Understanding Research Methods for Evidence-Based Practice in Health

About the authors vii Chapter 1 Introduction to research, the research process and EBP 1 1.1 The meaning of ‘evidence-based practice’ 2 1.2 Apprehension towards evidence-based practice 5 Decision making by anecdote 6 Decision making by press cutting 6 Decision making by expert opinion 6 Decision making by cost minimisation 7 1.3 Before you start: formulate the problem 8 Chapter 2 Asking questions and searching for evidence 11 2.1 Different types of searching for evidence 12 Informal 12 Focused looking for answers 13 Searching the literature 13 2.2 Differences between primary and secondary research 13 2.3 Effective search strings 13 Steps for effective searching 14 One-stop shopping: federated search engines 16 2.4 Other avenues for how to search for evidence 17 Searching for information using social media 19 Chapter 3 Reviewing literature 21 3.1 Is a paper worth reading at all? 23 Question 1. Who wrote the paper? 23 Question 2. Is the title appropriate and illustrative, and is the abstract informative? 23 Question 3. What was the research design, and was it appropriate to the question? 24 Question 4. What was the research question, and why was the study needed? 24 Question 5. Do the results or findings answer the question? 24 3.2 Reviewing the methods of primary research papers 25 Sample and setting: who are the participants, and where is the study being carried out? 25 What data-collection methods were used? 26 How was the data analysed? 26 3.3 Reviewing the methods of secondary (review) papers 26 Question 1. What is the focused clinical question that the review addressed? 27 Question 2. Was a thorough search of the appropriate database(s) carried out, and were other potentially important sources explored? 27 Question 3. Who evaluated the studies, and how? 28 Question 4. How sensitive are the results to the way the review has been performed? 28 Question 5. Have the results been interpreted sensibly, and are they relevant to the broader aspects of the problem? 28 Meta-analyses and meta-syntheses 28 Chapter 4 Qualitative research 32 4.1 Qualitative research explained 33 4.2 The difference between qualitative and quantitative research 34 4.3 Qualitative methodologies and data collection strategies 35 Qualitative sampling 36 Data collection 36 4.4 Evaluating papers that describe qualitative research 37 Question 1. Did the paper describe an important clinical problem addressed via a clearly formulated question? 38 Question 2. Was a qualitative approach appropriate? 38 Question 3. How were (a) the setting and (b) the subjects selected? 38 Question 4. What was the researcher’s perspective, and has this been taken into account? 38 Question 5. What methods did the researcher use for collecting data, and are these described in enough detail? 39 Question 6. What methods did the researcher use to analyse the data, and what quality control measures were implemented? 39 Question 7. Are the results credible and, if so, are they clinically important? 40 Question 8. What conclusions were drawn, and are they justified by the results? 40 Question 9. Are the findings of the study transferable to other settings? 40 Chapter 5 Quantitative research 43 5.1 Why and how quantitative research is done 44 5.2 Quantitative research designs 46 Intervention studies 46 Observational studies 47 5.3 Measurement 48 Variables — independent and dependent 49 Reliability and validity in measurement 50 Chapter 6 Levels of evidence 55 6.1 Clinical questions in healthcare 56 Finding the best evidence 56 NHMRC and evidence-based practice 57 How researchers answer clinical questions 57 6.2 Matching clinical questions to NHMRC levels of evidence 58 NHMRC evidence levels for intervention studies 60 6.3 How bias threatens the validity of research evidence 63 6.4 Evaluating the evidence – quality of evidence and grades of recommendations for practice guidelines 65 6.5 Levels within levels 66 Chapter 7 Statistics for the non-statistician 73 7.1 Storing quantitative data in a data set 74 7.2 Descriptive statistics for summarising sample characteristics 75 Descriptive statistics for categorical variables 75 Descriptive statistics for continuous variables 76 7.3 The researchers ‘setting the scene’ 77 Have the researchers tested the assumption that their groups are comparable? 77 What assumptions apply to the shape of the data? 77 Have valid assumptions been made about the nature and direction of causality? 78 7.4 Probability and confidence 79 How are p values interpreted? 79 Confidence intervals 81 7.5 Clinical importance of treatment effects 81 Clinical importance 81 7.6 Summarising treatment effects from multiple studies of interventions in a systematic review 84 Chapter 8 Mixed methods research 88 8.1 An overview of mixed methods research 89 Why use mixed methods in nursing and health sciences research? 89 8.2 Different mixed methods designs 90 Convergent study 90 Sequential study 91 Multiphase (multilevel) study 91 Embedded study 92 8.3 Integration in mixed methods research 93 Integrating the research question 93 Research design 93 Sampling 93 Analysis 93 Interpretation 94 8.4 Mixed method design considerations 94 Weighting (dominance) 94 General challenges associated with mixed methods studies 94 Chapter 9 Sampling 97 9.1 Understanding the terminology around sampling 98 Theoretical population (or target population) 98 Study population (or accessible population) 98 Sampling 99 Sample 99 Sampling frame 99 9.2 Types of sampling 99 Probability sampling 99 Non-probability sampling 100 Sampling methods 100 9.3 Sampling error 102 9.4 Calculating sample size 102 Quantitative research 102 Qualitative research 103 Chapter 10 Ethics 106 10.1 Ethical principles 107 Autonomy: patients/clients are free to determine their own actions 107 Beneficence: acting to benefit human kind 108 Justice: obligation to treat fairly 108 Non-maleficence: avoiding or minimising harm 108 Respect for human dignity 108 Confidentiality: maintenance of privileged information, including the right to privacy and anonymity 109 Veracity: obligation to tell the truth 109 10.2 The role and function of human research ethics committees 109 10.3 Judging the ethical aspects of a published journal article 111 Chapter 11 Getting evidence into practice 114 11.1 Adoption of evidence-based practice (EBP) 115 Individual barriers 115 Organisational barriers 116 11.2 Encouraging individuals to implement evidence-based practice 116 11.3 Organisational support of evidence-based practice 117 Integrated care pathways 117 Clinical practice guidelines 118 11.4 The client perspective in evidence-based practice 119 Patient-reported outcome measures (PROMs) 119 Shared decision-making 119 Option grids 120 Chapter 12 Challenges to evidence-based practice 124 12.1 When evidence-based practice is done badly 126 12.2 When evidence-based practice is done well 126 Guidelines devalue professional expertise 126 The guidelines are too narrow (or too broad) 127 The guidelines are out of date 127 The client’s perspective is ignored 127 There are too many guidelines 128 Practical and logistical problems 128 The evidence is confusing 128 12.3 Achieving evidence-based practice 129 Index 133