Post on 19-Jan-2018
description
Framing a research question
Chitra Grace A Scientist- C (PGDHE)
NIE, ChennaiE-mail: chitragrace@yahoo.co.uk
RM Workshop for ICMR Scientists
01/11/2011
Personal interest/ experiencePublished literatureNew developmentsSocial problems
PUBLIC HEALTH PROBLEM
ClearResearchableConnected to published literaturePotential for contributing to subject
domainBe neither too broad or too narrow
Two ways to deal with a poor or irrelevant research question: Try to answer it▪ The answer may be of no use of anyone▪ There may be no answer…
Try to reframe it If your research question is wrong:
No good hard work will save your work If your research question is right:
You have an opportunity to do a good job
Fundamental research Studies assessing candidate vaccine antigens
Applied investigation Clinical trials
Prevention research Social marketing, cost effectiveness
Assessment, monitoring and evaluation Post implementation evaluation,
coverage survey
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Any disease, injury, risk factor, environment threat or social condition that can cause death / disability
Points that need to be characterized What▪ Nature / etiology of the condition
How much▪ Magnitude
Who▪ Population at risk
Where▪ Geographic locations
When▪ Time of occurrence / seasonal variations
Diphtheria rates in Hyderabad, AP, India, increased from 11 to 21 per 100,000 between 2003 and 2006, particularly affecting children 5 to 15 years of age▪Specifies:▪What▪Where ▪How much▪When ▪Who
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Burden of disease: Use local reports and national / international estimates Death Disease Disability Economic losses
Effective interventionsCost effective interventions
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Identify the problem E.g., High diphtheria rates
Identify causes Immediate determinants▪ E.g., Low immunization coverage
Direct and indirect contributing factors▪ E.g., Minorities
Identify consequences E.g., Mortality from diphtheria
Identify possible solutions E.g., Increase coverage of boosters
1 1Health
problem
DeterminantsDirect
contributing factors
Indirect contributing
factors
Consequences: -1 -2 -3
Possible intervention 1
Possible intervention 2
Possible intervention 3
2
3
2
<Specify>
<Specify>
<Specify>
Indirect contributing
factors
Diphtheria
ExposureHealth problem
Determinants
Direct contributing
factors
Consequences: -Deaths -Disease
- Disability
Immunization
Supplemental vaccination
activities
Treatment
Susceptibility
Minorities
Crowding
VentilationHousing
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Locate the level of intervention: Determinants Contributing factors
Review effectivenessEstimate cost effectivenessAnalyze implementation status
Input Process Outcome
Treatment of cases Antibiotics and support, no antitoxin
Immunization Intervention▪ 3 doses of primary vaccination▪ 2 boosters during the 2nd and 4th year
Implementation▪ Reported coverage: 100%▪ No validation▪ Possibility of pockets with low coverage
Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to
improve
Is the problem a consequence of a failure to implement a validated strategy? Assessment, monitoring and evaluation
Is the problem a consequence of difficulty to apply a recommended strategy? Prevention research
Is the problem a consequence of a limitation or of a lack of validated strategy? Applied investigation
Identify what is known (easy) Guidelines Recommendations Reviews Literature search
Identify what is not known (difficult) Meeting reports Research agenda Expert opinion
Facts Primary immunization protects small children Boosters are needed for longer term
protection Reported coverage is high
Research questions: Vaccine failure?▪ Is the vaccine as effective as it is supposed to be ?
Failure to vaccinate?▪ Could there be pockets of lower coverage that
could allow the disease to spread?
Identifying data needs
Spelling out the research question
Formulating the study objectives
Planning the analysis
Preparing data collection instruments
Analysing data
Drawing conclusions
Formulating recommendations
Involving the programme
Collecting data
Anticipate the various possible results of the study Imagine scenarios of various possible
answers to the research question Identify the kind of public health
action that could be realistically taken for each case scenario
If the vaccine efficacy is low: Programme evaluation could identify
where the problem is If there are pockets of lower
coverage: Supplemental immunization activities
could increase population immunity
Sound answers to good research question bring new questions
These questions should be framed with the same careful methods
Addressing consecutive publichealth questions is: Useful Gratifying
Conclusions Booster is key for protection among
children > 5 years Booster coverage drops among selected
minoritiesPossible next question
What is the best strategy to use to increase the coverage of booster among minorities?
Local problem to be identified What? When? Where? Who? How?
Problem statement Specified, quantified
Causal web Problem, consequences, determinants,
contributing factors and possible interventionsReview evidence available
What is known and What is unknown?Research question
Specific; with a question mark