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Library of Congress Cataloging-in-Publication Data
Names: Forister, J. Glenn, editor. | Blessing, J. Dennis, editor.
Title: Introduction to research and medical literature for health
   professionals / [edited by] J. Glenn Forister, J. Dennis Blessing.
Description: 5 edition. | Burlington, MA : Jones & Bartlett Learning, [2020]
   | Includes bibliographical references and index.
Identifiers: LCCN 2018038124 | ISBN 9781284153774 (pbk. : alk. paper)
Subjects: | MESH: Biomedical Research | Research Design | Medical Writing
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Brief Contents
Dedication ix
Preface xi
Contributors xiii
Reviewers xv

SECTION 1 Getting Started 1

Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 Regulatory Protection of Human Subjects in Research. . . . . 11
Chapter 3 The Research Problem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 4 Review of the Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter 5 The Systematic Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

SECTION 2 The Research Process: Design 71

Chapter 6 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 7 Survey Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Chapter 8 Qualitative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Chapter 9 Community-Based Participatory Research. . . . . . . . . . . . 125
Chapter 10 Clinical Investigations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

iii
iv Brief Contents

SECTION 3 The Research Process: Analysis 155

Chapter 11 Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Chapter 12 Exploring Statistics Comparing Differences
in Health Care���������������������������������������������������������������������� 171
Chapter 13 The Results Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Chapter 14 The Discussion Section. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

SECTION 4 The Research Process: Writing and Interpretation 203

Chapter 15 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Chapter 16 Writing and Publishing in the Health Professions. . . . . . 215
Chapter 17 Interpreting the Literature . . . . . . . . . . . . . . . . . . . . . . . . . 237
Appendix 249
Glossary 251
Index 261
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Contents
Dedication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix How Is Research Approved? . . . . . . . . . . . . . . . . . . . 15
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi When Is IRB Approval Required? . . . . . . . . . . . . . . . 17
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii What Are the Investigator’s
Responsibilities?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Chapter 3 The Research Problem . . . . . . . 27
SECTION 1 Getting Started 1 Salah Ayachi, PhD, PA-C
J. Dennis Blessing, PhD, PA
Chapter 1 Introduction. . . . . . . . . . . . . . . . .3 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
J. Glenn Forister, PhD, PA-C The Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
J. Dennis Blessing, PhD, PA What Constitutes a Research Problem?. . . . . . . . . 28
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Research and Students in Healthcare How to Identify a Research Problem . . . . . . . . . . . 30
Professions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Narrowing the Focus of the Question. . . . . . . . . . 33
Research Equals Curiosity. . . . . . . . . . . . . . . . . . . . . . . . 4 Sources of Ideas for
Research and the Students of Healthcare Research Problems. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Professions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Research and Healthcare Professionals. . . . . . . . . . . 5 Chapter 4 Review of the Literature . . . . . 37
Research Takes Many Forms. . . . . . . . . . . . . . . . . . . . . . 5 Laura Zeigen, MA, MLIS, MPH, AHIP
Developing a Research Project. . . . . . . . . . . . . . . . . . . 6 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
ASK: The Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Chapter 2 R egulatory Protection of Human ACQUIRE: The Details . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Subjects in Research. . . . . . . . . 11 Specific Databases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Rhonda Oilepo, MS, CIP Writing the Literature Review. . . . . . . . . . . . . . . . . . 53
Kimberly K. Summers, PharmD
Joseph O. Schmelz, PhD, RN, CIP, FAAN Chapter 5 The Systematic Review. . . . . . . 55
J. Glenn Forister, PhD, PA-C Margaret J. Foster, MS, MPH
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 The Systematic Review . . . . . . . . . . . . . . . . . . . . . . . . 55
Historical Context. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Steps of the Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

