Jimma university

College of health sciences

DEPARTMENT OF epidemiology

Research methodology
group presentation

By Year-I mph & MSc students

of 2016
1
 Presentation Topic:
Conceptualizing Health System
Research and Problem
Identification (Module II)

2
 GROUP-II MEMBERS
S.No Name ID No Department

1 Abeje Kebede RM/0491/09 Epidemiology

2 Bedatu Gemechu RM/0381/09 Nutrition
3 Selamawit Baye RM/0/09 Reproductive Health
4 Bizuwarek Sharew RM/0527/09 Medical Microbiology
5 Chali Endalu RM/0/09 Health Education

3
 Presentation Outline (Contents)
1. Scientific enquiry - Introduction
 Research purpose
 Exploration
 Description
 Explanation
2. Research topic
3. Theories and literatures
4. Concepts and variables
5. Identification of research problem
6. Fields of health research theory
Germ theory
Life style theory 4
 Objectives
At the end of this session, students should be
able:
• To describe the important steps in the
conceptualization of health system research.
• To identify the determinants of health.

5
 1. Introduction

Scientific inquiry is the diverse ways in

which scientists study the natural world and
propose explanations based on the evidence
derived from their work.
• It is a process by which scientist test,
refine and discover new ideas

6
 Cont….
• The purpose of scientific inquiry is to create knowledge
• Is also democratic,
 Allowing independence & freedom of
thought,
 Encouraging disagreement & alternative
explanations
• Through these process scientific ideas become
understood, then accepted or rejected.

7
 What is Research
Research is:
o A systematic search for information and new
knowledge.
o An essential and powerful tool for accelerating
health development.
o Necessary to the process of:
 Identifying priority problems
Designing and evaluating polices and program

8
 Types of research
• The two classical broad divisions of research
are:
– Basic research is necessary to generate new
knowledge and technologies to deal with major
unresolved health problems.
– Applied research is necessary to identify priority
problems and to design and evaluate policies and
programs that will deliver the greatest health
benefit, making optimal use of available resources.

9
 Basic Vs. Applied Research
Basic Applied
– Pure, fundamental – Central purpose to
solve an immediate
research problem
– Discovery of new – Improved products or
knowledge; processes
theoretical in nature – Infers beyond the
– Takes many years for group or situation
studied
the results of basic
– Interpretation of
research to find results relies upon
some practical utility Basic research
10
 Importance of Research
1. Guiding action
2. Developing new tool
3. Saving resources
4. Multiplying benefits
5. Enhancing capacity development process

11
 Characteristics of Research

• It demands a clear statement of the problem.

• It requires clear objectives and a plan
It is not aimlessly looking for something in the
hopes that you will come across a solution.
• It builds on existing data, using both positive and
negative findings.
• New data should be systematically collected and
analyzed to answer the original research objectives

12
 Desired attributes of research

• Timeliness

• Dynamic

• Context related

• Reliable

• Unbiased

13
 Research Purpose

• The three general purposes of research are:

1. Exploration

2.Description

3.Explanation
• A given study can have more than one of these
purposes
14
 1.Exploratory Research

• Usually conducted when relatively little is known

about the phenomenon under study
• The subject of study is itself relatively new and
unstudied.
• The researcher explores the topic in order to become
familiar with it and to gain ideas and knowledge
about it.
15
 2.Descriptive Research

• Is conducted to describe certain

phenomenon
For example :
 Health status & its determinants,
utilization of heath resources, and
health care expenditure
It provides detailed numerical descriptive of
relatively few dimensions of a well defined
subject.
16
 Cont …
• Seeks to accurately describe current or past
phenomena - to answer such questions as:
a) What is the defaulter rate for TB patients?
b) What is the success rate for particular
treatment?
c) What is the dropout rate on particular
immunization Programmes?

17
 3.Explanatory research

• Attempts to seek answers to research

hypotheses or problems
• Answer cause-effect questions
• “Why” and “what will be”

18
 Conceptualization
Concept :
• Mental image or perception or idea or thought.
• Concept may be impossible to observe directly,
such as equity or ethics, or they may have
referents that are readily observable, such as a
hospital or a clinic.

