HCMT3007- Health Science Research and Regulations PDF

HCMT3007- Health Science Research and Regulations Dr Jennifer Egbunike, Associate Professor Healthcare Management Programme About Me  First year in Qatar  Over 20 years experience in Healthcare Academic Research, Teaching and Consulting  Working acro...

HCMT3007- Health Science Research and Regulations Dr Jennifer Egbunike, Associate Professor Healthcare Management Programme About Me  First year in Qatar  Over 20 years experience in Healthcare Academic Research, Teaching and Consulting  Working across UK, Europe, Africa, USA  UCL Global Business School for Health- Global Healthcare Management Programme  Kingston and St Georges Universities- Research in Health  London Metropolitan University- Public Health and Social Care  Oxford Brookes- Research  Bsc. Clinical Biochemistry  PGCertLTHE  MSc Public Health  PhD Health Policy and Organisational Studies  Senior Fellow UK Higher Education Academy  Fellow, Royal Society for Public Health  Courses Taught include:  Clinical Leadership and Management  Global Healthcare Management  Innovation and Change Management  Research Methods 2  Quality Improvement and Implementation Science  Dr. Egbunike  Contact Information:  Email: [email protected]  Office: BM11.2.05  Telephone: 4495-2795 3 Contacting Dr Egbunike Best to use email Contacting Use UDST email me Please write your full name and student ID number in your emails 4  Course Overview/Aims  To investigate the importance of research in all areas of Healthcare Management  To understand ethical principles, policies, regulations and best practice in undertaking human subject research  Learning Outcomes  To identify historical and contemporary health research projects as well as implications for modern day healthcare  Understand the functions and role of an Institutional Research Board (IRB)  Identify legislation that impacts on healthcare research and be aware of penalties and breaches  Evaluate healthcare research proposals from an ethical and legal perspective  Compare research methodologies in healthcare industry to understand their advantages and disadvantages  Course Outline (1)  Introduction to Research  Understanding the research process  Developing a Research Topic/Question  Understanding databases  Developing a literature review  Referencing correctly in academic writing  Developing and appraising a Research Proposal  Course Outline (2)  Research Ethics, Legislation, Policies and Good Clinical Practice  Research Design, Methodology, Methods  Strengths and limitations of research methods  Outlining and developing your research project report  HCMT3007- Expectations  Early formation of your groups- Finalize this week!  Register your groups on D2L  Meet weekly in your groups  Work promptly and regularly (7-week term)  Use available computer rooms or personal devices for your research  Remember- You are in the driving seat! Assignments and Assessments  Group identification of a research topic/question  Review of the literature on your choice of topic (2500words) submission end of week 3  Exercise on Ethics (? Week 4 -TBC)  Quiz- Week 4/5  Developing your research propsal (3000 words - due week 5)  Outline your project report- Report pre-liminary findings from your research and present (Week 6 and 7) Assessments & Weights (TBC) Assessment Type Weight of final Grade Remarks Literature Review (2500words) 15% Group Quiz 20% Individual Research Proposal (3000words) 15% Group Project Report 30% Group Presentation 20% Group 11 What is Research?  Session covers the following:  What is research?  Who conducts Research?  Why do you need to understand the research process?  Some of the key terms used in research  The purpose & role of research in professional practice What is research? What is research?  What is research ? Research involves finding out about a particular topic for a specific purpose. For example:  Gaining a greater understanding on human behaviour/ attitudes/ motivations/ perceptions  Improving service provision (in health and social care settings)  Improving medical treatment – clinical trials Who conducts research?  Who conducts research?  Students – You….undergraduates in final year, MSc, MRes, MPhil, PhD  Research Focused Institutions – e.g. Qatar Foundation  Think Tanks –e.g. Centre for Policy Studies  Government departments –e.g. HMC, PHCC, Sidra  Charitable organisations –  International Agencies/ organisations- e.g. UNICEF, WHO, UNAIDS  Independent researchers/ consultants – conduct commissioned research What is the purpose & role of research?  To identify need & gaps in service provision –e.g. if a new compound/housing estate is being built, and there will be an influx of new residents –will a new health centre or other services required? how many doctors, nurses for a hospital etc.  To further knowledge – e.g. PhD research on analysing policies aimed at caring for the elderly, exploring innovations in healthcare  To plan for service provision – once needs and gaps have been identified, and recommendations implemented, some groups may be overlooked, and research would be required to plan for their needs – the health needs of young people or other seldom heard groups- give some examples you know…?  Why do you need to understand the research Process?  As part of this course you will need to write a research Proposal – group assignment  To complete this course, you will be required to write a research report and present your findings  Further studies ? PhD  By understanding why research is carried out in healthcare, and the methods used to conduct it, you will be able to critically assess any claims made about the services as a student and future management practitioner  ? Possible employment involving research or research governance What is the purpose & role of Research?  Informing & improving policy and practice – e.g. a research can be carried in 3 years time to find out the effectiveness of “a new service provision”- findings will inform policy & practice modifications  Aiding reflection and allowing progress to be monitored  Evaluating service provision – UDST Students satisfaction survey / Course evaluation forms  Exploring topics of contemporary importance – migration and health or obesity, diabetes or genetic disorders in Qatar – these are “hot” topics/issues that impact health and social care services  Historical and Contemporary Research Projects  First Clinical Research by Naval Surgeon James Lind (1947)  Clinical advancement in the treatment of scurvy (deficiency of vit C.)  The discovery of penicillin and other antibiotics  Revolutionised medicine by reducing mortality rates (death) due to infectious diseases  Contemporary research in antimicrobial resistance (AMR)  Drug discovery in chemotherapy (cancer treatment)  Research into multi-drug resistance  mRNA vaccines and the rapid development of COVID vaccines  Research Homework Find out more about the research and historical development of penicillin The evolution of clinical research through the years Research the details of the first clinical research by James Lind Group Formation Identify members and form your groups of 5 maximum. You will work in this group for your proposal and other group research tasks Key words used in research Some of the key words used in research  Demographic data- any data that describes population groups in a given location & their characteristics (race, religion, age, sex, gender etc.)  