Defining what the problem is Framing a research question FETP India.
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Transcript of Defining what the problem is Framing a research question FETP India.
Competency to be gained from this lecture
Formulate a precise research question that usefully addresses public health
needs
Key areas
• Levels in fundamental or applied research
• Working with programmes to understand their data needs
Asking yourself the right question
• 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
Applied epidemiology
Field epidemiology
Field epidemiologists feed programme managers with
information for action
Plan
AssessEvaluate
Implement Applied epidemiology
Fundamental and applied epidemiological projects
Type of projects Objective of the investigations
Relevance to field epidemiology
Fundamental research
Theoretical rationale -
Applied research Efficacy +
Prevention research Effectiveness ++
Assessment, monitoring and evaluation
Implementation +++
Progressing towards applied research questions: Immunization
example• 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 Applied epidemiology
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Identification of a public health problem
• 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
Health problem statement: Example
• 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
Addressing the data needs of programmes
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Criteria used to assess the public health importance of a problem
• Burden of disease Use local, national and international
estimates• Death• Disease• Disability• Economic losses
• Recent emergence • Availability of effective interventions• Cost effectiveness of interventions
Addressing the data needs of programmes
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Analysing a public health problem:Spreading out issues to identify
options• 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
Addressing the data needs of programmes
1 1Health
problem
Determinants
Direct contributing
factors
Indirect contributing
factors
Consequences: -1 -2 -3
2
3
2
<Specify>
<Specify>
<Specify>
Determinants and contribution factors diagram for a public health problem
Possible intervention 1
Possible intervention 2
Possible intervention 3
Diphtheria
ExposureHealth
problem
Determinants
Direct contributing
factors
Consequences: -Deaths -Disease
- Disability
Immunization
Supplemental vaccination
activities
Treatment
Susceptibility
Minorities
Crowding
Ventilation
An analysis of the problem of diphtheria in Hyderabad, AP, India
Housing
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Reviewing planned, ongoing or completed interventions
• Locate the level of the various interventions: Determinants Contributing factors
• Review effectiveness• Estimate cost effectiveness• Analyze implementation status
Input Process Outcome
Addressing the data needs of programmes
Interventions for diphtheria in Hyderabad, AP, India
• 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
Addressing the data needs of programmes
Working with public health managers to identify data needs
• Identify public health problems • Estimate public health importance • Analyze problems• Review what is being already done• Identify the information needed to
improve
Addressing the data needs of programmes
Identifying the information needed to allow better prevention and
control• Is the problem a consequence of a failure to
implement a well validated strategy? Need of assessment, monitoring and evaluation
• Is the problem a consequence of difficulty to apply a recommended strategy? Need of prevention research
• Is the problem a consequence of a limitation or of a lack of validated strategy (i.e., the recommendations are implemented but they don’t work)? Applied investigation
Addressing the data needs of programmes
Making sure you are not re-inventing the wheel
• Identify what is known (easy) Guidelines Recommendations Reviews Literature search
• Identify what is not known (difficult) Meeting reports Research agenda Expert opinion
Addressing the data needs of programmes
What is known and unknown about Diphtheria in Hyderabad, AP, India
• Established facts Primary immunization protects small children Boosters are needed for longer term
protection Reported coverage is high
• Areas of uncertainty: Vaccine failure?
• Is the vaccine as effective as it is supposed to be ? Failure to vaccine?
• Could there be pockets of lower coverage that could allow the disease to spread?
Addressing the data needs of programmes
Anticipating what will be done with the information that will be delivered
by an applied research project
• 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
Addressing the data needs of programmes
Expected benefit of a diphtheria study in Hyderabad, AP, India
• If the vaccine efficacy is low: Programme evaluation could identify where
the problem is (e.g., Cold chain? Manufacturer?)
• If there are pockets of lower coverage: Supplemental immunization activities could
increase population immunity
Addressing the data needs of programmes
Evolving public health concepts are like onions being peeled
• Sound answers to good research question allow prevention BUT bring new questions
• These questions should be framed with the same careful methods
• Addressing consecutive publichealth questions is: Useful Gratifying
Addressing the data needs of programmes
The life cycle of epidemiological investigations: The never ending
storyIdentifying 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
Here we go again
Possible future next step for the diphtheria study in Hyderabad, AP,
India• Conclusions
Booster is key for protection among children > 5 years
Booster coverage drops among selected minorities
• Possible next question What is the best strategy to use to increase
the coverage of booster among minorities?
Addressing the data needs of programmes
Take home messages
• Have a customer-focused attitude with public health managers to cater to their needs for strategic information
• Imagine yourself with your results in hands and try to imagine how they would contribute to better health Determine how the results of the study will
bring strategic information that will unlock new prevention / control opportunities