An Introduction to Health Services Research
Publication Year: 2014
Subject: Health Services Research (general)
This is a primary, comprehensive textbook for people who are considering undertaking a piece of health-related research. It is an accessible companion with the aim of getting the reader to think broadly about all of the issues that need to be considered when embarking on a project. This is a pragmatic book, a step-by-step guide to research which mirrors the structure of a research project, taking you through the thought process for designing and conducting your study from formulating the right research question at idea inception, ascertaining what methodologies and analysis can answer what type of questions, right through to dissemination, all presented in an easy, digestible style. The book is full of case study illustrations and practical tips such as how to work out ...
- Front Matter
- Subject Index
Part I: Getting Started
- Chapter 1: Asking the Right Question
- Chapter 2: Finding the Evidence to Support your Research Question
- Chapter 3: Critical Appraisal
- Chapter 4: Developing an Effective Research Proposal
- Chapter 5: Budget and Funding
Part II: General Methodologies
- Chapter 6: Quantitative Data Collection
- Chapter 7: Qualitative Data Collection
- Chapter 8: Mixed Methods
Part III: Specific Methodologies
- Chapter 9: Health Economics
- Chapter 10: Epidemiology
- Chapter 11: Clinical Trials
- Chapter 12: Surveys
- Chapter 13: The Internet as a Research Medium
- Chapter 14: Systematic Reviews
Part IV: Conducting Valid and Ethical Research
- Chapter 15: Designing and Conducting an Ethical Research Study
- Chapter 16: Patient and Public Involvement in your Research
- Chapter 17: Sampling
- Chapter 18: Recruitment and Retention
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Chapter 1 © Peter Blair and Andy Barton
Chapter 2 © Mary Edmunds Otter and Christine Keen
Chapter 3 © Christine Keen and Mary Edmunds Otter
Chapter 4 © Jane Dyas and Paul Leighton
Chapter 5 © Roz Sorrie, Andy Barton, Helen Hancock and Helen Close
Chapter 6 © Laura Gray and Katherine Payne
Chapter 7 © Jonathan Ives and Sarah Damery
Chapter 8 © Doreen Tembo
Chapter 9 © Matthew Jones & Casey Quinn
Chapter 10 © Puja Myles & Peter S. Blair
Chapter 11 © Paul Silcocks & Adrian Gheorghe
Chapter 12 © Roy Powell
Chapter 13 © Penny Benford & Dawn-Marie Walker
Chapter 14 © Jo Leonardi-Bee & Olwyn M.R. Westwood
Chapter 15 © Mary Patricia Tully & Gordon Taylor
Chapter 16 © Raksha Pandya-Wood & Andrew Robinson
Chapter 17 © Nick Taub, Abdel Douiri & Dawn-Marie Walker
Chapter 18 © Victoria Hall Moran & Diane Whitham
Chapter 19 © Nick Taub & Dawn-Marie Walker
Chapter 20 © Caitlin Notley Gill Green & Louise Marsland
Chapter 21 © Carol Rivas & Raksha Pandya-Wood
First published 2014
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Library of Congress Control Number: 2013937333
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ISBN 978-1-4462-4738-9 (pbk)
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Printed and bound in Great Britain by Ashford
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Notes on Contributors[Page vii]
Andrew Barton has an academic background in psychology but has been working as a generalist in health services research for thirty-five years. He has worked as a lecturer and senior lecturer at the medical schools in Newcastle and Cardiff and is currently Associate Professor in Health Services Research at Plymouth University Peninsula Schools of Medicine and Dentistry.
Dr Leonardi-Bee completed an MSc and PhD in medical statistics, and is an Associate Professor in medical statistics. Her areas of expertise focus on systematic review and meta-analysis of epidemiological studies and randomised controlled trials, and analysing large databases. She is the Statistical Editor of the Cochrane Collaboration Skin group, and has published widely in the areas of tobacco control, dermatology, and respiratory medicine.
After eleven years as a speech and language therapist within the NHS, Dr Benford was awarded a PhD in 2008 for her investigation of the use of the internet as a communication medium by people with Asperger syndrome. Since its completion, she has been working as a researcher within the School of Community Health Sciences at the University of Nottingham.
Dr Peter Blair has a background in medical statistics and a particular interest in infant and childhood epidemiology and is now a Senior Research Fellow at the University of Bristol. From his work on several major observational studies he is a recognised expert in Sudden Infant Death Syndrome and was made an honorary fellow and advisor to UNICEF, is the vice chair of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) and chair of the epidemiological working group.
