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INTRODUCTION TO
THIRD EDITION
HEALTH RESEARCH
METHODS
A Practical Guide
Kathryn H. Jacobsen, MPH, PhD
Professor of Epidemiology and Global Health
George Mason University
Fairfax, Virginia
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Names: Jacobsen, Kathryn H., author.
Title: Introduction to health research methods / Kathryn Jacobsen.
Description: Third edition. | Burlington, MA : Jones & Bartlett Learning, [2021] | Includes index.
Identifiers: LCCN 2019047577 | ISBN 9781284197631 (paperback)
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Brief Contents
Preface
xv
About the Author
xvii
New to This Edition
xix
CHAPTER 1
The Health Research Process. . . . . . . . . . . . . . . . . . 1
STEP 1 Identifying a Study Question
5
CHAPTER 2
Selecting a Research Question. . . . . . . . . . . . . . . . 7
CHAPTER 3
Reviewing the Literature . . . . . . . . . . . . . . . . . . . . . 17
CHAPTER 4
Defining Specific Aims. . . . . . . . . . . . . . . . . . . . . . . . 25
CHAPTER 5
Professional Development. . . . . . . . . . . . . . . . . . . . 31
CHAPTER 6
Coauthoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
STEP 2 Selecting a Study Approach
41
CHAPTER 7
Overview of Study Designs. . . . . . . . . . . . . . . . . . . 43
CHAPTER 8
Case Series. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
CHAPTER 9
Cross-Sectional Studies. . . . . . . . . . . . . . . . . . . . . . . 57
CHAPTER 10 Case–Control Studies. . . . . . . . . . . . . . . . . . . . . . . . . . 61
CHAPTER 11
Cohort Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
CHAPTER 12 Experimental Studies . . . . . . . . . . . . . . . . . . . . . . . . 85
CHAPTER 13 Qualitative Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . 101
iii
iv
Brief Contents
CHAPTER 14 Correlational Studies. . . . . . . . . . . . . . . . . . . . . . . . . 107
CHAPTER 15 Synthesis Research. . . . . . . . . . . . . . . . . . . . . . . . . . . 115
STEP 3 Designing the Study and Collecting Data
119
CHAPTER 16 Research Protocols. . . . . . . . . . . . . . . . . . . . . . . . . . . 121
CHAPTER 17 Ethical Considerations. . . . . . . . . . . . . . . . . . . . . . . 127
CHAPTER 18 Ethical Review and Approval. . . . . . . . . . . . . . . . 139
CHAPTER 19 Population Sampling. . . . . . . . . . . . . . . . . . . . . . . . . 147
CHAPTER 20 Sample Size and Power. . . . . . . . . . . . . . . . . . . . . . 159
CHAPTER 21 Questionnaire Development. . . . . . . . . . . . . . . . . 167
CHAPTER 22 Collecting Quantitative Data. . . . . . . . . . . . . . . . 183
CHAPTER 23 Collecting Qualitative Data. . . . . . . . . . . . . . . . . . 189
CHAPTER 24 Additional Assessments . . . . . . . . . . . . . . . . . . . . . 195
CHAPTER 25 Secondary Analyses. . . . . . . . . . . . . . . . . . . . . . . . . . 201
CHAPTER 26 Systematic Reviews and Meta-analyses. . . 207
CHAPTER 27 Writing Grant Proposals . . . . . . . . . . . . . . . . . . . . . 217
STEP 4
Analyzing Data
225
CHAPTER 28 Data Management. . . . . . . . . . . . . . . . . . . . . . . . . . . 227
CHAPTER 29 Descriptive Statistics. . . . . . . . . . . . . . . . . . . . . . . . 235
CHAPTER 30 Comparative Statistics. . . . . . . . . . . . . . . . . . . . . . 247
CHAPTER 31 Regression Analysis. . . . . . . . . . . . . . . . . . . . . . . . . 263
