Chapter 3 – Investigating Health

Lecturer PowerPoint
Lecturer Lesson Plan
Additional Case Study
3 Papers
3 Websites
3 Media Articles
Learning Tasks Discussion
Issues you may have considered in relation to the Learning Tasks in the book…

Learning Task 1: Where do I begin in thinking about my research project?

These questions are starting points to stimulate your thoughts about potential areas that you might want to explore in your project. The answers that you provide to these questions will each be different. Are you interested in a topic that has been getting lots of media coverage such as ‘safe’ amounts of alcohol, binge drinking, drug use or patient safety and care? These frequently appear in the media. You also may be interested in a topic from a personal point of view – your own experiences for example. When thinking about any of these examples, you will also need to pay attention to who would be included in the sample especially thinking about how you would get access to them to collect data.

Learning Task 2: Choosing an appropriate method for your project

Research questions should be answered by selecting methods to help the researchers address them. Here are some types of research question and associated methodological design to help you to think about this in more depth:

Cause and effect questions, e.g. do higher levels of social capital lead to reductions in health inequalities? Quantitative: RCTs, quasi RCTs, Cohort studies, Case control studies.
Is this intervention effective?, e.g. does providing early intervention for at-risk children protect against poor educational achievement? Quantitative: Systematic review, RCTs, quasi RCTs.
Are factors associated?, e.g. is discrimination related to poor mental health outcomes? Cohort studies, Case control studies, Surveys.
How does something work? (explanatory) Qualitative research, Surveys
Why does something happen? (explanatory and exploratory) Qualitative research
Descriptions of how much, how often, how many (quantification) Quantitative research, Surveys

A quantitative approach may include the use of a survey, so you would have to develop your own survey or it may be possible to use one that is already in existence (which ensures validity and rigour). How would you administer this, e.g. face to face, online via survey monkey or via the post? A quantitative study will include a larger sample than a qualitative sample and would produce numerical data, which you would then need to analyse statistically.

A qualitative study would use a smaller sample, and different methods such as interviews, focus groups or the collection of observational data. This would mean more face-to-face contact with those that are included in your study, and analysis of data that is mostly in the form of words. You may also use visual data within research in both quantitative and qualitative approaches, so perhaps your study may use innovative methods. In choosing your approach, quantitative data collection instruments are ideal when you are measuring an aspect of the social world, reporting attitudes and recording trends, whereas qualitative approaches are often used in a more exploratory way and to highlight participants’ views, so give consideration to this when deciding which approach you will use.

Learning Task 3: Sampling for your project

In deciding who to sample, you will need to ensure that those you include are the ones able to address your research questions. Therefore, if you are exploring women’s attitudes to childbearing, you may include women of childbearing age (with a variety of different characteristics, such as those who work, those who do not work, different religious and ethnic groups). You could also include partners of the women, too, depending upon the time that you have to complete your study. The size of the sample will be influenced by who is available and willing to participate, as well as the overall methodology that you are using, e.g. a quantitative study involving a questionnaire will include perhaps 100 respondents, whereas a qualitative study may involve semi-structured interviews with 10 people. You will also need to think about how you will get access to your sample, e.g. will it be through a specific organization such as a university or school, or will you use existing networks? There is no perfect sample and often there are limitations with sampling, but a good researcher will be able to recognize these and write about them within their dissertation.

Learning Task 4: Appraising evidence for your project

These questions are a useful starting point to guide your reading and to develop your critical appraisal skills. You will also need to think about how the literature that you appraise relates to your specific research focus.

Here is an example of how you can apply such questions to summarize a paper. The paper under critical scrutiny is Cunningham-Burnley, S. and Irvin, S. (1987) ‘And have you done anything so far? An examination of lay treatment of children’s symptoms’ British Medical Journal 295, pp. 700-702.

Paper is about Lay treatment of children’s illnesses.
What does it achieve? It dispels myths around doctors’ expectations of mothers with sick children always expecting prescriptions.
What do we know about the authors? 1 Sociologist, 1 GP: a combination of the social and medical perspectives? Otherwise we know very little in terms of their backgrounds, ideology and values.
What is the context of the research? One Scottish GP practice.
What are the main findings? Mothers with sick children wait to contact the GP. Mothers often treat children with home remedies/over the counter medications prior to seeking GP advice. Mothers with sick children do not always expect a prescription and so the GP’s role is advisory in many instances.
What evidence? Diaries – but what of their accuracy and how were they analysed? Qualitative interview findings. Reference made to a pilot study so demonstrates rigour within the process. Analysis was done by the qualitative induction method, but this is not explained and there is a lack of transparency regarding what this involved.
How convincing are the arguments? The data provided clearly supports the arguments made and the article is in peer reviewed in a well-respected journal.
Transferability? Constraints – clear class bias, small sample, dated, all participants are married – would the results be the same if the women were single parents or if the children were cared for by men?, location – are the findings generalizable to other contexts?
Other research that is contradictory? At the time there was a lack of work in this area. So this limits criticism in some respects.

