HLTC15 Midterm Study Notes (Lectures 1-3.docx

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Health Studies
Suzanne Sicchia

HLTC15 – LECTURE 1 – INTRODUCTION – SEPT. 11, 2012 TERM DEFINITION ADDITIONAL INFO. Health Research Inquiry conducted to develop - Includes a wide range of research methodologies: knowledge (related to health) based on from randomized control trials (RCT), to systematic available evidence, following certain reviews, to ethnographies, to surveys, and so on rules and procedures – contested - Differences between various methodological approaches is systematic, not idiosyncratic Positivist Divided into Natural Sciences (and - Advantages of Research Carried Out in the sometimes Social Sciences) and Positivist Tradition Quantitative Methodologies  Randomization and blinding effective means of reducing bias–––In medical research this gives us more confidence that the treatment we will be given is the most effective  Use consistent and relatively concrete outcome measures (e.g. recovery time, dose-response, etc.)–––In this way we know that the study is assessing (again, in a restricted way) the actual effects of the intervention or disease process, and not merely recording people‟s subjective feelings about how they have improved over the course of treatment - Disadvantages  Many questions about health and health care are not amenable to RCTs  Give insufficient attention to a person‟s lived experience which are complex, subjective, and embedded in social and historical contexts  Difficult to dissect and categorize (reduce) social life objectively, regardless of blinding and randomization procedures  Complete objectivity is a fallacy – it is not possible to say, understand, or communicate anything without a particular language or conceptual scheme (no neutrality) Natural Sciences Anatomy, Biology, Chemistry, Epidemiology, Physics, Physiology Quantitative Deductive. Include RCTs, Cohort Methodologies Studies, and Meta-analysis. Social Sciences History, Poli-Sci, Sociology, Women‟s Studies Qualitative Inductive. Include Case Studies, Ethnographies, and Document Reviews Methodology Paradigm A set of a priori assumptions, concepts, - They are discrete and they determine: What is values, and practices (in other words a studied; How research is conducted; What methods framework) that constitutes a way of are used; How research results are understood viewing the world. A priori frameworks - Influence research objectives and designs that inform theory and practice. - Parts of a Paradigm: Ontology, Epistemology, Methodology, Methods, Sources Epistemological A researcher‟s understanding of the Standpoint nature of knowledge Ontological A researcher‟s understanding of what Standpoint constitutes reality Epistemology The nature of knowledge or how we come to know certain things about the world Theoretical Theory: systematically organized Perspective knowledge applicable in a relatively wide variety of circumstances devised to analyze, predict, or otherwise explain the nature or behaviour of a specified set of phenomena that could be used as the basis for action. Methodology Pertains to the science and study of methods and the assumptions about the ways in which knowledge is produced Methods Techniques or procedures used to collate and analyze data Paradigm Shifts Dramatic changes in our way of - Rare, but profound thinking - e.g., Darwin‟s Theory of Evolution - e.g., Galileo from Geocentrism to Heliocentrism (earth orbits the sun, not the reverse) Positivist A philosophical system recognizing Epistemology only that which can be scientifically verified or which is capable of logical or mathematical proof, and therefore rejecting metaphysics and theism. Positivist Reality exists, independent of us, and as Ontological such it can be discovered and Position objectively measured Positivist Empiricism, Determinism, and Assumptions Skepticism Enquiry ought to be conducted through Empiricism observation and knowledge verified through evidence Determinism Events in the world occur according to The aims of research are to discover these rules and regular laws and causes. causes. Skepticism Any proposition or statement, even those by great authorities, is open to analysis and critique Features of a Determinism, Objectivity, Positivist Quantification, Reliability, and Paradigm at Generalizability Work in Health Research Determinism Phenomena can be predicted from knowledge of scientific laws Objectivity Researcher is separate and detached from patient/subject, maintaining objectivity, assisted by scientific evidence Quantification Information derived from what can be quantified Reliability Through randomization we can know that our hypothesis is right for other groups Generalizability When data is reliable and free from bias, we can generalize our findings to the rest of the population Positivist Epidemiological and analytic design Paradigm strategies (RCTs; pre-/post, Methods cohort/incidence, and cross sectional studies), survey research, secondary document analysis (e.g. content analysis), structured interviews (as opposed to un-structured interviews), and systematic reviews (i.e., meta- analysis) Scientific 1. Ask Question, It is positivist. Research 2. Do Background Research Process 3. Construct Hypothesis 4. Test with an Experiment 5. Analyze Results & Draw Conclusion a) Hypothesis is True b) Hypothesis is False or Partially True i. Think! Try Again (Step 3) 6. Report Results Interpretivist - Refocused (social) sciences to look at - Advantages of Interpretivist Research Paradigm the ways that meanings are constructed,  Flexible, descriptive and qualitative negotiated, and managed by particular approach encourages reflexivity and makes individuals and groups in different researcher less likely to „get stuck‟ in social and historical contexts conventional ways of thinking - Challenges the dominance of  Allows for the acknowledgement of positivism, precipitated development of conflict, ongoing struggle, tension and qualitative methods subjectivity, as well as the situated and co- - Theories that contribute to the produced nature of accounts interpretive tradition: grounded theory,  It is about subjectivity and complexity – it symbolic interactionalism, seeks to represent rich, subjective phenomenology, post-structuralism, experience, show differences, retain post-modernism nuanced data (not reductionist) - Divided into Social Sciences and - Disadvantages of Interpretivist Approach Qualitative Methodology  No real consensus on appropriate methods of data collection and analysis  Qualitative researchers do sometimes make unjustified generalizations from the accounts of a small number of people  Qualitative researchers may adopt convenience sampling strategies, resulting in samples that, some would argue, are „biased‟ through researcher assumptions and respondent self-selection strategies  Informants‟ accounts are not so much uncovered as created by the researcher Reality is constructed, not „set in stone‟, Interpretivist Ontological not objectively measurable Position Soft Acknowledges that there are both Constuctivist subjective and purely physical aspects Position to disease and treatment processes Features of a Interpretivist, Naturalistic, Subjectivity, Constuctivist/ Complexity, Political, and Validity Interpretivist Paradigm Interpretivist Seeks understanding with a focus on subjective meanings and interpretation Data are collected in the settings of Naturalistic everyday life (not a lab) Subjectivity Research practice and knowledge production is not objective or neutral- rather it is partial, political, ideological Complexity Not so concerned with inference but rather with the depth of analysis (richness, thick description) Political The position of value neutrality is viewed as misleading as it makes the focus on the research seem independent from social relations Validity High on validity (trustworthiness and credibility) as it draws on the understandings of research subjects, but not necessarily generalizable as it relies on the interpretation of the researcher Constuctivist/ In-depth, semi-structured or Interpretivist unstructured interviews, observation Paradigm (participatory or non-participatory), Methods focus groups, secondary discourse analysis Ways to - Health as the absence of disease and Conceptualize infirmity Health - Health as balance (homeostasis) - Health as function or fitness - Health as a state or status - Health as capital - Health as a norm - Health as a human right - Disease as deviance, punishment, etc. HLTC15 – LECTURE 2 – ETHICS IN HEALTH RESEARCH – SEPT. 18, 2012 TERM DEFINITION ADDITIONAL INFO. Ethics Enquiry into how we ought to act and - A branch of philosophy; moral philosophy conduct ourselves. A system of moral - Derived from the Greek word ethos: custom, habit, principles that affect how people make character, disposition decisions and how they (ought to) lead - Derived from religions, philosophies, and cultures their lives. - Divided into three branches: Meta-ethics, Normative Ethics, and Applied Ethics Meta-ethics The purpose of ethics. Deals with the Looks at origins and meaning of ethical principles nature of moral judgment. Normative The kind of conduct in which we should Ethics actually engage. Concerned with the content of moral judgments and the criteria for what is right or wrong Applied Ethics Looks at controversial topics like abortion, animal rights, capital punishment Autonomy, Beneficence, Non- Ethical Principal in maleficence, and Justice Medicine and Health Care Autonomy Obligation to respect the autonomy of others, to the extent that this is compatible with the autonomy of all who are likely to be affected by the action being considered Beneficence The ethical commitment in health care to produce benefit for patients or clients Non- Do no harm. Health care professional maleficence must ensure the balance is always in favour of benefit Justice Obligation to act fairly when dealing with competing claims to do with, for example, resources or rights Ethical - Purpose of the research, Considerations - Study Participants (Recruitment, Throughout the Inclusion/Exclusion, Remuneration, Research etc.), Process - Potential harm/benefits, - Privacy and confidentiality, -
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