Desain Penelitian Keperawatan

DESAIN
PENELITIAN
Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Riset
Riset Quantitative
Quantitative
Meningkat
• Descriptive Control
• Correlational
• Quasi-experimental
• Experimental

Research
Research Design
• Definisi: Blueprint atau rencana
detail dalam melaksanakan penelitian
• Tujuan, Review of Literature, &
Framework/kerangka
Study Design
Karakteristik
Karakteristik Desain
Desain
• Memaksimalkan control
meningkatkan validitas hasil.
• Membantu peneliti merencanakan
dan melaksanakan penelitian
• Tidak spesifik bagian dari langkah
penelitian tetapi berhubungan dengan
seluruh proses penelitian
Konsep
Konsep Relevan
Relevan dg
dg Desain
Desain
• Causality: A B
Tekanan Ulkus
• Multicausality:
Merokok
Penyakit
Diet tinggi lemak
Jantung
Terbatas aktifitas

Lanjutan….1
Lanjutan….1
• Probability: mengarah keakuratan
memprediksi kejadian
• Bias: Perbedaan temuan dari yang
sebenarnya
• Manipulation: Perlakuan atau
treatment

Lanjutan…2
Lanjutan…2
• Control
• Bisa digunakan dalam desain
• Meningkatkan keakuratan temuan/hasil
• Kontrol derajatnya meningkat pada
quasi-experimental research
• Kontrol paling tinggi pada experimental
research

Varying
Varying Control
Control in
in Studies
Studies
Quasi-experimental Experimental
Lower Control High Control
Type of Sample Selected:
Convenience ----------|--------> Random

Varying
Varying Control
Control in
in Studies
Studies
Type of Sample Selected:
Heterogeneous -----|----> Homogeneous

Varying
Varying Control
Control in
in Studies
Studies
Measurement
of Dependent Variable
Crude Precise
Measurement------|----> Measurement

Varying
Varying Control
Control in
in Studies
Studies
Control
of Independent Variable
Limited or Highly
no Control ----------|--------> Controlled

Varying
Varying Control
Control in
in Studies
Studies
Group
no comparison group ----> comparison
group ----> alternative treatment control
group ----> no treatment control group

Varying
Varying Control
Control in
in Studies
Studies
Selection of Groups
No randomization ---------> Randomization

Varying
Varying Control
Control in
in Studies
Studies
Setting Selected
Highly
Natural -----------|----------> Controlled

Design
Design Validity
Validity
• Measure of truth or accuracy of a
study examined with critique &
controlled in conducting a study
• Statistical conclusion validity
• Internal validity
• Construct validity
• External validity
Types
Types of
of Design
Design Validity
Validity
• Statistical Conclusion Validity --
is concerned with whether the
conclusions about relationships or
differences drawn from statistical
analyses are an accurate reflection
of the real world.

Statistical
Statistical Conclusion
Conclusion Validity
Validity
• Low statistical power: Type II error,

no significant difference when
there is.
• Violated assumptions
• At least interval data
• Random sample
• Normal distribution
Statistical
Conclusion Validity
Validity
• Reliability of Instruments:
consistency in measurement
• Physiological measures: Precision,
such as with temp., BP
• Likert scale: Homogeneity--Reliability
with Cronbach’s alpha (.7, .8, .9)
• Observations: Stability--Interrater
reliability

Statistical
Conclusion Validity
Validity
• Reliability of Treatment
• Protocol for treatment
• Training of researchers
• Interrater reliability: # of items
completed in protocol/ # of items
on protocol (%)

Types of Design Validity
• Internal Validity --
is the extent to which the effects
detected in the study are a
true reflection of reality,
rather than the result of
extraneous variables.
Internal
Internal Validity
Validity
• History: event impacting subjects
& data collected
• Maturation of subjects: wiser, tired,
older influencing responses
• Testing: learn from being in study
• Instruments’ accuracy

Internal
Internal Validity
Validity
• Subject selection nonrandom
& potentially biased
• Mortality: those dropping out
of study
• Diffusion or imitation of treatment:
control or comparison group
has access to treatment
Types
Types of
of Design
Design Validity
Validity
• Construct Validity--
examines the fit between the
conceptual definitions and
operational definitions of
variables. Link of framework
concepts & variables studied.
Construct
Construct Validity
Validity
• Validity of instruments
• Physiologic measure: Accuracy
• Scales: construct validity
• Mono-operation bias: 1 instrument
to measure a variable
• Mono-method bias: 1 type of
instrument, such as attitude scales
Construct
Construct Validity
Validity
• Subjects guessing outcome of study
& acting in a different way
• Subjects performing for experiment
to be seen in a good light or trying to
get an effective treatment
• Treatment interactions with more
than one treatment
Types
Types of
of Design
Design Validity
Validity
External Validity---
is concerned with the extent to
which study findings can be
generalized beyond the sample
used in the study.