Multiple Choice Quiz

1. What is the first stage of the research process?
a. Defining the research problem/question
b. Carrying out a research design
c. Analysing the data
d. Safely storing raw data

ANSWER

The correct answer is a: to be able to start a research project there needs to be a clear specification of the research problem and then some associated research questions can be addressed.

2. One step that is NOT involved in planning all research studies is:
a. identifying a researchable problem
b. stating research questions
c. conducting a meta-analysis
d. reviewing current research

ANSWER

The correct answer is c. Whilst some systematic reviews will involve meta-analysis, not all research projects are systematic reviews therefore this is a step that is not involved in planning all research studies.

3. Sources of researchable problems include all but one of the following. Select the answer which is NOT a source of a researchable problem.
a. Theory and past research
b. A practical problem that needs a solution
c. Researchers’ own experiences and interests
d. Statements of predicted relationships between variables

ANSWER

The correct answer is d.

4. A literature review is conducted as part of the research process in order to:
a. Make predictions
b. Establish correlations
c. Become familiar with prior research in the area of study
d. Identify a sample

ANSWER

The correct answer is c.

5. Which of the following is an example of a qualitative research method?
a. Survey research
b. Semi-structured interviews
c. Experiments
d. Randomized control trials

ANSWER

The correct answer is b: as chapter 3 outlines, semi-structured interviews are associated with the qualitative tradition. Survey research, experiments and randomized control trials are associated with the quantitative tradition.

6. Which of the following is an example of a quantitative research method?
a. Focus groups
b. Participant observation
c. Semi-structured interviews
d. Questionnaires

ANSWER

The correct answer is d: as chapter 3 outlines, questionnaires are part of survey research which is associated with the quantitative tradition. Focus groups, participant observation and semi-structured interviews are associated with the qualitative tradition.

7. The group of people who participate in a research study are called:
a. a focus group
b. the sample
c. the population
d. the respondents

ANSWER

The correct answer is b. A focus group is a research method. The population is a term that refers to groups of people or organisms which live in a specific location. Respondents are those who respond to the invitation to participate in research; not all individuals in a sample necessarily respond.

8. When conducting research, ethical considerations include all but one of the following. Select the answer which is NOT an ethical consideration.
a. Protecting the anonymity of participants
b. Ensuring that informed consent is achieved
c. Assessing potential risks for participants
d. Choosing an appropriate theoretical perspective

ANSWER

The correct answer is d.

9. A mixed-method approach, also called triangulation, is one that:
a. combines both quantitative and qualitative methods
b. combines the use of interviews and focus groups
c. combines the use of questionnaires and experiments
d. combines the use of valid and reliable measures

ANSWER

The correct answer is a: triangulation is the process of combining a number of different research methods together in order to address research questions. Kalof, Dan & Dietz (2008: 208) describe it as ‘a multi-faceted approach to studying a topic. Triangulation can involve the use of multiple data sources, multiple theories and/or multiple methods to provide a more well-rounded understanding of a topic’. It need not necessarily be a combination of interviews and focus groups (answer b) or questionnaires and experiments (answer c). Answer d is also incorrect, as validity and reliability are important within the research process but triangulation specifically means the process of combining a number of different research methods together in order to address research questions.

10. Which of the following is not part of data analysis?
a. Establishing correlations
b. Using descriptive statistics
c. Thematically presenting interview data
d. Research findings feeding into society as a mechanism for social change

ANSWER

Answer d is correct because it is NOT a part of data analysis – it follows analysis as part of dissemination.

Additional Case Study: The evidence base and ‘missing’ research: the example of gender

Brown (2019) argues that research in the UK is overwhelmingly male and as a result this has had a detrimental effect upon women’s health. For example, women report feeling pressure to accept interventions in childbirth but there is a lack of evidence to support many of these common treatment approaches. Therefore, many women have unnecessary interventions during childbirth. Brown (2019) goes on to note the historical exclusion of women from clinical trials due to their hormonal fluctuations, and accompanying perceptions of the complexities associated with this. Perez (2019) discusses the same issue across research in several countries exploring different topics, again pointing out that, as a result of this bias, women’s health has suffered. There are many consequences associated with the exclusion of women from research, including more women falling and injuring themselves in winter (Swedish town officials cleared roads before pavements until 2011, not recognizing women’s complex lives in terms of childcare and shopping (more often using pavements) as well as going to work). Perez (2019) points out that the lack of sex-aggregated data in clinical trials is a significant disadvantage for women in terms of medical advice. Women, she argues, are often not thought about by male researchers. Jackson (2019) argues that medicine is constructed to reinforce discourses about women especially linked to their reproductive function, which is commonly seen by male doctors as linked to madness. Thus, many female diseases remain under-funded, under-studied and under-treated.

