Prem Prasad Panta

(Associate Professor)
Research and Biostatistics
Karnali Academy of Health Sciences
 Objectives
Commonly used active verbs
Quntitative research Qualitative research
• Descriptive research • Ethnography
– Identify, Assess, Find out – Assess, describe, explain,
– Describe, Compare discover
• Correlational • Grounded theory
– Determine, examine, – Develop, extend,
identify
identify, validate
• Experimental
• Phenomenological
– Determine , examine,
investigate, measure, – Describe, develop,
detect express
 Hypothesis
• Tentative statement of the expected relationship between two or
more variables
Types of hypothesis
• Simple and complex
– Simple hypothesis: relationship between 2 variables
– Complex hypothesis: relationship between more than 2 variables
• Associative and causal hypothesis
– Associative hypothesis: association between variables at natural settings
– Causal hypothesis: predicts the cause and effect relationship
• Directional and non directional
– Directional: direction is specified, positive and negative relationship
– Non directional: not specify the direction, there is relationship
• Null and alternative hypothesis
– Null hypothesis: statistical hypothesis: no relationship
– Alternative hypothesis: research hypothesis: there is relationship
 Literature Review
• Defined as broad, comprehensive, in depth,
systematic, and critical review of scholarly
publication, unpublished printed, or audio
visual materials and personal
communications.
• It develops new knowledge, insights and
overall scenario of that topic
 Types of literature review
On the basis of purposes and methodologies, it would be broadly
classified as:
• Traditional and narrative literature review: gather a volume of
literature ad summarize the facts and findings,
• Systematic literature review : more rigorous and more
systematic, check reliability and validity of research, selection
criteria, quality of research, inclusion and exclusion criteria for
literature, analysis part
• Meta-analysis: advanced form of systematic literature review,
involves the findings of several quantitative studies on a single
subject area and draw the integrated inferences and conclusions
• Meta-synthesis: non statistical technique, used in qualitative
research, integrates the research of findings of grounded theory,
phenomenological and ethnographic studies
 Sources of literature
• Published information
- Primary source: Original, peer-reviewed and published
research journal articles by original researchers
- Secondary sources: description of studies prepared by
someone other than the original researcher, comment
and summaries of multiple research studies; e.g. Meta-
analysis, systematic reviews and meta- synthesis
• Unpublished information
• Experts, scientific societies and organisations

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 Resource of literature
Journals

Magazines
and news Books
papers

Resources of
literature
Research review Electronic
report database

Conference
Thesis
papers
 Electronic Sources
• Search engine: Google, Yahoo, MSN etc.
• Using database:
– Pubmed (http://www.ncbi.nlm.nih.gov/pubmed)
– ResearchGate (www.researchgate.net
– Web of Science (https://www.webofknowledge.com)
– Cochrane (systematic review for health sciences related
literature)
– WHO countries (free database, WHOSIS=who statistical
information system)
– African Index Medicus (African biomedical information, support
by WHO)
• Google Scholar
• Using online version of the Journals
• Online magazines, e-books, etc.
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 Research Design
• Experimental research design
– True experimental design/RCT
– Quasi experimental design
– Pre experimental design
• Features
– Intervention/Manipulation
– Randomization
– control
 Observational research design
• Descriptive research design: accurate description of
characteristics of individual/group, natural setting, no
manipulation, no control, variables are studied as they
exit in the real world.
– Case report
– Case series
– Cross sectional
• Case control : causes of diseases is investigated
• Cohort: longitudinal approach, investigation of
occurrence of disease in a cohort with existing
presumed causes
 Research design
• Meta analysis: Quantitatively combining and integrating
the findings of multiple research studies on a particular
topic
• Secondary data analysis: collected data are reanalyzed by
others
• Evaluation studies: involves the judgement about success
of programs, practices, procedures or policies
• Operational research: involves the study of complex
human organizations and services to develop new
knowledge about institutions, programs, use of facilities
and personnel in order to improve working efficiency of an
organization.
 Randomization
• Means that every subject has an equal chance
of being assigned to the experimental or
control group.
• Also know as random assignment of subjects
• Used in true experimental research design
• Minimize the threat of internal validity of the
study and to eliminate the effect of
extraneous variable on dependent variable
 Descriptive research
• Case report: Descriptive observational study
of a single patient or case with rare, specific
and unique features
• Case series: group of patients with similar
clinical presentation, diagnosis or who are
exposed to similar intervention are observed
over a period of time
 Cross sectional research
• Relationship between disease and other
factors at one point in time in defined
population
• Prevalence studies or epidemiological studies
• Exposure and outcome measured at the same
point of time
• Types: univariant, explorative and comparitive
 Case control research
• Causes of a disease are investigated after the
occurrence of a disease
•Association between exposure and outcome= odds ratio
•Specially used for studying rare and emerging diseases
•Not possible to calculate the incidence or prevalence rate

