Operational Research in Health

Types of Research

1. Descriptive vs. Analytical: Descriptive research includes surveys and fact-finding inquiries of different kinds. The major purpose of descriptive research is description of the state of affairs as it exists at present. The main characteristic of this method is that the researcher has no control over the variables; he can only report what has happened or what is happening. for example, Prevalence study of night blindness among older population in Pokhara, Kaski.

In analytical research, on the other hand, the researcher has to use facts or information already available and analyze these to make a critical evaluation of the material. It involves the in-depth study and evaluation of available information in an attempt to explain complex phenomenon. E.g. Study on effect of sunlight exposure and Ocular surface squamous neoplasia.

Descriptive research attempts to determine, describe, or identify what is, while analytical research attempts to establish why it is that way or how it came to be.

2.   Applied vs. Fundamental: Research can either be applied (or action) research or fundamental (to basic or pure) research. Applied research aims at finding a solution for an immediate problem facing a society or an organization, whereas fundamental research is mainly concerned with generalizations and with the formulation of a theory. E.g. Study on management of Polio epidemic in Nepal.

    “Gathering knowledge for knowledge’s sake is termed ‘pure’ or ‘basic’ research.” Research concerning some natural phenomenon or relating to pure mathematics are examples of fundamental research. For e.g. Formulation of gravitational theory

Similarly, research studies, concerning human behavior carried on with a view to make generalisations about human behaviour, are also examples of fundamental research, but research aimed at certain conclusions (say, a solution) facing a concrete problem is an example of applied research.

3.   Quantitative vs. Qualitative: Quantitative research is based on the measurement of quantity or amount. It is applicable to phenomena that can be expressed in terms of quantity. E.g. Prevalence of trachoma in Bharatpur, Nepal. Qualitative research, on the other hand, is concerned with qualitative phenomenon, i.e., phenomena relating to or involving quality or kind. For instance, when we are interested in investigating the reasons for human behaviour (i.e., why people think or do certain things), we quite often talk of ‘Motivation Research’, an important type of qualitative research. Attitude or opinion research i.e., research designed to find out how people feel or what they think about a particular subject or institution is also qualitative research.

4.   Conceptual vs. Empirical: Conceptual research is that related to some abstract idea(s) or theory. It is generally used by philosophers and thinkers to develop new concepts or to reinterpret existing ones.
On the other hand, empirical research relies on experience or observation alone, often without due regard for system and theory. It is data-based research, coming up with conclusions which are capable of being verified by observation or experiment.

5.   Experimental Research: Experimental research is a study that strictly adheres to a scientific research design. It includes a hypothesis, a variable that can be manipulated by the researcher, and variables that can be measured, calculated and compared. Most importantly,  experimental research is completed in a controlled environment. The researcher collects data and results will either support or reject the hypothesis. This method of research is referred to a hypothesis testing or a deductive research method. E.g. Study on short-term use of topical corticosteroid eye drops for management of pterygium

6. Operational Research: This research type aims to discuss and study a recurring problem in an organization which may involve a study of concretization of the organization’s mission, vision, philosophy, and goals. E.g. Success with antiretroviral treatment for children in Accham: experience with health center / nurse-based care

7.   Action Research: Action research is undertaken to address a recurring problem in an organization immediately, usually a part of a major problem is addressed in this type of research. For e.g. Ways to improve the health workers performance in Geriatric Hospitals.

8.      Some Other Types of Research:

• Form the point of view of time, we can think of research either as one-time research or longitudinal research.
• Research can be field-setting research or laboratory research or simulation research, depending upon the environment in which it is to be carried out.
• Historical research is that which utilizes historical sources like documents, remains, etc. to study events or ideas of the past, including the philosophy of persons and groups at any remote point of time. E.g. Development of Ophthalmic Science in Nepal.

Introduction to Research

The word research was coined from a French word “CERCHIER” meaning “to seek or to search”. Thus, research is an attempt to solve or gain a solution to a problem.

• What is Research???

- Research is “the process of systematically obtaining accurate answers to significant and pertinent questions by the use of the scientific method of gathering and interpreting information”.(Balsley & Clover)

- A systematic, controlled, empirical and critical investigation of hypothetical propositions about the presumed relations among natural phenomenon. (Kerlinger, 1976)

- Research is an honest, scientific investigation undertaken for discovering new facts or establishing new relationships among facts already known which will contribute to the present body of knowledge and can lead to an effective solution of existing problems.

- The process of collecting/gathering data and information by a scientific or logical procedure that aims to solve a particular scientific problem.

• What is not a Research?

Research is not only gathering information; such as gathering information from resources such as books and magazines. Research is not only the transportation of facts; only transporting facts from one resource to another doesn’t constitute research. 

