HLTA0H3 FINAL EXAM PT 2

Paradigms of Health Research week 9

Research Paradigm: reflects one's belief about what constitutes knowledge and how knowledge should be generated 

Three Dimensions: Epistemology, Ontology, Methodology 

Epistemology - concerned with nature and definition of knowledge and truth, define types of data considered “valid” or “useful”

Two parts of Epistemology: Positivism, Interpretivism

Positivism 

• scientific processes based on observation and measurement

Ex. cause and effect, clinical trials for new drugs, assess causation, measurable outcomes 

• Ex. Measuring population health through epidemiological studies 

Interpretivism 

• Generates subjective understandings, not measurement but meaning, more description wise   

Ex. understanding patient experience with chronic illness, lived experience of the disease, personal meanings and themes 

Ontology - Branch of philosophy focused on nature of reality, things that have a fixed reality is independent of our perspectives 

Two parts: Objectivism, Constructionism 

Objectivism

• External reality exists independently of observation 

Ex. a tumour exists whether or not a patient/ doctor recognise it 

Constructionism 

• Socially constructed objects

• Reality is socially constructed 

Ex. depression is not a biological reality but shaped by social understandings 

Methodology - data collection and analysis 

Two parts: Quantitative, Qualitative 

Quantitative 

• Relies on numeric data and analysis

• Guided by measurement 

Ex. surveys

Qualitative

• Relies on open ended questions, with meaning and experience

Ex. focus groups, interviews

Patient satisfaction with telehealth services using interviews to understand barriers to access

• Positivism 

• Interpretivism 

Obesity as a biological condition caused by genetics and metabolism

• Objectivism 

• Constructivism

Mental health treatment effectiveness as measured by symptom

• Quantitative 

• Qualitative 

Health Research Methodologies part 1 week 10

Quantitative Methods?

• Study designs: driven by study question, available population for study, and current state of research 

Quantitative study designs: Randomised control trial, Cohort, Case- Control, Cross-sectional study

Randomised Control Trial - evaluate the therapeutic effects of disease in a person

• researcher controls who receives the treatment or exposure and who gets the alternative

• Control group: those receiving alternative

Cohort Study - people with diseases are sampled and classified according to whether they have the exposure or not 

• Followed overtime to see who gets the disease

• Health measurements and incidence rates

Case-control study - cases from specific populations are studied 

• Matching: cases and controls from similar populations..age, sex, race/ ethnicity, SES

Cross-sectional / prevalence study - population sampled and disease status measured at the same time 

• can’t predict causality, incidence rates cannot be calculated

Ecological studies 

• Not individual level data, data summarizing exposure and disease samples or populations 

Statistics - Study of the use of statistical principles that allows us to understand data 

Data - Numbers that represent some features of something you're measuring 

Measurement - Process of assigning numbers to a thing

Types of Measurement: Nominal, Ordinal, Interval 

Nominal: number represents a label for a category

Ordinal: category of things can be ordered(smaller, larger, before or after)

Interval: Category of things can be put in groups equally spaced

Categorical judgments

• People choose among a number of alternatives

Scaling judgments 

• Continuous judgments: requires person to indicate their response along a continuum

• Likert scale: extreme values at both ends

Confidence interval 

• Gives range of values within which we expect the true population parameter to fall

Ex. 95% confident that the true effect is between 1.5 and 2.5 = 95% CL of (1.5, 2.5)

P-value 

• How likely we are to observe data if the null hypothesis were true 

Health Research methodologies part 2 week 11

 Qualitative research?

• Attempts to find out what's going on, what is happening, and the nature of something from the perspective of those involved in the study

Naturalistic: research in natural environment, rather then lab

Interpretive: constructing meaning from data sith the aim of explaining the phenomenon 

Explores: identification of health needs, patterns in health seeking behaviors 

Approaches to Qualitative Research: Ethnography, Autoethnography, Phenomenology, Grounded Theory, Qualitative Description 

Ethnography: 

• Oldest approach, focus on exploration of culture 

• Roots in anthropology 

• Specific places, people

Autoethnography:

• links personal to cultural through self-narrative 

• Focus on the individual, researcher becomes participant and observer

Phenomenology: 

• Seeks to explore, and analyse “lived experience” 

• Gain deeper understanding of nature of everyday experiences

• Identifies object of human experience (pain)

Grounded Theory: 

• Develop theory based on data 

Qualitative Description:

• Research that doesn’t fit neatly into other types 

• Against forcing research into a type 

Sampling: 

purposeful sampling:

selecting best participants based on quality of their insights

snowball sampling: 

participants are asked to invite others who meet sampling criteria

convenience sampling:

selected based on availability 

theoretical sampling:

based on emerging theoretical framework 

Methods 

Visual methods - photo voice

• collaboration with community partners is central focus 

Focus groups 

• involves more then two participants in a focused interview

Interviews 

• guided conversation 

Rigour : 

keeping an audit trail  - documenting research decisions and rationale 

reflexivity - examining one’s place, biography, self and others to understand how they shape analytic exercise 

prolonged engagement - extended time in field

Member engagement - exploring findings with participants 

triangulation - check integrity of inferences using multiple data 

peer debriefing - checking findings and interpretation with a peer

Ethical Consideration Week 12

Ethics : 

• branch of philosophy associated with the systematic examination of right and wrong 

Ethical challenges 

• Conflicts over treatment decisions

• Determining essential services 

• All of services for vulnerable populations 

• Shortage of healthcare worker to provide care

• Decisions about end of life care 

• Determining who can make health care decisions on behalf of another 

• Medical error emergence of new technologies 

• Ability to give informed consent prior to receiving care

• Risks and benefits of participation in medical research 

Ethics in healthcare practice: 

• determining essential services 

• lack of services for vulnerable populations 

• shortage of healthcare workers to provide care 

4. Potential conflicts : 

conflict of interest - will research team members, or immediate family members receive any personal benefit 

restrictions on information - are there any restrictions regarding access, or disclosing of information 

Researcher relationships - are there any pre-existing relationships between the researcher and researched? 

Collaborative decision making - is this a community based project?