Peer Reviewed –before an article is published in a specialist journal, e.g. the lancet – it must be scrutinised by other specialists in the field – this ensures high quality research  Sample - a group of research participants selected from the target population, e.g. a group selected from a population of pregnant women  Hypothesis – a precise statement which makes a prediction about the findings a researcher expects to find  E.g 1: The more control patients are given in health care settings, the better their health outcomes  E.g 2: There is a relationship between sugar consumption and the rate of diabetes in Qatar Some of the key words used in research  Researcher bias – the possibility that a researcher may interpret findings in a way which suits their hypothesis/ beliefs/ influencing participant responses  Research Rationale / justification – Your key reasons (objective- academic ) for wanting to conduct a piece of research - why is the topic relevant to your field of practice? Usually, there is a gap in knowledge , there is a problem evidenced by a high prevalence - statistical evidence backed by academic literature  Secondary data – data that has been collected by another researcher and is published is some source = used for literature reviews = secondary research  Primary data – data that you have collected by yourself – e.g. asking students to complete a questionnaire on healthy eating – if you get published = becomes secondary data to someone else  Where we are going: research questions All research start with a research question –the problem or issue that we are trying to explore Different knowledge positions lead us to be interested in different things, and ask different questions about the world we are trying to explore The research process  The Research Process  Define the research problem(s)-  Phrase/craft the research question  Develop aims and objectives  Determine study design: sampling, methods of data collection and analysis  Explore ethical considerations  Data collection & Analysis  Interpretation and report writing- with conclusions and recommendations  Not usually a linear process  Research Thinking Research Questions  What is happening?  Is there a systematic (causal) effect?  Why or how is it happening (“mechanism”)? Steps in Conducting Research 1. Identify and define a research problem 2. Formulate hypothesis based on theory, research, or both 3. Design the research 4. Conduct the research 5. Analyze the data 6. Interpret the data as they relate to the research question  Core Texts (HCMT3007)  Sheppard V (2020). Research Methods for the Social Sciences. Vancouver: BC Campus. E book (open source).  Bryman A. (2021). Bryman’s Social Research Methods. (6th Edition). Oxford University Press.  Bell J. and Waters S. (2018). Doing your Resarch Project: A guide for first time researchers. 7th edition. Open University Press.  Other academic text focussed on research Any Questions? CONSIDERATIONS AND REPARATION FOR YOUR LITERATURE REVIEW Dr Jennifer Egbunike Associate Professor Healthcare Management AIM & OBJECTIVES FOR THE SESSION Aim  By the end of the session you will gain knowledge and an understanding into the process of undertaking a literature review, for clinical leadership Objectives  1. To consider what is knowledge  2. To define a literature review  3. To gain insight into how to approach and write up a literature review  How do we acquire our knowledge?  How is it validated? Who decides?  When is it a fact?  Itis objective, or is it subjective? Or is it constructed as we go? WHAT IS THE TRUTH?  WHAT IS A LITERATURE REVIEW? AIMS 1. To demonstrate your knowledge & understanding of the topic 2. To identify the main researchers 3. To explore the gaps in research evidence 4. To consider application, to your own context Objectives To use a search strategy, search engines, snowballing To identify a structure with themes identified, to show synthesis To utilise skills that critique research articles (use matrix) To reflect and apply conclusions, into your own clinical context WHAT IS THE PURPOSE OF A LITERATURE REVIEW  What information already exists in your field of research- what has been said or done  Identify any gaps in the literature  Show any relationships between theories and previous studies  Provide context, rationale, basis for your own research- This is your ‘why’  Identify seminal work, methodologies used and research techniques  Assess similarities and differences  key questions or narratives  Identify ideas, conclusions and theories  Review Aims  Good background provided  Comprehensive and up to date  Contextualise the problem  States clearly how your work builds on or responds to earlier studies  Be selective about points you raise for discussion  Does it open up your inquiry adequately?  Analyse and synthesize thematically  WHAT MAKES A GOOD RESEARCH QUESTION? WHAT – the health issue or problem? Any sub-topics in developing the background information? Any gaps or questions unanswered? WHO- target population you are interested in? Gender, age, ethnicity, WHERE- geographic location/ context? But beware of getting too narrow WHEN- Time/period restrictions Current or historic context. Where historic, how relevant in the now? ?causative timeline of event A LITERATURE REVIEW What is your story? Is it contemporary? Why is it important? What is your rationale? What are your key messages, for your clinical context? What further questions need to be explored and How?  Blooms Taxonomy of Critical Thinking Type of Level Activity Verbs Used for Objectives or Question Lowest define, memorize, repeat, record, list, recall, name, relate, collect, label, Knowledge level specify, cite, enumerate, tell, recount Comprehen restate, summarize, discuss, describe, recognize, explain, express, sion identify, locate, report, retell, review, translate exhibit, solve, interview, simulate, apply, employ, use, demonstrate, Application dramatize, practice, illustrate, operate, calculate, show, experiment interpret, classify, analyze, arrange, differentiate, group, compare, Higher organize, contrast, examine, scrutinize, survey, categorize, dissect, probe, Analysis levels inventory, investigate, question, discover, text, inquire, distinguish, detect, diagram, inspect compose, setup, plan, prepare, propose, imagine, produce, hypothesize, invent, incorporate, develop, generalize, design, originate, formulate, Synthesis predict, arrange, contrive, assemble, concoct, construct, systematize, create judge, assess, decide, measure, appraise, estimate, evaluate, infer, rate, Evaluation deduce, compare, score, value, predict, revise, choose, conclude, recommend, select, determine, criticize Descriptive Writing (Cottrell 2003) Critical analytical writing (Cottrell, 2003) States what happened Identifies the significance States what something is like Evaluates strengths and weaknesses Gives the story so far Weighs one piece of information against another States the order in which things happened Makes reasoned judgements Says how to do something Argues a case according to the evidence Explains what a theory says Shows why something is relevant or suitable Explains how something works Indicates why something will work (best) Notes the method used Identifies whether something is appropriate or suitable Says when something occurred Identifies why the timing is of importance States the different components Weighs up the importance of component parts States options Gives reasons for selecting each option Lists details Structures information in order of importance Lists in any order Shows the relevance of links between pieces of information States links between items Draws conclusions DEVELOPING CRITICAL THINKING SKILLS  Review of an authors argument  Be critical, identify strengths/limitations, challenges/benefits, themes & gaps in evidence  Development