Module 1
Research Literacy and the Idea of Knowledge
Overview
Welcome to Research Methods in Gerontology; Research Literacy, GERO 3126. This is a very important course for all students who want to use the most updated and proven methods and procedures of care. Although this course is a course in Gerontology, the breadth and scope of being research literate applies to all fields that are associated with caring for human beings around us.
Watch the following overview:
Module 1
Learning Outcomes
When you have successfully completed this module, you will be able to:
1. Explain research literacy and its role in the context of your practice.
2. Situate the role of your knowledge and its role in influencing your practice.
3. Explain briefly the outline of a research process and its relevance to evidence informed practice.
Required Readings
You will be prompted to read the following chapters from your course textbook:
Chapter 1: Introduction to Research Literacy for Health and Community Practice
Chapter 2: What are Knowledge and Evidence?
Introduction to Research Literacy
It is perhaps best to start with the notion of what research is. We have all heard of, seen, participated in and experienced both research and its outcomes in our day-to-day lives. News reports that investigate a political scandal, a decision to change our cell phone plans based on the best bang for our buck, or using Google to verify a confident statement from someone we know that somehow does not fit, are all examples of some very informal research that we are exposed to and engage in our daily lives.
In order to conduct our day to day research today, we use search the internet using search engines such as Google, Bing, and Duckduckgo to name a few. Each of these searches, depending on what our search terms or keywords are, return to us a vast assortment of results. Let us consider the example of searching for an inexpensive smartphone plan in Ontario. Once we enter the search terms, we then have to sift through a large number of results and make a decision that allows us to move forward. How do we make that decision? Do we pick the most prominent search result? Do we pick a search result that is seen multiple times? Can we tell if one search result is simply a copy-pasted result from another? How do we make the best decision for ourselves?
The example above illustrates both the ease of finding information along with the challenge of sifting through it to find the best and most relevant information that we can use. Also, as in the example, a poor decision can lead to the choice of a poor cell phone plan. Choice of a bad cell phone plan has some monetary consequences and there may be a lower level of satisfaction that one may derive as a customer, something most of us would like to avoid. It, however, does not have a large impact on the consumer’s health or mental well being. Whether we end up choosing a great cell phone plan or a poor one, the exercise has exposed us to several options and created knowledge for us. Research always creates knowledge, some useful and some of no use. How do we ensure that we generate knowledge that is usable and applicable?
Caring for other individuals, particularly older adults, requires us to make decisions. Often, these decisions are based on instructions communicated by supervisors, based on a care plan created for the individual. The care plan is created by an interdisciplinary team comprising nursing staff, a physician, physiotherapist, restorative care professional, occupational therapist, nutritionist, and others, based upon the unique needs of the individual. Each of the mentioned professionals make a decision to enhance the quality of life and care for the resident based on their best understanding of current best practices in the field.
How does a professional determine what practice is best? Similar to the cell phone plan example, when a professional, let us say, a registered dietitian or nutritionist, wants to create a meal plan for an older adult with type 2 diabetes and on Warfarin (a blood thinning medication), they will consult textbooks on nutrition to start. They will then proceed to go though research databases to find the best nutritional plans to assist this client. Similar to the search for the cell phone plan, the research database can return multiple results, which may have different recommendations from each other. In order to use the best information, our nutritionist must be able to distinguish between valid and reliable research and poor research. In addition, they will need to be able to rank the research in order of credibility so that only the best evidence basedresults are used. In order to do all of this, the nutritionist needs to be research literate. As you have probably gathered, being research literate has a lot more to it that simply being able to read and understand research. It is also the ability to assess the validity and applicability of the findings that we see in front of us to determine good evidence.
Required Readings
Take the time now to read the following chapter from your course textbook
Chapter 1: Introduction to Research Literacy for Health and Community Practice
Reading the Learning Objectives and Introduction to Research Literacysections of Chapter 1 will expose you to several new concepts and definitions. As discussed in the section, the use of good evidence is a must for the research literate. The emphasis on being able to find, read, and understand primary literature and systematic reviews is a prerequisite to being research literate. Research literacy is an ongoing process. Despite the initial challenges around vocabulary, repeated exposure to academic literature and some effort will pay rich dividends for individuals involved in care or as the textbook states ‘community practice.’
We live in an era where all the published knowledge of humankind is available in the palm of our hands. We are hyper connected and inundated with information. Being able to make sense of this deluge is essential to ensuring that we can safely use the best evidence to inform our decisions. Box 1.1 of your textbook attributes certain skills to being research literate, which is a subset of being research minded. Becoming research literate and research minded is a journey and process. It takes time. The first step to your becoming a conscientious practitioner is for you to be research literate.
As you get to the end of Chapter 1, the authors of the textbook outline the objectives of the textbook and of the chapters presented. They also suggest what they believe to be the best methods to gain the most out of the textbook, using the practical learning activities provided to reflect upon and assimilate the content better. The contents of this course are of little use if simply memorized and regurgitated for the purposes of securing a good mark. In order to carry forward the knowledge the course has to offer and in order to be truly research literate and embark on the journey to research mindedness, being reflective through the process of reading, thinking, and understanding would be of most value to you.
Learning Activity 1.1: Independent Activity
1. Read the Review and Reflect section at the end of Chapter 1 of your textbook.
2. Consider the following scenario:
Assume that you are the program director of a community health centre. An older adult wellness advocacy group comes to you wanting to know the best ways to address the current malnutrition problem identified by caregivers, family, and healthcare professionals that community dwelling older adults encounter.
How could you use research to provide useful suggestions to this advocacy group? Use either a flowchart or bullet points to create a response as part of this exercise.
Click here to see how your process could look.
Information, Knowledge, and Evidence
Required Readings
Take the time now to read the following chapter from your course textbook
Chapter 2: What are Knowledge and Evidence?
