Internet, Secondary Analysis, and Historical Research
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Chapter 16: Internet, Secondary Analysis, and Historical Research
NGR 6812 Nursing Research
Florida National University
Internet Based Research
There are several ways in which the Internet may be used to support and/or conduct research. These are:
Access to resources: Search capabilities on the Internet provide access to published work, information about other data sources such as historical archives, research-related services, and communication with other researchers.
Participant recruitment: Online support groups, professional organizations, and special interest group websites and blogs are just a few of the ways that participants can be recruited over the Web.
Replace paper-and-pencil surveys and tests: The Internet provides a more efficient way to collect data. Data input is already done and accuracy may be higher.
Collect data on socially undesirable behavior and sensitive topics: People are often more willing to share this type of data in the more anonymous-appearing environment of the Internet (Gosling & Mason, 2015).
Participant recruitment: As the number of people using the Internet and the amount of time they spend on the Internet increase exponentially, it has become easier to recruit a large, diverse sample via the Internet.
Behavior on the Internet as a potential topic for research: The way in which people communicate with each other over the Internet (Hine, 2011), how they obtain health-related information electronically, and how groups provide support to their members over the Internet are just a few examples of behaviors that can be studied.
Tracking outbreaks: A potentially important use of the Internet is to track outbreaks of disease and other health concerns.
Internet Based Research
Recruitment of Participants via the Internet Volunteer Standing Panels have been created to provide access to potential participants for research. The advantage of these panels is that members have already supplied basic sociodemographic information about themselves so that an appropriate, if not exactly representative, sample may be obtained by sorting through the membership rolls a
There are several other ways to recruit participants via the Internet, discussed in the following sections.
Prerecruited Panels, List Based Sampling, Harvested Email Addresses, Self-Selected Surveying, and Intercept Surveys
Participant Testing and Interviewing
Computer-assisted testing (CAT) has a long and generally successful track record and some attractive features that paper-and-pencil tests lack. Questionnaires may be designed so that participants are not asked questions that are inapplicable. For example, if you do not smoke, then questions about number of packs a day or type of tobacco used (cigar, cigarette, filtered, and so forth) are not applicable and will not come up on the screen.
Electronic measurement of response time can be more precise than people can do manually. Even more helpful is the ability to accurately time participant responses, providing data on response time including any hesitations that may occur. Tests of attention are also amenable to electronic presentation. Another example is the useful field-of-vision tests that are especially important for drivers who may be visually or cognitively impaired. Finally, complex scoring of results can be done automatically, and data (the results) can be generated in analyzable form.
Internet Based Research
Intervention on the Web: Some interventions that you might want to evaluate can be provided via the Internet. Health education, diet planning and monitoring, online counseling, and support groups are examples of commonly used Internet-based interventions.
Quality Considerations: Many of the concerns regarding the quality of data obtained from Internet-based research revolve around questions of sampling and participant responses. Selection bias, in particular, is a major concern.
Acceptability: Are people willing to participate in online research? This is a question addressed in a study done by Vereecken and colleagues (2009).
Special Ethical Concerns: Sharing existing communications with other visitors to a website poses a considerable challenge to protection of human subjects. If researchers inform visitors to the website that the exchanges are being observed and recorded, this may suffice in some instances.
However, it remains difficult to ensure that every visitor to the site is fully informed. Consultation with your IRB coordinator and reference to the latest published standards are recommended during the planning phase to be sure you are following ethical guidelines and that you will not encounter a denial of approval from your IRB.
Secondary Data Analysis
There is a wealth of already collected data available to interested researchers.
Secondary data analysis is a reanalysis of existing datasets asking a different question or taking a different focus. The data may be quantitative or qualitative, although secondary analyses are more common in quantitative work (Gray, 2009).
It may be data collected for research purposes or for other purposes such as Medicare billing data, health system or hospital records, pharmacy benefit records, or insurance records (often called “big data”).
Big data come in many forms and data types including numbers, images (x-rays, for example), narrative, handwritten notes, even video.
One of the challenges is transforming all of this information into an analyzable form.
Secondary Data Analysis
Sources of Datasets There are a number of official government-sponsored or government-created datasets available at local, state, and national levels.
The U.S. Census is one of the best known, but there are many others such as the National Health and Nutrition Examination Survey (NHANES), a national database that has produced a rich variety of reports. Advantages and Disadvantages to Secondary Analysis
Advantages & Disadvantages: It may seem that undertaking a secondary analysis is relatively easy to do. After all, it is a shortcut to obtaining a completed database, isn’t it?
