If All You Have is a Hammer….. A Brief Look Inside a Researcher’s Toolbox Funding was provided through a Community Engagement Supplement to the Oregon.

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Presentation transcript:

If All You Have is a Hammer….. A Brief Look Inside a Researcher’s Toolbox Funding was provided through a Community Engagement Supplement to the Oregon Clinical and Translational Research Institute at Oregon Health & Science University (National Institute of Health/NCRR/NCATS grants UL1TR and ACTRI0601).

“What we have here is a failure to communicate.”

Disclaimer WARNING: The following presentation will not make you into a professional researcher.

What I hope it will do:  Give you a glimpse of how academic researchers might think of problems and questions of interest  Give you a taste of some of the research methods (tools) often used by researchers who work with communities  Provide a foundation, on which you can build, that may make it easier to work in partnership with academic researchers

If the only tool you have is a hammer, you tend to see every problem as a nail. -- Abraham Maslow

Which tool ? ?

?

?

Some Items in a Researcher’s Toolbox Basic Terms and Concepts Association Exposure and Outcome Quantitative Methods Descriptive study Cross-sectional study Case-Control study Cohort study Randomized Trial Qualitative Methods

Some Items in a Researcher’s Toolbox Basic Terms and Concepts Association Exposure and Outcome Quantitative Methods Descriptive study Cross-sectional study Case-Control study Cohort study Randomized Trial Qualitative Methods

Some Items in a Researcher’s Toolbox Basic Terms and Concepts Association Exposure and Outcome Quantitative Methods Descriptive study Cross-sectional study Case-Control study Cohort study Randomized Trial Qualitative Methods

Some Items in a Researcher’s Toolbox Basic Terms and Concepts Association Exposure and Outcome Quantitative Methods Descriptive study Cross-sectional study Case-Control study Cohort study Randomized Trial Qualitative Methods

Association

Ice Cream Consumption Sunburn

Association Ice Cream Consumption Boating Accidents

Association Ice Cream Consumption Shark Attacks

Association Ice Cream Consumption Overweight

Basic Terms Exposure:  Traditional medical: A state of contact with something, such as an infectious agent (germs), radiation, or chemicals that may have a harmful effect  Could be any relevant characteristic, habit, or practice that may increase or decrease the likelihood of an outcome  Independent variable

Basic Terms Outcome:  Traditional medical: A disease that results from an exposure.  Could be a condition other than a disease (for example, social or economic events or circumstances)  Dependent variable

Association Ice Cream Consumption (Exposure; Independent Variable) Overweight (Outcome; Dependent Variable)

Exposure & Outcome Outcome (e.g., Overweight) No Outcome (e.g., Not Overweight) Exposed (e.g., High Ice Cream Consumption) Non-exposed (e.g., Low Ice Cream Consumption)

Exposure & Outcome Outcome (e.g., Overweight) No Outcome (e.g., Not Overweight) Exposed (e.g., High Ice Cream Consumption) Non-exposed (e.g., Low Ice Cream Consumption)

Exposure & Outcome Outcome (e.g., Overweight) No Outcome (e.g., Not Overweight) Exposed (e.g., High Ice Cream Consumption) Non-exposed (e.g., Low Ice Cream Consumption)

Problem: Too many of our kids are overweight

Some Items in a Researcher’s Toolbox Basic Terms and Concepts Association Exposure and Outcome Quantitative Methods Descriptive study Cross-sectional study Case-Control study Cohort study Randomized Trial Qualitative Methods

Descriptive study Question: How many kids are overweight?  Population of Interest: Which kids?  Study design: 1) Measure BMI of all 10-year old children in the county 2) Calculate the percentage overweight

Exposure & Outcome Overweight Not Overweight Exposed (e.g., High Ice Cream Consumption) Non-exposed (e.g., Low Ice Cream Consumption)

Descriptive Study Overweight Not Overweight 600 children in the study

Descriptive Study Overweight 180 Not Overweight children in the study

Descriptive Study Overweight 180 Not Overweight children in the study 180/600 = 30%

Cross-sectional Study Question: Do overweight kids exercise less?  Get information about the exposure (exercise) and the outcome (overweight) at the same point in time  Study design: 1) Measure BMI 2) Survey about current exercise

Exposure & Outcome Overweight Not Overweight Exercise less than 1 hour/day Exercise 1 hour or more/day

Overweight Not Overweight Exercise less than 1 hour/day Exercise 1 hour or more/day

Overweight Not Overweight Exercise less than 1 hour/day Exercise 1 hour or more/day

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more

Overweight Not Overweight Cross-sectional study Less than 1 hour/day 1 hour/day or more /30 = 66%35/70 = 50%

Cross-sectional studies Advantages:  Feasible  Inexpensive  Quick Disadvantages:  Cannot observe the temporal (“before & after”) relationship between exposure and outcome

Case-control Study Question: Is playing video games associated with obesity in children? Compare study participants according to their outcome status (case or control)  Identify kids who are obese (cases)  Identify kids who are just like the cases in all ways except for obesity (controls)  Get information about prior video game use (exposure) for the past 2 years

Case-control study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Case-control study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Case-control study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Case-control studies Advantages:  Quick  Low cost Disadvantages:  Biases from case or control selection  Information bias (recall)

Cohort Study Compare study participants according to their exposure status (exposed/not exposed)  Identify kids with high use (exposed)  Identify kids with low use (non-exposed)  Survey about video game use and other relevant factors at intervals for 3 years  Measure obesity (outcome)

Cohort study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Cohort study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Cohort study design Obese (Cases) Not Obese (Controls) High Video Game Use (Exposed) Low Video Game Use (Non-exposed)

Cohort studies Advantages:  Measurement of exposure not biased  Temporality is known  Can measure multiple outcomes Disadvantages:  Time  Cost  Loss to follow-up

Randomized Trial Question: Does teaching parents how to motivate their children to exercise work?  Define the study population  Randomly assign participants to “treatment” or comparison group  Handle the “treatment” and comparison groups the same except for the “treatment”  Measure changes in amount of exercise

Randomized trial design Increased Exercise No Increased Exercise Education Program (Treatment) Placebo (Comparison)

Randomized trial design Increased Exercise No Increased Exercise Education Program (Treatment) Placebo (Comparison)

Randomized trial design Increased Exercise No Increased Exercise Education Program (Treatment) Placebo (Comparison)

Randomized Trials Advantages:  Randomization makes the groups comparable with respect to all factors - known and unknown, measurable and unmeasurable - except for the one factor being studied Disadvantages:  Time and Cost  Complex

Qualitative Research Quantitative research uses data based on numeric measurements and mathematical methods Qualitative research uses data based on focus group discussions, interviews, and/or the observations of the researcher(s)

Problem  We added healthful options at the school cafeteria.  We did a quantitative study and found that a minority of children were choosing these items more than twice a week:  6 to 8 year olds: 32%  9 to 11 year olds: 24%  12 to 14 year olds: 13%

What helps kids choose healthful alternatives in the cafeteria?  Observe the cafeteria; field notes  Interviews: Students Cafeteria staff Parents  Record interviews and transcribe  Multiple researchers “code” the transcripts and come to agreement about themes