It would be useful to embark on a reflective exercise, thinking about what the word ‘knowledge’ means to us. We all have knowledge of different aspects of our everyday lives. Let us consider some examples of what we all know or have knowledge of. We know that we need to wear warm clothes in winter. We know that we should protect our skin from exposure to the sun on a sunny day. We know that we should pay for products that we pick up at a grocery store. What is common to our having knowledge of the information stated in these examples? If you are still thinking about it and having a hard time finding a common thread, perhaps, the question can be re-phrased to ask, “What do you need to use when you go out in the sun?” The knowledge that sun can damage your skin enables you to decide to use sunscreen or an umbrella or a hat to shade exposed skin. Similarly, the knowledge that we must pay for products that we intend to keep from a store allows us to plan to carry our wallets/purses to carry modes of providing payment. Knowledge or knowing has the power to let us act! In Chapter 2 of your textbook, the authors describe the origin of the word and four elements of knowledge. The authors also discuss the limitations of the elements by themselves. Knowledge is a complex concept and much of it is socially constructed, which fits with at least two of the four elements discussed by the authors.
The difference between formalized knowledge (explicit or propositional) and non-formalized knowledge (tacit or non-propositional) has been described as the difference between knowing that and knowing how, and is further explained using the example of knowledge of riding a bicycle.
Learning Activity 1.2: Independent Activity
List three activities that you may be able to write out formalized steps in order to accomplish, but might not be able to accomplish simply on the basis of knowing the instructions alone.
Click here for the instructor’s list.
Both explicit and tacit knowledge are important in practice and tacit knowledge is a direct product of experience, reflection, and an effort to find the best outcome or interpretation of available explicit knowledge. This is also called professional craft knowledge.
Personal knowledge is not necessarily a distinct form of knowledge from tacit and explicit knowledge. Personal knowledge is exactly what it means – personal. That means, if two individuals were to have a comparable level of explicit knowledge and tacit knowledge due to experience, the application of their knowledge in practice will still have nuanced differences. As the authors in the textbook explain, these differences are largely due to each individual’s personal and professional life experiences and life journeys.
The following section in the textbook is a discussion on information. Academics and researchers will frequently refer to information as data. We see data around us all the time, for example, prices of stocks, median income in a city, raising of tax rates, and even quotes related to a heated topic by prominent individuals. Data or information is somewhat meaningless in the absence of a theoretical context. It is the theoretical context that allows you to use the data as this combination equals knowledge. To use the best information to assemble knowledge for us to act upon, we need to be able to sift through and curate information or as the authors of the textbook state, Information literate.
Evidence or proof in practice is a complex concept. The authors of your textbook try to distinguish between research and evidence informed practice. Unfortunately, they end up creating a false dichotomy. The best way to understand these concepts is to see them as a flow sheet, where evidence informed practice is a downstream consequence of the research process. In Table 2.1 of your textbook, the word evidence in the sentence that describes the process of evidence informed practice is significant. The reason for the significance of this word is the fact that a significant amount of evidence is based on research findings and program evaluations. Research literacy is a required skill for both research and the downstream process of evidence informed practice. The authors of your textbook also mistakenly state that research must have a stated pre-determined outcome – that is not necessarily accurate.
Research often starts with an enquiry that has piqued our curiosity. In order to carry out a meaningful research project that creates new knowledge, researchers must know what information already exists on the topic and whether the information that they are about to unearth is truly of benefit, either in adding to the existing body of knowledge or to enable a change in a practice or its direction. Knowing what to research and how to research it takes a lot of experience. Often, knowing what to research requires a thorough understanding of all the significant findings in that area, often referred to as a literature review, which is typically followed by a literature search on relevant databases. Only when a researcher truly understands the magnitude of the field, are they able to frame an answerable research question, taking into account their own research capacity. There are four examples of situations in your textbook that allow for framing of research questions. It is not unnatural for a student to not know how to proceed with those questions. It is also important to understand that how the research question is framed has a major implication of the type of research conducted and the data that is obtained. Table 2.2 of your textbook provides examples of different types of studies that result in different types of information generated.
Module 1 Discussions
Post your response to the following questions in the Discussion Forum.
Question 1
Comment on a recently learned skill, observation in practice, experience as a service user, etc. Discuss concerns for effectiveness, efficiency, and efficacy of this skill. What issues or challenges drive research literacy and research capacity needs in your area of practice or work? What are some issues (or potential innovations and alternatives) that might need research from your field of practice or discipline?
Question 2
What is wisdom? Where does wisdom fit in evidence-informed decision-making?
Module 2
The Construction of Ethical Research and the Evidence for Practice
Overview
Watch the following overview:
Module 2
Learning Outcomes
When you have successfully completed this module, you will be able to:
1. Describe how personal and societal beliefs and explanations help in the creation of your knowledge.
2. Explain the purposes of different models of research.
3. Explain the rationale and the process for a literature review.
Required Readings
You will be prompted to read the following chapters from your course textbook:
Chapter 3: How Is Research Framed and Organized, and How Are Ethics Applied?
Chapter 4: How Do I Search for Evidence in Practice?
Research Paradigms
The simplest way to think of a paradigm is to think of the word model or template. From a practical purpose, it would be able think of it as a way to conduct research. There are several simple paradigms that we use to address our day-to-day activities. Think about the activity of shopping at a grocery store from when you enter the store to when you get to the checkout row. If we were to break down this activity into multiple steps, we would come up with something like this:
1. Find a shopping cart (preferably with wheels that move freely)
2. Look at the shopping list (if you make lists!)
3. Pick up first item that is proximal to you that also features on the list
4. Look at the shopping list again unless you have memorized the list
5. Pick up the next item that is proximal to you that also features on the list
6. Repeat steps 2 to 5 until there are no more items on the list
7. Go to the checkout counter
When you think about it, most individuals go through these steps or a modification of some sort, but for the most part, it is safe to surmise that this is a reasonable model or paradigm for grocery shopping in North America.
