PUBH 4333 Spring 2019 Review for Mid-term Chapter 1 ● Planning a program ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ● ● 1.Needs Assessment 2.Literature Review 3.Research Questions 4.Logic Model 5.Qualitative Data 6.Quantitative Data 7.Budget and Stakeholders 8.Evaluation 9.Data Analysis 10.Final Report The differences between research and evaluation Developing a research question ○ Concentrate on important & changeable issues ○ Use needs assessment results to answer questions: ■ Perception of proposed program? ■ Extent of problem confirmed? ■ Project priority level? ■ Long-term increasing trend? ○ Who? Identify target population ○ What? Describe main purpose ○ When? Determine length of study ○ Where? Describe location of study ● Role of the stakeholder ○ ○ ○ ○ ○ ● Plan, implement, and evaluate program Empowered to sustain community projects Embrace disenfranchised groups Provide legitimacy to community partners Diverse roles & power offer diverse perspectives Types of evaluation ○ Formative ■ ■ ■ ■ ■ ○ Aka “exploratory evaluation” Conducted during planning & implementation phase Includes qualitative and/or quantitative data Data collected at each phase Program modified as needed Summative ■ Measurement about impact, outcome or benefits ■ Conducted by external evaluators ■ Uses quantitative data ○ Process ■ ■ ■ ■ ■ ○ Examines program fidelity & implementation Investigates the organization & administration Monitors the feedback of the program Investigates issues which influence implementation Investigates the environment surrounding program Outcome ■ ■ ■ ■ Uses data to document short-term results Descriptive data defines output activities Documents stakeholders satisfaction level Documents social influence on output activities Chapter 2 Ethics ● Tuskegee ○ ○ ○ ○ ○ ○ ○ ○ ● ● 1932: Study of the progression of syphilis 600 African American men in Macon County, Alabama 399 participants had syphilis 201 participants did not have syphilis Participants received free medical exams, meals and burial insurance Were never allowed to quit participation in study Did not receive treatment for syphilis Never told that they were participating in a research study Henrietta Lacks Respect for her cells ○ ○ ○ ○ ○ ○ 1951: African American woman diagnosed with cervical cancer A piece of her tumor was used to grow a cell line for research The immortal cell line was named HeLa First human cell to grow in cultured medium Her cells were used for 25 years after her death Was not compensated for research profits Medical Ethics-Basic ethical considerations ○ Respect for persons or autonomy ■ ■ ■ ■ Persons are treated with respect Given enough information to make informed decision Autonomy reassessed throughout research Individuals with diminished decision-making capacity need extra protection ■ Self-determination and understanding of risks and benefits are maintained ○ Beneficence ○ Justice ■ “Do no Harm” related to Hippocratic Oath ■ Assumes that risks are minimized as individuals and society benefit from participation in research ■ •Researchers are required to stop study if participants are harmed ■ Fair distribution of burden and benefits ● Individual justice: specific volunteers are recruited because they would potentially benefit from the research and other volunteers are specifically not recruited due to undesirable traits or medical conditions. ● Social justice: equal distribution of research benefit or burden across the target population rather than a select portion of the population ● ○ Nonmaleficence ○ Paternalism ○ Utilitarianism ■ relationship of uneven power between a health care provider and patient ■ the decision, behavior or action that achieves the greatest good for the greatest number of people IRB role ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ● ■ refraining from causing harm or acting with malice toward a person Institutional Review Board Approve, monitor and review research that involves human subjects Protect the rights and welfare of the research subjects Requirements for research approval from IRB committee include: Research protocols and amendments Written informed consent forms Participant recruitment procedures and advertisements Written information provided to participants Research plan Information about availability of compensation and schedule of payments Safety information HIPPA ○ ○ ○ ○ ○ 1996: Health Insurance Portability and Accountability Act (HIPAA) Individuals determine who may read or receive a copy their medical records Add corrections to their medical records Give permission for sharing health information File a complaint with the health care provider, health insurer or the federal government Chapter 3 ● Social determinants of health ○ Complex relationship of factors that influence an individual’s or population’s health ○ Good health does not always equal the absence of disease ○ Healthy People 2020: improve an individual’s social and physical environments to improve health ○ In research: must look at whole individual participating in study ○ When conducting research one must recall social