SHORT ANSWER QUESTIONS

1. Explain the difference between closed and open questions. What is the purpose of open questions? (2 marks)
2. Give three reasons for using focus groups in qualitative research (3 marks), and three reasons why using focus groups for research may be difficult or challenging (3 marks).
3. What are the differences between structured, semi-structured and unstructured interviews? (3 marks)
4. In the context of questionnaire design, what is the think-aloud method (also known as cognitive interviewing), and why is it used? (2 marks)
5. The following two questions are taken from a survey questionnaire. For each question, name one thing that is wrong with the question. (2 marks)
   1. How satisfied are you with the provision of GP and nursing services at your health centre?

• Very satisfied
• Fairly satisfied
• Neither satisfied or dissatisfied
• Fairly dissatisfied
• Very dissatisfied
  1. What is your marital status?
• Single
• Married
• Divorce

6. Divorced The following three questions are taken from a survey questionnaire. For each question, name one thing that is wrong with the question. (3 marks)
   1. At your last appointment at the health centre, were you satisfied with the punctuality and professional attitude of the GP?
   2. Have you been screened for a sexually transmitted disease since you turned 18?
   3. Do you not like exercising?
7. Define ‘validity’ in the context of survey research measurement. (1 mark) Give an example of one type of validity and explain it briefly (2 marks)
8. You plan to use a questionnaire to find out about people’s engagement in physical activity following a heart attack. Give an example of a closed question you might ask about participants’ attitudes to physical activity. (1 mark)
9. Give three advantages of secondary data analysis in research. (3 marks)

10. What is a systematic review? (2 marks).
11. You plan to carry out a study to understand how women with breast cancer experience cancer-related fatigue.
    1. What kind of study would you carry out? (1 mark)
    2. Write an appropriately worded research question for your study. (1 mark)
12. Give three ways in which survey data can be collected (3 marks), and give one advantage or disadvantage of each method (3 marks).

Read the following summary of a research study, and use it to answer question 13:

Background: Falls in elderly people are a common presenting complaint to accident and emergency departments. Current practice commonly focuses on the injury, with little systematic assessment of the underlying cause, functional consequences, and possibilities for future prevention. We undertook a randomised controlled study to assess the benefit of a structured interdisciplinary assessment of people who have fallen in terms of further falls.

Methods: Eligible patients were aged 65 years and older, lived in the community, and presented to an accident and emergency department with a fall. Patients assigned to the intervention group (n=184) underwent a structured interdisciplinary rehabilitation intervention; those assigned to the control group (n=213) received usual care only. Follow-up data on the number of falls were collected every 4 months for 1 year.

Findings: At 12-month follow-up, the total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group. The risk of falling was significantly reduced in the intervention group, as was the risk of recurrent falls.

interdisciplinary assessment of people who have fallen in terms of further falls.

Methods: Eligible patients were aged 65 years and older, lived in the community, and presented to an accident and emergency department with a fall. Patients assigned to the intervention group (n=184) underwent a structured interdisciplinary rehabilitation intervention; those assigned to the control group (n=213) received usual care only. Follow-up data on the number of falls were collected every 4 months for 1 year.

Findings: At 12-month follow-up, the total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group. The risk of falling was significantly reduced in the intervention group, as was the risk of recurrent falls.

13. a) From the information given, identify each element of the PICO structure of a research question for a randomised controlled trial. (4 marks)
14. Use this information to write an appropriately worded research question.(2 marks)
15. Patients with osteoarthritis are being invited to participate in a randomised controlled trial of the effectiveness of a physiotherapy intervention to improve knee pain. The Participant Information Sheet sets out the benefits of taking part in the study as follows:

“What are the benefits of taking part?

You will receive a physiotherapy intervention which will help your knee pain.”

Explain why this is problematic (1 mark), and suggest a more appropriate statement of the benefit to patients of participating in the study. (1 mark)

Read the abstract that follows, and use the information to answer question 15:

There has been increasing social debate in recent times surrounding men’s identities, men’s health and wellbeing, and men’s place within contemporary western society. The purpose of this study was to contribute to new knowledge of these issues through an exploration of two small sub-cultures of young adults. Using participant observation, the researcher described in detail the ways in which masculinities were constructed in everyday life. The researcher spent over two years as a participant observer of small groups of men in two fieldwork sites: a gymnasium in a large city, and a small rural community. A non-clinical and non-deviant sample were used to build in-depth knowledge from a neutral lens that did not assume an existing male deficit or crisis. The major findings revolved around the complexity of the male social networks, including the men’s need for belonging and in particular same sex friendships, the implicit and explicit rules of engagement, rational reflective discussion, and male engagement in their social worlds.

