1. Research Methodology and Epidemiology Dr. Sean Lynch

2. Research Methodology, Epidemiology and Evidence Based Psychiatry-4 This module will cover the following areas:- n An introduction to research concepts, audit, research governance, funding and dissemination of research n Qualitative and Quantitative methods n Different forms of research study and their interpretation n Parametric and non-parametric statistics n Other advanced statistical methods n Epidemiological concepts in mental health and psychiatric research instruments n Meta-analysis, systematic reviews and evidence based practice

3. Qualitative Research Today we will examine the methodology used in qualitative research. We will look at the limitations and benefits of the principal methods. The aims of today’s session are:- 1. To understand the use of different interview approaches used in qualitative research 2. To understand the use of group based methods 3. To understand sources of data loss and bias in qualitative studies

4. Research Methodology and Epidemiology -4 Programme (approximate times) 1030 - 1115 Feedback on problems in last session Interview designs in qualitative research Interview designs in qualitative research 1115 - 1130 Break 1130 - 1215 Group, observational and ethnographic methods in qualitative research methods in qualitative research 1215 - 1230 Discussion of morning 1230 - 1330 Lunch 1330 - 1530 Small group work on problems

5. Research Methodology and Epidemiology -4 Main aims 1. Exploratory 2. Explanatory 3. Evaluative 4. Developmental

6. Research Methodology and Epidemiology -4 Why are qualitative methods being used more? n Quantitative methods measure summed data e.g. on outcomes, differences in groups n They tell us little or nothing about behaviour, preference, satisfaction or individual experience preference, satisfaction or individual experience n Increased patient participation in service design, delivery and evaluation delivery and evaluation

7. Research Methodology and Epidemiology -4 Advantages 1. Naturalistic - “real life” 2. Subjective experience 3. Detailed descriptive data 4. Can assess processes 5. Greater validity in data

8. Research Methodology and Epidemiology -4 Advantages Can be used in supplementary studies to increase validity of quantitative design studies Can be used in “mixed methods” or “triangulation model”

9. Research Methodology and Epidemiology -4 Advantages Some qualitative data can be summarised and subject to more conventional statistical analysis Methods are being devised for secondary analysis equivalent to systematic review methodology for quantitative methods

10. Research Methodology and Epidemiology -4 Disadvantages n Difficulty in standardising and replicating methods n Sample selection n Importance of data loss and non-response n Subject to bias of researcher (interview, focus group)

11. Research Methodology and Epidemiology -4 Disadvantages n Difficulty in standardising data extraction method and analysis and analysis n Difficulty in comparison of studies

12. Research Methodology and Epidemiology -4 Interview studies 1. Unstructured - data more difficult to analyse 2. Semi-structured - most commonly used, balance of open and closed questions 3. Structured - loss of validity, ease of data analysis

13. Research Methodology and Epidemiology -4 Interview studies May need to focus on certain areas May need to promote active participation and interest Use of guides or checklists Prompted - vignettes, audio-visual More passive styles directed by preference of subject - more costly but will get “deeper” and “richer” data.

14. Research Methodology and Epidemiology -4 Interview studies Depth interview Paired interview Peer-led interview Incentives

15. Research Methodology and Epidemiology -4 Different interview methodologies NarrativesE-interviews Telephone interviews Interview based on subject diaries or narrative

16. Research Methodology and Epidemiology -4 Analysis Methods Transcript analysis Verbal analysis Visual analysis Manual and other methodologies Word processor based programmes Specific computer programmes

17. Research Methodology and Epidemiology -4 Analysis Methods A priori categories and dimensions Categories and dimensions generated by analysis - most frequent category of response - by particular response characteristic e.g. adjectival or affective or behavioural (chronic pain research) or affective or behavioural (chronic pain research)

18. Research Methodology and Epidemiology -4 Analysis Methods n Correspondence analysis n Didactic n Semantic

19. Research Methodology and Epidemiology -4 Group, observational and other methodologies Focus groups Sample selection Motivation Group dynamics Facilitator role Observer / active roles

20. Research Methodology and Epidemiology -4 Group, observational and other methodologies Jury Groups Specific type of focus group One or two aims Have common purpose or link

21. Research Methodology and Epidemiology -4 Group, observational and other methodologies Action Research Empowerment of research subjects through participation Researcher identifies user groups who work together identifying a common problem, devising a solution and assessing its effects

22. Research Methodology and Epidemiology -4 Group, observational and other methodologies Observational research To assess group interactions To assess power relationships InfluencesSub-groups

23. Research Methodology and Epidemiology -4 Group, observational and other methodologies Ethnographic research Researcher lives in group to be studied Becomes steeped in culture, values Learns about culture, subculture, group values

24. Research Methodology and Epidemiology -4 Group, observational and other methodologies Questionnaire research Can be individualised e.g subject identifies problem or issue and rates Can be more or less structured e.g. leave option for respondent to express views on important issues e.g your feedback on this module!

25. Research Methodology and Epidemiology -4 Group, observational and other methodologies Questionnaire research By e-mail, Postal Convenience sample Household (door-to-door)

26. Research Methodology and Epidemiology -4 Group, observational and other methodologies Questionnaire research There are significant problems with response rates Incentives can be used There may be a problem with the information “depth” These can be difficult to interpret due to non-response bias

27. Research Methodology and Epidemiology -4 Group, observational and other methodologies E-focus groups “Chatrooms” or communities E-mail shots IncentivisedCost-effective

28. Research Methodology and Epidemiology -4 Problem One Problem One You are a NHS Trust manager working with the PCT in trying to increase the uptake of a primary care counselling service for people who have milder to moderate severity depression, as referrals of people with these problems to the community mental health teams are relentlessly increasing.

29. Research Methodology and Epidemiology -4 Problem One Problem One The PCT has commissioned a consumer satisfaction questionnaire which has found high satisfaction levels with users of the counselling service and are puzzled by the low take up rate. The NHS Trust has similarly sought views of users of the CMHTs, who while very satisfied with the service offered by the CMHT are uncertain they would use primary care services

30. Research Methodology and Epidemiology -4 Problem One Problem One Why are there such different views of the primary care counselling service? What qualitative methods could be used to understand this problem? How would this help to change perception of this service?

31. Research Methodology and Epidemiology -4 Problem Two Problem Two There is a high rate of non-attendance at all the out-patient services at your hospital. These are mental health services for a working age adult population in a rural area. There has been a demographic change of inward migration from other parts of the United Kingdom and the EU.

32. Research Methodology and Epidemiology -4 Problem Two Problem Two Using qualitative methodology how might you 1. Aim to find out reasons for non-attendance 2. Understand how services might be altered to improve attendance rates Again, using these principles, what are the potential risks of any service redesign?

33. Research Methodology and Epidemiology -4 Problem Three Problem Three How can the benefits and adverse effects of clozapine treatment be evaluated using qualitative methodology? What specific findings might make you want to redesign the service?