Health Research Methods Research Articles

Protocol for a systematic review of the use of qualitative comparative analysis for evaluative questions in public health research

BackgroundThere is an increasing recognition that health intervention research requires methods and approaches that can engage with the complexity of systems, interventions, and the relations between systems and interventions. One approach which shows promise to this end is qualitative comparative analysis (QCA), which examines casual complexity across a medium to large number of cases (between 10 and 60+), whilst also being able to generalise across those cases. Increasingly, QCA is being adopted in public health intervention research. However, there is a limited understanding of how it is being adopted. This systematic review will address this gap, examining how it is being used to understand complex causation; for what settings, populations and interventions; and with which datasets to describe cases.MethodsWe will include published and peer-reviewed studies of any public health intervention where the effects on population health, health equity, or intervention uptake are being evaluated. Electronic searches of PubMed, Scopus, Web of Science (incorporating Social Sciences Citation Index and Arts & Humanities Citation Index), Microsoft Academic, and Google Scholar will be performed. This will be supplemented with reference citation tracking and personal contact with experts to identify any additional published studies. Search results will be single screened, with machine learning used to check these results, acting as a ‘second screener’. Any disagreement will be resolved through discussion. Data will be extracted from full texts of eligible studies, which will be assessed against inclusion criteria, and synthesised narratively, using thematic synthesis methods.DiscussionThis systematic review will provide an important map of the increasing use of QCA in public health intervention literature. This review will identify the current scope of research in this area, as well as assessing claims about the utility of the method for addressing complex causation in public health research. We will identify implications for better reporting of QCA methods in public health research and for reporting of case studies such that they can be used in future QCA studies.Systematic review registrationPROSPERO, CRD42019131910

Capacity building in the field of public health in Tunisia: processes and challenges

Abstract Introduction Capacity building activities between 3 Tunisian Medical Faculties (University of Sfax, University of Tunis el Manar and University of Sousse) and 3 European Universities (Babes-Bolyai University, University of Southern Denmark and Trnava University) began in 2017 in the framework of an Erasmus+ project. The aim of the collaboration is threefold: first, Tunisian partners were assisted in developing the infrastructure of the Centre for Evidence into Health Policy (C4EHP); second, EU- Partners delivered the Research into Policy training programme with 3 modules: public health research methods, evidence-based policymaking and health promotion policies. The program consisted of train-the-trainer and train-the-trainee sessions; third, partners are continuously working on strengthening the collaboration between the academic and non-academic sectors in the field of public health. Lessons learnt Developing the C4EHP contributed to the official recognition of the research structure in the partner Universities. The challenges faced were administrative and legislative national procedures and delays in the equipment delivery and instalment. The train-the-trainer sessions empowered the 18 Tunisian participants to acknowledge their importance in the development of the public health field. Knowledge transfer faced challenges due to differences in the culture and working process, adhering to deadlines, communicating via email as well as due to language barriers. The capacities were, however, strengthened when the trainers started teaching themselves and delivered the train-the-trainee sessions. We observed a level of distrust from the non-academic sector due to previous international projects, unrelated with the current project or implementation team, and which had elicited little to no impact. Development of local collaboration between academic and non-academic sectors needs to be explored deeper.

Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia?

ResumenLa verificación del cumplimiento de los principios éticos en la investigación en salud legitima su ejercicio ante la sociedad y posibilita la resolución de dilemas éticos frente a nuevos intereses y métodos de investigación. En Colombia, la Resolución 8430 de 1993 es una de las principales pautas éticas que regulan la investigación en salud. Dado que no ha sido revisada ni actualizada desde su adopción, se hace necesario valorar su vigencia y suficiencia para abordar los potenciales dilemas éticos que se plantean actualmente en la investigación en salud en el país. En este contexto, se detallan algunos vacíos y contradicciones, así como aspectos que requieren de una revisión profunda, a partir de una concepción amplia de las áreas y los métodos de investigación en salud. Tras discutir las principales falencias e imprecisiones, se proponen alternativas para que la Resolución responda a las necesidades actuales del país frente a la ética en investigación en salud con seres humanos.