v
vi Contents

SECTION 2 T he Research Process: Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Philosophical Perspective. . . . . . . . . . . . . . . . . . . . . 112
Design 71
Comparing Quantitative and Qualitative
Research in the Healthcare Field. . . . . . . . . . . . 113
Chapter 6 Methodology. . . . . . . . . . . . . . . 73
Applying Qualitative Research in
Christopher E. Bork, PhD Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Robert W. Jarski, PhD, PA-C Assessing the Quality of a Qualitative
J. Glenn Forister, PhD, PA-C Study: Ensuring Trustworthiness. . . . . . . . . . . . 121
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 9 C ommunity-Based
The Methods Section. . . . . . . . . . . . . . . . . . . . . . . . . . 74
Understanding Research Design. . . . . . . . . . . . . . . 75
Participatory Research. . . . . . 125
Threats to Internal Validity . . . . . . . . . . . . . . . . . . . . . 78 Scott D. Rhodes, PhD, MPH, FAAHB
Threats to External Validity. . . . . . . . . . . . . . . . . . . . . 79 Christina J. Sun, PhD, MS
Types of Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Pre-Experimental Designs. . . . . . . . . . . . . . . . . . . . . . 84 Four Study Designs. . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Experimental Designs. . . . . . . . . . . . . . . . . . . . . . . . . . 86 Initiating CBPR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Quasi-Experimental Designs. . . . . . . . . . . . . . . . . . . 88 A Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Chapter 7 Survey Research . . . . . . . . . . . . 91 Chapter 10 Clinical Investigations . . . . . 147

J. Dennis Blessing, PhD, PA J. Glenn Forister, PhD, PA-C
What Surveys Can and Cannot Do . . . . . . . . . . . . . 92 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Types of Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 The Clinical Research Process . . . . . . . . . . . . . . . . . 147
Planning Is Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Phases of Clinical Research. . . . . . . . . . . . . . . . . . . . 152
Response Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Survey Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Follow-Up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 SECTION 3 T he Research Process:
Types of Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Analysis 155
Survey Item Construction. . . . . . . . . . . . . . . . . . . . . 100
Demographic Data . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Chapter 11 Data Analysis. . . . . . . . . . . . . 157
The Survey Instrument. . . . . . . . . . . . . . . . . . . . . . . . 102 Meredith A. Davison, PhD, MPH
Putting the Survey Together . . . . . . . . . . . . . . . . . . 107 Bruce R. Niebuhr, PhD
Pilot Testing the Survey. . . . . . . . . . . . . . . . . . . . . . . 107 J. Glenn Forister, PhD, PA-C
How Many Subjects? . . . . . . . . . . . . . . . . . . . . . . . . . 108 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Confidence Level and Interval . . . . . . . . . . . . . . . . 108 Levels of Measurement. . . . . . . . . . . . . . . . . . . . . . . 158
What Statistics to Use?. . . . . . . . . . . . . . . . . . . . . . . . 109 Descriptive Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . 160
Distributions, Normality, and Variance
Chapter 8 Qualitative Research . . . . . . . 111 Equality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Elsa M. González, PhD Inferential Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . 162
J. Glenn Forister, PhD, PA-C Hypothesis Testing: Nominal Data. . . . . . . . . . . . . 164
 Contents vii

Analysis of Continuous Data: Measures SECTION 4 T he Research Process:

