Valg av metode og design

Transkript

1 Valg av metode og design Kvalitative eller kvantitative forskningsmetoder - hvorfor og hvordan? Anette Fosse Mo i Rana AMFF-stipendiat ved AFE-Bergen (50%) Fastlege på Øvermo Legesenter for 800 pasienter Sykehjemslege på Ytteren korttidsavdeling

2 Elefanten og de blinde forskerne

3 Litt vitenskapsteori Paradigmer vitenskapelige verdensbilder og «tatt-for-gitt-heter» Eksempler på vitenskapsfilosofier Naturvitenskap Humanistiske vitenskaper Samfunnsvitenskap Teknologisk vitenskap

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5 Det biomedisinske paradigmet?

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9 Malterud K. Theory and interpretation in qualitative studies from general practice: Why and how? Scand J Public Health. Epub December 8, 2015

10 Litt mer vitenskapsteori Eksempler på metodetradisjoner Epidemiologi Eksperimentell (RCT osv) Hermeneutikk (fortolkning) Fenomenologi (menneskelig erfaring) Eksempler på tematiske teorier («forståelsesbriller») Læringsteori Kjønnsteori Mestringsteori

11 Definere forskning Systematisk og refleksiv prosess der kunnskapsutviklingen kan etterprøves og deles Ambisjon om overførbarhet av funnene utover den sammenheng der den enkelte studien ble gjennomført Vitenskapelighet Relevans Hvorfor? Refleksivitet Forutsetninger Validitet Gyldig om hva?

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13 Kvantitativ eller kvalitativ? Kvantitative metoder Hvor mye? Hvor ofte?.mer effektivt enn? Kvalitative metoder Hva er? Hva betyr? Hvordan foregår?

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15 Forskningsspørsmålet styrer valg av metode

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18 METHODS: A retrospective observational study A self-report questionnaire CONCLUSIONS: Implementation of new clinical guidelines for follow-ups after insertion of VTs did not negatively affect audiological outcomes or subjective hearing complaints two years after surgery.

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20 METHODS: A retrospective observational study Degree of guideline adherence at the hospital and in general practice was measured CONCLUSIONS: The methods for guideline implementation were successful in securing consultations for follow-up care in general practice. Lack of guideline adherence in the hospital can partly be explained by the lack of quality of the guideline

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22 METHODS: A focus group study 25 Norwegian GPs from four pre-existing groups. CONCLUSIONS: The GPs experienced negative consequences when obliged to apply a variety of single disease guidelines to multimorbid patients, including increased risk of polypharmacy and overtreatment. We believe patient-centered care and the GPs courage to non-comply when necessary may aid in reducing these risks. Health care authorities and guideline developers need to be aware of the potential negative effects of applying a single disease focus in general practice, where multimorbidity is highly prevalent.

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27 DESIGN: A systematic review of the literature. RESULTS: Sixteen studies were included. None of the interventions in the educational programs aiming to improve doctors' management of MUPS patients succeeded in lowering sick leave.

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29 METHODS: Two focus-group discussions were conducted with a purposive sample of 12 participants, Systematic text condensation was applied for analysis. Thematic theories of marginalization and coping RESULTS: Invisible symptoms and lack of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were - a supportive social network - positive coping strategies - positive attention and confidence from professionals.

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31 METHOD: Survey During a four-week period the participating Norwegian GPs (n=84) registered all consultations with patients who met a strict definition of MUPS using a questionnaire with simple tick-off questions. CONCLUSION: A consultation prevalence rate of 3% implies that patients with persistent MUPS are common in general practice.

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