Now I'm going to talk about the

significance of the problem, and also

research questions.
So how do clinicians decide what they
should do
research on, and what their research
article should be about?
Now research is really based on people's
experience and ideas that they have.
As clinicians, I always say we are really
good at doing observations.
And based on our observations you might
come up with
your own idea of what a research study
could be.
Or it might be a clinical experience, it
might be that you've seen many, many
families
or patients with a certain problem and
you're
really interested in understanding it a
little bit more.
Or it might be that you have an interest
in theory.
It might be that you have some personal
experience or interest of your own
that you'd like to explore in a new way
and you'd like to do research.
So in this cartoon that says, never ever
think outside the box.
We know that that's a really good idea if
you have a cat.
But, research is the opposite.
Research is one of the fields that is very
exiting, because you get to think
outside the box and do something creative
and new, and really contribute to the
science.
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As we talked about, when you're thinking
about the significance of a research
problem,
the first thing you want to do is to know
what's known about your topic.
You need to find the facts.
You need to look at statistics.
Look at number of cases, fatalities.
You need to look at published research
findings.
And then you need to look at what is
not known about the topic of interest that
you have.
What is new about your idea that's
not been previously addressed in published
studies?
Maybe you have an idea for a new
method, maybe it's a different sample,
drug, or intervention.
So the research question that you come up
with should address

the gaps between what is known and what is

not known.
When you're identifying your research
question, as we
talked about it's based on the literature
review.
You provide background, theory and
conceptual framework for
it, statistics and support for the new
study.
And then you can develop a problem
statement,
a study objective, a research question, or
a hypothesis.
So an example here is in Dr. Dracup's
study, the
one we were talking about before, that was
published in Circulation.
It was a randomized control trial to
reduce patient
pre-hospital delay to treatment in Acute
Coronary Syndrome, or ACS.
So what's known about the subject, which
he talked about
in the background, was there is there a
delay in
treatment for people who experience signs
and symptoms of ACS
of a few hours and that can impact
patient's survival.
A 30 minute delay can reduce life
expectancy by one year.
So what's known?
Community-based interventions have failed
to reduce pre-hospital delay.
So here you can see that through the
introduction section of
her article, she's really laid out what's
known about the subject.
And now whats not know?
She talked about her study as being the
first randomized control trial, and what
it was going to do is to test the
education and counseling interventions for
individuals at high risk of ACS events to
reduce their pre-hospital delay time.
What she laid out was primary study
hypotheses.
She said, patients who receive a
face-to-face
education and counseling intervention and
who experience symptoms
of ACS during two years of follow-up,
would
have reduced pre-hospital delay time
compared to controls.
Her secondary hypothesis was about
decreasing the use of emergency medical
services, the emergency department and the
increase in the use of aspirin.

So here we can see how she used

the introduction section of the article
talking about
what's known and not known to develop our
ideas about understanding why these
hypotheses are necessary.
And she also talked about the intervention
and the patient population
so that we can understand why she has
these hypotheses.
In Dr. Lee's article, the care and
modifications to
the bedroom environment improve the sleep
of new parents.
She also talked about what's known in her
introduction.
She said parents caring for newborns have
sleep deprivation and fatigue.
That behavioral and educational
intervenants
have focused on improving infants sleep.
But what's not known.
She said, using sleep hygiene principles
and using,
including both the new mothers and the
fathers, will
the parents have longer sleep times,
higher sleep
efficiency, and less sleep disturbance
compared to control parents?
So here she's laid out what's known and
not known.
So it leads us into what is her research
question?
So instead of writing a research question,
she wrote a study objective.
And she stated it as this, to evaluate
the effectiveness of sleep hygiene
intervention package for parents.
Her hypotheses were, parents in the
SHIPP intervention, will have better sleep
outcomes,
meaning, longer sleep times, higher sleep
efficiency, and less sleep disturbance
than controls.
Our second hypothesis is about mothers in
the SHIPP intervention
will have high rates of use and
satisfaction with the intervention.
So again, she used the introduction
section of her article
talking about what's known and not known
to really give us
the information where we needed to
understand why this objective was
going to be met, and what her study
hypotheses would be.
One thing you'll see is, there's a lot of
different terms.
Instead of saying a research question, a

