LEAH Research Seminar Series: Preparing for Research Cari McCarty, Ph.D. November 2, 2012
Outline
• The purpose of research questions• Getting started: identifying your BIG
questions• Literature reviews• Finding questions you can answer as a
fellow• Refining your research question• Putting together your Team• Assignment: define your research question
Goal of Research Questions
A successful Research Question
will specify and interest the reader in
an important question
your study will answer
Getting Started…
Identify Your BIG Questions
• Novel: Is there an important question you have not been able to find a good answer to?
• Important: What do you think are the essential questions facing patients, clinicians, clinical leaders or policymakers?
• Reading: research, reviews, reports & books (IOM)
• Experts: meetings, phone, conferences– Your clinical discipline– Topic or methods experts
Case Study:From Big Questions to Literature
ReviewsBIG Questions• How do mental health and physical health
problems intersect?
Intermediate question(s)• Is drinking alcohol associated with poorer
mental health? In what direction? – Still too general and big…. What kind of people? Where? In
what setting? What level of drinking?
More suitable to literature searches:• Does depression predispose adolescents
to use alcohol or have alcohol-related problems?
Literature Reviews – Getting Started
Choose & Set-up a Citation Management System
Why? Saves your library of citations, inserts markers in your writing, formats your bibliography for different journals
Which tools are used most frequently at UW?
http://guides.lib.washington.edu/content.php?pid=69943&sid=518591
Citation Management Systems
Refworks: free, great online “help”, web, transferable, no updates needed, tutorial and UW librarian support
Zotero: free, saves your library on your local computer but allows you to sync,
Endnote: many faculty use and like; costs; “updates” often pain
Endnote Web: free, limited to 10,000 citations, can import citations from a bookmark
Literature Reviews: Librarians
Meet with a Health Sciences Librarian
• Write your research question(s) down• Identify the optimal librarian liaison
http://www.lib.washington.edu/subject/librarians/• Email him/her and set up a meeting (in person or
phone); they are expecting you!• Meet with a librarian to refine your search
Literature Reviews
Benefits of Standardized Literature Reviews
• Research ideas: Gaps in literature, patterns in what has been examined
• Publishing: Write a standardized literature review or an editorial
• Save time when writing later:– Research manuscripts: intro & discussions;
Tables when asked for (efficiency)– Grants: Significance and Background
Standardize Your Literature Reviews
Develop a Table/Form to Abstract Key Information
• For a specific question and a specific search • Specify inclusion/exclusion criteria for articles• Author/year, Sample, Measures, Results, Notes• Start simple; add detail as specific use(s) becomes
clear• What is it you want to know about the literature?
Case Study
Research Questions for Literature Review
• Is there an association between depression and alcohol use during adolescence?– Mixed findings, no consensus– Limited understanding of timing,
sequence, severity, role of conduct problems
Case StudyResults of Standardized Review
Study# of depression time points
# of alcohol timepoints
CP included
Depression Measure
Capaldi et al. (1999) 3 1 Yes Symptoms
Hussong et al., 1998Chassin et al., 2002
1 3 NoNo
Symptoms
Kaplow et. al., 2001 1 3 No Symptoms
King et al., 2004 1 2 No Diagnosis
Measelle et al., 2006 4 4 No Diagnosis & Symptoms
White et al., 2001Pardini et al., 2007
11
62
NoYes
SymptomsSymptoms
Mason et al., 2008 1 1 Yes Symptoms
Fleming et al., 2008 4 4 No Symptoms
PROPOSED STUDY 7 7 Yes Diagnosis & Symptoms
Example 1: Studies on Depression as a Risk Factor for Alcohol Use
Authors/Date
Sample Size
Type of Sample
Location Age Span
% Boys Ethnic
Englund et al., 2008
178 High-risk Midwest 9-18 53% 67.6% White10.6% African American21.8% Other
Maggs et all, 2008
16,009 Community Great Britain
7-42 50.8% Not provided
Hooshmand et al., 2012
4412 School-Based
Ontario, Canada
14-17 51% Not provided
Example 2: Meta-Analysis of Treatment Studies for Youth Depression
Author/Year
Sample Type
Control Group
Other Outcomes
Effect Size
Notes
Clarke et al., 2001
Subclinical Usual care in an HMO
Externalizing 0.11 6.3% attrition
DeCuyper et al., 2004
Subclinical school sample
Waitlist Anxiety 0.40
Diamond et al., (2002)
Diagnosed, referred youth
Waitlist Anxiety Family Functioning
0.68
Summary - Literature Reviews
• Set up a reference Library: endnote or refworks• Meet with a librarian liaison: select from website• Standardize important literature reviews
Finding Questions You Can Answer
Data Sources Fellows Have or Could Use
• Literature reviews• Seattle investigators’, public health, & clinical data
– Children’s Hospital, Harborview, VA, UW Schools of Medicine, Public Health, & Pharmacy, Fred Hutch Cancer Research Center; UW Institute for Health Metrics and Evaluation
– Group Health Cooperative Center for Health Studies– Dept. of Public Health Seattle King County– Medic 1, Emergency data systems, etc.