Connecting adverse childhood experiences and community health to promote health equity

AbstractAdverse childhood experiences (ACEs) can have negative effects on health outcomes across the lifespan. Furthermore, the effects of ACEs are often compounded by social determinants of health and historical and contemporary trauma that can affect entire communities. The socio‐ecological model is a valuable framework for understanding the complex systems in which efforts to promote health equity are situated. Using a trauma‐informed lens, community health becomes a powerful focal point for viable prevention and treatment options to address ACEs and promote health equity. Self‐healing on a community level involves collective engagement; people most affected by ACEs and trauma come together around activities that have the potential to lift up the entire community and foster individual and community resilience. The use of community health research and evaluation methods that are consistent with trauma‐informed, empowerment approaches can contribute to community healing. This paper is intended to establish a common language for how community healing can address ACEs and foster health equity.

El método Delphi en la investigación en reumatología: ¿lo estamos haciendo bien?

IntroductionThe Delphi method is a technique that allows consensus to be reached by a group of experts who have opinions on a specific issue. It has been widely used in different areas of knowledge, including health sciences. Rheumatology is one of the medical specialties that has used this consensus technique the most. ObjectivesTo conduct a review of the ideal process for application of the Delphi method. To describe the current impact of the Delphi method on health research, and take a critical look at its application in rheumatology research. Materials and methodsThe frequency of use of the Delphi method in publications indexed in MEDLINE was evaluated, as an approximation to the measurement of its use in health sciences. A search was made of the articles that mentioned the use of the Delphi method as a research tool in rheumatology. ResultsA total of 4,574 articles were found when searching Medline using the MeSH term “Delphi Technique”. The analysis included 148 articles that applied the Delphi method in rheumatology research. It was found that the application of the method did not follow the guidelines originally defined. This was due to not meeting its defining characteristics, or omitting some of its phases. There was also lack of rigour in developing it, to the point that only a fifth of the articles analysed fulfilled the defining characteristics of the method. All these can put the validity of the results reported by these investigations at risk. ConclusionsUse of the Delphi method in health research is growing, and rheumatology is no exception. The lack of standardisation and adherence to the Delphi methodology may jeopardise the validity of the results obtained from its use in research. Researchers must take into account the basic methodological aspects that define the Delphi method, in order to include them in their work.

Bivariate Copula-based Linear Mixed-effects Models: An Application to Longitudinal Child Growth Data

Multiple longitudinal outcomes are common in public health research and adequate methods are required when there is interest in the joint evolution of response variables over time. However, the main drawback of joint modeling procedures is the requirement to specify the joint density of all outcomes and their correlation structure, as well as numerical difficulties in statistical inference, when the dimension of these outcomes increases. To overcome such difficulty, we present two procedures to deal with multivariate longitudinal data. We first present an univariate approach, for which linear mixed-effects models are considered for each response variable separately. Then, a novel copula-based modeling is presented, in order to characterize relationships among the response variables. Both methodologies are applied to a real Brazilian data set on child growth.

Methodology and criteria for setting national health research priorities in Bhutan: a workshop report

The Bhutanese health system is committed to providing health services for all citizens and is interested in strengthening the country’s health research capacity. The objectives of this workshop were to understand the range of health research activities in Bhutan; to formulate a prioritized research agenda for the Ministry of Health (MoH); to share challenges, gaps and opportunities in health research; and to provide insights for future prioritization exercises. The MoH partnered with Khesar Gyalpo University of Medical University of Bhutan and USA-based facilitators to develop and pilot a methodology for health research priority setting. The Bhutan priority setting process was adapted from the Combined Approach Matrix and the Essential National Health Research methods. The methodology proved successful in the systematic creation of a list of health research priorities. Future priority setting processes will build on this workshop, continuing to refine and strengthen the priority setting process in Bhutan.

