RESEARCH
DESIGN: A CONTRIBUTION TO THEAUTHOR
Dalmo
Valério Machado de Lima¹
1 Universidade Federal Fluminense
ABSTRACT
Objective:
To assist readers, researchers and authors to
understand the main research designs used by the nursing
and health in general. Method: Bibliographic
research. Results: Schematic picture in one sheet with
links to the essential characteristics of the various designs
or methodologies used in health. Four categories of designs
were identified: experimental, non-experimental, secondary and
additional. The dismembering of the categories resulted in
36 designs. Conclusion: The proposed tool consisted of
a facilitator to the authors in different
sections of the articles: title, methodology and metadata.
Keywords: Measures, Methods and
Theories; Access to Information; Authorship and Co-Authorship in
Scientific Publications; Evidence-Based Nursing.
INTRODUCTION
The plurality of research methodologies that are brought, by chance, by
the advancement of science include those related to the health
sector. In this sense, it is essential to both the producer
and the research consumer the sedimentation of classic
designs for research, as well as the attention to new trends
that underlie this advancement. The purpose of this guide is to
help readers, researchers and authors to understand
the main research designs used by the nursing
and health in general.
METHODOLOGY
It
is a bibliographic research which has
used classical books of epidemiology, research in health
methodology, nursing and social sciences.
RESULTS
It is a
schematic picture with links to the essential characteristics of
the various drawings used in health. Four categories
of drawings were
identified: experimental, non-experimental, secondary and
additional.
Table 1 -
Research designs adopted in health*
*Each term in blue is a hyperlink that directs straight to the
definition of the design adopted in article
1. NON-EXPERIMENTAL RESEARCH DRAWINGS
They are used when the researcher wants to build
the framework of a phenomenon or explore events, people or
situations as they occur naturally. In these studies the
independent variables have already occurred, so to speak, and
the investigator cannot control them directly by manipulation1.
1.1.
DESCRIPTIVE RESEARCH
1.1.1. Descriptive Research
The study focuses on, and is
designed only to describe the distribution of existing
variables, regardless of causality or
other hypotheses. Contrast ANALYTICALSTUDY. An example is
the community health survey used to determine the health
status of individuals in a community. Descriptive studies, such
as data analysis of cancer registry can be used to measure
risks, generate hypotheses, etc2.
1.1.2. Documental Research
The documental research, due to its characteristics, may
be mistaken for bibliographic research. The main
difference between these types of research is the difference of their
sources. The bibliographic research uses mainly the
contributions of several authors on a particular topic of
study. On the other hand, the documental research is based
on areas that have not yet received an analytic
treatment or that can be redesigned according to the
research objectives. Like most typologies, the documental
research can be integrated to the list of surveys used in
the same study or be characterized as the only one used for
this design. In this typology of research, documents
are classified into two main types: first-hand sources (official
documents, newspaper articles, letters, contracts, diaries, films, photographs,
recordings, etc.) and second-hand sources (research
reports, reports of companies, statistical tables, etc.) 3.
1.1.3. Case Study
Detailed investigations are a single
entity or a small number of entities. Entity may be an
individual, family, institution, community or other social unit. In a
case study, the researchers obtain rich descriptive information and
can examine relationships between different phenomena or trends over
time. The researchers of case studies attempt to analyze and
understand issues important to the history, development, or the circumstances
of the entity studied4.
1.1.4. Exploratory
It is the study where the main objective is to
explain, rather than simply describing a situation in
which the effects of specific variables and the
understanding the mechanisms of action are isolated2.
1.1.5. Motivation
Seeks to know the hidden and unconscious reasons that
lead, for example, the consumer to use a certain product
or which determine certain behavior or atitudes5.
1.1.6. Opinion
Seeks to know attitudes, viewpoints and preferences that
people have about any subject, in order to make
decisions. The survey covers a very wide range of investigations aimed at
identifying flaws or errors, describe procedures, discover trends and recognize
other interests and behaviors5.
