AM_1255
VU Amsterdam
2025-2026
Contents
Lecture 1: research perspectives, research objective and research questions ................ 3
Epistemology and theoretical perspectives and the relationship between them ....................... 3
Objective and research questions ............................................................................................ 5
Lecture 2: Research priority setting & Research agenda’s .................................................. 6
Consumers and priority setting procedures ............................................................................. 7
Priority setting in the Dutch context ......................................................................................... 7
Lecture 3: Conceptual frameworks and operationalizing your research ........................... 9
Role of theory/conceptual frameworks ..................................................................................... 9
Inductive vs deductive reasoning ............................................................................................. 9
Why and how to use theories/conceptual frameworks ............................................................ 11
Selecting a theory / conceptual framework for a given study .................................................. 12
Lecture 4: PAR, interdisciplinary and transdisciplinary research ..................................... 14
Why do we need these approaches? ..................................................................................... 14
What is interdisciplinarity? ...................................................................................................... 15
What is participatory action research? ................................................................................... 16
Participatory video ................................................................................................................. 17
What is transdisciplinarity? ..................................................................................................... 18
Lecture 5: Qualitative research design and data collection ............................................... 19
Sampling strategies ............................................................................................................... 20
Four major types of non-probability sampling designs ............................................................ 20
Questionnaires and surveys ................................................................................................... 21
Interviewing ........................................................................................................................... 22
Non-participant observation................................................................................................... 23
Ethnography and participant observation .............................................................................. 24
Focus groups ......................................................................................................................... 25
Visual research methods ........................................................................................................ 26
Lecture 6: Quantitative studies ............................................................................................. 27
Measurement and public health campaigns ........................................................................... 27
Validity & reliability ................................................................................................................. 27
General aspects of measurement .......................................................................................... 29
1
, Introduction of COSMIN ......................................................................................................... 30
Lecture 7: Evaluation in Health Sciences 1 .......................................................................... 39
Evaluations: What and why? ................................................................................................... 39
Types of evaluations/study designs ........................................................................................ 40
Confirmation bias / appreciating complexity / unintended consequences of purposive action 41
Lecture 8: Risk factors vs development of prediction models ........................................... 41
Case control studies .............................................................................................................. 41
Cohort studies ....................................................................................................................... 42
Patient registries to increase efficiency .................................................................................. 43
Lecture 9: Analysing and presenting qualitative data ........................................................ 46
What are principles of qualitative research ............................................................................. 46
Two examples of qualitative analytic methods ........................................................................ 48
Apply quality criteria in qualitative analysis ............................................................................. 52
Reflexivity............................................................................................................................... 53
Lecture 10: Evaluation in Health Sciences 2 ........................................................................ 54
Context – work field/research field ......................................................................................... 54
Criteria for the following ......................................................................................................... 59
Some alternative experimental designs .................................................................................. 60
Lecture 11 systematic reviews .............................................................................................. 61
Literature reviews; a general perspective ............................................................................... 61
Cochrane collaboration .......................................................................................................... 62
Methods systematic reviews .................................................................................................. 63
Lecture 12 Meta analyses ...................................................................................................... 66
Meta analyses (MA) & clinical relevance ................................................................................ 67
Heterogeneity ........................................................................................................................ 70
Interpretation ......................................................................................................................... 71
2
,Lecture 1: research perspectives, research objective and
research questions
Current and complex public health issues
Complex issue:
- Globalization ‘a world that is becoming increasingly integrated and
interdependent’
- Fuzzy, instead of rigid, boundaries
o With human systems it is quite unclear to distinguish between groups
- Internalised rules drive action
o Human beings don’t always know why they do something. They’re not
clear of their assumptions.
- Agents (people) within the system change
o Conflicts of interest?
o New things are learned and people change
- Systems are embedded in other systems and co-evolve
In order to understand and address these complex problems we need a range of
methods, methodologies, theoretical perspectives and epistemologies.
Epistemology and theoretical perspectives and the relationship
between them
Episteme = knowledge
Epistemology = study of knowledge
- What constitutes valid knowledge
Theory of knowledge = how do we know what is true?
Epistemology is important because:
- Knowledge of research philosophy will help the researcher to recognize which
designs will work for a given set of objectives and which will not
- It can help to clarify issues of research design especially in interdisciplinary teams
while working on complex problems
1. Objectivism
Reality exists independently of consciousness – in other words, there is an objective
reality ‘out there’. research is about discovering this objective truth. Researchers should
strive not to include their own feelings and values
Connected to theoretical perspective positivism: there is only one reality/truth. Reality
can be measured. Knowledge can be formulated into laws.