Dr Helen Close is a health research methodologist with the Research Design Service (North East) and an academic trialist in Durham Clinical Trials Unit at Durham University. Helen has a clinical background in community and palliative care, and her research interests focus on end-of-life care. Her current research focuses on mixed-methods approaches to cardiovascular disease and gastrointestinal disorders.[Page viii]
Dr Sarah Damery is a research fellow in clinical epidemiology at the Department of Primary Care Clinical Sciences, University of Birmingham. She has expertise in the use of both qualitative and quantitative methodologies, and her research interests focus on the prevention and early diagnosis of cancer, and interventions to improve the uptake of cancer screening. She is a senior adviser for the West Midlands Research Design Service.
Abdel Douiri is an applied mathematician by background, MSc in 1998 and PhD in 2002. He is currently a Lecturer in Medical Statistics at King's College London. His research interests focus mainly on statistical and mathematical models and methods applied to medical research, with a current application in stroke and cognitive impairment.
Jane Dyas is a Senior Research Fellow with the NIHR Research Design Service for the East Midlands based at the University of Nottingham. In this capacity she has developed experience of, and insight into, the process of applying for funding. Her methodological experience is qualitative and her current research activity includes research on insomnia and health care in care homes.
Mary Edmunds Otter has been a librarian and information specialist in pharmaceutical and health fields since the 1980s. She currently works for the NIHR Research Design Service East Midlands. She gives advice on the design and methodology of systematic reviews, developing search strategies and critical appraisal, and conducts literature searches.
Adrian Gheorghe, MSc, trained as a health economist and has since been working in clinical trials. He has expertise in clinical trials methodology, evidence synthesis, decision modelling and economic evaluation, and has been involved in trial methodology research on topics such as the generalisability of trial results and clinician recruitment.
Laura J. Gray is a medical statistician currently working as a Lecturer at the University of Leicester. The main focus of her research is in the area of type 2 diabetes, focusing on early detection and prevention, including developing and validating clinical risk scores, meta-analyses, and clinical trials (in particular ordinal outcomes, complex interventions and cluster randomised trials).
Gill Green is the Regional Director of the Research Design Service East of England. She is a Professor of Medical Sociology at the University of Essex, and has been researching aspects of chronic illness since the early 1990s with a particular interest in the experience of long-term illness and the impact it has on self-identity. She has also conducted research related to socially excluded groups such as offenders with mental health problems and people living in poor-quality housing.[Page ix]
Helen Hancock is a methodologist in the Research Design Service (North East) and an academic trialist in Durham Clinical Trials Unit at Durham University. Her main area of interest is cardiovascular disease, with a current research focus in the diagnosis and management of heart failure.
Jonathan Ives is a Senior Lecturer in Bioethics in the University of Birmingham. He has expertise in applied ethics (bioethics) and the use and application of qualitative research methods. His primary research interests lie in the methodological integration of ethical and empirical research methods. He currently co-chairs the Wellcome Trust Interdisciplinary and Empirical Ethics Network (IEEN), and sits on the Royal College of General Practitioners Ethics Committee.
Matthew Jones is a PhD student in the Division of Primary Care at the University of Nottingham, with his thesis investigating the cost-effectiveness of smoking cessation during pregnancy. He studied economics before undertaking an MSc in health economics, both at the University of York. On completion of his masters, he worked at the East Midlands Research Design Service, giving advice on health economics and designing economic evaluations.
Christine Keen is an information officer for East Midlands Research Design Service, where her main role is searching for literature on health and health-related databases. She provides guidance and advice in the use of electronic databases and undertaking systematic reviews. A former public librarian Christine began working in health information after gaining an MSc in health information management.
Paul Leighton is a Senior Research Fellow in the NIHR Research Design Service for the East Midlands based at the University of Nottingham. Through his role at the RDS he has worked with researchers from a range of settings in designing studies and seeking funding. He maintains research activity in a number of clinical areas, contributing to funded studies in audiology, rheumatology, pain management and orthopedic surgery.
Louise Marsland is based in the School of Health and Human Sciences at the University of Essex. She has an eclectic mix of research interests including complementary therapies, cancer care, brain injury, women's health and vulnerable young people. Methodologically, she specialises in qualitative methods but also has expertise in longitudinal survey research.