Data is information. As previously described, the best way to think about data is unstructured or disorganized information. Once data is organized into information, it must be contextualized before use as knowledge. There are several pieces of data that are quite meaningless without the appropriate context. Data is not always numbers as the authors in the textbook inform you.
The term theory can be thought of in a couple of different ways. A theory can be a sentence that explains/summarizes a set of observations. Consider the following observations of Jim’s behaviour in the context of Rita.
1. Jim smiles and his face his visibly happy when he sees Rita.
2. Jim signs up for all classes that Rita does.
3. Jim hangs out with Rita’s group of friends more often now than his own.
If you had to fill in the blanks for the sentence, “I have a theory that Jim _______________________,” it is likely that you would end up theorizing that Jim has a crush on Rita. There are alternative theories possible, too, in this particular situation. In any case, the reason that you were able to come up with this theory is because your experience observing these patterns of behaviour throughout your life has consistently led to some obvious outcomes. Your theory comes out of your observations of Jim (and of others) and this is explained as grounded theory in your textbook.
Alternatively, let us assume that you were of the opinion that a significant amount of partying leads to poor academic performance. You speculate (hypothesize) that “Attending two or more parties a week of more than 3 hour duration each leads to a GPA below a B.” You embark upon a research project following ethics approval from the University’s Research Board to anonymously survey undergraduate students in Laurentian University using a tool like Survey Monkey. You find that typically, students who attend more than two social events of 3 hours or more each per week, average below a C+ on their GPA.
The difference between the two scenarios described is that in the first situation, the observation determined the theory and in the second, theory determined you hypothesis, your collection of observations and validation of the theory itself. The first scenario used what is referred to as an inductiveapproach and, second, a deductive approach.
Inductive Approach
Deductive Approach
Although your textbook and other research method courses will present them as distinct research paradigms, they are truly part of the same continuum.
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 3: How Is Research Framed and Organized, and How Are Ethics Applied?
Paradigms of Research
There are three models of research that all research can be classified into: quantitative research, qualitative research, and mixed methods research. Typically, the nature of the question determines which approach is best suited to answer that question. Your textbook describes the three paradigms in some detail, outlining the similarities and differences for each method. The mixed methods model represents the continuum of research well. In the end, as a service provider, it is important for you to know that no method is superior to the other. Table 3.1 of your textbook unpacks each type of method so that you can understand it better.
Watch the following video for an example that will create a context for you to get a better sense of the three models:
Research Paradigms
Ethics
The best way to think about ethical practice would be to ask ourselves the question as to how we would feel if we were at the receiving end of this practice. In the context of research, it would behoove us to ask how we might feel if we were subjected to the process that we plan to subject others. There are several principles that guide ethical practices for professionals in various fields. For the purposes of research, there are guidelines that researchers must adhere to if they are affiliated with a college or university. Ethical practices in research is not limited to research with human beings as you may discover in your textbook.
Learning Activity 2.1: Independent Activity
Consider a problem or issue in your practice and restate it as a researchable question. What different insights on the problem could be gathered from deductive and inductive approaches?
Evidence for Practice
It is probably fair to assume that we are comfortable with the notion of using the best available evidence to support our practice, which for many of us will involve the care of older adults. In that case, how do we find the evidence that we need? If we find that there is evidence that supports different methods or alternatives, how do we choose the best, most reliable method?
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 4: How Do I Search for Evidence in Practice?
The Search for Evidence
As your textbook indicates, searching well is important. A poor or disorganized search will lead you to results that may be of little or no benefit for your practice. A good search is truly a balancing act between using your time efficiently and still being thorough. Often times, the beginning of the process of searching for evidence starts with a Research Question followed by a Literature Search. Following the search is the process of curating the findings to keep or eliminate pieces of evidence, referred to as the Data Evaluation step. A structured discussion of analysis in a formal or scientific manner concludes the review, contextualizing our findings and allowing us to answer our very questions on evidence.
Watch the following video to see what a better literature review looks like:
A Better Literature Review
Sometimes, a literature review might not need to be performed as there may be a current review available that addresses the area and scope of your research question. Performing our own literature reviews and incorporating information from existing reviews is a way to keep ourselves current and updated. One thing to remember is the fact that literature reviews are continuing processes as new research and findings will change what we understand and conclude. The discussion in your textbook about specificity and sensitivity as it pertains to the literature search is important as no one has unlimited time to read everything. The key to an efficient search is an efficient question, which allows you to use clear search terms.
As a student or a practitioner, the best way to start to formulate efficient research questions is to use the tools mentioned in your textbook. Tools like PICO, PICO(T), COPES, and PS are very useful in unpacking your question and reorganizing it into a researchable format. Tools like SPIDER and SPICE, used for qualitative research question design, are invaluable in ensuring that your question is narrow, focused, and searchable.
Your textbook emphasizes the value of peer-reviewed research and presents a screenshot of a peer-reviewed article. Although the peer-reviewed process ensures that articles coming form academic journals are of the highest quality, it is not completely foolproof. Finding peer-reviewed articles must be a priority. Your textbook discusses the use of Pubmed and Google Scholar as free search tools. Other tools are available with a university affiliation and often being a student or employee at a university comes with a free subscription to hundreds of academic journals. Typically, libraries will also carry subscriptions to trade publications as well. As discussed in your textbook, articles in trade publications may or may not be penned by experts in the field. They might serve as a starting point to launch a literature search.
