RESEARCH

Polly T. Chua-Chan, MD, MPH, MHA, FPAFP

RESEARCH
A scientific investigation to discover new
knowledge and to test this knowledge
It is an orderly system of solving problems.
Research is a tool for growth of science, a tool
of human and environmental development.

Other Uses of Research

Evaluation of programs, procedures and
systems
e.g. Determination of efficiency or
effectiveness of delivery of a service

PURPOSE of RESEARCH in Medicine

The general purpose of research is to develop
new knowledge and technology
translated to skills and tools needed to
improve the practice of the profession and the
provision of services for the attainment of
health for the people.

BASIC STRATEGIES:
1. Description of the nature of events by
observation of all members of a defined
population or an adequate representative
sample.
2. Generation of hypothesis of relationship/
association from analysis of prevalence rates
in different sub-groups of a defined
population.

BASIC STRATEGIES:
3. Testing of hypothesis by comparison of
frequencies of factors/ conditions in different
groups.
4. Formulation of solutions/ interventions based
on findings of previous studies.
5. Testing of solutions by comparison of
frequencies of outcome in experimental and
control groups.

BASIC STEPS:
I. Identification and Definition of the Problem
1.1 Analysis of needs
1.2 Review of the Literature
1.3 Determination of the Significance of the
Problem
1.4 Formulation of Hypothesis and
Categorization of the variables

BASIC STEPS:
2. Planning the Research
The Plan of Investigation includes:
2.1 Statement of Objectives
2.2 Study Population and Selection of subjects
2.3 Research Design
2.4 Method of Data Collection
2.5 Plan of Data Processing and Analysis

BASIC STEPS:
3. Implementation of Plan
3.1 Data Collection
3.2 Data Processing
3.3 Data Analysis
4. Interpretation and Conclusion
5. Reporting of Study

PROBLEM IDENTIFICATION AND

CLARIFICATION

Session Objectives:
At the end of the session, the learner should be
able to:
1. Identify a research problem.
2. Clarify the problem.
3. State the research question properly.

RESEARCH PROBLEM
The research problem is the question to be
answered or resolved.
It is the issue to be settled.
It does not represent a moral or ethical
position on an issue.

RESEARCH PROBLEM
Research is a problem-solving process.
Without a problem, there is no need for one
to undertake research.
The research problem is central to research
its identification and definition is the starting
point of any research activity.

Research Question usually asks about:

1. The nature or characteristics of an event or
phenomenon, such as:
- anatomic structure
- physiologic principle
- biochemical pathway
- pathologic process
- pharmacologic action
- clinical course of illness
- disease pattern in population

Research Question usually asks about:

2. The relationship between two or more
variables or events, such as:
- precursor and product
- exposure and outcome
- cause and effect
- factor and prognosis
- intervention and result
- process and reflections

WHERE DO RESEARCH PROBLEMS

COME FROM?
1. Intellectual curiosity
-

Most common source of research problem

In the course of practice, one often comes across
some problems he cannot solve or questions he
cannot answer.

WHERE DO RESEARCH PROBLEMS

COME FROM?
2. Serendipity
Something happens at the right time
and place to the right individual.
Or an idea simply comes up to the
individual who has a research interest.

WHERE DO RESEARCH PROBLEMS

COME FROM?
3. Analysis of needs and practice
Identification of research problems by
careful appraisal of the state of the art
or situational analysis of the particular
subject of interest to them.

WHERE DO RESEARCH PROBLEMS

COME FROM?
3. Analysis of needs and practice
From the analysis, gaps in knowledge,
technology or skill for which research is
indicated are identified.

WHERE DO RESEARCH PROBLEMS

COME FROM?
3. Analysis of needs and practice
A complete study of the state of the
art requires critical review of available
documents on the subject.

WHERE DO RESEARCH PROBLEMS

COME FROM?
4. Organized and systematic
determination of research needs.
- PCHRD
- NUHRA
- NIH

WHAT IS A GOOD RESEARCH

PROBLEM?
1. Researchability
A problem is researchable if it can be resolved
through research.
That it can be tested empirically, data can be
collected to answer the question or resolve the
problem

WHAT IS A GOOD RESEARCH

PROBLEM?
1. Researchability
A problem that requires value judgement
cannot be tested.
E.g. Is induced abortion immoral?
What can be resolved is what the values of
people are. Ex. What percent of the people
think or believe induced abortion is immoral?

