2. RESEARCH DESIGN Department of Epidemiology and Biostatistics 2010

3. Objectives To understand the concepts of different study design To learn the advantages and disadvantages of several study design

4. Classification of Study Design

5. Types of study design Analytic Experimental Non-experimental Observational Randomizes Clinical Trial Non-randomized Clinical Trial Cohort Case-control Cross-sectional Descriptive Grounded theory Case report Quantitative Qualitative Ethnography Phenomenology

6. a formal, objective, systematic process in which NUMERICAL DATA are utilized to obtain information about the world Quantitative research

7. Is used to - describe variables - examine relationships among variables - determine cause- and-effect interactions between variables the predominantly used method of scientific investigation Quantitative research

8. a systematic, subjective approach used to describe life experiences and give them meaning not a new idea in social and behavioral sciences Qualitative research

9. Types of study design Analytic Experimental Non-experimental Observational Randomizes Clinical Trial Non-randomized Clinical Trial Cohort Case-control Cross-sectional Descriptive Grounded theory Case report Quantitative Qualitative Ethnography Phenomenology

10. Epidemiologic Study Design Descriptive epidemiology: –Measure the frequency in which disease occur –Collect descriptive data on possible causal factors Analytic epidemiology –Specify the causes of particular disease

11. Types of study design Analytic Experimental Non-experimental Observational Randomizes Clinical Trial Non-randomized Clinical Trial Cohort Case-control Cross-sectional Descriptive Grounded theory Case report Quantitative Qualitative Ethnography Phenomenology

12. Types of Studies Experimental: study factor is manipulated by the investigator –Pure vs quasi experimental –Laboratory vs real world Observational: no manipulation of study factor –Descriptive vs analytic –Prospective vs retrospective

13. Types of study design Analytic Experimental Non-experimental Observational Randomizes Clinical Trial Non-randomized Clinical Trial Cohort Case-control Cross-sectional Descriptive Grounded theory Case report Quantitative Qualitative Ethnography Phenomenology

14. Cross-sectional Study Population DM Obese (+) Obese (-) Non dM Sample

15. Exposure A Case control With disease Without disease Starting point Exposure B CONCLUSION

16. Cohort Exposure A With disease Without disease Starting point Exposure B CONCLUSION

17. Types of study design Analytic Experimental Non-experimental Observational Randomizes Clinical Trial Non-randomized Clinical Trial Cohort Case-control Cross-sectional Descriptive Grounded theory Case report Quantitative Qualitative Ethnography Phenomenology

18. Clinical Trial Treatment Placebo Population Sample No Yes NoYes Disease Randomselection Blindedadministration CONCLUSION

19. T i m e l i n e Time line of different study design Case Control Clinical Trial Cohort study ` Case Series Cross Sectional Case Report

20. Types of Epidemiology Study Type of studyAlternative nameUnit of study Observational studies Descriptive studies Analytical studies Ecological Cross-sectional Case-control Cohort Experimental studies Randomized controlled trial Field Trials Community Trials Correlation Prevalence Case-reference Follow-up Clinical Trial Com.intervention study Populations Individuals Patients Healthy people Communities

21. Application of Observational study design EcologicalCross- sectional Case- control Cohort Investigation of rare disease Investigation of rare cause Testing multiple effects of cause (eg hypertension) Study of multiple exposures and determinants (eg: AMI) Measurement of time relationship Direct measurement of incidence Investigation of long latent period ++++ ++ + ++ - ++ - +++++ - ++++ +a +b +++ - +++++ +++ +++++ - ++ = degree of suitabilitya=if prospective - = not suitableb=if population-based

22. Selection of study design depends on: Research question/problem/objective Time & resources availability Common/rare disease Expected outcome Quality of data Established design

23. Choose the most appropriate design for each study title Assessment of student’s health status using Treadmill

24. Choose the most appropriate design for each study title Association between 3 months Treadmill exercise and student’s health status

25. Choose the most appropriate design for each study title Association between lung cancer and smoking behavior.

26. Choose the most appropriate design for each study title Distribution of bone-fracture location in patient with motorcycle accident admitted to Emergency Room, Hasan Sadikin Hospital.

27. Choose the most appropriate design for each study title New emerging disease: Severe Acute pneumonia in children in urban area of Bandung.

