Health Research Method

Jamal Abdu (Assistant professor of Epidemiology)

Samara University

12/15/2022
 Course Description:
❑ The research methods course is designed to assist students in
developing research proposal, writing scientific paper, and
critically appraising individual researches and systematic
reviews
 Methods of Instruction
❑ Lectures, class practical exercises, and group discussions are
methods of instruction

❑ Attendance of classes and group discussions is strictly

compulsory
Evaluation
 Test one 10%

 Test two 10%

 Group Assignment 15%

 Individual assignment 15%

 Final Exam 50%

Research and Research Proposal

5
 Learning Objectives
At the end of this session, you should be able to:
➢ Define research in general and health systems research in
particular
➢ Describe the major characteristics of research
➢ Identify the different types of research
➢ List essential features of health systems research
➢ Describe the broad steps involved in research process
6
 What is research?
 Scholars have not agreed on a single, objective definition of
the term research.

 Oxford Encyclopedic English Dictionary defines it as “the

systematic investigation into the study of materials, sources etc.
in order to establish facts and reach new conclusion”

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 What is research?...cont
 Other scholars, such as Paul Leedy, defines research
in a more utilitarian manner.

 For Leedy, research is “a procedure by which we attempt to

find systematically, and with the support of demonstrable
fact, the answer to a question or the resolution of a problem”

8
 What is research?...cont
 Despite these varying definitions, scholars have come up
with a working definition of research.

 Research is a systematic collection, analysis and

interpretation of data to answer a certain question or solve a
problem.

◼ Research is defined as the scientific investigation of a

problem or gap, which aims at the discovery of new facts.
9
 What is research?...cont
 Research= Re + search

 Process must be replicable (Reliability)

 Process must generate information that answers the research

problem (Validity)

10
 What is research?...cont
 Is a search for knowledge.

 It is actually a voyage of discovery to establish facts … TO ..

extend, correct or verify knowledge, through objectives and
systematic methods … for its advancement.

 The inquisitiveness is the mother of all knowledge and

method, man employs for answering the questions.
 What is research?...cont
 It is crucial to follow cascading scientific steps when
conducting one’s research

 Research is a specific term, which necessarily involves a

scientific rigor.

 Any type of inquiry that does not involve a scientific rigor

cannot be called “research” in the strict sense of the word,
such as the mere act of gathering facts and information.

12
 What is research?...cont
 What is scientific rigor?
 By scientific rigor we mean the implementation of highest
standards and best practices of science.
 For instance, someone may say he/she wants to go to the
library to do further research on the meaning, nature and
dynamics of malnutrition.
◼ The term research is wrongly used here because in the first
place it lacks the scientific rigor.

13
 Steps of Scientific Research
Selection of area no need for study
Selection of topic answers found

Crude research question Literature review

no answer

Refined research question

Research hypothesis, goals and objectives

Study design Ethical issues

Population & sampling

Variables confounding bias

Research tools

Pilot study

Work plan

Collection of data

Data management/analysis

Interpretation

Reporting
Research Methodology
 A science of studying how research is done scientifically
 A way to systematically solve the research problem by
logically adopting various steps.

Aims:
 To describe and analyze methods,
 Throw light on their limitations and resources,
 Clarify their presuppositions and consequences.
 Why it is important to know about methodology?
 In writing your research, make sense of how your methods all
worked.
 The methodology piece explain:
✓ Why you did what you did.
✓ Write about what you did not do and why,
✓ Write about the weaknesses or limitations of your project as
well as its strengths.
✓ Every research has a limitation, it is perfectly acceptable to
identify the weaknesses of your own study.
 Characteristics of Research Method
 The research process must be a permanent sequence of
analysis, statement, action, reflection, etc.

 There must be sufficient time allowed to the research

process to deal with the complexity of the problem.

 Allows for “reciprocal relationship” by the researchers and

the members of the culture where the research is done
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 Characteristics of Research…
 Objectivity- It must answer the research questions

 Replicable- reproducible

 Transmittable

 Quality control- Accurate measurements

 All well designed and conducted research has potential

application

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 Characteristics of Researcher
 The ability to effect such reciprocal relationship.

 he is capable of making mistakes as the other participants in

the research do.

 The researcher must also possess the ability to constantly

evaluate what is happening.