WHAT IS A GOOD RESEARCH

PROBLEM?
2. Significance
It matters what the answer is.
The problem:
- affects a large population
- has serious morbidity consequences
- is related to on-going projects

WHAT IS A GOOD RESEARCH

PROBLEM?
2. Significance
It matters what the answer is.
The answer:
- fills a gap in knowledge or technology
- has practical application
- will improve the practice of the profession

WHAT IS A GOOD RESEARCH

PROBLEM?
2. Significance
It matters what the answer is.
The concepts and ideas are novel and the
problem is not over researched in the past.
The potential result is worth the effort, time and
money that will be put into the research.

WHAT IS A GOOD RESEARCH

PROBLEM?
3. Feasibility
The methodology that will be required in answering
the question must be feasible and practical.
- adequate subjects can be gathered for the study
- the procedures are technically possible
- the information needed can be collected
- Resources are available
- the study can be completed within a reasonable
period

WHAT IS A GOOD RESEARCH

PROBLEM?
Other considerations:
1. Critical Mass
The problem is broad and large enough
such that there would be adequate mass of
information to work on;
The problem should not be too specific
and small in scope

WHAT IS A GOOD RESEARCH

PROBLEM?
Other considerations:
2. Interest
There must be current interest in the
problem area.
It must be in the priority of or within the
national or institutional mission.

AFTER IDENTIFICATION OF THE

PROBLEM...
Planning of the research cannot proceed until
the problem has been adequately dissected
and clarified.

A thorough literature review is a must

DISSECT AND CLARIFY THE PROBLEM

Breakdown the problem into smaller
components or subproblems
Help in understanding and clarifying the problem
Guide us in setting more achievable or realistic
goals, choosing the appropriate methods and
identifying variables and parameters for the study
as well as interpreting the results.

DISSECT AND CLARIFY THE PROBLEM

Each component or subproblem should be
researchable.
The answer to the subproblems, when
taken together, should be adequate in
answering the main question or resolving the
main problem.

DISSECT AND CLARIFY THE PROBLEM

Problem clarification is aided by literature
review and/ or consultation with experts.
These can provide information on the state of
the art, what has been done, and the
methods used in resolving similar or related
problems.

TASKS:
1. Select a problem which you will pursue .
2. What are the various facets/components of
your problem?
3. Review the literature.
3.1 What is the state of knowledge regarding
your problem?
3.2 What facets of your problem have not
been resolved?

TASKS:
4. Considering the criteria in problem selection.
4.1 Is your problem testable/researchable?
4.2 Will the answer fill a gap in literature or
improve the state of knowledge?
4.3 Will the solution to the problem improve
the practice of medicine?

TASKS:
5. Consult with an expert in your subject.
5.1 What does he say about the problem?
-- its significance?
5.2 What are his suggestions?

FORMULATION OF HYPOTHESIS

Session Objectives:
At the end of the session, the learner should be
able to:
1. Differentiate the types of research
hypothesis.
2. Formulate logical hypothesis for a given
problem.

WHAT IS A HYPOTHESIS?
A suggested or tentative answer to the
research problem
Usually a researcher has some ideas as to
what the answers are to the general problem
and subproblems of his intended research.
Stating the answers in the form of declarative
sentence constitutes or converts the problem
statements to hypothesis.

Why is it Necessary to Formulate

Hypothesis?
A hypothesis provides the basis for the testing
of the statistical significance of the findings of
the study.
It helps the researcher in establishing the
framework with which to approach the
problem.

Why is it Necessary to Formulate

Hypothesis?
Studies should have sample size
determination: a hypothesis is essential for
this.
Even a descriptive study requires an adequate
sample size to produce statistical data of
adequate reliability.