Finding Questions You Can Answer
Ask investigators: do they have data for important analyses they have not had time to do?
Finding Questions You Can Answer
Data Sources Fellows have Used
• Washington state data: Comprehensive Hospital Abstract Reporting System (CHARS), Medicaid data, prison data; death records.
• National publicly available datasets: CDC Behavioral Risk Factor Surveillance Survey (BRFSS), National Health National Health and Nutrition Examination Survey (NHANES), AHRQ Healthcare Cost and Utilization Project (HCUP), Adolescent Health (ADD Health);
Finding Questions You Can Answer
Data Sources Fellows have Used
• Primary data collection – Surveys: physician, patient, or community surveys – Qualitative research: ethnography, focus groups, etc.– Instrument development (e.g. health literacy screen)
• Find other data sources…– Specific trials or disease specific NIH datasets?– FDA?– Etc.
Finding Questions You Can Answer
Tension between Ideal and Feasible
Ideal Research Question and
Design
•Interesting •Novel•Relevant•High internal validity•High external validity
Feasibility
•Access to data•Access to patients •Access to expertise•IRB and DUA approvals•Time•Budget
SummaryFinding Questions You Can Answer
• Literature reviews• Secondary data from both local and distant
investigators• Local, state and federal datasets (non-VA and VA):
administrative, clinical and public health• Primary data collection: surveys, qualitative,
instrument development • Find other data sources…
Refining Your Research Question(s)
Qualities of Strong Research Questions
• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.
Refining Your Research Question(s)
Qualities of Strong Research Questions
• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.
• Clearly written, with unambiguous language: Does it mean to others what it means to you?
Refining Your Research Question(s)
Qualities of Strong Research Questions
• Important and interesting: Check it out with your mentor and parents, spouse, friends, etc.
• Clearly written, with unambiguous language: Does it mean to others what it means to you?
• Specific enough to tell the reader what you’ll learn: Population? Exposure? Outcomes? Timeframes?
Research Questions
Tensions in creating a
a simple yet specific question in lay language
• Specificity: Vague Detailed• Length: Long Short• Wording: Unclear Excessive
lingo
Refining Your Research Question(s)
Qualities of Strong Research Questions
• Imply a hypothesis: Can you phrase it “To determine or test whether “ ______ “? Does it imply the “directionality” of your hypothesis?
• Ethical: If unsure, discuss it with the IRB• Answerable (by you): How sure are you that YOU
can do the study that answers the question? What is your data source? Are you sure you can get the data? Do you have or can you recruit the needed expertise?
Refining Your Research Question(s)
Summary
• Have lots of other people review it• Have non-researchers review it • Re-review it yourself• Make sure the study you are doing answers it• Make sure you can do the study• Make sure the IRB approves
Choosing between Projects
• Choosing between projects– Your interest– Feasibility– Educational value– Foundation for later work– Work with and learn from a specific mentor
• Recommendation– Primary (passion) research question– Secondary (safer) research question (back-up thesis)– At least 1 quantitative study w/ multivariable analyses
Putting Together yourInterdisciplinary Study Team
• Senior researcher from your own discipline: adolescent medicine, nursing, psychology, nutrition, social work, etc.
• Topic expert(s): who knows your area• Methodologist +/or biostatistician:
from start• Investigator who knows dataset• Other necessary expertise: clinical,
analytic or design expertise?
Learning Many New Languages
During fellowship you will consult with diverse experts (technology, IRB, data management, research design, data analysis, biostatistics, scientific writing, etc.) …each speaking a different language…Ask for help when you are unsure what is meant …
Summary
• Identify your “big” questions• Focus them down to searchable questions• Review the literature – standardized tables• Write your RQ(s)• Find data or design a study to answer it• Put together your study team• Get lots of feedback from mentors at every
stage