problem statement,
you might see things like a statement of
purpose.
It might be stated as a goal, or an intent
of a
study, or an aim, objective, or, most
commonly known as a research question.
So, I like to just say interchangeable
terms is
something that you'll see in terms of many
different disciplines.
Journals might request you to use one of
this
terms, and really they are very much the
same.
They're really explaining the same thing.
So what are the components of a good
research question?
It really should have three parts.
You should be able to breakdown every
research
question and find out what is the study
sample.
Or really the population of interest.
What are the concepts being studied?
Or it might be listed as variables of
interest.
In the research question, if it's analytic
study or an experimental study,
it will tell you a little bit about the
relationship between the variables.
Sometimes a setting is included, but not
that often.
So here's an example of a research
question talking about the key elements
here.
So if the question is, I'm going to change
Dr.
Lee's objective into a question, and say,
state it this way.
Is sleep hygiene associated with fewer
nighttime arousals,
and does it promote sleep maintenance for
new parents?
So, what are the key variables here?
We have nocturnal sleep time, we have
nocturnal sleep efficiency, sleep
disturbance, and there's also going to be
an intervention and control group.
What are the relationships that she's
talking about?
She's talking about relationships by
group, by
sleep time, their efficiency, and sleep
disturbance.
Who is her sample?
It's going to be new parents.
In particular, she talked in the article
about mothers and fathers.
So here you can take apart the

research question, and find the three

different elements.
Another example?
Doctor Dracup's research question.
Does a face-to-face intervention reduce
prehospital delay time and/or decrease the
emergency medical services, or EMS, and
increase aspirin use for the IHD patients?
Her key variables here is intervention
status because we know
that some people will have an intervention
and some won't.
Emergency medical services, the aspirin
use, and pre-hospital delay.
So what is the relationship between the
variables that she's looking at?
The intervention participants are going to
have lower EMS use,
increased aspirin use, and less
pre-hospital delay compared to controls.
And that's been outlined here in the
research question.
And who is her sample?
A sample is those diagnosed with ischemic
heart disease, or IHD.
So we can break down the research question
and find the different elements.
So what are the characteristics of a good
research question?
First we just talked about some of the
components.
But also developing a research question
also requires other skills.
We have to think about a research question
in terms
of these five different components, and
here it's abbreviated as FINER.
So we'll go through F-I-N-E-R.
The
issue is, is the question even feasible?
Would we even have an adequate number of
subjects to answer the question?
Do we have the expertise?
Is it affordable?
Is it manageable?
Is the question interesting?
Getting the answer intrigues the
investigator and friends.
Is it something that would intrigue you?
N stands for novel.
It confirms refutes or extends previous
findings, and it should provide new
findings.
So, any question you have should include a
novel, should
be a novel question so we can find
something new.
Is the question ethical?
Is it amenable to a study that maybe
an institutional review board would have

to approve?
R stand for relevant.
Is it relevant to scientific knowledge?
To clinical and health policy?
To future research?
So FINER stands for feasible, interesting,
novel, ethical and relevant.
So here, if we look at the question that
Dr. Dracup
had and Dr. Lee, we could ask, do each of
these
questions meet the criteria that we're
looking for in a good research question,
using the finer feasible, interesting,
novel, ethical, and relevant criteria?
So, hypotheses are another part of the
introduction section of an article.
Along with the research question, you
might find different
hypotheses that are stated after this,
statement of purpose.
The hypotheses are predictions or
explanations of
the relationship between two or more
variables.
It helps translate a research question
into a precise prediction of expected
outcomes.
Here, in this example, the question being,
does a face-to-face intervention reduce
pre-hospital delay
time and/or decrease EMS and increase the
aspirin used for patients with Ischemic
Heart Disease?
So, if we write this as a research
question, it could be stated that way.
But we could also take the question and
write is as a hypothesis.
It could be stated that patients who
received a face-to-face
educational and counseling intervention,
and who experienced symptoms of ACS
or acute coronary syndrome, during two
years of follow up,
would have reduced pre-hospital delay time
compared to the controls.
So here you can see that with the
hypothesis, we're actually going to
include the direction of the relationship,
but it isn't asked as a question.
So, what's the difference with a
statistical hypothesis or a null
hypothesis.
This is a statement saying that there's
no relationship between the dependent or
independent variables.
And example would be, new mothers in the
intervention group have
the same number of nighttime arousals as
mothers in the control group.

Meaning that there's no difference between

the two groups.
So the null hypothesis is used when we are
doing statistical tests.
It is not that commonly seen in the
introduction of an article, but it
is something that is implied when you're
looking at the statistical parts of an
article.
Here the question is, which component of a
research question is not always stated?
A, being the study sample?
B, variables of interest.
C, relationship between the variables of
interest.
And D, the setting.
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The answer is, setting.
As I stated, the three components of a
research question should be the
study sample or the population of
interest,
the variables and the relationship between
them.
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