TYPES OF HYPOTHESIS:
Hypothesis may be classified as:
A. Null Hypothesis (H0)
B. Alternative or Positive Hypothesis (H1 or HA)
1. Two-tailed or Non-directional
2. One-tailed or Directional

Null Hypothesis
Is one that assumes that association does not
exists
(a) sample is not different from a population
(EQUALITY OR NO DIFFERENCE)
(b) The independent variable (suspected cause) is
not associated with the dependent variable
(outcome)
(c) an intervention is not effective or more effective
than another intervention

Null Hypothesis:
The serum uric acid level of diabetics is not
elevated.
Coffee drinking does not cause coronary
artery disease.
Ligation of the internal mammary artery does
not improve coronary circulation.
Metaproterenol and theophylline have equal
efficacy in the treatment of asthma.

Alternative Hypothesis:
The opposite of the null hypothesis
Assumes that an association exists
Researchers hypothesis

Two-tailed or Non-directional
Alternative Hypothesis:
Does not indicate direction of the association
such as whether it is direct or inverse;
OR which is greater or lesser when two
samples are being compared.

Two-tailed or Non-directional
Alternative Hypothesis:
Socio-economic conditions and drug abuse are
associated.
The serum uric acid level of diabetics varies
from the normal values.
Metaproterenol and theophylline differ in
efficacy in the treatment of asthma.

One-tailed or Directional
Alternative Hypothesis:
Gives the direction of the relationship, OR
States which is greater or lesser when two
samples are being compared.

One-tailed or Directional
Alternative Hypothesis:
Socio-economic conditions and drug abuse are
inversely associated.
The uric acid level of diabetics is higher than
normal.
Metaproterenol is more efficacious than
theophylline in the treatment of asthma.

One-tailed or Directional
Alternative Hypothesis:
The sample size required is smaller when the
hypothesis is one-tailed.

SOURCES or BASIS of Hypothesis:

Hypothesis formulation begins with
identification of factors which may have a
relationship with the outcome of interest.
The factor is identified through the analysis of
data from existing descriptive or crosssectional studies.

Hypothesis may be generated

through:
1. Method of difference
- Get a population (or sample) with a high
frequency of the outcome. - Look for
factors which are prevalent in the first and
non-prevalent in the second. - Such factors
can be suspected of having something to do
with the occurrence of the outcome.

Hypothesis may be generated

through:
2. Method of Analogy
- Search for an outcome with a similar
pattern of occurrence as that of the outcome
of interest.
- If the causation of the first is known or
established, a hypothesis of relationship
similar to this known causation may be
formulated.

Hypothesis may be generated

through:
3. Method of Concomitant Variation
- If the occurrence of the outcome of interest
fluctuates, look for factors that
correspondingly fluctuates.
- Such factors could be causally related to the
outcome.

Hypothesis may be generated

through:
4. Method of Agreement
- Examine the distribution of the outcome
according to different descriptive variables
such as person, time or place.
- Look for factors that are similarly
distributed or fellow travellers of the
outcome.
They are possible causes of the outcome.

STATEMENT OF THE HYPOTHESIS:

After a factor has been identified, it may be
incorporated in the research question or
subquestion which is reestated in a declarative
sentence to form the hypothesis.
If information on the degree of relationship is
available it is of value to include it in the
hypothesis.

Examples of Hypothesis:
The incidence of coronary artery disease is
five times in cigarette smokers than in nonsmokers.
The efficacy of metaproterenol in the
treatment of asthma is 50% greater than that
of theophylline.

SETTING OF OBJECTIVES

Session Objectives:
At the end of the session, the learner should be
able to:
1. Formulate research objectives.
2. Identify relationship between different
types of variables.
3. Determine appropriate indicators for a
scientific study.

OBJECTIVES
Defines the expectations of the research
Gives the direction of the research

OBJECTIVES
Objective is the aim or goal of an action.
In research, it is what the researcher expects
to achieve or the outcome he hopes would be
produced by the study.
It is the solution to the research problem; its
attainment will give affirmation or nonaffirmation to the hypothesis that has been
formulated.

Importance of Stating the Research

Objectives:
1. Gives an indication of the relevant variables
to be considered in the study
2. Guides the researcher in the choice of
research design or methods
3. Tells the researcher what data to collect

Importance of Stating the Research

Objectives:
4. Helpful in planning the analysis of the results
5. Bases for the interpretation of results

How Research Objectives are

Stated
There are two types of objectives:
- General and Specific
The general objective is the overall purpose of
the research. It is derived from the statement
of the broad problem and the hypothesis.