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 Characteristics of research
➢ It demands a clear statement of the problem.

➢ It requires clear objectives and a plan

➢ It builds on existing data, using both positive and negative

findings.

➢ New data should be systematically collected and analyzed

to answer the original research objectives.

20
 Motivations In Research
1) Desire to get a research degree along with its
consequential benefits;
2) Desire to be of service to society;
3) Desire to face the challenge in solving the unsolved
problems,
4) Desire to get intellectual joy of doing some creative work;
5) Desire to get respectability
6) OR … directives of government, employment conditions …..
 Motivations In Research...
 Validate intuition

 Improve methods

 Demands of the Job

 For publication/patent

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Importance of Research
❑ Guiding action

❑ Developing new tools

❑ Saving resources

❑ Multiplying benefits

❑ Enhancing capacity development process

 What Is The Main Aim of Research?
1) To gain familiarity with a phenomenon or to achieve new
insights into it (exploratory research)
2) To portray accurately the characteristics of a particular
individual, situation or a group (descriptive research)
3) To test a hypothesis of a causal relationship between
variables (hypothesis-testing research).
4) To determine the frequency with which something occurs or
with which it is associated with something else (diagnostic
research studies)
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 Qualities of Good Research
 Objectives clearly defined

 Carefully planned design leading to objective results

 Complete frankness; flaws reported and their effect estimated

 Adequate and appropriate analysis of data.

 Carefully checked data for validity & reliability

 Conclusions confined to those justified by the data

 Confidence, competence/ reputation, experience, honesty &
integrity of researcher 25
 Qualities of Good Research contd..
 SYSTEMATIC - Reject the use of guessing & intuition.

 CONTROLLED – Variables are identified & controlled,

wherever possible

 LOGICAL - Guided by rules of logical reasoning

 REPLICABLE - Verified by replicating the study

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 Categories of research
1. Empirical and theoretical research

◼ The philosophical approach to research is basically of two

types: empirical and theoretical.

◼ Health research mainly follows empirical approach, i.e. it is

based upon observation and experience more than upon
theory and abstraction.
 Empiricalresearch in the health sciences can be
qualitative or quantitative in nature.
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 Categories of research…cont
2. Basic and applied
❑ Research can be functionally divided into basic (or pure)
research and applied research.
◼ Basic research is usually considered to involve a search for
knowledge without a defined goal of specific purpose.
◼ Applied research is problem-oriented, and is directed
towards the solution of an existing problem.

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 Categories of research…cont
3. Health research triangle
❑ Biomedical research deals primarily with basic research
involving processes at cellular level
❑ Health research deals with issues in the environment
surrounding man, which promote changes at cellular level
❑ Behavioral research deals with interaction of man and
environment in a manner reflecting the beliefs, attitudes and
practices of the individual in society.

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 Categories of research…cont
Based on Specific Objectives of Research
a-Descriptive research: Attempts to provide an accurate
portrayal of characteristics of a particular individual, situation,
problem, phenomenon, service or program.

b- Correlational research: refers to the systematic

investigation of relationships among two or more variables,
without necessarily determining cause and effect
C- Explanatory research: attempts to clarify why and how
there is a relationship between two or more aspects of a
situation or phenomenon. 30
 Categories of research…cont
❑ Based on Approaches of Research
❖ Quantitative: based on the measurement of quantity or amount.
➢ how much? How many? How often? To what extent? Etc.
❖ Qualitative: concerned with Qualitative phenomena (those relating
to involving quality/kind)
➢ concerned with why? How? In what way

❖ Mixed methods: resides in the middle of this continuum because

it incorporates elements of both qualitative and quantitative
approaches.
 Examples
QUANTITATIVE QUALITATIVE

 Survey  Case study

 Content Analysis  In-depth interview

 Analysis of recorded data  Focus Group Discussion

 Observation  Observation

 Experiment  Ethnography
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 Key Features: Quantitative & Qualitative
Research
QUANTITATIVE QUALITATIVE
 Determines extent of a  Identifies and explains
problem processes
 Data in the form of statistics  Data in the form of narratives
 Data collection & analysis  Data collection and analysis
separate go hand in hand
 Analysis involves computation  Meanings of acts important
 Large and representative  Sample: small and purposive
sample  Long field notes
 Structured instruments 33
 Categories of research…cont
❑ Based on Designs
◼ Experimental,

◼ Quasi-experimental, and

◼ Non-experimental (observational).

