Research methods in health : investigating health and health services

545 Pages·2009·4.281 MB·English

by  Ann Bowling

Third Edition
Research Methods
R
in Health
e
Research Methods
Third Edition
s
e
INVESTIGATING HEALTH AND HEALTH SERVICES a
r
c in Health
‘The new edition of Research Methods in Healthcontinues to provide an
h
excellent broad based introduction to the subject. New or expanded sections,

for example on the evaluation of complex interventions, mixed research M
methods, life history interviews, and socio-psychological theories make this
third edition well worth purchasing.The content is clearly presented and at a e
suitable level for its intended audience of health professionals and t
h INVESTIGATING HEALTH AND HEALTH SERVICES
post-graduate students in health and health-related social sciences.’
o
VIRGINIABERRIDGE, LONDONSCHOOLOFHYGIENEANDTROPICALMEDICINE, UK
d
This bestselling book provides an accessible introduction to the theoretical concepts s
and descriptive and analytic research methods used in health and health services.
i
n
The third edition has been thoroughly revised throughout to include updated

references and boxed examples, with additional information on key methodological H
developments, among them:
e
(cid:129) Complex interventions
a
(cid:129) Mixed research methods
l
t
(cid:129) Psychometrics
h
(cid:129) Secondary data analysis
(cid:129) Systematic reviews
(cid:129) Pertinent social science concepts
Third
The research methods described cover the assessment of health needs, morbidity and
mortality trends and rates, costing health services, sampling for survey research, Edition
cross-sectional and longitudinal survey design, experimental methods and techniques
of group assignment, questionnaire design, interviewing techniques, coding and
analysis of quantitative data, methods and analysis of qualitative observational studies
and types of unstructured interviewing.
B

o
Ann Bowlingis Professor of Health Services Research at University College London,
w
UK. She specialises in quality of life measurement, research on ageing and equity of
access to health services, and is author of bestselling books on research methods and
l
measurement including Measuring Disease, 2e, Measuring Health, 3e, and i
n
A Handbook of Health Research Methods jointly with Professor Shah Ebrahim
g
(all published by Open University Press).
Ann Bowling
Cover design Hybert Design (cid:129)www.hybertdesign.com
www.openup.co.uk
a01.qxd 23/02/2009 02:53PM Page i
RESEARCH METHODS
IN HEALTH
Third edition
a01.qxd 23/02/2009 02:53PM Page ii
a01.qxd 23/02/2009 02:53PM Page iii
Research Methods in Health
Investigating health and
health services
Third edition
Ann Bowling

Open University Press
a01.qxd 23/02/2009 02:53PM Page iv
Open University Press
McGraw-Hill Education
McGraw-Hill House
Shoppenhangers Road
Maidenhead
Berkshire
England
SL6 2QL
email: [email protected]
world wide web: www.openup.co.uk
and Two Penn Plaza, New York, NY 10121–2289, USA
First published 2009
Copyright © Ann Bowling 2009
All rights reserved. Except fot the quotation of short passages for the
purposes of criticism and review, no part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any form, or by
any means, electronic, mechanical, photocopying, recording or otherwise,
without the prior permission of the publisher or a licence from the
Copyright Licensing Agency Limited. Details of such licences (for
reprographic reproduction) may be obtained from the Copyright
Licensing Agency Ltd of 90 Tottenham Court Road, London, W1T 4LP.
A catalogue record of this book is available from the British Library
ISBN 13: 978 0 335 23364 9 (PB)
ISBN 10: 0 335 23364 3 (PB)
Library of Congress Cataloging-in-Publication Data
CIP data applied for
Typeset by Graphicraft Limited, Hong Kong
Printed in UK by Bell and Bain Ltd, Glasgow

Fictitious names of companies, products, people, characters and/or data
that may be used herein (in case studies or in examples) are not intended
to represent any real individual, company, product or event.
a01.qxd 23/02/2009 02:53PM Page v
Contents
Preface to the third edition xv
Acknowledgements xvii
Section 1 Investigating health services and health: the scope of research 1
1 Evaluating health services: multidisciplinary
collaboration 5
Introduction 6
Health services research 6
The assessment of quality 7
Audit 8
Medical audit, clinical audit, quality assurance and
clinical governance 8
Evaluation 10
Structure, process and outcome 10
Appropriateness and inappropriateness 12
Outcome 13
Summary of main points 16
Key questions 16
Key terms 17
Recommended reading 17