CHAPTER 32 Qualitative Analysis. . . . . . . . . . . . . . . . . . . . . . . . . 277
CHAPTER 33 Additional Analysis Tools. . . . . . . . . . . . . . . . . . . . 281
v
Brief Contents
STEP 5 Reporting Findings
287
CHAPTER 34 Posters and Presentations. . . . . . . . . . . . . . . . . . 289
CHAPTER 35 Article Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
CHAPTER 36 Citing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
CHAPTER 37 Critically Revising. . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
CHAPTER 38 Writing Success Strategies. . . . . . . . . . . . . . . . . . 321
CHAPTER 39 Reasons to Publish. . . . . . . . . . . . . . . . . . . . . . . . . . 329
CHAPTER 40 Selecting Target Journals. . . . . . . . . . . . . . . . . . . 333
CHAPTER 41 Manuscript Submission. . . . . . . . . . . . . . . . . . . . . . 341
CHAPTER 42 Peer Review and Publication. . . . . . . . . . . . . . . . 347
Glossary
355
Index
393
© DmitriyRazinkov/Shutterstock
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . xv
About the Author . . . . . . . . . . . . xvii
New to This Edition . . . . . . . . . . . xix
CHAPTER 1 The Health Research
Process. . . . . . . . . . . . . . 1
1.1 Clinical and Population Health
Research��1
1.2 The Research Process ��2
1.3 Text Overview��2
STEP 1 Identifying a
Study Question 5
3.3 Abstract Databases��18
3.4 Full-Text Articles��20
3.5 Critical Reading��21
3.6 Annotated Bibliographies��22
3.7 What Makes Research Original?��22
CHAPTER 4 Defining Specific
Aims��25
4.1 Refining the Study Question��25
4.2 One Study Goal ��25
4.3 Several Specific Aims��26
4.4 Conceptual and Theoretical
Frameworks ��27
4.5 Feasibility��28
CHAPTER 2 Selecting a Research
Question��7
CHAPTER 5 Professional
Development�� 31
2.1 Practical Research��7
2.2 Brainstorming and Concept
Mapping��8
2.3 Keywords��8
2.4 Exposures, Diseases, and
Populations (EDPs)��9
2.5 PICOT��11
2.6 From Inquiry to Research��12
2.7 Testable Questions��14
2.8 Framing for Generalizability��14
5.1 Research Teams��31
5.2 Finding Research Mentors��32
5.3 The Mentor–Mentee
Relationship��32
5.4 Professional Development��33
5.5 Social Media and Impact
Metrics��33
5.6 Responsible Conduct
of Research��34
CHAPTER 3 Reviewing the
Literature �� 17
6.1 Coauthorship��37
6.2 Authorship Criteria��38
6.3 Authorship Order��39
6.4 Decisions About Authorship��40
3.1 Informal Sources��17
3.2 Statistical Reports��17
CHAPTER 6 Coauthoring��37
vii
viii
Contents
STEP 2 Selecting a Study
Approach41
CHAPTER 7 Overview of Study
Designs�� 43
7.1 Types of Study Approaches��43
7.2 Primary, Secondary, and Tertiary
Studies��43
7.3 Observational and Experimental
Studies��46
7.4 Exposure, Disease,
or Population? ��47
7.5 Study Duration��48
CHAPTER 8 Case Series�� 51
8.1 Overview��51
8.2 Case Definitions ��52
8.3 Data Collection ��53
8.4 Ethical Considerations��54
8.5 Analysis��54
CHAPTER 9 Cross-Sectional
Studies ��57
9.1 Overview��57
9.2 Representative Populations��57
9.3 KAP Surveys ��58
9.4 Repeated Cross-Sectional
Surveys��58
9.5 Prevalence��59
CHAPTER 10 Case–Control
Studies�� 61
10.1
Overview��61
10.2 Finding Cases and
Controls��61
10.3 Matching ��63
10.4 Minimizing Bias��64
10.5 Odds Ratios��65
10.6 Matched Case–Control
Studies��69
CHAPTER 11 Cohort Studies �� 71
11.1 Overview��71
11.2 Prospective Cohort Studies ��73
11.3 Retrospective Cohort Studies��73