15. What methodology would have been appropriate for this study? (1 mark) Give two reasons for your choice. (2 marks)
16. Imagine that you work in an area where there is a large population of refugee mothers who report that it is very difficult to register with a General Practitioner (GP). You want to do a piece of research to find out why this is. You decide to use participant observation, using actors as ‘pretend patients’ who turn up to GP surgeries in the area requesting to register with a GP. You ask them to use a hidden microphone to secretly record their conversations with reception staff, which you plan to transcribe and analyse.
    1. What ethical problems might this study raise? (2 marks)
    2. Would this way of collecting data have any advantages? Why, or why not? (2 marks)
17. Read the abstract that follows and use the information to answer questions (a) and (b).
    • Objective

This study aimed to obtain an in-depth understanding of midwives’ lived experiences of caring for new mothers who have breastfeeding difficulties.

• Methods

A reflective lifeworld approach was used. Six midwives were recruited from a hospital in western Sweden. Data were collected via individual interviews.

• Results

The essential meaning can be described as a midwife’s wish to help new mothers reach their breastfeeding goals by trying to interact with them as individual women in unique breastfeeding situations. This wish constitutes a contradiction to the midwife’s own desire to succeed in enabling mothers to breastfeed and the perceived risk of failure as a midwife if the mothers decide not to breastfeed. This is further described by five constituents: striving to provide individualised care, collegial and personal responsibility both enables and prevents care, a struggle to be sufficient, an uphill struggle and mutual joy becomes the motivation to care.

1. What methodology would have been appropriate for this study? (1 mark)
2. Give two reasons for your choice (2 marks)

Section A: General research design and ethics (24 marks in total)

1. Imagine that you work in an area where there is a large population of refugee mothers who report that it is very difficult to register with a General Practitioner (GP). You want to do a piece of research to find out why this is. You decide to use participant observation, using actors as ‘pretend patients’ who turn up to GP surgeries in the area requesting to register with a GP. You ask them to use a hidden microphone to secretly record their conversations with reception staff, which you plan to transcribe and analyse.
   1. What ethical problems might this study raise? (2 marks)
   2. Would this way of collecting data have any advantages? Why, or why not? (2 marks)
2. Explain the differences between structured, semi-structured and unstructured interviews (3 marks)
3. What is problematic about each of the following two questions in a questionnaire? (2 marks)
   1. How often do you check your breasts for lumps?

• Once a week
• Once a month
• Every six months
• When you remember
  1. Do you feel that your relationship with your mother is affected by her desire to obtain vicarious gratification from your achievements?
• Yes
• No
• Don’t know

11. Read the abstract that follows and use the information to answer questions (a) and (b).
    • Objective

This study aimed to obtain an in-depth understanding of midwives’ lived experiences of caring for new mothers who have breastfeeding difficulties.

• Methods

A reflective lifeworld approach was used. Six midwives were recruited from a hospital in western Sweden. Data were collected via individual interviews.

• Results

The essential meaning can be described as a midwife’s wish to help new mothers reach their breastfeeding goals by trying to interact with them as individual women in unique breastfeeding situations. This wish constitutes a contradiction to the midwife’s own desire to succeed in enabling mothers to breastfeed and the perceived risk of failure as a midwife if the mothers decide not to breastfeed. This is further described by five constituents: striving to provide individualised care, collegial and personal responsibility both enables and prevents care, a struggle to be sufficient, an uphill struggle and mutual joy becomes the motivation to care.

1. What methodology would have been appropriate for this study? (1 mark)
2. Give two reasons for your choice (2 marks)

12. Read the abstract that follows and use the information to answer questions (a), (b) and (c).
    • Objectives

To evaluate the effects (benefits and harms) of flexible working interventions on the physical, mental and general health and wellbeing of employees and their families.

• Search methods

Our searches covered 12 databases including the Cochrane Public Health Group Specialized Register, CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Social Science Citation Index; ASSIA; IBSS; Sociological Abstracts; and ABI/Inform. We also searched relevant websites, hand searched key journals, searched bibliographies and contacted study authors and key experts.

• Selection criteria
• Randomized controlled trials (RCT), interrupted time series and controlled before and after studies (CBA), which used a validated instrument to examine the effects of flexible working interventions on employee health and wellbeing were included. We excluded studies assessing outcomes for less than six months.
• Data collection and analysis

Two experienced review authors conducted data extraction and quality appraisal. Substantial heterogeneity between studies meant that meta-analysis was not possible. Instead, data were analysed descriptively.

Main results

Ten studies fulfilled the inclusion criteria. The studies retrieved had a number of methodological limitations including short follow-up periods, risk of selection bias and reliance on largely self-reported outcome data. The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed-term contract and involuntary part-time employment, found ambiguous or negative health effects.

