LEAH

Research Seminar Series: Preparing for Research

Cari McCarty, Ph.D.November 2, 2012

Outline

• The purpose of research questions• Getting started: identifying your BIG

questions• Literature reviews• Finding questions you can answer as a

fellow• Refining your research question• Putting together your Team• Assignment: define your research question

Goal of Research Questions

A successful Research Question

will specify and interest the reader in

an important question

your study will answer

Getting Started…

Identify Your BIG Questions

• Novel: Is there an important question you have not been able to find a good answer to?

• Important: What do you think are the essential questions facing patients, clinicians, clinical leaders or policymakers?

• Reading: research, reviews, reports & books (IOM)

• Experts: meetings, phone, conferences– Your clinical discipline– Topic or methods experts

Wrong….DO think

outside the box…

Case Study:From Big Questions to Literature

ReviewsBIG Questions• How do mental health and physical health

problems intersect?

Intermediate question(s)• Is drinking alcohol associated with poorer

mental health? In what direction? – Still too general and big…. What kind of people? Where? In

what setting? What level of drinking?

More suitable to literature searches:• Does depression predispose adolescents

to use alcohol or have alcohol-related problems?

Literature Reviews – Getting Started

Choose & Set-up a Citation Management System

Why? Saves your library of citations, inserts markers in your writing, formats your bibliography for different journals

Which tools are used most frequently at UW?

http://guides.lib.washington.edu/content.php?pid=69943&sid=518591

Citation Management Systems

Refworks: free, great online “help”, web, transferable, no updates needed, tutorial and UW librarian support

Zotero: free, saves your library on your local computer but allows you to sync,

Endnote: many faculty use and like; costs; “updates” often pain

Endnote Web: free, limited to 10,000 citations, can import citations from a bookmark

Literature Reviews: Librarians

Meet with a Health Sciences Librarian

• Write your research question(s) down• Identify the optimal librarian liaison

http://www.lib.washington.edu/subject/librarians/• Email him/her and set up a meeting (in person or

phone); they are expecting you!• Meet with a librarian to refine your search

Literature Reviews

Benefits of Standardized Literature Reviews

• Research ideas: Gaps in literature, patterns in what has been examined

• Publishing: Write a standardized literature review or an editorial

• Save time when writing later:– Research manuscripts: intro & discussions;

Tables when asked for (efficiency)– Grants: Significance and Background

Standardize Your Literature Reviews

Develop a Table/Form to Abstract Key Information

• For a specific question and a specific search • Specify inclusion/exclusion criteria for articles• Author/year, Sample, Measures, Results, Notes• Start simple; add detail as specific use(s) becomes

clear• What is it you want to know about the literature?

Case Study

Research Questions for Literature Review

• Is there an association between depression and alcohol use during adolescence?– Mixed findings, no consensus– Limited understanding of timing,

sequence, severity, role of conduct problems

Case StudyResults of Standardized Review

Study# of depression time points

# of alcohol timepoints

CP included

Depression Measure

Capaldi et al. (1999) 3 1 Yes Symptoms

Hussong et al., 1998Chassin et al., 2002

1 3 NoNo

Symptoms

Kaplow et. al., 2001 1 3 No Symptoms

King et al., 2004 1 2 No Diagnosis

Measelle et al., 2006 4 4 No Diagnosis & Symptoms

White et al., 2001Pardini et al., 2007

11

62

NoYes

SymptomsSymptoms

Mason et al., 2008 1 1 Yes Symptoms

Fleming et al., 2008 4 4 No Symptoms

PROPOSED STUDY 7 7 Yes Diagnosis & Symptoms

Example 1: Studies on Depression as a Risk Factor for Alcohol Use

Authors/Date

Sample Size

Type of Sample

Location Age Span

% Boys Ethnic

Englund et al., 2008

178 High-risk Midwest 9-18 53% 67.6% White10.6% African American21.8% Other

Maggs et all, 2008

16,009 Community Great Britain

7-42 50.8% Not provided

Hooshmand et al., 2012

4412 School-Based

Ontario, Canada

14-17 51% Not provided

Example 2: Meta-Analysis of Treatment Studies for Youth Depression

Author/Year

Sample Type

Control Group

Other Outcomes

Effect Size

Notes

Clarke et al., 2001

Subclinical Usual care in an HMO

Externalizing 0.11 6.3% attrition

DeCuyper et al., 2004

Subclinical school sample

Waitlist Anxiety 0.40

Diamond et al., (2002)

Diagnosed, referred youth

Waitlist Anxiety Family Functioning

0.68

Summary - Literature Reviews

• Set up a reference Library: endnote or refworks• Meet with a librarian liaison: select from website• Standardize important literature reviews

Finding Questions You Can Answer

Data Sources Fellows Have or Could Use

• Literature reviews• Seattle investigators’, public health, & clinical data

– Children’s Hospital, Harborview, VA, UW Schools of Medicine, Public Health, & Pharmacy, Fred Hutch Cancer Research Center; UW Institute for Health Metrics and Evaluation

– Group Health Cooperative Center for Health Studies– Dept. of Public Health Seattle King County– Medic 1, Emergency data systems, etc.

