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Inaugural KEYSTONE Course on Health Policy and Systems Research 2015
Research Plan - 2
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Research plan - 2
Kabir Sheikh2 March 2015
KEYSTONE
Study design: from questions to
projects
IHPSR Presentation 6
www.hpsa-africa.org
@hpsa_africa
www.slideshare.net/hpsa_africa
Introduction to Health Policy and Systems Research
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Four key steps in HPSR1. Identify research focus
(problem/concern/ opportunity) and question
2. Design study 3. Ensure quality and rigour4. Apply ethical principles
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Robson, 2002
• Research design is concerned with turning research questions into projects – deals primarily with the aims, purposes,
intentions and plans within the practical constraints of location, time, money and availability of staff
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Design …. ‘… is also very much about style, the
architect’s [researcher’s] own preferences and ideas (whether
innovative or solidly traditional) and the stylistic preferences of those who pay for the work and have to live with the
finished result.’Robson, 2002
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Research questions
Purpose/s Theory
Methods Sampling strategy
Research design
Study design
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• The specific study design must be appropriate for: – the issues being investigated– the questions you want to answer; and – the underlying purpose
For example, to explore how actors’ understandings of a new policy change over time, don’t use a structured questionnaire at one time only
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Research design categories in HPSR
• Fixed designs• Flexible designs• Mixed methods designs
Terminology pause • Fixed-flexible vs quantitative-qualitative• Not about data forms!
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Fixed and flexible strategies
• ‘A fixed design calls for tight pre-specification before you reach the main data collection stage.’
• ‘A flexible design evolves during data collection. Data are typically non-numerical (usually in the form of words)’
Robson, 2002, p.87
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The image for fixed designs
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The image for flexible designs
Flexible: importance of the research spiral or cycle
Kemmis & McTaggart, 2005
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Design features Robson, 2002
Fixed• Carefully pre-planned• Focuses on ‘variables’
(defined property of person, thing, group, situation) that can be measured and compared
Data generally numerical, but could collect qualitative data
Flexible • Start with an idea or
problem and let relationships and causality emerge
• Evolving design, no predetermined ‘variables’
Data often non-numerical, but quantitative data also collected
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Study design examplesFixed• Impact evaluation• Quasi-experimental,
pragmatic RCT• Quantitative cross-
sectional (survey, record reviews)
• Discrete Choice Experiments
• Longitudinal (before and after, trend analysis)
Flexible• Process evaluation• Case study• Longitudinal case study• Qualitative cross-
sectional (key informant interviews, FGDs)
• Ethnography• History• Action research
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Mixed method design• Deliberately combines elements of fixed and
flexible design “to expand the scope of, and deepen the insights from, their studies” (Sandelowski, 2000)
• A PURPOSIVE combination, not a free for all • Combination of sampling, data collection &
analysis techniques; but not of paradigms• Benefits: e.g. allows triangulation across
datasets
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From question to study design …
Purpose Questions Study design examples
Normative • Does intervention x work? Positivist = Fixed: Quasi-experimental (adapted RCT, case control, before and after)
Exploratory • What categories of information are used in decision-making?
• What are the social processes, including power relations, influencing actors’ understandings and experiences, and shaping impacts of interventions?
Positivist= Fixed:Cross-sectional surveyRealist/Relativist = Flexible: EthnographyCase studyQualitative interviews
Descriptive • What is the quality of care in place q?
• What is the level of health worker motivation in place z?
• What are stakeholder positions on policy A?
Positivist = Fixed:Cross-sectional survey Realist = Flexible:Qualitative interviews (e.g. SHA)
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Purpose Questions Design examplesExplanatory (positivist)
• How do managers influence facility performance?
Fixed:Panel studyMulti-level modelling
Exploratory/ExplanatoryExplanatory(relativist/realist)
• How and why does management influence facility performance?
Flexible:Multiple case study (perhaps longitudinal)EthnographyHistoryTheory-based evaluation (realist)Mixed method
Emancipatory(critical)
Flexible:Action research
From question to study design (continued)
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From question to study design (continued)
Question Study designsWhat+? (who, what, where, how many, how much?) Exploratory & Descriptive
• Qualitative cross-sectional (e.g. in-depth interviews, FGDs, document review) / case study
• Surveys/archives/administrative statistics (includes longitudinal analysis)
Why + How? Impact evaluationExplanatory
• Case studies / history / ethnography• Surveys /simple modelling / experiment /
quantitative cross sectional (semi-structured interviews) (includes longitudinal studies & analysis)
What if?(includes impact studies)
• Experiment/scenarios/multi-variable modelling • Qualitative interviews & panels
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Research questions
Purpose/s Theory
Methods Sampling strategy
Research design
Study design
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Using theory in HPSR• HPSR addresses complex phenomena• Theory should play an important role within all HPSR
– e.g. conceptual frameworks = a set of concepts and their inter-linkages
– e.g. theory-driven evaluation– e.g. conceptual work
• Different disciplines have different ‘tools’ – and often utilise theory differently
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Robson, 2002Theory: a general explanation of what is going on in a situation or phenomenon
– from ‘grand theory’ to informal hunches and speculation– a theory explains why an answer is predicted (hypothesis)
Conceptual frameworks: diagram summarising theory– may not explain or predict behaviour or outcomes, but
identifies relevant elements and relationships among themHelp in investigating causality (and particularly important for complex causality)
– refine through discussion, literature review &, sometimes, through research
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HPSR (recap)• Non-hierarchical approach to study
design• Research design follows purpose,
question, and your positioning as a researcher
• HPSR makes use of theory and conceptual frameworks
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Citation of this work must follow normal academic conventions. Suggested citation:
Introduction to Health Policy and Systems Research, course presentation, Presentation 6. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa
This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.
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