HLTC15 Midterm notes.doc

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Health Studies
Suzanne Sicchia

HLTC15 Exam notes 14/10/2012 21:17:00 ← ← Lecture 2 ← ← Positivist- ← 1) natural sciences—bio etc ← 2) quantitative methods—rcts, cohort, and meta analysis (deductive ← 3) sometimes socialsci—history political science, socio and women’s studies ← ← Interpretive ← 1) social science but not always—history, political science, sociology, women’s studies ← 2) qualitative: inductive—case study, ethnographic, document review ← ← theories that contribute to interpretive tradition are ← 1) grounded theory ← 2) sy,bolic interactionalism ← 3) phenomenology ← 4) post structuralism ← 5) post modernism ← Refocussed social sci—look at ways that meanings are constructured negociated and managed by particular individuals and groups in different social and historical contexts ← Ontological position—reality is structured ← Soft constructivist position- there are subjective and purely physical aspects to disease and treatment processes ← ← Features of Constructivist and Interpretivist Paradigm ← Interpretivist: seeks understanding with a focus on subjective meanings and interpretation ← Naturalistic: done in real life not labs ← Complexity—more focus on the depth of analysis NOT inference ← Subjectivity: partial politics and ideology ← Polical: by valuing neutrality concept it makes the research misleading-makes it independent of social relations ← Validity- high trustworthy and credible because it draws on research subject but NO GENERALIZABLE ← ← Ways interpretavist and construcvist can be done 1) observatory studies (participatory or non part) 2) semi and structured interviews 3) focus groups 4) secondary analysis Advantages of Interpretivist research - flexible and descriptive - allows real accounts of nature and knowledge, conflict, subjectivity and ongoing struggle - represents rich, subjective experience, show differences and keep nuanced data - Disadvantages of interpretivist approach - no consensus of methods and data collection or analysis - unjustified generalizations of small groups - convenience sampling - informants accounts are created by the researcher See page 7 Operational definitions in health research The definition impacts 1)what question is posed 2) literature reviewed 3) what’s the sample 4) whats the methods 5) data analysis and interpretation 6) strategy for disseminating the research findings 9 ways to conceptualize health are 1) absence of disease 2) balance 3) function/fitness 4) state 5) capital 6) commodity 7) norm 8) human right 9) deviance and punishment Ethics and health research -branch of more philosophy -ethos: habit character coustom -enquiry about how we ought to act - moral principles that affect how people make decisions and lead their lives -derived from religions, philosophies and culutres Methodology of ethics in research systematic and logical study of the principles governing inquiry 1) sponsorship in terms of how sponsors help or hurt research 2) how the relations of research raise issues to access 3) power deception 4) dissemination of research findings 10 Things to consider when doing research (ethically) 1) purpose of the research 2) study participants—adequate (recruitment, inclusion criteria) 3) potential harm and benetifs 4) financial disclosure and conflict of interest 5) study designs 6) data analysis 7) data storage 8) dissemination of findings 9) privacy and confidentiality 10) transparency and informed consent 11) debriefing ← Ethical guidelines ← 1) Nuremberg code ← 2) Declaration of Helsinki ← 3)Canada tri council (NSER, CIHR, SSHRC) ← Three framework components for humans ← 1) respect for persons • intrinsic values • autonomy • transparency of research • vulnerable people in decision making ← 2)concern for welfare • welfare of participants and risks associated with research • disclosure of benefits • welfare of individuals and groups (stigmatization, discrimination, damage to reputation) ← 3) justice • obligation to treat everyone fairly and equiatably o fairly: everyone with respect and concern o everyone gets the benefits and burdens of research evenly  not equal across groups but consider individual needs of groups o vulnerable population and those with limited capacity to social goods o no one is denied research opportunities or exploited o looked at during inclusion criteria ← differences across what the guidelines are..NC—veto research without consent, D of H, keeps it in early draft of D of H ← ← Principles: respect for autonomy justice, doing no harm and using resources effectively and efficiently ← Rights: provide basic need with best available health care, protect peopme from harm. ← Outcomes: avoid or reduce harm and costs and promote benefits ← Ethics can be problematic in three cases ← 1) Consent and Covert research • always voluntary consent—based on rejection of covert in Nuremberg