1.2. ANALYTICAL OR OBSERVATIONAL RESEARCH
The study designed to examine associations, commonly putative
or hypothetical causal relationship. An analytical study is
usually concerned with identifying or measuring the
effects of risk factors, or is directed with effects in health or
a more specific exposure. Contrast is a DESCRIPTIVE
STUDY, which does not test hypotheses. The common types
of analytical studies are CORRELATIONAL, COHORT and
CASE CONTROL. In the analytical study, individuals in the
population examined may be classified according to the absence
or presence (or future development) of a particular disease and
according to the attributes that can influence the occurrence of
the disease. These attributes may include age, race, gender, other diseases, genetics,
biochemical or physiological characteristics, economic status, occupation,
residence and any other environmental or behavioral aspects2.
1.2.1. case-Control
(Synonym: comparison case study, partner case study, historical
case study, reference case study, retrospective study)
This is
the epidemiological observation study of
individuals with the disease (or with symptomatic variation) of
interest and a control group (for comparison and / or
reference) of people without the disease. The relation of an
attribute of the disease is examined by comparing
the diseased and the healthy in relation to the frequency
and presence of the attribute or, if quantitative, the
levels of the attribute in each group. Briefly, the past history
of the exposure to a suspected RISK FACTOR is compared
among the "cases" and "controls" individuals who
approach cases that respect age and gender, but do not
share the disease or conditions of interest3.
1.2.2. COHORT
1.2.2.1. Prospective and Classic
(Synonyms: rival, follow-up incident, longitudinal, prospective
study)
The analytic method of epidemiological study in
which portions of a defined population may be identified
considering who they are, have been or hereafter may
be exposed or not, or were exposed in
different levels to a factor or several hypothetical
factors that influence the likelihood of occurrence
of a certain disease or any other outcome. The main feature of
cohort studies is the observation of a large number for a
long period (usually for years) with incidence
rates of the groups that differ in exposure levels.
Alternate terms for a cohort study such as follow-up,
longitudinal and prospective
study describe an essential feature of the method, namely
the observation of the population of a sufficient number of
individuals per year to generate a reliable
incidence or mortality rates in some population groups. This
study implies in the study of a large population, a
study for a long period (years), or both. The denominator may be
individuals or time individual. See also historical cohort study2.
1.2.2.2. Retrospective or historical
(Synonyms: a prospective historical study, non-concurrent
prospective study, prospective study in retrospect)
This is a cohort study conducted by the reconstruction
of information about individuals in a given moment or moments in
the past. This method uses existing records on health or on
other relevant aspects of the population sometime in the
past and determines the current (or subsequent) state of
the members of this population in relation to conditions of interest.
Different levels of past exposure to the factor(s) of
risk(s) of interest can be identified for the
subgroups of the population. BOND RECORD Systems are
commonly used in historical cohort studies. The growing concern
about privacy protection threatens these types of studies, which
once made a great contribution to the understanding
of science of the causes of diseases. Reviewers of Ethics
Committees of research proposals of historical cohort
increasingly require researchers to obtain a declared consensus of
individuals whose medical records are searched. If the
study involves a very large number of people, and/or
some or all them are dead or cannot be found, it is obvious
that it is impossible to get such statements. Lines like the
ones Master made by the Council for International Organizations of
Medical Sciences (CIOMS) recommend that the consensus
statement should be discarded in such circumstances2.
1.2.3. Correlational
It is used to examine the relationship between two or
more variables. The researcher is not testing
whether one variable causes another variable or how
different a variable is each from the other. The
researcher is testing whether the
variables vary together, in other words, as a variable
changes, does a related change occur in another
variable? There is interest in quantifying the strength
of a relationship between the variables1.