of your argument ( what are your claims, with evidence and reasoning)  Exploring alternatives (reflexivity eg Brookfield)  Engagement with the world and contextualising in practice  AVOID THE BARRIERS TO CRITICAL THINKING (COTTRELL, 2005)  Include academic criticism and argument development  Consider the detail, supportive evidence, to support/justify any claims  Avoid just critiquing findings; consider the research design, ethical considerations, methods of data collection, study population, sampling methods and representativeness, data analysis methods and the relevance of the findings to your own clinical context ASSESS THE EVIDENCE How reliable is the evidence/source? Is it representative? Are the claims well substantiated? Consider other possible explanations  THE IMPORTANCE OF A CLEAR STRUCTURE  Introduction and Rationale (Policy, Location-Qatar, world, research focus)  Search strategy (explain, use tables where appropriate, inclusion/exclusion criteria)  Summarize the Literature by identifying 2/3 key themes (Use headings for your themes, to sign post the reader)  Consider methodology, gaps, strengths/benefits & limitations/challenges  Create depth in your review by selecting 5/6 core research articles  Reflection on literature and Clinical Impact/development and leadership implications  Gap identification, problem statement or rationale for your study  Research Question, Aims and Objective  Outline your findings  Recommendations (e.g. Research questions, Research design, Education & Training, local/national policy)  References-accurate, contemporary, wide range, relevant  Your research outline should contain: Problem statement- Think WHAT, WHO, WHERE, WHEN Research Question -Aim and Objectives Method- Secondary data review Key words- 3-5 keywords to be used in your literature search Relevant databases for your topic  Suggested Readings See core texts- ANY QUESTIONS ?  Considerations for Developing A Research Proposal Dr Jennifer Egbunike Associate Professor- Healthcare Management  In this session we will start to examine:  What is a research proposal?  What should your research proposal address?  Considerations in formulating your research aims and objectives? What is a Research Proposal and Why Write one? Does every house/ building need a plan?  What is a research proposal ?  It is a declaration of intent about ways of addressing your identified research problem/question  The proposal is therefore an envisaged plan of action  It explains why the research is necessary  It explains what it is you are attempting to achieve, how you will go about achieving it, and why it is worth the attention  There is a brief review of the literature at the beginning of every proposal  It is usually written in future tense- e.g  This proposal will……  We anticipate  What should your Research Proposal Address? 1. Tell the reader what you plan to accomplish  Be clear and succinct in defining the research issue/ problem and what it is you are proposing to research 2. Why do you want to do it? – Rationale/justification  You need to conduct a thorough review of the literature and provide a convincing evidence- with statistics (data) which show the research question is worthy of study in your chosen area of professional practice 3. How are you going to do it?  State your aim and outline your objectives  Outline your literature search strategy/ methods  Provide a schedule- your research timetable (provides envisaged time frames when each stage of the research process will be covered)  Outline any cost implications  Examine and discuss your ethical considerations **** Covering your- What, Why and How?  What makes a good research Question? WHAT – the healthcare, leadership or management problem/issue? WHO- target population? WHERE- location/ context?  *What is the impact of Questions to avoid government policy responses in Questions with an obvious yes/ no answer or known facts, e.g. tackling obesity in children (under Do university students in Qatar feel 18) in Qatar? stressed during exam time? Questions which are too broad, unfocused, lacking parameters or boundaries e.g. covering all of Africa How does social media impact on the health of young people in Qatar? How do cooking programs on TV impact on healthy eating? How do I know I have formulated a good question? Does the question address a specific/key healthcare, leadership or managemnet issue? Evaluate it !! Does it have a specific target population? Does it have a specific context/ location? Does it have a clear focus? Does it give sufficient room for analysis?  How to develop a question  Identify key elements.  Ask: o who, why, where, when, what and how? (quantitative) o to what extent …? how do …? what are …? (qualitative).  Be sure to get the length of the question right, i.e. a balance between being succinct and getting in all the necessary details.  Qualitative studies may have a statement rather than a question The Good Research Questions:  Identifies a gap in knowledge or a problem  Focuses attention on directly relevant and significant issues that need to be researched  Guides and focuses the research study  Leads to an appropriate research design  Research Aim/s Aim: Explains purpose of the research project & states your intentions The aim of the research project might be: To Investigate To Explore To Examine To Analyse The aim presents the general picture of your research study Emphasizes what will be addressed *using an action verb An Example: Start with your Research Question: What is the impact of government strategies aimed at tackling obesity in children (under 18) in Qatar? For your Aim, rephrase; change/re-phrase the wording of the question: To explore the impact of government strategies aimed at tackling tackling obesity in children (under 18) in Qatar?  What are Objectives ? Objectives are more specific & should: Be consistent with the aim Clearly portray/outlines the steps to be taken in order to accomplish the aim of the research project Be highly focused Usually be numbered to ensure clarity / short bullet points 2-3 maximum (at your study level)  What is the relationship between your aim and objectives Objectives should describe how the AIM will be achieved Research Question: What is the impact of government strategies aimed at tackling obesity in children (under 18) in Qatar? Aim: To examine the impact of government strategies aimed at tackling obesity in children (under 18) in Qatar? Objective 1: Focused on the nature and extent of the research problem/issue To examine the prevalence of Obesity in children under 18 in Qatar Objective 2: Focused on some aspect related to the research issue, e.g. To explore the health implications of childhood obesity in children under 18, drawing on the Qatar context Objective 3 : Focused on assessing government strategies To assess the impact of government strategies in tackling obesity in children (under 18) in Qatar  Objective 1: To examine the prevalence of obesity in children under 18, with reference to Qatar Aim: To examine the Impact of government strategies in Objective 3: tackling obesity Objective 2: To assess the impact in children under To explore the health of government 18 in Qatar and other implications strategies in tackling of obesity in children obesity in children under 18 in Qatar under 18 in Qatar Background information and Rationale What is the purpose of a foundation? A research proposal and project without background information =below Background information in research is the foundation upon which you build your research proposal and project Historical Policy/ Statistical legislation/ strategies Background information (may include) Social/cutural Political  Your Proposal Rationale  You need to provide a clear rationale- i.e. why your proposed study is important, in relation to both existing knowledge and to your field of practice  A clear research question supported by a convincing rationale that is justified by the academic literature is essential for the execution of a quality of research project  It should be objective - objectivity is derived from academic evidence  The topic is worthy of study because secondary data/ literature suggests there is a problem/ an issue worthy of attention and (?)requires Funding  At a higher level (e.g. PhD), a knowledge gap is usually identified – but at this level, the focus is on a problem/ issue within your field of healthcare leadership/management- professional practice  You can sometimes have just one section titled “Background and Rationale” or separate the two  Literature review  For your proposal you will need to provide a background summary of the available literature on your chosen topic – suitable for the lay reader.  