11.4 Longitudinal Cohort Studies��74
11.5 Data Collection ��75
11.6 Ratios, Rates, and Risk��76
11.7 Incidence Rates��76
11.8 Incidence Rate Ratios��78
11.9 Attributable Risk��79
11.10 Person–Time Analysis ��82
CHAPTER 12 Experimental
Studies�� 85
12.1 Overview��85
12.2 Describing the Intervention ��86
12.3 Defining Outcomes��87
12.4 Selecting Controls��88
12.5 Blinding��91
12.6 Randomization ��91
12.7 Ethical Considerations��93
12.8 Efficacy��94
12.9 Screening and Diagnostic Tests��96
CHAPTER 13 Qualitative
Studies��101
13.1 Overview��101
13.2 Ontology, Epistemology,
and Axiology��102
13.3 Theoretical Paradigms. . . . . . . . 103
13.4 Qualitative Methodologies ��104
13.5 Mixed Methods Research��105
CHAPTER 14 Correlational
Studies��107
14.1 Overview��107
14.2 Aggregate Data��108
14.3 Avoiding the Ecological Fallacy��109
14.4 Correlation��110
14.5 Age Standardization ��111
Contents
ix
CHAPTER 15 Synthesis
Research �� 115
17.11 Ethics Training and
Certification��137
15.1
CHAPTER 18 Ethical Review
and Approval �� 139
Overview��115
15.2 Selecting a Topic��117
15.3 Library Access��117
15.4 Narrative Reviews��117
18.1 Ethics Committee
Responsibilities��139
15.5 Systematic Reviews ��117
18.2 Ethics Committee Composition��140
15.6
Meta-analysis ��118
18.3 Application Materials ��140
15.7
Meta-synthesis��118
18.4 Exemption from Review ��142
18.5 Review Process��143
STEP 3 Designing
the Study and
Collecting Data 119
18.6 Review by Multiple
Committees��143
CHAPTER 16 Research
Protocols�� 121
18.9 Is Ethics Review Required? ��145
16.1 Overview of Research Plans
by Study Approach��121
16.2 Writing a Research Protocol ��121
16.3 Rigor and Reproducibility��123
16.4 Research Timelines ��124
16.5 Roles and Responsibilities��126
18.7 Ongoing Review��144
18.8 Conflicts of Interest��145
CHAPTER 19 Population
Sampling�� 147
19.1 Types of Research Populations��147
19.2 Target and Source Populations��148
19.3 Sample Populations ��148
19.4 Study Populations��150
16.6 Preparing for Data Collection��126
19.5 Populations for Cross-Sectional
Studies��150
CHAPTER 17 Ethical
Considerations�� 127
19.6 Populations for Case–Control
Studies��152
17.1 Foundations of Research
Ethics��127
17.2 Respect, Beneficence,
and Justice��128
17.3 Incentives and Coercion��129
17.4 Informed Consent Statements��132
17.5 Informed Consent Process��133
19.7 Populations for Cohort Studies��153
19.8 Populations for Experimental
Studies��155
19.9 Sampling for Qualitative
Studies��156
19.10 Vulnerable Populations��156
19.11 Community Involvement��157
17.6 Informed Consent
Documentation��133
CHAPTER 20 Sample Size and
Power �� 159
17.7 Confidentiality and Privacy��134
20.1 Importance of Sample Size ��159
17.8 Sensitive Issues��135
17.9 Cultural Considerations��136
20.2 Sample Size and Certainty
Levels��159
17.10 Vulnerable Populations��137
20.3 Sample Size Estimation��161
x
Contents
20.4 Type 1 and Type 2 Errors ��161
20.6 Refining the Study Approach ��165
23.6 Community-Based Participatory
Research��192
23.7 Consensus Methods��193
CHAPTER 21 Questionnaire
Development �� 167
CHAPTER 24 Additional
Assessments�� 195
21.1 Questionnaire Design
Overview��167
24.1 Supplementing Self-Reported
Data��195
24.2 Anthropometric Measures��195
24.3 Vital Signs ��196
24.4 Clinical Examination��196
24.5 Tests of Physiological Function��197