Understanding the breadth of the types of research publications is important and that is elaborated upon in Table 4.5 of your textbook. Using a tool to develop a research question and then following it up with a literature search using multiple databases for both specificity and sensitivity is key to finding good evidence.
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 54). Canadian Scholars.)
Figure 4.3 from your textbook (shown above) discusses the 6S pyramid, which presents a hierarchy of quality of evidence that may be useful as practitioners. As one moves up the pyramid, the findings are of greater value as they would have been through multiple rounds of evaluations by different experts. Books, as the authors describe, while being a good source for creating a background, tend to have limited value for practice as they lag behind current practices by several years. Like peer-reviewed articles, books must also be evaluated for true expertise in authorship of the topic of interest. Typically, reputed publishers will seek some correlation between the content and the authors’ area of expertise. The challenge with reviewing information from popular literature and grey literature presents its own set of challenges and use of a simple tool such as CRAAP can be very useful in evaluating institutional reports and government documents. CRAAP worksheets can be found for evaluating practice guidelines, government documents, and professional organization publications among others.
Searching and citing research appropriately as we go along the process of synthesis is important. Several citation platforms such as Endnote, Mendeley, Citation manager, etc., are useful in formatting your document as you type your literature review up. Finally, the report or review that you have created must present information as knowledge in a clear and logical manner. An annotated bibliography or a literature review is a good way to consolidate your findings.
Learning Activity 2.2: Independent Activity
How does the PICO(T) approach help you focus on and define the practice problem you want to address?
Module 2 Discussion
Post your response to the following question in the Discussion Forum.
Question 1
In your practice area, the search for the latest and best evidence to inform a practice problem or issue is underway. How will you know when it is time to stop narrowing the search and begin to retrieve and appraise the sourced papers/documents?
Module 3
Evaluating Qualitative and Quantitative Research Papers
Overview
In order to have the sensitivity and specificity that we need to procure the best evidence that we need for our practice, we have to be able to evaluate the quality of the evidence presented to us. Sometimes, it may not be possible to have systems level, a summaries level, or even a syntheses of synopses level of evidence available to us and we are left to choose between syntheses, synopses of single studies, and single studies themselves (refer to the 6S pyramid). In such situations, how do we figure out what the best evidence is? Will we need different criteria to appraise different types of publications? How is numerical and graphical information appraised differently from non-numerical information? It is precisely these types of questions that Module 3 addresses.
Learning Outcomes
When you have successfully completed this module, you will be able to:
1. Explain why research must be appraised critically.
2. Explain the organization of a research paper.
3. Explain how each section of a research paper must be appraised.
4. Perform a basic appraisal of a qualitative research paper.
5. Perform a basic appraisal of a quantitative research paper.
Required Readings
You will be prompted to read the following chapters from your course textbook:
Chapter 5: How Do I Approach the Appraisal of a Research Paper?
Chapter 6: How Do I Understand and Interpret Qualitative Research Papers?
Chapter 7: How Do I Understand and Interpret Quantitative Research Papers?
Appraising Research
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 5: How Do I Approach the Appraisal of a Research Paper?
This first section of Module 3 will focus on appraising/evaluating research or evidence. In order to evaluate research, one must be able to critique it in a unbiased fashion. Your textbook presents the rationale for a thoughtful and systematic critique. While learning how to critique a paper using this module and Chapter 5, it is a good idea to remember that critiquing the paper while being mindful of the context of your own practice may be of most benefit to you. Your textbook also highlights the role of appraisal in the Evidence Informed Decision Making (EIDM) process in Figure 5.1.
The textbook introduces you to the organization of a research paper. Understanding the basic structure of a research paper or review is important as it allows you to evaluate some of the key components of the publication itself. The process of review starts from understanding whether the publication that you are reading is based on primary or secondary research. A key distinction between primary and secondary data analysis or research is whether the data collected was for the intended project or not. Let us consider an example. If you, as a student researcher, were to participate in a research project to enquire if consuming more than 3 cups of coffee per day impacted students’ abilities to sleep well at night, you would probably administer surveys, collect responses, and analyze the data. This would be an example of primary research. On the other hand, if you were interested in knowing how many immigrants in Canada enter with a post secondary education every year and correlating that to their socioeconomic status, you could use data from Statistics Canada (link) and do the analysis. This would be an example of secondary research.
While both primary and secondary research need to be unique, the general organization of research papers remains somewhat similar with a title, abstract, introduction, methods, results, and discussion, even though some scientific journals may not follow this order as shown in the example below.
(Source: Venkataram, K., Brown, K.M., Gilmartin, G.M. (2005). Analysis of a noncanonical poly(A) site reveals a tripartite mechanism for vertebrate poly(A) site recognition. Genes & Development, 19, 1315-1327. Selection includes pages 1315, 1326, and 1327.)
In the example presented above, the materials and methods section is practically at the end of the research paper. This is atypical. Also, typically, research papers will have an acknowledgement section to thank contributors to the project for their participation in the project. At the end of all research papers, you will see a bibliography which will encompass all the previous research that the authors have used to contextualize both their rationale for their research (introduction section of the paper) and their research findings (discussion section of their paper). While the format of both in-text citations and the bibliography can vary from one scientific journal to the other, it is still quite simple to identify the various research projects that have contributed to the context and need of the paper that you are reading.
In order to appraise a research project well, it is a good idea to use tools as a novice researcher or practitioner. The Critical Appraisal Skills Program(CASP) is a UK based website that offers not just workshops but also useful checklists, which can be used to appraise research papers, literature reviews, systematic reviews, and meta-analyses. The National Collaborating Centre for Methods and Tools is another resource mentioned in your textbook.