of Association. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Analysis of Interval/Ratio Data:
Writing and
Comparisons of Groups . . . . . . . . . . . . . . . . . . . . 165 Interpretation 203
Meta-Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
Choosing a Statistical Test. . . . . . . . . . . . . . . . . . . . . 166 Chapter 15 References. . . . . . . . . . . . . . . 205
Statistical Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Laura Zeigen, MA, MLIS, MPH, AHIP
Becoming Part of the Scholarly Conversation. . . . . 205
Chapter 12 E xploring Statistics
General Concepts About Joining the
Comparing Differences Scholarly Conversation. . . . . . . . . . . . . . . . . . . . . 205
in Health Care . . . . . . . . . . . . 171 Documenting Sources Used in the Research
J. Glenn Forister, PhD, PA-C and Synthesis Process . . . . . . . . . . . . . . . . . . . . . . 206
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Citation Styles, with a Focus on AMA
and APA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Comparing Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Cite Everything. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
t-Test (Student t-Test) . . . . . . . . . . . . . . . . . . . . . . . . . 173
Bibliographic Citation Management Tools:
Paired t-test (Matched t-test). . . . . . . . . . . . . . . . . . 174
“Where the Magic Happens”. . . . . . . . . . . . . . . . 210
One-Way ANOVA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Copyright, Fair Use, and Avoiding
Factorial ANOVA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Unintentional Plagiarism . . . . . . . . . . . . . . . . . . . 212
Repeated Measures ANOVA. . . . . . . . . . . . . . . . . . . 181
Hotelling’s T 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Chapter 16 W
 riting and Publishing in
MANOVA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 the Health Professions. . . . . 215
Chapter 13 The Results Section. . . . . . . . 187 James F. Cawley, MPH, PA-C, DHL (Hon.)
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Patricia A. Carney, PhD, MS
Style Manuals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Anthony A. Miller, MEd, PA-C
Writing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
J. Dennis Blessing, PhD, PA
Research Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Approaches to Publication. . . . . . . . . . . . . . . . . . . . 221
The Results Section Text . . . . . . . . . . . . . . . . . . . . . . 188
Best Choices for New Writers. . . . . . . . . . . . . . . . . . 222
Tables and Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Elements of the Research Paper. . . . . . . . . . . . . . . 226
Chapter 14 The Discussion Section. . . . . 197 Oral Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Graduate Projects/Papers in the
Richard R. Rahr, EdD, PA-C
Healthcare Professions . . . . . . . . . . . . . . . . . . . . . 227
J. Dennis Blessing, PhD, PA
Basic Steps in Publication. . . . . . . . . . . . . . . . . . . . . 229
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Some Challenges for Health Professions
The Implications Subsection. . . . . . . . . . . . . . . . . . 198 Publications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
The Limitations Subsection. . . . . . . . . . . . . . . . . . . 199 Manuscript Flaws That Prevent
The Discussion Subsection. . . . . . . . . . . . . . . . . . . . 199 Publication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
The Recommendations Subsection. . . . . . . . . . . 200 On Writing and Publishing. . . . . . . . . . . . . . . . . . . . 235
The Conclusions Subsection. . . . . . . . . . . . . . . . . . 200 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
viii Contents

Chapter 17 I nterpreting the Evidence-Based Medicine: A New Way

of Looking at the Medical Literature . . . . . . . . 243
Literature. . . . . . . . . . . . . . . . 237
A General Approach to Reading the
J. Glenn Forister, PhD, PA-C Literature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
J. Dennis Blessing, PhD, PA
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Interpreting the Literature . . . . . . . . . . . . . . . . . . . . 238 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Significant Questions to Ask When Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Evaluating the Literature . . . . . . . . . . . . . . . . . . . 240
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Dedication

The fifth edition of this book is dedicated to all of the

contributors who have put forth their effort to improve
the research capabilities of healthcare professionals,
present and future. We further dedicate this book to
our friends and colleagues at Jones & Bartlett Learning.
They have worked behind the scenes for many years to
make us look good.

Ultimately, the contributors and publishers want this

to be a successful book that helps every reader in their
understanding of research and what it means to the
people who benefit from our healthcare efforts.
JGF
JDB

ix
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Preface
The editors of and contributors to this book are healthcare and education professionals with exper-
dedicated teachers, librarians, researchers, admin- tise in different aspects of research; however, each
istrators, and practitioners in healthcare profes- contributor has written with the novice researcher
sions. They have worked tirelessly to make this or clinician in mind. Prior knowledge of research
book readable, understandable, and useful for stu- is not assumed.
dents and practitioners in healthcare professions.
Our intent is to provide a tool that can be the first
step in understanding research and, perhaps, the
first step in a research career. We hope this book
▸▸ Organization
places that first step on a sound footing without
intimidation.
and Features
Research articles, news flashes, and advertise- Each chapter begins with a Chapter Overview
ments bombard us daily. To make sense of it all, designed to relate the essential information cov-
we must be able to interpret and apply the infor- ered in the chapter. Basic Learning Objectives for
mation in our patients’ best interests. This skill is the chapter are also provided. The important key
a critical requirement of clinical practice in today’s terms for each chapter are highlighted in bold
world, and it requires an understanding of the font, with definitions provided in the glossary. In
research process. most chapters, tables and figures are used to help
summarize key information. The overall scheme
allows the reader to move naturally through the
▸▸ Conceptual Approach research process, ending with concepts needed to
interpret the research of others.
We have tried to present our material in stepwise
order, beginning with the protection of human
subjects and the formation of a research question.
Next, we consider different types of literature
▸▸ New to This Edition
review and research methodologies. The anal- The changes in this edition are based on the
ysis, results, and discussion sections follow. We feedback from readers of the previous edition.
also consider the writing and publication process. A newly revised chapter on the regulatory pro-
Finally, a chapter on the interpretation of the lit- tection of human subjects provides readers with
erature covers the skills a health professional must the historical context and rationale for regula-
develop to be a consumer of the literature. tions. The latest updates to the Common Rule
Ultimately, understanding the research pro- have been added. We have updated and replaced
cess and interpretation of the research literature are prior chapters on literature review and refer-
inextricable—this book addresses both at the basic ences. New examples and updated references
level. Our contributors represent a wide range of have been added throughout the ­ remaining