This view has been challenged → post-positivism: we can only approximate the truth.
2. Constructivism
Truth and meaning do not exist in some external world but are created by the subject’s
interactions with the world. Meaning is constructed not discovered. Subjects construct
their own meaning in different ways, even in relation to the same phenomenon.
This is connected to theoretical perspective ‘Interpretivism’: Multiple, contradictory but
equally valid accounts of the world can exist. Knowledge is contextual. Multiple versions
of reality can exist at the same time, and people make sense of the world in different
ways.
3
, - Knowledge exists in interaction. In this interaction the knowledge is build.
Multiple, contradictory but valid accounts of the world can exist. Knowledge is
contextual.
Example of the difference between objectivism and constructivism
3. Subjectivism
Knowledge doesn’t come from interaction, it is imposed or shaped by the researcher by
the subject. The researcher doesn’t just interpret reality, they create it through their own
lens, assumptions and values. Very subjective and based on their own interpretations,
assumptions, or perspectives. It connects to the theoretical perspectives of post-
modernism; which can be taken as an example of a theoretical perspective linked to
subjectivism. Post-modernism emphases multiplicity, ambiguity, ambivalence and
fragmentation. It argues that reality is messy and open to multiple interpretations, and
the researcher’s voice plays a strong role in constructing meaning. It questions ideas like
‘objectivity’, ‘progress’, and ‘scientific neutrality’.
Because constructivism & subjectivism are often confused with each other, here is a
scheme that grasps the difference between the two:
Feature Constructivism Subjectivism
Where knowledge From interaction between people and From within the individual — their
comes from the world personal perceptions
Multiple truths can exist, but they’re
Truths are purely personal and can’t be
Truth
socially constructed shared objectively
Interprets or even imposes their own
Researcher’s role Co-creates meaning with participants
meaning on the data
Interpretivist qualitative methods Reflexive, deeply personal approaches
Typical approach
(interviews, ethnography) (autoethnography, narrative)
Other theoretical perspectives
Critical inquiry: doesn’t only want to understand things, but also wants to change and
question things. For example whether we want these values and assumptions. This
critical form of research is a meta-process of investigation, which questions currently
held values and assumptions and challenges conventional social structures. The
critical inquiry perspective is not content to interpret the world but also seeks to change
it. The assumptions that lie beneath critical inquiry are that: ideas are mediated by power
relations in society.
4
,Feminism: dynamic field that aims to address gender relations, power dynamics and
social justice. Feminist theories take the view that what a person knows is largely
determined by their social position.
Epistemic injustice
- Takes place on a systemic level
- Injustice related to knowledge e.g., exclusion, silencing, misrepresentation,
undervaluing.
- In the field of Global health there still is the tendency to disregards local
knowledge, and which refuses to learn from people often deemed to be ‘lesser’.
- In research this means being aware of whose voices are included, how
participants’ knowledge is treated, and whether the frameworks you use make
space for diverse ways of knowing.
Objective and research questions
- Research topic
- Literature
- Problems & questions of the workplace or community setting
- Research agenda’s
- Knowledge gap
Research objective
The research objective is a by b
a. External objective → contribution of your research project to solution of the
problem / what results can be expected
b. Internal objective → the way in which this will be done / the insights, information,
knowledge needed = very similar to your research question
Research questions
- One or more research questions
- Tight connection between literature/theories and the research questions
- Defining the investigations: discovering, exploring, understanding, explaining,
comparing
- Establish boundaries
- Concise and unambiguous
Summary lecture 1
• In order to understand and address complex problems in Health Sciences we
need a range of e.g., research methods, research methodologies
• The four elements (e.g., epistemology, theory, methodology and methods) are
always present in a research project and they are closely related and co-
dependent
• Objectivism: there is an objective reality ‘out there’
• Constructivism: subjects construct their own meaning in different ways
• Subjectivism: meaning is imposed by the subject on the object
• Exploring your own theory of knowledge and theoretical perspectives is important
because it influences your choices
• Research topic → research objective → research questions
5
,Lecture 2: Research priority setting & Research agenda’s
What is research priority setting?