❑ By Type of Data
◼ Primary research (field research)

◼ Secondary research
 Categories of research…cont
❑ By Fields of Study
◼ Natural science research,

◼ Social science research,

◼ Educational research,

◼ Behavioral science research,

◼ Health science research, etc.

 What is health systems research (HSR)
❑ Research that supports health development
❑ Definition of “health system “ A health system may be
described as:
◼ A set of cultural beliefs about health and illness that forms the
basis for health-seeking and health promoting behavior.
◼ The institutional arrangements within which that behavior
occurs; and
◼ The socioeconomic, political, physical context for those beliefs &
institutions
36
 Health research…cont
❑ The application of principles of research on health

❑ It is the generation of new knowledge using scientific method

to identify health problems

❑ Knowledge, both generalizable worldwide and locally specific,

is essential to effective action for health

37
 Major purposes of health research
Health research serves two main purposes.
1. To generate knowledge essential to effectively promote
health of the population.

2. To identify priority problems and to design and evaluate

policies and programs that will deliver the greatest health
benefits, making optimal use of available resources.

38
 Classification of Health research…cont
❑ Health research is divided into three groups
1. Essential health research: Consists of activities to define the
health problems of a given country or community, to measure their
importance and to assure the quality of activities to deal with them.
❑ The information, which may be obtained in a number of ways, is
essential and specific to each country for planning and monitoring
health services
❑ Some of the research conclusions, however, may be generalized and
applicable to other areas.

39
 Classification of Health research…cont
2. Clinical research:
❑ Ranges from studies of the prevention and diagnosis of
diseases through new methods of treatment to problems of
care and rehabilitation.
❑ Some of the research are mainly of local importance; much
are useful for other individuals in other countries.
❑ Examples: clinical trials of disease prevention and the design
of new chemotherapeutic agents.

40
 Classification of Health research…cont
3. Biomedical research:
❑ It is the most basic part of health research which demands
more resources, facilities and skilled investigators.
❑ The results of biomedical research are more often of universal
importance and thus of general significance.

41
 Essential Features of HSR
1. HSR should focus on priority problems.
2. It should be action oriented (aimed at developing solutions)
3. An integrated multidisciplinary approach is required
(research approaches from many disciplines)
4. The research should be participatory in nature (from policy
makers to community members)

5. Research must be timely.

42
 Essential Features of HSR…cont
6. Emphasis should be placed on comparatively simple, short-
term designs to yield practical results relatively quickly.

7. The principle of cost-effectiveness is important in the

selection of research projects. (low-cost and optimum output)

8. Results should be presented in formats most useful for

administrators, decision-makers and the community.

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 Review the Available
Literature

Publish Formulate a
Findings Question
Research Process
Interpret Select an Appropriate
Findings Research Design

Collect Relevant
Data
Main components of any research work

I. Preparing a research proposal

II. Fieldwork (i.e., data collection)

III. Analyzing data and preparing a research report

45
 Research Proposal
 It is a document that presents a plan for the project.
 Itcan be a supervised project submitted to instructors
as part of the educational degree
 Itspurpose is to convince reviewers that you are
capable of successfully conducting the proposed
research project.

46
Research Proposal cont...
❑A proposal describes the research problems and its
importance, and gives detailed account of the methods
that will be used and why they are appropriate.

47
Research Proposal cont...
❑A written proposal is important in order to:
✓ Clearly define the problem under study
✓ Avoid reinventing the wheel
✓ Clearly depict the methodology to be used
✓ Be cost and time conscious
✓ Be clear about what to expect in the end
 Research Proposal cont...
❑ Components of a research proposal
➢ Title
➢ Summary
➢ Background (Problem of Statement and Justification of the problem)
➢ Literature review
➢ Objectives
➢ Methods
➢ Ethical considerations
➢ Work plan
➢ Cost of the project
➢ References 49
 The Research Problem
Learning objectives.
At the end of this session, you should be able to:
➢ Describe the reasons for including a statement of the problem
in a research proposal
➢ Describe what a research problem/gap is
➢ Outline information that should be included in the statement
of the problem
➢ Prepare the statement of the problem for the research
proposal being developed during the course.
50
 What is a research problem?
 All research is set in motion by the existence of a problem.
 A problem is:
◼ A perceived difficulty, a feeling of discomfort about the way
things are, or

◼ A discrepancy between what someone believes the situation

should be and what it is in reality.

