Session 2 - Methods and Evidence Flashcards
What are the 2 main groups of methods for investigating health and illness?
Quantitative and qualitative
What is quantitative resarch? How are conclusions drawn? What are the strengths of quantitative research?
Quantitative research is a collection of numerical data, which begins as a hypothesis.
Conclusions can be drawn by deduction. Strengths of quantitative research include reliability and repeatability.
What is quantitative research good at?
- Describing
- Measuring
- Finding relationships between things
- Allowing comparisons
What are the problems with quantitative research?
- 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
What are the study designs of quantitiative research?
- RCT
- Cohort Studies
- Case Control Studies
- Cross-sectional surveys
What other sources can quantitative research utilise?
Official Statistics - Census
National Surveys - Conducted by e.g. charities, universities
Local and regional surveys - Conducted by e.g. NHS organisations, universities, local councils
What is a common method in quantitative research?
Questionnaires
Define valid and reliable
Valid - Measure what they’re supposed to measure
Reliable - Measure things consistently
What is the difference between published and unpublished questionnaires?
Published Questionnaires may have been tested for validity and reliability
What type of questions does a questionnaire usually offer?
Mainly closed
What is qualitative research good for?
- Understanding the perspective of those in a situation
- Accessing information not revealed by quantitative approaches
- Explaining relationships between variables e.g. why and how does ethnicity promote/discourage smoking cessation
What are the problems with qualitative research?
- Not good at finding consistent relationships between variables
- Generalisability - May be good at identifying a range of views on an issue, but dangerous to infer these views from a small sample may apply to the population as a whole
What are the types of qualitative research methods?
- Ethnography
- Interviews
- Focus groups
- Documentary and media analysis
What is ethnography?
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
Non-participant observation – overt
What are focus groups good for? Why are they not good?
Pros:
- Quick way for establishing parameters
- Accessing group-based, collective understanding of an issue
Cons:
- Not useful for individual experience
- Some topics may be too ‘sensitive’
- Difficult to arrange, need a fairly homogenous group and a good facilitator to manage group dynamics
What is evidence based practice?
Evidence-based practice, (/medicine/healthcare), involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research
What is the purpose of systematic research?
- Traditional literature reviews may be biased and subjective
- Can address clinical uncertainty and 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
What are the practical criticisms of evidence based practice?
- 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
What are the philosophical criticisms of evidence based practice?
- Population-level outcomes may not apply to an individual
- Evidence-Based Medicine 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.
What are some difficulties of getting evidence into practice?
Resources not available to implement change
Evidence exists, but doctors don’t know about it
- Distribution of the evidence ineffective?
- Doctors not incentivised to keep up-to-date
Doctors know about evidence but don’t use it
- Habit / Organisational culture / Professional judgement
Organisational systems cannot support innovation
- E.g. Managers lack the authority to invoke changes
Commissioning decisions reflect different priorities
- What if patients say they want something else