- Organizations conducting or funding public health research have to select
research priorities while often facing competing demands & scare resources
- Therefore a collective activity for deciding which uncertainties are most worth
trying to resolve through research is warranted
- Uncertainties considered may be problems to be understood or solutions to be
developed or tested; across broad or narrow areas
- At its core research priority setting answers the following question: ‘Given limited
resources, which research questions matter most – and to whom?’
It is also about negotiating values, needs, and feasibility with different stakeholders.
These stakeholders can consist of
Members of the public
Stakeholder involvement matters
Clinicians
because it reduces epistemic
Researchers injustice and it increases
Research funders legitimacy
Health-care commissioners
Public health organizations
Figure above: wheel of research priority setting
To understand the wheel, think about it in phases of preparation, exploration,
prioritization & implementation. You first want to clarify why and who is involved; then
gather and structure all possible topics; decide which topics are most important and
make them actionable; then apply results, monitor fairness and transparency.
6
, Consumers and priority setting procedures
This is often a challenge and some studies show:
- These results confirm.. that consumers have little understanding of the priority-
setting process, little knowledge of health R&D priorities, & relatively poorly
formulated priorities of their own
- These views may bolster the opinion that consumers have little to contribute to
R&D priority-setting
- Alternatively, they may be seen as evidence that closer involvement of consumers
with priority-setting processes could lead to useful inputs of views and
experience.
o Consumers are important in priority setting, because they are also
stakeholders in interventions. What do patients want for themselves for
example? It is very challenging to include the patient. Medical jargon can
be very intimidating for a patient.
Challenges
- Power imbalance: Traditional hierarchies in healthcare & research often place
researchers, clinicians, and policymakers in positions of authority, while patients
may have less influence.
- Heterogeneity of patient populations: patients are not a homogenous group.
Different individuals may have conflicting, priorities.
- Underrepresentation of marginalized groups: minorities & low-income individuals
may be underrepresented
- Lack of training and support: make it difficult to effectively participate in technical,
complex research discussions
- Time and resource constraints
EXAMPLE
Patients with osteoarthritis want to know how to improve self-management skills and suffer
from fatigue. Studies however are done on medication & surgery.
- A reason for this could be money. Surgery doesn’t help in most cases, but the
pharmaceutical industry is involved for profit. The people who finance the study will
have a big interest/bias.
It is therefore important to always be transparent.
Priority setting in the Dutch context
The National Health Care Institute
- Priority setting departs from the question which types of health care are
reimbursed (basic health insurance package) or not
- Evidence gap: systematic reviews
- Other considerations: rare diseases etc.
The research is financed as long as you can convince the institute that your
invention/procedure can safe them money eventually.
7
,The final decision is based on:
- Evidence (RCTs and/or systematic reviews)
- Other considerations
o Is it ‘necessary care’
o Own responsibility
- E.g. why reimburse a walker-rollator but not a walking stick while both provide
support for wakling and facilitate independence?
Pressure from the media/public can also lead to priority setting in studies (think about
programs like RADAR that kind of force institutes to investigate something)
ZonMW
Health care efficiency research
- Open calls for studies designed to address efficiency issues in health care
practice
- Targeted calls for studies designed to address efficiency issues that come from
policy parties in order to stimulate health care innovation, and to respond flexibly
to current developments
1. Early evaluation promising interventions
- New interventions only in research setting or a single hospital
- Acquire evidence for the decision as to whether or not conduct further research
or to implement the intervention
2. Evidence for guideline and insurance coverage
- Efficiency of an intervention (effectiveness proven)
- Evidence in support of guidelines & insurance coverage
- Intervention must already be applied in the Netherlands
- Existing intervention (national use), whose efficiency has been called into
question
Research agenda’s
- National hobby of many professional organizations
- Patient involvement is a key element, but we already saw that there are some
challenges.
