Understanding Research Methods for Evidence-Based Practice in Health

Table of Contents:
About the authors viii Chapter 1 Introduction to research, the research process and EBP 1 1.1 The meaning of 'evidence-based practice' 2 1.2 Research informs evidence-based practice 4 1.3 Apprehension towards research and evidence-based practice 5 1.4 Before you start: formulate the problem 8 Chapter 2 Asking questions and searching for evidence 13 2.1 Different types of searching for evidence 14 2.2 Differences between primary and secondary research 15 2.3 Effective search strings 16 2.4 Other avenues for how to search for evidence 21 Chapter 3 Reviewing literature 25 3.1 Is a paper worth reading at all? 27 Question 1. Who wrote the paper? 27 Question 2. Is the title appropriate and illustrative, and is the abstract informative? 27 Question 3. What was the research design, and was it appropriate to the question? 28 Question 4. What was the research question, and why was the study needed? 28 Question 5. Do the results or findings answer the question? 28 3.2 Reviewing the methods of primary research papers 29 3.3 Reviewing the methods of secondary (review) papers 31 Question 1. What is the focused clinical question that the review addressed? 31 Question 2. Was a thorough search of the appropriate database(s) carried out, and were other potentially important sources explored? 31 Question 3. Who evaluated the studies, and how? 32 Question 4. How sensitive are the results to the way the review has been performed? 32 Question 5. Have the results been interpreted sensibly, and are they relevant to the broader aspects of the problem? 33 Chapter 4 Qualitative research 37 4.1 Qualitative research explained 38 4.2 The difference between qualitative and quantitative research 39 4.3 Qualitative methodologies and data collection strategies 41 4.4 Evaluating papers that describe qualitative research 43 Question 1. Did the paper describe an important clinical problem addressed via a clearly formulated question? 44 Question 2. Was a qualitative approach appropriate? 44 Question 3. How were (a) the setting and (b) the subjects selected? 44 Question 4. What was the researcher’s perspective, and has this been taken into account? 45 Question 5. What methods did the researcher use for collecting data, and are these described in enough detail? 45 Question 6. What methods did the researcher use to analyse the data, and what quality control measures were implemented? 45 Question 7. Are the results credible and, if so, are they clinically important? 46 Question 8. What conclusions were drawn, and are they justified by the results? 46 Question 9. Are the findings of the study transferable to other settings? 47 Chapter 5 Quantitative research 51 5.1 Why and how quantitative research is done 53 5.2 Quantitative research designs 54 5.3 Measurement 57 Chapter 6 Levels of evidence 65 6.1 Clinical questions in healthcare 66 6.2 How bias threatens the validity of research evidence 68 6.3 Matching clinical questions to NHMRC levels of evidence 70 6.4 Evaluating the evidence — quality of evidence and grades of recommendations for practice guidelines 75 6.5 Levels beyond levels 76 Chapter 7 Statistics for the non-statistician 83 7.1 Storing quantitative data in a data set 84 7.2 Descriptive statistics for summarising sample characteristics 85 7.3 The researchers ‘setting the scene’ 87 7.4 Probability and confidence 90 7.5 Clinical importance of treatment effects 92 7.6 Summarising treatment effects from multiple studies of interventions in a systematic review 96 Chapter 8 Mixed methods research 101 8.1 An overview of mixed methods research 102 8.2 Different mixed methods designs 103 8.3 Integration in mixed methods research 106 8.4 Mixed methods design considerations 107 Chapter 9 Sampling 111 9.1 Understanding the terminology around populations and sampling 112 9.2 Types of sampling 114 9.3 Sampling error 116 9.4 Calculating sample size 117 Chapter 10 Ethics 123 10.1 Ethical principles 124 Autonomy: patients/clients are free to determine their own actions 124 Beneficence: acting to benefit human kind 125 Justice: obligation to treat fairly 125 Non-maleficence: avoiding or minimising harm 125 Respect for human dignity 125 Confidentiality: maintenance of privileged information, including the right to privacy and anonymity 126 Veracity: obligation to tell the truth 126 10.2 The role and function of human research ethics committees 126 10.3 Indigenous research 128 10.4 Judging the ethical aspects of a published journal article 129 Chapter 11 Getting evidence into practice 133 11.1 Adoption of evidence-based practice (EBP) 134 11.2 Encouraging individuals to implement evidence-based practice 135 11.3 Organisational support of evidencebased practice 136 11.4 The client perspective in evidencebased practice 138 Chapter 12 Challenges to evidence-based practice 143 12.1 When evidence-based practice is done badly 145 12.2 When evidence-based practice is done well 146 12.3 Achieving evidence-based practice 149 Summary 151 Key terms 151 Websites 151 Endnotes 151 Acknowledgements 153 Index 155