disparities ○ It is helpful to make a list containing the headings: ■ Health provider concerns ■ Health disparities and social determinants of health ■ Ways to reduce barriers ○ Obesity ■ Multi-level condition ■ Lack of physical activity ○ ○ ○ ○ ○ ○ ○ ○ ○ ● ● ■ Increased sedentary lifestyles ■ Leads to increase in chronic illnesses ■ Occurs over a long period of time ■ Investigate the physical, psychological and social aspects Educational Disparity: ■ In research, these literacy suggestions should be followed: ■ Place the most important information first ■ Group information together to increase understanding ■ Write in active voice Language Barriers ■ Determine an individual’s level of literacy in their native language before assuming a lack of health knowledge ■ Use a translator when needed ■ Use simple 1-2 syllable words rather than standard medical terminology ■ Provide a phonetic pronunciation of medical terms ■ The readability score of plain language documents should not exceed a 5th grade reading level Access to Health Care ■ Lack of insurance ■ Lack of transportation ■ Lack of funds to cover copayments and services not covered by insurance company ■ Lack of access leads to increase in untreated chronic illnesses ■ Increased health care spending does not equal improved health and longer life expectancy Safe Food Food Security ■ Availability of nutritious, adequate and safe food ■ Ability to acquire acceptable foods without stealing or using emergency food supplies Food Insecurity ■ A household economic condition of uncertainty about availability to regularly obtain nutritious, adequate and safe foods Hunger ■ An individual’s condition resulting from food insecurity Employment ■ Lack of or inadequate employment causes decreased ability to obtain food, education, health care, and childcare ■ If housing cost is over 50% of income, then homelessness risk is increased ■ Homelessness can lead to disability, domestic violence, mental illness and addiction disorders Safe Housing ■ Affordable Housing ○ A family paying less than 30 % of its annual income on housing ○ When cost a greater than 30% then difficulty paying for food, clothing, transportation and medical care Healthy People 2020 Health disparities ○ Health difference that is closely linked with social, economic, and/or environmental disadvantage ○ Affect groups of people who historically linked to discrimination or exclusion ○ Lead to an individual’s inability to achieve & maintain optimal health ○ Interconnected with biological, environmental and lifestyle behaviors that negatively impact health outcomes ● MAP-IT ○ Mobilize, Assess, Plan, Implement, Track ○ Mobilize objectives ■ Gather a broad representation of key individuals and organize a partnership/coalition ■ Identify roles for partners and organizations ■ Assign responsibilities to move process forward ○ Assess objectives ■ Assess both needs and resources in the community ■ Set priorities: Feasibility, effectiveness, and measurability ■ Collect State and local data to determine local needs ■ Explore social determinants of health related to the issue ○ Plan objectives ■ Use Healthy People 2020 to determine the goals and objectives ■ Clear objectives are needed in a good plan ■ Write concrete steps for achieving each objective ■ Assign responsibilities and activities to each team member ■ Search for best practices and other tested interventions ○ Implement objectives ■ Create a detailed work plan ■ Share reasonability by assigning a specific person to each activity ■ Celebrate accomplishments ○ Track objectives ■ Evaluate each segment to track progress over time ■ Check data collection for standardization, reliability and validity ■ Share progress with partners ■ If positive trend in data, issue a press release or announcement Chapter 4 ● Deductive ○ ○ ○ ○ ○ ○ ● ● Moves from theory to observations or findings Moves from general to specific 1.Start with a theory 2.Develop a specific hypothesis to test 3.Collect observations to confirm or refute the hypothesis 4.Confirm theory Inductive reasoning ○ ○ ○ ○ ○ 1.Observe specific behaviors and measures 2.Identify specific patterns among the collected data 3.Formulate a proposed hypothesis 4.Develop a conclusion, model or theory 5.Other researchers repeat the observations to confirm or refute the theory Types of theories and models ○ Universal Theories ■ Gravitational theory: theory of gravity and relativity ○ System Theories ■ Break apart a concept for the purpose of studying each segment independently ■ Examples: ■ Theory of Goal Attainment ■ The Ecological Model ● Theory of goal attainment ● Ecological model ● Social Networks and Social Support Theory ● Diffusion of Innovations Theory ○ Focuses on personal system concepts, interpersonal system concepts and social system concepts ○ Focuses on how the nurse interacts with patient and the environment to achieve maximum well-being ○ Multiple level investigation includes: ■ 1.Individual as a whole or the personal system concepts including perception, self, body image, personal space, time and coping ■ 2.How the individual