GPs
Societal perspective
- Burden of disease: patients or society; Impact of the results
Research perspective
- Probability of successful completion of studies; Probability of implementation
SUMMARY
Steps to follow
- Inventory of stakeholders
o Health care providers
o Patients
o Societal partners (e.g. insurance companies)
- Summary of evidence
- Priority setting
- Consensus procedures
8
,Lecture 3: Conceptual frameworks and operationalizing
your research
Role of theory/conceptual frameworks
Perception is influenced by our conceptualizations
- Economy
- Public administration
- Pedagogy
- History
- Health sciences
Conceptual frameworks and the role of theory within health sciences may differ
Health sciences (e.g. biomedical sciences/epidemiology) Concepts are also used in
- Introduction biomedical sciences and
- Objective + research questions (hypothesis) epidemiology, some concepts do
- Methods not require extensive explanation:
o no explicit section: nevertheless, concepts are often e.g. DNA
defined in text
- Results
- Conclusion/discussion
Health sciences (e.g., social sciences, interdisciplinary In social sciences and interdisciplinary
sciences) sciences concepts and their relations are
- Introduction + objective often differently interpreted, therefore
- Theory/concepts there is a need for clarification of
o Concepts and theories are discussed separately concepts to understand the research
- Research questions perspective and scope: e.g. what is
- Methods access to care?
- Results
- Conclusion/discussion
Inductive vs deductive reasoning
9
, In research, should we begin with theory, or should theory itself result from the research?
Two scientific approaches can be used. Deduction begins with a universal view of a
situation and works back to the particulars; in contrast induction moves from
fragmentary details to a connected views of a situation.
Deductive
For example; stigma
Theory → ‘a health related stigma is: “a social process, experienced or anticipated,
characterized by exclusion, rejection, blame, or devaluation that results from experience,
perception or reasonable anticipation of an adverse social judgement about a person or
group.”’
Hypothesis → the three types of stigma (internalized, perceived & enacted) are prevalent
in leprosy patients in Cirebon district Indonesia.
Data collection → gaining information in Indonesia
Confirmation, rejection, modification → ‘the moment the leprosy worker did not want to
shake my hand, I had the feeling leprosy cannot be cured and that people will not be
friendly with me anymore (informal interview). This confirms perceived and enacted
stigma.
Inductive
Data collection → gaining information in Indonesia
Analyses: patterns →
- ‘I expect people around me especially my family, not to talk about my disease to
other people’
o How?
- ‘I kept my illness secret. It would be nice if someone could understand my
feelings.. however many people who know that this person or that person is
affected by the disease, might avoid us. I did not want that to happen to me.’
o Why?
Hypothesis → ‘secrecy → concealment → disclosure
Theory → ‘secrecy → concealment (why and how?) → disclosure (why and how?)
In reality:
10
VU Amsterdam
2025-2026
Contents
Lecture 1: research perspectives, research objective and research questions ................ 3
Epistemology and theoretical perspectives and the relationship between them ....................... 3
Objective and research questions ............................................................................................ 5
Lecture 2: Research priority setting & Research agenda’s .................................................. 6
Consumers and priority setting procedures ............................................................................. 7
Priority setting in the Dutch context ......................................................................................... 7
Lecture 3: Conceptual frameworks and operationalizing your research ........................... 9
Role of theory/conceptual frameworks ..................................................................................... 9
Inductive vs deductive reasoning ............................................................................................. 9
Why and how to use theories/conceptual frameworks ............................................................ 11
Selecting a theory / conceptual framework for a given study .................................................. 12
Lecture 4: PAR, interdisciplinary and transdisciplinary research ..................................... 14
Why do we need these approaches? ..................................................................................... 14
What is interdisciplinarity? ...................................................................................................... 15
What is participatory action research? ................................................................................... 16
Participatory video ................................................................................................................. 17
What is transdisciplinarity? ..................................................................................................... 18
Lecture 5: Qualitative research design and data collection ............................................... 19
Sampling strategies ............................................................................................................... 20
Four major types of non-probability sampling designs ............................................................ 20
Questionnaires and surveys ................................................................................................... 21
Interviewing ........................................................................................................................... 22
Non-participant observation................................................................................................... 23
Ethnography and participant observation .............................................................................. 24
Focus groups ......................................................................................................................... 25
Visual research methods ........................................................................................................ 26
Lecture 6: Quantitative studies ............................................................................................. 27
Measurement and public health campaigns ........................................................................... 27
Validity & reliability ................................................................................................................. 27
General aspects of measurement .......................................................................................... 29
1
, Introduction of COSMIN ......................................................................................................... 30
Lecture 7: Evaluation in Health Sciences 1 .......................................................................... 39
Evaluations: What and why? ................................................................................................... 39
Types of evaluations/study designs ........................................................................................ 40