xi
xii Preface

c­hapters. We have left the information most

valued by readers. The language in this edition ▸▸ Instructor Resources
remains accessible while covering a variety of Qualified instructors can receive the full suite of
research methodologies, analysis, and writing Instructor Resources, including the following:
tasks. We hope this edition is as useful to begin-
ners as the prior editions have been.
■■ Slides in PowerPoint format, featuring more
than 400 slides
■■ Test Bank, containing more than 250 questions
Change Highlights ■■ Instructor’s Manual, including suggestions
for classroom discussions and activities
Ch 2 Reviewer-requested historical section on ratio- ■■ Sample Syllabus, providing guidance for
nale for human subjects protection and IRB
structuring a course around this text
Ch 2 Edits to reflect recent change in the Common
Rule for exempt research To gain access to these valuable teaching materials,
Newly written Ch 4 on review of the literature contact your Health Professions Account Specialist
Newly written Ch 15 on references at http://go.jblearning.com/findarep.
Updated examples and references throughout J. Glenn Forister
based on reviewer comments J. Dennis Blessing
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Contributors
Salah Ayachi, PhD, PA-C Margaret J. Foster, MS, MPH
Associate Professor (retired) Associate Professor
Department of Physician Assistant Studies Systematic Reviews & Research Coordinator,
School of Health Professions Medical Sciences Library
University of Texas Medical Branch Texas A&M University
Galveston, Texas College Station, Texas
Christopher E. Bork, PhD Elsa M. González, PhD
Professor (retired) Assistant Professor
Department of Public Health and Department of Educational Leadership &
Preventive Medicine Policy Studies
College of Medicine University of Houston
The University of Toledo Houston, Texas
Toledo, Ohio
Robert W. Jarski, PhD, PA-C
Patricia A. Carney, PhD, MS Professor
Professor School of Health Sciences
Department of Family Medicine William Beaumont School of Medicine
School of Medicine Oakland University
Oregon Health and Science University Rochester, Michigan
Portland, Oregon
Anthony A. Miller, MEd, PA-C
James F. Cawley, MPH, PA-C, DHL (Hon.) Distinguished Professor & Director
Professor Division of Physician Assistant Studies
Department of Prevention and Community Health Shenandoah University
Milken Institute School of Public Health Winchester, Virginia
Professor
Bruce R. Niebuhr, PhD
Physician Assistant Studies
Distinguished Teaching Professor (retired)
School of Medicine and Health Sciences
Department of Physician Assistant Studies
The George Washington University
School of Health Professions
Washington, D.C.
University of Texas Medical Branch
Meredith A. Davison, PhD, MPH Galveston, Texas
Associate Dean of Academic Services
Rhonda Oilepo, MS, CIP
School of Community Medicine
Director
Physician Assistant Program
Human Research Protection Program
College of Medicine
University of Texas Southwestern Medical Center
The University of Oklahoma-Tulsa
Dallas, Texas
Tulsa, Oklahoma

xiii
xiv Contributors

Richard R. Rahr, EdD, PA-C Kimberly K. Summers, PharmD

Professor Emeritus (retired) Director
Department of Physician Assistant Studies Research Protection Programs
School of Health Professions University of Texas Health Science Center
University of Texas Medical Branch San Antonio
Galveston, Texas San Antonio, Texas
Scott D. Rhodes, PhD, MPH, FAAHB Christina J. Sun, PhD, MS
Professor and Department Chair Assistant Professor
Department of Social Sciences and Health Policy Community Health, Health Promotion, and
Division of Public Health Sciences Health Studies
Director School of Public Health
Program in Community Engagement Oregon Health and Science University
Wake Forest Clinical and Translational Science Portland State University
Institute Portland, Oregon
School of Medicine
Laura Zeigen, MA, MLIS, MPH, AHIP
Wake Forest University
Liaison Librarian and Assistant Professor
Winston-Salem, North Carolina
Oregon Health and Science University
Joseph O. Schmelz, PhD, RN, CIP, FAAN Portland, Oregon
Assistant Vice President for Research
University of Texas Health Science Center
San Antonio
San Antonio, Texas
© gremlin/Getty Images

