Framing a research question

Chitra Grace A Scientist- C (PGDHE)

NIE, ChennaiE-mail: chitragrace@yahoo.co.uk

RM Workshop for ICMR Scientists

01/11/2011

Personal interest/ experiencePublished literatureNew developmentsSocial problems

PUBLIC HEALTH PROBLEM

ClearResearchableConnected to published literaturePotential for contributing to subject

domainBe neither too broad or too narrow

Two ways to deal with a poor or irrelevant research question: Try to answer it▪ The answer may be of no use of anyone▪ There may be no answer…

Try to reframe it If your research question is wrong:

No good hard work will save your work If your research question is right:

You have an opportunity to do a good job

Fundamental research Studies assessing candidate vaccine antigens

Applied investigation Clinical trials

Prevention research Social marketing, cost effectiveness

Assessment, monitoring and evaluation Post implementation evaluation,

coverage survey

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Any disease, injury, risk factor, environment threat or social condition that can cause death / disability

Points that need to be characterized What▪ Nature / etiology of the condition

How much▪ Magnitude

Who▪ Population at risk

Where▪ Geographic locations

When▪ Time of occurrence / seasonal variations

Diphtheria rates in Hyderabad, AP, India, increased from 11 to 21 per 100,000 between 2003 and 2006, particularly affecting children 5 to 15 years of age▪Specifies:▪What▪Where ▪How much▪When ▪Who

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Burden of disease: Use local reports and national / international estimates Death Disease Disability Economic losses

Effective interventionsCost effective interventions

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Identify the problem E.g., High diphtheria rates

Identify causes Immediate determinants▪ E.g., Low immunization coverage

Direct and indirect contributing factors▪ E.g., Minorities

Identify consequences E.g., Mortality from diphtheria

Identify possible solutions E.g., Increase coverage of boosters

1 1Health

problem

DeterminantsDirect

contributing factors

Indirect contributing

factors

Consequences: -1 -2 -3

Possible intervention 1

Possible intervention 2

Possible intervention 3

2

3

2

<Specify>

<Specify>

<Specify>

Indirect contributing

factors

Diphtheria

ExposureHealth problem

Determinants

Direct contributing

factors

Consequences: -Deaths -Disease

- Disability

Immunization

Supplemental vaccination

activities

Treatment

Susceptibility

Minorities

Crowding

VentilationHousing

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Locate the level of intervention: Determinants Contributing factors

Review effectivenessEstimate cost effectivenessAnalyze implementation status

Input Process Outcome

Treatment of cases Antibiotics and support, no antitoxin

Immunization Intervention▪ 3 doses of primary vaccination▪ 2 boosters during the 2nd and 4th year

Implementation▪ Reported coverage: 100%▪ No validation▪ Possibility of pockets with low coverage

Identify public health problems Estimate public health importance Analyze problemsReview what is being already done Identify the information needed to

improve

Is the problem a consequence of a failure to implement a validated strategy? Assessment, monitoring and evaluation

Is the problem a consequence of difficulty to apply a recommended strategy? Prevention research

Is the problem a consequence of a limitation or of a lack of validated strategy? Applied investigation

Identify what is known (easy) Guidelines Recommendations Reviews Literature search

Identify what is not known (difficult) Meeting reports Research agenda Expert opinion

Facts Primary immunization protects small children Boosters are needed for longer term

protection Reported coverage is high

Research questions: Vaccine failure?▪ Is the vaccine as effective as it is supposed to be ?

Failure to vaccinate?▪ Could there be pockets of lower coverage that

could allow the disease to spread?

Identifying data needs

Spelling out the research question

Formulating the study objectives

Planning the analysis

Preparing data collection instruments

Analysing data

Drawing conclusions

Formulating recommendations

Involving the programme

Collecting data

Anticipate the various possible results of the study Imagine scenarios of various possible

answers to the research question Identify the kind of public health

action that could be realistically taken for each case scenario

If the vaccine efficacy is low: Programme evaluation could identify

where the problem is If there are pockets of lower

coverage: Supplemental immunization activities

could increase population immunity

Sound answers to good research question bring new questions

These questions should be framed with the same careful methods

Addressing consecutive publichealth questions is: Useful Gratifying

Conclusions Booster is key for protection among

children > 5 years Booster coverage drops among selected

minoritiesPossible next question

What is the best strategy to use to increase the coverage of booster among minorities?

Local problem to be identified What? When? Where? Who? How?

Problem statement Specified, quantified

Causal web Problem, consequences, determinants,

contributing factors and possible interventionsReview evidence available

What is known and What is unknown?Research question

Specific; with a question mark