Health Care Research Methods, Techniques, and Design PDF

Health Care Research B A S I C M ET H O D S, T EC H N I Q U E S A N D D E S I G N October 2024 D r. A n d r e a B e a l l 1. Does a particular mouth rinse really reduce plaque build up? 2. Which brand of toothpaste is best? 3. Can non...

Health Care Research B A S I C M ET H O D S, T EC H N I Q U E S A N D D E S I G N October 2024 D r. A n d r e a B e a l l 1. Does a particular mouth rinse really reduce plaque build up? 2. Which brand of toothpaste is best? 3. Can nonsurgical periodontal therapy provide results comparable to thse of a surgical procedure? How do you answer these questions?  Research Defined Research is the continual search for truth using the scientific method. The research process includes:  Looking for a solution for a specific problem  Collection of data as evidence needed to solve a problem  Organization, classification, and analysis of the evidence into a logical pattern  Use of reasoning and statistical analysis to solve the problem according to the evidence collected Darby, M., Bowen, D., Research Methods for Oral Health Professionals An Introduction, J.T.K. McCann Company, 1993  General purposes of Oral Health research 1. To promote the oral health of the public by improving education, service, practice, and delivery 2. To contribute new knowledge or reevaluate current knowledge to improve all phases of oral health care 3. To improve the techniques and practices of identifying , preventing, and treating oral diseases in individuals and in groups  General Purposes of Oral Health research 4. To develop and test theories related to oral health care and oral disease process 5. To identify and solve problems indigenous to advancement, decision making and changes in oral health care  Scientific Method The scientific method refers to a series of standardized procedures used in research to increase the likelihood that information gathers will be relevant, reliable and unbiased Certain knowledge and skills must be part of every competent dental hygienist practicing in the dental community. The Evidence Pyramid  Evidence Based Practice Evidence based decisions come from research, practice, and patient preferences The scientific method and development of a research problem 1. Formulation of a problem asking the question 2. Formulation of a hypothesis a proposed answer to the question 3. Collecting the data finding existing information related to the question as well as gathering of your own information. 4. Analysis and interpretation of the results 5. Presentation of the results 6. Formulation of the conclusion Relationship of results to the hypothesis  Types of Research Approaches 1. Historical To determine meaning of the past events 2. Descriptive To describe and interpret current events or situations 3. Experimental (Prospective) To investigate cause and effect relationships 4. Quasi Experimental Same as experimental but lacks the control of the true experimental design  1. Historical Determines the meaning of past events  records review  Interviews  Literature Reviews Limitations: location of accurate data, gaps in knowledge, no ability to replicate, biased reports Eg. Development of ADHA water fluoridation program ( 1945-2005)  2. Descriptive To describe and identify current events or situations a. Survey b. Case study c. Developmental d. Cross sectional e. Cohort or longitudinal f. Document or content analysis g. Trend h. Correlational i. Retrospective (causal-comparative or ex post facto)  Descriptive- a) Survey To gather broad information about status quo; usually involves large sample size  Questionnaires  Opinionaires  Interviews  Indices  Limitations: lack of depth  Eg. Questionnaire looking at dental hygienists attitudes towards administering local anesthesia  Descriptive- b) Case Study To conduct in-depth report on a single person, group, event or situation  Interviews  Observation  Testing  Record reviews Limitations: replication not possible, subject to bias Eg. Ortho case reports  Descriptive-c) Developmental To study growth, development, maturation, or change over period of time Limitations: Obtaining representative population Eg. Primary teeth exfoliations pattern  Descriptive- d) Cross sectional To study cross-section of population in limited period of time - Snapshot of a moment in time Descriptive- e) Cohort or Longitudinal To study same population over extended period of time Limitations: Time consuming, extended financial commitment, loss of subjects (attrition) Eg. Preschoolers from 3 different schools (urban, rural, suburban) are evaluated on their reading skills. These groups are studied again in grades 3, 6, 9, and 12.  Descriptive-f) Document or Content Analysis To analyze documents themselves  Examination of records or documents for specific information or presentation style  Limitations: subjectivity in evaluation  Eg. Evaluation of dental journals for types of articles printed  Descriptive- g) Trend Combines descriptive and historical research to establish patterns from the past and present in order to predict future occurrences  Records review  Review of the literature  Interviews  Observation  Surveys Limitations- long range prediction is less valid and reliable than short range prediction Eg. 1968-2008 Regarding expanding scope of dh’s  Descriptive- h) Correlational Measures the relationship between variables  Comparison of 2 sets of data Eg. Frequency of flossing and periodontal disease  Descriptive- i) Retrospective To investigate existing differences to determine possible cause  Reverse of experimental approach Limitations: can’t determine causal relationships, can only determine functional relationship Eg. Perio disease study with 40 adults with periodontal disease and 40 without perio disease  3. Experimental (prospective) To investigate cause and effect relationships  Involves manipulation of independent variables  Control of extraneous variables  Measurement of dependent variables  Use of control group Limitations: