Developing your research question and writing an introduction Jennifer Hensel, MD MSc FRCpc Research summer school

Objectives To discuss the process from identifying an area of interest, to formulating a research question and writing a killer introduction for a proposal Key questions: What’s the gap? Why does it matter (i.e. who cares and why)? How will you answer it? By the end you will be able to: Generate a research question using PICO/PIE Know the key components of an effective introduction

What’s the gap? An area of interest for a research project can come from a range of places:

What’s the gap? Your research idea should: Address a topic of real or potential interest (to both you and the scientific or clinical community) Seek to add to what is known about the topic or generate knowledge on a brand new topic Aim to improve practice and/or the human condition Be feasible to study meaningfully in a timely way with available resources Align (when possible) with institutional and other local stakeholder priorities

What’s the gap? How do you know if your idea is novel? Review the literature Don’t forget about the unpublished (“grey”) literature Ask experts The truth is that ideas are rarely 100% novel – more often you are asking a question that adds to existing knowledge Testing an intervention in a new population eg. DBT for eating disorders (vs Borderline PD) Analyzing the effects of additional or different factors on a previously studied outcome eg. The moderating effect of ethnicity on antipsychotic-induced weight gain Replicating what has been shown in a different region eg. Virtual education programs for rural providers in Canada (vs United States)

The research question A good research question is: Clear and succinct Feasible Of significant importance Ethical to answer (hypothesis driven) The research question focusses the study, and informs choice of methodology and analysis

The research question PICO and PIE can help you create good, succinct questions Create a statement about your area of interest and what you want to study Take note of what type(s) of data you can collect Decide if PICO or PIE is appropriate PICO = quantitative PIE = qualitative Develop your research question Revise your research question

P I E Population, person or problem Same as PICO Issue or Intervention Evaluation, Effect What do you want to understand about the experience, meaning or mechanism? E

Example: Research Statement: I want to study videoconferencing for mental health care to determine if it increases access to care among patients with identified barriers Environment: I work in a clinic where we have identified key patient groups with barriers to office-based care, one of which is post- partum women Research question: Does the option of videoconferencing for psychotherapy among post-partum women increase the number of visits attended compared to usual office-based care?

Example: Research Statement: I am interested in the progression from a diagnosis of unspecified psychosis to a diagnosis of schizophrenia. What clinical and demographic factors are important? Environment: I work in Manitoba and have access to linked health administrative data through the Manitoba Centre for Health Policy Research Question: Among individuals age 15-60 who receive a diagnosis of unspecified psychosis, what are the demographic and clinical factors associated with progression to a diagnosis of schizophrenia compared to not?

Example: Research statement: I want to know more about the barriers to uptake of electronic consultation (eConsult) for psychiatric advice among primary care providers. Environment: I work in an institution that focusses on virtual care and health system solutions Research question: What are the perceived barriers to the uptake of eConsult for psychiatric advice among primary care providers in Ontario?

Come up with a research question Research statement: I am interested in studying medication non- compliance among individuals with schizophrenia. Environment: I work in a psychiatric outpatient program that serves a large population of individuals with schizophrenia. Research statement: I would like to study frequent ED users for mental health reasons in Winnipeg to understand more about their health care needs. Environment: I work in the ED and I also have access to individual level health care and social data through MCHP. Research Statement: I want to know if biomarker A is associated with time to antidepressant response for major depression. Environment: I work in a clinic where we use antidepressants frequently to treat major depression and can measure biomarker A.

Writing an introduction You will need to write an introduction as part of any proposal, research ethics submission, or grant funding application, and later as part of your study write up Know your audience** The introduction sets the stage It identifies the problem It justifies the problem as important (i.e. tells us why we should care) It highlights the gap in what is and isn’t known And it tells the reader how you intend to address the problem’s gap The introduction needs to get the reader’s attention and make them want to read more

Writing an introduction Approximately 4-5 paragraphs Paragraph 1: What is the nature of the problem you are studying Use stats – what is the prevalence, what are the individual and societal implications (e.g. disability/mortality), how much does it cost? The first 1-2 sentences can make it or break it in some cases – so start strong

Up to 1 in 5 Canadians will be affected by a serious mental health problem in their lifetime (1). Mental health-related disability is increasing, with more than $51 billion CAD in annual direct and indirect costs (2). In Ontario, as well as nationally, more accessible and better co-ordinated high quality mental health services is a priority (1, 3). Health Quality Ontario is in the process of drafting quality standards for some mental health conditions because existing data suggest that wait times for specialized assessment and treatment are problematic (1, 4). Recent studies simulating referral requests to psychiatrists in urban Canadian and U.S. cities, report that the majority of referrals are actually rejected (5, 6). Consequently, it is not surprising that nearly 60% of primary care providers in Canada rate accessibility to psychiatry as poor (7). More importantly, one third of Ontarians in need of mental health services report their needs as unmet (1).

Writing an introduction Paragraphs 2 and 3: What is known about the topic What is not known about the topic (may include why what is known may be subject to contextual factors such as geography, health system organization, population demographic factors, etc) Summarize the available literature, including specific statistics when relevant, or offer a range – e.g. A systematic review on the topic found prevalence rates of 20-40% Be specific about what is missing to lead into your research question which will follow e.g. While this intervention has been shown to be effective in adults, it has not yet been evaluated in youth

Writing an introduction Final Paragraph: Introduces your study, including a summary of your research aim e.g. This study aims to determine if offering videoconferencing to post- partum women will increase the number of psychotherapy sessions attended. May include your exact research question: e.g. This study will answer the following research question: Does the option of videoconferencing for psychotherapy among post-partum women increase the number of visits attended compared to usual office-based care?

Questions and Discussion