1. What kind of study is this? (1 mark)
2. From the information provided here, identify each aspect of the PICO structure of a research question. (4 marks)
3. The authors say that they included studies that used a validated instrument to measure the effects of flexible working interventions. What is meant by a validated instrument? (2 marks)

6. The board of a local hospital is concerned about the high turnover of nursing staff and they have commissioned you to carry out some qualitative research with nurses in the hospital about their job satisfaction. You decide to do in-depth individual interviews with 40 nurses and carry out a further six focus groups with nursing staff across a range of staff grade bands. Nurses participated in either an interview or a focus group – none of the nurses did both. During the analysis of the interview data, you realise that nurses on lower grade bands seem to be saying that they aren’t happy in their jobs, yet this finding isn’t apparent in the focus group data.
   1. How would you explain the difference in findings between the individual interviews and the focus groups?(3 marks)
   2. Would you reject either set of findings? Explain why or why not. (2 marks)

Please read the abbreviated abstract of a research study below and answer all of the questions that follow. Be concise.

Title

Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2–9 years.

DeChristopher, et al. (2015) Public Health Nutrition 19(1):123-130.

Abstract

Objective: High soft drink consumption has been linked with asthma. Anecdotal evidence links high-fructose corn syrup with asthma. The receptor of advanced glycation end products (RAGE) has emerged as a mediator of asthma. The objectives of the present study were to: (i) assess the correlation between intake of beverages containing excess free fructose (EFF beverages) and asthma in children; and (ii) epidemiologically test the mechanistic hypothesis that intake of high EFF beverages, such as apple juice or beverages sweetened with high-fructose corn syrup, is associated with increased risk of asthma.  This hypothesis is based on the possible effect of increases in the in situ intestinal formation of advanced glycation end products (enFruAGE) with EFF, which may be absorbed and play a role in RAGE-mediated asthma.

Design: We examined cross-sectional associations between beverage intake and self-reported current or history of asthma. Exposure variables were EFF beverages, including apple juice (AJ), non-diet soft drinks (ndSD) and fruit drinks (FD).  Orange juice (OJ), not an EFF beverage, was included as a comparison.  Logistic regression were used for associations, adjusted for age, sex, race/ethnicity, BMI and total energy intake.

Setting: Data are from the National Health and Nutrition Examination Survey 2003–2006, a nationally representative survey.

Subjects: US children (n=1,961) aged 2–9 years with complete responses on the dietary frequency questionnaire.

Results: Intakes of EFF beverages were significantly associated with asthma in 2–9-year-olds. Adjusted odds ratio of asthma in children consuming EFF beverages 5 times/week was more than five times that in children consuming these beverages less than 1 time/month (OR=5.29, 95% CI  1.49 to 18.72, P=0.012). Children consuming AJ more than 5 times/week versus  less than 1 time/month, adjusted for the other beverages, were more than twice as likely to have asthma (OR=2.43, 95% CI 1.07 to 5.54,  P=0.035). In contrast, there was a tendency for OJ to be protective.

Conclusions: These results support the hypothesis that intake of high EFF beverages, including AJ and beverages sweetened with high-fructose corn syrup, is associated with asthma in children aged 2–9 years. Results support the mechanistic hypothesis that enFruAGE may be an overlooked contributor to asthma in children. Longitudinal studies are needed to provide evidence of causal association.

Abbreviations used:  

• 95% CI            95% confidence interval
• OR                  odds ratio
• p                      significance p-value

Note to students:

This study uses a form of regression analysis to examine for correlations known as logistic regression, and additionally report findings as odds ratios (OR). Refer to the following to help you interpret the results of this study.

Odds ratio: the odds ratio (OR) represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. The three OR outcomes are interpreted as:

OR=1 Exposure does not affect odds of outcome

OR>1 Exposure associated with higher odds of outcome

OR<1 Exposure associated with lower odds of outcome

1. (a)What type of study design was used here? (b)Define the advantages of this using this design for this study.
2. For the (logistic) regression analysis, adjustments were made for a number of identified factors (such as age, BMI, energy intake, etc.) for the correlations here. Why would such adjustments be necessary in a study of this type?
3. a) What were the odds ratios and their 95% Confidence Intervals for asthma in children       consuming EFF and AJ respectively?
4. b) What does the 95% CI for the OR mean here?

Confidence interval (CI) is a type of interval estimate, computed from the statistics of the observed data, that might contain the true value of an unknown population parameter. So there a 95% chance the true/population OR lies in this interval or range.

4. What is the hypothesised link provided here as to how consumption of EFF drinks might be linked to RAGE mediated asthma?
5. Why would these findings, obtained from the identified age group for increased OR for asthma following consumption of EFF, be a health concern?
6. What would be the advantages of using a longitudinal study design instead, to address the suggested association between EFF and asthma?