How Research Objectives are

Stated
General Objective
It is stated by transforming the problem statement
from an interrogative (question) form to a run-off
declarative expression introduced by the phrase
to determine or similar phrases.

How Research Objectives are

Stated
General Objective
Examples:
- To determine if there is a relationship
between socio-economic background and
drug abuse.
- To establish the magnitude and pattern of
occurrence of coronary heart disease in
Manila.

How Research Objectives are

Stated
General Objective
Examples:
- To determine if continuous deworming
can eradicate ascariasis.
- To determine the accuracy of two-hour
postglucose serum sugar level in detecting
diabetes mellitus.

Specific Objectives:
Statements of the specific outcome expected
of the study
The statements of the subproblems provide
the basis for the formulation of the specific
objectives following the same process as in
the formulation of the general objective.

Specific Objectives should satisfy

the following criteria:
1. Adequate to meet the purpose of the
study
the attainment of the specific objectives, taken
collectively, should enable the researcher to
achieve the general objective

Specific Objectives should satisfy

the following criteria:
2. Written clearly as statements which
incorporate the specific hypotheses and
specify the variables.
3. Expressed in measurable term the outcome
is in quantitative form, preferably in term of
indicators

EXAMPLES of OBJECTIVES:
General Objective To determine the
effectiveness and safety of vaccine A against
disease X.
Specific Objectives:
1. To determine difference in the incidence
rate of the disease in the vaccinated and
control groups.

EXAMPLES of OBJECTIVES:
Specific Objectives:
2. To determine the protective value of the
vaccine
3. To determine how long it takes for the
vaccine to take effect
4. To determine the duration of the
effectiveness of the vaccine

EXAMPLES of OBJECTIVES:
Specific Objectives:
5. To determine difference in the case fatality
rates in the vaccinated and control groups.
6. To compare the frequency and severity of
adverse reactions in both groups .

Specific Objectives:
The specific objectives are based on the
components of the broad problem.
If they are achieved, the investigator would be
able to deduce if the vaccine is effective and
how effective against the disease.

Specific Objectives:
The specific objectives are clearly stated in
measurable terms e.g. Attack rates,
protective value, duration of protection,
severity and frequency of adverse effects.
The variables are specified.

SMART

S Specific
M Measurable
A Attainable
R Realistic / Relevant
T Time Bound

Should not be value-laden (non-judgemental)

VARIABLES
Qualitative
Quantitative
- Discrete
- Continuous
Independent
Dependent
Confounding

INDEPENDENT VARIABLE
The factor that affects the value of the
dependent condition that produces the
outcome.
In a cause-effect relationship, it is the cause.
In an experiment, it is what the researcher
manipulates or varies

DEPENDENT
VARIABLE
The factor whose value is affected by the
independent variable.
It is the outcome of a process
It is the effect in a cause-effect relationship
It is the indicator of change in the event

CONFOUNDING VARIABLE
A variable which is not the principal interest in
the study, but it distorts the results of the
study because it is associated with both the
independent and dependent variables.
Control variable

Confounding Variables
Example: In a study of smoking and coronary
artery disease, unless the sex composition is
controlled, more females would find their
way in the non-smoking group. As a
consequence, the CAD rate in this group
would be lower than in the smoking group
whether or not smoking influences CAD
occurrence, since females are protected by
estrogen.

VARIABLE
The variable must be defined in operational
term and not in conceptual or dictionary
definitions.
Meaning, the researcher should define the
variable according to what it means in the
research.

Operational Definition:
Rheumatic Heart Disease
A person shall be labelled a case rheumatic heart
disease if he has both of the following:
- Stenosis and/or insufficiency of the mitral and/or
aortic valves
- History of rheumatic fever confirmed by the
presence of carditis and/or migratory polyarthritis,
and an elevated ASO titer.

INDICATOR
Indicators are the computed or collated
collective characteristics of the persons
making up the study population.
Examples:
- Measurements mean, variance and
frequency distribution
- Counts rates and ratios of disease
occurrence (incidence, prevalence, death rate)