19
 Conceptual framework
• The philosophical concerns, theories, and
methodological approaches towards scientific
inquiry that characterize a particular
discipline.
• It is the diagram that identify and illustrate
the relationships among factors that influence
outcome.

20
 Importance of a conceptual framework
(program theory)
• Articulates the pathways by which an
intervention is expected to cause the desired
outcomes
• Provides evaluator with specific elements to
assess
• Other names:
– Logic model,
– program model,
– outcome line,
– cause map,
– action theory 21
 Conceptual framework to assess the
magnitude of mortality from Tuberculosis.

22
 Conceptualization Cont…
• The process of finding out what data need
to be collected and analysed
Or
• The refinement and specification of
abstract into concrete terms.

23
 The conceptualization stage
• The research purpose
• Specific research topic
• Identifying relevant theories and literature related
to the topic
• Specifying the meaning of the concepts and
variables to be studied and
• Formulate general hypotheses or research
questions

24
 Health Research
• It is a systematic collection, analysis and
interpretation of data to solve health problem
• It is the application of principles of research on
health
• it aims to develop tools to prevent and cure illness
and mitigate its effects and it attempts to devise
better approaches to health care for the individual
and community
(Davies 1991)

25
 Purpose of Health Research?
 To generate knowledge essential to effectively
promote the health of the population.
 Without this knowledge, effective action is
impossible because it has no logical or empirical
basis.
 To making progress in health
 Progress in health (medicine) can only be achieved if
good quality information are generated through
research to guide interventions and to inform the
general public.
26
27
 Health Systems Research (HSR)
• HSR is ultimately concerned with improving the
health of people and communities, by enhancing the
efficiency and effectiveness of the health system as
an integral part of the overall process of socio-
economic development, with full involvement of all
partners.

• Its major objective is to provide people at all levels

with the relevant information they need to make
decisions on health-related problems they are facing.
28
 Types of HSR
a) Operational Research
• Type of HSR which looks at the actual delivery of health
services.
• It examines the resources and processes used by the
health services and the outputs they attain.
• It aims to improve health service delivery by providing
practical answers to the questions asked by managers of
the health services.

29
 Types of HSR

b) Policy Research
• Type of HSR which is not carried out at service
delivery level and which is more explicitly aimed at
informing higher levels of health policy choices.

30
 Characteristics of HSR
1. It should focus on priority problems
2. It should be action-oriented; i.e. aimed at developing solutions
for health problems
3. It utilizes an integrated multi-disciplinary approach
4. It should be participatory
5. It must be timely; i.e. studies must be done in such a way that
results will be available when needed for key decisions.
6. Research designs should be simple and effective.
7. Results should be accessible and easily understood.
8. Its projects should focus on finding solutions which are
affordable and effective.
9. It should be evaluated by how much
– it has influenced policy,
– improved services, and
– ultimately led to better health 31
Stages of HSR (Research Process)

32
 Research must be
1. Purposeful: what do you want to contribute?
2. Targeted: who are the audiences?(interest of
study)
3. Credible: consider sources of information,
method of data collection, personnel
involved...(should be realistic)
4. Timely: when is the information needed?
* Research is done to find solutions to health
problems.
33
 2. Research Topic

Should be:-
• Appropriate or relevant to the situation.
• Informative and specific.
• Concise/ brief.
• Understandable.

34
How do we choose a research topic?
Criteria
– Relevance
How widespread is the problem? Who is affected? How severe is the
problem?
– Avoidance of duplication
Has the topic been researched?
– Feasibility
Complexity of the problem Versus resources
– Political acceptability
– Applicability
Will the recommendations of the research be applied?
– Urgency of data needed
35
– Ethical acceptability
 1. Relevance
The topic you choose should be a priority problem.
• How large or widespread is the problem?
• Who is affected?
• How severe is the problem?
Try to think of serious health problems that affect a
great number of people or the most serious
problems that are faced by managers in the area of
your work.
All the community members and local managers
have an interest in solving the problem.
36
 2. Avoidance of duplication
Before you decide to carry out a study, Answer
• has the suggested topic been investigated before,
within the proposed study area or in another area
with similar conditions ?
• If the topic has been researched, the results should
be reviewed to explore whether major questions that
deserve further investigation remain unanswered. If
not, another topic should be chosen.