decreased external validity Eg. Effects of frequent sugar exposure on tooth enamel of laboratory rats  4. Quasi Experimental To investigate cause- and- effect relationships BUT lacks control of true experimentation (randomization) Limitations: decreased internal validity, lack of control of extraneous variables Eg. Effects of sugar exposure on tooth enamel of dental patients  Independent & Dependent (outcome) variable Rainstorm: The height of the water in the river will rise. The amount of water in the river has no effect on how much it will rain. So, the amount of rain affects the height of the water in the river, but the height of the water in the river does not determine the amount of rain that falls. Independent variable: The rain Dependent variable: The height of the water in the river  Sampling Techniques Types of Sampling A. Non probability a) Quota b) Convenience B. Probability a) Simple random b) Systemic sampling c) Stratified random sampling d) Cluster sampling Sample Size Regardless of sampling technique used, the sample selected should be as large as possible.  Sampling continued…… Sample: Representative portion of the population A. Non probability sampling a) Accidental: by chance, may be misleading or biased b) Quota: based on set % of categories  Sampling Continued B. Probability sampling More likely to be representative of the population from which it is drawn and is required for statistical inference. 1) Random sample Every element has an equal and independent chance of being selected All subjects in the sample have an equal chance of being selected  Sampling Continued 2) Systematic- samples every nth subject 3) Stratified random sampling Subgroups are used and simple random samples are taken then combined to form the total sample. 4) Cluster sampling Combinations, used for large groups  Bioethics  Bioethics- inherent role of ethics in health care and the established norms of conduct in performing research that distinguish between morally acceptable and unacceptable behavior  Institutional Review Board (IRB)  Ensures that the rights and safety of the research subjects are respected and protected  Protects the institution and the researchers against the lawsuits and helps to ensure that research results will not be flawed because the study was ethically unsound  Government role in community dental research  Government Role in Community Dental Research  Federal government has played an increasingly important role in dental research: Defines research priorities Grants  Most Government research in dentistry is sponsored by the Department of Health and Human Services through NIDRC  Important Elements /Terminology  A problem is a statement or a question that poses an unknown relationship between variables and serves to focus the entire investigation.  A hypothesis is a proposition, condition, or principle that predicts or indicates a relationship between, or behavior of, variables under certain conditions.  A research approach is the type of research used to obtain information. All approaches observe, describe, measure, analyze, and interpret occurring phenomena  A research design- t he overall plan for the study  A variable is a state, condition, concept, or event whose value is free to vary within the population.  Important Elements /Terminology  An Independent variable is a variable that is directly manipulated and controlled by the investigator.  A dependent variable is the object of change in the that is observed and measured to determine the effects of the independent variable manipulation.  A target population comprises all members of specific group who possess a clearly defined set of characteristics.  A sample is a representative portion or subset of the population.  Important Elements /Terminology  An experimental group is a sample group, in a study, that is exposed to the experimental variable under study; group who receives the independent variable.  A control group is a sample group in an experiment that does not receive the experimental treatment (independent variable) but rather receives a placebo treatment or no treatment at all.  Split Mouth- one side of the mouth is used for test treatment and the other side of the mouth is used for the control  A literature review is the theoretical basis for the research that enables the researcher to build on existing knowledge.  Important Elements / Terminology  A pilot study is a preliminary trial of the research process on a small sample to determine feasibility and practicality or the study  A research report is a manuscript written to inform a relevant audience of the problem, the procedures used in implementation of the research design, the results of the research, and the investigator’s interpretation of the findings. Validity The means that a test instrument or study has actually measured or investigated that which it claims to have been measuring or investigating Reliability Deals with issues of consistency from one test administration or study to the next  Important Elements / Terminology  The blind method is a part of the scientific Method, used to prevent research outcomes from being influenced by either the placebo effect or the observer bias.  Single-blind describes experiments where information that could introduce bias or otherwise skew the result is withheld from the participants, but the experimenter will be in full possession of the facts.  Double-blind describes an especially stringent way of conducting an experiment, usually on human subjects, in an attempt to eliminate subjective bias on the part of both experimental subjects and the experimenters. In most cases, double-blind experiments are held to achieve a higher standard of scientific rigor.  Reading research literature  Well written research articles contain the following elements: 1. A Statement of the problem 2. A review of the literature 3. The methods used to study the problem 4. The results of the study 5. The author’s conclusion drawn from 6. Summary of discussion section  Conclusion EBP