External
External Validity
Validity
• Interactions of:
• Selection of subjects & treatment
• Setting & treatment: closing clinic,
nonsupportive staff
• History & treatment: events
influence treatment

Elements
Elements of
of Strong
Strong Design
Design
• Controlling the Environment:

selection of the study setting
• Natural setting
• Partially controlled setting: clinic

• Highly controlled setting: lab
Elements
Elements of
of Strong
Strong Design
Design
• Controlling the Equivalence of
Subjects & Groups
• Random subject
selection
• Random assignment
to groups

Elements
Elements of
of Strong
Strong Design
Design
• Controlling the Treatment (Tx)

• Tx based on research & practice
• Protocol developed for implementation
• Document Tx was implemented
• Checklist to determine extent Tx
was implemented if incomplete
• Re-evaluate Tx during study

Elements
Elements of
of Strong
Strong Design
Design
• Controlling Measurement
• Reliability
• Validity
• # Measurement methods
• Types of instruments

Elements
Elements of
of Strong
Strong Design
Design
• Controlling Extraneous Variables
• Identify & eliminate by sample
criteria, setting, design
• Random sampling
• Sample: heterogeneous, homogeneous,
matching
• Statistical control

Problems
Problems with
with Study
Study Designs
Designs
• Inappropriate for purpose

& framework
• Poorly developed
• Poorly implemented
• Inadequate treatment, sample,
measurement methods

Critiquing
Critiquing aa Study
Study Design
Design
1. Was the type of design identified?

2. Was the study design linked to the
purpose &/or objectives, questions,
or hypotheses?
3. Were all variables manipulated
or measured?

Critiquing
Critiquing aa Study
Study Design
Design
4. If the study included a treatment,
was it clearly described &
consistently implemented?
5. Were extraneous variables
identified & controlled?
6. What were the threats to design
validity in this study?
Critiquing
Critiquing aa Study
Study Design
Design
7. Was a pilot study performed prior
to this study? What was the reason
for the pilot & the outcome?
* Study feasibility
* Refine design or treatment
* Examine validity & reliability
of measurement methods

Identifying a Design
in a Quantitative
Research Report

Study
Study Purpose
• Describe Variables
• Examine Relationships
• Determine Differences
• Test a Treatment
• A Combination of these
Types
Types of
of Designs
Designs
• Descriptive Study Designs
• Correlational Study Designs
• Quasi-Experimental
Study Designs
• Experimental Study Designs
Identifying
Identifying aa Design
Design
Is there a treatment?
No Yes
Is the primary purpose Is the treatment tightly controlled

examination of relationships? by the researcher?
No Yes No Yes
Descriptive Will the sample be Quasi-Experimental Will a randomly assigned

Design studied as a single Study control group be used
group?
No Yes
No Yes
Is the original sample
Correlational randomly selected?
Design
No Yes
Experimental
Study
Identifying
Identifying aa Descriptive
Descriptive Design
Design
Examining sequences across time?
No Yes
One Group? Following same subjects across time?
No Yes No Yes
Comparative Descriptive Data collected Single unit

Descriptive Design across time of study
Design
No Yes No Yes
Cross-sectional design Studying events partitioned Longitudinal Case

across time? Study Study
No Yes
Trend Analysis Repeated measures of each subject
Yes No
Cross-sectional design Longitudinal design with

Copyright © 1999 by W.B.Saunders Company. All rights reserved. with treatment partitioning treatment partitioning
Descriptive
Descriptive Study
Study Designs
Designs
• Typical Descriptive Design

• Comparative Descriptive Design
• Time Dimensional Design
• Case Study Design

Diagramming
Diagramming the
the Design
Design
• Clarifies the variables to be
measured or manipulated
• Indicates focus of the study:
description, relationships,
differences, &/or testing a
treatment
Diagramming
Diagramming the
the Design
Design
• Identifies data collection process:
time for study, treatment
implementation, measurement
of variables
• Provides direction to
data analysis
Typical
Typical Descriptive
Descriptive Design
Design
Clarification Measurement Description Interpretation
Description
Variable 1 of
Variable 1
Description
Variable 2 Interpretation
Phenomenon of
Variable 2 of Meaning
of Interest
Description
Variable 3 of
Variable 3
Development of
Description Hypotheses
Variable 4 of
Variable 4

Comparative
Comparative Descriptive
Descriptive Design
Design
Group I
{variable(s) Describe
measured}
Comparison of
Interpretation
Groups on
of Meaning
Selected Variables
Group II
{variable(s) Describe Development
measured}
of Hypotheses

Correlational
Correlational Study
Study Designs
Designs
• Descriptive
Correlational Design
• Predictive Design
• Model-Testing Design