37
3. Urgency of data needed (timeliness)

• How urgently are the results needed for

making a decision or developing interventions
at various levels (from community to policy)?

• Consider which research should be done first

and which can be done later.

38
 4. Political acceptability
• In general it is advisable to research a topic that has the
interest and support of the local/national authorities.
• This will increase the chance that the results of the
study will be implemented.
• Under certain circumstances, however, you may feel
that a study is required to show that the government’s
policy needs adjustment.
• If so, you should make an extra effort to involve the
policy-makers concerned at an early stage, in order to
limit the chances for confrontation later.
39
 5. Feasibility
• Look at the project you are proposing and
consider the complexity of the problem and
the resources you will require carrying out your
study.
• Thought should be given first to manpower,
time, equipment and money that are locally
available.
• Finally, explore the possibility of obtaining
technical and financial assistance from
external sources.
40
 6. Applicability of possible
results/recommendations
• Is it likely that the recommendations from the
study will be applied?
• This will depend on
▫ Management capability ,
▫ Willingness of the authorities and
▫Availability of resources for implementation.
• Likewise, the opinion of the potential clients
and of responsible staff will influence the
implementation of recommendations.
41
 7. Ethical acceptability
• We should always consider the possibility that we
may inflict harm on others while carrying out
research. Review the following:
 How acceptable is the research to those who will
be studied?
 Can informed consent be obtained from the
research subjects?

42
 Ethical Cont. …
 Will the condition of the subjects be taken into
account?
o For example, if individuals are identified during
the study who require treatment, will this
treatment be given? What if such treatment
interferes with your study results?
 Will the results be shared with those who are being
studied?
 Will the results be helpful in improving the lives or
health of those studied?
43
Scales for rating research topics
Relevance
1.= Not relevant
2.= Relevant
3.= Very relevant
Avoidance of duplication
4. = Sufficient information already available
5.= Some information available but major issues not
covered
6.= No sound information available on which to base
problem-solving 44
 Rating cont…
Urgency
1. = Information not urgently needed
2.= Information could be used right away but a delay
of some months would be acceptable
3.= Data very urgently needed for decision-making
Political acceptability
4. = Topic not acceptable to high level policy makers
5.= Topic more or less acceptable
6.= Topic fully acceptable

45
 Rating cont…
Feasibility
1. = Study not feasible, considering available resources
2.= Study feasible, considering available resources
3.= Study very feasible, considering available resources
Applicability
4. = No chance of recommendations being implemented
5.= Some chance of recommendations being
implemented
6.= Good chance of recommendations being
implemented
46
 Rating cont…
Ethical acceptability
1.=Major ethical problems
2.= Minor ethical problems
3.= No ethical problems

47
 3. Theories and literature
• Theory is an integrated set of defined
concepts, existence statements, and
relational statements that present a view of
phenomenon .
• It used to describe, explain, predict, or control
a fact or an event in nature or society.
• Literature consists of all written sources
relevant to the topic you have selected.

48
 Why Literature Review?
(Importance)
Why is it important to review already available
information when preparing a research proposal?
1. It helps to identify theories related to the topic of
interest
2. It helps to narrow down the topic and refine your
statement of the problem.
3. It helps to identify relevant as well as control
variables
4. It provides convincing arguments for why your
particular research project is needed
49
 Why cont. ..
Literature review…
• It helps to find out what others have learned and
reported on the problem you want to study.
It prevents from duplicating work that has been
done before.
• It helps to become more familiar with the various
research approaches that might be used in your study.
It suggests pertinent research design, procedures
and analysis method by indicating how other
researchers have addressed the topic.
50
 What are the possible sources of information?

• Individuals, groups, and organizations

• Published information (books, articles, indexes,
abstract of journals); and
• Unpublished information (other research proposals
in related fields, reports, records, computer data
bases)

51
 4. Concepts and Variables
• Concept: is a term abstractly describes and
names an object or phenomenon, thus
providing it with a separate identity or
meaning.