Confirmation bias / appreciating complexity / unintended consequences of purposive action 41
Lecture 8: Risk factors vs development of prediction models ........................................... 41
Case control studies .............................................................................................................. 41
Cohort studies ....................................................................................................................... 42
Patient registries to increase efficiency .................................................................................. 43
Lecture 9: Analysing and presenting qualitative data ........................................................ 46
What are principles of qualitative research ............................................................................. 46
Two examples of qualitative analytic methods ........................................................................ 48
Apply quality criteria in qualitative analysis ............................................................................. 52
Reflexivity............................................................................................................................... 53
Lecture 10: Evaluation in Health Sciences 2 ........................................................................ 54
Context – work field/research field ......................................................................................... 54
Criteria for the following ......................................................................................................... 59
Some alternative experimental designs .................................................................................. 60
Lecture 11 systematic reviews .............................................................................................. 61
Literature reviews; a general perspective ............................................................................... 61
Cochrane collaboration .......................................................................................................... 62
Methods systematic reviews .................................................................................................. 63
Lecture 12 Meta analyses ...................................................................................................... 66
Meta analyses (MA) & clinical relevance ................................................................................ 67
Heterogeneity ........................................................................................................................ 70
Interpretation ......................................................................................................................... 71
2
,Lecture 1: research perspectives, research objective and
research questions
Current and complex public health issues
Complex issue:
- Globalization ‘a world that is becoming increasingly integrated and
interdependent’
- Fuzzy, instead of rigid, boundaries
o With human systems it is quite unclear to distinguish between groups
- Internalised rules drive action
o Human beings don’t always know why they do something. They’re not
clear of their assumptions.
- Agents (people) within the system change
o Conflicts of interest?
o New things are learned and people change
- Systems are embedded in other systems and co-evolve
In order to understand and address these complex problems we need a range of
methods, methodologies, theoretical perspectives and epistemologies.
Epistemology and theoretical perspectives and the relationship
between them
Episteme = knowledge
Epistemology = study of knowledge
- What constitutes valid knowledge
Theory of knowledge = how do we know what is true?
Epistemology is important because:
- Knowledge of research philosophy will help the researcher to recognize which
designs will work for a given set of objectives and which will not
- It can help to clarify issues of research design especially in interdisciplinary teams
while working on complex problems
1. Objectivism
Reality exists independently of consciousness – in other words, there is an objective
reality ‘out there’. research is about discovering this objective truth. Researchers should
strive not to include their own feelings and values
Connected to theoretical perspective positivism: there is only one reality/truth. Reality
can be measured. Knowledge can be formulated into laws.
This view has been challenged → post-positivism: we can only approximate the truth.
2. Constructivism
Truth and meaning do not exist in some external world but are created by the subject’s
interactions with the world. Meaning is constructed not discovered. Subjects construct
their own meaning in different ways, even in relation to the same phenomenon.
This is connected to theoretical perspective ‘Interpretivism’: Multiple, contradictory but
equally valid accounts of the world can exist. Knowledge is contextual. Multiple versions
of reality can exist at the same time, and people make sense of the world in different
ways.
3
, - Knowledge exists in interaction. In this interaction the knowledge is build.
Multiple, contradictory but valid accounts of the world can exist. Knowledge is
contextual.
Example of the difference between objectivism and constructivism
3. Subjectivism
Knowledge doesn’t come from interaction, it is imposed or shaped by the researcher by
the subject. The researcher doesn’t just interpret reality, they create it through their own
lens, assumptions and values. Very subjective and based on their own interpretations,
assumptions, or perspectives. It connects to the theoretical perspectives of post-
modernism; which can be taken as an example of a theoretical perspective linked to
subjectivism. Post-modernism emphases multiplicity, ambiguity, ambivalence and
fragmentation. It argues that reality is messy and open to multiple interpretations, and
the researcher’s voice plays a strong role in constructing meaning. It questions ideas like
‘objectivity’, ‘progress’, and ‘scientific neutrality’.
Because constructivism & subjectivism are often confused with each other, here is a
scheme that grasps the difference between the two:
Feature Constructivism Subjectivism
Where knowledge From interaction between people and From within the individual — their
comes from the world personal perceptions
Multiple truths can exist, but they’re
Truths are purely personal and can’t be
Truth
socially constructed shared objectively
Interprets or even imposes their own
Researcher’s role Co-creates meaning with participants
meaning on the data
Interpretivist qualitative methods Reflexive, deeply personal approaches
Typical approach
(interviews, ethnography) (autoethnography, narrative)
Other theoretical perspectives
Critical inquiry: doesn’t only want to understand things, but also wants to change and
question things. For example whether we want these values and assumptions. This
critical form of research is a meta-process of investigation, which questions currently
held values and assumptions and challenges conventional social structures. The
critical inquiry perspective is not content to interpret the world but also seeks to change
it. The assumptions that lie beneath critical inquiry are that: ideas are mediated by power
relations in society.