Medical research is biased in a number of areas, not just those related to women. Goldacre (2017) has written extensively about research bias and the publication of positive trials in the evidence-base associated with clinical trials, illustrating the serious health impacts that this has had for many people. These authors all point out that research is flawed in a variety of ways, so this is an important consideration to always pay attention to when appraising evidence.

References

Brown, A. (2019) ‘Research into pregnancy, birth and infant care are historically underfunded – and women are paying the price’ The Conversation 19th November 2019.

Goldacre, B. (2017) Bad Science, https://www.badscience.net/

Jackson, G. (2019) ‘The female problem: how male bias in medical trials ruined women’s health’ The Guardian 13th November 2019.

Perez, C. (2019) Invisible Women: Exposing Data Bia in a World Designed for Men, London, Penguin.

3 Papers

Berlin, Smith, D. & Newton, P. (2018) ‘“It’s because it’s cancer, not because you’re a Traveller” – exploring lay understanding of cancer in English Romany Gypsy and Irish Traveller communities’ European Journal of Oncology Nursing 34, pp. 49-54. LINK
This paper discusses the importance of understanding community views to support strategies to improve health, especially for marginalized populations. Lay understandings of cancer, and illness in general, vary between different ethnic groups suggesting that educational strategies and screening opportunities that work for one community may not work for another, especially in often hard-to-reach groups such as Gypsy and Traveller communities. This article illustrates the importance of qualitative contributions to the health-related evidence base.

Tsui, E.K. & Starecheski, A. (2018) ‘Uses of oral history and digital storytelling in public health research and practice’ Public Health 154, pp.24-30. LINK
This paper (based upon a narrative review) discusses the use of digital storytelling as an example research method that is useful in public health contexts and provides examples of ways that this method (and oral history) have contributed to work in several domains of public health. This links to the discussions in chapter 3 about the value of qualitative research methods, as well as the case study which discusses digital methods.

Warwick-Booth, L., Coan, S., and Bagnall, AMB. (2019) ‘Personalised housing support to improve health and wellbeing: findings from a local pilot programme in Yorkshire’ Cities and Health LINK
This paper is an example of the use of mixed methods being applied within health research. In this context, the methods are used to evaluate a partnership pilot intervention implemented by one housing association and one community healthcare service provider that aimed to improve the health and well-being of people with complex needs living in social housing stock in one area in England. The mixed-methods tools of qualitative interviews and community healthcare services usage patterns showed positive client experiences as well as cost savings. Chapter 3 introduces readers to the use of mixed methods and this is a further example of the benefit of using mixed-method approaches.

3 Websites

1. Social research methods
This is the website with resources that accompanies the 5th edition of Bryman, A. (2015) Social Research Methods. There are various links to student experience podcasts, student researcher toolkits and other links to numerous helpful research-related websites.

2. Statistics for the terrified
This is a guide to basic statistics, targeted at undergraduate students and those who are new to research and critical thinking. Several sections of the website have free content that is accessible to all.

3. Social sciences – qualitative research
This is an excellent site, capturing innovative qualitative research methods, mixed-methods approaches and their contribution to ‘real-life’ social research. There are blogs, email interviews and participant-produced videos, as well as toolkits and a variety of resources for students.

3 Media Articles

1. BBC Radio 4 – More or Less
More or Less is a BBC Radio 4 programme about numbers and statistics. The programme often presents statistical issues which pertain to topics in the news and explores the reality of the statistics that are being quoted. Episodes cover a range of topics and can be downloaded.

2. ‘Tories pledge to double dementia research funding’
This news report discusses potential funding for dementia research as part of the election campaign taking place at the time of writing – health research and health services are often the focus of governments, especially when political parties are seeking votes.

3. ‘Five research papers that revolutionised health’
This article discusses five medical research papers that have been used to implement evidence-based medicine to the advantage of patients, including the development of the smallpox vaccination, the importance of cleanliness for surgeons and the establishment of the link between smoking and lung cancer. A very useful reminder of the importance of health-related research.