Health Research Methodology: A Guide for Training in Research Methods (WHO Pacific Regional Office Education in Action Series)

245 Pages·2001·1.22 MB·English

Health research methodology: A guide for training in research methods
H R M
EALTH ESEARCH ETHODOLOGY
A Guide for Training in Research Methods
Second Edition
WORLD HEALTH ORGANIZATION
Regional Office for the Western Pacific
Manila, 2001
i
Health research methodology: A guide for training in research methods
WHO Library Cataloguing in Publication Data
Health Research Methodology: A guide for training in research methods. Second
Edition.
1. Health services research - methods.
2. Research design.
I. World Health Organization. Regional Office for the Western Pacific
ISBN 92 9061 157 X
The World Health Organization welcomes requests for permission to reproduce or
translate its publications, in part or in full. Applications and enquiries should be addressed
to the Office of Publications, World Health Organization, Geneva, Switzerland or to the
Regional Office for the Western Pacific, Manila, Philippines, which will be glad to provide
the latest information on any changes made to the text, plans for new editions, and
reprints and translations already available.
© World Health Organization 2001
Publications of the World Health Organization enjoy copyright protection in accordance
with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.
The designations employed and the presentation of the material in this publication do
not imply the expression of any opinion whatsoever on the part of the Secretariat of the
World Health Organization concerning the legal status of any country, territory, city or area
or of its authorities, or concerning the delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers’ products does not imply
that they are endorsed or recommended by the World Health Organization in preference
to others of a similar nature that are not mentioned. Errors and omissions excepted, the
names of proprietary products are distinguished by initial capital letters.
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CONTENTS

Foreword v

Introduction vii

Acknowledgements ix

Chapter 1: Introduction to research 1

Chapter 2: Research strategies and design 11

Chapter 3: Descriptive epidemiological studies and clinical trials 43

Chapter 4: Experimental studies and clinical trials 55

Chapter 5: Sampling methods and sampling size 71

Chapter 6: Bias and confounding 85

Chapter 7: Basic risk measurement 97

Chapter 8: Tests of significance 107

Chapter 9: Association and causation 125

Chapter 10: Ethical aspects of health research 141

Chapter 11: Construction of a research proposal 147

Annexes:

Annex 1: Questionnaire design 169

Annex 2: Descriptive statistics: Table, graphs, and charts 187

Annex 3: Organization of a workshop on research 211
methods in health sciences

Index 232

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Health research methodology: A guide for training in research methods
FOREWORD
Scientific research plays a very important role in our efforts to
maintain health and combating diseases. Research helps us create
new knowledge and develop proper tools for the use of existing
knowledge. Not only does it enable health care providers to diagnose
and treat diseases, research also provides evidence for policies and
decisions on health and development.
WHO and its Member States are aware of the importance of
research. However, health research has not been a priority in many
developing countries in the Region. The lack of research methodology
and the absence of qualified researchers hinder many developing
countries to conduct health research by themselves. In many
countries, the system for management and coordination of health
research has not been established or is not functioning properly.
WHO is committed to stimulating scientific research in
developing countries. An articulate and clearly defined WHO
framework and vision on research and partnership with Member States
will strengthen research capacity in developing countries. The WHO
Regional Office for the Western Pacific has organized more than 20
training courses on health research design and methodology in the
last two decades. In 1992, the Regional Office published a training
manual entitled Health Research Methodology: A Guide for
Training in Research Methods. Since then, the manual, well received
by readers worldwide, has been translated into Chinese, Khmer,
Laotian, Mongolian and Vietnamese.
To accommodate requests from readers to incorporate recent
developments on research methodology and experiences of past
training courses, the manual has been revised and reissued.
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Health research methodology: A guide for training in research methods
We hope this revised version of the landmark manual will help
scientists, researchers, health practitioners and administrators to learn
and practise the concepts and principles of scientific research. The
knowledge of the scientific methods will help them design and conduct
research projects with precision in their own countries. The publication
of the revised manual also reiterates our commitment to developing
countries in the Region to help them build and strengthen the health
research systems.
Shigeru Omi, MD, Ph.D.
Regional Director
WHO Western Pacific Regional Office
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Health research methodology: A guide for training in research methods
INTRODUCTION
This is a revised version of an earlier manual on Health
Research Methodology and deals with the basic concepts and principles
of scientific research methods with particular attention to research in
the health field.
The research process is the cornerstone for informed and
effective decision-making, and is integral to countries’ efforts to
improve the health of their populations and the effectiveness of their
health systems, particularly during times of dramatic epidemiological,
demographic, and economic changes that profoundly affect health
systems. Research on (1) health policy and health systems, (2)
epidemiology dealing with noncommunicable diseases and existing,
new and emerging communicable diseases, (3) reproduction, child
health and nutrition, including domestic or sexual violence, and (4)
social-behaviour, including analysis of peoples’ health seeking
processes and their beliefs, knowledge and practices about health
and illness, conducted by multi-disciplinary teams will enhance
developing countries’ efforts to fight diseases and maintain health for
the public.
The manual describes methods for planning and conducting
scientific research: from formulation of problems to setting research
objectives, to designing the study, including methods of data collection,
statistical analysis as well as interpretation and dissemination of the
results. The earlier manual, used as resource and guide for the conduct
of workshops on health research methodology in various countries of
the Western Pacific Region has been expanded to include more details
on some of the commonly used statistical methods and to clarify the
points raised during workshops. The discussion on biases has been
expanded considerably.
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Health research methodology: A guide for training in research methods
This manual is expected to be used by the WHO Western Pacific
Regional Office as a reference guide in training young scientists to
conduct health sciences research. It will be used as a starting point
and not as a comprehensive textbook on research methods. Many
excellent textbooks are available for this purpose and are referenced
in the manual. We have tried to use real life examples from the
Region for illustrating the principles and methods used in the manual
to make it more relevant to the regional context.
The manual will be useful in planning a research project,
especially in preparing a research grant application for a donor agency.
In particular, the attached copy of the application form of WHO serves
as a guide. The issues discussed in the manual will help the researcher
to focus on issues of importance before the study is proposed and
undertaken. In addition, the manual would also be useful when writing
a thesis to meet academic requirements of a degree in the health
field.
We hope that this manual will not only provide basic information
on research methods in the health field, but also stimulate the reader
to inquire further into the complex area of research methodology as
well as increase the productivity of the young researcher in the Region.
We hope it will attract researchers to conduct further studies in the
health field, be it a clinical trial or field epidemiology or study of health
services.
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Health research methodology: A guide for training in research methods
ACKNOWLEDGEMENTS
The World Health Organization - Regional Office for the Western Pacific acknowledges the
original contributions of Professor Yung-Han Parik, Professor Ung-Ring Ko and
Dr Kamini Mohan Patwary to the first edition of this manual.
We also wish to acknowledge Dr Rama Nair and Dr Lye Munn Sann for their collaborative
efforts in revising this manual.
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Health research methodology: A guide for training in research methods
Chapter 1
Research and Scientific Methods
1.1 Definition
Research is a quest for knowledge through diligent search or
investigation or experimentation aimed at the discovery and
interpretation of new knowledge. Scientific method is a systematic
body of procedures and techniques applied in carrying out investigation
or experimentation targeted at obtaining new knowledge. In the
context of this manual, research and scientific methods may be
considered a course of critical inquiry leading to the discovery of fact
or information which increases our understanding of human health
and disease.
1.2 Categories of research
1. Empirical and theoretical research
The philosophical approach to research is basically of two types:
empirical and theoretical. Health research mainly follows the empirical
approach, i.e. it is based upon observation and experience more than
upon theory and abstraction. Epidemiological research, for example,
depends upon the systematic collection of observations on the health-
related phenomena of interest in defined populations. Moreover,
even in abstraction with mathematical models, advances in
understanding of disease occurrence and causation cannot be made
without a comparison of the theoretical constructs with that which
we actually observe in populations. Empirical and theoretical research
complement each other in developing an understanding of the
phenomena, in predicting future events, and in the prevention of events
harmful to the general welfare of the population of interest.
1