Victoria Hall Moran is a Reader in Maternal and Child Nutrition at the University of Central Lancashire. Her research has focused on the nutritional intake of women during pregnancy and lactation. Her methodological expertise is in quantitative research design and systematic review. She is Senior Editor of Maternal and Child Nutrition (Wiley-Blackwell).[Page x]
Puja Myles is a public health specialist and epidemiologist. She is an Associate Professor at the University of Nottingham. Her main area of interest is infectious disease, with a current research focus in influenza and other respiratory diseases.
Caitlin Notley is a Senior Research Fellow in the Norwich Medical School at the University of East Anglia. She has expertise in qualitative research methodologies applied across health and social sciences and extensive experience in running qualitative studies alongside clinical trials. She has been researching in the field of addiction and substance misuse for over ten years. Her research has focused particularly on opiate addiction, exploring populations in and out of treatment. Her current research on smoking relapse prevention targets at-risk groups.
Raksha Pandya-Wood works for the Research Design Service East Midlands as the Regional Lead for Patient and Public Involvement in Research. Raksha is a Senior Research Fellow who is based at De Montfort University. Raksha is currently in the middle of her PhD looking into the impact of patient and public involvement in cancer research. Raksha's previous teaching and research projects have been on women and children living with HIV, substance misuse in minority populations and promoting independence for young people living with disabilities.
Katherine Payne is Professor of Health Economics in the University of Manchester. She has eighteen years' experience working as an academic health economist with a main research interest focusing on the economic evaluation and valuation of healthcare technologies and services. She is a senior methodologist for the North West Research Design Service.
Roy Powell has worked in health services research for the past twenty years, based at the Royal Devon and Exeter Foundation NHS Trust and the University of Exeter Medical School. He has a zoology and biostatistics background, with further training in medical statistics and epidemiology, and has co-authored over seventy peer-reviewed publications. He currently works in the NIHR Research Design Service – South West and has served on ethics committees for over ten years. His current research interest is in the prevention of skin lacerations in people with fragile skin and the elderly, using novel protective leg and arm hosiery.
Casey Quinn is a health economist and econometrician with experience in health economic analysis, economic evaluation and decision analysis, and expertise in econometrics and modelling methodologies. Casey is an associate at the University of Nottingham, where he was a lecturer for three years. There, he worked on economic evaluation alongside clinical trials and complex interventions, as well as being part of the NICE Technology Appraisal Committee. He has a PhD from the University of York.
Carol Rivas is the NIHR Research Design Service Regional (London) Lead for Qualitative Research Methods. She is also trained in cognitive neuropsychology [Page xi]and her research interests are ethnicity, communication and cognition, gender and identity, mental health and behaviour change. She currently runs an NIHR programme grant on smoking cessation. Carol also teaches qualitative research methods and lectures in medical sociology at Barts and the London School of Medicine and Dentistry. In the past she has worked as a medical journalist and as a writer for a medical communications agency.
Andrew Robinson is Patient and Public Involvement Lead for Research Design Service North East. His experience of patient and public involvement spans many years, in contexts including NHS primary and secondary care, the voluntary sector and, more recently, health and social care research. Andrew has developed a particular interest and specialism in the development of community-based models of involvement, including involvement of disadvantaged and marginalised groups and communities.
After graduating in medicine, Paul Silcocks trained originally as a pathologist, later developing an interest in epidemiology. Previously he was a Clinical Senior Lecturer at the University of Nottingham, working for the NIHR Research Design Service East Midlands and helped to set up the Clinical Trials Unit at the University. Since retirement he works at the Cancer Research UK Liverpool Cancer Trials Unit as a senior statistician, and is currently working on trials in pancreatic cancer, melanoma, head and neck cancer and chronic lymphatic leukaemia.
Roz Sorrie has worked in the NHS for over 22 years in the fields of clinical audit and effectiveness, clinical governance and research. She joined Leicestershire, Northamptonshire and Rutland Comprehensive Local Research Network (LNR CLRN) in 2008 as Lead Research Management and Governance Manager. Her role involves overseeing the research governance reviews of National Institute for Health Research Portfolio studies and ensuring that studies are resourced appropriately before they start. She also works closely with local LNR investigators and CLRN colleagues to ensure that studies can be delivered within a timely way in the NHS.