28. Choose the most appropriate design for each study title The effect of peer-education on student’s smoking cessation

29. Choose the most appropriate design for each study title Protein concentration in several kind of peas

30. Graduate: –Regular physician, Researcher, Pediatritian, Obstetritian, Surgeon, Internal medicine –Jakarta, Bandung, Banjaran, Majalengka, Kuningan

31. Real Problem Menkes dan Mendiknas 2010 –Rasio dokter dengan jumlah penduduk –Penyebaran dokter tidak merata, kabupaten masih kekurangan dokter, terutama daerah terpencil

32. Many researchers have narrowly defined scientific research method to include only quantitative research. This research method is based on the philosophy of logical empiricism

33. Qualitative research Qualitative researchers aim to gather an in-depth understanding of human behavior and the reasons that govern such behavior.human behaviorreasons The qualitative method investigates the why and how of decision making, not just what,where, when.decision making Smaller but focused samples are more often needed, rather than large random samples.samplesrandom samples

34. Qualitative research seeks TO UNDERSTAND a given research problem or topic from the PERSPECTIVES OF THE LOCAL POPULATION it involves. –Qualitative research is especially effective in obtaining culturally specific information about the values, opinions, behaviors, and social contexts of particular populations

35. What can we learn from qualitative research? It can provide complex textual descriptions of how people experience a given research issue. It PROVIDES INFORMATION ABOUT THE “HUMAN” SIDE of an issue – that is, the often contradictory behaviors, beliefs, opinions, emotions, and relationships of individuals.

36. What can we learn from qualitative research? Qualitative methods are also EFFECTIVE IN IDENTIFYING INTANGIBLE FACTORS, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research issue may not be readily apparent.

37. What can we learn from qualitative research? When used along with quantitative methods, qualitative research can help us to INTERPRET AND BETTER UNDERSTAND THE COMPLEX REALITY of a given situation and the implications of quantitative data.

38. What forms do qualitative data take? The types of data these three methods generate are –FIELD NOTES –AUDIO (AND SOMETIMES VIDEO) RECORDINGS –TRANSCRIPTS

39. Comparison of quantitative and qualitative research approaches General framework QuantitativeQualitative Seek to confirm hypotheses about phenomena Seek to explore phenomena Instruments use more rigid style of eliciting and categorizing responses to questions Instruments use more flexible, iterative style of eliciting and categorizing responses to questions Use highly structured methods such as questionnaires, surveys, and structured observation Use semi-structured methods such as in-depth interviews, focus groups, and participant observation

40. Comparison of quantitative and qualitative research approaches Analytical objectives QuantitativeQualitative To quantify variationTo describe variation To predict causal relationshipsTo describe and explain relationships To describe characteristics of a population To describe individual experiences or group norms

41. Comparison of quantitative and qualitative research approaches Question format Data format QuantitativeQualitative Closed-endedOpen-ended QuantitativeQualitative Numerical (obtained by assigning numerical values to responses) Textual (obtained from audiotapes, videotapes, and field notes)

42. Comparison of quantitative and qualitative research approaches Flexibility in study design QuantitativeQualitative Study design is stable from beginning to end Some aspects of the study are flexible (for example, the addition, exclusion, or wording of particular interview questions) Participant responses do not influence or determine how and which questions researchers ask next Participant responses affect how and which questions researchers ask next Study design is subject to statistical assumptions and conditions Study design is iterative, that is, data collection and research questions are adjusted according to what is learned

43. Types of Qualitative Research 1. Phenomenology 2. Grounded Theory 3. Ethnography

44. 1. Phenomenological Research an inductive, descriptive approach developed from phenomenon The focus is understanding the response of whole human being, not just specific parts of behaviors

45. The aim : to describe an experience as it is lived by the person describing a person’s experience of pain as it is lived by that person 1. Phenomenological Research

46. 2. Grounded Theory Research an inductive research technique useful in discovering problems which exist in a social scene the process persons use to handle them GTR emphasizes observation and the development of practice-based intuitive relationships between variables

47. The research process involves formulation, testing, and redevelopment of propositions until a theory evolves. The theory developed is “grounded” or has its roots in the data from which it was derived

48. 3. Ethnographic Research investigating cultures through an in-depth study of the members of the culture. attempts to tell the story of people’s daily lives while describing the culture they are a part of ER process is the systematic collection, description, and analysis of data to develop a theory of cultural behavior

49. Using ER different cultures are described, compared and contrasted to add to the understanding of the impact of culture on human behavior and health