There are several steps to critically appraising a research paper, which are summarized in Box 5.1 of your textbook. It is important to understand a research paper well in order to appraise its applicability. Appraising the source is probably among the easier appraisals. The source of a research publication is the journal/medium and the authors. The quality of a journal can be easily evaluated as those metrics are available on a journal’s homepage. Also, that information can be corroborated on academic websites that rank journals. Internet based reports or reports on organizational websites are harder to evaluate as they are typically not peer reviewed. Often, evaluation of the authors in terms of their experience and prior record of publication in the said area lends credibility.
Appraising the literature review is more challenging as a novice researcher, simply because of our limited awareness of the depth and breadth of the field. However, with repeated exposure to literature and multiple literature reviews, one can build familiarity and start to identify the strength and rigour demonstrated by the authors of a publication. Appraising a research question or a hypothesis requires some experience as well. With practice, novice researchers will be able to identify the relevance of a hypothesis or a research question in the context of an existing body of knowledge. Appraising data, methods, and conclusions tend to be far more challenging as the level of expertise required takes a profound level of research literacy and, sometimes, a certain degree of research capacity. Despite those challenges, as we build upon our research literacy, we need to be mindful of how we may best evaluate these components of a research paper. Most times, as novice researchers, this may mean consulting an expert, familiar with either methodology or data or analysis, to provide insight on the quality of these components of the research paper in question.
Finally, any research that we wish to use to enhance our practice must be formalized. This formalization often takes the form of a research critique, which has been described in your textbook.
Appraising Qualitative Research
Much of the research that we think of tends to be numerically and graphically oriented with mental images of bar graphs and pie charts in our minds when we hear the word research. However, this simply is one form of research. Research that deals with numerical data, large sample sizes, and generalized information tends to be quantitative in nature. Quantitative research dominates public consciousness of research represents. This section is notabout quantitative research. Research about individual experiences, phenomena, and experienced realities are now being recognized by research foundations and funding agencies as being significant to individual health outcomes. Therefore, while “big data” from quantitative research provides a somewhat broader context or framework towards a general picture for best practice, it is in the personal context of experiences drawn from life, culture, and society that may determine how practice, service, and care are directed towards our very diverse care recipients.
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 6: How Do I Understand and Interpret Qualitative Research Papers?
Take the time to read the following example research papers:
Ethnography
Niemeijer, A.R., Depla, M.F., Frederiks, B.J., & Hertogh, C.M. (2015). The experiences of people with dementia and intellectual disabilities with surveillance technologies in residential care. Nursing Ethics, 22(3), 307-320.
Grounded Theory
Waller, J., Bower, K.M., Spence, M., & Kavanagh, K.F. (2015). Using grounded theory methodology to conceptualize the mother-infant communication dynamic: Potential application to compliance with infant feeding recommendations. Maternal and Child Nutrition, 11, 749-760.
Phenomenology
Tsorng-Yeah, L., Landy, C.K., Wahoush, O., Khanlou, N. Liu, Y., & Li, C. (2014). A descriptive phenomenology study of newcomers’ experience of maternity care services: Chinese women’s perspectives. BMC Health Services Research, 14.
The simplest way to think about qualitative research is to think about the “how” and the “why” in asking/addressing the research question. For example, consider the question: What were the factors that influenced your decision to go to Laurentian University? Now, when you think about responding to this question, it is obvious that this question can be answered adequately without presenting a numerical fact. In contrast, if you were asked the question: What is the annual tuition at different Canadian universities?, you would need to present numerical facts. Consider your responses to the following hypothetical questions:
1. What did it feel like when you realized that you won the $16 million lottery jackpot?
2. What must it feel like to be a resident of an urban slum in Buenos Aires or Mumbai?
3. Why do traditional Hindu families insist that guests enter their home and accept their offerings of food and beverages?
While you might not have the answers to two of the three questions, it is apparent that the answers to these questions go beyond numbers. An investigation to find answers can involve not just interviews with people involved in a cultural practice, but may also require the investigator to live the experience by putting themselves in the shoes of the people whose realities they wish to investigate. Several modern reality television shows and documentaries present a unique, contextualized qualitative investigative experience, which allows the viewer or investigator to virtually experience the lived reality of the person(s) or population in question. As your textbook indicates, you may be exposed to research as an ethnography, based in grounded theory or as phenomenology.
Your textbook presents an example each of the three approaches that qualitative researchers use. In order to understand the boxed examples better, it is a good idea to read these papers first and then return to your textbook to correlate the summaries in the examples to the actual paper. The objective of this exercise is not just to expose you to three forms of qualitative research, but to also demonstrate as to what we must attempt to glean from these papers.
As any conscientious practitioner, we must be mindful of the truthfulness of the information and its reliability as it is being presented to us. Table 6.2 of your textbook presents a simple and systematic starting point to reviewing a qualitative research article.
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 89). Canadian Scholars.)
While the list presented above looks straightforward, students will realize that each of the 13 steps presented will require the appraiser to spend time thinking and reflecting on the paper, its contents, the authors, their expertise, and the overall value of the findings to their own practice. Credibility, dependability, confirmability, and transferability are key criteria for evaluating rigour or trustworthiness of qualitative research.
There are several ways of determining credibility and your textbook provides a few different examples including triangulation, member checking, and engagement with the topic. The mnemonic FACTS is used to describe an alternate way to assess rigour in your qualitative readings. Using Table 6.2, the authors present Box 6.4 in which they have appraised the paper by Waller et al. on Grounded Theory.
A concept presented in your textbook, but only briefly explained, is the idea of sampling. Sampling is the process of using a subset of individuals/subjects/observations, etc. to study a phenomenon, as studying entire populations may be neither desirable nor feasible. In qualitative research, researchers are attempting to understand phenomena or cultural contexts with a specific population or group in mind. Therefore, only those members are approached and form the sample. This kind of sample, selected with researcher bias for a very specific purpose, is referred to as purposive sampling. Random sampling is the opposite of purposive sampling and is applicable when studying broader phenomena and typically researchers have little to no influence on constituents of the sample. Random sampling is more typical of quantitative research.