51
 What is a research problem? Cont...
A potential research situation arises when three conditions exist:
◼ A perceived discrepancy exists between what is and what
should be.
◼ A question exists about why there is a discrepancy.

◼ At least two possible and plausible answers exist to the

question.

52
 Formulating the Problem Statement and Justification of
the Problems
 The statement of the problem describe the problem that is to
be investigated and questions that will guide research process.

 Proper justification of the importance of the research

questions to be addressed requires some sense of the likely
contribution to knowledge that the research will make and its
place in current debate or technological advance

53
 Formulating the Problem Statement and Justification of
the Problems
 A research problem is a statement about an area of concern, a
condition to be improved, a difficulty to be eliminated, or a
troubling question that exists in scholarly literature, in theory,
or in practice that points to the need for meaningful
understanding and deliberate investigation.

54
 Formulating the Problem Statement
 The purpose of a problem statement is to:
1. Introduce the reader to the importance of the topic being
studied.
2. Places the problem into a particular context that defines the
parameters of what is to be investigated.
3. Provides the framework for reporting the results and indicates
what is probably necessary to conduct the study and explain
how the findings will present this information.

55
Why is it important to state and define the problem well?
Because a clear statement of the problem:
 Is the foundation for further development of the research
proposal (research objectives, methodology, work plan, etc)
 Makes it easier to find information and reports of similar
studies from which your own study design can benefit.
 Enables to systematically point out why the proposed research
on the problem should be undertaken and what you hope to
achieve with the study results.

56
 Basic characteristics of research problem
 For your research problem to be effective, make sure that it
has these basic characteristics:
◼ Reflecting on important issues or needs;

◼ Basing on factual evidence (it’s non-hypothetical);

◼ Being manageable and relevant;

◼ Suggesting a testable and meaningful hypothesis (avoiding
useless answers).

57
 Basic Steps in Formulating a Research Problem
(i) Identify the Broad Study Area
➢ This is a great idea to thinking about the subject area of your
interest.

➢ You should identify the field in which you would like to work a
long time after your academic study or graduation.

➢ It will help you tremendously to get an interesting research

topic.

58
 Basic Steps in Formulating a Research Problem
(ii) Dissect the Broad Study Area into Subareas
➢ In this stage, you need to dissect and specify your research
broad study area into some subareas.
➢ You would consult with your supervisor in this regard. Write
down subareas.
➢ For example- if you select IDP as your broad study area, then
dissect it into IDP & social stability, IDP & crime, IDP and
Malnutrition, IDP & individual frustration, etc.

59
 Basic Steps in Formulating a Research Problem
(iii) Mark-up your Interest
➢ It is almost impossible to study all subareas. That’s why you
must identify your area of interest.
➢ You should select issues in which you are passionate about.
➢ Your interest must be the most important determinant of your
research study.
➢ Once you selected your research study of interest, you should
delete other subareas in which you do not feel interested.
60
 Basic Steps in Formulating a Research Problem
(iv) Study Research Questions
➢ In this step in formulating a research problem, you would
point out your research questions under the area of interest as
you decided in the previous stage.

➢ If you select unemployment as your study area, your

questions might be “how IDP impacts on individual social
status?” “How it affects social stability?” “How it creates
frustration on individuals?”

61
 Basic Steps in Formulating a Research Problem
(v) Set Out Objectives
➢ Research objectives essentially come from research questions.

➢ If you do study “Impact of unemployment on individual social

status” as your research problem or research question.
➢ Then, set out what would you like to explore to address. For
Example- your main objective might be to examine the IDP
status in a particular society or state.
➢ And sub-objectives would be its effects on individuals’ social life.
62
 Basic Steps in Formulating a Research Problem
(vi) Assess your Objectives
➢ Assess your objectives in terms of time, budget, resources and
technical expertise at your hand.
➢ You should also assess your research questions in light of
reality.
➢ Determine what outcome will bring your study. If you can
assess accurately the purpose of the research study it will
bring significant results in the long run.

