COMMUNITY:
PREPARING A RESEARCH PROPOSAL IN COMMUNITY MEDICINE
SALIM M. ADIB, MD, Dr.PH
2015
LEARNING OBJECTIVES
WHAT IS RESEARCH?
WHAT TOPICS ARE ADEQUATE FOR COMMUNITY MEDICINE?
OVERALL STRUCTURE OF A PROPOSAL
CONTENT OF AN INTRODUCTION
CONTENT OF THE METHODOLOGY SECTION
ISSUES IN THE FINAL THESIS
WHAT IS RESEARCH?
USING DATA FROM EMPIRICAL OBSERVATION AND/OR EXPERIMENTATION TO
GENERATE NEW KNOWLEDGE
COMPLETING CHECKLISTS, PERIODICAL REPORTS, MONITORING DATA IS NOT RESEARCH
WHAT IS COMMUNITY MEDICINE?
It is MEDECINE… there is a therapeutic intervention taking place
It is SOCIAL… the intervention addresses groups “communities”
It is PREVENTIVE… interventions can be about detecting and controlling health
problems
WHAT IS A COMMUNITY?
Same jobs:
OCCUPATIONAL MEDICINE
SPORTS MEDICINE
MILITARY MEDICINE
Same environment/geography:
RURAL MEDICINE
ALTITUDE MEDICINE
Same age-groups:
GERIATRICS
SCHOOL/ADOLESCENT MEDICINE
TOPICS FOR COMMUNITY MEDICINE?
TOPICS THAT FIT AND TOPICS THAT DON’T
Prevalence and risk factors of hypothyroidism in pregnant women in Doha
OR
Detection and follow-up of pregnant women with hypothyroidism in Doha
TOPICS THAT FIT AND TOPICS THAT DON’T
Hepatitis B and C among dialysis patients in Baghdad
OR
Failure of diabetes control among patients entering a dialysis program in Baghdad
TOPICS THAT FIT AND TOPICS THAT DON’T
Etiology of nosocomial infections in public hospitals in Amman
OR
Effect of hand hygiene campaigns on the incidence of acute respiratory infections in
primary schools in Amman
TOPICS THAT FIT AND TOPICS THAT DON’T
Knowledge, attitudes and behaviors regarding AIDS among healthcare workers in the
hospitals of Basrah
OR
Outcomes of long-term care for AIDS patients living in Basrah
TOPICS THAT FIT AND TOPICS THAT DON’T
‫نوعية الحياة والعوامل المحددة لها بين كبار السن من القطريين الذين يراجعون مراكز الرعاية الصحية األولية‬
-‫بقطر‬
HOW TO PREPARE A PROPOSAL FOR A THESIS IN COMMUNITY MEDICINE?
PRE-PROPOSAL SUMMARY
Before starting to write a proposal, submit a summary of no more than 500 words for
discussion and pre-approval:
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Title
Problem statement, aims and objectives
Study design and target population
Expected practical implications
OUTLINE OF A PROPOSAL
TITLE*
INTRODUCTION*
METHODS*
EXPECTED BUDGET
TIMETABLE
SUPPORT
REFERENCES*
OUTLINE OF A THESIS
TITLE
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSIONS WITH PRACTICAL IMPLICATIONS
REFERENCES
INTRODUCTION
RATIONALE:
1. What is the issue in large terms?
2. Why is it important?
3. What do you intend to propose grossly?
BACKGROUND:
1. Literature review: What is known? What is controversial
2. Local information
INTRODUCTION
AIM: ultimate goal of this work
OBJECTIVES
HYPOTHESES/ RESEARCH QUESTIONS
CONCEPTUAL FRAME
LITERATURE REVIEW
PART OF THE PROPOSAL CONSTRUCTION
HELPS FORMULATE
1.
2.
3.
4.
5.
Aims
Objectives
Hypotheses or research questions
Instruments
Discussion of results
LITERATURE REVIEW
SOURCES
1. Medline (www.pubmed.com) and other databases
2. Websites: with a grain of salt!(www.google.com/publicdata)
3. Local and regional journals: may have to be reviewed manually
AIMS
EXPECTED PRACTICAL IMPLICATIONS AND POTENTIAL BENEFICIARIES
1.
2.
3.
4.
5.
Health policies
Treatment procedures
Patients’ awareness
Training/capacity-building
Future research
OBJECTIVES
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THE OBJECTIVES OF THIS STUDY ARE:
1. To measure
2. To assess
3. To determine
THE AIM GOES HIGHER
NO MORE THAN 5 OBJECTIVES!