By now, since you will have read the paper, the critical review will make a lot more sense. It is a good idea to pay attention to the fact that the authors of your textbook have explained their analysis in addition to performing the appraisal to enable students to understand the appraisal process better. You should now be able
Learning Activity 3.1: Independent Activity
In qualitative research, the researcher may follow hunches or be guided by experience, rather than starting from a hypothesis.
1. How do such hunches or preconceptions differ from hypotheses?
2. How would these researchers manage for bias and avoid influencing the research outcomes in these cases?
Appraising Quantitative Research
Quantitative research typically involves the use of a lot of numerical data, which is processed to allow for a conclusion that is supported in redundancy of numbers. It is in the strength of numbers and the strength of numerical association based on statistics that allows researchers to make broad generalizations and conclusions. Much like the section about qualitative research, this section is brief in highlighting some of the key aspects of the corresponding book chapter.
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 7: How Do I Understand and Interpret Quantitative Research Papers?
Quantitative data and research is very prominently represented in our society and culture – right from facts and figures that are reported in the news to the pie charts and graphs that advertisers use to convince the audience to favour their products. Chapter 7 of your textbook explains quantitative research well and provides a context for you to situate your readings better. The chapter presents a broad categorization of quantitative research as falling into either an “experimental” or an “observational” category. That is an accurate dichotomy, although research papers can often incorporate an interventional/experimental component on the basis of preliminary observational data.
It is important to understand that in the real world, interventions to existing practice in organizations occur as a result of social or political change. Researchers are often able to study this change and attribute a cause and effect statement. Since the researchers themselves do not control or cause these interventions, these “experiments” are considered “quasi-experiments.” An example of such a quasi-experiment would be researchers studying the impact on divorce rates in families with a child/children on the autism spectrum in the aftermath of the rollback of social services under the Doug Ford administration in Ontario. In this particular example, hypothetically, if researchers were able to document an increase in divorce rates subsequent to change in social policy, they would still have to suggest a correlation as there may be multiple factors in play leading to increased decoupling. A true causal relationship can be stated only and only if all variables are identified and accounted for. This is possible only in a laboratory setting, using identical clone animals.
Chapter 7 also exposes you to the idea of an independent and a dependent variable, which continues to suggest an influence of the independent over the dependent. Other concepts that you are exposed to are the notion of presenting a research enquiry as a hypothesis. The chapter also presents clear and well-written sections on the various formats of quantitative research that you will likely be exposed to as you search for evidence. Students will benefit by familiarizing themselves with the different formats of quantitative research presented as shown in Table 7.1 of your textbook.
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 103). Canadian Scholars.)
Awareness of the format of research conducted allows the reader to anticipate a certain pattern of results and therefore its potential applicability. In order to understand these formats better, an example of each of these studies is presented. As you read through these papers, do so with your textbook available so that you can identify with each of these formats better.
Required Readings
Take the time to read the following example research papers:
1. Quasi-experimental study
Romanelli, E. & Tushman, M.L. (1986). Inertia, environments, and strategic choice: A quasi-experimental design for comparative-longitudinal research. Management Science, 32(5), 608-621.
2. Experimental study
Harper, C.E., Cook, L.M., Patel, B.B., Wang, J., Eltoum, I.A., Arabshahi, A.,, Shirai, T., & Lamartiniere, C.A. (2009). Genistein and Resveratrol, alone and in combination, suppress prostate cancer in SV-40 tag rats. The Prostate, 69(15), 1668-1682.
3. Case control study
Baughman, R.P., Teirstein, A.S., Judson, M.A., Rossman, M.D., Yeager, H., Bresnitz, E.A., DePalo, L., Hunninghake, G., Iannuzzi, M.C., et al. (2001). Clinical characteristics of patients in a case control study of sarcoidosis. American Journal of Respiratory and Critical Care Medicine, 164(10), 1885-1889.
4. Case series study
Antoniou, A., Pharoah, P.D.P., Narod, S., Risch, H.A., Eyfjord, J.E., Hopper, J.L., et al. (2003). Average risk of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: A combined analysis of 22 studies. American Journal of Human Genetics, 72(5), 1117-1130.
5. Cross sectional study
Karahanna, E., Straub, D.W., & Chervany, N.L. (1999). Information technology adoption across time: A cross-sectional comparison of pre-adoption and post-adoption beliefs. MIS Quarterly, 23(2), 183-213.
6. Longitudinal study
Hines, M., Golombok, S., Rust, J., Johnston, K.J., Golding, J., & Avon Longitudinal Study of Parents and Children Study Team. (2002). Testosterone during pregnancy and gender role behavior of preschool children: A longitudinal, population study. Child Development, 73(6), 1678-1687.
7. Longitudinal and cross sectional study
Sandler, I.N., Tein, J., & West, S.G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65(6), 1744-1763.
8. Ecological study
Kennedy, B.P., Kawachi, I., & Prothrow-Smith, D. (1996). Income distribution and mortality: Cross sectional ecological study of the Robin Hood index in the United States. BMJ, 312, 1004-1007.
9. Cohort study
Knekt, P., Jarvinen, R., Reunanen, A., & Maatela, J. (1996). Flavonoid intake and coronary mortality in Finland: A cohort study. BMJ, 312, 478-481.
If you have read Chapter 7, you will notice that in addition to the types of studies mentioned in Chapter 7, longitudinal and longitudinal cross-sectional studies are mentioned. A longitudinal study requires that the researcher gather and process data on how a dependent variable changes over time with a change in the independent variable. An example of such a study would be, “How has per capita median income changed in the city of Greater Sudbury over the past 40 years?” A longitudinal cross sectional study uses the attributes of a cross-sectional study to provide a representative snapshot of a question over a length of time. So, if we think about the median income question, a longitudinal cross sectional equivalent would be: “How have per capita median incomes changed in the largest 7 cities of Ontario in the last 40 years?”