Both the recruitment and the testing of participants are done already, and the data have been cleaned and entered into a database, so many steps have already been completed.
There are some very good reasons to do a secondary analysis, there are also a number of potential pitfalls you should be aware of before using this method of data collection.
Not one of these disadvantages is enough to cause you to abandon the idea of conducting a secondary analysis; however, if too many of them pertain, it may take weeks or even months to complete the transformation and the subsequent analysis, so be prepared for extensive data work.
Secondary Data Analysis
Accessing Existing Databases Understandably, there are often restrictions on the use of existing databases, including protection of participant identities and safely discarding (erasing) the data when the analysis is done.
Some databases, such as Medicare information, may be costly to obtain and involve a complex application process, but the majority are available at low or no cost to qualified researchers.
You may need to provide extra levels of security for sensitive data or databases containing personal health information, learn how to use a new software package, and spend some time understanding the setup and variables contained in an acquired database.
However, if the database contains valuable information that you can extract and analyze to address your research question, then it is certainly worth the effort involved.
Historical Research
There seems to be a little bit of that famous fictional detective Sherlock Holmes in historical researchers as they search existing archives, unearthing forgotten documents, interviewing people who were on the scene of an important event, or browsing the Internet for clues to the history of nurses and the nursing profession.
Some of what they uncover can make us proud of our professional heritage: the nursing leaders who rallied and protested on behalf of women’s rights or on behalf of their half-starved, poorly educated clients and who were independent practitioners before we used the term nurse practitioner.
Other historical records can shock and appall us as we read of systematic discrimination against nurses of color or downright silly nursing practices such as moving flowers outside patient rooms at night.
Historical researchers work primarily with mute evidence (Hodder, 2003, p. 155).
Their role is to give voice to this evidence and the people it represents through their review, analysis, and interpretation of these materials. Some look back hundreds of years in their research; others trace changes that have occurred relatively recently, such as Beyea and Slattery (2013) tracing the evolution of research utilization into today’s emphasis on evidence-based practice.
Historical Research
There are three major phases to historical research: discovery, appraisal, and synthesis (Cramer, 1992). But first, as with all research, a topic must be selected, and a title created. Selecting a Topic There are a few things to consider when selecting a topic for a historical study:
• How much preparation you have to conduct for a historical study
• Familiarity with the historical era being considered
• Potential contribution this study could make
• What is already known or not known about this topic (Fitzpatrick, 2007) You may want to do some literature searches and read and talk with other researchers before you decide on a topic, especially if you are new to historic research
Composing a Title Although every research report and article has a title, titles are especially important in historical research. The following are some of the reasons why:
• The title informs the reader of the subject of the report.
• Creative titles can entice the potential reader to read further (Lewenson, 2008, p. 31).
• Titles help the researcher stay focused. It is so easy to go astray when doing historical research—there are so many interesting stories in the documents you read that it is hard to stay on topic.
Reminding yourself of the title can help. Lewenson (2008) adds a caveat, however: if the title is too creative, it may make it difficult for interested researchers to find your study. So do not go overboard with your title but do make it interesting.
Historical Research
Your first attempt to compose a title is unlikely to be your last.
As the study evolves and you begin the interpretive phase, you may want to shift the focus of the study somewhat and change the title as well.
Discovery This is the search phase. Once a general topic has been identified and preliminary title composed, the next step is to find the needed information. The emphasis should be on primary sources, such as original documents, records, or interviews about the event or person under study, rather than secondary sources. Sources Historical researchers have a variety of possible sources that may provide the information needed.
Sources: Historical Researchers has a variety of possible sources that may provide the information needed.
The sources may include interviews, archives, photographs, statistics, appraisals, all before conducting the synthesis where the organization of the synthesized information is interpreted by the researcher. More meaning is given to the collected information.
The information now become a commentary on a historical event.
Conclusion
The data collection strategies review in your chapter readings are a departure from the more common testing, observation, and interviewing strategies.
Each raises different questions about the quality of the data obtained, access to participants, and the protection of human subjects.
There is still a lot to be learned about the strengths and weaknesses of Internet-based research and questions to be answered about the ethics of using existing data that are felt to be private yet are publicly available.
Secondary data analysis probably should be done more often than is currently the case. Although there are challenges to using data collected for another purpose, secondary data analyses often generate a rich yield for the effort expended.
Historical research addresses entirely different questions and uses different data collection methods. It requires a sense of context and continuity unlike that of the other data collection strategies.
As different as they are, each contributes to our understanding of the patients, the clients, their families, and the environment in which nurses provide care.