Utilizing the focused conversation method in qualitative public health research: a team-based approach

BackgroundQualitative research studies are becoming increasingly necessary to understand the complex challenges in the healthcare setting. Successfully integrating interdisciplinary teams of investigators can be challenging, as investigators inherently view data through their disciplinary lens. Thus, new methods, such as focused conservation, are needed to facilitate qualitative data analysis by interdisciplinary teams. The purpose of this manuscript is to provide a clear description of how we implemented the focused conversation method to facilitate an organized data-driven discussion that responded to our study objectives and ensured participation of our interdisciplinary team. The focused conversation method has not, to our knowledge, been utilized for this purpose to date.MethodsTo better understand the experience of healthcare personnel (HCP) during preparations for the 2014–2015 Ebola Virus Disease (EVD) outbreak, we interviewed HCP who participated in decision making about EVD preparations and training of workers in the use of enhanced personal protective equipment ensembles in the metropolitan Chicagoland area of Illinois to attain a priori research objectives. We identified a systematic method – the focused conversation method – that enabled our interdisciplinary team to interactively contribute to the framing, analysis and interpretation of the data that would enable us to focus on our research objectives.ResultsThe focused conversation developed to support our a priori research objective about the training of HCP in preparations included objective, reflective, interpretive and decisional questions. These questions grounded the conversation in the data, while leveraging discipline-specific lenses and professional experience in the analysis and interpretation. Insights from the conversation were reviewed later against interview transcripts to ensure validity. The conversation identified areas for future research directions and deficiencies in the interview instrument.ConclusionsThe focused conversation is an efficient, organized method for analysis of qualitative data by an interdisciplinary team.

The pros and cons of using photographs in nursing research.

Traditional approaches to research can sometimes face difficulties in engaging participants, being flexible and ultimately eliciting data about people's experiences. Visual methods are alternative approaches that use image - often photographs - as stimuli or structure in interviews. However, little has been published in the literature to guide nurse researchers in applying and evaluating these methods. To increase nurse researchers' awareness of visual methods and their potential. The paper explores visual methods, with a focus on those that use photographs. It discusses the benefits of using photographs in research, such as reducing the gap between the researcher and participant and helping participants to express meaningful data. It also examines associated ethical, analytical and practical difficulties. The paper illustrates discussion points with reflections from research and compares interviews that do and do not use photographs. Using photographs is a good alternative to more traditional approaches but the exact benefits are difficult to evidence because of the complexities of the interactions involved. for practice This paper should increase nurse researchers' awareness of visual methods, help them to make informed choices about research methods and encourage the use of visual methods in health research.

A Pest to Mental Health? Exploring the Link between Exposure to Agrichemicals in Farmers and Mental Health.

The current literature acknowledges that occupational exposures can adversely affect mental health. This review seeks to elucidate the current understanding of the effect of agrichemical exposure on mental health in the agricultural sector, including low-dose, chronic pesticide exposure. This scoping review adopted a snowballing and saturation approach. The review highlights inconsistencies in linking poor mental health and pesticide use. While some studies specifically showed that both high- and low-dose pesticide exposure were associated with poor mental health, consistent and rigorous research methods are lacking. The review also proposes terms to delineate exposure types described in the literature. The review outcomes direct efforts to protect the health, wellbeing and safety of farming communities across the globe.

Unintended consequences in traffic-light food labeling: A call for mixed methods in public health research

Nudge theory describes how indirect suggestions and positive reinforcement can influence decision-making. We used nudge theory to implement a traffic-light labeling and choice architecture (modifying product placement) intervention at Harvard University cafeterias, but found no significant change in sales. Survey and focus group data showed that some students thought the labeling may exacerbate eating disorders, however, there is extremely limited research on potential negative consequences of labeling. One way to describe these findings is through 20th century philosopher Michel Foucault’s concept of biopower. Biopower manipulates cultural norms and nudges individuals to engage in self-surveillance and self-discipline, de facto subjugating themselves to certain ways of being. Biopower may lead to the creation of an in-group and an out-group based on who can adopt the new behaviors, such as healthy eating. Those in the out-group may face additional unintended consequences, highlighting the need for mixed-methods research to better evaluate public health interventions.