Only gathering information, and merely transporting facts from one resource to another does not contribute to new knowledge although this might make existing knowledge more accessible.

• Characteristics of Research

The characteristics of the research are as follows:

- Originates with a question or problem

- Involves the gathering of new data from new sources or 1st hand information

- Directed towards the solution of a problem

- Characterized by carefully designed procedures applying rigorous analysis

- Emphasizes the development of generalizations, principles, hypothesis, and theories that may be helpful in predicting future occurrences

- Requires expertise

- Demands accurate observation and description of what is being studied

- Strives to be logical, applying every possible test to validate the procedures being employed

- Requires innovative approaches and determination to succeed

- Carefully and accurately recorded and reported

- Cyclical (helical) in nature.

• Purpose of Research

The purpose of research are as follows:

- Corrects perceptions

- Develops and evaluates concepts, practices, and theories

- Gathers information on a certain phenomenon that is lacking in knowledge

- Obtains knowledge for practical purposes

- Provides hard facts that serve as a basis for planning, decision-making, project implementation, monitoring, and evaluation.

- Finding answers to questions or solutions to problems

- Discovering and interpreting new facts

- Testing theories to revise accepted theories or laws in the light of new facts

- Formulating new theories.

• Importance of Research

According to Hudson Maxim “All progress is born of inquiry. Doubt is often better than overconfidence, for it leads to inquiry, and inquiry leads to invention”. Research is important because it contributes to new knowledge. Further explanation of the importance of research are highlighted as follows:

- Research inculcates scientific and inductive thinking and it promotes the development of logical habits of thinking and organization.

- New knowledge and facts are obtained through research which can lead to invention and innovation

- Solve operational problems; research, as an aid to economic policy, has gained added importance, both for government and business.

- Research provides the basis for nearly all government policies in our economic and health system.

- Perceptions and assumptions can be generalized or proved through research

- Appropriate decisions can be made through evidence generation via research

- Existing technologies are invented and upgraded through research which makes our daily life and work life easier

- Research is important to broaden our knowledge

- Research is equally important for social scientists in studying social relationships and in seeking answers to various social problems.

In addition to what has been stated above, the significance of research can also be understood keeping in view the following points:

1. To those students who are to write a master’s or Ph.D. thesis, research may mean a careerism or a way to attain a high position in the social structure;
2. To professionals in research methodology, research may mean a source of livelihood;
3. To philosophers and thinkers, research may mean the outlet for new ideas and insights;
4. To literary men and women, research may mean the development of new styles and creative work;
5. To analysts and intellectuals, research may mean the generalizations of new theories.

Thus, research is the fountain of knowledge for the sake of knowledge and an important source of providing guidelines for solving different business, governmental and social problems. It is a sort of formal training which enables one to understand the new developments in one’s field in a better way.

• WHAT ABOUT RESEARCH in Health Science???

Research in health science is a systematic study and assessment of 

- health problems or phenomenon; 

- finding ways to improve practice and patient care through creative studies; 

- initiating and evaluating change; and 

taking action to make new knowledge useful in health.

RESEARCH in health science includes the breadth and depth of the discipline of health science and the rehabilitative, therapeutic and preventive aspects of health science as well as the preparation of practitioners and personnel involved in the total health sphere.

• Importance of Research in Health Science

- Research is essential to find out preventive ways for better health of the people and find out better treatments for patients. 

- It plays an important role in discovering new treatments and making sure that we use existing treatments in the best possible ways. 

- Research can find answers to things that are unknown, filling gaps in knowledge and changing the way that healthcare professionals work. 

- Improve the quality of life for people living with illness

- Improve future healthcare.

• Who needs Research???

Research is for the: 

- PCL Level/Undergraduate students doing term papers

- Graduate students defending master thesis/doctoral dissertation

- Doctors/nurses

- Legislators needing information to formulate the right kinds of laws.

- Technical staff of government officials providing the baseline reports.

- Supervisors, managers, top executives in both public and private sectors engaged in planning, decision-making evaluation and even in dealing with human behaviors.

- Consultants

- NGOs

• Limitations of Research

- Result of faulty planning and implementation of the project

- The individual researcher; research is better in team

- The scope of knowledge or information available about the topic and the problem under study also must be considered

- The tools of measurement may be inadequate or entirely lacking.

Public Health Ethics: Social Health Justice

Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information.

Social justice is defined as

• “justice in terms of the distribution of wealth, opportunities and privileges within a society,” according to the New Oxford American Dictionary. Ensuring social justice is, therefore, one component to achieving health equity and maintaining public health ethics. 