Finding Questions You Can Answer

Ask investigators: do they have data for important analyses they have not had time to do?

Finding Questions You Can Answer

Data Sources Fellows have Used

• Washington state data: Comprehensive Hospital Abstract Reporting System (CHARS), Medicaid data, prison data; death records.

• National publicly available datasets: CDC Behavioral Risk Factor Surveillance Survey (BRFSS), National Health National Health and Nutrition Examination Survey (NHANES), AHRQ Healthcare Cost and Utilization Project (HCUP), Adolescent Health (ADD Health);

Finding Questions You Can Answer

Data Sources Fellows have Used

• Primary data collection – Surveys: physician, patient, or community surveys – Qualitative research: ethnography, focus groups, etc.– Instrument development (e.g. health literacy screen)

• Find other data sources…– Specific trials or disease specific NIH datasets?– FDA?– Etc.

Finding Questions You Can Answer

Tension between Ideal and Feasible

Ideal Research Question and

Design

•Interesting •Novel•Relevant•High internal validity•High external validity

Feasibility

•Access to data•Access to patients •Access to expertise•IRB and DUA approvals•Time•Budget

SummaryFinding Questions You Can Answer

• Literature reviews• Secondary data from both local and distant

investigators• Local, state and federal datasets (non-VA and VA):

administrative, clinical and public health• Primary data collection: surveys, qualitative,

instrument development • Find other data sources…

Refining Your Research Question(s)

Qualities of Strong Research Questions

• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.

Does Your Question Interest Others?

Refining Your Research Question(s)

Qualities of Strong Research Questions

• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.

• Clearly written, with unambiguous language: Does it mean to others what it means to you?

Is it Clear and Unambiguous?

Refining Your Research Question(s)

Qualities of Strong Research Questions

• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.

• Clearly written, with unambiguous language: Does it mean to others what it means to you?

• Specific enough to tell the reader what you’ll learn: Population? Exposure? Outcomes? Timeframes?

Research Questions

Tensions in creating a

a simple yet specific question in lay language

• Specificity: Vague Detailed• Length: Long Short• Wording: Unclear Excessive

lingo

Refining Your Research Question(s)

Qualities of Strong Research Questions

• Imply a hypothesis: Can you phrase it “To determine or test whether “ ______ “? Does it imply the “directionality” of your hypothesis?

• Ethical: If unsure, discuss it with the IRB• Answerable (by you): How sure are you that YOU

can do the study that answers the question? What is your data source? Are you sure you can get the data? Do you have or can you recruit the needed expertise?

Refining Your Research Question(s)

Summary

• Have lots of other people review it• Have non-researchers review it • Re-review it yourself• Make sure the study you are doing answers it• Make sure you can do the study• Make sure the IRB approves

Choosing between Projects

• Choosing between projects– Your interest– Feasibility– Educational value– Foundation for later work– Work with and learn from a specific mentor

• Recommendation– Primary (passion) research question– Secondary (safer) research question (back-up thesis)– At least 1 quantitative study w/ multivariable analyses

Putting Together yourInterdisciplinary Study Team

• Senior researcher from your own discipline: adolescent medicine, nursing, psychology, nutrition, social work, etc.

• Topic expert(s): who knows your area• Methodologist +/or biostatistician:

from start• Investigator who knows dataset• Other necessary expertise: clinical,

analytic or design expertise?

Learning Many New Languages

During fellowship you will consult with diverse experts (technology, IRB, data management, research design, data analysis, biostatistics, scientific writing, etc.) …each speaking a different language…Ask for help when you are unsure what is meant …

Summary

• Identify your “big” questions• Focus them down to searchable questions• Review the literature – standardized tables• Write your RQ(s)• Find data or design a study to answer it• Put together your study team• Get lots of feedback from mentors at every

stage

Optional AssignmentDevelop a Research Question

• Title and Study Team

• Background /significance

• Research question: feasible, interesting, novel, ethical, relevant