4
,Feminism: dynamic field that aims to address gender relations, power dynamics and
social justice. Feminist theories take the view that what a person knows is largely
determined by their social position.
Epistemic injustice
- Takes place on a systemic level
- Injustice related to knowledge e.g., exclusion, silencing, misrepresentation,
undervaluing.
- In the field of Global health there still is the tendency to disregards local
knowledge, and which refuses to learn from people often deemed to be ‘lesser’.
- In research this means being aware of whose voices are included, how
participants’ knowledge is treated, and whether the frameworks you use make
space for diverse ways of knowing.
Objective and research questions
- Research topic
- Literature
- Problems & questions of the workplace or community setting
- Research agenda’s
- Knowledge gap
Research objective
The research objective is a by b
a. External objective → contribution of your research project to solution of the
problem / what results can be expected
b. Internal objective → the way in which this will be done / the insights, information,
knowledge needed = very similar to your research question
Research questions
- One or more research questions
- Tight connection between literature/theories and the research questions
- Defining the investigations: discovering, exploring, understanding, explaining,
comparing
- Establish boundaries
- Concise and unambiguous
Summary lecture 1
• In order to understand and address complex problems in Health Sciences we
need a range of e.g., research methods, research methodologies
• The four elements (e.g., epistemology, theory, methodology and methods) are
always present in a research project and they are closely related and co-
dependent
• Objectivism: there is an objective reality ‘out there’
• Constructivism: subjects construct their own meaning in different ways
• Subjectivism: meaning is imposed by the subject on the object
• Exploring your own theory of knowledge and theoretical perspectives is important
because it influences your choices
• Research topic → research objective → research questions
5
,Lecture 2: Research priority setting & Research agenda’s
What is research priority setting?
- Organizations conducting or funding public health research have to select
research priorities while often facing competing demands & scare resources
- Therefore a collective activity for deciding which uncertainties are most worth
trying to resolve through research is warranted
- Uncertainties considered may be problems to be understood or solutions to be
developed or tested; across broad or narrow areas
- At its core research priority setting answers the following question: ‘Given limited
resources, which research questions matter most – and to whom?’
It is also about negotiating values, needs, and feasibility with different stakeholders.
These stakeholders can consist of
Members of the public
Stakeholder involvement matters
Clinicians
because it reduces epistemic
Researchers injustice and it increases
Research funders legitimacy
Health-care commissioners
Public health organizations
Figure above: wheel of research priority setting
To understand the wheel, think about it in phases of preparation, exploration,
prioritization & implementation. You first want to clarify why and who is involved; then
gather and structure all possible topics; decide which topics are most important and
make them actionable; then apply results, monitor fairness and transparency.
6
, Consumers and priority setting procedures
This is often a challenge and some studies show:
- These results confirm.. that consumers have little understanding of the priority-
setting process, little knowledge of health R&D priorities, & relatively poorly
formulated priorities of their own
- These views may bolster the opinion that consumers have little to contribute to
R&D priority-setting
- Alternatively, they may be seen as evidence that closer involvement of consumers
with priority-setting processes could lead to useful inputs of views and
experience.
o Consumers are important in priority setting, because they are also
stakeholders in interventions. What do patients want for themselves for
example? It is very challenging to include the patient. Medical jargon can
be very intimidating for a patient.
Challenges
- Power imbalance: Traditional hierarchies in healthcare & research often place
researchers, clinicians, and policymakers in positions of authority, while patients
may have less influence.
- Heterogeneity of patient populations: patients are not a homogenous group.
Different individuals may have conflicting, priorities.
- Underrepresentation of marginalized groups: minorities & low-income individuals
may be underrepresented
- Lack of training and support: make it difficult to effectively participate in technical,
complex research discussions
- Time and resource constraints
EXAMPLE
Patients with osteoarthritis want to know how to improve self-management skills and suffer
from fatigue. Studies however are done on medication & surgery.
