Framing a research question Chitra Grace A Scientist- C (PGDHE) NIE, Chennai RM Workshop for ICMR Scientists 01/11/2011

 Personal interest/ experience  Published literature  New developments  Social problems  PUBLIC HEALTH PROBLEM

 Clear  Researchable  Connected to published literature  Potential for contributing to subject domain  Be neither too broad or too narrow

 Two ways to deal with a poor or irrelevant research question:  Try to answer it ▪ The answer may be of no use of anyone ▪ There may be no answer…  Try to reframe it  If your research question is wrong:  No good hard work will save your work  If your research question is right:  You have an opportunity to do a good job

 Fundamental research  Studies assessing candidate vaccine antigens  Applied investigation  Clinical trials  Prevention research  Social marketing, cost effectiveness  Assessment, monitoring and evaluation  Post implementation evaluation, coverage survey

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Any disease, injury, risk factor, environment threat or social condition that can cause death / disability  Points that need to be characterized  What ▪ Nature / etiology of the condition  How much ▪ Magnitude  Who ▪ Population at risk  Where ▪ Geographic locations  When ▪ Time of occurrence / seasonal variations

 Diphtheria rates in Hyderabad, AP, India, increased from 11 to 21 per 100,000 between 2003 and 2006, particularly affecting children 5 to 15 years of age ▪ Specifies: ▪ What ▪ Where ▪ How much ▪ When ▪ Who

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Burden of disease: Use local reports and national / international estimates  Death  Disease  Disability  Economic losses  Effective interventions  Cost effective interventions

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Identify the problem  E.g., High diphtheria rates  Identify causes  Immediate determinants ▪ E.g., Low immunization coverage  Direct and indirect contributing factors ▪ E.g., Minorities  Identify consequences  E.g., Mortality from diphtheria  Identify possible solutions  E.g., Increase coverage of boosters

1 1 Health problem Determinants Direct contributing factors Indirect contributing factors Consequences: Possible intervention 1 Possible intervention 2 Possible intervention Indirect contributing factors

Diphtheria Exposure Health problem Determinants Direct contributing factors Consequences: - Deaths - Disease - Disability Immunization Supplemental vaccination activities Treatment Susceptibility Minorities Crowding Ventilation Housing

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Locate the level of intervention:  Determinants  Contributing factors  Review effectiveness  Estimate cost effectiveness  Analyze implementation status  Input  Process  Outcome

 Treatment of cases  Antibiotics and support, no antitoxin  Immunization  Intervention ▪ 3 doses of primary vaccination ▪ 2 boosters during the 2nd and 4th year  Implementation ▪ Reported coverage: 100% ▪ No validation ▪ Possibility of pockets with low coverage

 Identify public health problems  Estimate public health importance  Analyze problems  Review what is being already done  Identify the information needed to improve

 Is the problem a consequence of a failure to implement a validated strategy?  Assessment, monitoring and evaluation  Is the problem a consequence of difficulty to apply a recommended strategy?  Prevention research  Is the problem a consequence of a limitation or of a lack of validated strategy?  Applied investigation

 Identify what is known (easy)  Guidelines  Recommendations  Reviews  Literature search  Identify what is not known (difficult)  Meeting reports  Research agenda  Expert opinion

 Facts  Primary immunization protects small children  Boosters are needed for longer term protection  Reported coverage is high  Research questions:  Vaccine failure? ▪ Is the vaccine as effective as it is supposed to be ?  Failure to vaccinate? ▪ Could there be pockets of lower coverage that could allow the disease to spread?

Identifying data needs Spelling out the research question Formulating the study objectives Planning the analysis Preparing data collection instruments Analysing data Drawing conclusions Formulating recommendations Involving the programme Collecting data

 Anticipate the various possible results of the study  Imagine scenarios of various possible answers to the research question  Identify the kind of public health action that could be realistically taken for each case scenario

 If the vaccine efficacy is low:  Programme evaluation could identify where the problem is  If there are pockets of lower coverage:  Supplemental immunization activities could increase population immunity

 Sound answers to good research question bring new questions  These questions should be framed with the same careful methods  Addressing consecutive public health questions is:  Useful  Gratifying

 Conclusions  Booster is key for protection among children > 5 years  Booster coverage drops among selected minorities  Possible next question  What is the best strategy to use to increase the coverage of booster among minorities?

 Local problem to be identified  What? When? Where? Who? How?  Problem statement  Specified, quantified  Causal web  Problem, consequences, determinants, contributing factors and possible interventions  Review evidence available  What is known and What is unknown?  Research question  Specific; with a question mark