24.6 Laboratory Analysis of
Biological Specimens��197
24.7 Medical Imaging��197
24.8 Tests of Physical Fitness ��198
24.9 Environmental Assessment��198
24.10 Geographic Information
Systems��199
24.11 Monitoring and Evaluation��199
20.5 Power Estimation��163
21.2 Questionnaire Content ��168
21.3 Types of Questions ��169
21.4 Types of Responses ��171
21.5 Anonymity ��173
21.6 Wording of Questions��173
21.7 Order of Questions ��175
21.8 Layout and Formatting��176
21.9 Reliability and Validity��177
21.10 Commercial Research
Tools��181
21.11 Translation��181
21.12 Pilot Testing��182
CHAPTER 22 Collecting
Quantitative
Data�� 183
22.1 Interviews Versus SelfAdministered Surveys��183
22.2 Recruiting Methods��184
22.3 Encouraging Participation ��184
22.4 Data Recording Methods ��185
22.5 Training Interviewers ��187
CHAPTER 23 Collecting
Qualitative
Data��189
23.1
Overview��189
23.2 In-Depth Interviews ��189
23.3 Focus Group Discussions��190
23.4 Observational Methods��191
23.5 Other Qualitative Research
Techniques��192
CHAPTER 25 Secondary
Analyses�� 201
25.1 Overview of Secondary
Analysis��201
25.2 Accessing Secondary Data��201
25.3 Publicly Available Data Sets��202
25.4 Private Data Sets��203
25.5 Challenges of Secondary
Research��203
25.6 Clinical Records ��204
25.7 Health Informatics, Big Data,
and Data Mining ��204
25.8 Ethics Committee Review��205
CHAPTER 26 Systematic
Reviews and
Meta-analyses�� 207
26.1 Overview of Tertiary Analysis��207
26.2 Search Strings��207
26.3 Search Limiters��209
Contents
26.4 Supplemental Searches��210
26.5 Eligibility Criteria��210
26.6 Quality Assessment ��211
26.7 Data Extraction��212
26.8 Systematic Review Results��212
26.9 Pooled Analysis��213
26.10 Forest Plots and Funnel Plots��214
CHAPTER 27 Writing Grant
Proposals �� 217
27.1 Preparing to Write a Proposal��217
27.2 Identifying Grant Opportunities��217
27.3 Requests for Proposals ��218
27.4 Research Proposal
Components ��219
27.5 Writing a Research Narrative��220
27.6 Funding Criteria ��221
27.7 Budgeting ��222
27.8 Financial Accounting��223
27.9 Grant Management��224
27.10 Unfunded Research ��224
STEP 4 Analyzing
Data225
CHAPTER 28 Data
Management�� 227
28.1 Data Management��227
28.2 Codebooks��227
28.3 Data Entry ��229
28.4 Data Cleaning ��230
28.5 Data Recoding��231
28.6 Statistical Software Programs��231
28.7 Data Security��232
CHAPTER 29 Descriptive
Statistics��235
29.1 Analytic Plan by Study Approach��235
29.2 Types of Variables��236
xi
29.3 Measures of Central Tendency��237
29.4 Range and Quartiles��238
29.5 Displaying Distributions��238
29.6 Normal Curves, Variance, and
Standard Deviation��240
29.7 Reporting Descriptive
Statistics ��243
29.8 Confidence Intervals��243
29.9 Statistical Honesty ��244
29.10 Statistical Consultants��245
CHAPTER 30 Comparative
Statistics�� 247
30.1 Comparative Analysis
by Study Approach��247
30.2 Hypotheses for Statistical
Tests��248
30.3 Rejecting the Null
Hypothesis��248
30.4 Interpreting p Values��250
30.5 Measures of Association��251
30.6 Interpreting Confidence
Intervals��253
30.7 Selecting an Appropriate Test��254
30.8 Parametric and
Nonparametric Tests ��255
30.9 Comparing a Population
Statistic to a Set Value ��255
30.10 Comparing Independent
Populations��256
30.11 Multivariable Comparisons
of Means ��258
30.12 Correlation Analysis��260
