quality ◦ Results can be varied but not totally at odds (Woo, 2018)  Analytic Decisions WHAT EFFECT HOW WILL WILL THERE BE WILL SIZE INDEX HETEROGENEITY SUBGROUP PUBLICATION WILL BE USED? BE ASSESSED? ANALYSES? BIAS BE ASSESSED? (Woo, 2018)  Heterogeneity ◦ Effects inevitably vary across studies ◦ Heterogeneity can be formally tested but also can be assessed visually via a forest plot ◦ Factors influencing variation in effects are usually explored via subgroup analysis ◦ Do variations relate to: ◦ Participant characteristics (e.g., men vs. women)? ◦ Methods (e.g., RCTs vs. quasi-experiments)? (Woo, 2018) ◦ Intervention characteristics (e.g., 3-week vs. 6-week intervention)?  Meta-synthesis ◦ Terminology relating to qualitative integration is diverse and complex ◦ Meta-synthesis umbrella term, representing “family of methodological approaches to developing new knowledge based on rigorous analysis of existing qualitative research findings” ◦ Meta-synthesis is not a literature review ◦ Integrations more than sum of the parts - novel interpretations of integrated findings (Woo, 2018)  Meta-synthesis: Ongoing Debates Whether to Various typologies Whether to integrate studies and approaches; exclude low- based in multiple differing quality studies qualitative terminology traditions (Woo, 2018)  Meta-synthesis Steps Decide design Formulate with selection Search for data in problem criteria, search literature strategy Perform data Evaluate study Extract data for analysis and quality analysis interpretation (Woo, 2018)