1.2.4. Research of Results
It is in the intervention results the
research. It's a great deal of work of the clinical
epidemiologists2. For example: Rafferty and
collaborators (2007) examine the effect of the levels
of nursing staff in hospitals in relation to patient
mortality, failures to rescue and service quality rated by
nurses in the UK. Results similar to the
1.2.5. Transversal or of Prevalence
(Synonyms: research on disease frequency, prevalence study)
It is a study that examines the relation among diseases (or other
characteristics relating to health) and other variables of interest as they
exist in a given population at a given time. The presence or absence of a
disease and the presence or absence of other variables (or, if they are
quantitative elements, what is their level?) are determined in each member of
the studied population or in a representative sample at a given time. The
relation between the variable and the disease can be examined(1) in terms of
the disease prevalence in different subgroups of the population defined
according to the presence or absence (or level of variables and(2) in the
presence or absence (or level ) of the variables in patients against
non-patients. We note that the prevalence of a disease, instead of the
incidence, is normally studied through the cross-sectional study. The temporal
sequence of cause and effect is not necessarily determined in a transversal
study2.
2. EXPERIMENTAL STUDY
It is a study in which the conditions are under the direct control of the
investigator. In epidemiology, it is a study where the population is selected
for a planned test of a scheme in which the effects are measured by comparing
the results in an experimental group with the results of another control group.
To avoid the bias of the researcher and members of the experiment and of the
control group, everything must be compared, except the scheme that is offered
to both. The location of individuals in an experimental or control group is
done randomly, preferably. In a RANDOM CONTROLLED PROCESS, individuals are
randomly allocated, in some experiments, such as fluoridation of drinking
water; entire communities were (not randomly) allocated in experimental groups
and groups of control2. The experimental studies are a special type
of cohort study in which the conditions of study - that is, the selection of
the treatment groups, the nature of interventions, monitoring and management
during the measurement of outcomes - are specified by the investigator with the
purpose of making non-biased comparisons. These studies are generally referred
to as clinical trials. Clinical trials are submitted to a control and a more
intensive management than cohort studies. The researchers are conducting an
experiment, similar to those made in a laboratory. They took on the task (with
the permission of patients) study for of isolating the unique contribution of a
factor, maintaining, wherever possible, all other determinants of the outcome6.
2.1. ALMOST EXPERIMENT
It is the situation in which the investigator does not have full control over
the lease and / or time of intervention; however, he leads the study as if it
were an experiment, allocating subjects into groups. The inability to randomly
allocate subjects is the common situation that can best be described as a
quasi-experiment. See also Natural Experiment
2.2. CLINICAL TRIAL
(Also: the therapeutic
process)
It is a research activity that involves the administration of a test
regimen to humans to evaluate its efficacy and safety. The term is subject to a
considerable variety of use, since the first use in humans without any control
treatment to an experiment designed and executed rigorously, involving tests
and treatments of control and randomness2. Several phases of clinical trials are
distinguishable2:
Phase I process safety and pharmacological profiles. The first
presentation of a candidate vaccine or drug in a human population to determine
its safety and course of action. In drug testing, this phase may include
studies of dose and routes of administration.
The Phase I tests usually involve less than 100 healthy volunteers.
Phase II Pilot Efficacy Study process. Initial processes for the appraisal
of the effectiveness in 200 to 500 volunteers, with vaccines, the focus is on
the immunogenicity, and with drugs in the
demonstration of safety and efficacy compared with other existing schemes.
Usually, but not always, subjects are randomly assigned to study and control
groups.
Phase III Clinical Trials Extensive process. This phase is intended to
fully evaluate the safety and efficacy. It involves a much larger number,
perhaps thousands of volunteers, usually with random allocation in study and
control groups, and may have a multi-centered process.
Phase IV process with drugs. This phase is conducted after the national
authority for registration of medicines (e.g. the Food and Drug Administration
in the
2.2.1. Randomized
Clinical Trial
The best way to balance all the external variables among the groups is to
allocate patients randomly to groups, so that each patient has an equal
probability of being in the exposed or unexposed group. A special feature of
randomization is that it not only balances the variables known to affect the
prognosis, but also balances the ones that are unknown. Therefore randomization
offers good protection against incorrect conclusions over the risk factors or
prognoses. Randomized clinical trials, in which treatment is allocated
randomly, are the gold standard for scientific studies on the effect of
treatment6.
