1. Primary Care Research: An Introduction (To Some Really Important Concepts) John B. Schorling, M.D., M.P.H. Professor of Medicine and Public Heath Sciences James R. Martindale, Ph.D. Assistant Professor of Research and Public Health Sciences

2. Objectives: Be able to better formulate a research question Be able to better formulate a research question Feel more comfortable with the clinical research process Feel more comfortable with the clinical research process Understand the ideas of constructs and operationalization Understand the ideas of constructs and operationalization Understand the major differences between quantitative and qualitative approaches to doing educational research Understand the major differences between quantitative and qualitative approaches to doing educational research

3. “If we knew what we were doing, it wouldn’t be called research, would it?” Albert Einstein

4. Developing Your Question Start with a clear purpose Start with a clear purpose Know your literature Know your literature Be iterative in your approach Be iterative in your approach Try to specify the who, what, where and when of your purpose Try to specify the who, what, where and when of your purpose Ask yourself “What would the answer to this question add to the literature?” and… Ask yourself “What would the answer to this question add to the literature?” and…

5. Developing Your Question Don’t let methodology drive the question!

6. The Research Process 1. Identification of general problem/question 2. Literature review 3. Specify questions/hypotheses 4. Determination of design/methodology 5. Data collection 6. Data analysis/presentation 7. Interpretation of findings

7. The Right and the Left Quantitative research - numbers, numbers, numbers Quantitative research - numbers, numbers, numbers Qualitative research - words, words, words Qualitative research - words, words, words

8. Quantitative vs. Qualitative: Assumptions about the World Based upon the idea of “logical positivism”, that is, there is a singular reality with stable, social facts that are separate from the feelings and beliefs of individuals. Based upon the idea of “logical positivism”, that is, there is a singular reality with stable, social facts that are separate from the feelings and beliefs of individuals. Based on the notion of “constructivism”, which assumes multiple realities that are socially constructed through individual and collective perceptions or views of the same situation.

9. Quantitative vs. Qualitative: Research Purpose Seeks to establish relationships and explain causes of changes in measured variables. That is, the goal of science is to explain and predict. Seeks to establish relationships and explain causes of changes in measured variables. That is, the goal of science is to explain and predict. Concern is with the understanding of the social phenomenon from the participants’ perspectives. This requires, to some degree, researcher participation.

10. Quantitative vs. Qualitative: Methods and Process The scientific method, also known as a priori or pre- established design. The scientific method, also known as a priori or pre- established design. Use of emergent design utilizing constant comparison and revision.

11. Quantitative vs. Qualitative: Prototypical Studies Experimental or correlational designs are used to reduce error, bias and the influence of extraneous variables--control of bias is through design. Experimental or correlational designs are used to reduce error, bias and the influence of extraneous variables--control of bias is through design. Use of ethnography, which helps readers understand the multiple perspectives of the situation by the persons studied. Subjectivity in data analysis and interpretation is acknowledged.

12. Quantitative vs. Qualitative: Researcher Role Detachment from study in order to avoid bias. Detachment from study in order to avoid bias. Immersion in situation and the phenomenon being studied.

13. Quantitative vs. Qualitative: Context Context-free generalizations Context-free generalizations Generalizations are contextually-bound.

14. Quantitative vs. Qualitative: Precision Obtained through the use of measurement and statistics Obtained through the use of measurement and statistics Provided by detailed description of phenomenon

15. Quantitative vs. Qualitative: Verification Results replicated by others. Results replicated by others. Extension of understandings by others.

16. Quantitative vs. Qualitative: Explanation Traditionally, parsimonious explanations were sought, but this may be changing due to technology. Traditionally, parsimonious explanations were sought, but this may be changing due to technology. Summary through narrative-- importance is placed on reducing complex realities to simple explanations.

17. Quantitative vs. Qualitative: Logical Reasoning DEDUCTIVE-- What’s the classic example? DEDUCTIVE-- What’s the classic example? INDUCTIVE-- anyone have an example?