• Variables: are qualities, properties, or

characteristics of persons, things, or situations
that change or vary and manipulated,
measured, or controlled in research.
52
 Cont….
Concepts
• mental images or conceptions
• observations and experiences
• specified in understandable terms
Concepts are defined on two levels:
 A nominal definition
 Operational definition
53
 A Nominal definition

• Serves as the working definition

• To rule out other possible dimensions of the

concept

• Not specific as to how a concept is to be

observed

54
 Operational definition
• To be specific as to how a concept
should be actually observed

• The second level of concept specification

• Specifies a unique way of observation

55
 Cont…
• Nominal definition points out the
direction for observation but operational
definition is necessary to indicate how to
make the observation

56
 Variables
• A characteristic of a person, object or
phenomenon which can take on different
values
• In the form of numbers or non-numerical
Example: Age, Sex, etc

57
 Cont…
Dependent variable
 The variables that are used to describe or measure
the problem under study.
Independent variable
 The variables that are used to describe or measure
the factors that are assumed to cause or influence
the problems.
E.g. smoking and lung cancer
58
 Cont…

Background variables
E.g. age, sex, educational status, monthly
family income, marital status and religion
 often related to a number of independent
variable

59
 Cont…
Confounding variable
 A variable that is associated with the problem
and with possible causes of the problem
 May either strengthen or weaken the
apparent relationship between the problem
and a possible cause eg diarrhea & bottle
feeding v mother's education.

60
 5. Formulating objectives: Research
Questions vs. Hypothesis
Hypothesis-
• It is testable statements derived from theories
• A hypothesis requires sufficient knowledge of the
problem to be able to predict relationships among
factors which can then explicitly tested.

• Research questions are formulated when the

investigators do not have enough insight into the
problem being studied.

61
 Formulation of a Research Question
Defining a problem:
- First step & the most difficult in research
- Tendency for the beginner to ask diffuse or vague
question

62
 Criteria for setting research
questions/objectives

1. Focused- each covering a single point

2. Ordered- in logical sequence
3. Realistic- and feasible to answer
4. Operational- using action verbs such as:
- Determine - Verify - Identify
- Describe - Assess - Compare
- Calculate - establish - Explore
5. Measurable- outcomes at the end of the
research
63
 Problem Analysis
• Systematic analysis of problem is a very crucial
step in designing the research b/c
 Pool knowledge of the problem
 Clarify the problem and factors
 Determine the focus & scope of the

research

64
Steps in Analyzing the Health
Research-
Step1:
 Clarify the viewpoints of managers,
health care workers and researchers in
relation to the problem
Step 2:
• Further specify and describe the core
problem
65
 Steps Cont. …
Step 3: Analyse the problem
 Step 3.1: Write down the core problem as defined in
step 2
 Step 3.2: Brainstorm on possible causes or factors
contributing to the problem
 Step 3.3: Identify further contributing factors
 Step 3.4: Attempting to organize related factors
together into larger categories, and develop your
final draft of the diagram

66
 Steps Cont. …

Step 4:Formulating the problem statement

• A problem statement is a nothing well detailed
description of the problem
• A problem statement is the initial step before
undertaking or venturing into any kind of
research
67
 Steps Cont. …

• It is necessary to formulate a good and effective

problem statement to ensure that the research is
successful.
• Good problem statement would always be specific and focus
on one particular issue instead of being Vague & running the
risk of being confused.
• Therefore a good problem statement would be restrictive and
would express one major idea.

68
 Statement of the Problem
What is a problem?
• A problem is a gap or a difference between
what is expected or desired to be and the actual
condition exists.

