International Journal of Nursing Education. January-June., 2013, Vol.5, No. 1 163
Conceptualization of a Research Study: An Exemplar
Saleema Allana1, Khurshid Khowaja2, Tazeen Saeed Ali3, Aamir Hameed Khan4, Debra Moser5
Instructor, The Aga Khan University School of Nursing, Karachi, Pakistan, 2Director of Nursing, and Assistant
Hospital Director, Al-Noor Hospital Alain UAE, 3Assistant Professor, The Aga Khan University School of Nursing
and at the Community Health Sciences Department, Karachi, Pakistan, 4Assistant Professor of Medicine, Department
of Cardiology Medicine, Aga Khan University Hospital, Karachi, Pakistan, 5Professor and Gill Endowed Chair,
University of Kentucky, College of Nursing, Editor, The Journal of Cardiovascular Nursing, Co-Director, RICH Heart
Program and Director, Center for Biobehavioral Research in Self-Management of Cardiopulmonary Diseases
University of Kentucky, College of Nursing, Kentucky, USA
1
ABSTRACT
Conceptualization of a research study is the most critical phase, which includes several meticulous
steps. The first step in the process is to identify the common research problems that prevail in a
particular context, either through clinical observations or through literature review; each of these
sources may be used to validate the problem identified through the other. The next step involves an
in depth literature search to identify the work previously done in the field, determining the gap in
the existing body of literature and establishing the need for the proposed study. The final step of the
conceptualization phase is concerned with establishing the significance of the proposed study. This
paper reports the conceptualization of a research study conducted in Karachi, to identify the gender
differences among Acute Coronary Syndrome (ACS) patients, in terms of their prehospital delay
times and in the associated factors of delay.
Keywords: Conceptualization, Research Study, Gender Differences, Acute Coronary Syndrome, Prehospital
Delay Time
INTRODUCTION
Planning and conducting a research study is an
exhaustive, but fulfilling activity. Each step in this
process is important; however, the conceptualization
phase is the most significant one whereby the intent
of the study is finalized based on the gaps in the
existing body of literature and the significance of the
problem. The purpose of this paper is to describe the
stages in conceptualization of a research study titled
‘Gender differences in factors associated with
prehospital delay among acute coronary syndrome
(ACS) patients in Karachi, Pakistan’, conducted as part
of the primary investigator’s graduate thesis. The
process of conceptualization described in the paper
Corresponding author:
Saleema Allana
Office # 109 Second Floor, Aga Khan University School
of Nursing and Midwifery
Contact Number: 03463048085/ 02134865440 (Office)
Email: saleema.allana@aku.edu
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163
may be helpful for the novice researchers, so as to use
it as a guide.
Identification of the Research Area
The very first step in conceptualization of any given
study is the identification of a research area which is
the most relevant to the researcher’s context, and
which is the most in need of further exploration. In
the instance of the said study, it was identified through
literature review that the epidemiological transition 1
is anticipated to result in the emergence of
cardiovascular diseases as the major cause of mortality
in developing countries, within the next few years.2,3
Moreover, approximately 17.5 million deaths are
attributed to acute coronary events each year
worldwide; 80 percent of these deaths occur in
developing countries.4 In Pakistan, cardiovascular
mortality accounts for 12% of all deaths.5 This grave
situation in Pakistan and other developing countries,
with respect to the cardiovascular morbidity and
mortality, led the investigators to choose
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164 International Journal of Nursing Education. January-June., 2013, Vol.5, No. 1
‘cardiovascular diseases’ as their area of interest for
this study.
Clinical and Theoretical Significance of the Research
Topic
The next step in the process of finalizing the thesis
topic was aided by the primary investigator’s clinical
experience. During the researcher’s clinical experience
at one of the renowned tertiary care hospitals of
Karachi, it was quite alarming to see that many patients
arrived hours and even days after the onset of acute
coronary syndrome (ACS) symptoms and ended up
with complications, poor prognosis and even death.
