Teaching the Science Base of MCH Donna Strobino, PhD

TEACHING THE SCIENCE BASE OF MCH OBJECTIVE: To present examples of approaches to teaching the evidence base of MCH

ASSUMPTIONS OF EXAMPLES SOLID GROUNDING IN: Biostatistics Epidemiology Evaluation or Study Design in the Social Sciences or Health Services Research

EXAMPLES OF APPROACHES Critiquing a research article Synthesizing the literature on an intervention/program Translation of a study to practice or policy Debating the science Choosing measures for population- based data

CRITQUE OF A SCIENTIFIC ARTICLE: OBJECTIVE Participants demonstrate Knowledge of critical study methods that affect the validity of inference The link of study objectives and rationale to study results and conclusion Objective evaluation of strengths and weaknesses of study

FOCI OF THE CRITIQUE Study Objectives and Rationale Study methods -Study design -Sample: who, where, when, how many -Variable Measures

FOCI OF CRITIQUE Study Results -Text consistent with data in tables -Consistent with study methods Study Conclusions -Consistent with objectives -Consistent with findings

EXAMPLES OF STUDIES Study Design Case Control Study of Stillbirths -Stillbirths of all birth weights -Controls: Live births > 2500 grams Sister pairs -Teenage mothers -Mothers in their early 20’s

EXAMPLES OF STUDIES Sample Restrictions Require repeated interviews during pregnancy of high-risk women; very low follow-up -Sample bias versus recall bias Reduce sample by half because of data on gestational age -Sample bias versus measurement bias

EXAMPLES OF STUDIES Timing of measurement of risk factors: hematocrit at delivery Poorly constructed measures of underlying concept: racism Analysis determines results: Longitudinal data on repeated births Text misrepresents data in tables: data sources for measuring drug use

SYNTHESIZING THE LITERATURE: OBJECTIVES Students learn: How to conduct a literature search How to determine the most appropriate criteria for inclusions of studies in a review To succinctly, but comprehensively describe studies Evaluate the evidence Make conclusions about the intervention

LECTURE POINTS Important aspects of study methods Content of a study description Information for doing a search Criteria for selection of studies Selecting the studies to highlight Synthesizing/compiling the evidence

ASSIGNMENTS Topic and selection of studies -Criteria for selecting studies -List of studies Paper presenting the evidence -Description of the intervention -Description of studies and critique -Conclusions about the evidence

EVALUATING LITERATURE FOR POLICY OR PRACTICE OBJECTIVE: Students will show: Ability to evaluate the evidence Ability to determine limits of inferences Ability to translate study findings for programs, practice, and policy

ARTICLE SELECTION Gold standard design? Sample exclusions Appropriate age range? Secondary prevention Clinical interpretations:To whom should the results be applied? Controversial politically

DEBATING THE SCIENCE OBJECTIVES: Students will show: Understanding of the science underlying the debate A balance of the strengths and weaknesses of the science Knowledge of the reasons for policy recommendations

UNIVERSAL BREAST CANCER SCREENING: WOMEN Debate: Pro and Con Hinges on interpretation of studies Requires additional population data Regardless of position, must present in writing both sites; requiring a synthesis of the literature.

BIRTH CERTIFICATE ANALYSIS: OBJECTIVES Student will show: Knowledge of the vital statistics system and its uses Knowledge of data for surveillance and research Knowledge of the constraints in collecting population-based data Knowledge of measurement of items on the certificate

APPROACH TO PAPER Geopolitical area VS System in that area Content of current certificate Recommendations for changes -System of data acquisition -Format of form -Content/measurement of items

TESTING PREPARATION TO UNDERTAKE RESEARCH Take-home exam: Objective: To test student’s ability to: Critically analyze research in their area of interest Synthesize and integrate both concepts and methods learned in course work

Exam: Using 1-2 Research Articles Focus of questions about articles: Conceptual basis of the research -Conceptual framework -Variables and their conceptualization Study methods -Study design -Sampling plan -Statistical analysis

DrPH versus PhD Students DrPH students: -Program, policy or practice implications of the study PhD students: -Research implications of the study