RESEARCH METHODOLOGY

Study Variables
Source :
DESIGNING AND CONDUCTING HEALTH SYSTEMS RESEARCH PROJECTS

Dr. Khalifa Elmusharaf, PhD Researcher Royal College of Surgery of Ireland Connecting health Research in Africa and Ireland Consortium

INTRODUCTION
In the previous lectures we analysed the problem we wanted to investigate. The problem itself and all the factors that might influence it were presented in a diagram, which then served as the basis for the formulation of research objectives. Now we have come to a stage where we must ask ourselves the question: What information are we going to collect in our study to meet our objectives?

We must first describe the problem itself more precisely For example, in a study that is investigating why so many tuberculosis (TB) patients default from outpatient treatment. We first want to know how high the defaulter rate is: is it 10%, 30%, 50%? To obtain the defaulter rate we need a clear definition of what we mean by defaulting (how many times treatment was missed).

We also want to know whether certain factors do indeed influence the problem, and to what extent. If we know the extent to which a certain factor influences the problem, we are much more likely to be able to convince ourselves (and relevant others) to take action. For example, if we find that becoming a dropout of TB treatment is strongly associated with the following factors, we have clues that will help us to solve the problem:
The patients lack of knowledge concerning the actual duration of treatment and the danger of relapse or death when the full course is not completed; y Living more than 8 km away from the clinic where the drugs have to be collected monthly; and y Being between 15 and 30 years of age.
y

To find these associations between problems and contributing factors, it is essential that we carefully define the problem itself, as well as each of the factors identified when analysing the problem We do this by formulating variables.

FORMULATING VARIABLES

WHAT IS A VARIABLE?

A VARIABLE is a characteristic of a person, object or phenomenon which can take on different values. These may be in the form of numbers (e.g., age) or non-numerical characteristics (e.g., sex).

NUMERICAL VARIABLES

Age Weight Home - clinic distance Monthly income Number of children

Years or months Kilograms

Km or in minutes walking distance

Pounds Numbers

CATEGORICAL VARIABLES
Sex Male Female Residency Urban Rural Outcome of disease Recovery Chronic illness Death

NUMERICAL VARIABLES

Continuous.
Height in centimetres (2.5 cm or 2.546 cm or 2.543216 cm) y Temperature in degrees Celsius (37.20C or 37.199990C etc.)
y

Discrete. These are variables in which numbers can only have full values, e.g.:
number of visits to a clinic (0, 1, 2, 3, 4, etc). y number of sexual partners (0, 1, 2, 3, 4, 5, etc.)
y

CATEGORICAL VARIABLES

Ordinal variables: (how much)

y

These are grouped variables that are ordered or ranked in increasing or decreasing order

Income

High income Middle income Low income

Severity of disease

Severe Moderate Mild

Nominal variables (what)

Sex

Male Female

Religion

Moslem Christian Others

FACTORS REPHRASED AS VARIABLES

Factors are variables which have negative values (e.g., lack of knowledge) . It is much easier to visualise these factors in the negative. Not everyone with good knowledge of TB treatment is a regular attender and not everyone with poor knowledge absconds from treatment. We want to determine to what extent these contributing factors play a role. Therefore we have to formulate them in a neutral way, so that they can take on positive as well as negative values.

NEGATIVELY PHRASED FACTORS AND HOW THEY CAN BE REPHRASED AS NEUTRAL VARIABLES.

Examples of negatively phrased factors and how they can be rephrased as neutral variables.

Negatively phrased factors Long waiting time Absence of drug Lack of supervision Poor knowledge

Neutral variables Waiting time Availability of drug Frequency of supervisory visits Level of knowledge

OPERATIONALISING VARIABLES BY CHOOSING

APPROPRIATE INDICATORS

Some variables it is not possible to find meaningful categories unless the variables are made operational with one or more precise INDICATORS.

Operationalising variables means that you make them measurable Example:

level of knowledge y Nutritional status

y

LEVEL OF KNOWLEDGE

You would need to develop a series of questions to assess the knowledge. The answers to these questions form an indicator of someones knowledge on this issue, which can then be categorised. If 10 questions were asked, you might decide that the knowledge of those with:
0 to 3 correct answers is poor, y 4 to 6 correct answers is reasonable, and y 7 to 10 correct answers is good.
y

NUTRITIONAL STATUS OF UNDER-5 YEAR

Widely used indicators for nutritional status include:

Weight in relation to age (W/A) y Weight in relation to height (W/H) y Height in relation to age (H/A) y Upper-arm circumference (UAC)
y

Internationally accepted categories are already exist, which are based on standard growth curves. For the indicator Weight/Age, for example, children are:
Well-nourished if they are above 80% of the standard, y Moderately malnourished if they are between 60% and 80%, y Severely malnourished if they are below 60%.
y

NOTE

When defining variables on the basis of the problem analysis diagram, it is important to realise which variables are measurable as such and which ones need indicators. Once appropriate indicators have been identified we know exactly what information we are looking for. This makes the collection of data as well as the analysis more focused and efficient.