Assimilate up to date information on the topic.  Identify gaps in research/human knowledge – Rationale for the research  Can help to refine your research question through determining inconsistencies in a body of knowledge  Contd…  A research problem may emerge from your literature review  A good literature review also helps to inform your research design  The literature review itself will help you to become an expert in your field- to scope and understand your study properly  Overview of the literature review process  Use your identified research problem to develop/craft a review topic  Formulate the review question  Define inclusion/exclusion criteria- see related publications in your field to develop these  Access, search and select the literature  Assess the quality of the literature gathered  Synthesise findings to write your rationale and to provide background  Keep detailed notes for your writing and store your references  PICO Framework  The PICO framework can be a useful tool to help develop your research question  Usually used to frame questions when searching for evidence of a quantitative nature  Can be modified for use with qualitative research questions:  Intervention is replaced by Issue and Comparison by context eg.  ‘ What factors (outcome) contribute to the uptake of smoking (issue) in young people (population) looked after by the state (context)’  The PICO framework  Population: children  Intervention: use of the wii  Comparison: no intervention  Outcome: improvement in balance  Example: Does the use of the wii (gaming device) improve balance among children with acquired brain injuries  Useful databases/resources  British Nursing Index  CINAHL  Cochrane Library (Systematic reviews)  Pubmed/MEDLINE  PsycINFO (related to psychology)  EBSCO (Educational literature)  NICE  Any others?- We will explore availability with UDST Librarian  Why do we need statistics?  In health and healthcare, we make use of prevalence data to assess how often a specific diseases occurs in different groups of people and why  Used to plan and evaluate strategies to prevent illness & as a guide to the management of patients where diseases have already developed  Through this data we assess if the issue, e.g. incidence of pressure sores is major healthcare issue “worthy” of attention from staff, leadership or management  You can also consider “frequency- incidence of cases”  However, statistics / cases do not tell the whole story hence the need to incorporate qualitative data where these exist in your research proposal  What not to write!  My aunt was recently diagnosed with depression so I thought it would be interesting to find out more.... (subjective)  Studies suggest that many people were diagnosed with COVID in England last year so...(vague – name the studies, present the statistics)  Many children in Doha were referred to Al Rumelia dermatology services... (present the figures and supporting evidence) What about my interest in a topic, is it not enough to justify the study?  You must be interested in a topic which motivates you, but this cannot be used to justify the study when you write  Be objective – present literature evidence, be specific – name the research studies, present statistics, number of cases, relevant qualitative evidence etc.  Introduction Proposal Outline  Background (including rationale/case for support)  Research problem statement/question  Study aim and objectives  Methodology and Methods (including justification for your choice)  Any ethical considerations  Data Management and protection- how you will achieve this  Schedule- Time table and resource implications  Any consideration of sources of bias  Abstract or lay summary- written last but comes at the top  Impact statement- Who benefits, how and the process  Experience and qualifications of the project delivery team  References  Common pitfalls in writing a proposal  Failure to have a clear & precise research question/ statement  Framing a research problem/ issue with irrelevant literature  Writing style which lacks clarity and precision  Evidence / Statistics - not supported by relevant academic sources (lack of clear and adequate referencing)  Failure to highlight the issue / problem in the relevant target population & location  Failure to have contextual boundaries on the research issue ( population & location)  Failure to develop a coherent and persuasive argument  Failure to stay focused on the research question – going off on a tangent  Poor grammar, lack of paragraphs, spelling errors  Too much detail on minor issues, but not enough detail on major issues  Failure to appropriately acknowledge information sources – e.g. Research / evidence suggests…..  Suggested Reading  See core texts  Zina O’leary- (any version) Doing your research project  Saunders, M. N. K. & Lewis, P. (2012) Doing your research project. Harlow, England: FT Prentice Hall.  Gray, D. E. (2009) Doing research in the real world (2nd ed.). London, England: Sage.  Robson, C. (2011) Real world research (3rd ed.). Oxford, England: Blackwell.  Punch, K. F. (2001) Developing Effective Research Proposals. London: Sage Publications. Questions?  Group Funnel Activity 10-15 minutes  Discuss and map your research problem  Write down all the associated keywords/concepts you can think of  Look at some of these ideas and begin to focus/agree on a particular area of interest  Choose the topic that interests you all the most  Narrow the focus- demographic group/ location/ context  A hierarchy of questions to ask yourselves Research Area/theme Research Topic Main Research Question Any Research Sub-Questions Specific Data Collection and methodology Questions WELCOME TO UDST LIBRARY! Rebecca Leonhard Information Services Librarian Main Library – 14.2.02D [email protected] +974 4495 2467  Services available to you from the Library Literature Reviews Plagiarism APA 7 Citations Database searches Library Locations Main Library Learning Commons ◦ Building 14 ◦ Building 3 ◦ Has most of the books, including: ◦ Has some easy reading books in ◦ Popular fiction English, magazines & journals ◦ Arabic section ◦ Study rooms ◦ Graphic Novels/Manga ◦ Digital Media equipment available to ◦ magazines & journals borrow ◦ Course Reserves ◦ Study rooms Library Website https://library.udst.edu.qa /home What is a Literature Review? ◦ An overview which brings together all the published literature on a specific topic or research question. ◦ The ”literature” is the academic writing. It can be: ◦ Journal articles ◦ Academic books ◦ Government pamphlets ◦ Conference proceedings ◦ Association papers ◦ Dissertations ◦ It is comprehensive and contains an analysis of the compiled information. ◦ Contains the most relevant studies and the most important past and current research and practices. ◦ Provides background and context and shows how your research will contribute to the field.  