Going beyond the interview: Methodological considerations for “getting at” life skills transfer using a longitudinal integrated qualitative approach

ABSTRACTLife skills transfer represents an ongoing process by which an athlete learns/refines a life skill in sport and subsequently applies the same skill beyond sport. Many qualitative investigations on transfer have used the ‘one-shot’ interview design to explore the experiences of athletes, thus offering static snapshots of perceived life skills learning and application. The integration of multiple qualitative methods has been advanced as having the potential to more comprehensively capture or ‘get at’ the life skills transfer process. The study’s purpose consists of detailing a longitudinal integrated qualitative approach that can be used to examine life skills transfer from sport to life. The integrated approach is illustrated through an exemplar case of a 23-year-old athlete and her process of learning/refining and applying emotional regulation skills. Three individuals able to speak to the athlete’s behaviour outside of sport (i.e., mother, classmate, and work colleague) were also part of the case. Data collection occurred over eight months and involved the integration of (a) individual semi-structured interviews, (b) chronological chart, (c) timeline, and (d) solicited journal. Findings provide a tangible illustration, based on empirical data, of how qualitative techniques can be integrated to capture the athlete’s process of life skill learning in sport and skill application beyond sport. In doing so, the longitudinal integrated qualitative approach produced insights into the life skills transfer process to an extent not previously gleaned through interviewing alone. Lastly, key considerations for using integrated methods in sport, exercise, and health research are offered.

Resolución 8430 de 1993: ¿Responde a las necesidades actuales de la ética en investigación en salud con seres humanos en Colombia?

Verifying compliance with ethical principles of health research legitimizes it in society and allows the resolution of ethical dilemmas that emerge from new research concerns and methods. Resolution 8430 of 1993 is one of the main ethical guidelines that governs health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation, it becomes necessary to evaluate its currency and sufficiency to address the potential ethical dilemmas in the existing country’s health research. Some gaps, contradictions and aspects that require a deep review are detailed in this paper, assuming a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternative are proposed, so that the resolution can answer to the actual needs in health research with human beings.

Letter to Editor Regarding

Sir: It was with great interest that we read the article by Dr. Lee and colleagues on the location of the internal mammary vessels for microvascular autologous breast reconstruction.1 Knowledge of the anatomic variations of the internal mammary vessels is necessary for efficient operative dissection with minimal costal cartilage excision. For this reason, the senior author (A.T.) of this letter pursued a similar cadaveric study, albeit for another purpose, almost 30 years ago2: to delineate the internal mammary vessels, not as recipient vessels but as donor vessels, for the free vascularized anterior rib graft. Thoma et al.2 reported the pertinent anatomy of the internal mammary vessels, their diameters, and the distance from the sternal midline. Notably, the internal mammary vein was found to branch between the third and fifth ribs, most commonly in the fourth intercostal space.2 Lee et al.1 claimed that this finding had not been established prior to their study. The 1987 publication also delineated the costal blood supply from the inferior intercostal and supracostal vessels branching from the internal mammary vessels.2 The Lee et al.1 article bears fundamental similarities to the Thoma et al.2 article; however, we acknowledge, it entails a larger sample of cadavers, and a far more rigorous tabulation of findings. In the Lee et al.1 article, the costal level at which the internal mammary vein bifurcates is documented for the left and right of each cadaver. The authors also report the distance between the internal artery and vein, and the distance of the vessels from both the sternal border and the costochondral junction at each intercostal level.1 These precise findings allow a more detailed mapping of the vessels and represent an improvement in the standard of data reporting since the publication of the Thoma et al.2 article. Despite its similarities, we do not believe Lee et al.1 had knowledge of our publication, as the branching of the internal mammary vein in the fourth intercostal was reported as novel information. A well-constructed literature search should be done before any project is undertaken to avoid the duplication of labor in research, and all similar papers should be appropriately cited. Readers can refer to the guide by Waltho et al.3 for step-by-step instructions on searching and synthesizing evidence. Use of the keywords “internal mammary vessel*” and “plastic surgery” identified the Thoma et al.2 article in Medline. Given the significant improvement in reporting between the Lee et al.1 and Thoma et al.2 articles, we consider this article a new and valuable contribution to the literature. However, we would like to emphasize the importance of a thorough literature review before a study is begun. If the Thoma et al.2 findings had been reported more meticulously, it would be a redundant waste of research resources to conduct another cadaveric study of the internal mammary vessels. With an estimated $170 billion wasted on faulty and redundant research annually, overlooking simple steps of a literature search is a mistake we cannot afford.4 Nevertheless, we commend the thorough work done by Lee et al.,1 and we hope it will have a positive impact on dissection of the internal mammary vessels in the future. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. No funding was obtained for the production of this communication. Syena Moltaji, B.Sc., M.D.(c)Michael G. DeGroote School of MedicineMcMaster University Jessica Murphy, M.Sc.Division of Plastic SurgeryDepartment of SurgeryMcMaster University Achilleas Thoma, M.D., M.Sc.Division of Plastic SurgeryDepartment of SurgeryDepartment of Health Research Methods, Evidence, and ImpactMcMaster University.Hamilton, Ontario, Canada