Nick Taub is a medical statistician with the NIHR Research Design Service for the East Midlands and a Research Fellow at the University of Leicester. He has collaborated on studies in a wide range of areas of medicine, currently concentrating on musculoskeletal and public health research.
Gordon Taylor is a Reader in Medical Statistics at the University of Bath, and spends part of his time working for the NIHR Research Design Service South West. He has experience of being a member of grant funding panels, as well as ethics committees. His research interests are in the health and well-being of the NHS workforce, older adults and those with high cardiovascular risk.
Doreen Tembo is a Senior Research Officer working with the NIHR Research Design Service for the East of England and the University of Essex. Dr Tembo specialised in [Page xii]global health policy and policy making in the field of HIV/AIDS with a focus on resource poor countries for both her MSc and Doctorate at the University of Oxford. She is a mixed-methods specialist whose research experience lie in health policy, health promotion, patient and community experiences of health and health care.
Mary Tully is Reader in Pharmacy Practice in the University of Manchester. She also works one clinical day per week. She has served on and chaired research ethics committees for the past thirteen years. Her main research interests are about prescribing, especially hospital and non-medical prescribing, including patient safety and the measurement of the outcomes.
Dawn-Marie Walker currently works at the NIHR Research Design Service for the East Midlands. After an undergraduate degree in psychology and an MSc in research methods and statistics in psychology, Dr. Walker went on to complete a PhD looking at the cognitive function in early-onset psychosis. She is a mixed-methods researcher, with vast experience of conducting research concerning mental health, complementary medicine and studying complex interventions. She is also very interested in emergent online research technologies and public, patient involvement.
Olwyn M. R. Westwood is Professor of Medical Education and the Associate Dean (Education Quality) at Barts and The London School of Medicine and Dentistry and has worked for around twenty years in medical and health care education. She is recognised for her work in integrated medical curricular design, and her expertise has led to her being called upon as an adviser in Europe, China, Brunei and Australia. She has a keen interest in making biomedical sciences education accessible and relevant in medicine.
Diane Whitham is Deputy Director of the Nottingham Clinical Trials Unit based at University of Nottingham. She has over twenty years of commercial and academic clinical trials management experience. Her trial methodology research interest is site identification and selection.
To all of those people throughout my life who believed in me when sometimes I didn't believe in myself. I am forever grateful for your support and kindness. Thank you x[Page xiv]
The teacher who is indeed wise does not bid you to enter the house of his wisdom but rather leads you to the threshold of your mind. (Khalil Gibran)
I wish this book had been around when I was first starting out in research. I am not a born nerd (although I guess I would be described as one now), and did not find research easy initially. I remember after a further statistics masters class I would go home and pull out three or four textbooks and have to read the section regarding that analysis in them all. Bits would make sense in one, other bits in another, and so on … together giving me an overall understanding. I think that this lack of innate ability to understand research methods and analysis has enabled me to be able to communicate the complex process of research in a manner which my former self would have understood and appreciated, and I hope you do too.
I strongly believe that the best way to learn about research is to actually do it (hence the quote above)! However, from my experience as an academic working within health services research, I noticed that there were no easy-to-engage-with textbooks to take students and health service professionals through their projects from start to finish. I designed this book to be a ‘guide’ through the process, which mirrors the steps that one takes in a project, from ‘Asking the Right Question’ right through to ‘Dissemination’ with lots of examples and case studies, so that the topic comes alive and is more tangible. The book is not written in a theoretical, academic or intimidating way. My experience has taught me that often people do not want to know the theory behind the methodology, just how to do it! If you do wish to explore any area further, we have incorporated a further reading section in each chapter. My aim is to get you thinking broadly about all of the issues that need to be considered when embarking on a project, and then prompting you to access further resources and support to enable you to produce a good study.
This book will be useful for any student project, whether undergraduate or postgraduate, and any health service professionals who would like to conduct a study who are new, or fairly new, to research, and who have little knowledge of how to conduct health services research. Maybe this book will support you in your first ever journey into a piece of health services research, and you will go onto become an eminent professor! Some of you might try and decide it is not for you: [Page xvi]research definitely has the ‘marmite factor’; people either love it, or hate it. However regardless of whether you enjoy the experience or not, at some stage you may need a research portfolio for career progression, or you may have a good idea to improve patient care that you need ‘evidence’ for in order to be able to implement it. This book will provide enough information for you to make an informed decision whether you would like to take your idea forward, and whether it is possible to do so.