2 Social research on health: sociological and
psychological concepts and approaches 18
Introduction 19
Sociological and psychological research on health 19
1 Health and illness 20
The bio-medical model 20
The social model of health 21
Lay definitions of health 22
a01.qxd 23/02/2009 02:53PM Page vi
vi Contents
Lay theories of illness 23
A disability paradox? 24
Variations in medical and lay perspectives 25
2 Social factors in illness and responses to illness 26
Social variations in health: structural inequalities 26
Psycho-social stress and responses to stress 27
Stigma, normalisation and adjustment 31
The Sick Role and illness behaviour 33
3 Models of health behaviour 37
Health lifestyles 37
Health behaviour 38
Models of health-related actions 39
4 Health-related quality of life 43
Self-efficacy, self-mastery, autonomy and control 44
Theoretical influences on measurement 45
5 Interactions between health professionals
and patients 47
Communication 47
Patients’ evaluations of health care 47
Summary of main points 60
Key questions 61
Key terms 62
Recommended reading 62
3 Health needs and their assessment: demography
and epidemiology 63
Introduction 64
1 The assessment of health needs 64
Health needs 64
The need for health and the need for health care 65
Methods of assessing health needs 68
The role of epidemiological and demographic research 71
2 Epidemiology 72
The role of epidemiology 72
Epidemiological research 73
Methods of epidemiology 75
Assessing morbidity, mortality, incidence
and prevalence 82
3 The role of demography 86
Demographical methods in relation to assessing need 87
Rates: births and deaths 88
The need to standardise 89
Analyses of survival 92
a01.qxd 23/02/2009 02:53PM Page vii
Contents vii
Summary of main points 95
Key questions 96
Key terms 96
Recommended reading 96
4 Costing health services: health economics 98
Introduction 99
Health economics 99
Demand, utility and supply 101
Economic appraisal 102
Cost minimisation 103
Cost-effectiveness 104
Cost–benefit analysis 104
Event pathways 107
Opportunity cost 107
Discounting 109
Cost–utility analysis 109
Cost–utility analysis and summary health indices 110
Costing health services 118
Study methods used for costings 122
Summary of main points 123
Key questions 123
Key terms 124
Recommended reading 124
Section II The philosophy, theory and practice of research 125
5 The philosophical framework of measurement 127
Introduction 128
The philosophy of science 128
Paradigms 129
Objectivity and value freedom 129
Plato’s cave 130
Deductive and inductive approaches 131
The survival of hypotheses and paradigm shifts 135
Theoretical influences on social research methods 135
Social science and grounded theory 136
Positivism 136
Phenomenology 138
Choice of methods 141
Summary of main points 142
Key questions 142
Key terms 143
Recommended reading 143
a01.qxd 23/02/2009 02:53PM Page viii
viii Contents
6 The principles of research 144
Introduction 145
Searching the published and unpublished literature 145
Systematic literature reviews 147
Meta-analyses 150
Rigour 152
Aims, objectives and hypotheses 152
Concepts and theories 154
Research proposals 156
Research design and research methods 158
Selection of measurement instruments 158
Level of data and statistical techniques 159
Reliability and validity 162
Threats to reliability and validity 171
Ethics and ethical committees 176
Dissemination 177
Summary of main points 179
Key questions 180
Key terms 181
Recommended reading 181
Section III Quantitative research: sampling and research methods 183
7 Sample size and sampling for quantitative research 185
Introduction 186
1 Calculation of sample size, statistical significance
and sampling 186
The sampling unit 186
Calculation of sample size and statistical power 187
Testing hypotheses, statistical significance,
the null hypothesis 188
Type I and type II errors 190
One- or two-sided hypothesis testing 192
Statistical, social and clinical significance 193
Sampling frames 194
Sampling 196
Confidence intervals and the normal distribution 197
External validity of the sample results 202
2 Methods of sampling 203
Random sampling 203
Non-random sampling: quota sampling 206
Sampling for qualitative research 207
Sampling for telephone interviews 209
a01.qxd 23/02/2009 02:53PM Page ix
Contents ix
Summary of main points 209
Key questions 211
Key terms 211
Notes 211
Recommended reading 212
8 Quantitative research: surveys 213
Introduction 214
1 Survey methods 214
The survey 214
Descriptive and analytic surveys 215
Retrospective (ex post facto), cross-sectional surveys 217
Prospective, longitudinal surveys 217
Cross-sectional and longitudinal cohort studies 221
Triangulated research methods and surveys 222
2 Methods of analysing change in longitudinal studies 223
Analysing change 223
Sample attrition and analysing change 230
Stopping rules and analysis of interim results 233
Summary of main points 234
Key questions 234
Key terms 235
Recommended reading 235
9 Quantitative research: experiments and other analytic
methods of investigation 236
Introduction 237
The experimental method 237
Internal and external validity 241
Reducing bias in participants and the investigating team 245
Blind experiments 246
The RCT in health care evaluation 247
Other analytic methods of investigation 252
Before–after study with non-randomised control group 254
After-only study with non-randomised control group 255
Time series studies using different samples

(historical controls) 255
Geographical comparisons 256
People acting as own controls 256
Within-person, controlled site study 257
Threats to the validity of causal inferences in
other analytic studies 257
Summary of main points 257
Key questions 258
Key terms 259
Recommended reading 259