Reviewers
Allison Bernknopf, PharmD, MSMI, BCPS Carolyn Orbann, PhD
Professor Associate Teaching Professor
Ferris State University University of Missouri
Grand Rapids, MI Columbia, MO
Daniel Cipriani, PhD, PT Andrea Shelton, PhD
Professor Professor
West Coast University Texas Southern University
Los Angeles, CA Houston, TX
Sarah Gabua Lynette Watts, PhD
Ferris State University Assistant Professor
Grand Rapids, MI Midwestern State University
Wichita Falls, TX
Anuli Njoku Anuli Njoku
Assistant Professor
Ferris State University
Grand Rapids, MI

xv
 SECTION 1
Getting Started
CHAPTER 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CHAPTER 2 Regulatory Protection of Human Subjects
in Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
CHAPTER 3 The Research Problem. . . . . . . . . . . . . . . . . . . . . . . . 27
CHAPTER 4 Review of the Literature. . . . . . . . . . . . . . . . . . . . . . 37
CHAPTER 5 The Systematic Review. . . . . . . . . . . . . . . . . . . . . . . 55

© gremlin/Getty Images

1
© gremlin/Getty Images

CHAPTER 1
Introduction
J. Glenn Forister, PhD, PA-C
J. Dennis Blessing, PhD, PA

CHAPTER OVERVIEW
This chapter is designed to introduce health professionals and students to research. The chapter introduces
readers to the basic definitions and sources of research. An outline is offered to aid in the development of
a project or research agenda. Each small piece of research that can add to the body of medical knowledge
results in improvement in the physical, mental, and social well-being of patients.

LEARNING OBJECTIVES
■■ Define research.
■■ Describe types of research.
■■ Describe and discuss the importance of research in the health professions.
■■ Begin to develop a scientific approach to study and practice.

▸▸ Introduction many clinicians may not connect research to their

work. Research, however, provides an opportu-
The bottom line is that research determines nity to explore, understand, and explain practice.
almost everything that is practiced now and in the By mastering research, healthcare professionals
future. The word research frequently evokes an can enhance their clinical careers and improve
emotional reaction. Novice professionals may see patient outcomes.
research as a mysterious process that is difficult Many clinical practices are becoming
to understand and difficult to conduct. Students involved with clinical trials and quality improve-
may not see the impact of a required research ment studies. This involvement makes under-
assignment on their future careers. Similarly, standing the scientific process and research a

