Week 1 - Quantitative Health Research

Question 1

EPISTEMOLOGY

Answer 1

Is the theory of knowledge, regarding its methods, validity, and scope.
Is the investigation of what distinguishes justified beliefs from opinions.

-> Subjectivism
-> Objectivism

Question 2

Subjectivism

Answer 2

• Knowledge is merely subjective and there is no external or objective truth,
• Individual experience is truth.
• There is no ‘one’ truth to be discovered,
• Truths are experienced and/or constructed.

Question 3

Objectivism

Answer 3

‘Things’ exists as meaningful entities independently of consciousness and experience, concerned with ‘objective truth’ which can be attained through empirical research.

Question 4

PARADIGM

Answer 4

Distinct set of concepts or thought patterns, including theories, research methods, postulates, and standards for what constitutes legitimate contributions to a field.

Depends on:
Beliefs about the nature of the world;
- what kind of things exist in the world, and what is their nature
- nature of the phenomena studied in research; ontology (framework of how to share knowledge)
Beliefs about the nature and status of human knowledge,
- how we might come to hold knowledge; epistemology (study of knowledge and how to reach it)

-> Constructivism / Interpretivism
-> Positivism

Question 5

Constructivism and Interpretivism
(Subjective)

Answer 5

• Aims to understand and explain human and social reality
• focuses on interpreting the social life world within its cultural context
• Knowledge and meaningful reality are constructed in and out of interaction between humans and their world
  • Inductive approach
  • Individual constructs are elicited and understood through interaction between
  researchers and participants with participants being relied on as much as possible
  • Produces highly contextualised qualitative data

Question 6

Positivism
(Objective)

Answer 6

Explains every rationally justifiable assertion can be scientifically verified or is capable of logical or mathematical proof.
• Assumes that there is one truth and asserts that all authentic knowledge allows verification;
• Phenomena have independent existence which can be discovered by research
• Attempt to identify causes, associations and correlations which influence outcomes
• Deductive approach
• Assumes research is value free

Question 7

METHODOLOGIES

Answer 7

Analysis of all methods and procedures of the investigation. Primary data

Body of methods, rules, and postulates employed by a discipline: a particular procedure or set of procedures.

-> Grounded theory
-> Phenomenology
-> Ethnography

Question 8

Grounded Theory

Answer 8

Methodology for developing theory that is grounded in data which is systematically gathered and analysed.

It is used to uncover social relationships and behaviours of groups, known as social processes.

Question 9

Phenomenology

Answer 9

The study of phenomena as they manifest in our experience, of the way we perceive and understand phenomena, and of the meaning phenomena have in our subjective experience.
• The study of an individual’s lived experience of the world.

Question 10

Ethnography

Answer 10

Examines behavior that takes place within specific social situations, including;
- behavior that is shaped and constrained by these situations,
- people’s understanding and interpretation of their experiences.

Question 11

METHODS

Answer 11

*Methods and Methodologies are different from one another.
Methods: behaviours or tools used to select a research technique. Secondary data

-> Data collection
-> Data analysis

Question 12

Data collection

Answer 12

• Interviews: One on one, or in a big group.
• Focus Groups: Small groups with aim.
• Observations: Observing a situation in its natural setting.
• Images: Instagram, Facebook, social media, etc.
• Documents: Policies, social media, blogs, etc.
• *Consider where, how, how long for and what.

Question 13

Data Analysis:

Answer 13

• Thematic analysis
• Constant comparative analysis
• Interpretative Phenomenological Analysis (IPA)
• Framework analysis
• Conversation analysis
• Discourse analysis

Question 14

If there is only one truth then….

Answer 14

• We need to consider certainty of results
• Impact of bias on influencing the findings
• Importance of critical appraisal
• Communication of results to patients

Question 15

Wakefield study

Answer 15

Andrew Wakefield and 12 of his colleagues published a case series in Lancet, suggesting that the measles, mumps, and rubella (MMR) vaccine may predispose to behavioral regression and pervasive developmental disorder in children (Autism)

Impact:
• 90% immunisation coverage for herd immunity
• Fell to 73% worldwide between 2000-2018 (now back up to 86%)
• Outbreaks of Measles particularly in UK, US and Canada
• More than 140,000 people (mostly children < 5 years) died from Measles in 2018
• The Lancet retract the study completely in 2010 the authors were found guilty of ethical violations and fraud, Wakefield was removed from the GMC but we continue to see the damage caused

Question 16

Wakefield Study: what was wrong with that study?

Answer 16

• Small sample size - no statistical significance
• No randomisation (what bias does this introduce?)
• Association through temporal link, not causation
• Undeclared financial conflict
• Fraud (Data selection) - only selected data that fit his story

Question 17

Fast thinking
(Kahneman)

Answer 17

• Is unconscious, emotional, and instinctive.
• Fast thinking results in snap judgments and, sometimes, prejudice.
• Slow thinking is what most of us would consider actual thought: it’s conscious, deliberative, and mostly rational.