NSG 604 Module 9  Question I Discussion: Quantitative and Qualitative Methods

NSG 604 Module 9  Question I Discussion: Quantitative and Qualitative Methods

NSG 604 Module 9  Question I Discussion: Quantitative and Qualitative Methods

Module IX: Quantitative and Qualitative Methods

Introduction

While descriptive studies are always observational, analytic studies may be observational or experimental. Analytic epidemiologic research attempts to identify the determinants of states of health, using methods to test hypotheses generated from descriptive studies. Nurse researchers have used case-control, case-crossover, cohort, and intervention studies to examine relationships between exposure and outcome variables using a variety of techniques.

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A controlled experimental design involves individuals who have been assigned to an intervention; when groups are involved it is called a community-controlled experimental study. If the controlled experimental study is performed in a clinical setting, it is called a clinical trial. These are primarily quantitative studies. The research design should be appropriate for the research question.

Qualitative research is a powerful tool that can be used to determine the meaning of symptoms and mechanisms of health behaviors.

Objectives

Upon completion of this module the student will be able to:

explain the differences between qualitative and quantitative research

compare and contrast case-control, cohort, and case-crossover studies

define experimental/interventional studies

describe the process of randomization

explore ethical issues associated with experimental studies

Identify the general strengths and weaknesses of controlled trials

Overview of Qualitative Research

Using qualitative research to study human phenomena is grounded in the social sciences (Streubert & Carpenter, 2011). It was about 20 years ago that epidemiology was called upon to consider the context of our more complex, multifactorial causes of illness. These considerations of causal inference reflect our increased focus on social determinants of health. “Qualitative research aims to investigate how different phenomena are related and interact within and across different units of analysis, from individuals to families to broader social groupings; it seeks to elicit the perspectives, meanings, and experiences, frequently from the research participants’ point of view” (Bannister-Tyrrell & Megari, 2020, p.28). Some of the possible designs relevant to epidemiology include observational approaches, process tracing, survey research, and comparative analysis. In addition to its own merits, qualitative research may be used to formulate hypotheses for quantitative research or to enhance understanding of quantitative findings.

Case-Control, Cohort and Case-Crossover Studies

Case-control studies, exploratory in nature, originated in the 1920s, but are very much in use today. This type of study is usually the first to be performed when determining whether a specific characteristic is related to a health problem. This type of study investigates two groups of people:

â—¦ one with a specific health problem (cases) and

â—¦ one without the health problem (controls).

Data collection involves looking back retrospectively at exposure factors that caused individuals to develop the health problem. This type of study is helpful when an event or a disease is rare. Rather than following a group of people for many years waiting for a rare chronic condition to develop, researchers can identify affected and unaffected people and determine exposure factors inexpensively.

Defining the disease and establishing diagnostic criteria are the first steps in selecting cases for a case-control study. These may be new cases (incidence) or cases at a particular point in time (prevalence) but they usually come from sampled data of the population of interest, and therefore, they must be randomly assigned.

Controls (who do not have the health problem) are drawn from the same population as cases in any type of environment. Determining the time between the exposure and the outcome occurrence is critical.

Bias is defined as systematic error in the collection or interpretation of epidemiology data (Merrill, 2013, p. 185) and may lead to overestimation or underestimation of associations. There are several types of biases in case-control studies:

Selection bias – the selection of cases and controls

Prevalence-induced bias – selective survival among certain cases

Recall bias – questionable accuracy of exposure

Interviewer bias – questioning cases differently from controls

There are a variety of techniques for controlling for bias in case-control studies.

Case-crossover studies occur when individuals serve as their own controls. In this type of study, the exposure of an individual is studied just before the disease occurs and is compared to that same individual’s status at a prior time. Case-crossover studies are similar to matched-pair designs.

Cohort studies look at a group of people who share a common experience within a certain timeframe. When the outcome to be measured has not yet occurred, the study is prospective. In a retrospective cohort study, the cohort is reconstructed based on the predictor variable and outcomes measured in the past (during follow-up). The primary factor between these types of cohort studies is time.

The cohort effect refers to the change that occurs in the health status of the study population over time. The Framingham Heart Study (available at http://www.framinghamheartstudy.org and the Nurses Health Study (available at http://www.channing.harvard.edu/nhs/) are examples of longitudinal cohort studies.

When the exposure is rare or the sample size is likely to be small, a double-cohort study may be conducted. This design uses two distinct populations/groups involved with different exposure levels, but it is still best to select populations where sampling will be effective.