2.2.2. Non
Randomized Clinical Trials
Clinical trial in which random forwarding was not carried for exposed and
not exposed groups.
2.2.3. Controlled
Clinical Trial
An epidemiological study in which the individuals in a population are
randomly allocated to groups, usually called study group and control group, to
receive or not an experimental preventive or therapeutic procedure, maneuver or
intervention. The results are evaluated by a rigid comparison of rates of
disease, deaths, recovery or other appropriate results of the study and control
groups. Randomized controlled processes are generally said to be the most
rigorous scientific method of hypothesis testing that can be found in
epidemiology. Few authors refer to this method as "random control process"2.
2.2.4. Uncontrolled
clinical trials
The non-controlled clinical trials describe the course of the disease in a
single group of patients before and after exposure to an intervention. Another
name for this design study is before/after. The hypothesis of this PE approach
means that any improvement observed after treatment results from the treatment
itself6.
2.3. CROSSOVER
It is the method of comparing two or more treatments or interventions in which
the individuals or patients, after completing a stage of treatment, are
exchanged for another. In the case of two treatments, A and B, half the
subjects are randomly assigned to receive in the order A-B, and the other half
to receive treatment in the order B-A. The criticism of this model is that the
effects of the first treatment may be taken to the period in which the second
is given2.
3. SECONDARY RESEARCH
3.1. BIBLIOGRAPHIC RESEARCH
This is the assessment of the entire bibliography published as books,
magazines, spare publications in written press. Its purpose is to put the
researcher in direct contact with everything that was written about a subject,
in order to allow the scientist to analyze the parallel strengthening of their
researches or handling of their information7.
3.2. INTEGRATIVE REVIEW
It is a specific method of review that summarizes the previous literature
of theoretical or empirical basis for a more comprehensive understanding of a
phenomenon or particular sanitary problem (Broome, 1993). Integrative reviews
have the potential to develop the science of nursing, informing researches,
practices and public initiatives. Well developed integrative reviews present
the state of science, contribute to the theoretical development and have direct
application in practice and policies8.
3.3. A SYSTEMATIC REVIEW
It is the
application of strategies that limit bias in an assembly, a critical evaluation
and synthesize all relevant studies on a specific topic. The META-ANALYSIS may be,
but it is not necessarily used as part of this process. Systematic reviews
focus on reviewed publications by partners about a particular health problem
and uses standardized and rigorous methods for selecting and evaluating
articles. A systematic review differs from the meta-analysis by not including a
quantitative summary of results2.
3.3.1. Qualitative Systematic Review
The review is
called qualitative RS, or just RS when the information
obtained is not susceptible to statistical analysis9.
3.3.2. Meta-analysis
It is a statistical summary of the data of a separate study even though it
is similar, such as comparative studies that lead to quantitative summary of
results. In biomedical sciences, the systematic, organized
and structured assessment in a problem of interest, using the information
(usually in the form of statistical tables or other data) from a number of
independent studies of a problem. The frequent application has been the
congregation of the results of a randomized controlled set of processes, none
of them sufficiently strong to demonstrate statistically significant
differences, but if added, will be able to show them. The
meta-analysis has a qualitative component such as the application of a predetermined criterion of quality (e.g. complementation of data,
the absence of bias), and a qualitative component (e.g. the integration of numerical information). The goal is to integrate the findings, mine the data and identify the general trend of results1.
An essential prerequisite is that the studies should be abstinent of any critical
value and any bias2.
See also SYSTEMATIC REVIEW
4. ADDITIONAL METHODS
4.1. BIBLIOMETRIC STUDY
Bibliometrics emerged in the early twentieth century due to the need
to study and evaluate the activities
of production and scientific
communication. Bibliometrics is understood as "technical
and quantitative statistical
measurement of the rates of production and dissemination of
scientific knowledge"10. It is a set of laws and empirical principles that contribute
to the establishment of the
theoretical foundations of Information Science11.
