chapter011

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 11

Specific Types of Research


Mixed Method Research

• Research that integrates qualitative and quantitative data and strategies in a single study or coordinated set of studies

• Advantages

– Complementarity—words and numbers, the two languages of human communication

– Incrementality—quicker feedback loops between hypothesis generation and testing

– Enhanced validity—triangulation strengthens the ability to make inferences


Applications of Mixed Method Research

• Instrument development

• Hypothesis generation and testing

• Explication and illustration

• Theory building and refinement

• Intervention development


Mixed Method Designs• Component vs. Integrated designs

– Component design—qualitative and quantitative aspects are discrete components

– Integrated design—integration of methods throughout the study

• Sandelowski’s design typology:

– Which aspect (qualitative or quantitative) has priority?

– How are aspects sequenced (sequentially or concurrently)?


Types of Research with Different Purposes• Studies that involve an intervention:

– Clinical trials

– Evaluation research

– Nursing intervention research

• Studies that do not involve an intervention

– Outcomes research

– Surveys

– Secondary analyses

– Methodologic research


Question

Which of the following would involve an intervention?

a. Outcomes research

b. Clinical trials

c. Secondary analyses

d. Methodologic research


Answer

b. Clinical trials

• Studies that involve an intervention include clinical trials, evaluation research, and nursing intervention research. Outcomes research, surveys, secondary analyses, and methodologic research do not involve an intervention.


Clinical Trials

• Studies that develop clinical interventions and test their efficacy and effectiveness

• May be conducted in four phases


Phases of a Full Clinical Trial• Phase I: finalizes the intervention (includes efforts

to determine dose, assess safety, strengthen the intervention)

• Phase II: seeks preliminary evidence of effectiveness—a pilot test often using a quasi-experimental design

• Phase III: fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often in multiple sites; sometimes called an efficacy study

• Phase IV: focuses on long-term consequences of the intervention and on generalizability; sometimes called an effectiveness study


Practical Clinical Trials

• Emphasis on EBP has led to a call for studies that bridge the gap between tightly controlled efficacy studies and subsequent effectiveness studies.

• Practical clinical trials (or pragmatic clinical trials) are designed to help in making decisions in real-world applications.


Evaluation Research

• Examines how well a specific program, practice, procedure, or policy is working

• Clinical trials are sometimes evaluations of an intervention or program.

• Some (but not all) evaluations are clinical trials because evaluations can address a variety of questions.


Types of Evaluation

• Process (implementation) analysis

• Outcome analysis

• Impact analysis

• Cost (economic) analysis


Question

During which phase of a full clinical trial would an efficacy study be done?

a. Phase I

b. Phase II

c. Phase III

d. Phase IV


Answer

c. Phase III

• Phase III fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often in multiple sites; this phase is sometimes called an efficacy study. Phase I finalizes the intervention; phase II seeks preliminary evidence of effectiveness, usually via a pilot test; and phase IV focuses on long-term consequences of the intervention and on generalizability (sometimes called an effectiveness study).


Process Analysis

• Also called an implementation analysis

• Yields descriptive information about how a program actually functions

• Often combines qualitative and quantitative information


Outcome Analysis

• Seeks preliminary evidence about program success

• Common design: One-group pretest–posttest design


Impact Analysis

• Yields information about a program’s net effects

• Typically uses an experimental or strong quasi-experimental design


Cost Analysis

• Also called an economic analysis

• Assesses monetary consequences of a program—which may affect its ultimate viability

• Typically done in connection with an impact analysis (or an RCT)


Outcomes Research• Designed to document the quality and

effectiveness of health care and nursing services

• Often focuses on parts of a health care quality model developed by Donabedian; key concepts:

– Structure of care (e.g., nursing skill mix)

– Processes (e.g., clinical decision-making)

– Outcomes (end results of patient care)


Outcomes Research (cont.)

• Typically relies on nonexperimental (correlational) designs

• Tools include classification systems and taxonomies

– Nursing actions and diagnoses (e.g., NANDA)

– Nursing interventions (e.g., NIC)

– Nurse-sensitive outcomes (e.g., NOC)


Question

Is the following statement True or False?

• An impact analysis is also called an economic analysis.


Answer

• False

– A cost analysis is also called an economic analysis. An impact analysis provides information about a program’s net effects.


Survey Research

• Obtains information (via self-reports) on the prevalence, distribution, and interrelations of variables in a population

• Secures information about people’s actions, intentions, knowledge, characteristics, opinions, and attitudes

• Survey data are used in correlational studies.


Survey Research (cont.)

• Modes of collecting survey data:

– Personal (face-to-face) interviews

– Telephone interviews

– Self-administered questionnaires

•Distributed by mail or the Internet

• Personal interviews tend to yield the highest quality data but are very expensive.


Survey Research (cont.)• Advantages

– Researchers can collect extensive information fairly quickly.

– Can be used with many different populations

– Can be cross-sectional or longitudinal

– Questions limited only by what people are willing to answer

• Limitations

– Data tend to be fairly superficial.

– Better for extensive than intensive inquiry


Secondary Analysis

• Study that uses previously gathered data to address new questions

• Can be undertaken with qualitative or quantitative data

• Cost-effective; data collection is expensive and time-consuming

• Secondary analyst may not be aware of data quality problems and typically faces “if only” issues (e.g., if only there was a measure of X in the dataset).


Question

Is the following statement True or False?

• Telephone interviews provide the best quality data for survey research.


Answer

• False

– Personal interviews used with survey research tend to provide the highest quality data, but they are very expensive.


Methodologic Research

• Studies that focus on the ways of obtaining, organizing, and analyzing data

• Can involve qualitative or quantitative data

• Examples:

– Developing and testing a new data-collection instrument

– Testing the effectiveness of stipends in facilitating recruitment


End of Presentation

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Documents

intervention phase

pragmatic clinical trials

clinical interventions

clinical trialsc

clinical trial phase

controlled efficacy

randomized clinical

efficacy study phase