Experimental/Interventional Study Designs

In observational studies, associations are observed but not manipulated.

The gold standard among experimental designs is the randomized, double-blind study which is difficult to put in place but is very effective in determining a cause-and-effect relationship. Cause-and-effect relationships are determined by the strength of the association of the cause and effect, the time sequence, the findings, and the biological credibility of the exposure and outcomes.

Between-group designs are most effective in determining outcomes when two groups are compared using different levels of interventions. When the outcome in a group is compared before and after an intervention, it’s called a within-group design.

These epidemiological studies may be experimental or quasi-experimental in nature. Random selection of the sample and random assignment to the intervention or comparison groups are ideal, making groups look as similar as possible, and producing results that are generalizable to the population from which the sample was drawn. The subjects should be educated about the study protocols and comply with them.

There are instances when randomization is not appropriate, such as when a large sample is unavailable or when the entire population is to receive the treatment. Merrill (2021) addresses several steps in designing a randomized controlled study:

Selecting the intervention depends on the research objective

Assembling the study cohort determining inclusion and exclusion criteria

Measuring baseline variables identifying and variables that might be associated with the outcome

Choice of a comparison group

Ensuring compliance maintaining contact with subjects, monitoring compliance

Selecting the outcome

Types of randomized study designs include the run-in design, factorial design, randomization of matched pairs, and group randomization.

Ethics in Epidemiologic Research

The establishment of Institutional Review Boards (IRB) began in the 1980s when the boards were charged with protecting human subjects. This came about because of unethical research practices including lack of informed consent, the contagiousness of a disease never communicated to the family, and prevention of treatment from reaching exposed cases. First and foremost in conducting studies is patient safety, so patients must be informed of the research and understand that, if declining, their healthcare will not be affected.

Welcome to week 9

Readings

Merrill Chapters 7 & 8

Bannister-Tyrrell, M., & Meiqari, L. (2020). Qualitative research in epidemiology: Theoretical and methodological perspectives. Annals of Epidemiology, 49, 27-35. Qualitative research in epidemiology: theoretical and methodological perspectives – ScienceDirect (oclc.org)

Here is a link to a 10-minute video reviewing the types of epidemiologic studies Epidemiological Studies – made easy! – YouTube

Salerno, J., Peters, E. S., Pinney, S. M., Morain, S., & Hlaing, W. M. (2019). Untangling the ethical intersection of epidemiology, human subjects research, and public health. Annals of Epidemiology, 34, 1-5. Untangling the ethical intersection of epidemiology, human subjects research, and public health – ScienceDirect (oclc.org)

Discussion

Module IX
Discussion 1

The scholarly project for the Wilkes DNP program is a quantitative pilot project. Tell us what topic you are thinking about. What ethical issues do you feel are important to consider in a study on this topic? What do you need to do to control for chance, bias, and confounding in your scholarly project planning? When responding to your classmates, share anything else you think might help.

Post a Panopto video response by Wednesday at midnight. The response should follow the word requirements for the written guidelines, a minimum of 300 words. Your references can be written and posted to the discussion board under the Panopto video. Respond to two students in written posts by Sunday at midnight. All responses should be a minimum of 300 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.

Instructions for Panopto: There are two ways to capture video with Panopto: Capture – the browser based recorder and the desktop Recorder for Windows (or Mac) which requires a one time download. When you click on Panopto in the course navigation bar, you will be placed in the Panopto course for NSG 604. Use the green Create button to begin a recording in Panopto. You can upload a video as well. All recordings will automatically be placed in the Panopto assignment folder. The preferred browsers are Chrome or Firefox. Student instructions for the Panopto Video Assignment can be found in the course resource section with the addition of new instructions for Capture in a separate document if you prefer to use that method of recording. Insert Stuff is used to place your video in the discussion topic.

Module IX – Discussion 1
Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59 PM EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced. A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resources module.

Special Guidance on APA formatting in Discussion Posts

APA formatting is required in discussion posts with the following two exceptions (due to limitations with the text editor in LIVE): double line space and indent 1/2 inch from the left margin. Discussion posts will NOT be evaluated on those two formatting requirements. All other APA formatting guidelines should be followed. For example, in-text citations must be formatted with the appropriate information and in the correct sequence (Author, year), reference list entries must include all appropriate information following guidelines for capitalization, italics, and be in the correct sequence. Refer to the APA Publication Manual 7th ed. for each source type’s specific requirements. Please let your instructor know if you have any questions.