TRANSLATING RESEARCH INTO PRACTICE New York University Tbilisi, July 15-19, 2013 Allison Squires, PhD, RN Adam Sirois, MPH
SESSION 2: QUESTIONS, CONCEPTS, & THEORIES
Goals for Session t1 Describe the characteristics of a good research question. Describe the characteristics of a good clinical question. Differentiate between clinical and research questions. Describe the purpose of theories and conceptual models in evidence creation.
Slide 3 t1 This should be in all slide sets: Learning Goals or Objectives... ok? tmpguest; 06.07.2013
4 To Practice Based on Evidence It is important to know how researchers develop and answer QUESTIONS that create the evidence we want to use in our practice. Key Differences Research question Clinical question
DEVELOPING & CRITIQUING QUESTIONS
How Clinical Problems Guide Research Questions Clinical Problem Solved Through Research An area of concern A gap in knowledge Requires a solution to improve clinical practice Solved through: Description Explanation Prediction
8 Things We Need to Ask About a Research Question What are the potential benefits to patients, healthcare practitioners, and society? Will the results will be applicable to clinical practice?
9 Research Questions Should Define the specific question Reflect a review of the literature Identify the potential significance to Patients or Practitioners
10 Next, Determine Feasibility: Can We Actually Answer It? Is there time? Is the population of interest available? Are facilities, equipment, and money adequate? Does the researcher have the experience and skills necessary? Are there ethical difficulties?
Ethical Considerations We must be certain that research questions posed can be answered while respecting the rights of human subjects Prioritize studies that generate significant contributions to patient outcomes We need to recognize the difference between ethical questions and researchable questions. Example: Research with pregnant women
Clinical Questions Aim to address a patient or population s physical, psychological, or social problem May also address risk reduction Research helps to address the patient s issue Clinical questions can help solve patient care issues immediately by analyzing evidence The PICOT format helps you to develop a clinical question
PICO(T) Provides structure to developing clinical questions P = Patient group, population, or problem I = Intervention C = Comparison O = Outcome T = Time frame or period of measurement
Example: Good PICOT Question Does post-operative ambulation (I) every four hours (T) decrease the length of stay (O) in adult abdominal surgery patients (P) compared to ambulation every shift (C)?
Example: Bad PICOT Question How do long term care patients (P) feel about their health care team members compared to patients (C) who stay in hospitals?
Exercise Let s develop a PICOT question!
Summary Research helps to solve patient problems Research requires many studies to determine the best way to solve a problem Clinical problems are solved by synthesizing results from research studies
CONCEPTS & CONCEPTUAL MODELS/FRAMEWORKS
19 Concepts (LoBiondo-Wood & Haber 2010) An image or symbolic representation of an abstract idea Concept Practice: Patient Safety
Conceptual Models or Frameworks (LoBiondo-Wood & Haber 2010) Are a diagram or picture Illustrate relationships between variables Data driven Researcher derived Suggest a direction for a result or outcome Defines the conditions of a system
Example 1: O Brien et al (2009) The Role-Outcomes Linkages Evaluation (ROLE) Model for evaluating the link between Community Health Worker training programs and patient outcomes
Example 2: Mark et al (2008) Model for exploring organizational context and structures for predicting medication errors and falls.