3
4 Section 1 Getting Started

practice requirement. Beyond the possibility of

being directly involved in research, every health- ▸▸ Research Equals
care professional must understand how to inter-
pret the literature. The decision to incorporate a
Curiosity
new treatment modality depends on the ability to Whether they realize it or not, everyone has
assess and understand the research that led to that researched in something. Seeking an answer to
modality. Additionally, healthcare professionals a question is a form of research. Even looking
must be able to evaluate the literature regarding up a word in an online dictionary can be consid-
how it relates to patients and to evaluate the best ered a form of research. Curiosity drives investi-
treatment options. gation. Indeed, much “research” is informal and
without the systematic constraints required by
formal research, but it occurs every day. Prac-
▸▸ Research and Students titioners do research when they investigate the
literature for solutions to patients’ problems.
in Healthcare Students do research as part of their education.
Self-study and exam preparation are informal
Professions research processes.
The word research sometimes conjures up the fol- Research occurs in the laboratory, class-
lowing images: room, office, and society at large. The results
may be directly applicable to a problem or only
■■ Individuals hidden away in a lab doing some- a small piece of a broader solution. Learning
thing unrelated to everyday life how research works help relieve anxieties and
■■ Boring work forced on students increase the ability to appreciate and enjoy the
■■ The pursuit of information that has little process. Ultimately, the goal is to improve the
application in the real world lives of patients.
■■ Not something a healthcare professional does In some ways, research may be more import-
in clinical practice ant to the practitioner than to the s­ tudent, but
For many people, the research process is dif- learning of these skills begins in training. Sim-
ficult to understand. Research often requires the ilarly, what interests a healthcare practitioner
use of formulas and language only other research- or ­student may be mundane but necessary to
ers comprehend. Research findings are often the profession or livelihood. For example, an
contradictory, leaving professionals wondering occupational therapist may have little interest
what to do with the information. Because it can in the differences in practice census flows by
be a confusing endeavor, clinicians and educators disability type, but that information may have
may not engage in research. However, research a significant impact on patient scheduling and
provides the basis for practice. It is the key to the clinical assignments. It may or may not require
present and future, regardless of one’s profession, statistical analysis, but it requires the systematic
position, or function in health care. Healthcare gathering, analysis, and interpretation of infor-
practices are based on scientific research. The evi- mation (data).
dence produced drives artificial intelligence (AI) Another example of research application
solutions in healthcare. In the future, healthcare in practice is patient outcomes. What is the
professionals will find research-based, computer- difference in practice outcomes between treat-
guided recommendations to be part of their day- ment regimen A and B? There may be a wealth
to-day job. of information in texts and the literature, but
Practice can only advance by applying evi- what happens in a particular practice setting?
dence of what works. Personal research is needed to determine the
 Chapter 1 Introduction 5

answer, whether a formal or informal process the ­literature is the foundation for maintaining,
is used. The values of informal versus formal redefining, and increasing that base. Research is
research may be equal, but a formal ­investigation one tool that helps practitioners to “learn how to
might lead to benefits beyond a single setting. learn” and meet future healthcare challenges.

▸▸ Research and the ▸▸ Research and Healthcare

Students of Healthcare Professionals
Professions The unknowns and seemingly complex methods
of systematic research and its processes make
For a student, research is part of the task of dis- some people uncomfortable. Data collection,
covery and learning. Research provides the infor- statistical analysis, and interpretation can be
mation needed to build a fund of knowledge that daunting. Because the research world has its jar-
guides what a student will do as a healthcare pro- gon, many healthcare professionals want to leave
vider. Every student must become an informed this ­activity to others. However, at a minimum,
consumer and learn to interpret the medical healthcare professionals must be able to inter-
research and healthcare literature. At a minimum, pret and apply research as steps in patient care.
learning how to interpret research findings is a As healthcare professionals develop, they may
necessary skill for a professional career. Useful find additional roles and responsibilities in the
interpretation skills allow healthcare practitioners research arena.
to deliver an acceptable level of care.
Education in the healthcare professions
should be consistent with adult learning theory.
All healthcare practitioners should be lifelong
▸▸ Research Takes
learners; the healthcare professional that stops
building his or her knowledge base and a­ bilities
Many Forms
will not be able to contribute to meaningful Research takes many different forms (TABLE 1.1).
change. Experience is part of that knowledge Research can be categorized in various ways,
base, but continuing to understand and interpret including pure research, experimental research,

TABLE 1.1 Types of Research

Type Description Example(s)

Pure Abstract and general, concerned with Theory development

generating new theory and gaining new
knowledge for knowledge sake

Experimental Manipulation of one variable to see its effect Double-blind random assignment control
on another variable, while controlling for groups, response to an intervention
as many other variables as possible and
randomly assigning subjects to groups

(continues)
6 Section 1 Getting Started

TABLE 1.1 Types of Research (continued)

Type Description Example(s)

Clinical Performed in the clinical setting where Drug trials, therapeutic results
control over variables is quite difficult

Applied Designed to answer a practical question, to Time use studies, evaluation of different types
help people do their jobs better of interventions with the same purpose

Descriptive Describing a group, a situation, or an Surveys, qualitative research, measurement

individual to gain knowledge that may be of characteristics, response to phenomena
applied to further groups or situations, as
in case studies or trend analyses

Laboratory Performed in laboratory surroundings that Basic science research

are controlled

Data from Bailey DM. Research for the Health Professional: A Practical Guide, 2nd ed. Philadelphia, PA: FA Davis; 1997, xxii.