It has two concerns
since its origin. One of them is to analyze the scientific production,
while the second is
to seek practical and immediate
benefits for libraries. The Bibliometrics was initially focused on the measurement of
books (number of editions and copies, number of words contained in books, space
occupied by books in libraries, statistics related to the book industry), and
was slowly moving towards the study of other bibliographic producing formats,
such as journal articles and other types of documents, and then also deal with
the productivity of authors and the study of citations10.
4.2. ECOLOGICAL STUDY
It is a study in which the units of analysis are populations or groups of
people rather than individuals. An example is the study of association between
the middle class and rates of cancer mortality in administrative jurisdictions
such as states and countries2.
4.3. METHODOLOGICAL RESEARCH
It involves investigation of methods for collecting and organizing data and
conducting rigorous researches. The methodological studies deal with the
development, validation and evaluation of tools and research methods. The
growing demands for assessments of results, solid and reliable, rigorous tests
of intervention and sophisticated procedures for obtaining research nurses4.
4.4. PSYCHOMETRIC STUDY
Psychometry is a branch of statistics that studies
psychological phenomena. It was developed by statistical of formation and,
therefore, is still defined as a branch of statistics. For psychologists, it
must be conceived as a branch of psychology that interfaces with statistics. Psychometry is not just about methods, it is inserted in
measure theory that deals with the use of numbers in the study of natural
phenomena. Measuring means assigning values to
characteristics or attributes of an object, using procedures that ensure the
validity and reliability of measurement results.
There are several ways to assign numbers or values to the characteristics
of objects. Psychometry is based on measurement as a
theory and to better understand it you need an explanation of other types of
measurement: fundamental and derived12.
4.5. ETHNOGRAPHY
Main tradition of anthropological research, it provides a framework for the
study of patterns, lifestyles and experiences of a specific cultural group in a
holistic manner. Ethnographers often engage in extensive field work,
participating often and as much as possible, in the life of the studied
culture. The researchers' goal is to learn from members of a cultural group
(more than studying this group), for then, to understand their world view of
how they perceive and live4.
4.6. ETHNOMETHODOLOGY
The ethnomethodology seeks to discover how people
make sense of their daily activities and interpret their social worlds in order
to behave in socially acceptable ways. In this tradition, researchers try to
understand rules and assumptions of a particular social group that are so
deeply rooted to the point that its members no longer need to think about the
reasons underlying their behavior4.
4.7. ETHOLOGY
The discipline of psychology has several traditions of qualitative
research, focusing on behavior. The human ethology,
which has been described as the biology of human behavior, studies the behavior
as it stands in its natural context. The human ethologists
primarily use observational methods in an attempt to discover universal
behavior structures4.
4.8. PHENOMENOLOGY
Originally from a philosophical tradition developed by Husserl
and Heidegger, it is related to experiences lived by humans. It is an approach
used to think how the life experiences of people are and what they mean. The phenomenologists believe that the experience gives meaning
to the perception that each person has of a given phenomenon. The goal of
phenomenological research is to fully understand the experience and insights
that it generates. Four aspects that matter to phenomenologists
are: lived space or spatiality, lived body or corporeality, lived time or
temporality, and lived human relation or relationship4.
4.9. Hermeneutics
It has its disciplinary roots in philosophy. It discusses the meaning of
the experiences lived by humans. A closely related research tradition is
hermeneutics that uses experiences as a tool to better understand the social,
cultural, political or historical contexts in which they occur. The
hermeneutical research emphasizes the meaning and interpretation - as
individuals interpret the world in a given context4.
4.10. HISTORICAL RESEARCH
It is a systematic approach to understand the past through the collection,
organization and critical evaluation of the facts. One of the goals for the
researcher to use the historical method is to shed light on the past so that it
can guide the present and future1. For example, Manocchio
(2008) conducted a social and historical analysis of nursing in the culturally
diverse environment of the border of
4.11.