DEFINING VARIABLES AND INDICATORS OF

VARIABLES

It is necessary to clearly define the variables and indicators of variables to ensure that:
Everyone understands exactly what has been measured y There will be consistency in the measurement, it is necessary to clearly define the variables (and indicators of variables).
y

For example
y

To define the indicator waiting time it is necessary to decide what will be considered the starting point of the waiting period e.g., is it when the patient enters the front door, or when he has been registered and obtained his card?

CAUSES AND ASSOCIATIONS; CONFOUNDING

DEPENDENT AND INDEPENDENT VARIABLES

Dependent variable (problem) variable: The variable that is used to describe or measure the problem under study. Independent variables (factors) variables: The variables that are used to describe or measure the factors that are assumed to cause or at least to influence the problem

SMOKING AND LUNG CANCER

Type of variable Dependent variable Independent variable variable Suffering from lung cancer Smoking

WHY PEOPLE SMOKE

Type of variable Dependent variable variable Smoking

Independent variable

Pressure from peers to smoke

CAUSES AND ASSOCIATIONS

Although in everyday language we may speak of possible CAUSES of problems, in scientific language we prefer to speak of ASSOCIATIONS between variables, unless a causal relationship can be proven. If we find an association between smoking and cancer, we can conclude that smoking causes cancer only if we can both demonstrate that the cancer was developed after the patient started smoking and that there are no other factors that could have caused both the cancer and the habit of smoking.

CONFOUNDING VARIABLE

A variable that is associated with the problem and with a possible cause of the problem is a potential CONFOUNDING VARIABLE. Nervous people, for example, may both smoke more and suffer more from cancer than persons who are not nervous. A confounding variable may either strengthen or weaken the apparent relationship between the problem and a possible cause. In order to give a true picture of cause and effect, possible confounding variables must be considered, either at planning stage or while doing data analysis.

EXAMPLE

A relationship is shown between bottle-feeding and diarrhoea in under-twos. However, mothers education may be related to bottle-feeding as well as to diarrhoea.

BACKGROUND VARIABLES

In almost every study, BACKGROUND VARIABLES, such as age, sex, educational level, socio-economic status, marital status and religion, should be considered. These background variables are often related to a number of independent variables, so that they influence the problem indirectly (hence they are called background variables).

DESCRIPTIVE STUDY

If you do a purely descriptive study, for example knowledge, attitudes and practices related to schistosomiasis or AIDS, you do not need to differentiate between dependent and independent variables, as there are no causal relationships between variables. In this type of study you may simply concentrate on variables and give operational definitions, with indicators if needed, to measure knowledge, attitudes and practices

EVALUATION STUDIES

It is particularly important that we prepare good operational definitions, because here we want to compare and measure results at the beginning of the project phase and in the middle or at the end.

NOTE
When you select the variables for your study, it is important to review your objectives and problem analysis diagram. When you review your objectives you may find that you need to consider some new factors not originally included in your problem analysis diagram. You may discover that your objectives are too vague and can be revised and clarified, now that you have identified your variables You should continue to adjust your problem analysis diagram, variables and objectives until they are all in line with each other.

IDENTIFICATION OF VARIABLES IN RESEARCH

A health researcher believes that in a certain region anaemia, malaria and malnutrition are serious problems among adult males and, in particular, among farmers. He therefore wishes to study the prevalence of these diseases among adult males of various ages, family size, occupations and educational backgrounds in order to determine how serious a problem these diseases are for this population Questions: What are the dependent and independent variables in the study? Which of these are categorical (ordinal and nominal) and which are numerical (continuous and discrete) variables?

In a study concerning prevalence of schistosomiasis in the adult population of a village community, a researcher found that being a farmer was a risk factor for developing bilharzia. He was however not convinced that it was being a farmer that made these people more likely to develop bilharzia. Question: Are there any variables whose inclusion in the study might ensure that the researcher could show how much being a farmer actually contributed to a person developing schistosomiasis? Are there farmers who did not get bilharzia? Which variables might help explain why some farmers got bilharzia and others did not?

Important independent variables that could be taken into account include:

y y y y y y

Age Location in the village Contact with water Type of farming activities Division of labour Season

Closer study revealed that schistosomiasis was present among 70% of the young farmers between 20-25 years of age, while it was almost entirely absent in farmers older than 50 years of age. It turned out that younger farmers tended to have farms much further away from the village where the land was more fertile, and they had to cross a river where they bathed on their way home in the evening. The older farmers, on the other hand, had always had their farms close to the village and obtained water from wells.

GROUP WORK

Using the diagram of factors that possibly influence the problem you are studying (the diagram that you prepared for the statement of the problem), identify for each of these factors the variables that will be included in your study:
y y y y

What is/are your dependent variable(s)? (List them.) What are your independent variables? (List them.) Which of the variables can be measured as they are? Choose appropriate indicators for the variables that are not measurable as they are and/or formulate appropriate definitions for these variables/indicators. State whether you have identified themes that need further exploration during your study before you can define the concepts adequately.