research methodology and epidemiology dr. sean lynch

Research Methodology and Research Methodology and EpidemiologyEpidemiology

Dr. Sean LynchDr. Sean Lynch

Research Methodology, Research Methodology, Epidemiology and Evidence Based Epidemiology and Evidence Based

Psychiatry-4Psychiatry-4

This module will cover the following areas:-This module will cover the following areas:- An introduction to research concepts, audit, research An introduction to research concepts, audit, research

governance, funding and dissemination of researchgovernance, funding and dissemination of research Qualitative and Quantitative methodsQualitative and Quantitative methods Different forms of research study and their interpretationDifferent forms of research study and their interpretation Parametric and non-parametric statisticsParametric and non-parametric statistics Other advanced statistical methodsOther advanced statistical methods Epidemiological concepts in mental health and psychiatric Epidemiological concepts in mental health and psychiatric

research instrumentsresearch instruments Meta-analysis, systematic reviews and evidence based Meta-analysis, systematic reviews and evidence based

practicepractice

Qualitative ResearchQualitative Research

Today we will examine the methodology used in qualitativeToday we will examine the methodology used in qualitative

research. We will look at the limitations and benefits of theresearch. We will look at the limitations and benefits of the

principal methods.principal methods.

The aims of today’s session are:-The aims of today’s session are:-

1. To understand the use of different interview approaches 1. To understand the use of different interview approaches used in qualitative researchused in qualitative research

2. To understand the use of group based methods2. To understand the use of group based methods

3. To understand sources of data loss and bias in 3. To understand sources of data loss and bias in qualitative studiesqualitative studies

Research Methodology and Research Methodology and Epidemiology -4Epidemiology -4

Programme (approximate times)Programme (approximate times)

1030 - 1115 Feedback on problems in last session1030 - 1115 Feedback on problems in last session

Interview designs in qualitative researchInterview designs in qualitative research

1115 - 1130 Break1115 - 1130 Break

1130 - 1215 Group, observational and ethnographic1130 - 1215 Group, observational and ethnographic

methods in qualitative researchmethods in qualitative research

1215 - 1230 Discussion of morning1215 - 1230 Discussion of morning

1230 - 1330 Lunch1230 - 1330 Lunch

1330 - 1530 Small group work on problems1330 - 1530 Small group work on problems


Main aimsMain aims

1. Exploratory1. Exploratory

2. Explanatory 2. Explanatory

3. Evaluative3. Evaluative

4. Developmental4. Developmental


Why are qualitative methods being used more?Why are qualitative methods being used more?

Quantitative methods measure summed data e.g. on Quantitative methods measure summed data e.g. on outcomes, differences in groupsoutcomes, differences in groups

They tell us little or nothing about behaviour, They tell us little or nothing about behaviour,

preference, satisfaction or individual experiencepreference, satisfaction or individual experience Increased patient participation in service design,Increased patient participation in service design,

delivery and evaluationdelivery and evaluation


AdvantagesAdvantages

1. Naturalistic - “real life”1. Naturalistic - “real life”

2. Subjective experience2. Subjective experience

3. Detailed descriptive data3. Detailed descriptive data

4. Can assess processes4. Can assess processes

5. Greater validity in data5. Greater validity in data



Can be used in supplementary studies to increaseCan be used in supplementary studies to increase

validity of quantitative design studiesvalidity of quantitative design studies

Can be used in “mixed methods” or “triangulationCan be used in “mixed methods” or “triangulation

model”model”



Some qualitative data can be summarised and subjectSome qualitative data can be summarised and subject

to more conventional statistical analysisto more conventional statistical analysis

Methods are being devised for secondary analysisMethods are being devised for secondary analysis

equivalent to systematic review methodology for equivalent to systematic review methodology for

quantitative methodsquantitative methods


DisadvantagesDisadvantages

Difficulty in standardising and replicating methodsDifficulty in standardising and replicating methods Sample selectionSample selection Importance of data loss and non-responseImportance of data loss and non-response Subject to bias of researcher (interview, focus group)Subject to bias of researcher (interview, focus group)


DisadvantagesDisadvantages

Difficulty in standardising data extraction method Difficulty in standardising data extraction method

and analysis and analysis Difficulty in comparison of studiesDifficulty in comparison of studies


Interview studiesInterview studies

1. Unstructured - data more difficult to analyse1. Unstructured - data more difficult to analyse

2. Semi-structured - most commonly used, balance of 2. Semi-structured - most commonly used, balance of open and closed questionsopen and closed questions

3. Structured - loss of validity, ease of data analysis3. Structured - loss of validity, ease of data analysis



May need to focus on certain areas

May need to promote active participation and interest

Use of guides or checklistsUse of guides or checklists

Prompted - vignettes, audio-visual Prompted - vignettes, audio-visual

More passive styles directed by preference of subject -More passive styles directed by preference of subject -

more costly but will get “deeper” and “richer” data.more costly but will get “deeper” and “richer” data.