Exploring Community Residents’ Motivations for Interacting With American Field School Undergraduates in South Africa

Background: Learning by experience in field schools (FSs) depends implicitly on the willingness of local residents to engage with students. Although critical perspectives have highlighted the potential harms of study abroad on local people, their views are less frequently investigated. Purpose: The purpose of the study is to explore the perspectives and motivations of local residents who agreed to be interviewed by American undergraduates undertaking a 5-week FS in community health research methods in Cape Town, South Africa. Methodology/Approach: Semi-structured interviews were conducted with 23 residents to explore their perspectives on why they, and others, were willing to be interviewed by students. These were thematically analyzed. Findings/Conclusions: Emphasis was given to the status implicit in being “a student” and “a visitor” and the respect, hospitality, and support this status engendered. To be a student was to be a child and not in a position to help. However, expectations were that help would come later. Residents valued the conversations they had which were seen as opportunities for enjoyment, exchange, and bridging social divides. Implications: In experiential learning programs such as these, local residents are a key community learning resource. Certain design features appear to help optimize the engagement and relationship-building valued by students and residents alike.

Drawing Careers: The Value of a Biographical Mapping Method in Qualitative Health Research

Narrative interviews are the methodological gold standard for biographical research. To facilitate memory work in interviewees, qualitative researchers increasingly fuse interviewing with visual elicitation strategies. In this article, we advance the integration of methods by introducing a graphic elicitation strategy that allows interviewees to map biographical developments and critical health experiences, in addition to verbalizing them. The biographical mapping approach was originally developed for a research project on adolescents’ health and illness experiences in elite sport but lends itself to qualitative biographical research in general. Using case material, we first demonstrate how the mapping process helps interviewees to recall past episodes and to produce more detailed biographical data. Second, we describe how the depth of focus in the biographical drawing and interview data allows researchers to identify biographical turning points and to analyze interactions between context, life events, and health in a unique way. By visualizing different strands of development, the elicited drawings also hold heuristic value, as they show the nonlinearity and multidimensionality of biographical developments.

Epidemiology and forensics

Epidemiology is a science that studies the spread and disease factors of the human population and the application of this science to addressing health problems. Epidemiology is considered a fundamental set of methods in all public health research and has great application in clinical medicine in determining the risk factors of the disease and determining the best health effect in clinical practice. Epidemiology as a science deals with factors affecting the health and illness of individuals and societies, and in that sense serves as the basis and logical basis for interventions in the interest of public health and preventive medicine.

Capturing fine-scale travel behaviors: a comparative analysis between personal activity location measurement system (PALMS) and travel diary

BackgroundDevice-collected data from GPS and accelerometers for identifying active travel behaviors have dramatically changed research methods in transportation planning and public health. Automated algorithms have helped researchers to process large datasets with likely fewer errors than found in other collection methods (e.g., self-report travel diary). In this study, we compared travel modes identified by a commonly used automated algorithm (PALMS) that integrates GPS and accelerometer data with those obtained from travel diary estimates.MethodsSixty participants, who made 2100 trips during seven consecutive days of data collection, were selected from among the baseline sample of a project examining the travel behavior impact of a new light rail system in the greater Seattle, WA (USA) area. GPS point level analyses were first conducted to compare trip/place and travel mode detection results using contingency tables. Trip level analyses were then performed to investigate the effect of proportions of time overlap between travel logs and device-collected data on agreement rates. Global performance (with all subjects’ data combined) and subject-level performance of the algorithm were compared at the trip level.ResultsAt the GPS point level, the overall agreement rate of travel mode detection was 77.4% between PALMS and the travel diary. The agreement rate for vehicular trip detection (84.5%) was higher than for bicycling (53.5%) and walking (58.2%). At the trip level, the global performance and subject-level performance of the PALMS algorithm were 46.4% and 42.4%, respectively. Vehicular trip detection showed highest agreement rates in all analyses. Study participants’ primary travel mode and car ownership were significantly related to the subject-level mode agreement rates.ConclusionsThe PALMS algorithm showed moderate identification power at the GPS point level. However, trip level analyses found lower agreement rates between PALMS and travel diary data, especially for active transportation. Testing different PALMS parameter settings may serve to improve the detection of active travel and help expand PALMS’s applicability in geographically different urbanized areas with a variety of travel modes.