Cause Effect
 Cohort research design
• Cohort: group of people who have something in common
and who remain part of a group over an extended time
• Longitudinal approach is used to investigate the
occurrence of disease in a cohort
• Known as incidence studies
• Individuals subjects are followed over time to measure
the exposure the exposure when it happens, then they
measure the outcome at a point in time after exposure
• Used to measure the risk differences, risk ratio,
somewhere odds ratio
• Also known as prospective study
 Cohort research
Cause Effect
 True experimental design
• Effect of independent variable is observed on dependent variable
• Used to find the cause and effect relationship
• Independent variable is manipulated through treatment or
intervention
• Randomization and control
Example
• Post test only control design
• Pretest-post test only design
• Factorial design
• Randomized block design
• Latin square design
 Quasi- Experimental Research
• Popular method in health science research
where experimental design is not done
• Cause and effect is studies
• Manipulation is done in independent variable
but at least two properties are absent
(randomization or control group )
 Sample size
• To measure the prevalence
n = Z2pq/d2
Z = 1.96 at 95% CI
P = prevalence of an attribute
Q=1-P
D= allowable error (5% to 10%)
• To estimate the average
n= Z2SD2/d2
SD = standard deviation
 Data collection
Data sources:
• Primary sources
– People, objects, programs etc.
– Collected through interviews, questioning,
observations, measurements
• Secondary sources:
– Published: journals, newspapers, government
reports, census reports, mass communications
– Unpublished: thesis, dissertations, official records
 Types of method
Techniques Tools
Interview: Interview schedule/ Questionnaire
Questioning(self report): Questionnaire/attitude scale
Observation: Rating scale/check list/video
Types of Question
Open format(open ended)
Closed format(closed ended): Dichotomous/Multiple
choice/cafeteria/rank order/rating/importance/ Likert
question
 Reliability
• Reliability means the consistency with which set of
test scores measure whatever they do measure.
• The reliability of the measuring scale must be stable,
consistent.
• Reliability is necessary for validity but not sufficient.
• A measurement is reliable it gives the same results
in many times
• Reliability refers to the repeatability of findings.
• A instrument is reliable if it has absence of error.
 Validity
• The most critical criteria of the scaling
technique is validity.
• A scale is said to be valid when it measures
correctly what is expected to be measure.
Reliability and Validity
 Reliability Validity
• It is the extent to which • A valid measure is one
the measurements which is measuring what
resulting from a test it is supposed to measure.
reflect characteristics of • A valid measure must be
the subject of reliable but a reliable
measurement measure may not be valid.
• An experiment is reliable • Validity refers that getting
is we are getting results reflect the real
consistent result from one.
the same measure
 Reliability and Validity
• Reliability: How consistent or stable is the
instrument?
– Is the instrument dependable?

• Validity: How well does the measure or

design?
 Measuring reliability
• Reliability of any research is the degree to which it gives an
accurate score across a range of measurement.
• Test-retest: Same people, different times.
• Parallel/Alternate/Equivalent forms: Different people, same
time, different test.
• Split Half Method: same people taken odd and even form
• Correlation coefficient reveals the magnitude and direction of
the relationship between scores
• Cronbach's alpha is a measure of internal consistency, that is,
how closely related a set of items are as a group.
• Interpretation
– R= 1, perfect reliability
– R= 0, no reliability
– R> =0.7, acceptable level of reliability
 Test Retest reliability
N  XY   X  Y
rxy 
N  X 2   X  N Y 2  Y 
2 2

• X= score of first test

• Y = score of second test
• N= pair of observation
 Validity
• Validity refers to the credibility or believability
of the research.
• A scale possesses validity when it actually
measures what it claims to measure. In other
words, a scale is said to be valid if it measures
what is expected to measure. If a test is an
accurate predictor, it is said to have good
validity.
 Types of validity
• Face validity: Does the content of the test
appear to be suitable to its aims?
• Content validity: Is the test fully
representative of what it aims to measure?
• Criterion validity: Do the results correspond
to a different test of the same thing?
• Construct validity: Does the test measure the
concept that it’s intended to measure?
 Types of Validity
1. Face validity: overall look of an instrument regarding
its appropriateness to measure particular attribute
2. Content validity:
 concerned with the scope of coverage of the content area to
be measured.
 Content validity refers to how accurately an assessment or
measurement tool taps into the various aspects of the
specific construct in question
 This validity is ensured through the judgements of experts
about the content.
 3. Criterion validity
• Criterion validity (or criterion-related validity) measures how
well one measure predicts an outcome for another measure.
• Criterion validity establishes whether the variable or concept
can be measured with accuracy by comparison with an
existing gold standard, and whether the instrument can
substitute for the gold standard or vice versa.
For example:
• Performance test of applicant is taken during the interview
process.
• The GRE has been shown as an effective tool (i.e. it has
criterion validity) for predicting how well a student will
perform in graduate studies.
 Types of Criteria-related Validity