Depth interviewDepth interview

Paired interviewPaired interview

Peer-led interviewPeer-led interview

Incentives Incentives


Different interview methodologiesDifferent interview methodologies

NarrativesNarratives

E-interviewsE-interviews

Telephone interviewsTelephone interviews

Interview based on subject diaries or narrativeInterview based on subject diaries or narrative


Analysis MethodsAnalysis Methods

Transcript analysisTranscript analysis

Verbal analysisVerbal analysis

Visual analysisVisual analysis

Manual and other methodologiesManual and other methodologies

Word processor based programmesWord processor based programmes

Specific computer programmesSpecific computer programmes



A priori categories and dimensionsA priori categories and dimensions

Categories and dimensions generated by analysisCategories and dimensions generated by analysis

- most frequent category of response- most frequent category of response

- by particular response characteristic e.g. adjectival- by particular response characteristic e.g. adjectival

or affective or behavioural (chronic pain research)or affective or behavioural (chronic pain research)



Correspondence analysisCorrespondence analysis DidacticDidactic SemanticSemantic


Group, observational and other methodologiesGroup, observational and other methodologies

Focus groupsFocus groups

Sample selectionSample selection

MotivationMotivation

Group dynamicsGroup dynamics

Facilitator roleFacilitator role

Observer / active rolesObserver / active roles



Jury GroupsJury Groups

Specific type of focus groupSpecific type of focus group

One or two aimsOne or two aims

Have common purpose or linkHave common purpose or link



Action ResearchAction Research

Empowerment of research subjects throughEmpowerment of research subjects through

participationparticipation

Researcher identifies user groups who work togetherResearcher identifies user groups who work together

identifying a common problem, devising a solution andidentifying a common problem, devising a solution and

assessing its effectsassessing its effects



Observational researchObservational research

To assess group interactionsTo assess group interactions

To assess power relationshipsTo assess power relationships

InfluencesInfluences

Sub-groupsSub-groups



Ethnographic researchEthnographic research

Researcher lives in group to be studiedResearcher lives in group to be studied

Becomes steeped in culture, valuesBecomes steeped in culture, values

Learns about culture, subculture, group valuesLearns about culture, subculture, group values



Questionnaire researchQuestionnaire research

Can be individualised e.g subject identifies problem orCan be individualised e.g subject identifies problem or

issue and rates issue and rates

Can be more or less structured e.g. leave option forCan be more or less structured e.g. leave option for

respondent to express views on important issues e.grespondent to express views on important issues e.g

your feedback on this module!your feedback on this module!




By e-mail,By e-mail,

PostalPostal

Convenience sample Convenience sample

Household (door-to-door)Household (door-to-door)




There are significant problems with response rates There are significant problems with response rates

Incentives can be usedIncentives can be used

There may be a problem with the information “depth”There may be a problem with the information “depth”

These can be difficult to interpret due to non-responseThese can be difficult to interpret due to non-response

biasbias



E-focus groupsE-focus groups

““Chatrooms” or communitiesChatrooms” or communities

E-mail shotsE-mail shots

IncentivisedIncentivised

Cost-effectiveCost-effective


Problem OneProblem One

You are a NHS Trust manager working with the PCT inYou are a NHS Trust manager working with the PCT in

trying to increase the uptake of a primary caretrying to increase the uptake of a primary care

counselling service for people who have milder tocounselling service for people who have milder to

moderate severity depression, as referrals of peoplemoderate severity depression, as referrals of people

with these problems to the community mental healthwith these problems to the community mental health

teams are relentlessly increasing. teams are relentlessly increasing.



The PCT has commissioned a consumer satisfactionThe PCT has commissioned a consumer satisfaction

questionnaire which has found high satisfaction levelsquestionnaire which has found high satisfaction levels

with users of the counselling service and are puzzledwith users of the counselling service and are puzzled

by the low take up rate. by the low take up rate.

The NHS Trust has similarly sought views of users ofThe NHS Trust has similarly sought views of users of

the CMHTs, who while very satisfied with the servicethe CMHTs, who while very satisfied with the service

offered by the CMHT are uncertain they would useoffered by the CMHT are uncertain they would use

primary care servicesprimary care services



Why are there such different views of the primary careWhy are there such different views of the primary care

counselling service?counselling service?

What qualitative methods could be used to understandWhat qualitative methods could be used to understand

this problem?this problem?

How would this help to change perception of thisHow would this help to change perception of this

service? service?


Problem TwoProblem Two

There is a high rate of non-attendance at all the There is a high rate of non-attendance at all the

out-patient services at your hospital. These are mentalout-patient services at your hospital. These are mental

health services for a working age adult population in ahealth services for a working age adult population in a

rural area. There has been a demographic change ofrural area. There has been a demographic change of

inward migration from other parts of the United Kingdominward migration from other parts of the United Kingdom

and the EU.and the EU.


Problem TwoProblem Two

Using qualitative methodology how might youUsing qualitative methodology how might you

1. Aim to find out reasons for non-attendance1. Aim to find out reasons for non-attendance

2. Understand how services might be altered to improve 2. Understand how services might be altered to improve attendance ratesattendance rates

Again, using these principles, what are the potentialAgain, using these principles, what are the potential

risks of any service redesign?risks of any service redesign?


Problem ThreeProblem Three

How can the benefits and adverse effects of clozapineHow can the benefits and adverse effects of clozapine

treatment be evaluated using qualitative methodology?treatment be evaluated using qualitative methodology?

What specific findings might make you want to redesignWhat specific findings might make you want to redesign

the service?the service?

research methodology and epidemiology dr. sean lynch

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