Literature Review Definition Qualitatively summarizes evidence on a topic using informal or subjective methods to collect and interpret studies. Literature Goals Provide summary or overview of topic Reviews Question Can be a general topic or a specific question What are the requirements? Components Introduction Methods Discussion Conclusion Reference list Number of Authors One or more Kysh, L. (2013). Timeline Weeks to months Difference between a systematic review and Requirements Understanding of topic a literature review Perform searches of one or more databases (Version 1). figshare. https://doi.org /10.6084/m9.figshare.76 Value Provides summary of literature on a topic 6364.v1 Systematic & Literature Reviews Subject Guide https://library.udst.edu.qa /literature-review HCMT3007: Healthcare Research Development & Management Subject Guide https://library.udst.edu.qa /hcmt3007 PLAGIARISM  What is plagiarism? ◦ The dictionary defines plagiarism as “the act of using or closely imitating the language and thoughts of another author without authorization and the representation of that author's work as one's own, as by not crediting the original author.” ◦ http://vimeo.com/105598832 Different Types of Plagiarism ◦ Submitting another person’s work and claiming it as one’s own. ◦ Did your friend write your paper? ◦ Buying a research paper on the internet. ◦ Copying big portions of text from a single source without alterations. ◦ Copying & pasting from the internet. ◦ Not paraphrasing correctly. ◦ Changing key words and phrases, but keeping the main content of the source. Different Types of Plagiarism ◦ Combining perfectly cited sources with copied passages without an in-text citation. ◦ Including citations to non-existent sources or giving incorrect information about sources. ◦ Failing to put a quotation in quotation marks.  Ways to Avoid Plagiarism ◦ Start your research early. ◦ Read the sources you find during the research process. ◦ Write down citation information as you find it, so you don’t have to hunt for it later. ◦ Put researched information inside quotation marks or paraphrase it. ◦ Give credit where credit is due. ◦ Pick a citation style and learn how to cite information. How do you make APA citations? Publication Manual of the American Purdue OWL Psychological Association Call Number: BF76.7.P83 2020 https://tinyurl.com/2wwzecwm http://tinyurl.com/mrx884ew RefWorks A web-based reference management tool that allows you to manage your references when writing or collaborating with other researchers. https://refworks.proquest. com/library/all/  Who can check my References? ◦ Advanced Writing Centre (AWC) ◦ Can also read your paper ◦ Located in the Learning Commons ◦ Book appointments online ◦ https://library.udst.edu.qa/learningcommons/h elpcentre Ask a Librarian! We are here to help. https://library.udst.edu.qa /assignmenthelp/appoint ment The Research Process https://library.udst.edu.qa /researchprocess/home Questions? Contact Us! Rebecca Leonhard Douglas Williams ◦ Office: 14.2.02D (Main Library) ◦ Office: 03.1.73 (Learning Commons) ◦ Phone: +974 4495 2467 ◦ Phone: +974 4495 2265 ◦ [email protected] ◦ [email protected] Help Me Help You! Let me know how I did. Scan the QR code or go to https://udst.libwizard.com /f/library-instruction- student KEYWORD CHOICES How to Pick Keywords to Conduct Searches in Databases and on the Internet  PICO The four elements needed to construct a well-built clinical foreground Defining your question P research I C O Patient/Population/ Intervention Comparison Outcome Problem How would I describe the What main intervention, Is there an alternative to What do I hope to problem or a group of prognostic factor or compare with the accomplish, measure, patients similar to mine? exposure am I intervention? improve or affect? considering? Middle-aged men Angiotensin- Beta1-adrenergic Control blood with hypertension Converting Enzyme antagonists pressure (ACE) Inhibitors (beta-blockers) In middle-aged men with hypertension are ACE Inhibitors better than Beta-blockers in the control of blood pressure?  PICOT T can also be included as an element of your question if your topic or research Defining your allows. P research I C O T Patient/Population/ Intervention Comparison Outcome Time Problem How would I describe the What main Is there an alternative What do I hope What is the problem or a group of intervention, to compare with the to accomplish, time period or patients similar to mine? prognostic factor or intervention? measure, timeframe? exposure am I improve or considering? affect? Middle-aged men Angiotensin- Beta1- Control During flu with hypertension Converting adrenergic blood season Enzyme antagonists pressure (ACE) Inhibitors (beta-blockers) In middle-aged men with hypertension are ACE Inhibitors better than Beta-blockers in the control of blood pressure during flu season? The T in PICOT ◦ T is optional. ◦ Time describes the duration for your data collection or how long it will take to reach the desired outcome ◦ Can also be for Type of Study or Question. ◦ What study types are most likely to have the information you seek? ◦ What clinical domain does your question fall under? ◦ Is this a diagnosis, etiology/harm, therapy, prognosis, or prevention question? KEYWORD CHOICES How to Pick Keywords to Conduct Searches in Databases and on the Internet What is a keyword? ◦ Any significant word or phrase, especially a word used to describe the contents of a document. ◦ A significant or memorable word or term in the title, abstract, or text of an item being indexed, used as the index entry. ◦ A keyword is a word that is essential to communicating your need. ◦ Keywords are often common or proper nouns, but they can also be other words, too. Consider 3 Things When Choosing Keywords ◦ Think about what you are trying to find. ◦ Choose the words that you think will appear on the page. ◦ Put yourself in the mindset of the author of those words--what words would he or she use? WHY??? ◦ The words you choose will influence the kinds of results you get. WHY??? ◦ The words you choose will influence the kinds of results you get. In middle-aged men with hypertension are ACE inhibitors better than Beta-blockers in the control of blood pressure? Medical Subject Headings (MeSH) ◦ Medical Subject Headings (MeSH) are a controlled vocabulary thesaurus of terms created by the National Library of Medicine and used for PubMed article records. ◦ What do they do? ◦ Give uniformity and consistency to the indexing and cataloging of biomedical literature. ◦ Give thorough scope notes helping you to define concepts. ◦ Are divided into 16 main categories arranged in a hierarchical tree structure. ◦ Are updated yearly and selected based on their importance to clinical care and research. ◦ Can be accessed here: https://meshb.nlm.nih.gov/search or through the databases PubMed Central and MEDLINE at UDST Libraries. ◦ Many medical databases have their own subject thesaurus which you should use when searching for subject headings. ◦ CINAHL Ultimate  MeSH Headings in PubMed Central To find MeSH headings: Do a basic search Find MeSH in the dropdown list Enter your search terms MeSH Headings in PubMed Central Narrow down your search results by adding subheadings. MeSH Headings are also used in the database MEDLINE. Synonyms and Related Concepts ◦ A synonym is a word that