RESEARCH NOTES
WHAT STUDY DESIGN SHOULD I CHOOSE?
Zailinawati Abu Hassan, FRACGP GradDipFamMed(Monash), Klinik Keluarga, Kuala Lumpur
Nik Sherina Hanafi MMed(FamMed UM), Department of Primary Care Medicine, University of Malaya
Teng Cheong Lieng MMed(FamMed UM) FRACGP, Department of Family Medicine, International Medical University
Zailinawati AH, Nik-Sherina H, Teng CL. What study design should I choose? Malaysian Family Physician. 2006;1(1):29-31
THE PROBLEM
You are a general practitioner in a five-doctor group practice. Recently you and your colleagues decided to reserve Tuesday afternoons for your diabetic patients, so as to provide more comprehensive care to them. To your dismay, you found that only half of your scheduled patients turned up for their appointments.
A few questions come to your mind:
- Why are the patients not attending?
- How many of them are not attending and what are the associated factors?
- Does default result in poor outcome e.g. diabetic control?
- Which intervention is useful to reduce the non-attendance?
All the above questions can be answered using different research methods. Question 1 can be answered using qualitative study and question 2 is to determine the prevalence for non-attendance therefore a cross-sectional study is appropriate. In question 3, we are looking for the association between the cause and effect, either case-control or cohort design could be used. In the fourth question, we are testing the usefulness of the intervention, hence a randomized control trial study design may be appropriate.
To answer your questions you decided to look through the published literature, looking for "What are the characteristics of patients who miss their diabetic appointments and why do they miss it?"
Studies in the West identified these characteristics of patients who are likely to miss their appointments: younger patients, those from lower socio-economic class, those patients who has appointments with junior doctors, and long waiting time.1,2 Other reasons quoted were: problems with the appointment system, inaccessible health care, clinic administrative errors, bad weather, lack of insurance coverage and problem with transportation.1-3
However, you are not sure if the above reasons and associated factors are applicable to your clinic. To satisfy your curiosity you decide to conduct a study among your patients. You feel that finding the answers from your own clinic is more likely to bring about a solution for your problem.
QUALITATIVE STUDY
Why are the patients not attending?
Your initial exploration may be a qualitative study. Qualitative study is a good research method if you want to understand the views and opinions of patients. Qualitative study may take several forms, all of which aim to allow the research subjects to reveal their thoughts and feelings about specific issues with as little interference as possible from the researchers (Box 1). Thus the words expressed by the research subjects are the "data" - these will need to be captured in some way for subsequent analysis.
Box 1. Some examples of qualitative study4,5
Focus group discussions. In this method a facilitator (the researcher) sits with a group of participants in an effort to get information on the issue discussed. This method is used to find out the various issues related to the particular topic. Researchers observe how participants react and discuss the issues and ideas together. Ideally, the number in each group is between 8–13 participants, taking a time of between 60 and 120 minutes. The facilitator may use a prepared guide to facilitate the discussion. The discussions will be recorded either using audio or/and video tape, which later will be transcribed verbatim and later on analysed. The basis to analysis is to make sense and interpreting the data.
Participant observation. In this method, the researcher observes the research subjects in their natural environment. The researcher may want to be involved (participatory research) or take an outside role (non-participatory research). It is often used for studies of social roles and formal organisations. People are studied in their natural environment with minimal interference from the researcher.