By this time, with your exposure to the papers presented, you would have seen a lot of statistics. As practitioners, the knowledge of statistics in depth is helpful, but not required. A general idea and the implications of statistical information is well presented in Chapter 7. It is recommended that as a novice reader, you use your textbook and the internet as a resource to explain the implications of the statistics presented to you in the papers that you read. The details of the tests themselves to ascertain significance, p-values, correlations, etc. are not as important as simply recognizing what these different terms mean. Also, remember that peer reviewed publications in reputed journals have already been reviewed by experts who have an in-depth understanding of the statistical analyses performed by the researchers and any criticism or require changes to the analyses will have already been made by the time you read it. Therefore, your evaluation of the statistics themselves or of the experimental designs and methods may be a time consuming endeavour that does not provide a significant benefit in your being able to use the findings towards your practice.
Learning Activity 3.2: Independent Activity
If a research paper presented a research study that did not use an instrument or measure that was previously examined and determined reliable or valid, what impact would this have on your decision to use the study results in practice?
Module 4
Using the Best Evidence
Overview
As you have progressed through the modules and textbook chapters, it is impossible to ignore the fact that evidence for practice is abundant and sometimes one line of evidence disputes another. As a practitioner or a frontline service provider, what then must one do? This module focuses on evaluating the most reliable and trustworthy evidence available to you and once you have access to that evidence, to be able to put that evidence into practice.
Learning Outcomes
By the end of this module, students will be able to:
1. Demonstrate ability use the hierarchy of evidence to inform their practice decisions.
2. Recognize their role as a knowledgeable and research minded service provider in the larger context of their employment and work structure
Required Readings
You will be prompted to read the following chapters from your course textbook:
Chapter 8: How Do I Know What is Best Evidence for Practice?
Chapter 9: How Do I Use Research in Practice?
Evaluating Best Evidence for Practice
Your textbook emphasizes the role of multiple publications embedded in a larger body of work in forming the basis for your evidence informed practice. This is important. Consider the alternative, an example of which has played out to quite disastrous outcomes. The example that is being referred to is the Wakefield paper mentioned in your first module. The authors’ conclusions that the MMR (Measles, Mumps, and Rubella) vaccine caused autism was picked up by news channels and disseminated as though that was a scientific breakthrough. Not only was this piece of work not embedded in a larger body of supportive evidence coming from different research groups, the research itself was poorly done. However, since it grabbed the attention of popular media (who are quite incapable of curating research evidence), it found support among the public and celebrities who lent it credibility that it never should have received. The paper was retracted under pressure by the authors, but too many people had become suspicious and fearful of vaccines. We continue to have enough “anti-vaxxers” or people opposed to vaccinations to this date whose children are often at the centre of measles and mumps outbreaks in US and Canada. In a mini documentary, the New York times traces the impact of that study over the last two decades.
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 8: How Do I Know What is Best Evidence for Practice?
It is unlikely that a research literate and research minded practitioner will fall into the same trap as the general public or popular media. Nonetheless, your textbook offers several guidelines and considerations that are very useful when evaluating a publication of interest. These elements address different forms of bias that can creep into what appears to be a pretty reasonable study with reasonable findings. Box 8.1 in your text presents questions for you to ask yourself as you are reading a research publication. These considerations are simple but important and will allow you to make a basic, but strong, evaluation of what you read.
Sometimes, you may find evidence from different sources, both of which pass your initial appraisal, but are at odds with one another – what then? Your textbook redirects your attention to the pyramid of evidence:
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 125). Canadian Scholars.)
The pyramid is a great visual tool and when considering evidence for use, it is helpful to see where our research evidence lies on this pyramid. Clearly, evidence from a single study is unlikely to make it past the fifth tier on the pyramid (RCTs, Case Cohorts, Control Studies). Even though many types of studies below “Evidence Summaries” are based on existing gaps in knowledge, they are singular in nature. “Reviews of the Literature” are more of a narrative of studies and “Clinical Research Critiques” are based of evaluation of clinical research which generally are not held to the same standards as basic scientific or social science research. Evidence drawn from the higher levels of the pyramid tends to have been not just peer reviewed for publication, but peer reviewed multiple times, by very different experts. In a sense, evidence found from “Systematic Reviews” and “Meta-analyses” has been scrutinized or triangulated in a variety of ways, thereby allowing it to be evaluated as the best evidence available.
A Systematic Review (SR) is considered a document in knowledge synthesis. Due to the rigour in selecting or rejecting research on the basis of different unbiased criteria, it is of tremendous value in evidence informed practice. Compiling SRs is typically done by experts in the field and often there may not be an SR for the problem that you need to find a solution for. Therefore, our evidence for practice may need to come from Evidence Guidelines and Evidence Summaries. The general idea is that in searching for EIP, one must start looking for evidence at the apex of the pyramid and move downwards as is necessary.
EIP must result in best practices and the criteria for Best Practice Guidelines (BPG) are listed in your textbook. BPGs must be treated as living documents as guidelines reflect knowledge that was current to the research that they were drawn from at the time of their creation. That means several guidelines will be out of date and irrelevant even by the time the guidelines are published. Why?
Here is a hypothetical example:
1. In 1970, a research group identifies that increasing fibre content in daily diet in animal models reduces the incidence of colon cancer.
2. Follow up studies by research groups find a correlation of high fibre diets with lower colon cancer in humans in longitudinal studies from 1971-1980.
