Health Research Methods (NHR 4811) Flashcards

Module Overview: Health Research Methods (NHR 4811)

• Institution: University of Namibia (UNAM), Faculty of Health Sciences, School of Nursing.
• Module Name: Health Research Methods (General Nursing Science).
• Module Code: NHR 4811.
• Review Context: Based on the May/June 2022 regular examination paper.
• Examiners: Takaedza Munangatire (UNAM) and Mr. Epafras Anyolo (UNAM).
• Moderators: Dr. K. Amakali (Internal, UNAM) and Dr. RR Marie Modeste (External, Cape Peninsula University of Technology, South Africa).

Fundamental Concepts of the Research Process

• Initial Research Steps: Identifying the research problem is considered the initial and one of the most significant steps in conducting the research process. Other early steps include defining research variables, stating the research purpose, and determining study feasibility.
• Sources of Information:
  • Primary Source: A journal article reporting on a study that used previously unpublished databases (e.g., from a statistics bureau) is an example of a primary source.
  • Secondary/Tertiary Sources: Published commentaries on other studies, doctoral dissertations critiquing existing research (literature reviews), and medical-surgical nursing textbooks are not primary sources of original research.
• Reasoning Types in Nursing:
  • Inductive Reasoning: Reasoning from specific observations to a general conclusion. Example: Reasoning from observations of a single diabetic patient to form a conclusion about all diabetic patients.
  • Deductive Reasoning: Reasoning from the general to the specific. Example: Reasoning from the characteristics of all chronically ill patients to make predictions about a single chronically ill patient.
• Researcher Roles in Nursing Practice:
  • Consumer: A nurse who reads research articles and incorporates findings into clinical practice.
  • Primary Investigator: The lead person responsible for the design and conduct of a study.
  • Collaborator: A participant in a research team working with others.
  • Producer: Someone who actively creates or conducts research.

Qualitative vs. Quantitative Research Methodologies

• Qualitative Research Characteristics:
  • Studies are conducted in natural settings.
  • The goal is to explore meanings and lived experiences.
  • Terminology often includes "phenomenon," "exploration of meaning," and asking subjects to "relate perceptions."
  • Example Research Question: "What is the meaning of health for migrant farm-worker women?"
• Quantitative Research Characteristics:
  • Research designs are systematic, objective, and controlled.
  • Data collection involves large numbers of subjects and numeric data.
  • Rigor is defined by the amount of control and precision exerted by the methodology.
  • Terminology often includes "hypothesis," "measurement using scales," "control groups," and "treatment implementation."
  • Example Research Question: "Which pain medications decrease the need for sleep medication in elderly patients?"

Research Designs and Control Levels

• Categories of Control and Precision:
  • Experimental Research: Characterized by high researcher control, random sampling, and a laboratory setting. Hypotheses typically predict a specific relationship of magnitude, such as: "The incidence of urinary tract infections will be greater in patients whose Foley catheters are irrigated frequently than in those whose Foley catheters are irrigated less frequently."
  • Quasi-experimental Research: Involves at least some control by the researcher to implement study treatments but lacks full random assignment or a laboratory setting.
  • Applied Research: Research designed to solve practical problems. Example: "Does telephone follow-up by nurses improve patients' compliance with their medication regimens?"
  • Basic Research: Research conducted to generate knowledge for its own sake rather than immediate application.
  • Descriptive and Correlational Research: These designs focus on describing variables or identifying relationships between them without implementing controls or treatments.

Variables, Hypotheses, and Definitions

• Types of Variables:
  • Discrete (Categorical) Variables: A variable with a finite number of values between two points, representing discrete quantities (e.g., 2.1 matching with L/K).
  • Dichotomous Variables: Categorical variables that take on only two values (e.g., Male/Female, Yes/No).
  • Continuous Variables: Variables that can take on values from zero to more than $100$, including non-whole numbers (fractions/decimals).
  • Dependent Variable: The outcome variable. In the hypothesis "Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support," the dependent variables are perception of pain and request for analgesics.
• Hypothesis Types:
  • Directional Hypothesis: Specifies the expected direction of the relationship. Example: "The risk of falling increases with the age of the patient."
  • Non-directional Hypothesis: States there is a relationship but does not specify the direction. Example: "There is a relationship between the age of a patient and the risk of falling."
• Definitions:
  • Conceptual Definition: Academic or theoretical meaning. Important because the meanings of terms may differ depending on the study framework.
  • Operational Definition: Specifies exactly what the researcher must do to measure a concept and collect needed information.
  • Theory: A systematic, abstract explanation of some aspect of reality.
  • Grounded Theory: A qualitative approach involving the study of processes, social structures, and social interactions.