63
 Basic Steps in Formulating a Research Problem
(vii) Check Back
➢ Before you go on research work you should review all steps in
formulating a research problem and all the things that you
have done till now for the purpose of your research study.
➢ Then, ask yourself about your passion. Do you have enough
resources to step up?
➢ If you are quite satisfied, then you forward to undertake your
research work.

64
 What is a research gap?...cont
What is a research gap?
 A *research gap* is the problem that researchers would
want to see addressed in the research.

 As the name suggests, it is the gap that researchers fill with

their proposed research

 Hence, a research gap is “what is missing” or “what is not

addressed” in the current state of knowledge.

65
 What is a research gap?...cont
 Put simply, a research gap is the question or problem that
has not been answered in your area of specialization.

 For this reason, the research gap establishes “the need” or

the “importance, urgency, and necessity” of your proposed
research project, thesis, or dissertation.

 This explains why all types of research always begin with a

research gap.

66
 What is a research gap?...cont
 Identifying the research gap and articulating it in the
“background” or “rationale” of the study is important not only
◼ it will spare the researcher the unnecessary toil of making major
revision, but also because it will make the research publishable.

 If the researcher clearly identifies the research gap, the

reviewers will be able to conclude right away that the
proposed research project is unique and original

67
 What information should be included in the
problem statement?
1. A brief description of socio-economic and cultural
characteristics and an overview of health status and the
health-care system in the country/district in as far as these
are relevant to the problem.

2. A concise description of the nature of the problem and of

the size, distribution and severity of the problem.

68
 What information should be included cont..
3. An analysis of the major factors that may influence the
problem and a discussion of why certain factors need more
investigation if the problem is to be fully understood.

4. A brief description of any solutions to the problem that have

been tried in the past, how well they have worked, and why
further research is needed (justification for your study).

69
 What information should be included cont..
5. A description of the type of information expected to result
from the project and how this information will be used to help
solve the problem.

6. If necessary, a short list of definitions of crucial concepts

used in the statement of the problem.

70
 How to write a Problem Statement
 The section should be precise and concise, while not forgetting
to mention essential points.

 An outline listing the major points to be covered could be

prepared before any writing is done, so the section will be
logical and well organized

71
 Example
Factors Contributing to Unattended Delivery among ANC Attendants at Government-
owned Health Centers in Addis Ababa.

Addis Ababa is the capital city of Ethiopia with an area of 530 km2 and a total population of 3
Million. It has 10 sub- cities. The health service coverage of Addis Ababa is 71%. There are 5
hospitals, 24 health centers, 32 health posts & more than 500 private health institutions providing
health services including ANC and Delivery.
ANC coverage of the city is estimated at 86%. Despite this high coverage of ANC only 56% of
pregnant women give birth in health institutions, while the remaining 44% deliver elsewhere,
including unattended home deliveries. Unattended deliveries are known to be associated with
maternal and perinatal morbidity and mortality, such as antepartum haemorrhage (APH),
postpartum haemorrhage (PPH), birth trauma, infection, and fistula.
There are no studies that have examined the factors contributing to unattended delivery despite
high overall service coverage and antenatal care coverage in Addis Ababa. Many health institutions
attempt to improve the situation through the training of traditional birth attendants, expanding
health education and community mobilization activities. However, these efforts are not based on
systematic evidence into possible determinants of the prevailing practice. The present study is
intended to contribute to bridging the information gap, and subsequently the coverage of
institutional deliveries in the city. 72
Selecting the research topic
Novel Idea??
Mother of All Successful
Proposals
 The Research Topic
 Before considering what literature to use in a research, first
identify a topic to study and reflect on whether it is practical
and useful to undertake the study.
 The topic is the subject or subject matter of a proposed study
 Describe the topic in a few words or in a short phrase.
 The topic becomes the central idea to learn about or to
explore.

74
 The Research Topic…cont.
 How would the working title be written?

 A response might be, “My study is about at-risk children in

the junior high school,” or “My study is about helping college
faculty become better researchers.”

 A common shortcoming of beginning researchers is that they

frame their study in complex and erudite language.