3. With a large body of research available, SRs and Meta Analyses are created that identify daily requirements of dietary fibre needed between 1985-1990.
4. Nutritional guidelines are created nationally on the basis of evidence by 1995.
Interestingly, an SR published in 2011 on dietary fibre has its roots in studies originating from the 1970’s.
While this particular situation may seem unproblematic on the surface, consider the dietary realities of the 1970’s when people ate far less processed food, smaller meal portions, and had jobs and activities that were less sedentary. Caloric and other dietary requirements would have changed in 25 years. This form of a knowledge lag will unfortunately persist despite our best efforts to have updated guidelines. It is important to recognize this limitation of guidelines and an experienced practitioner will make individualized adaptations that are evidence supported to inform their care within the parameters of the existing guidelines.
The textbook discusses Best Practice Guidelines (BPG) in some detail. As explained, these are a set of clear statements based on evidence that allow for practitioners to provide a consistent level of care. BPGs have several other uses in practice as identified in Chapter 8, such as eliminating practices that are not or are no longer supported by evidence or in resolving a problem in a clinical setting.
While policies, protocols, and guidelines promote EIP, they must be periodically appraised using tools such as AGREE II. AGREE II is a 23-item tool, distributed among six domains. The 23 items are used to evaluate each guideline using at least two appraisers, although four are recommended. Each of the 23 items are evaluated on a 7-point Likert scale.
Overall scores determine usability of a guideline in practice.
In practice, often local contexts differ due to staffing, target population, and geographical and cultural differences. This is in addition to significant interpersonal variability between care recipients. One of the key steps in the EIP action cycle is the adaptation of an existing guideline to support successful care. Your textbook highlights this key step as a precursor to successful implementation.
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 131). Canadian Scholars.)
Adaptation of a guideline is often done by experienced practitioners who have a strong understanding of the context in which a guideline is not quite as useful due to the challenges associated with a direct, literal implementation. Often, care recipients and/or their families (as stakeholders) will have a say in adapting a guideline. Additionally, as a service provider, one may be required to appraise both the original as well as the adapted guideline using a tool such as AGREE II to determine if the guideline is suitable in the given context. Using tools such as ADAPTE allows for both appraisal as well as adaptation of a particular guideline.
One of the challenges with several published guidelines is the absence of a strong methodological process that evaluates the evidence behind those guidelines. This is mentioned in your textbook. The simplest way to determine if the guidelines that you are expected to follow for your practice are evidence informed with the best evidence available is to search for an expert appraisal of those BPGs. Your textbook additionally outlines a systematic list of steps that you can go through to verify the rigour and trustworthiness of the guidelines that you will use in practice.
Learning Activity 4.1: Independent Activity
1. What are the advantages and disadvantages of employing an evidence hierarchy to help you determine which evidence should be applied to your practice?
2. How can the evidence hierarchy be helpful and not for determining best practices?
Using Research in Practice
There is a considerable amount of skill that you will develop as you develop your research literacy skills and start becoming more research minded. As we approach the end of your online course material, we will address the obvious question of how one must apply or put into practice everything they have learned about research informed practice.
Required Readings
Take the time now to read the following chapter from your course textbook:
Chapter 9: How Do I Use Research in Practice?
The focus of this section of Module 4 is on utilizing the skills that you will work on as a service provider or practitioner. The first step in utilizing evidence in practice is to understand how evidence is currently being used in your place of work for the program that you are a part of. Your textbook explains that often, guidelines and policies are created as part of a top-down approach by experts or authorities whose input into those guidelines may be framed by their own personal expertise, or public policy around them.
There is a general list of considerations that your textbook provides that are practical and relevant to your practice that enable you to think about a proposed guideline or set of guidelines:
• Does the evidence-informed guideline apply to all areas of the organization?
• Are there specific recommendations that address known organizational needs?
• Are any recommendations already being implemented?
• Have some recommendations been partially implemented (e.g., only certain recommendations are implemented or only on some units or at certain sites)?
• Are there recommendations that must be implemented before others?
• Can any recommendations be implemented quickly?
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 139). Canadian Scholars.)
Implementation is a key step in EIP and successful implementation often involves simultaneous activity in all phases of the EIP cycle. If you consider the example presented in Box 9.1, it is obvious that a top-down approach was of limited value in improving the overall quality of care for the care recipients.
Required Readings
Take the time now to review Box 9.1 in your course textbook.
The research minded changes incorporated in care following reflection and a re-evaluation of existing programs allowed for implementation of more meaningful care at the Sunnybrook Health Centre.
The example presented above is not typical. Most long-term care homes are under budgetary constraints, supposedly understaffed and the emphasis and support to use research to improve or to personalize care is non-existent. Care is administered top-down from a repository of guidelines that may not have contextual meaning to the population or the care recipient in question. To have research and evidence serve as the basis for best care requires research literacy and research mindedness among a broad swathe of administrators and supervisors in long term care homes. This is typically not the case and it presents a significant barrier in faster uptake of EIP.
Research discovery to implementation, as mentioned in the previous section of this module, takes a lot of time. Your textbook estimates that time to be about 17 years. While there is a case to be made for sufficient evidence to accumulate and self-triangulate, often implementation barriers are due to other factors that take time as identified in Table 9.1, which identifies the steps required for research uptake.
(Source: Jakubec, S.L. & Astle, B.J. (2017). Research literacy for health and community practice (p. 143). Canadian Scholars.)
Often, organizations that are set up with a culture of utilizing research find efficiencies in the steps to implementation of research evidence as they have policies and procedures in place to address all the components of research uptake activities.
The last section of Chapter 9 creates a context for you to put your research mindedness and research literacy skills to use. The section is particularly useful to students and new entrants into the workforce as it is somewhat unlikely that you will, at this early stage in your career, author or implement guidelines yourself.