According to Paula Braveman and Laura Gottlieb in a 2014 article in Public Health Reports:

• Social justice in health means no one is denied the possibility to be healthy for belonging to a group that has historically been economically/socially disadvantaged. Social justice in health is also considered as health equity. Health disparities are the metrics that are used to measure progress toward achieving health equity. A reduction in health disparities (in absolute and relative terms) is evidence that we are moving toward greater health equity and sustaining social justice in health. 

Importance of Social Justice in maintaining a Healthy Society

1. According to Aristotle, society's obligation to maintain and improve health rests on the ethical principle of “human flourishing” i.e. the ability to live a flourishing, and thus healthy, life.
2. It is important in allowing individuals to exercise a range of human rights – both civil and political (e.g. physical integrity, personal security, political participation), social and economic (e.g. employment, education and family life).
3. Health is necessary for well-functioning societies so is justice in health. If a population does not have a decent level of health, it is very difficult to ensure economic prosperity, political participation, collective security and so forth.
4. Social health justice gives special moral importance to health capability: an individual's opportunity to achieve good health and thus to be free from preventable morbidity and mortality.
5. When there is harmony in health and social justice, then health burden and problems are lessened with the reduction in health disparities.

Click health for Notes on Components of Social Justice in Health

Bibliography

1. https://www.cdc.gov/od/science/integrity/phethics/index.htm
2. http://www.who.int/healthsystems/topics/equity/en/
3. http://www.who.int/bulletin/volumes/89/1/10-082388/en/
4. BENJAMIN, G.C. Health Equity and Social Justice: A Health Improvement Tool
5. Peter, F., Anand, S., Sen, A. “Public Health, Ethics, and Equity” (2004).
6. Ruger, Jennifer Prah. “Health and Social Justice.”(2004).

Components of Social Justice in Health

The components of social health justice are as follows:

• Equity, Equality, Fairness, Inclusion, Opportunity, Rights
• Moral agency, action
• Equal treatment as natural law
• Removing barriers
• Impartiality

                                         

• Equity, Equality, Fairness, Inclusion, Opportunity, Rights

Health equity cannot be concerned only with health, seen in isolation. Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Health inequities, therefore, involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. They also entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.

Equality is guaranteeing people or groups are not treated contrastingly/differently or less favorably, on the basis of their specific characteristics, including areas of age, race, sexual orientation, gender, religion or belief, disability, etc.

Understanding the difference between equity and equality is a key component in the effort to reduce health disparities among vulnerable populations. Thus, equality is not equitable.

Example of Equality	Example of Equity
All mothers are provided with the same amount of transportation incentive after institutional delivery.	Considering geographical locations and transportation condition, mothers are provided with transportation incentive after institutional delivery respectively: Himalayan region  : Nrs. 1500 Hilly region            : Nrs. 1000 Terai region           : Nrs. 500

• Moral Agency, action

Moral agency in terms of health is also considered as enacted justice. It is an individual's ability to make moral judgments, based on some commonly held idea of right and wrong and to be held accountable for these actions; to become increasingly capable of making decisions and taking action themselves. A moral agent is a being who is capable of acting with reference to right and wrong. For e.g. If a patient is referred for physical therapy treatment, then there should be some kind of coherence between therapist and patient. There should be freedom for exercise choice and opportunity for change.

• Equal Treatment as Natural Law

Natural Equality is found among all humans solely by the constitution of their nature. Equal treatment as natural law is the principle and foundation of liberty. It is clear according to natural law that one must value and treat other people as so many individuals who are naturally equal to oneself. For example, one can demand preferential services, and must not claim more than others but, on the contrary, allow them to enjoy equally the same rights that one assumes for self.

• Removing Barriers

Removing Barriers mainly aims advocacy, understanding, collaboration on inclusion and diversity within the healthcare system. We advance social justice when we remove barriers that people face because of age, gender, ethnicity, race, religion, culture or disability.

• Impartiality

Impartiality as such is not a virtue. It assumes its morally worthy nature in the context of rights and duties. Furthermore, impartiality in relation to equity is something more than and other than the mere consistent application of rules of behavior. Actions, in order to be good ones, must treat persons appropriately as persons. This is the base of all good actions and, therefore, of all good just actions.

Bibliography

1. https://www.cdc.gov/od/science/integrity/phethics/index.htm
2. http://www.who.int/healthsystems/topics/equity/en/
3. http://www.who.int/bulletin/volumes/89/1/10-082388/en/
4. BENJAMIN, G.C. Health Equity and Social Justice: A Health Improvement Tool
5. Edwards, I., et al., Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice. Physical Therapy, 2011. 91(11): p. 1653-1663.
6. McLachlan HV Justice and the NHS: a comment on Culyer Journal of Medical Ethics 2005; 31:379-382.
7. Peter, F., Anand, S., Sen, A. “Public Health, Ethics, and Equity” (2004).
8. Ruger, Jennifer Prah. “Health and Social Justice.”(2004).