A brief introduction to Research Methodology By Dr.Shaikh Shaffi Ahamed Ph.d., Asst. Professor Dept. of Family & Community Medicine

What is Research? A systematic investigation, involving the collection of information (data), to solve a problem or contribute to knowledge about a theory or practice. Research is critical in medicine because it leads to new discoveries and can change peoples’ lives by improving health and well being. Research helps to provide scientific understanding and solves practical problems.

Research (cont.) Relies on methods and principles that will produce credible and verifiable results. All research starts with an idea or question based on personal experiences.

Scientific Approach The most sophisticated method of acquiring knowledge is by scientific approach. Combines important features of induction and deduction together with other methods to create a system of acquiring knowledge. Generally more reliable than other methods. Approach used most often to perform medical research.

Scientific research is an integrated approach of deduction and induction Deduction Hypothesis generation Testing the hypothesis Induction (Inference on hypothesis) generalization of the results In sample population Universe Known/unknown truths

Aims of epidemiologic research Describe the health status of a population Explain the etiology of disease Predict the disease occurrence Control the disease distribution

Definition of Epidemiology The study of the distribution and determinants of health-related states or events in specified population, and the application of this study to control of health problems. [source: Last (ed.) Dictionary of Epidemiology, 1995]

Definition of Epidemiology Study: surveillance, observation, hypothesis testing, analytic research, and experiments. Distribution: analysis by time, place, and person. Determinants: physical, biological, social, cultural, and behavioral factors that influence health. Health-related states or events: diseases, causes of death, behavior, reactions to preventive regimens, and provision and use of health services.

Epidemiology and Biostatistics Epidemiology: Study design and interpretation Biostatistics: Methods for analysis

Policy making, planning, Management evaluation Health systems research Epidemiological Biomedical Statistical Behavioral Social & economic MODEL OF THE RELATIONSHIP BETWEEN DIFFERENT TYPES OF RESEARCH

BCG vaccination is not effective. Why ? (a)BCG vaccination coverage is good but not effective (i)Immuno-microbiological factors Poor nutrition (low protein intake) Poor immune reaction (race-specific) Tubercle bacillus strains Atypical mycobacterial infection ---- BIOMEDICAL PROBLEMS (ii)Technical factors Quality of BCG vaccine ---- BIOMEDICAL PROBLEMS (iii) Operational factors Storage and transport of vaccine Handling of vaccine after reconstitution Technique of vaccination Logistic support (supply of vaccine, vaccinating equipment) HEALTH SYSTEMS RESEARCH

(b) BCG vaccination coverage is poor (i) Operational factors Coverage and efficiency of local health services ---- HEALTH SYSTEMS RESEARCH (ii) Human factors Indifference of population toward immunization Fear of reaction and low level of confidence in BCG Decline in concern about tuberculosis BEHAVIOURAL PROBLEMS

Preventable Causes of Disease BEINGS Biological factors and Behavioral Factors Environmental factors Immunologic factors Nutritional factors Genetic factors Services, Social factors, and Spiritual factors [JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]

Causal model of risk factors for CVD Morbidity and Mortality (Stroke, MI) Biological Risk Factors (Hypertension, Blood Lipids, Homocysteine) Genetic Risk Factors (Family History) Behavioral Risk Factors (Cigarette, Diet, Exercise) Environmental Factors (Socioeconomic Status, Work Environment)

Clinical issues and questions in the practice of medicine Issue Question Normality/abnormality Is a person sick or well? What abnormalities are associated with having a disease ? Diagnosis How accurate are diagnostic tests or strategies used to find a disease ? Frequency How often does a disease occur ? Risk What factors are associated with an increased likelihood of disease ? Prognosis What are the consequences of having a disease ?

Treatment How does treatment change the future course of a disease ? Prevention Does intervention on people without disease keep disease from arising? Does early detection and treatment improve the course of disease ? Cause What conditions result in disease ? What are the pathogen tic mechanisms of disease ?

Execution of Research: Conceptualizing the problem: Need Background & Rationale Formulating the Objectives Generating hypotheses Testing hypotheses Designing the Approach Research design Methods and Materials Target population Study population Methods of collection Analysis and Interpretation of results

THERE ARE ONLY A HANDFUL OF WAYS TO DO A STUDY PROPELY BUT A THOUSAND WAYS TO DO IT WRONG --- Sackett (1986)