perceives their environment or interpersonal system concepts (objects, persons, events, stress, and communication) ■ 3.Social system concepts (authority, power, status, and organizations) ○ Developed to recognize how behavior change occurs when individuals have social networks and social support in their community ○ Some support services are conditional (support until fail-to-pay) ○ Social support include the following characteristics: ○ Emotional support ○ Instrumental support- tangible support ○ Informational support ○ Appraisal support- self evaluation ● RE-AIM model ○ To evaluate program interventions to determine the impact of programs ○ Programs are assessed at the individual, organization, and community level using five dimensions: ■ 1.Reach ■ 2.Efficacy ■ 3.Adoption ■ 4.Implementation ■ 5.Maintenance ● Health Belief Model ● Transtheoretical Model Chapter 5 ● Reliability ○ ways to establish reliability ■ Related to consistency or ability to repeat results ■ A test is reliable if the results are the same each time it is used with the same individuals ■ It is not possible to calculate reliability, researchers can only estimate ■ Stability ● When the results of a survey or instrument are consistent over time ● Test-retest technique ● ○ measurement of reliability Validity○ Internal ■ History ● When an event happens during research that influences the behavior of participating individuals ■ Maturation ● The natural changes that occur over time with individuals ■ Testing ● Differences noted from pretest to post test that can be attributed to students becoming familiar with the test ■ Instrumentation ● Measures changes in respondent performance which cannot be credited to the treatment or intervention ■ Regression ● Some respondents performing well on pretests and poorly on posttests or vice versa merely by chance ■ Ceiling and floor effects ● Ceiling effect is when all participating individuals perform extremely well on a pretest and posttest ● Floor effect occurs when individual performance starts out low a\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ion ● Individuals lost from the study ■ Selection ● When participating individuals are different at the onset of the study ■ Hawthorne effect ● Workers at the Western Electric Company in Hawthorne, Illinois improved their performance when they know that they are being watched ○ external (types of each) ■ Population ● When population selection is so specific, treatment is matched to a specific sample and doesn’t apply to a wider population ■ Environment ● The change from a controlled environment to a less controlled environment vice versa ■ Temporal / Sequential ● Change in external events ■ Participants ● ◦Animal to human links ● ◦Human to human links ● ◦Gender bias ● ◦Racial bias ● ◦Cultural and ethnocentric bias ■ Testing and treatment interaction ● If participants learn from the pretest, then they may be less likely to learn as much from treatment ■ Reactive arrangements ● If individuals change their behavior when observed (threat to internal validity), results are not generalizable to real world conditions (threat to external validity) ■ Multiple treatment conditions ● Multiple treatments may create an artificial setting that does not exist in the real world, so results are not generalizable ● ● Threats to validity-know the types Measurement errors ○ Random errors ■ ■ ■ ■ Occur by chance and are inconsistent across the respondents Increase or decrease results in an unpredictable manner Researchers have no control over the occurrence of random errors Reduced through statistical methods by averaging scores over a larger sample size ■ Influences reliability ○ Systematic errors ■ Consistent in the same direction (all results have the same error) ■ Introduce inaccuracy and bias into the measurement ■ Problematic to detect and eliminate ■ Not possible to reduce the effect of systematic errors through statistical methods ■ Influences validity ■ Occurs in three areas: Environment, Observation, Drift ○ How to reduce ■ Collect data from a larger sample size ■ Pilot testing ■ Data collection training ■ Double data entry ■ Statistical consultation ■ Triangulate data collection Chapter 6 ● Qualitative data ○ Advantages ■ Useful for complex subjects ■ ■ ■ ■ ■ ■ ○ Disadvantages ■ Not needed for simple hypothesis ■ ■ ■ ■ ■ ■ ● In-depth and comprehensive information Greater understanding of entire situation Interactions between variables Generates useful data Not dependent on large sample sizes Unique results Subjective; difficulty establishing reliability and validity Limited scope due to data collection approaches Possible researcher bias Requires detailed planning No precise results with mathematical calculations Not able to be replicated; lacks generalizability Types of design ○ Observations ■ ■ ■ ■ ■ ■ ■ ○ •Participant and non-participant observation •Obtrusive and unobtrusive observation •Natural or contrived observation •Disguised and non-disguised observation •Structured and unstructured observation •Direct and indirect observation •Human and mechanical observation case