Session 2 - Methods and Evidence

Question 1

What are the 2 main groups of methods for investigating health and illness?

Answer 1

Quantitative and qualitative

Question 2

What is quantitative resarch? How are conclusions drawn? What are the strengths of quantitative research?

Answer 2

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.

Question 3

What is quantitative research good at?

Answer 3

• Describing
• Measuring
• Finding relationships between things
• Allowing comparisons

Question 4

What are the problems with quantitative research?

Answer 4

• 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 5

What are the study designs of quantitiative research?

Answer 5

• RCT
• Cohort Studies
• Case Control Studies
• Cross-sectional surveys

Question 6

What other sources can quantitative research utilise?

Answer 6

Official Statistics - Census

National Surveys - Conducted by e.g. charities, universities

Local and regional surveys - Conducted by e.g. NHS organisations, universities, local councils

Question 7

What is a common method in quantitative research?

Answer 7

Questionnaires

Question 8

Define valid and reliable

Answer 8

Valid - Measure what they’re supposed to measure

Reliable - Measure things consistently

Question 9

What is the difference between published and unpublished questionnaires?

Answer 9

Published Questionnaires may have been tested for validity and reliability

Question 10

What type of questions does a questionnaire usually offer?

Answer 10

Mainly closed

Question 11

What is qualitative research good for?

Answer 11

• 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

Question 12

What are the problems with qualitative research?

Answer 12

• 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

Question 13

What are the types of qualitative research methods?

Answer 13

1. Ethnography
2. Interviews
3. Focus groups
4. Documentary and media analysis

Question 14

What is ethnography?

Answer 14

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

Question 15

What are focus groups good for? Why are they not good?

Answer 15

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

Question 16

What is evidence based practice?

Answer 16

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

Question 17

What is the purpose of systematic research?

Answer 17

• 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

Question 18

What are the practical criticisms of evidence based practice?

Answer 18

• 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 19

What are the philosophical criticisms of evidence based practice?

Answer 19

• 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.

Question 20

What are some difficulties of getting evidence into practice?

Answer 20

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