has the same meaning as another word in the same language. ◦ For example... Happy Joyful Elated ◦ Writers use a variety of terms to describe the same thing. ◦ Computers only search for the term you enter, so you need to identify any synonyms or related terms. ◦ Dictionaries, thesauri and encyclopedias are good sources to look for synonyms and related terms. The Same, but Different! X-ray = Radiographic Imaging Heart Attack = Myocardial Infarction Car = Automobile = Motor Vehicle Hypertension = High Blood Pressure SIDS = Sudden Infant Death Syndrome Cancer = Tumor = Tumour = Carcinoma Plan Your Search Strategy ◦ Using your question, think about which databases you might use to find information and answers. ◦ Use advanced search techniques and a variety of search terms to execute your searches and refine your results. ADVANCED SEARCH TECHNIQUES Advanced Search helps to pinpoint what you are looking for from the start. Good for: Any search after the first one Seeing all options for narrowing down your search Understanding search statements as a whole Phrase Searching ◦ Searching by a particular phrase or word combination. ◦ Multiple words are put together inside quotation marks. ◦ “job satisfaction” ◦ “hazardous waste” ◦ Narrows the search results. ◦ Use only on established phrases. ◦ If you put too many words in quotations, the database may not find any results. Boolean Searching ◦ Also called “Boolean Logic.” ◦ A type of search syntax or search technique which helps the user conduct a better, more exact search. ◦ It is used when searching using more than one keyword or phrase. ◦ When conducting a search, a person uses the Boolean operators: AND, OR, and NOT. ◦ These operators are used to link words and phrases for more precise queries. Where Does Boolean Come From? ◦ Boolean logic takes its name from British mathematician George Boole (1815-1864), who wrote about a system of logic designed to produce better search results by formulating precise queries. ◦ He called it the "calculus of thought." ◦ From his writings, we have derived Boolean logic and its operators: AND, OR, and NOT. How Boolean Logic Works ◦ It uses the words AND, OR and NOT to search for items containing both terms, either term, or a term only if not accompanied by another term. ◦ All databases and web search engines have help pages explaining how Boolean logic works in their specific system. Boolean “and” ◦ The Boolean AND actually narrows your search by retrieving only documents that contain every one of the keywords you enter. The more terms you enter, the narrower your search becomes. EXAMPLE: truth AND justice EXAMPLE: truth AND justice AND ethics AND congress Boolean “and” A search for ‘rock AND roll’ will locate all records containing both the word “rock” and the word “roll.” (same as ‘all’) Boolean “or” ◦ The Boolean OR expands your search by returning documents in which either or both keywords appear. Since the OR operator is usually used for keywords that are similar or synonymous, the more keywords you enter, the more documents you will retrieve. EXAMPLE: college OR university EXAMPLE: college OR university OR institution OR campus Boolean “or” ◦ A search for ‘rock OR roll’ will locate all records containing either the word “rock” or the word “roll” – not necessarily both. (same as ‘any’) Boolean “not” / “and not” ◦ The Boolean NOT or AND NOT (sometimes typed as ANDNOT) limits your search by returning only your first keyword but not the second, even if the first word appears in that document, too. EXAMPLE: cloning NOT sheep EXAMPLE: pepsi NOT coke ◦ Tip: NOT can be dangerous. Let's say you want to search for items about Mexico, but not New Mexico, so you use NOT to exclude the word "New" from your retrieved set. This would prevent you from retrieving an article about "New regulations in Mexico" because it contained the word "New," although that wasn't what you intended. Boolean “not” / “and not” ◦ A search for ‘rock NOT roll’ will locate records containing the word “rock” but NOT the word “roll.” Boolean Logic A search for ‘rock AND roll’ will locate all records containing both the word "rock" and the word "roll.” (same as ‘all’) A search for ‘rock OR roll’ will locate all records containing either the word "rock" or the word "roll" -- not necessarily both. (same as ‘any’) A search for ‘rock NOT roll’ will locate records containing the word "rock" but NOT the word "roll”. Nesting... With Boolean Operators ◦ Nesting, i.e., using parentheses, is an effective way to combine several search statements into one search statement. Use parentheses to separate keywords when you are using more than one operator and three or more keywords. EXAMPLE: (hybrid OR electric) AND (Toyota OR Honda) ◦ For best results, always enclose OR statements in parentheses. Implied Boolean Operators ◦ Implied Boolean operators use the plus (+) and minus (-) symbols in place of the full Boolean operators, AND and NOT. Typing a (+) or (-) sign in front of a word will force the inclusion or exclusion of that word in the search statement. EXAMPLE: +dementia -alzheimers ◦ Similarly, putting double quotation marks (" ") around two or more words will force them to be searched as a phrase in that exact order. EXAMPLE: "green tea” ◦ In some databases and search engines, you may have to select “Exact phrase.” Things to Consider When Using Boolean Logic ◦ Different databases and search engines handle Boolean operators differently. For example, some accept NOT, while one accepts ANDNOT as one word, others AND NOT as two words. Some require the operators to be typed in capital letters while others do not. ◦ You may have to indicate if it’s a Boolean search. This option would usually be available in the advanced search option. ◦ Different databases and search engines may only allow full Boolean operators in the advanced search option, while implied Boolean operators may only be used in the basic search options or vice versa. Things to Consider When Using Boolean Logic ◦ Some databases and search engines use drop-down menu options to spell out the Boolean logic in short phrases. ◦ For example... ◦ "All of the words" or "Must contain” = AND ◦ "Any of the words" or "Should contain” = OR ◦ "Must not contain” = NOT.  Wildcards & Truncation Use truncation (or stemming) and wildcards to look for variations in spelling and word form and to increase your search results. The English language has many variations of the same word. For example: dog and dogs give and giving Some words also are combinations of several words. For example: doghouse You may need to search for some of these combinations at the same time, normally the singular and plural form of the same noun.  Wildcards & Truncation Involves substituting symbols for certain letters of a word so that the search engine will retrieve items with any letter in that spot in the word. The symbol used is usually *.  Wildcards For a wildcard search, put the symbol in the middle of the word. For example: colo*r Search results: color colour A wildcard search makes it easier to search for related word groups. For example: wom*n Search results: woman women womyn  Truncation For a truncation search, put the symbol only at the end of the word. For example: librar* Search results: library, libraries, librarian, etc. Truncation can be useful to search for a group of words instead of typing all the words in separately with the Boolean operator OR. For example: Invest* Search results: invest, investor, investors, investing, investment, investments, etc.  