The Research Report and Documentation

• Report Sections:
  • Abstract: The portion used to capture the reader's attention and summarize the study.
  • Introduction/Purpose Section: Contains statements such as "The purpose of this study was to examine the relationship between health beliefs and breast self-examination."
• APA Referencing:
  • Example: Harris, R. M., Bausell, R. B., Scott, D. E., Hetherington, S. E., & Kavanagh, K. H. (1998). An intervention for changing high-risk HIV behaviours of African American drug-dependent women. Research in Nursing and Health, 21(3), pp. 239-250.
  • In the example above, 21 refers to the Volume number.
• Study Logistics:
  • Feasibility: Determined by examining availability of subjects, researcher credibility, and obtaining written permission from facilities (access).
  • Ethics: Relates to the protection of human subjects and moral conduct.

Statistical Analysis and Interpretations

• Comparing Means:
  • T-test: Used to compare the mean scores between two groups (e.g., Male vs. Female).
  • ANOVA (Analysis of Variance): Used to compare mean scores among three or more groups (e.g., comparing students based on four different years of study).
• Interpreting P-values:
  • A p-value of $0.03$ ($p < 0.05$) indicates that the difference between groups is statistically significant.
  • A p-value of $0.07$ ($p > 0.05$) indicates that the differences are not statistically significant.
• Correlation:
  • Pearson's r: Used to test the relationship between two continuous variables (e.g., Knowledge scores and Practice scores).
  • Interpretation: A correlation of $+0.7$ with a p-value of $0.05$ indicates a strong, positive, and statistically significant relationship.
• Chi-square: Used for cross-tabulations to analyze the association between categorical variables.
• Cause and Effect: Inferential statistical tests are used to determine cause-and-effect relationships among variables.

Research Problem Statements

• Definition: A research problem is a situation in need of a solution, improvement, or a discrepancy between the way things are and the way they need to be (Brink, 2018).
• Purpose: To provide a clear rationale for the study and guide the research design.
• Key Questions to Answer:
  1. What is the problem?
  2. Where is the problem?
  3. Who does the problem affect?
  4. What is the magnitude/extent of the problem?
  5. Why is the problem important?
  6. What is the gap in current knowledge?

Population and Sampling: Case Study Analysis

• Study Profile (Ahmed et al., 2006): Breast cancer risk factor knowledge among nurses in Karachi, Pakistan.
• Geographic Context: Karachi, population approximately $13 \times 10^{6}$.
• Target Population: All female registered nurses working in teaching hospitals in Karachi. This represents the entire group the researcher wishes to generalize findings to.
• Accessible Population: Registered female nurses in the six teaching hospitals that granted permission for the study.
• Sampling Method: Stratified random sampling.
  • The six hospitals served as strata.
  • Registered nurses were listed, male nurses were excluded.
  • A computer-generated simple random sample was selected from each stratum.
• Inclusion/Exclusion Criteria:
  • Inclusion: Diploma in general nursing.
  • Exclusion: Past or current history of breast cancer (to avoid bias from personal experience).
• Sampling Error: The difference between a sample statistic and the actual population parameter. It is important because it dictates how accurately the sample represents the total population.

Questions & Discussion

• Question (1.3.5): "Thinking about last night, how painful would you say was your hand on a scale from 0 to 10?"
  • Approach: Quantitative.
  • Justification: It uses a numerical scale to measure a variable, allowing for objective statistical analysis.
• Question (1.3.6): "Tell me about how you have experienced being in isolation as a suspect of patient for Covid-19."
  • Approach: Qualitative.
  • Justification: It uses an open-ended question to explore personal experiences and lived meanings.
• Question (1.3.7): State the design for "The purpose of this study was to describe the lived experience of patients who suffered from Covid-19 and were on ventilation."
  • Design: Phenomenological research (specifically descriptive phenomenology).
• Critique (1.3.8): "The purpose this study is to examine the association between waist circumference and body mass index."
  • Critique: The sentence is grammatically incomplete ("purpose of this"). Furthermore, BMI is calculated using weight and height; since waist circumference is a separate physical measurement, the purpose should specify the population and the intent (correlation) more clearly.
• Critique (3.3): Analysis of Ndawo (2022) problem statement regarding self-skills in nursing education.
  • The statement identifies a discrepancy: the expectation of "well-rounded graduates" versus the reality of "performative culture" and "lack of self-skills."
  • It references current challenges like COVID-19 and the need for "authentic self" in compassionate care.