The review of literature further confirmed the
significance of prehospital delay in ACS. Literature
showed that although reducing the prehospital delay
time is important for any given set of symptoms, its
significance increases in ACS due to its devastating
consequences. Prehospital delay in ACS is a barrier to
early reperfusion, and hence, it is an important
predictor of the complications associated with ACS,
such as loss of cardiac muscle with subsequent
reduction in ejection fraction, increased incidence of
arrhythmias and higher mortality.6 The impact of
prolonged prehospital delay time on the clinical
outcomes of ACS patients is evident by the fact that
every 30 minute delay in reperfusion after an acute
coronary event increases the risk of 1 year mortality
by 7.5 times.6 Besides worsening the clinical outcomes
and the chances of survival, prehospital delay in ACS
also has financial implications for the patients, as it
increases the cost associated with the treatment due
to the complications. It was surprising to see that
despite the widely acknowledged significance of
prehospital delay in ACS, quite prolonged delay times
have been reported among ACS patients in various
developed and developing countries.7, 8,9,10
Another aspect of the researcher ’s clinical
experience further helped in determining the final
thesis topic. In researcher’s clinical experience, it was
quite distressing to see that women delayed longer
than men in reaching the hospital after the onset of
ACS symptoms. The observation of gender disparity
in prehospital delay times of ACS patients led the
researcher to look for international trends through a
comprehensive literature review. The literature review
affirmed the trend of gender differences in prehospital
delay times of ACS patients. Literature further showed
that the factors associated with prehospital delay may
vary between men and women, as gender has been
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164
found to be one of the important factors contributing
to the treatment seeking behavior. 11 Differences
between the genders in factors related to prehospital
delay can be explained on the basis of biological and
social theories. One of the most important explanations
for gender differences in treatment seeking for ACS is
the varying presentation of ACS symptoms among
men and women. Studies around the world have
established that women with ACS present with more
atypical symptoms like jaw pain, back pain,
indigestion, shortness of breath, and nausea or
vomiting, as compared to the men who mostly present
with typical symptoms like crushing chest pain.12, 13, 14
Atypical presentation of symptoms often leads to an
incorrect assessment of the source of the symptoms,
which results in the subsequent delay in treatmentseeking. 15 Additionally, gender plays quite an
important role in determining treatment seeking
behavior among South Asian residents. The social
explanation for gender differences in health-seeking
derives from the deprived conditions that women in
South Asia are subject to, and from the male dominance
in decision making related to health and other issues.16,
17
Women in this part of the world are more prone to
delay in seeking care for ACS symptoms because they
can neither make nor exercise their choices in accessing
health care. 18, 17 In contrast, South Asian men are
susceptible to delay due to their need to portray the
traditional masculine characteristics of courage and
physical strength.
Determining Gap in the Existing Body of Literature
Thus, after a thorough literature review, this study
was planned considering the fact that studies done in
the West have demonstrated gender differences in
treatment seeking for the ACS symptoms; 19, 20, 21
however, to the best of the researchers’ knowledge,
before this study, no study had been conducted in
Pakistan to evaluate gender differences in factors
associated with prehospital delay in ACS.
Establishing the Significance of the Proposed Study
Another important step of the conceptualization
phase is establishing the significance of the proposed
study. This study was deemed to be significant because
the subject of prehospital delay among ACS patients
was a novel area that was to be explored in the
Pakistani context for the very first time. This study was
an attempt to identify gender-specific factors that
contribute to delay among men and women diagnosed
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International Journal of Nursing Education. January-June., 2013, Vol.5, No. 1 165
with ACS in Karachi, Pakistan. It was hypothesized
that the factors associated with delay among Pakistani
men and women may be different as compared to the
factors that have been identified in Western studies,
due to cultural differences and difference in the social
status of the two genders in Pakistan. It was expected
that the study findings will help in targeting the gender
specific factors of delay, subsequently preventing the
complications and mortality associated with delayed
treatment in ACS.
6.
7.
8.
CONCLUSION
In conclusion, this research study was
conceptualized based on: the rising trend of
cardiovascular morbidity and mortality in Pakistan;
strong evidence from the literature suggesting the
importance of prehospital delay in ACS and the
presence of gender disparity in treatment seeking for
the ACS symptoms, worldwide; and a substantiation
of the fact through the researchers’ clinical experience
within the local context. Based on this evidence, an
analytical, comparative, cross-sectional study was
planned which intended to explore gender differences
in the prehospital delay time and its associated factors,
among ACS patients in Karachi, Pakistan.
Conflict of Interest: nil
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