Truncation Tricks BUT REMEMBER... invest* will also retrieve: investigate, investigated, investigator, investigation, investigating, etc. The trick is to combine terms with the Boolean operator AND to try and narrow your search results to the kind of documents you’re looking for. For example: (invest*) AND (stock* or bond* or financ* or money)  Truncation & Wildcard Tips Truncation or wildcards work best when the stem is longer and if the stem is not a root of many other common words. A lot of search engines "stem" keywords automatically. For example, they will automatically search for dog if you enter the keyword "dogs" and vice versa. If you do a search for... Your results will include: Dog dog* Dogs Dogged Doggy Dogma If you do a search for... Your results will include: Injuries injur* Injury Injured If you do a search for... Your results will include: Cat c*t Cot Cut If you do a search for... Your results will include: Back b**k Bilk Bark Bank Book Limiting the Search ◦ Narrow down your search results using built-in limiting options. ◦ Some examples are: ◦ Language ◦ Year of publication ◦ Full-text ◦ Peer-reviewed ◦ Publication type ◦ Subject ◦ Publisher ◦ Source type Some databases will have a “Peer-Reviewed” box you can check during searches. Can be called ‘Peer-reviewed’ or ‘Refereed’ or ‘Juried.’ Check the Journal’s website if you aren’t sure whether an article is peer-reviewed. WHAT ABOUT GOOGLE SCHOLAR? What About Google Scholar? How do you search for peer-reviewed It works, but... articles? You can’t. At least not easily. Look for these blue buttons when you search the web! Connect with UDST resources from any website. Available on all campus computers. Want this on your personal devices and off campus? ◦ Download the LibKey Nomad add-in on your browser. ◦ Choose UDST as your institution. ◦ Let me know if you need help. PRACTICE SEARCH? Questions? Contact Us! Rebecca Leonhard Douglas Williams ◦ Office: 14.2.02D (Main Library) ◦ Office: 03.1.73 (Learning Commons) ◦ Phone: +974 4495 2467 ◦ Phone: +974 4495 2265 ◦ [email protected] ◦ [email protected] Help Me Help You! Let me know how I did. Scan the QR code or go to https://udst.libwizard.com /f/library-instruction- student  Bibliography ◦ Bare Bones Lesson 8: Searching with Boolean logic and proximity operators. (n.d.). The University of South Carolina Beaufort. Retrieved February 20, 2013, from http://www.sc.edu/beaufort/library/pages/bones/lesson8.shtml ◦ Beginner 1: Picking the right search terms. (n.d.). Google Search Education Lesson Plans. Retrieved February 13, 2013, from https://docs.google.com/document/d/1l4pS26nZLUok_-rx2_w5qu5aYy40p5gXX58l6dgE4_c/edit ◦ Boolean searching: The operators and, and not, or. (1998-2012). Retrieved February 20, 2013, from http://www.pandia.com/goalgetter/4.html ◦ Chamberlain, E. (2006, September 7). Bare bones lesson 7: Basic search tips. The University of South Carolina Beaufort Library. Retrieved March 20, 2013, from http://www.sc.edu/beaufort/library/pages/bones/lesson7.shtml ◦ Class 1-introduction. (n.d.). Power Searching with Google. Retrieved February 11, 2013, from http://www.powersearchingwithgoogle.com/course/ps/lesson14.html ◦ Keyword. (2013). Dictionary.com. Retrieved February 13, 2013, from http://dictionary.reference.com/browse/keyword?s=t ◦ Kysh, L. (2013). Difference between a systematic review and a literature review (Version 1). figshare. https://doi.org/10.6084/m9.figshare.766364.v1 ◦ Neyer, L. (2013, February 11). Library database searching. Library Database Searching. Retrieved February 20, 2013, from http://www.slideshare.net/lneyer/library-databasesearcing ◦ P&S Koch. (2012). Truncation or wildcards in internet searching. Truncation or Wild Cards in Internet Searching. Retrieved March 20, 2013, from http://www.pandia.com/goalgetter/9.html ◦ Schwartz, K. L. (2008). Skills for online searching. Ipl2: Research & Writing Info Search. Retrieved March 12, 2013, from http://www.ipl.org/div/aplus/skills.htm ◦ Schwartz, K. L. (2009-2012). Skills for online searching. A+ Research & Writing for High School and College Students. Retrieved February 20, 2013, from http://www.ipl.org/div/aplus/skills.htm Research Methods Overview Dr Jennifer Egbunike Healthcare Management  Research Methodology What does the word methodology mean to you?  Research Methodology  The science of understanding how research is performed methodologically  A systematic way to sole a research problem  The entire strategy towards the achievement of research objectives  Methodology Your theoretical perspective informs the method you choose to collect your data Methodology : The way/approach of doing research It is the explanation of the strategy of how you go about conducting your study You would outline your approach, view or thinking as a researcher as well as: Your Procedure, Process or Sequence of use of Methods Methodology = Research Design The interphase of thinking between theory and methods  Research Paradigms  A research paradigm is “the set of common beliefs and agreements shared between scientists about how problems should be understood and addressed” (Kuhn, 1962) According to Guba (1990), research paradigms can be characterised through their:  ontology – What is reality?  epistemology – How do you know something?  methodology – How do you go about finding it out?  Relationship Overview The diagram below explains the above terms and the relationship between them: If the above still doesn’t make things clear, don’t worry. I would now recommend Ontology and epistemology create a holistic view of how knowledge is viewed, how we see ourselves in relation to the knowledge and the strategies/methods we use to unpick it  Research Thinking Research Questions What is happening? Is there a systematic (relationship or causal) effect? Why or how is it happening (“mechanism”)? Steps in Conducting Research 1.Identify and define a research problem 2.Outline the aims, objectives and research question 3.? Formulate hypothesis based on theory, research, or both 4.Design the research 5.Conduct the research 6.Analyze the data 7.Interpret the data as they relate to the research question  Secondary and Primary research – what is the difference? Secondary research Primary research Secondary research is the use of Primary research refers to information that has been collected by the collection of original data others, i.e. You undertake secondary research every time you write an from the field using selected assignment! This information comes from a & justified method/s variety of sources & is based on the work of an original researcher or The nature of research based on the interpretation of their topic determines the work by someone else Secondary research is an integral part method/s which will be used of primary research as the researcher needs to be fully aware of what others have studied in relation to their subject/topic of interest (Stretch, 2002; Creswell, 1998 ) Secondary research: what are the sources of information?  Ward level data – logs of treatment, outcomes, incidences, length of bed stays etc.  Books/ e-books – library catalogue etc.  Journals – Excellent sources of information – peer reviewed.  Media (Newspapers, TV, Radio etc.): Consider bias issues e.g. daily mail far right  Think Tanks – consider political leanings, e.g. The Bow Group, the oldest Tory think tank founded to counter socialism  Government Departments - e.g. the Office for national statistics (www.statistics.gov) provides very useful information on children, education & skills, crime & justice, Health & social care , population, equality & diversity, migration etc.  Potential challenges with government statistics/ information source? – clinical iceberg/ fragile contexts  ? Wikipedia – How reliable & authentic is it? Is wikipedia an academic source of secondary information? Why Wikipedia is not considered an academic source of secondary information?  