code o voluntary consent of human subject is essential • Delcaration of Helsinki says nothing on covert research o Doctor’s duty to relieve suffering and advance progress in research and project rights and health ← Object: do not know they are being researched ← Subject: have agreed to be researched but know little about the nature or purpose ← Participants: give informed consent and may contribute ideas that influence the research ← 2) Therapeutic research • D of H claims therapeutic research has lower ethical standards due to the direct benefit • Excuses risks associated with treatment, because when its normally given its accepted regardless of risks o Promises by social research  Problem because it misleads researchers and participants to think the direct benefit should not be refused ← 3) Harm and Benefit Analysis • normally look at the potential risks and benefits to the individual • should look at risks to individual and benefit to the future ← Benefits of Ethical Guidelines • Address complex issues of justice respect, harm and benefit • Raise awareness of issues not dealt with by researchers • Created ethical research standards • Guidance for researchers • Assist in preventing unethical research • Promote high ethical research • Protect research subject/participants • Warn about ethical problems that might arise • Ensures adequate informed consent • Protect researchers and their institutions ← Criticisms of Research Ethics Guidelines • Bias against social science methods • What is defined as potentially harmful • No universal principles of research ethics • Cumbersome approcal processes • Competence of members United Kingdom Research governance Framework for health and Social care - detts, defines, monitors, asses improves safeguards reduce and prevent and lessons learned HLTC05 Exam notes 14/10/2012 21:17:00 ← Lecture 3 ← ← ← Narrative Reviews • Social science research • Theoretical approaches adopted by different authors key concepts • Editorials, commentaries and descriptive aritcles • Most common but not sound in terms of quality • Theories methods etc have changed over time • Descriptive but opinion pieces ← Concepts: terms used to describe a specific phenomenon ← Theories: ideas developed to explain a phenomenon ← Emerpical research: research that has ALREADY been undertaken to explain the phenomena ← Methodology: the philosophical approach adopted to study a phenomenon ← Methods: techniques to test phenonmenon ← ← ← Qualitative Systematic reviews • Clinical practice through the efficacy of health care intervention • Obtain all primary research from multiple databses, performing hand searchers and contacting authors of previously published research • Reviewed in systematic and consistent manner, by several independent reviewers • Rated used standardized system ← ← Quantitative systematic reviews • Meta analysis • Critically evaluates each paper and statistically combines the results of study • Useful when studies have small sample sizes • Determines what is know and not known about an intervention • Evidence of clinical decisions because the results are based on rigourous critical appraisal and pooling of data. • ONE drawback, rarely, disagreements about evidence of wah to pool—which statistical methods to use Literature Reviews -pose a question, target population of information of sources identified and accessed, get appropriate unbiased information from population and conclusions derived ← ← Using Documents in Health Research ← - documents produced by others ← Two strengths are ← 1) authenticity: u get primary research ← 2) variety of sources can be used and combined with other methods ← ← Three levels of Analysis of Documentary Analysis ← ← Statistical Analysis ← - coding and purposeful search for themes ← - codes sorted in categories and variables ← - codes converted into numbers ← -quantify relationships between variables ← ← Content Analysis ← -used quantitatively or qualitatively ← -quantify or analyze the presence of meanings and relationships ← -can make inferences about text ← ← Three approaches to content analysis ← 1) conventional content analysis: observation, codes defined during content analysis, derived from data ← 2) directed content analysis: theories, codes defined before and during, derive from theories ← 3) summative content analysis: keywords, derive before and during, derived from lit review ← ← ← ← Structural Analysis ← -texts viewed as the social processes that CREATED the documents ← -social processes are evident in the text and structure ← - how are documents created and achieve their effect ← - HLTC15 exam notes 14/10/2012 21:17:00 ← Lecture 4 ← What is participant observation: ← - understand an aspect of the social world by observing and participating ← - get behind the public face of the social world ← ← Why do participant observation ← - indept st
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