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Unformatted text preview: Section I Investigating health services and health: the scope of research ‘Would you tell me, please, which way I ought to go from here?’, asked Alice. ‘That depends a good deal on where you want to get to,’ said the cat. Lewis Carroll (1865) Alice’s Adventures in Wonderland INTRODUCTION Research is the systematic and rigorous process of enquiry which aims to describe phenomena and to develop and test explanatory concepts and theories. Ultimately it aims to contribute to a scientific body of know- ledge. More specifically, in relation to the focus of this book, it aims to improve health, health outcomes and health services. The book aims to provide an overview of the range of research methods that are used in investigations of health and health services. Ultimately the purpose is to guide the reader in choosing an appropriate research method and design in order to address a particular research question. However, it is not possible to place research methods in a hierarchy of excellence, as different research methods are appropriate for addressing different research questions. If the research question is descriptive, for example, ‘What is the health status of population X?’, then a cross-sectional survey of a sample of that population is required to provide population estimates. The survey method will also enable the answers to secondary questions to be esti- mated for that population (e.g. ‘Are men more likely than women to report poor health status?’) and certain (non-causal) types of hypotheses to be tested (e.g. ‘Men will be X times more likely than women to report good health status’). If the research question is ‘Do women have worse health outcomes than men following acute myocardial infarction (AMI)?’, then a prospective, longitudinal survey of identified men and women who had suffered an AMI would be undertaken in order to be able to compare their health outcomes over time in the future. 2 Investigating health services and health: the scope of research If the research aims to find out information on a topic about which little is known, or is too complex or sensitive for the development of standardised instruments, then qualitative methods (e.g. observational methods, in-depth interviews and/or focus groups) may be more appro- priate (e.g. ‘Is there quality of life on long-stay psycho-geriatric wards?’; ‘Are there dehumanising care practices in long-stay institutions?’; ‘How do doctors prioritise their patient caseload?’). And if the research aims to investigate cause-and-effect issues, then an experimental design is, in theory, required (e.g. ‘Do women aged 75 + have worse health outcomes than men aged 75 + following thrombolysis ther- apy for acute myocardial infarction?’; ‘Do patients with osteoarthritis of the knee benefit from physiotherapy?’; ‘Are spets’ outreach clinics held in general practitioners’ surgeries as cost-effective as spets’ out-patient clinics in hospitals?’). While the double-blind, randomised out-patient clinics in hospitals?...
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- Spring '11
- Alice in Wonderland