studies ■ A thorough exploration on a specific topic ■ •An analysis of narrow and detailed variables describing individuals, groups, social units or situations ■ •Focus on the individual unit rather than the population ■ •Not generalizable but concentrate on greater understanding of specific topics ○ Phenomenology ■ The study of human experiences and interpretations of an occurrence within a population ■ •Explores an event or situation within a study population ■ •Researchers are not searching for accuracy but rather perceptions of events ○ historical documents ■ •Study the details of past events ■ Possible source materials to study include newspapers, magazines, legal and medical documents, textbooks, periodicals, training manuals, photographs, etc. ■ This information is useful in planning future events ○ content analysis ■ A collection of existing documents on a specific topic: ■ One type of document over time ■ Different types of documents on a specific topic during a specific time period ■ Various personal documents on a specific topic ■ Each document collection is analyzed to get an in-depth view ○ Ethnography ■ A combination of interviews, observations and case studies with emphasis on the relationship between behavior and culture ■ A researcher team studies a particular location or population to gain greater understanding to address researcher questions ■ Is labor intensive and involves extensive time on location ○ grounded theory ■ Used to generate new theory based on a process of comparison ■ Steps include: ● Develop a hypothesis ● Collect data about the topic from a variety of sources ● Select certain documents and make comparisons ● Accept or Reject some documents ● Repeat process until reach “saturation” ● Be able to explain techniques for used in analysis of qualitative data ○ Broad holistic or big picture view of the data ○ Collaborative partnerships from various and opposing viewpoints ○ Detailed descriptions of the studied topic across multiple data sources to seek regular patterns or trends ○ Involve sifting through data, coding data, and sorting data over and over again as each observation or interview is added to the data collection ○ Data organization ■ Manual ■ Notebooks ■ Boxes and file cabinets ■ Computers ■ The tool of choice for organizing data ■ Open Source: Coding Analysis Toolkit (CAT) ■ Proprietary: ATLAS.ti or Nvivo ■ Cannot analyze the complex meanings and perceptions explored in qualitative research ○ Coding data ■ Data reduction ■ Organize the data ■ Identify emerging themes, categories, and patterns ■ Test hypotheses against the data ■ ■ ■ ■ Priori codes Described by researchers prior to starting data analyses Exploratory codes Added to the a priori codes as data are collected and analyzed once new themes emerge ○ Data display ■ Data is displayed in tables, diagrams, charts and graphs ■ Frequency tables are used to describe categorical data, such as demographics ■ Diagrams provide a visual depiction of volumes of data ■ Charts and graphs show chronological order or categories Chapter 7 ● Constructs ● Variables- types ○ Independent variables ■ Manipulated, causes change ○ Dependent variables ■ Affected by the IV ○ Mediating variables ■ Acts between the IV and DV. ○ Moderating variables ■ Show how relationships change with different variables (e.g. age) ○ Confounding variables ■ Extraneous, interfere with IV and DV ○ Controlled variables ■ Held constant to eliminate interference. ○ Categorical variables ● Operational definition- why is this important ○ Based on constructs as well as the research questions ○ Researcher must provide clear and concise definitions for each construct used ○ Select a dictionary definition or provide a more specific definition suited for the research ● Quantitative research designs ○ True experimental ■ When random assignment is used to determine how participants are assigned to groups ● True Experimental Design includes: ● Manipulating the independent variable ● Exploring cause and effect relationships ● Random assignment of participants to equivalent groups ○ Research blinding (Blind Study) ○ Double-blind study ○ Quasi-experimental ■ Does not use random assignment ■ Researchers do not manipulate the independent variable ■ Research results yield limited generalizable conclusions ■ The assignment is based on factors such as cost, convenience, feasibility or some other criteria ■ Also if the design involves using multiple waves of enrollment ○ Nonexperimental ■ Used when there is no need for group assignment ■ The most common design ■ Non-Experimental Research involves: ● No manipulation of the independent variable ● No random assignment of participants ● No cause and effect conclusions due to alternative explanations ● Uses mostly descriptive statistical analysis ● Group assignment- types ○ Random group assignment ■ Conducted using a variety of methods ○ Quota group assignment ■ Researchers use census data to determine what percent of individuals are in each group ○ Every nth group assignment ■ Researchers select individuals or data in a preset and specific pattern