30.13 Comparing Paired Data ��260
CHAPTER 31 Regression
Analysis�� 263
31.1 Regression Modeling ��263
31.2 Simple Linear Regression ��264
31.3 Simple Logistic Regression��265
31.4 Dummy Variables ��267
xii
Contents
31.5 Confounding and Effect
Modification��267
31.6 Multiple Regression ��270
31.7 Causal Analysis��273
31.8 Survival Analysis��275
31.9 Cautions��276
CHAPTER 32 Qualitative
Analysis�� 277
32.1 Overview��277
32.2 Analytic and Interpretive
Frameworks ��278
32.3 Codes, Categories,
and Themes��278
32.4 Manual and Electronic
Coding ��280
32.5 Quality Assurance��280
CHAPTER 33 Additional
Analysis Tools �� 281
33.1 Spatial Analysis��281
33.2 Bayesian Statistics��281
33.3 Mathematical Modeling ��282
33.4 Agent-Based Modeling��283
33.5 Machine Learning��283
33.6 Cost-Effectiveness Analysis��284
33.7 Burden of Disease Metrics��285
STEP 5 Reporting
Findings287
CHAPTER 34 Posters and
Presentations �� 289
34.1 Purpose of Conferences��289
34.2 Structure of Conferences��289
34.3 Writing an Abstract��290
34.4 Submitting an Abstract��291
34.5 Preparing a Poster��291
34.6 Using Images��293
34.7 Presenting a Poster ��293
34.8 Preparing for an Oral
Presentation ��294
34.9 Giving an Oral Presentation��296
CHAPTER 35 Article
Structure�� 299
35.1 Outlining a Manuscript��299
35.2 Abstract��300
35.3 Introduction��301
35.4 Methods��302
35.5 Results��303
35.6 Discussion��303
35.7 Writing Checklists��304
35.8 End Matter��305
35.9 Tables and Figures��306
CHAPTER 36 Citing�� 309
36.1 Referring to the Scientific
Literature��309
36.2 Formal and Informal Sources��310
36.3 Writing in One’s Own Words��312
36.4 Common Knowledge
and Specific Knowledge��312
36.5 Avoiding Plagiarism ��313
36.6 Citation Styles��314
CHAPTER 37 Critically
Revising �� 317
37.1 Clarifying the Storyline��317
37.2 One Paper, One Story ��318
37.3 Structure and Content ��318
37.4 Style, Clarity, and
Consistency��319
CHAPTER 38 Writing Success
Strategies�� 321
38.1 The Writing Process��321
38.2 Getting Started ��321
38.3 Staying Motivated ��323
Contents
xiii
38.4 Conquering Writer’s Block��324
38.5 Finishing a Manuscript��326
CHAPTER 41 Manuscript
Submission�� 341
CHAPTER 39 Reasons to
Publish �� 329
41.1 Submission Timing��341
41.2 Journal Selection ��341
41.3 Manuscript Formatting��342
41.4 Cover Letter��344
41.5 Online Submission ��345
39.1 Scientific Dialogue ��329
39.2 Critical Feedback ��329
39.3 Respect for Participants and
Collaborators��330
39.4 Personal Benefits��330
CHAPTER 40 Selecting Target
Journals ��333
40.1 Choosing a Target Journal��333
40.2 Aim, Scope, and Audience ��333
40.3 Impact Factors ��334
40.4 Other Journal Characteristics��335
40.5 Open Access and Copyright��336
40.6 Publication Fees��338
40.7 Predatory Journals��338
CHAPTER 42 Peer Review and
Publication �� 347
42.1 Initial Review��347
42.2 External Review Results��348
42.3 Rejection ��349
42.4 Revision and Resubmission��350
42.5 After Acceptance��353
Glossary. . . . . . . . . . . . . . . . . . . . . 355
Index . . . . . . . . . . . . . . . . . . . . . . . 393
© DmitriyRazinkov/Shutterstock
Preface
Research is the necessary foundation for
meaningful improvements in clinical and public health practice. Research helps us learn
how to be healthier and how to help our
families, friends, patients, communities, and
nations improve and maintain their health.
