HLTB15: Introduction to Research in Health Studies
Lecture 2: Health Studies: a multi-disciplinary approach
Health Services Research: the multidisciplinary field of scientific investigation that studies how social
factors, financing systems, organizational structures and processes, health technologies, and personal
behaviors affect access to health care, the quality and cost of health care, and ultimately our health and
Research: the systematic and rigorous process of enquiry which aims to describe phenomena and to
develop and test explanatory concepts.
Types of Research Studies include:
Qualitative methods: aims to find out information on a topic in which little is known
Double-blind RCT (Randomized Controlled Trial): used to investigating cause and effect issues
A triangulated or combined methodological approach to addressing different facets of a
research issue is also a useful approach
Health Research: has an important role in informing the planning and operation of services aiming to
achieve health of individuals/populations
also systematic and rigorous
1. Health Systems Research: ultimately concerned with improving the health of a community, by
enhancing the efficiency and effectiveness of the health system as an integrated part of the
overall process of socio-economic development
a. Eg. Pumping more money in to improve SES factors
2. Health Services Research: relationships between health service delivery and the health needs of
the population – aim is evaluation
a. Eg. Looking at the types of accessibilities/service in a community. Will depend on the
needs of a population, services available and how delivered
b. More specifically HSR aims to produce reliable and valid research data on which to base
appropriate, effective, cost-effective, efficient, and acceptable health services at the
primary and secondary care levels.
3. Health Technology Research: Looks at health care interventions
a. Eg. Interested in what is done at level of health or improving health care to improve
effectiveness/efficiency but at individual level. Such as giving individuals glucose
Audit and quality assessment: aim to monitory whether predefined and agreed standards have been
Assessment of Quality: relation to its effectiveness with regard to improving the patient’s health status,
and how well it meets professionals’ the public’s standards about how the care should be provided
Donabedian: focused on measurement of structure (inputs and resources, such as staffing,
buildings, funding); process (service delivery, organization and use, including resources), output
and outcome Maxwell: Described six dimensions of quality: appropriateness; social acceptability (patent’s
views, met expectations); effectiveness (consistent with desired effect); relevance to need;
Higginson: Defined health care as effectiveness, acceptability and humanity, equity and
Audit: aims to improve patient outcome, to develop a more cost effective use of resources and to have
an educational function for health professionals.
Consists of reviewing and monitoring current practice and evaluation against predefined
Medical Audit: the systematic critical analysis of the quality of medical care, including a review
of diagnosis and the procedures used for diagnosis, clinical decisions about treatment, use of
resources and patient outcome.
Clinical Audit: conducted by doctors and other health care professionals and is the systematic
critical analysis of the quality of clinical care.
Quality Assurance: a clinical and management approach which involves the systematic
monitoring and evaluation of predefined and agreed levels of service provision. Quality
assurance is the definition of standards, the measurement of their achievement and the
mechanisms employed to improve performance.
Quantitative research methodology is most appropriate for audit, much can be gained by
supplementing this with qualitative methods such as observation
Evaluation: the use of the scientific method, and the rigorous and systematic collection of research
data, to assess the effectiveness of organizations, services and programs.
Formative evaluation: involves the collection of data while the organization or program is active, with
the aim of developing or improving it.
Summative evaluation: involves collecting data about the active (or terminated) organization or program
with the aim of deciding whether is should be continued or repeated.
Methods for evaluation:
1. Structure: refers to the organizational framework for the activities
a. Refers to the buildings, inputs such as equipment, staff, beds, and resources needed to
meet defined standards
b. Data on structure and inputs can be obtained by questionnaire and document analysis
2. Process: refers to the activities themselves. Outputs: relate to productivity
a. Process is the documentation and analysis of dynamic events and interactions. Data on
processes are essential for the evaluation of whether scarce health service resources are
b. Outputs are types of data that is collected. These can be operationalized in relation to
rates of productivity for hospital discharge, number and type of supplies given, the
number of patient-professional contacts and their type, the number of home visits etc.
3. Appropriateness: relevant to outcome. The emphasis in health services research is on the
measurement of the appropriateness of, as well as the effectiveness of, interventions in the
a. Inappropriateness: the assessment of health outcomes and appropriateness of
treatments has been given impetus by the increasing evidence about high rates of
inappropriate treatments. 4. Outcome: the effects of health services on patients’ health as well as patients’ evaluations of
their health care. Donabedian defined health outcome as a change as a result of antecedent
a. Refers to the effectiveness of the activities in relation to the achievement of the
Comparative spending on health research: Canada is not funding health research as much as others. US
is the most. The UK is based on public and private funding so the reported amount is inflated.
Health Research: Mostly focused on aetiology (cause of diseases) and underpinning (underlying factors
not diagnosis, but factors that are linked to it), very little is used for prevention. The Canadian Institute
of Health Research (CIHR) identifies priority aspects based on workshops, patient summaries to allocate
Multidisciplinary Diversity in Methodology: Recognizes the new definition of social well being. Makes it
more valid and meaningful results. Different than trends that exists before that were focused on
biomedical model of health which looked at the absence of disease (body that broke down has be fixed
mechanically and if it doesn’t get fixed the body dies)
1. Quantitative research: explores relationships using numbers. Uses numeric data (surveys, lab
experiments, incidence rates).
a. Based on the theory of positivism which evolved from scientific method which was
developed to determine rigorousness of results. Objective measures is a method that
says all social phenomena can be measured objectively. This is easily achieved when
2. Qualitative Research: Came into existence when people figured out not everything can be
measured objectively. It address behavior, feelings. Positivism doesn’t capture reality all the
a. Interpretative school of thought
b. Theories of ethnomethodology (ethic differences), social/symbolic interactionism,
reaction theory, structural theory. Eg. Unstructured interviews, observation, case
studies, ethnography, focus groups.
c. Textual, rather than numerical or ordered data
d. Analytical Techniques broad themes in quantitative methodology
i. Linear Regression
ii. Sampling Techniques
iv. Variable Classification
v. Variable Reduction
vi. Hypothesis Testing
vii. Logistic Regression
e. Takes more time even though it’s subjective, but that’s the whole purpose -> to capture
the entire picture in a structured way, it could be a done in a rigoress way.
i. High aggregation vs. low aggregation: high = talking to a lot of people to put
ii. Low overhead vs. high overhead: costs for research
3. Exploratory research: infrequent diseases that are prevalent – describe (prevalence) symptoms
4. Descriptive Research: describing a phenomena that is being undertaken. Anything that looks at
describing a situation, or a research. 5. Analytical Research: a researcher has a specific hypothesis that he or she wants to test. It might
be looking at the relation between exposure and an outcome.
a. Usually: exploratory descriptive analytical
Disciplines: There are many disciplines involved. They borrow tools, theories, methods, from many
disciplines or fields.
Medical anthropology: relationships between issues of health/ health care and culture or
Demography: characteristics of human populations
Epidemiology: patterns, causes, and control of disease
Health Economy: comparison of costs and consequences of health care
Health Geography: spatial patterns of health, disease, and health care
Health Policy: health resource allocation
Medical Sociology: social factors and health, application of sociological theory
Health psychology: biology, behavior, and societal relationships and health and illness
Health Professionals: Identifying or preventing or treating illness or disability
Biostatistics: Application of statistics to a topic in biology, health, disease and healthcare.
Social Sciences: Understanding individuals’ perceptions, behaviours. Experiences in the face of
health and illness, health care experience, coping and management strategies, how soc