Use of various obesity measurement and classification methods in occupational safety and health research: a systematic review of the literature

BackgroundThis study systematically examined obesity research in occupational safety and health regarding the use of various obesity measurement and classification methods.MethodsA systematic search of the PubMed database on English language publications from 2000 to 2015 using related keywords and search of citations resulted in selection of 126 studies. They were categorized into two groups based on their main research question: 1) general physical or mental work-related functioning; and 2) task or body part specific functioning.ResultsRegardless of the study group, body mass index (BMI) was the most frequently used measure. Over 63% of the studies relied solely on BMI to define obesity. In only 22% of the studies, body fat was directly measured by methods such as dual energy x-ray absorptiometry. Abdominal obesity was defined using waist circumference in recent years, and waist-hip ratio in earlier years. Inconsistent cut-offs have also been used across studies investigating similar topics.ConclusionsFew authors acknowledged the limitations of using indirect obesity measures. This is in part due to the limited understanding of some occupational safety and health researchers regarding the complex issues surrounding obesity classification and also the mixed recommendations over the past 2–3 decades and across populations. Efforts need to be made to promote appropriate obesity measurement and reporting in this field.

Effectiveness and stakeholder impact of the Sistema Cymru - Codi'r To music programme in north Wales: a social return on investment evaluation

BackgroundSistema Cymru - Codi'r To is a community development project that delivers music sessions in two schools in disadvantaged neighbourhoods in Gwynedd, Wales. This programme aims to raise educational attainment, improve confidence and behaviour, and encourage community relationships. The organisation sought an economic evaluation of the programme to establish effectiveness and stakeholder impact. MethodsWe used a social return on investment (SROI) evaluation to measure a wide range of values across a range of stakeholders to identify benefits or disadvantages that have a social, economic, or environmental impact. The cost of the intervention was generated using the set up and running costs provided by Codi'r To. From the two schools taking part, 228 children were randomly selected to complete questionnaires, and 14 teachers and 50 parents gave answers to questionnaires. Sistema Cymru - Codi'r To approved the study and informed consent was given by the parent or guardian of all the children taking part in the study by asking them to return a completed form if they did not want their children to take part. We completed the SROI Impact Map as recommended by the UK Cabinet Office. We identified financial proxies from the Global Value Exchange and the HACT Social Value Bank so that we could calculate how much the benefits were worth. SROI does not lend itself to the traditional methods of statistical analysis. The data were analysed in line with the UK Cabinet Office SROI guidelines. For sensitivity analysis, we altered the assumptions by varying elements such as deadweight, drop off, and attribution to produce a range of social value. FindingsThe SROI evaluation showed that Codi'r To has the potential to generate social value from £4·49 to £8·95 for every £1·00 invested. With the best assumptions, a base-case social value ratio of £6·69:£1·00 is created. Improved pupil confidence, pupil relationships, family relationships, and classroom behaviour were observed and monetised using proxy values from the HACT Database and the Global Value Exchange. InterpretationThis is the first SROI, to our knowledge, to be carried out for this type of school-based intervention. The data collected could contribute to a further study of the same cohort at older ages to assess the impact of the programme across their school career. Although SROI is a new method in public health research, this study identified benefits for multiple stakeholders that might not have been revealed using other methods. FundingPaul Hamlyn Foundation.