1. The DCST’s, research and health service evaluation

2. Fundamental questions to be addressed -Should the DCSTs be doing research? -Why should they be doing research? -What research should they be doing? -How do they ensure that research findings are used

3. Purpose of research for DCST
Evaluation of health programmes
Advocating for change
To Make better and informed decisions on operations of the health care system
Provide evidence for the effectiveness of interventions
Scholarship and academic growth

4. DCST can do research at almost any stage of the planning cycle

5. We can do research at almost any stage
Situation analysis
Health needs
Health care utilisation
Perceptions about the health care services
Priority setting / option appraisal
Economic analysis
Cost benefit analysis
Evaluation
Determine impact of interventions

6. What kind of research should the DCST’s be doing?
Priority problems (national, provincial, local)
Action orientated – aimed at developing solutions
Broad – multi-disciplinary approach
Timely – results should be available in time for key decision making
Simple research designs
Presented in format that useful for decision makers and it should be used

7. Focus on Action orientated research
Translational research
Integrating basic research, patient-oriented research, and population- based research so that scientific discoveries made in the laboratory, clinical setting, or population setting result in clinical applications such as interventions to prevent, diagnose, or treat disease. 
Need to think explicitly about implication for practice

8. What is research?
Research is defined as a SYSTEMATIC, SCHOLARLY SCIENTIFIC INVESTIGATION or INQUIRY into an issue, materials and sources in order to establish facts, generate new knowledge and reach new conclusions

9. Purposes of research The primary purposes of research are:
Documentation
Discovery
Interpretation
Development of new knowledge
Verification of existing facts
Advancement of knowledge

10. General research principles
is based on an open system of thought that allows exploration
It involves systematic gathering of data
It involves critical analysis of data
It involves the drawing of conclusions that may be generalised or that specify limits of generalisation

11. Approaches in research
Depending on the purpose of the study, method of collection, analysis, and interpretation of data, two main approaches are applicable:
Quantitative research
Qualitative research
(None of these is deemed superior to the other)
Others include Operational research, action research, health services research

12. Quantitative research

13. Quantitative Research
Research that examines phenomena through the numerical representation of observations and statistical analysis
Quantitative research - measures variables; compares results; tests a hypothesis; generalises its findings to the target population
Quantitative research can either be descriptive or analytical

14. QUANTITATIVE STUDY DESIGNS
Analytical
Descriptive
Experimental
Researcher compares
Outcomes through
intervention
Observational
Researcher compares
outcomes
through observation
Examples:
Case-report
Case of 1 scorpion sting
Case series
Treatment of 30 scorpion
stings
Examples:
Clinical trials
Comparison of effectiveness of 2
anti-convulsants
Educational intervention
assessment using OSCE
Compared to “long case”
Examples:
Case-control (Retrospective)
Smoking and lung ca
Cohorts (Follow-up)
Alcohol use and liver cirrhosis
Cross-sectional
Obesity among teenagers

15. Descriptive studies
Descriptive studies use numerical depiction of the characteristics of a single occurrence/ episode OR several similar occurrences.
Descriptive studies include the following designs:
Cross sectional studies
Case report
Case series

16. Analytical studies
Analytical studies: look for risk factors, associations (between exposure and outcome) and causation.
Analytical studies are either Observational or Experimental

17. Observational studies
cross-sectional: snapshot of characteristics of a population at a specific point in time. Associations are examined; exposure and effect/outcome are measured at the same time
Case control:
- outcome is known, exposures are looked for retrospectively, associations are examined
Cohort:
- exposure is known, individuals are followed up until outcome of interest

18. Experimental studies
Involve interventions directly controlled by the researcher
Randomised Controlled Trials:
- randomised clinical trials, gold standard of experimental design, every participant has an equal chance of being assigned to either group
Field trials: healthy at-risk participants, eg vaccine trials
Community trials: whole communities participate

19. Procedures in quantitative research
Study population identification
Sampling with the aim of representation hence random or systematic sampling
Data collection techniques/tools: Questionnaires, data collection sheet/table, surveys
Data analysis: Usually numerical and uses statistical methods

20. Questionnaires

21. What is a questionnaire
List of questions, answered by the respondent
Indirect measure of the variables you are interested in.
Questions can be:
-Self administered – respondent fill the questionnaire in themselves
-Interview – interviewer asks the questions

22. General aspects of a questionnaire
Consult the respondent
Able to express opinion freely, opinions valued
Keep it short
Ask only pertinent questions
Achieve precise measurement
Collect data in its rawest form (income in rand, precise occupation, age to the year, not age category)
highest level of measurement possible

23. Steps in developing a questionnaire
List all the variables to be measured
These are based on the objectives

24. Steps in developing a questionnaire
Step 2a)
Decide what type of questions you will ask
Step 2b)
Formulate the questions you will ask

25. Phrase your questions Use simple words Be concise and clear
Vary wording to produce variation in replies
Avoid complexity – make it simple
Use existing wording if comparative study
Take the edge off sensitive questions
Be precise, highly specific when choosing wordings

26. Step 3. Sequence of questions
Start with an introduction – who is doing the study and why – legitimate.
Often put demographic information at beginning – non-threatening
Do not put most sensitive questions at the beginning
Do not put the most important questions last – participant may have given up by then / tired .

