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This 10 page Class Notes was uploaded by Maya Blair on Wednesday February 3, 2016. The Class Notes belongs to Psyc 3128 at George Washington University taught by Thomas Nassif in Winter 2016. Since its upload, it has received 41 views. For similar materials see Health Psychology in Psychlogy at George Washington University.
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Date Created: 02/03/16
CH 2: RESEARCH METHODS SECTION I: MEASURING HEALTH Borrowing from Epidemiology Epidemiology the study of factors or determinants of health status among population groups and the use of that knowledge to help control the spread of health problems in the population Greek Epi = among Demos = people Logos = referring to scholarly discipline or study Epidemiologists study the determinants and distribution of diseases (medical detectives) Study causes of health problem by determining the origins of a disease through examining the first or earliest known human infected as well as the agent that caused the infection AKA: inform us about origin and impact on prior generations Determine the risk of the disease to current and future populations AKA: Inform us on potential risk at the present and in the future History of Epidemiology ● Not a new term ● Hippocrates recorded communicable outbreaks (the plague, cholera, dysentery) ● John Graunt comprehensive analysis of mortality data. Birth, death, and disease occurrence by location Mortality vs. Morbidity Mortality refers to death ● Ex. # of deaths due to heart disease Morbidity refers to diseases that may contribute to mortality ● Ex. Diabetes does not cause death but can cause a number of health problems that lead to death Reporting mortality/morbidity rates 2 types of data: Raw Data total number of deaths Rates if we want to understand the magnitude of a health problem in comparison to other countries Mortality Raw Data the raw data are the total number Mortality Rates death in a population during a of deaths for a defined population specific time period, scaled to size of the population 1 CONS: cannot determine whether the number of infant PROS: Allows us to compare mortality statistics across deaths represents a large or small % of the infant two or more countries. Formula: total # of infant deaths population in each country. AKA: using raw data we in a given time period for a specific population /total conclude that infants in the US are 178.5 times more population of infants for the time period *1,000 likely to die than infants in Finland...this isn’t true. We see that even though France had the 2nd highest RAW number of infant deaths, they actually have the 5th highest infant mortality rate: 3.6 Incidence, Prevalence, and Relative Risks Turn raw data into incidence rates and prevalence rates Incidence refers to the number of new cases of a disease in a specific population for a given time period We can examine how quickly a disease is spreading by looking at the # of new cases, or incidence, of a disease Prevalence total number of cases (old and new) of a disease Relative Risk used to express the risk to members of a specific group compared to another group of acquiring a disease Rate Illness/Cause Sample Calculation Mortality Automobile Accident Automobile fatalities in 2005 in U. X 100,000 U.S. Population in 2005 Morbidity Hypertension Hypertension in 2005 in U.S. X 100,000 U.S. Population in 2005 Incidence (RATES) HIV in Ukraine New HIV Cases in 2004 in Ukraine X 100,000 Ukrainian Population in 2004 Prevalence (RATES) HIV in Ukraine All HIV Cases in 2004 in Ukraine X 100,000 Ukrainian Population in 2004 Relative Risk HIV in Ukraine HIV Cases in 2004 of drug users in Ukrain X 100,000 HIV Cases in 20004 of nondrug users in Ukraine Proximal Vs. Distal Causes of Death 2 measures that help explain individual or community health problems Proximal immediate or precipitating causes of health and illness Individual, situational, or environmental factors Ex. Gastrointestinal distress caused by food poisoning Distal remote in time or predisposing causes of health and illness Atrial septal defect (hole in wall) is a distal factor because it can CAUSE hypertension (high blood pressure) 2 SUMMARY : 5 classic measures (mortality, morbidity, incidence, prevalence, and relative risk) enable health researchers to describe the health status of a population in general terms. Proximal and distal factors help explain the timing of an illness as well as the probable cause SECTION II: METHODOLOGY Quantitative Studies Quantitative research research that focuses on data that can be measured numerically Ex. surveys, experiments Qualitative Studies Qualitative research narrative description with words rather than numbers to analyze patterns and their underlying meanings Used to gather largely nonstatistical data to help explain behaviors or outcomes Provides rich contextual data Allows for indepth exploration of issue Researchers use the CONTEXT in which the health event occured to explore a phenomenon and to identify factors that contribute to an outcome Ex. Indepth interviews, focus groups, observational studies, conducting a secondary analysis using narrative documents (ex. letters or diaries) Case Studies Allow for an indepth analysis of rare or unique events Case Report : very detailed report of specific features of particular participant/case Case Series : systematic review of interesting/common features of a small series ○ Does not include a control group Both are used to generate a hypothesis, which is then tested in larger studies ○ Advantages : easy to conduct ○ Disadvantage : unplanned, uncontrolled, and not designed to answer specific questions Focus Groups Used primarily to gather information and generate insight through the interaction of a small group of informants Four main functions ○ To gather information ○ To generate insight ○ To explore a decisionmaking process ○ To encourage interactions between a small group → create new insights Interviews Allows for structured and unstructured responses to specific questions ○ Structured: closeended (ex. yes/no) responses ○ Unstructured : openended (ex. descriptive), unrestricted responses 3 Correlational Studies A way to examine the relationship between two variables Asks: do two variables share something in common? Pearson Correlation Coefficient (r) measures strength and direction of relationship Positive Correlation as one variable increases in value, so does second variable, OR, as one variable decreases in value so does second Negative Correlation as one variable increases in value, the second decreases Strength of correlation determined by value of r and by pvalue associated with the statistic Expressed numerically as a value ranging from +1.00 to 1.00 Strongly positive (r = +1.00) Strongly negative ( r= 1.00) No correlation (r = 0.00) General “rule of thumb” r values greater than .60 = strong correlations r values between .40 .59 = moderate correlations r values between .21 .39 = weak correlations r values between .00 .20 = no correlation Correlation does not imply causality, does not test for cause and effect Experimental Studies Explores whether there exists a causeandeffect relationship between two variables A researcher must restate the question as a null hypothesis or a research hypothesis ○ Null Hypothesis assumes no relationship between two variables. Research assumes null hypothesis is valid until shown otherwise ■ Ex. There is no effect of exercise on stress ○ Research Hypothesis assumes a relationship between the two variables. Must be shown by outcome of research ■ Ex. There is a relationship between exercise and stress Independent vs. Dependent Variables Investigator can limit or control many of the variables to be studied ○ Independent (IV) variable that the investigator manipulates or controls ■ Researcher examines effect of variable on study’s outcome ■ May have more than one IV ■ Ex. Exercise (manipulate how much exercise) ○ Dependent (DV) the study’s outcome variable ■ May be influenced by IV ■ Ex. Stress (depends on how much exercise) 4 Experimental vs. Control Groups Experimental research includes at least two groups of study participants ○ Experimental group the test group that receives a special treatment or condition ■ Ex. 30 minutes of swimming ○ Control group does not receive any special condition or treatment that would affect the dependent variable ■ Ex. Reading about swimming for 30 minutes Random Sampling vs. Random Assignment Random Sampling method of choosing participants such that… All have an equal chance of participating in the study The study sample will be representative of the population to be studied It minimizes possibility of experimenter bias Random Assignment methodology that assures every person has an equal chance of being assigned to either experimental or control condition Longitudinal vs. CrossSectional Design Longitudinal studying a phenomenon over an extended period of time using the same participants ○ Good for studying health problems ○ Limits variability in the results due to subject factors such as age, ethnicity, or gender ○ Disadvantage: time consuming, costly, may loose participants over time ( attrition) Ex. Framingham Heart Study Designed to study heart disease Goal to investigate the possible factors related to the development of various forms of cardiovascular disease (CVD) Started in 1948 with 5,000 participants free of CVD Longitudinal cohort (cohort = group) study involved repeated assessments of participants every 2 years Able to demonstrate an association between coronary artery disease and individual as well as environmental causes (smoking, physical inactivity, and hypertension) Continues today with second and third generation offspring Ex. Stanford Three Community Study Sought to test factors related to heart disease Educational interventions: 1. mas media sources, individualized instruction, and neither Results showed that the more intervention, the better Communitybased study Crosssectional studying a phenomenon across a wide group of participants ○ Require less time and money than longitudinal studies ○ Measure each participant or group of participants only once ○ Disadvantages: multiple groups introduces more variability in the results due to possible individual or subject differences 5 Intervention Studies Used often in research on health issues because they test the extent to which an intervention (a special program, therapeutic treatment, or training) improves health outcomes Preposttest Design Participants Phase I Phase II Phase III Experimental Group Pretest Intervention Posttest Control Group Pretest No Intervention Posttest Uses control group to determine whether the DV is influenced by the intervention Ethical Considerations in Experimental Design Randomized Clinical Trials Use one control and at least one experimental group to test the effects of a new medication, a therapeutic approach, or an apparatus as a treatment for a medical or mental illness Studies conducted to ensure drugs are safe and don’t cause lifethreatening complications But time needed to complete testing procedures delays distribution of potential life saving drugs Randomized Control Trial One group gets experimental drug One group gets control drug (placebo) Modified Intervention Design Prepostposttest design (CROSSOVER TRIAL) both the experimental and control groups receive the actual treatment, although not at the same time Preserves scientific approach and ability to test drug’s safety and effectiveness Ensures that both group gets potentially lifesaving drug with minimal delay “Washout period” : time when no treatments are given Treatment Assignment Random assignment: random assignment to experimental treatment or control treatment Fixed assignment: all participants assigned to same treatment sequence Advantages Each participant acts as their own control Fewer participants needed to show an effect Disadvantages May be carryover effects If participant drops out, lose data 6 QuasiExperimental Intervention Studies Adjusts for the fact that researchers cannot always control independent variables Ex. cannot control health conditions, or demographic variables Compromises