PARTICIPATORY ACTION RESEARCH
One way to study known as participatory action research (PAR) is closely associated
with both feminist and critical analysis. PAR, one of several types of action
research, developed in the 1940s by psychologist Kurt Lewin,
is based on the finding that the production of knowledge can be political and
used to exert power. The researchers of this approach typically work with
minorities or vulnerable communities to control or oppression of a dominant
group or culture4.
4.12. EVALUATION RESEARCH
Discusses the development of useful information about a program, practice,
procedure or policy - key information so that the responsible person may decided upon the adoption, modification or abandonment of
the practice or program. Commonly, what is being assessed is a new
intervention. In the current situation, in which health costs grow more and
more, the program evaluations may also include the economic analysis (cost) to
determine whether the benefits outweigh the financial costs. Administrators and
staff responsible for public policies to make decisions about resource
allocation for health services, not only assess whether any solution
"works", but also if it is economically viable. The cost analyzes are
made, typically in conjunction with the assessments of impacts (or with the
clinical trials of phase III), ie, when the
researchers generate persuasive data regarding the effectiveness of the program4.
4.13. SOCIAL REPRESENTATIONS
The Theory of Social Representations, advocated by the European social
psychologist Serge Moscovici, is mainly related to the
study of social symbols at both macro and micro analysis, ie,
the study of symbolic exchanges infinitely developed in our social
environments, of our interpersonal relationships, and how it influences the
construction of shared knowledge, of culture. Social representations have as
one of their purposes make familiar something unfamiliar, that is, an
alternative classification, categorization and naming of new developments and
ideas with which we had no previous contact, thus enabling the understanding and
manipulation of these, starting from pre-existing and internalized ideas,
values and theories by us and widely accepted by society. Social
representations are defined as a form of socially elaborated and shared
knowledge, with a practical vision and contributing to a reality in a social
set13. Constitute a form of practical knowledge that contemplates
the knowledge of common sense, and are a guide to the action which encompasses
a global network that link the object to a context14.
4.14. SOCIOPOETICS
The sociopoetics is every social practice of
knowledge production which asserts the importance of the body in the
construction of the imaginary, basis of abstractions, the importance of
dominated cultures and concepts they produce, the role of research subjects as
co-responsible of the knowledge produced, the role of creativity of artistic
type in learning, knowledge and research, the importance of human spiritual
meaning in the forms and contents of knowledge. Upholding these principles is
to ensure the occurrence of processes of deconstruction/construction since the
use of multiple references15.
4.15. CONVERGENT CARE RESEARCH
It is a kind of research that, in its development, maintains a close
relationship with the social situation and is intended to find solutions to problems, make changes and introduce innovations in the
social situation. When used by the nursing, it includes activities of
care/assistance, however it is not consolidated with the act of assisting or
caring, which is merely part of the research process. This modality of research
seeks to discover realities, solve problems or introduce innovations in a
particular context of healthcare practice, similar to action research which
discusses and implements actions with the aim of improving the real world16.
4.16. GROUNDED THEORY
Inductive approach that implements a systematic
set of procedures to reach the theory about basic social processes1.
The grounded theory has become an important method of research for research
nurses and has contributed to the development of many mid-range theories about
relevant phenomena to nurses. It was developed in the 1960s by two
sociologists, Glaser and Strauss (1967), whose theoretical roots lie in
symbolic interaction, which focuses on how people give meaning to social
interactions and interpretations that they attach to social symbols (e.g.
language)4.
DISCUSSION
There are several causes of rejection of scientific articles when submitted
to journals. Many of which will not even be assigned to peer review, since they
do not meet the formatting requirements of journals. In this sense, several
journals such as Online Brazilian Journal of Nursing, following international
trends of quality, recommend explicit description of the research design
adopted by the author in the metadata, in the title and in the methods section.
This guideline is based on facilitating for the reader and visibility for the
article and journal.
On the other hand, the standardization of language facilitates the understanding
and the teaching of methodologies. However, the reappraisal of this proposal is
a continuing act in which the contribution of experts will always be welcome.
CONCLUSION
The proposed tool consists of an enabler for the authors in different
sections of articles: title, methodology and metadata.
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