THEORIES & THEIR ROLE IN SHAPING EVIDENCE
24 Theories (LoBiondo-Wood & Haber 2010) Set of interrelated concepts, definitions, and propositions Present a systematic view of phenomena Help explain or predict phenomena Qualitative studies help create them Quantitative studies use them or test them
25 Theories Help to provide structure and direction for a research study so it can answer the proposed question (Fawcett 1986) Very useful for complex questions Authors should briefly and clearly explain the theory in the research article Research helps determine if theories are true, or not (Fawcett, 1986) Not every study uses a theory
THE PROCESS FOR ANSWERING QUESTIONS What you find in a research article
27 After We Have the Question, We Need These Components Purpose Declares WHY this study occurs Sets the stage for making an argument Specific Aims/Objectives Describe HOW the researcher intends to answer the question Describe the goals of the study, what it seeks to accomplish
29 Next: The Literature Review Background Section It should: Critically review the existing literature Justify why the question is important Show what has been studied and where gaps exist Often identifies variables important to answering the research question
30 Variables The object(s) of the study Represented in quantitative research articles as X and Y X = Independent Variable Y = Dependent Variable X and Y can change places in different studies
Dependent & Independent variables Which combination of oral care interventions are the most effective for preventing cavities in adults? X X X X Y X
32 Testing Variables Can the research question be tested by measuring the relationship between the independent (X) and dependent (Y) variables? YES! If the variables can be observed, measured, and analyzed.
33 Variables You might want to determine if: If X has an effect on Y If yes, to what degree??
34 ALERT: Important Concepts! Causal Relationships Changes in X do not necessarily CAUSE changes in Y. It cannot be assumed that changes in X CAUSED changes in Y. Bradford-Hill Causality Assessment Criteria (see slide from Intro. To Critique lecture) Associative Relationships X and Y are systematically related
35 Next Step: Who and Where Population Who will provide the data to answer the question Needs to be clearly described by key demographic variables Setting/Location/Context The place where the question will be answered Different contexts will change how questions can be answered
36 What About A Hypothesis? You need one when: When you want to test the relationships between two or more variables that suggest an answer to a question You want to provide a direction for a result
Not all studies require a hypothesis Required Studies examining causality Experimental studies Randomized controlled trial Quasi-experimental studies CAN HAVE, BUT NOT REQUIRED Observational Cross-sectional studies Case control Cohort studies NOT REQUIRED Qualitative studies
38 In General, a Hypothesis Flows from the research question, literature review, and theoretical framework Predicts the expected outcome Formulated before the study is started because it determines how data are collected, analyzed, and interpreted
39 A Good Hypothesis Makes a declarative statement that predicts a relationship between X and Y Causal Associative The nature of the relationship is implied in how the hypothesis is worded
A Good Hypothesis Is Testable variables can be observed or measured Consistent with: Existing theory The proposed relationships in a conceptual model Current research findings
PUTTING IT ALL TOGETHER
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44 Once We Have All These Things The methods for answering the question are selected A plan for analysis of the collected data is developed The plan is executed and notes are taken to keep track of problems
45 Once We Have All These Things The results/findings are synthesized to try to answer the question The discussion considers: Why they happened that way Surprises Implications Finally, recommendations are made
46 At the same time Everything has limitations Methods Population Theoretical framework Studies should always acknowledge their limitations No study is perfect
CRITIQUING QUESTIONS, THEORIES, & CONCEPUTAL MODELS
48 Evaluation Checklist: Research Questions The variables being considered are clearly identified. The population/patients/problem being studied is specified. The possibility of empirical testing is implied.
Evaluation Checklist: Theoretical framework Do the authors make a good argument for why they chose the theory and/or framework? Do they clearly describe the theory and why it relates to the patients, population, or problem?
Evaluation checklist: Conceptual Models Does the model proposed by the authors: Describe the relationships between variables? Illustrate a process that is logically sequenced? Come from a theory? If not, do they explain why?
51 In Summary Answering questions is complex Creating the right question to answer helps provide the best possible outcome for patients
Ask yourself Do I know the difference between clinical questions and research questions? Can I start to create a clinical question using PICOT? Do I understand the role of theories and how they help create evidence? Do I understand how a conceptual model can help me understand a piece of evidence?
EXERCISE 2: CREATE A PICOT QUESTION
Create a PICOT Question From your chosen topic with your team Choose your patient or problem Identify your intervention Identify your comparison Determine your outcome Determine the time frame or time aspect
Create a PICOT Question When details are finalized, write out your question in a sentence Seek feedback from the teachers Present your question for feedback from the class