ability to demonstrate cause and effect relationship between variables Do not include control groups Cannot demonstrate causal effect of intervention on outcome SECTION III: RESEARCH ETHICS AND POLICY Reactions to the Word Research Can be positive (life saving discoveries) Can be negative (abuse, using people as human “guinea pigs”) The Nuremberg Code of 1947 After liberating camps, the US and Allied forces learned that many detainees of the camps were used as subjects in medical experiments in the name of science When the experiments were revealed to the world, a US military tribunal convened an international court known as the Nuremberg trials The Nuremberg Trials and Outcomes International Court called the Nuremberg convention to address abuse of welfare of human beings One purpose was to try the doctors and other persons responsible for conducting such research Nuremberg Code of 1947 , a list of 10 conditions that regulated the use of human subjects in research First formal document defining the rules of conduct for research involving human subjects Specific to medical experiments Emerged from Nazi war crimes trial 7 Such research could only take place in context where broader human rights were systematically abrogated Other Outcomes Declaration of Helsinki (1964): Recommendations Guiding Medical Doctors in Biomedical Research Involving Human Subjects Broadened the scope of the Nuremberg Code Institutional Review Board (RIB) (1953) monitor human research. Review board approves or disapproves. Adds a lot of time. American Psychological Association (APA) joined efforts to protect the rights of volunteers in research by establishing codes of ethical standards for psychologists The Tuskegee Syphilis Study Conducted in the US from 1932 1972 (longest run study) Was only suppose to be a ninemonth study to examine the course of syphilis and its impact on neurological functioning Example of Breech of Research Ethics Researchers wanted to observe the effects of syphilis on different races Proposed that syphilis affected the cardiovascular system for blacks, and the neurological systems for whites PROCEDURE Studied 400 African American Males Nor did they know the demonstration could be accomplished only by autopsies (after death) Syphilis was untreated even when penicillin became available in the late 1940s Letters “not to treat” were inserted in army service records Told that nontherapeutic procedures were “special treatment[s]” ETHICAL PROBLEMS Deception “Volunteers” misled Not informed of the true study Not informed of their true health condition Not aware that medical treatment (intervention) would not treat their health condition Not made aware of effective treatment of syphilis Not told that untreated, their condition would result in death Spouses and children of volunteers at risk for contracting untreated syphilis Flagrant disregard of rights and welfare of study participants FOLLOWING PUBLIC EXPOSURE National Research Act of 1974 an outcome from hearings conducted by the US Senate Committee on Labor and Human Resources “Require the (then) Health, Education and Welfare Department to [formalize and regulate] its policy for the protection of human subjects…” BELMONT REPORT : 3 fundamental ethical principles for the protection of human subjects: 8 1. Respect for persons 2. Beneficence 3. Justice Principle Application Respect for Persons Informed Consent Autonomy says that each individual... Very clear Is unique and free This is what you’re Has the right and capacity to decide responsible for Has value and dignity We want to make sure Has the right to i formed consent you’re okay with this Protection for vulnerable persons Have the right to leave at Special protections must be in place for those whose any time decisionmaking capacity is impaired or diminished, whether due to physical or social factors (youth, cognitive impairment, other mental health issues or illness) Beneficence Assessment of Protection of the study participants is the most important responsibility of Risks/Benefits the researcher MUST think about the risks Can be physical, social, or Research must mental harm Protect the physical, mental and social wellbeing of each research participant Minimize physical and social risks Maximize the possible benefits Retain the community perspective Justice Fair Selection of Subjects Obligation to treat people fairly and equitably Making sure all participants Equal access to benefits/equal share of burdens get equal share of Avoid underprotection and overprotection burdens/risk HOW ON EARTH DID TUSKEGEE HAPPEN? System of peerreview in the field of Medicine in 1930’s Complete absence of a code of ethics Preserving professional autonomy vs. defining good practice Healing technicians versed in methods, strategies, and procedures for treatment and cure Yet uninterested in theorizing; no dialogue between theory and practice Theorizing questions the status quo, promotes reflection about practice and research, and lays the groundwork for ethics and promotion of social justice Study of Interpersonal Dynamics (Stanford Prison Experiment) 1971 Philip Zimbardo designed a twoweek study on interpersonal dynamics and sought to determine whether social contexts can influence, alter, shape, or transform human behavior 24 male Stanford University students volunteered to participate 9 Randomly assigned 2 roles: prison warden or prisoner Prisoners assigned to live in a mock prison for a full two weeks Wardens worked 8 hour shifts “guarding” the prisoners Study terminated after 6 days due to prisoner’s extreme psychological trauma and the increasingly hostile and abusive behavior of the wardens “Bad” social contexts or environments can alter the behavior of otherwise “good” people Study suggests that individuals may come to perform hostile or abusive behaviors when placed in a social context that permits or encourages such behaviors SUMMARY: research abuses demonstrate the need to establish regulations and regulatory bodies that protect the health and wellbeing of study participants 10
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