Problems with lack of authority  Open editing policy problematic  Lack of knowledge on the author – may not be expert in the field  Incorrect information can go unchallenged for a very, very, long time!!  Secondary research: sources of information- organisations Charities & intergovernmental organisations usually focus on specific issues. They conduct research, engage in advocacy & lobby government/s for specific policy changes: YoungMinds - a UK leading charity committed to improving the emotional wellbeing and mental health of children and young people Qatar Charity Action on Smoking and Health - a campaigning charity that works to eliminate the harm caused by tobacco United Nations Children’s Fund UNAIDS- the Joint United Nations Programme on HIV/AIDS Save the Children Federation World Health Organisation Private companies – Social justice/ accountability issues What are the potential challenges associated with these sources of information ?  The Secondary Research Process  Identifying the subject domain and where to acquire information  Searching, collating and gathering existing data  Comparing data from different sources if necessary and feasible  Analyzing the data  Ensure use of credible sources of information  Remember- It is not a linear process as stages can be repeated as necessary Examples of secondary research methods  Literature Review  Scoping review  Narrative review  Systematic Review  Meta-narrative mapping- looks historically at how particular research traditions have unfolded overtime, shaping the kind of questions being asked and the related methods (Greenhalgh and Wong, 2013)  Meta-analysis- summarizing and comparing results of large numbers of quantitative studies on a particular topic  Outline of Systematic Review Process Read more from Qualitative Research (Edited by David Silverman)  Advantages of secondary research  Relative ease of access of secondary data, the availability of online access makes it more easily accessible, offers convenience  Low cost - secondary data allows researchers to access valuable information for little cost in comparison to conducting primary research  Less intrusive on people’s lives – especially on sensitive topics  Clarifying Research Question & focus / subject secondary research is used by researchers to clarify their research focus / question before carrying out primary research  Addressing a research question – usually in well researched subject areas, hence no need to carry out primary research  Provides that data that researchers may not be able to collect , e.g. crime rates, disease prevalence, death rates etc. (Creswell, 1998; Bryman,2008)  Disadvantages of secondary research ? Limitations Quality of information needs to be constantly assessed Information can be biased towards the views of publishers depending on who they are- organisations, think tanks, newspapers etc. Information maybe out of date- you must ask yourself how relevant is this information to current debates in your area of professional practice? Research articles can be published a long time after the original research (Stretch, 2002)  Primary Research: Methods of data collection Scientific experiments : Interviews – face to face Usually used in natural communication with researcher / sciences (biochemistry , also on the phone- Skype – involve recording conversations e.g. PhD physics, psychology etc.) research with young people  Primary research: Methods of data collection Questionnaires / surveys – usually involve a large number participants e.g. Population censors survey/ Manicaland HIV Project Observations – gathering information on human behaviour as opposed to thoughts, attitudes or feelings Interviews and Focus group discussions- gathering information on people’s thoughts, attitudes or feelings etc. through facilitated conversations In health and healthcare these are the most used methods What are the potential challenges to these data collection methods ?  Advantages of Primary research  Researchers gather up to date information  Researchers potentially address specific questions  Data can be obtained quickly (on line / telephone surveys)  Researchers have control over the research study & what information to collect & how the information is collected  Disadvantages of primary research  It can be very costly to collect data and without funding it is almost impossible  It can be slow or difficult to gain ethical approval and access research participants  Targeted people may be reluctant/ not want to participate  It can take a very long time to collect data – financial implications  May produce misleading results due to researcher bias/ questionnaire or questions not worded properly  Requires expertise!  Key points to remember Secondary research Primary research Ease of access Easier to address specific questions Little / no cost Up to date information Less intrusive on people’s lives Research control Clarifying Research Question & focus / subject Challenges Costly & time consuming Challenges Research bias issues It can be out of date Expertise It may be difficult to recruit Potential for Publisher bias participants Processes to consider for quantitative research  Examples of Quantitative Research Design Experimental research  Hypothesis testing, which is about theory generation. Often features 1.) control groups and experimental groups and 2.) independent and dependent variables and manipulation of independent variables.  Randomised controlled trials, often used in medicine. Important elements of this research design are: >informed consent >genuine doubt about which treatment is best For example, use of randomised controlled trials with cancer treatment  Examples of Quantitative Research Design 2  Surveys: which can be gathered on a probability or non- probability sampling basis, and can be: >descriptive >exploratory >information gathering >demographic – for example Charles Booth’s mapping of poverty in London in the 1800’s >epidemiological – for example, studies of the rates and incidences of diseases such as TB or HIV/AIDS  Questions are probably ‘closed’, i.e., require a yes/no answer or a graded tick box response. Preoccupations of a quantitative researcher  Measurement  Correlation or Causality  Replication/Reproducibility  Reliability  Validity  Generalizability Are quantitative research studies better than qualitative? Hierarchy of Evidence Pyramid  Key points to remember  As research students in Healthcare Management and related studies you must take sufficient steps to critically evaluate the validity and reliability of the secondary data you use  You must avoid plagiarism – the use of secondary data means that you must acknowledge the sources.  Copying and pasting is cheating - plagiarism is an academically punishable offence.  Suggested References  Bryman, A (2008) Social Research Methods.Oxford: Oxford University Press  Creswell, J.W. 1998 Qualitative Inquiry and Research Design: Choosing Among Five Approaches. London. Sage  De Vaus, D. (2004) Surveys In Social Research. London. Routledge  Denscombe, M. (2007): The Good research Guide for Small Scale Social Research Projects. Maidenhead: Open University Press  Ritchie, J and Lewis, J. (2004) Qualitative Research Practice: A Guide for Social Science Students and Researchers. London. Sage  Talman, H. (2007) Research Methodology in Stretch B & Whitehouse M. Health and social Care. Oxford. Heinemann  Moonie N. (2003) Health and Social Care. Oxford. Heineman  Stretch, B (2002): Health studies. Oxford. Heineman