We rely on researchers to identify risk factors
for infections, noncommunicable diseases,
and injuries and to determine which interventions are most effective at preventing adverse
health conditions and improving individual
and community health status. But it is not just
the outcomes of research that make research
rewarding. The research process itself—the
systematic exploration of the unknown that
discovers answers to important questions—
can be exciting. The goal of this book is to
make the health research process accessible,
manageable, and perhaps even enjoyable for
new investigators.
This is not a book about the theory
of research; it is a book about how to do
research. The book provides a practical,
step-by-step guide to the entire research process. All research projects follow the same
steps: identifying a focused research question, choosing a study design, collecting data
that will answer the question, analyzing the
accumulated evidence, and disseminating the
findings. The investigation proceeds through
these same basic steps regardless of whether
the researchers are surveying community
members, running clinical trials, conducting focus groups, analyzing existing data
sets, or synthesizing the existing literature
through meta-
analysis. The same steps are
followed whether the researcher is trained in
medicine, nursing, public health, dentistry,
physical therapy, occupational therapy, dietetics and nutrition, athletic training, health
policy, psychology, sociology, counseling,
speech-language pathology, respiratory therapy, radiation technology, pharmacy, podiatry,
optometry, audiology, or any other clinical
or social science discipline. The steps are the
same regardless of whether the investigator is
an undergraduate student, a master’s or doctoral candidate, or a seasoned professional.
Health research is an intentional process
that requires fastidiousness and perseverance,
but it does not have to be complicated. Anyone who is willing to follow the steps outlined
in this guidebook can conceptualize a research
project and see it through to completion. Pursuing a research project may lead to the acquisition of new skills, the fulfillment of degree
or work requirements, the satisfaction of
personal curiosity, and even the opportunity
to become a published author. More importantly, every project, no matter how modest,
has the potential to contribute to expanding
the knowledge base for the health sciences.
Researchers who see their projects through
to completion may eventually see their findings translated into improved patient care,
enriched organizational effectiveness, and
enhanced community health. This book is
an invitation to make your own contribution
to the evidence base that will inform future
decisions about promoting healthy behaviors,
allocating health resources, and preventing,
diagnosing, and treating diseases.
xv
© DmitriyRazinkov/Shutterstock
About the Author
Kathryn H. Jacobsen, PhD, MPH, is a professor of epidemiology and global health at George
Mason University in Fairfax, Virginia. Her research portfolio includes a mix of primary s tudies that
use quantitative and qualitative methodologies, secondary studies that analyze existing datasets,
and tertiary studies that synthesize the results of prior publications about the p
opulation-level
burdens from infectious diseases, noncommunicable diseases, mental health disorders, and
injuries. She is the author of Introduction to Global Health (Jones & Bartlett Learning) and more
than 180 peer-reviewed articles.
xvii
© DmitriyRazinkov/Shutterstock
New to This Edition
In the third edition of Introduction to Health
Research Methods, every chapter from the
second edition has been updated to enhance
content and improve clarity. The new edition
also features several new chapters and subsections that provide expanded coverage of
the clinical and population health research
process.
The most important update is the significantly expanded coverage of qualitative research methods. There are now
separate chapters on qualitative methodologies (Chapter 13), qualitative data collection (Chapter 23), and qualitative analysis
(Chapter 32). Qualitative research methods
are also integrated into other chapters, such
as the chapters on sampling, ethics, and data
management. This update aligns the book
with the Council on Education for Public
Health (CEPH) accreditation criteria initiated
in 2016 that require public health students to
demonstrate their ability to collect, analyze,
and apply both quantitative and qualitative
data. Another major enhancement is the
improved integration of glossary terms into
the main text. The number of terms in the
glossary has been increased from 600 entries
to more than 800, and a clear explanation of
each key term has been embedded within the
main text in the section where the term is first
introduced.
All of the information from the second
edition remains in the new edition, and the
organization of the book remains largely the
same. However, new content has been added
to nearly every chapter in response to user
feedback. The section on Step 1 of the research
process (Identifying a Study Question) presents more information about how to generate research ideas, frame research questions,
develop testable hypotheses, and define specific aims. Step 2 (Selecting a Study Approach)
provides new sections on minimizing bias, conducting person–time analysis