About the Author :
Dr Trisha Greenhalgh is a Professor of Primary Care Health Sciences at the University of Oxford and a practising GP. She completed a BA in Social and Political Sciences at the University of Cambridge in 1980 and a medical degree at the University of Oxford in 1983. Trisha's research aims to apply the traditional aspects of medicine while embracing the opportunities of contemporary science to improve health outcomes for patients. She is the author of more than 240 peer-reviewed publications as well as a number of scholarly textbooks. Trisha has received numerous accolades for her work, including twice winning the Royal College of General Practitioners Research Paper of the Year Award, and receiving the Baxter Award from the European Health Management Association. In 2001, she was awarded an OBE for services to evidence-based medical care. Dr John Bidewell is a Lecturer in Research Methods at the School of Science and Health at Western Sydney University. From an early career in school teaching, John moved into psychology, acquiring three degrees while always maintaining an interest in education. Opportunities arose in applied social research and data analysis, leading John in that direction. For many years, he provided technical and inspirational support to academic and student researchers, covering every stage of the research process from concept to publication, and especially data analysis and interpretation, at Western Sydney University's nursing and midwifery school. John has provided consultancy services in research and statistics to business, industry and governments, and has taught research methods and statistics to nursing, business and allied health students at undergraduate and postgraduate levels. Dr Elaine Crisp is a Registered Nurse (RN) and Lecturer at the School of Nursing at the University of Tasmania, where she has developed and coordinated both the Bachelor of Nursing (BN) course and the research methodology units within the BN. This dual role has enabled her to highlight the connection between research and clinical knowledge to demystify and encourage evidence-informed practice. She has also taught research methods to nursing and allied health students at the postgraduate level, encouraging clinicians to understand and use research evidence in their everyday practice. Elaine worked as an RN in aged care and in the perioperative area before commencing her PhD, which combined her love of history and nursing. Her major research interests are nursing and welfare history, aged and dementia care, and nurse education. Amanda E Lambros is a Professional Speaker, Author and Clinical Counsellor as well as a past Clinical Fellow. She has completed a Bachelor of Health Sciences at the University of Western Ontario (2001), a Postgraduate Diploma of Ethics (2002), a Master of Forensic Sexology (2004) and a Master of Counselling (2014). Amanda has developed, coordinated and taught evidence-informed health practice to thousands of Interprofessional First Year Health Sciences students throughout her career. Amanda's private practice focuses on relationships, mental health, and grief and loss. Providing her clients with the most upto-date and evidence-based care is imperative to her, and she has a strong focus on EBP, ethics and communication. Amanda has received numerous accolades for her work, including being inducted into the Victoria Park Business Hall of Fame, NifNex 100 Most Influential Business Owners, Telstra Business Award nominations and a Telstra Business Woman of the Year nomination. Dr Jane Warland is an adjunct Associate Professor at the School of Medicine at the University of Adelaide. She worked as a midwife from 1988 to 2007, and gained her PhD from the University of Adelaide in 2007. Jane has taught foundational research courses to undergraduate and postgraduate midwifery students. Jane has a track record in research using qualitative, quantitative and mixed methods. She has a strong interest in research ethics and has served on various human research ethics committees in both South Australia and Western Australia. Jane has written numerous book chapters about research — she has more than 120 publications, including books, chapters and peer-reviewed journal articles. Dr Gordana Dermody is a gerontologic nursing expert with 20 years of nursing experience and she has taught in the tertiary sector for over 10 years. Gordana's research is undertaken across multiple disciplines, in the space between nursing, allied health, engineering, and computer science, under the umbrella of gerontechnology, where technologies are developed and studied to support older adults as they age. She is interested in remote health monitoring to promote culturally appropriate, safe ageing-in-place for older adults with chronic conditions, frailty and associated functional decline, which frequently impact this population. Gordana values pragmatic research approaches, as well as end-user input, to solve problems and to study a variety of technologies and solutions that can enable older adults to live as independently as possible.