Methods & Evidence

Question 1

What are the social science methods used for investigating health & illness?

Answer 1

Quantitative
Qualitative

Policies are practices based on social science research, and doctors need to be able to integrate & critically evaluate multiple resources

Question 2

What is quantitative research?

Answer 2

A collection of numerical data, which begins as a hypothesis

Question 3

What are the strengths of quantitative research?

Answer 3

Reliability
Repeatability
Conclusions can be drawn from deduction

Question 4

What are quantitative methods good at?

Answer 4

Describing
Measuring
Finding relationships between things
Allowing comparisons

Question 5

What problems with quantitative methods are there?

Answer 5

May force people into inappropriate categories
Don’t allow people to express things in the way they want
May not access all important information
May not be effective in establishing causality

Question 6

Name some quantitative research using experimental study designs

Answer 6

• RCT
• Cohort studies
• Cross-sectional surveys

Question 7

Name some quantitative research designs using secondary analysis of data from other sources

Answer 7

Official statistics
- Census
National surveys
- Conducted by e.g. charities, universities
Local & Regional surveys
- Conducted by e.g. NHS organisations, universities, local councils

Question 8

What type of research tool is commonly used in quantitative research?

Answer 8

Questionnaires

• Exposure to risk factors
• Knowledge & Attitudes e.g. sexual health
• Satisfaction with health services

Question 9

Describe a typical quantitative questionnaire design

Answer 9

VALID - measure what they’re supposed to measure
RELIABLE - Measure things consistently, differences in results come from differences between participants, not from differences between understanding of Qs or interpretations of answers

Question 10

What are the differences between published and unpublished questionnaires?

Answer 10

Published questionnaires may have been tested for validity & reliability
Unpublished questionnaires are developed in specific contexts & validity & reliability have to be established

Question 11

How do you make questionnaire Qs reliable?

Answer 11

E.g. Want to know how often people smoke:
Do you smoke very often/often/infrequently/rarely
Ambiguous. People may interpret Q differently

How many cigarettes do you smoke? 40+ a day/20-39 per day/1-20 per day/fewer
Clearer. Much less likely to get inaccurate responses

Question 12

What types of questions are usually found in a questionnaire?

Answer 12

Mainly closed Qs
Yes/No
Strongly agree/disagree
Numeric scale (rate pain 0-10)
Self completed on paper/telephone/interviewer/internet

Offer Qs
‘Other - Please specify’ option
Can be open Qs, take longer to complete & analyse

Question 13

What is qualitative research?

Answer 13

It’s about exploring issues, understanding phenomena & answering Qs by analysing & making sense of unstructured data

Question 14

What are qualitative methods of research good at?

Answer 14

Understanding the perspective of those in a situation
Accessing information not revealed by quantitative approaches (detailed)
Explaining relationships between variables

Question 15

What problems are there with qualitative methods of research?

Answer 15

Not good at finding consistent relationships between variables
Generalisability
(may identify range of views on an issue but dangerous to infer these views from small sample on general population)
Should be carried out robustly

Question 16

What is the Critical Appraisal Skills Programme (CASP)?

Answer 16

One tool that assesses the quality of qualitative research - its Rigour, Credibility & Relevance
Transparency around sampling, methods & analysis is key.
Qualitative research will leave an audit trail

Question 17

What are the 4 main types of qualitative research design?

Answer 17

Ethnography & Observation
Interviews
Focus Groups
Documentary & Media analysis

Question 18

What is ethnography (& observation)?

Answer 18

Studying behaviour in its natural context

• Observe what people actually do, rather than relying on them telling you what they do
• Participant observation - usually covert (no one knows they’re being wathced)
• Non-participant observation - overt, Labour intensive (ethically challenging) but provides valuable insight to what actually happens, commonly combined with more formal interviews & other sources of data

Question 19

What takes place during interviews?

Answer 19

Semi-structured

• Prompt guide
• Clear agenda of topics
• Conversational
• Emphasis on participants giving their perspective

Question 20

What are focus groups?

Answer 20

Flexible method - quick way for est. parameters, accessing group-based, collective understanding of an issue
Not useful for individual experience
May encourage people to participate
Some topics may be too ‘sensitive’
Difficult to arrange, need fairly homogenous group & good facilitator to manage group dynamics
Able to see how people interact with each other

Question 21

What is documentary & media analysis?

Answer 21

Independent evidence
- Medical records, patient diaries
May provide historical context
Can analyse TV, newspaper & media stories
- E.g. media coverage of bottle & breastfeeding

Question 22

What is evidence based medicine?

Answer 22

Evidence-based practice/medicine/healthcare, involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research

Question 23

What is the origin of evidence based healthcare?

Answer 23

Healthcare should be on best available evidence
i.e. findings of rigorously conducted research
Effectiveness (drugs, practices, interventions)
Cost-effectiveness (finite resources)
Ineffective & inappropriate interventions waste resources that could be used more effectively

Question 24

What were previous practices influenced too much by?

Answer 24

Professional opinion
Clinical fashion
Historical practice & precedent
Organisations & social culture

Research showed clinicians persisted in ineffective interventions, failed to take up more effective ones, tolerated huge variations in practice (loss of £££)

Question 25

What was Archie Cochrane’s role in evidence based healthcare?

Answer 25

Called for register of all RCTs & criticised the medical profession for failing to take account of research

Question 26

What does systemic research offer?

Answer 26

Has become very important in informing evidence base

• Traditional literature reviews may be biased and subjective
• Can address clinical uncertainty & highlight gaps or poor quality in research (Critical appraisal tool to assess quality of evidence)
• Offers authoritative, generalisable and up to date conclusions
• Save clinicians from having to locate and appraise the studies for themselves
• May reduce delay between research discoveries and implementation

Question 27

What practical criticisms of evidence based practice are there?

Answer 27

• May be impossible to create and maintain systematic reviews across all specialities
• Challenging and expensive to distribute and implement findings
• RCTs seen as the gold standard, but not always feasible or desirable (ethics)
• Choice of outcomes very biomedical, limiting which interventions are trialled and therefore funded (e.g. NICE Guidance)
• Requires ‘good faith’ from pharmaceutical companies

Question 28

What philosophical criticisms of evidence based practice are there?

Answer 28

• Population-level outcomes may not apply to an individual
• EBM may make professionals ‘unreflective rule followers’
• Professional responsibility/autonomy
• Might be seen as a means of legitimising rationing, with potential to undermine trust in the doctor-patient relationship and ultimately the NHS

Question 29

What difficulties are there of getting evidence into practice?

Answer 29

Resources not available to implement change (financial/human)
Evidence exists, doctors don’t know about it (ineffective distribution/no incentive to keep up-to-date)
Doctors know about evidence but don’t use it (habit/organisational culture/professional judgement)
Organisational systems cannot support innovation
Commissioning decisions reflect different priorities (what if pts want something else?)