75
 The Research Topic…cont.
❑ Good, sound research begin with straightforward,
uncomplicated thoughts that are easy to read and understand

 Be brief and avoid wasting words.

 Eliminate unnecessary words, such as “An Approach to ... ,” “A

Study of . . . ,” and so forth.

76
 The Research Topic…cont.
 Another strategy for topic development is to pose the topic as
a brief question.

 What question needs to be answered in the proposed study?

 A researcher might ask, “What treatment is best for

depression?”

77
 Selection of Research Topic…cont
❑ Selecting the research topic, considering factors such as
❑ Magnitude of the problem and its impact
❑ Urgency of the need for a solution
❑ Relevance to the aims of the funding agency
❑ Amenability of the problem to investigation
❑ Feasibility of the approach
❑ Chances of success
❑ Expected impact of a successful outcome
❑ Spin-off in terms of training of staff and other research
❑ Capability strengthening elements
 Selection of Research Topic…cont
❑ Where do we get our ideas from?
◼ Advisor/ Committee members/ colleagues

◼ Reading literature/publications

◼ Library/internet

◼ Conferences/seminars

◼ Look what has been funded, who gets funded and by whom?

◼ Draw inspiration from anywhere you can

I wish, I would have thought of it, first!

❑ Need based (~50%)

❑ Solving a problem that exists

❑ Something is unknown so fill in the gap

❑ INNOVATIVE IDEA!

❑ Try to think big and out of the box!!!

Selection of Research Topic…cont
❑ Should be in line with your general objective
❑ A good title should be short, accurate, concise
❑ It should make the central objectives of the study clear to the
reader.
❑ It is important to specify what population will be investigated,
& where it will be conducted.
Selection of Research Topic…cont
Choosing an interesting topic

When looking for a topic consider:

❖ Your favorite hobbies

❖ Personal experiences

❖ Based on your reading/ idea/ originally

❖ Values- what is important to you

❖ Interests- what would you like to learn more about?
 Selection of Research Topic…cont
 Selection of this broad entity of research is based on the
following:
◼ researcher’s:
 Specialty

 Interest

 Scientific background

 Experience

◼ Actual need for research in this area

◼ Available resources (interest of funding body)
Criteria for selecting a topic:
❑ Is this topic appropriate to the occasion?
❑ Will this topic appeal to my listeners’ interests?
❑ Is this topic something I can speak about with enthusiasm
and insight?
❑ Will I be able to offer a fresh perspective on this topic?
 Prioritizing selected a research topic
❑ Each topic that is proposed for research has to be judged
according to certain guidelines or criteria.
❑ There may be several ideas to choose from.
1. Relevance: priority, magnitude of problem
2. Avoidance of duplication: manpower, time…
3. Feasibility: complexity, manpower, time, money…
4. Political acceptability:
5. Applicability: cost-effectiveness
6. Urgency of data needed: for making decision
7. Ethical acceptability
 Criteria for a “good research and topic, title & RQ”
A good research topic should be:

 Concrete statement.

 Feasible (can be done),

 Interesting,

 Novel,

 Ethical

 Relevant (has an implication). 86

 Feasibility
 The possibility to recruit the number of subjects, within the
timeframe of the planned research.

 The research facilities available to the investigators

(equipment, supplies and other requirements …. )

 The investigators must have the required expertise.

 The cost must be affordable and the financial resources

available.
87
 Interest
 YOU

 OTHERS

88
 Novelty
 up to-date literature's.

 new information.

 Novel … necessary ???

 Research ……
 Novel ??? but whether it will add to the existing body of
knowledge
 The progress of science is incremental ….
89
 Ethics
 Ethical issues … stage of selecting the research topic.
 Others …. in planning the research.
 Should not be considered from the beginning.
 In experimentation
 If a new therapy or procedure, evidence should already be
available to suggest that it can be superior.
 Adequate data must be available from animal studies and
from studies on a small number of human subjects to confirm
safety and to suggest effectiveness,
 The research should not conflict with the society’s cultural,
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moral, religious and legal values.

Relevance
 This criterion can be called: the “so-what?” test.

 For the research to be considered relevant it must have:

 Our locality

 All Community

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 Group work
Form working groups

 Identify one of the health/health related problems in Afar

region

 Select a title and write statement of the problem for the

problem you identified

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