HYPOTHESES
THE HYPOTHESES ARE PRESENTED AS STATEMENTS TO BE CONFIRMED OR INFIRMED
1. The prevalence of X is more important in men than in women
2. Maternal diabetes is associated with higher risk of overweight infants
METHODS
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STUDY DESIGN
TARGET POPULATION
SAMPLING/SELECTION PROCEDURES
SAMPLE SIZE
STUDY INSTRUMENTS
POTENTIAL LIMITATIONS
ACTIVITIES AND PROCEDURES
ETHICAL CONSIDERATIONS
VARIABLES: CONCEPT & MEASUREMENT
ANALYSIS PLAN
EPIDEMIOLOGICAL STUDIES
STUDY DESIGN
DESCRIPTIVE
Case series
Prevalence survey
Cross-sectional study
ANALYTICAL
Retrospective case-control study
Observational retrospective cohort
Longitudinal trial
EXPERIMENTAL STUDIES
SAMPLING (not always needed)
SIMPLE RANDOM SAMPLING
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All units have the same probability of selection
All units easily identifiable in sequentially numbered lists (sampling frame)
Sometimes it is easier to identify units within randomly selected clusters: schools,
ministries, etc…(random cluster sampling)
STRATIFIED SAMPLING
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Target population is divided in sub-groups sampled equally regardless of their
sizes
Random sampling within each strata
Preserves the representatively of meaningful subgroups whose numbers are too
small
CLUSTER SAMPLING
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Cluster sampling is a procedure of selection in which the elements for the
sample are chosen from the population in groups or clusters rather than singly.
Clusters used are often preexisting natural or administrative groupings of the
population: factories, schools, or administrative subdivisions.
MULTISTAGE CLUSTER SAMPLING
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Select strata
Select clusters randomly (primary sampling units)
Select secondary sampling units randomly
NON-RANDOMISED METHODS
1. Convenience sample
2. Expert judgment sample
SAMPLE SIZE
For a prevalence survey:
n = (Zα)2 (p) (q) / d2
Other designs: www.samplesize.org
SELECTION PROCEDURES IN NON-SURVEY STUDIES (CASE-CONTROL, TRIALS)
1. Mention the selection criteria: who is a case? a control? where do you find
them?
2. Mention exclusion criteria
QUESTIONNAIRE DESIGN
1.
2.
3.
4.
5.
Defining the information needed
Drafting the questionnaire
Validating the questionnaire (when is it needed?)
Piloting and Redrafting the questionnaire
Administration
QUESTIONNAIRE DESIGN
Closed-ended questions
1. Avoid forcing answers  invalid answers
2. Allow an “other” option
3. Allow “undecided” or “don’t know” options
Piloting
It is wise to try the drafted questionnaire with a small group of respondents and with
colleagues, to improve the clarity and remove problems before starting
(Pilot testing versus pilot study?)
ETHICAL CONSIDERATIONS
ETHICAL CLEARANCE LETTER:
a) Explain potential for harm and means of mitigating it.
b) Informed consent: freedom to opt in or out at any time, with no
penalty, rights of special subgroups
c) Importance of avoiding moral abuse in obtaining consent
d) Possible advantages for participants
STATISTICAL ANALYSIS
1. Presentation of variables
 Categorical: numbers and %
 Quantitative: measures of dispersion (mean, SD, median, range)
2. Clearly separate the outcome (dependent) and independent ones
DO NOT COLLECT QUANTITATIVE DATA IN CATEGORIES
3. Bivariate analysis: statistical testing methods and significance level
(p ≤ 0.05)
Multivariate analysis: logistic regression if outcome is dichotomous or linear regression
in most other situations
SELECTING A STATISTICAL TEST
When is a statistical test needed?
How do we select the adequate test
ALTERNATIVE METHOD:
Quantify the association between an outcome and independent variable(s) using the
relative risk with a 95% confidence interval
RR 1…association
95% CI includes 1= not statistically significant
Limits of RR/ Alternatives?
REFERENCES: Vancouver style
Came out of a meeting of medical journal editors in 1978, held in Vancouver, BC, and is
maintained by the International Committee of Medical Journal Editors (ICMJE). It is the
Uniform Requirements for Manuscripts Submitted to Biomedical Journals.
REFERENCES: Vancouver style
library.vcc.ca/downloads/VCC_VancouverStyleGuide.pdf
OUTLINE OF A THESIS
TITLE
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSIONS WITH PRACTICAL IMPLICATIONS
REFERENCES
RESULTS
 Avoid duplicating the same data in tables and graphs
 Use the text to highlight and complete data presented in tables NOT to list again
what is shown already
AVOID ANY ATTEMPT TO EXPLAIN OR DISCUSS RESULTS IN THIS SECTION
DISCUSSION:
Start with a brief review of findings especially as they relate to hypotheses
1. Avoid as much as possible repeating numbers and text presented in Results.
2. Worse! Avoid contradictions!
Present potential limitations of your study and their expected effects: biases limiting
generalizability, or leading to over- or under-estimation of findings
Attempt to explain individual findings, without too much speculations or use of context
information not related to the study
Use similarities/differences with findings from the literature review to further explain
findings
CONCLUSIONS
SO WHAT?
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1. Practical implications of results and discussion
2. Recommendations for future health action or research
DO NOT REPEAT ANYTHING ALREADY SAID IN RESULTS OR DISCUSSION
DO NOT RECOMMEND THINGS NOT ORIGINATING FROM YOUR WORK
DO NOT RECOMMEND OBVIOUS THINGS OR NON-ACTIONABLE THINGS
GENERAL REMARKS
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Use the FUTURE in the proposal and the PAST TENSE in the thesis
Make sure a spelling/grammar check has been done: if you use either US or UK
English, use it consistently
Preferably have a native English speaker edit the paper before submission
Be concise. A sentence going beyond two lines is too big. Cut it!
Be patient and do not take reviewers’ remarks personally!
Be sober, too much artwork may be perceived as cover for no substance
ALWAYS REMEMBER
SO WHAT?
THE END