27. Organise questions
Have consistent formatting so respondents can get used to answering
Group questions by objectives
Anticipate computer data entry
Pre-code questions before data collection
Clearly indicate branching
Clear respondents away from irrelevant questions
Make it easy to fill out; will increase response rate

28. Step 4. Plan the layout and the design
Have a distinctive look
E.g., coloured paper, graphics for questions is appealing
Well laid out questionnaire more likely to be filled in
Don’t squeeze too much onto one page
Crowding questions on a page can make the questionnaire appear too long

29. Pre-testing Pre-test the questionnaire Pilot study
Start by filling out the survey yourself, then ask individuals to do so
Ask for feedback on the questionnaire
Is it too long? Any problem with wording?
Pilot study
Send questionnaire to a small sample of respondents
Use data to determine which items will be used for indexes, modify unclear questions, create pre-coded, single-choice questions based on responses to open-ended questions

30. Disadvantages of questionnaires
Provides only limited insight into problem
Limited response allowed by questions
Maybe not the right questions are asked
Varying response
Misunderstanding/misinterpretation
Need to get it right first time
Hard to chase after missing data

31. End product of Quantitative research
Reports usually with numerical and statistical indices of comparison e.g. prevalence, incidence, Relative Risk, Odds Ratio, sensitivity, specificity, P-value, confidence intervals
Comparison, association, causation
Tested hypothesis
Generalizable information

32. Qualitative Research

33. Qualitative Research
This is any a type of research that produces findings not arrived at by means of numbers and statistical procedures or other means of quantification
Qualitative research focuses on the way human beings live and interact in their natural setting.
Has an interpretive character, aimed at discovering the meaning events have for the individuals who experience them

34. When to use qualitative methods
Exploration: they can reveal the nature of certain situations, setting, processes, relationships, systems or people
Interpretation: enable the researcher to;
a) gain new insights about a particular phenomenon
b) discover problems that exist within the phenomenon
c) Elicit feelings, thoughts, ideas, perceptions
Verification: allow the researcher to test the validity of certain assumptions, claims, theories or generalisations within real-world contexts

35. Qualitative designs Case study Ethnography Phenomenological study
Narrative study
Participatory Action Research

36. Case study
Case study:
- a particular individual, program or event is studied in depth for a defined period of time
- suitable for learning more about a little known or poorly understood situation
- useful for generating or providing preliminary hypothesis

37. Ethnography Ethnography:
- looks in depth at an entire group that shares a common culture
- the group is in its natural setting for a lengthy period of time
- intention is to identify cultural norms, beliefs, social structures and cultural patterns

38. Phenomenology
Attempts to understand peoples’ perceptions, ideas, perspectives and understanding of a particular situation or phenomenon
Phenomenological studies are appropriate in providing insight into human experiences e.g. what is it like to have a terminal illness?

39. Narrative research
This design uses stories of experiences by an individual or group of individuals in establishing an understanding of an event or way of life.
Stories are a powerful way of presenting qualitative information and data is collected over long period of time from one or more participants

40. Participatory Action Research
A research method that involves researcher(s) and participants collaborating to create change/improve a particular situation
In this design the researcher gains deep insights by being a participant, living together and observing the other study participants during the life event under study
It allows the researcher an unobstructed view of the participants lives/experiences
Useful in studying intense social circumstance e.g. prison life, refugees, times of war

41. Procedures in Qualitative studies
The researcher acts as a “human instrument” of data collection
Sampling usually aims at richness of the information hence Purposive sampling
Data is in the form of speech, language, stories, expressions, observations etc
Analysis include: Content, language, discourse, ethnographic (culture patterns)

42. Data collection techniques
1. Interviews
Individual standardized interview
Semi-structured interview
Unstructured interview
2. Focus group interviews
3. Observation
External observer
Internal observer
Participant observer

43. End product of qualitative research
Informative Reports that are descriptive, incorporating expressive language and the “presence of voice of participants in the text”
Ideas, perceptions, experiences, feelings
Hypothesis generation

44. Other priority research approaches for Department of Health
Quality of care
Strengthening the system – drugs, pharmacy, laboratories
Action research
”Essentially action research is concerned with generating knowledge about a social system, while, at the same time, attempting to change it” (Meyer, 2001:173).

45. Health service evaluation
Health service evaluation is always used for decision making
The research questions are derived from goals
Always takes place in real world setting
Results pertain ONLY to programme / service being evaluated.
NOT generalisable

46. Health services research
Health services research is the scientific investigation of the use, costs, delivery and effects of health care treatments or services for individuals and populations.
It is not about collecting information for information’s sake or transforming facts from one place to another.
Health services research involves systematically seeking knowledge which will lead to improvements in the delivery of health care.

47. Use of Research findings
Sometimes No use
Have it as an interesting fact
Use it to make decisions
Use it to persuade / influence others
Use it to change behaviour
Use it to evaluate services, improve patient care, improve management etc

48. Barriers to utilisation of research findings
Time taken to do research
Way it is presented – complicated and use of specialised terminology
Specific recommendations absent
Recommendations impractical
Results not communicated at all
Decision often based on more than research findings – cost, politics, equity etc.

49. Facilitating implementation of research findings
Involve stakeholders throughout the research process
Give them regular feedback
Develop a systematic dissemination and communication strategy for reaching potential users including publishing
Identify and present research to all stakeholders and obtain feedback on findings and recommendations
Actively lobby and mobilise action for and support the use of results

50. How to ensure research is used
Communication between researcher and consumer of research.
Decision makers should be involved in development of research so that it is relevant and meets their needs
Identify all potential users of research at the beginning – if they are only involved at the end the results will never be used
Manage conflict of expectations – policy makers want results quickly and research takes time

51. Conclusion
If a man will begin with certainties, he will end in doubts; but if he will be content to begin with doubts, he will end in certainties. Francis Bacon ( ),_Advancement of Learning_