Research Methods and Applications in Health Care Systems
 

 The Research Process

 Introduction to research
T. Bevins
Spring 1999

In order to set the stage for our discussion of research, we should discuss what we mean by science and research, and the role they play in the practice of the health professions. Science/research has done a lot to develop the theoretical basis upon which much of the practice of health care is based. However, not all of the practice of health care is based on science.
 
 

Clinical practice has components of "art" and "science".

• the art of practice is concerned with methods or ways of effecting certain outcomes
• the science of practice is concerned with theoretical truth
• science permits accurate quantitative measurements of existing phenomena (see basic research)
• science allows us to test and validate the effectiveness of practices used (see applied research) (Currier)

First, lets define profession:

Profession: an occupation whose members must possess a body of knowledge that is both identifiable and different from that of other professions.

• This body of knowledge (theory) forms the basis upon which the profession rationalizes its practice.
• Mastery of the theory is essential before acquiring the skill to practice, and preparation for the profession must be an intellectual as well as a practical experience.
• Research is required to develop valid theory that provides a firm base for the techniques and procedures used in the profession. (Currier)

In the health professions practice is often thought of as both!  Science exists in the theoretical basis of the profession and in some aspects of the execution of the practice. Art exists in the historical basis of the profession and in some aspects of the execution of the practice.

• Science has a body of knowledge gained through systematic study it is concerned with facts and principles.
• Research is a method of science that supplies pieces of knowledge by finding answers to  questions; seeking theoretical truth. (Currier)

 

 
 
 

Please note that Naturalistic Inquiry (or qualitative research) does not fit in well with these descriptions of research.  That does not mean that qualitative research is not real research.  Really, it only means that Currier is only looking at quantitative research.  In this course we examine a broader view of research.

Scientific research is systematic, controlled, empirical, and critical investigations about the presumed relations among natural phenomena, provides insight, uncovers facts and causes, describes attributes or events, improves reasoning and adds knowledge.

Research is the study of a problem in pursuit of a definite objective through the employment of precise methods, with due consideration of the adequate control of factors other than the variable under investigation, and followed by analysis according to acceptable statistical procedures. Research and problem solving are not the same. Research is the search for new knowledge, or the verification of beliefs, and uses the controlled process of scientific inquiry - a rigorous process problem solving is the systematic approach to the solution to a problem through the process of action or thought - used for day-to-day solutions. (Currier)

DePoy gives a much broader definition of research. She includes any type of investigation that uncovers knowledge, and offers a definition that is more inclusive of qualitative/naturalistic inquiry, and still distinguishable from other forms of gaining knowledge. She defines research as multiple, systematic strategies to generate knowledge about human behavior, experience and environments in which the thought and action process of the researcher are clearly specified so that they are logical, understandable, confirmable and useful.

Basic research is experimental, associated with laboratory research -- more abstract . Applied or clinical research is concerned with applying or gaining knowledge related to clinical practice; determines efficacy. There is not an absolute or clear line between the two (Currier)
Clinical Research is a structured process of investigating facts and theories.  It is a method of answering questions in a systematic and objective way to examine clinical conditions and outcomes, to establish relationships among clinical phenomena, and to provide the impetus for improving methods of practice.  Clinical research must be empirical and critical; that is, results must be observable, documented, and examined for their validity. This objective process is, however, also a dynamic and creative activity, performed in many different settings, using a variety of quantitative and qualitative measurement tools, and focusing on the application of clinical theory and interventions.  It is a way of satisfying ones curiosity about clinical phenomena, and of stimulating intellectual pursuit of truth to understand or explain clinical events.  Although research has often had less than a positive image, it can actually be an enjoyable and highly rewarding activity when it presents new or different ways of viewing clinical problems. (Portney & Watkins)

According to the definition of a profession, members have a responsibility to develop and add to its body of knowledge through research.  It is our investment in the theoretical basis of our profession that distinguishes the profession from art or technology.  (Currier)

Research is an important professional responsibility that develops and advances knowledge from which to base practice. (DePoy)

• Research evolves from a curiosity or a need to test the existing knowledge and procedures.
• What is learned and practiced in the research process is a groundwork for developing a scientific approach to clinical practice.  It teaches us how to question, and apply the methods of scientific inquiry to clinical practice; that is, establishing objectives clearly, performing objective measurement and assessment, identifying problems, making judicious selection of treatment, establishing efficacy of new approaches to patient management, and being systematic in making observations of the patient's condition and reaction to treatment.
• Why we teach the research process to individuals who might not perform research: practitioners often hesitate to attend presentations of original research or read research reported in their professional journal because they do not understand what is being presented.
• we must challenge authoritative thinking and insist on evidence.
• we must at least mimic the research process in our day to day consideration of treatment efficacy and assessment of outcomes.
• DePoy gives five reasons for conducting research:
• Obtain scientific knowledge which forms the basis of treatment approaches, and a validation of those practices
• To guide health care decision making and policy formulation
• To participate in research as a member of your institution and profession
• To be an effective and critical consumer of research literature
• Many aspects of the research process can be incorporated into your daily practice. It is a good framework and mind set with which to approach a problem.