- A reason for this could be money. Surgery doesn’t help in most cases, but the
pharmaceutical industry is involved for profit. The people who finance the study will
have a big interest/bias.
It is therefore important to always be transparent.
Priority setting in the Dutch context
The National Health Care Institute
- Priority setting departs from the question which types of health care are
reimbursed (basic health insurance package) or not
- Evidence gap: systematic reviews
- Other considerations: rare diseases etc.
The research is financed as long as you can convince the institute that your
invention/procedure can safe them money eventually.
7
,The final decision is based on:
- Evidence (RCTs and/or systematic reviews)
- Other considerations
o Is it ‘necessary care’
o Own responsibility
- E.g. why reimburse a walker-rollator but not a walking stick while both provide
support for wakling and facilitate independence?
Pressure from the media/public can also lead to priority setting in studies (think about
programs like RADAR that kind of force institutes to investigate something)
ZonMW
Health care efficiency research
- Open calls for studies designed to address efficiency issues in health care
practice
- Targeted calls for studies designed to address efficiency issues that come from
policy parties in order to stimulate health care innovation, and to respond flexibly
to current developments
1. Early evaluation promising interventions
- New interventions only in research setting or a single hospital
- Acquire evidence for the decision as to whether or not conduct further research
or to implement the intervention
2. Evidence for guideline and insurance coverage
- Efficiency of an intervention (effectiveness proven)
- Evidence in support of guidelines & insurance coverage
- Intervention must already be applied in the Netherlands
- Existing intervention (national use), whose efficiency has been called into
question
Research agenda’s
- National hobby of many professional organizations
- Patient involvement is a key element, but we already saw that there are some
challenges.
GPs
Societal perspective
- Burden of disease: patients or society; Impact of the results
Research perspective
- Probability of successful completion of studies; Probability of implementation
SUMMARY
Steps to follow
- Inventory of stakeholders
o Health care providers
o Patients
o Societal partners (e.g. insurance companies)
- Summary of evidence
- Priority setting
- Consensus procedures
8
,Lecture 3: Conceptual frameworks and operationalizing
your research
Role of theory/conceptual frameworks
Perception is influenced by our conceptualizations
- Economy
- Public administration
- Pedagogy
- History
- Health sciences
Conceptual frameworks and the role of theory within health sciences may differ
Health sciences (e.g. biomedical sciences/epidemiology) Concepts are also used in
- Introduction biomedical sciences and
- Objective + research questions (hypothesis) epidemiology, some concepts do
- Methods not require extensive explanation:
o no explicit section: nevertheless, concepts are often e.g. DNA
defined in text
- Results
- Conclusion/discussion
Health sciences (e.g., social sciences, interdisciplinary In social sciences and interdisciplinary
sciences) sciences concepts and their relations are
- Introduction + objective often differently interpreted, therefore
- Theory/concepts there is a need for clarification of
o Concepts and theories are discussed separately concepts to understand the research
- Research questions perspective and scope: e.g. what is
- Methods access to care?
- Results
- Conclusion/discussion
Inductive vs deductive reasoning
9
, In research, should we begin with theory, or should theory itself result from the research?
Two scientific approaches can be used. Deduction begins with a universal view of a
situation and works back to the particulars; in contrast induction moves from
fragmentary details to a connected views of a situation.
Deductive
For example; stigma
Theory → ‘a health related stigma is: “a social process, experienced or anticipated,
characterized by exclusion, rejection, blame, or devaluation that results from experience,
perception or reasonable anticipation of an adverse social judgement about a person or
group.”’
Hypothesis → the three types of stigma (internalized, perceived & enacted) are prevalent
in leprosy patients in Cirebon district Indonesia.
Data collection → gaining information in Indonesia
Confirmation, rejection, modification → ‘the moment the leprosy worker did not want to
shake my hand, I had the feeling leprosy cannot be cured and that people will not be
friendly with me anymore (informal interview). This confirms perceived and enacted
stigma.
Inductive
Data collection → gaining information in Indonesia
Analyses: patterns →
- ‘I expect people around me especially my family, not to talk about my disease to
other people’
o How?
- ‘I kept my illness secret. It would be nice if someone could understand my
feelings.. however many people who know that this person or that person is
affected by the disease, might avoid us. I did not want that to happen to me.’
o Why?
Hypothesis → ‘secrecy → concealment → disclosure
Theory → ‘secrecy → concealment (why and how?) → disclosure (why and how?)
In reality:
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