clinical research, applied research, descriptive s­ubstantial body of medical knowledge is very
research, laboratory research,1 and outcomes satisfying. Health care at every level continu-
research. These forms depend on many factors. ally creates questions that need answers. Society
There are many study designs available to has q­ uestions that need answers. Learning the
beginning investigators.2 Some research does research process offers the highest likelihood of
not require specialized knowledge or skills, such finding those answers. One does not have to be a
as counting how many patients have a particular genius to do research. One does not have to be
diagnosis. Other research requires specialized mathematically gifted. One must only have an
skills and must follow an exact methodology, interest. It is a process to be learned and used to
such as clinical drug trials (studies of new med- help healthcare practitioners, patients, students,
ications). The recording of experimental results and others.
and writing of research have unique requirements
that must be learned, p ­ racticed, and perfected.
For most, research is about phenomena that affect
what is done. Research is about observation and
▸▸ Developing a Research
interpretation of what is learned to answer the
questions posed.
Project
Research can be enjoyable and reward- If a research project is part of education and
ing. At every level and in every format and training, it may take many forms. Choos-
design, research should add to knowledge. It is ing a project and developing its design
unlikely that any single piece of research will depend on ­several ­factors (1) knowing what is
make headlines. However, answering questions expected, (2) i­dentifying clear parameters, and
and making small contributions to the more (3) ­following organizational guidelines. Many
 Chapter 1 Introduction 7

organizations prescribe a ­scientific writing for- A student, for example, may have an assigned
mat. Student investigators must know which topic, but there may be many ways to approach
style and style manual is required and should the assigned project. Once a list of ­possibilities
obtain a copy. has been developed, the refining process can be
Schools or institutions may assign research done in this way:
topics and specific designs to follow. Develop- 1. Make a list of everything of interest or
ment of a research project depends on many questions to be answered.
factors. Some introspection and consideration 2. Prioritize the list in the order of i­ nterests.
about time, effort, cost, resources, and ability 3. Make a second ordered list (from the first)
are required for any project. This introspection of the things that are within the capabilities
must include an assessment of personal attri- of the investigator.
butes, interests, resources, and expectations 4. Make a third ordered list (from the first)
of self. Part of this assessment must consider of the things that are important to the
strengths as a researcher and abilities to accom- effort.
plish the project. Students and inexperienced 5. Make a fourth ordered list (from the first)
investigators must be able to concentrate their of the things that are important to society,
research efforts to develop or use their exper- or health, or the particular profession.
tise to the maximum benefit. It is better to be 6. Compare the lists. Items that appear at
an expert in one small area than somewhat of the top of all four lists should be priori-
an expert in several. Every beginning researcher tized and merged into a single list.
needs mentors and collaborators. Students and 7. Make decisions about what can and c­ annot
beginning investigators should seek out people be accomplished. Mark off the things
who have skills in their area of interest and ask that cannot be done for financial or other
for their help. They should explore the possi- ­reasons.
bilities of collaborating with someone on their 8. The topic that survives or is central to the
research as a learning activity. Another key ele- lists is the basis of the research project.
ment to a successful research effort is the allot- This topic represents a process of summa-
ment of adequate time for investigations. For tion that includes challenges that need to
students, time may be limited by schedules, class be researched; challenges to the capability
obligations, planned graduation date, and the of the researcher; and challenges that are
like. A timeline for a research project should be important to the individual, the program,
created and followed. and the topic of interest. What could be
Research is a systematic, organized pro- better?
cess that goes through some sequential (or 9. Develop a timeline for the study; set aside
near sequential steps (see FIGURE 1.1). The first research time and plan the step-by-step
step in developing a research project is brain- process.
storming. This activity should be as expansive 10. Get started. Time passes regardless, do not
as possible by making a list (by hand or on the hesitate to get started.
computer) of everything of interest. Once these
ideas are recorded, a short break of a few min-
utes or a few days should be taken (the key is
not to think about the project for a short while). Summary
Then the list can be refined; new items can be Whether one loves it, hates it, or would rather not
added, and those that do not seem relevant can think about it, research is a part of professional life
be e­liminated. This process may be repeated in a healthcare career. Research provides the basis
more than once before a project is defined. for all that healthcare providers do. ­Individual