Research should be done by members of a profession, contributing to the body of knowledge of that profession.

Desirable qualities of a researcher:

•   interest in research and the field
•   motivation and perseverance
•   knowledge of the field
•   training in research
•   knowledge of statistics
•   ability to write clearly
•   breadth of experience
•   technical skills
•   imagination / creative thinking  curiosity
•   ingenuity
•   observational skills
•   good memory
•   patience
•   critical judgment
•   honesty
•   critical (tactful) judgments of peers humility

  The molding and production of researchers is the responsibility of graduate programs.  Here attention can be directed towards solving the unknown.  (Currier)  Faculty and students in graduate programs are the most prolific producers of research.  Their purpose is largely scholarly activity.

  Clinicians as researchers: adding stimulation and added accomplishment to the clinical position.  Clinical research:

• stimulates inquiry for greater clinical efficacy
• advances knowledge in field

At the University: Education, clinical practice and research are usually intertwined at a college of health professions. Educational information is derived from scientific inquiry. The faculty and clinicians who work with the students are the role models.

In the clinic: Clinicians can perform research, and contribute to the body of knowledge of the profession. Clinical management must support research -- establishing a climate of scientific inquiry in the clinical practice arena. There is no doubt that research increases the costs of operation.

In for-profit labs: As funding at the educational institutions has decreased, more research is seen to be funded by corporations.  Sometimes these corporations use their own labs, and sometimes they fund activity at educational/research institutions.

Most research is performed when a student is in graduate school, with the concurrent activity of research institution faculty. However, there is a great need for more clinical research to investigate efficacy of treatments, and conduct outcomes research.  This activity is often conducted concurrently with clinical practice, and in scheduled extra-clinical time to perform activities such as the literature search, statistical analysis, and writing of the report.

The history of the development of the health professions and sciences show that the organization of professional service and teaching preceded that of formalized research. (Currier)

• Study the history of research in your own discipline. Is this true that the organization of professional service and teaching preceded that of formalized research in your discipline?

Quantitative	Qualitative
frame the problem	frame the problem/phenomenon
state the purpose of study	state the purpose of study
literature reveiw	literature reveiw
decide on quantitative approach	decide on qualitative approach
identify theoretical framework	state the researcher's perspective
write a research question  identify variables  formulate hypothesis	write research question
decide on type of design	decide on qualitative method
sampling strategy	define parameters of saturation
consider legal and ethical issues	consider legal and ethical issues
decide on measurement instrument  consider reliability and validity	decide on "instrument" (to gather data)
consider feasibility  write proposal  get IRB approval	consider feasibility  write proposal  get IRB approval
collect data	collect data
analyze data  statistical analysis	analyze data
acept/reject hypothesis
interpret results	interpret results
	develop concepts
	draw conclusions
examine generalizability	examine universality
	create hypotheses  build theory
communicate results  consider implications, limitations,  and recommendations	communicate results  consider implications, limitations,  and recommendations

Quantitative/Deductive	Qualitative/Inductive
Humans are biophysiological beings, known by their biological psychological, and social characteristics.	Humans are complex beings attribute unique meaning to their  life  situations. They are known by their personal expressions.
Researcher selects a representative (of population) sample and determines sample size before collecting data.	Researcher selects participants who are experiencing the phenomenon of interest and collects data until saturation is reached.
Researcher uses an extensive approach to collect data.	Researcher uses an intensive approach to collect data.
Questionnaires and measurement devices are preferably administered in one setting by an unbiased individual to control for extraneous variables.	Researcher conducts interviews and participant or non participant observation in environments where participants usually spend their time. Researcher bias is acknowledged and set aside.
Primarily deductive analysis is used, generating a numerical summary that allows the researcher to reject or accept the null hypothesis.	Primarily inductive analysis is used leading to a narrative summary,   which synthesizes participant information, creating a description of human experience.
Differences in the research process  state problem review literature identify theoretical framework state hypothesis\ select method collect data analyze data test hypothesis interpret results examine generalizability communicate results	state problem review literature select method collect data analyze data interpret results develop concepts draw conclusions examine universality created hypothesis communicate results

Currier D.P. (1984). Elements of research in physical therapy (2nd ed.). Baltimore, MD: Williams & Wilkins.
Portney L.G., & Watkins M.P. (1993). Foundations of clinical research: Applications to practice. East Norwalk:  Appleton &Lange.
Hulley S.B., & Cummings S.R. (1988). Designing clinical research. Baltimore, MD: Williams & Wilkins.
LoBiondo-Wood, G., & Haber, J. (1998). Nursing research: Methods, critical appraisal, and utilization (4th ed.).  St. Louis, MO: Mosby.
 
 
 
 

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