18. Quantitative vs. Qualitative: Conditional Conclusions Statements of statistical probability. Statements of statistical probability. Tentative summary interpretations.

19. Types of Quantitative Studies Descriptive Descriptive True experimental True experimental Quasi-experimental Quasi-experimental Correlational Correlational Predictive Predictive

20. Research Using Primary Data Cross-sectional Cross-sectional Case Control Case Control Cohort Cohort Randomized controlled trial Randomized controlled trial

21. Cross-sectional Study Data gathered at one point in time Data gathered at one point in time Often used for surveys Often used for surveys Can not make inferences about causality Can not make inferences about causality

22. Robert Johnston’s Project Interested in PTSD Reviewed literature on PTSD in primary care settings for his POM1 presentation Decided to do a survey to determine prevalence and associated conditions Reviewed existing instruments Survey includes 2 PTSD questionnaires, AUDIT, SF-12 and PHQ-9 Obtained IRB approval June, 2010 Goal is to survey 100 patients at UMA

23. Case Control Study Start with the outcome- identify a sample with the condition of interest Start with the outcome- identify a sample with the condition of interest Identify a similar control group Identify a similar control group Look back to determine exposure Look back to determine exposure Calculate the risk in the cases and controls- odds ratio used Calculate the risk in the cases and controls- odds ratio used Can not use to establish prevalence Can not use to establish prevalence

24. Cohort Study Start with an identified group Start with an identified group Determine exposure in everyone at the same time Determine exposure in everyone at the same time Follow the group to determine who develops the outcome of interest Follow the group to determine who develops the outcome of interest Can be used to determine prevalence Can be used to determine prevalence Association measured as relative risk (rate ratios) Association measured as relative risk (rate ratios)

25. Randomized Controlled Trial Gold standard for determining associations Gold standard for determining associations Identify a group Identify a group Randomly assign individuals to exposure Randomly assign individuals to exposure Only reliable way to control for confounding Only reliable way to control for confounding

26. Research Using Secondary Data Literature review Literature review Systematic review Systematic review Metanalysis Metanalysis Analysis of existing data collected for another purpose Analysis of existing data collected for another purpose

27. Literature Review Gather articles on a topic of interest Gather articles on a topic of interest Summarize the findings Summarize the findings

28. Systematic Review Gather articles using a pre-defined search strategy- may include unpublished studies Gather articles using a pre-defined search strategy- may include unpublished studies Develop a-priori objective criteria to evaluate the quality of the studies Develop a-priori objective criteria to evaluate the quality of the studies Summarize the quality of the data and the results Summarize the quality of the data and the results

29. Metanalysis Do a systematic review Do a systematic review Obtain the primary data if possible Obtain the primary data if possible Summarize the data quantitatively Summarize the data quantitatively

30. Analysis of Existing Data Use administrative data for research Use administrative data for research Insurance claims data- Medicare Insurance claims data- Medicare Central Data Repository (CDR) at UVa Central Data Repository (CDR) at UVa Use regularly collected survey data Use regularly collected survey data National Center for Health Statistics performs multiple surveys periodically- NAMCS, NHIS, NMCES, NHANES National Center for Health Statistics performs multiple surveys periodically- NAMCS, NHIS, NMCES, NHANES Use data collected for another study Use data collected for another study

31. Timeline for GSP Research Project Fall 2010- develop a research idea Fall 2010- develop a research idea Spring 2011 Spring 2011 Work with mentor on developing your idea Work with mentor on developing your idea Put together a protocol for IRB approval Put together a protocol for IRB approval Summer 2011- MSSRP, collect data Summer 2011- MSSRP, collect data Fall 2011- medical student research day Fall 2011- medical student research day Fall 2013- research elective to finish project Fall 2013- research elective to finish project Spring 2013- GSP thesis + presentation Spring 2013- GSP thesis + presentation

32. THANK YOU! Contact: jrm7e@virginia.edu