Identifying
Identifying Type
Type of
of
Correlational
Design
Describe Predict Test
relationships relationships theoretically
between/among between/among proposed
variables? variables? relationships?
Descriptive Predictive Model

correlational correlational testing
design design design

Descriptive
Descriptive Correlational
Design
Measurement
Description
Research
of variable Interpretation
Variable
of Meaning
1
Examination of
Relationship
Research Description
Variable of variable Development
2
of Hypotheses

Predictive
Predictive Design
Design
Value of Value of Predicted

Value
Independent Value of
of
Intercept
+ Independent
Variable + Variable = Dependent
1 2 Variable

Study
Study Groups
• Groups in comparative
descriptive studies
• Control group
• Comparison group
• Equivalent versus
nonequivalent groups
Pre-Experimental
Pre-Experimental Designs
Designs
• One-group post-test–only design

• Post-test–only design with
nonequivalent groups
• One-group pretest–post-test
design

Quasi-Experimental
Quasi-Experimental Designs
Designs
• Untreated control group design

with pretest & post-test
• Nonequivalent dependent
variables design
• Removed-treatment design
with pretest & post-test
Pretest––Post-Test
Pretest Post-Test Control
Control
Group
Group Design
Design
Measurement Manipulation of Measurement
of dependent independent of dependent
variables variable variable(s)
Randomly selected PRETEST TREATMENT POST-TEST

experimental
group
Randomly selected PRETEST POST-TEST

control group
Treatment: Under control of researcher
Findings: comparison of pretest and post-test scores

comparison of experimental and control groups
comparison of pretest-post-test differences between samples
Example: Your self (1990). The impact of group reminiscence counseling on a depressed elderly
population
Uncontrolled testing mortality
threats to validity: instrumentation restricted generalizability as control increases

Post-Test––Only
Post-Test Only
Control
Control Group
Group Design
Design
Measurement Measurement
of independent of dependent
variables variable(s)
Randomly selected TREATMENT POST-TEST

experimental
group
Randomly selected POST-TEST

control group
Treatment: Under control of researcher
Findings: comparison of experimental and control groups
Example: Clochesy, Difani & Howe (1991). Electrode site preparation techniques: a
follow-up study
Uncontrolled instrumentation
threats to mortality
validity: limited generalizability as control increases

Advantages
Advantages of
of Quasi-
Quasi-
Experimental
Experimental Designs
Designs
• More Practical: Ease
of implementation
• More Feasible: resources,
subjects, time, setting
• More Generalizable:
Comparable to practice
Advantages
Advantages of
of
Experimental
Experimental Designs
Designs
• More Controls: design
& conduct of study
• Increased internally valid:
decreased threats to
design validity
• Fewer Rival Hypotheses
Outcomes Research
• Agencies Supporting Outcomes
Research
• Agency for Health Services
Research (AHSR)
• Agency for Health Care Policy
& Research (AHCPR)

Outcomes Research
• Structure of Care
• System Characteristics
• Provider Characteristics
• Patient Characteristics

Outcomes Research
• Process of Care
• Ordering tests
• Treatments: pharmacological
& nonpharmacological
• Referral
• Hospitalization
• Counseling & education

Outcomes Research
• Outcomes
• Clinical end points
• Functional status
• General well-being
• Satisfaction with care

Critiquing
Critiquing A
A Design
Design
• Identify elements that were
controlled in the study
• Identify possible sources of bias
• Are there elements that could
have been controlled to improve
the study design?
Critiquing
Critiquing A
A Design
Design
• What elements of the design were
manipulated and how were they
manipulated?
• How adequate was the manipulation?
• What elements should have been
manipulated to improve the validity of
the findings?

Critiquing
Critiquing A
A Design
Design
• Based on your assessment of

the adequacy of the design,
how valid are the findings?

Critiquing
Critiquing A
A Design
Design
• Is there another reasonable
(valid) explanation (rival
hypothesis) for the study
findings other than that
proposed by the researcher?

Questions

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DESAIN

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Type of Sample Selected:

Convenience ----------|--------> Random

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Type of Sample Selected:

Heterogeneous -----|----> Homogeneous

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

No randomization ---------> Randomization

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• Low statistical power: Type II error,

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• Controlling the Environment:

• Partially controlled setting: clinic

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• Controlling the Treatment (Tx)

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• Inappropriate for purpose

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

1. Was the type of design identified?

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Is the primary purpose Is the treatment tightly controlled

Descriptive Will the sample be Quasi-Experimental Will a randomly assigned

Comparative Descriptive Data collected Single unit

Cross-sectional design Studying events partitioned Longitudinal Case

Trend Analysis Repeated measures of each subject

Cross-sectional design Longitudinal design with

• Typical Descriptive Design

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Descriptive Predictive Model

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

Value of Value of Predicted

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• One-group post-test–only design

Copyright © 1999 by W.B.Saunders Company. All rights reserved.

• Untreated control group design

Randomly selected PRETEST TREATMENT POST-TEST

Randomly selected PRETEST POST-TEST