• It is broadly classified as
a. Predictive validity : it is the degree of
forecasting judgment
b. Concurrent validity: It is the degree of the
measures at present
 4. Construct Validity
• Construct validity is "the degree to which a test
measures what it claims, or rationales, to be
measuring.
• Construct validity is the extent to which the
measurements used, often questionnaires,
actually test the hypothesis or theory they are
measuring. Construct validity should
demonstrate that scores on a particular test do
predict the theoretical trait it says it does.
 Interpretation
• The validity coefficient is measured in terms of
the correlation coefficient (r) of the scores of
he different tests. If r lies in between
• 0.9 ≤ r ≤ 1 =Very high validity
• 0.8 ≤ r ≤ 0.9 =high validity
• 0.6 ≤ r ≤ 0.8 =Satisfactory validity
• 0.4 ≤ r ≤ 0.6 =moderate validity
• 0.0 ≤ r ≤ 0.4 =poor validity
 Format of a research report

• Introduction • Materials and method

– Research design
– Background
– Research setting
– Need for study – Target population
– Research problem – Sampling technique and
– Objectives sample size
– Validity and reliability
– Hypothesis/research
– Data collection procedure
question – Ethical consideration
– Operational – Plan for data analysis
definition • Results
– Conceptual • Discussions
framework • Conclusion
– Literature review • references
 Basic Concepts on Research Ethics
• The word ethics – derived from the Greek word ethos,
which means “character”, and from the Latin word
mores, which means “customs”.
• Ethics is defined “a science of morals”.
• Ethical considerations are not legal considerations.
• Medical Ethics - Protects the Patient
• Research Ethics - Protects the
Study Participants Or
Community
 Ethics in Health Research
• Ethics in Health Research in general is related with
professional responsibility and moral value for
protecting human rights and social justice.

• A way of characterizing actions with regard to

human dignity

• Types of behavior related to morality, social justice,

human rights, and social as well as professional
responsibility.
Ultimately….
• Ethics in Health Research in general is related with
professional responsibility and moral value for
protecting human rights and social justice.

• So, ethics is – a type of behavior related to morality,

social justice, human rights, and social as well as
professional responsibility.
 Ethical issues and clients rights
Responsibility of researcher Rights of subjects
• Privacy • Privacy
• Consent • Consent
• Rewards promises
• Rewards promises
• Protection
• Information
• Information
• Debriefing
• Debriefing
• Approval
• Permission
• Publication
 Ethical issues in Biomedical research

• Principle of ethics
– Beneficence: Positive risk benefit, focus on
potential risk and physical harm; avoid discomfort
– Justice: fair and nondiscriminatory selection,
anonymity and confidentiality, not misused of
data, protect the vulnerable group
– Respect of human dignity: right to question and
clarification, right to quit from study, fully
informed consent
 Confidentiality and Anonymity
• Confidentiality and anonymity are ethical practices
designed to protect the privacy of human subjects
while collecting, analyzing, and reporting data.  
• Confidentiality refers to a condition in which the
researcher knows the identity of a research subject,
but takes steps to protect that identity from being
discovered by others.
• Anonymity is a condition in which the identity of
individual subjects is not known to researchers.
 Respect for the Dignity of Persons
• Respect for the autonomy of persons –
Promoting the essential freedom in decision making
attributable to persons based on their moral and
rational dignity and their capacity for self-
determination
• The active protection of persons –
Requiring those who are dependent or vulnerable
be affordable security against harm or abuse.
• No research should prevail over for human rights,
fundamental freedoms and human dignity.
• Right to full disclosure
• Inform consent
 Beneficence (Non-maleficence)
• Obligation to maximize possible benefits and to
minimize possible harms and wrongs (Do Good).

• Non-maleficence: Safeguarding against possible harms

and abuses (Do no harm) i.e. protecting the health of the
participants and their communities.(freedom from harm)

• Risk/Benefit ratio: establishing the positive risk benefit

ratio
 Justice
• It requires that persons in similar circumstances be
treated alike. (Right to fair treatment)

• It also requires the equitable distribution of the

burdens and benefits of research (Distributive and
compensatory justice).