• A problem is a perceived difficulty, a feeling of

discomfort about the way things are, or a
discrepancy between what someone believes
should be the situation and what the situation is
in reality. 69
 Cont …
• A problem statement is a concise , and precise
well documented, detailed description of the
nature, scope, causes, severity and the effect
or impact of a problem to be addressed and
the need for the proposed project or
research.
• Thus a problem statement is the specific
description of a problem which is essential to
understand it properly.
70
 Cont. …
• A problem statement is the initial step before
undertaking into any kind of research.
• A well formulated and effective problem
statement ensures the research success.
• A good problem statement is always specific
and focused to a particular issue.
• A confused or vague problem statement will
raise a question on the importance of the
research.
71
 Sources of Research Problem
• The sources of a research problem could be
– Observations
– Experts
– Literature reviews
– Professional conferences

72
 When does a research problem
exists?

• Problems are the initiating force behind a

research, however all problems does not
require a research.

73
 Cont. …
A potential research situation arises when
three conditions exist:
1. A perceived discrepancy exists between
what is and what should be.
2. A question exists about why there is a
discrepancy.
3. At least two possible and plausible
answers exist to the question.

74
 Cont. …
• Note that , If there is only one possible and
plausible answer to the question about the
discrepancy, then a research situation does
not exist

75
 Identification and Prioritization of
Research Problem
• First bear in mind about the problem to be
studied
• The problem should be researchable
• Should contribute to new knowledge
• There must be appropriate method available to
investigate the problem
• Consider participants, ethical implication, time,
budget and other necessary resource constraints
76
 Importance of problem
statement

• It is foundation for further development of

research proposal
• Makes it easier to find information and reports
of similar studies from which our study design
can benefit.

77
 Cont. …

• Enables us to systematically point out why

the proposed research on the problem
should be undertaken and what you hope to
achieve with the study results.
• To focus the attention of the problem solving
team

78
Information should be included in problem statement

1. A brief description of nature of the problem

2. Major factors that may influence the problem

3. A brief description of any solutions that have

been tried in the past to solve the problem.
4. A description of type of information expected
from the current study and how it can solve the
problem (justification)

79
How to write problem statement

• It should be precise and concise, while not

forgetting to mention essential points
• Information concerning the problem should be
summarized
• An outline listing the major points to be covered
could be prepared before any writing is done, so the
section will be logical and well organized

80
6. Theories under the field of
health research

81
 A. Pasteur’s Germ Theory

• Pasteur
– A Scientist (not a doctor)
• Brewery in France
– Asked Pasteur to investigate why some vats of
alcohol would go bad
• His theory
– Germ = Germination
• A growing, living organism caused the problem
• His solution to the problem was to boil the
liquid to kill the germs
– Pasteurisation
• Applied to milk, beer, wine, vinegar 82
 Pasteur bottles Spontaneous Generation
Theory
• French Academy
launches competition to
prove or disprove
Spontaneous
Generation in 1860
• Pasteur devises
experiments to show
that microbes existed in
the air.
83
 Linking Germs to Disease
• “If wine and beer are changed by germs, then the
same can and must happen sometimes in men and
animals”
• French Silk Industry
– Asked Pasteur to investigate why their silkworms
kept dying.
– He discovered that a certain germ was
responsible for disease development.
– Finally he states that microorganisms cause
disease & it is possible to control disease using
antibiotics and vaccine.
84
Linking Germs to Disease

85
 B. Life style Theory
• This theory rejects the notion central to the classic
germ theory that a single disease has a single
etiology.
• Instead they emphasize the interrelatedness of many
variables in disease causality, particularly those
under the control of the individual, fore example,
stress, alcohol, lack of exercise, etc., Nevertheless,
this approach resembles the germ theory, for it
conceives of disease as an individual event, the
difference is that prevention, instead of requiring
physician's ministrations, demand personal behavior
change. 86
 C. The Environmental Theory
• This theory explains that significant number of
disease are caused by toxins in the environment
and it implies that disease prevention instead of
requiring medical treatment or personal hygiene,
demands change in the industrial production.
• This theories were developed through
investigations & searching solutions for the
problems.

87
 References
• Introduction to Health Services Research. Lynda
Burton, ScD Johns Hopkins University
• WHO , Health research methodology, A guide for
training in research methods, Second edition, 2004
• WHO, A Practical Guide for Health Researchers, 2004
• http:// www.Maxwell.qxd 10/1/2004 3:13 PM Page
33

88
 ! ! !
o u
k y
a n
Th
89