References
Tappen, R. M. (2015). Advanced Nursing Research. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781284132496/
Chapter 17: Intervention
NGR 6812 Nursing Research
Florida National University
Interventions
1. Intensity of care: This dimension reflects the acuity level of the patient/client and whether the intervention is typical (routine) or novel (infrequent).
2. Focus of care: This dimension reflects several characteristics of the intervention: whether it is directed toward an individual, group, or entire community or population; if the action taken is on behalf of the target “patient” or provided directly; and if it is done by nurses independently or in collaboration with others.
3. Complexity of care: This dimension reflects the amount of knowledge and skill needed to carry out the intervention and the degree of urgency in doing so.
You can see that nursing interventions not only are many in number, but also vary greatly in scope, intensity, duration, and target population.
The following review is not all-inclusive, but it will introduce you to the many types of interventions that may be examined for their ability to either improve health and well-being or reduce the negative effects of a health-related concern.
Interventions
Educational Interventions
Self Care
Lifestyle Changes
Population Level Interventions.
Naturally Occurring Events
Physical Care
Biofeedback
Usage of Animal Models
Over-the-Counter Medications
Psychotherapeutic Interventions
Case Management Care Coordination, Transitional Care, and Follow Up Care
Multicomponent Interventions (quality, education, behavioral aspects, promotional materials, communications)
Administrative and Managerial Changes in Care Processes
Alternative and Complementary Interventions
PREPARING TO IMPLEMENT THE INTERVENTION
When considering a selection, consider the following:
Educational Interventions
Knowledge and Skill related to the intervention
Dependability
Good judgement
Objectivity
Training in terms of research protocols (consider the following)
Purpose of the study
Background information
Importance of maintaining protocol
Human subject considerations
The protocol itself
Research Design (Rationale and outline of treatment)
PREPARING TO IMPLEMENT THE INTERVENTION
Working With Facility Staff
There is another group of stakeholders involved in making the implementation of the planned intervention a success. These are the staff of the facility you are conducting the study in, both administrative and staff-level personnel.
Permission to conduct the study in the facility should have been obtained during the planning of the study and should have been documented for IRB review. This, however, is only the beginning of the relationship with a cooperating institution. All staff members need to know what is expected of them and how they can help to make the study a successful one.
Now that implementation is about to begin, the staff and management of the facility need to know what to expect of the research team and how they themselves will be involved. In some instances, staff of the institution will make the initial approach to a potential participant.
This will require training of the staff member as well as training specific to the study being conducted. In other instances, staff will actually become part of the research team, implementing the intervention to be tested. In this case, they will need far more training, including information about the conduct of research, the rights of participants in the study, and guidance in distinguishing research protocol from regular care.
Working With Facility Staff
It is also important to check with nursing management about the type of documentation of patient participation they require. In some instances, a considerable amount of information needs to be added to the medical record.
In other instances, a notation of the patient or client’s participation in the study and evidence of consent are all that are needed. Patients and families often look to their regular care providers for assurance that participation in a clinical study is a good idea.
Physicians, therapists, nurses, and nursing assistants often influence this decision. Information about the study and its purposes will help staff make informed responses to the people in their care.
In the community, potential participants will often look to their religious leaders, community center managers, or other leaders for this assurance.
Implementation
No matter how well prepared you are, there will likely be some surprises and some adjustments to be made once you begin implementation.
It is hard to predict what these might be, but here are just a few examples to illustrate what might be encountered:
Monitoring Protocol Adherence and Monitoring Participant Safety
Serious adverse events (SAEs) are expected to be reported immediately to the DSMB and the IRB. These may include the following:
Death • Life-threatening event • Hospitalization • Disability • Congenital anomaly • Treatment required to prevent permanent damage.
The IRB usually requires a written plan for data and safety monitoring.
This plan may include the following: • Level of risk to participants • Identification of the monitor: the investigator, a single monitor, or a DSMB • How often data and reports will be reviewed • The specific data and reports that will be reviewed • To whom the results of the reviews will be submitted (NIH, 2000; NIH, Human Research Protections Program, 2013) All of this is done in addition to the usual reports to an IRB and the usual oversight done by the investigator and the IRB.
Conclusion
The intervention phase of research requires active involvement of the investigator and members of the research team. A carefully designed intervention based on previous research and an underlying theoretical framework are the basis for undertaking this phase of the study. Those providing the intervention need to be well trained, the provision of the intervention needs to be monitored and recorded meticulously, and the safety of participants needs to be assured throughout the study.