• Special provisions must be made for the protection of

the rights and welfare of all persons in vulnerable
situations.
• Right to privacy (confidentiality and anonymity)
 Respect for Environment
• Ensure the proper and safe disposal of biologically
hazardous waste from laboratory, clinical or field
research.
• Safeguard the cultural, including religious and
linguistic, heritage of communities and persons.
• Prevent any damage or degradation of the natural
environment caused by the implementation, conduct or
product of research.
• Treat with respect domestic and wild animals in the
context of research and with regard to the effects of the
conduct or outcome of research.
Application of principles
 Vulnerable groups
Incapable of giving fully informed consent or at high
risk group
• Children (less than 12 years)
• Mentally or emotionally disabled people
• Physically disabled people
• Pregnant women
• Institutionalized people (hospital, prisons etc)
 MCQ

1. Ex post facto studies are also called

a. Exploratory
b. Correlational
c. Longitudinal
d. Descriptive
2. Consider this title: “the live experience of surviving
from Earthquake”, this title would indicate which of the
following types of qualitative research.
a. Ethnographic
b. Phenomenological
c. Action
d. Historical
 MCQ
3. When a researcher starts with the dependent variable and
moves backwards, it is called
a. Predictive research
b. Retrospective research
c. Exploratory research
d. Descriptive research
4. The group that does not receive the experimental
treatment condition is called
e. experimental group
f. Control group
g. Treatment group
h. Independent group
 MCQ

5. Cluster sampling is also called

a. Systematic sampling
b. Quota sampling
c. Multistage sampling
d. Network sampling
6. Which of the following studies would require
the largest sample?
e. Correlational
f. Ethnography
g. Phenomenological
h. Grounded theory
 MCQ
7. A total of 40 nurses ae randomly selected from a random
sample of five large hospitals from Kathmandu. This is an
example of
a. Simple random sampling
b. Convenience sampling
c. Cluster sampling
d. Purposive sampling
8. Which of the following sampling technique is less
representative of population?
e. Quota sampling
f. Systematic sampling
g. Cluster sampling
h. Convenience sampling
 MCQ
9. Which of the following is not a type of reliability?
a. Split half
b. Content
c. Internal consistency
d. Test- retest
10. Which of the following types of reliability indicates
the consistency of test scores over time?
e. Equivalent forms of reliability
f. Parallel forms of reliability
g. Split half reliability
h. Test- retest reliability
 MCQ
11. Which of the following is not a method of data
collection?
a. Interviews
b. Experiments
c. Observations
d. questionnaires
12. The confidence interval is widest if we take
e. 99%
f. 95%
g. 90%
h. None of the above
 MCQ

13. To analyze the relationship between blood pressure and height in a sample of
students, we would use
• Paired t-test
• Correlation coefficient
• Chi square test
• Independent t-test
14. Which of the following is a non-parametric test?
a. ANOVA test
b. Student t test
c. Chi square test
d. Z test
15. While computing chi-square test for a 3x2 contingency table, then degree of
freedom is………………….
e. One
f. Two
g. Three
h. Four
 MCQ
16. Which of the following is not a major parts to the
research report?
a. Abstract
b. Results
c. Method
d. Footnote
17. Which of the following is non-probability sampling?
a. Snowball
b. Random
c. Cluster
d. Stratified
 Multiple Choice Question
18. A cross sectional study design is also known as
a. Incidence study
b. Prevalence study
c. Relative risk study
d. None of the above
19. Internal validity refers to ..
e. Whether or not there is really a causal relationship between two
variables
f. Whether or not the findings are relevant to the participants’
everyday lives
g. The degree to which the researcher feels that this was a worthwhile
projects
h. How accurately the measurements represents underlying concepts
20. The key defining characteristic of experimental
research is that:
a. The independent variable is manipulated
b. Hypotheses are proved
c. A positive correlation exists
d. Samples are large
21. In an experiment, the group that does not
receive the intervention is called:
a. The experimental group
b. The participant group
c. The control group
d. The treatment group
22. Standard deviation is a measure of:
a. range
b. central tendency
c. inference
d. dispersion
23. In an experiment the researcher manipulates the
______variable and measure the ___ variable.
a. independent, dependent
b. dependent, independent
c. causal, spurious
d. spurious, causal
24. In a normal distribution most scores are located:
a. at the high end of the distribution
b. at the low end of the distribution
c. in the center of the distribution
d. at the extremes of the distribution

25. Correlation coefficients range from:

a. r = -1 to r = +1
b. r = 0 to r = +1
c. r = -1 to r = 0
d. r = +.5 to r = +1

26. Data from a correlational study is usually shown as a:

a. scatterplot
b. pie chart
c. bar graph
d. b or c
• n = z2PQ/d2
• Z = 1.96 at 95% CI
• P =30%
• Q= 70%
• d = 5% to 10%
• N= (1.96)2 (30)(70)/52 = 322
Thank you