Nursing Research Methodology

for surgical Nursing specialty

Prepared by Getu M.(MSc. N)

1 05/01/2024
Introduction to research
What is a research?
 Research in common parlance refers to a search for
knowledge.
 It is a scientific and systematic search for pertinent
information on a specific topic.
 It is an art of scientific investigation.
 It is a scientific inquiry aimed at learning new facts, testing
ideas, etc. It is the systematic collection, analysis and
interpretation of data to generate new knowledge and answer
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OBJECTIVES OF RESEARCH

 The purpose of research is to discover answers to questions

through the application of scientific procedures.

 The main aim of research is to find out the truth which is

hidden and which has not been discovered as yet.

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Objectives….
 To gain familiarity with a phenomenon or to achieve new
insights into it (studies with this object in view are termed as
exploratory or formulative research studies);
 To portray accurately the characteristics of a particular
individual, situation or a group (studies with this object in
view are known as descriptive research studies);
 To determine the frequency with which something occurs or
with which it is associated with something else (studies with
this object in view are known as diagnostic research studies);
 Totest a hypothesis of a causal relationship between variables
(such studies are known as hypothesis-testing research studies)
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 Motivation in research
What makes people to undertake research?
1. Desire to get a research degree along with its consequential
benefits;
2. Desire to face the challenge in solving the unsolved
problems, i.e., concern over practical
problems initiates research;
3. Desire to get intellectual joy of doing some creative work;
4. Desire to be of service to society;
5. Desire to get respectability.

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Why should Nurse educators read research related to clinical
practice?

 To remain clinically current and competent.

 To maintain a scholarly/intellectual attitude toward patient
care.
 To model professional behavior to staff and students.
 To remain familiar with research terminologies and concepts.
 To encourage Nurse researchers.
 To foster ideas for individual study.

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 Importance of Nursing Research
 To contribute to the development of the profession’s
knowledge through research
 Nursing research empowers every nurse’s clinical
practice.
 To gain new knowledge to improve:
 Patient care,
 Nursing profession and
 Overall health care

 Research-based (evidence based) practice = integrating

research findings into clinical decision making

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 Importance of Nursing Research…

 Validate existing nursing knowledge, procedures

or interventions
 Accountability for care-related decisions
 Research expands nursing practice
 Reinforce the identity of nursing as a profession

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 Importance of Nursing Research…
 Nurses need to be research literate, to:
 Having the capacity for critical thinking
 Possessing analytical skills having the skills to gain access
to relevant research and evidence
 Having a critical understanding of research processes
 Being able to read and critically appraise research and other
types of evidence
 Having an awareness of ethical issues related to research.
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RESEARCH PROCESS

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 RESEARCH PROCESS
1. Formulating the research problem;
2. Extensive literature survey;
3. Developing the hypothesis;
4. Preparing the research design;
5. Determining sample design;
6. Collecting the data;
7. Execution of the project;
8. Analysis of data;
9. Hypothesis testing;
10. Generalizations and interpretation, and
11. Preparation of the report or presentation of the results, i.e., formal
write-up of conclusions reached.
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Main components of any research work

I. Preparing a research proposal

II. Fieldwork (i.e., data collection)

III. Analyzing data and preparing a research report

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 Criteria of Good Research
1.Good research is systematic: research is structured with specified

steps to be taken in a specified sequence in accordance with the well

defined set of rules.

2.Systematic characteristic of the research does not rule out creative

thinking but it certainly does reject the use of guessing and intuition in

arriving at conclusions.

3. Good research is logical: This implies that research is guided by the

rules of logical reasoning and the logical process of induction and

deduction
13 are of great value in carrying out research.
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 Criteria….
4. Good research is empirical: It implies that research is
related basically to one or more aspects of a real situation
and deals with concrete data that provides a basis for
external validity to research results.

5. Good research is replicable: This characteristic allows

research results to be verified by replicating the study and
thereby building a sound basis for decisions

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TOPIC SELECTION

Problem identification
 If the answer to the research question is obvious, we are
dealing with a management problem that may be solved
without further research.

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Where does Idea of research come from?
 Professional experience
 Burning questions
 Yours
 Others
 Literature
 Professional meetings
 Discussions

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 Whether a problem requires research depends on three
conditions:

I) There should be a perceived difference or discrepancy

between what it is and what it should be;

II) The reason(s) for this difference should be unclear (so that it
makes sense to develop a research question); and

III) There should be more than one possible and plausible

answer to the question (or solution to the problem).
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 Criteria for prioritizing problems for research

Criteria for prioritizing problems for research

Criteria for prioritizing problems for research

 Criteria for selecting a research topic

 Relevance: The topic you choose should be a priority
problem: Questions to be asked include:ƒ
 How large or widespread is the problem?
 Who is affected?
 How severe is the problem?
 Avoidance of duplication: Investigate whether the topic has
been researched.
If the topic has been researched, the results should be
reviewed to explore whether major questions that deserve
further investigation remain unanswered.
If not, another topic should be chosen.
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 Feasibility: Consider the complexity of the problem and the
resources you will require to carry out the study.
 Thought should be given first to personnel, time, equipment
and money that are locally available.
 In situations where the local resources necessary to carry out
the project are not sufficient, you might consider sources
available at the national level.

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Political acceptability:
It is advisable to research a topic that has the interest and support of
the authorities.
 This will facilitate the smooth conduct of the research and
increases the chance that the results of the study will be
implemented.

 Applicability of possible results and recommendations Is it

likely that the recommendations from the study will be applied?

 This will depend not only on the blessing of the authorities but

also on the availability of resources for implementing the

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recommendations.
Urgency of data needed
How urgently are the results needed for making a decision?
Which research should be done first and which can be done
late?
Ethical acceptability
We should always consider the possibility that we may
inflict harm on others while carrying out research.
Therefore, it will be useful to review the proposed
study.

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Scales for rating research topics
Relevance
1 = Not relevant
2 = Relevant
3 = very relevant
Avoidance of duplication
1 = Sufficient information already available
2 = Some information available but major issues not covered
3 = No sound information available on which to base problem-
solving
Feasibility
1 = Study not feasible considering available resources
2 = Study feasible considering available resources
3 = Study very feasible considering available resources
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 …..
 Political acceptability
1 = Topic not acceptable
2 = Topic somewhat acceptable
3 = Topic fully acceptable
Applicability
1 = No chance of recommendations being implemented
2 = Some chance of recommendations being implemented
3 = Good chance of recommendations being implemented
Urgency
1 = Information not urgently needed
2 = Information could be used but a delay of some months would be acceptable
3 = Data very urgently needed for decision-making
Ethical acceptability
1 = Major ethical problems
2 = Minor ethical problems
3 = No ethical problems
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 Statement of the problem
 The problem statement describes the context for the
study.
 Why is the research important/ urgent?
 If the problem is not urgent (i.e. not important to the
beneficiaries) it will not be interest of the donor
 A problem might be defined as the issue that exists in the
literature, theory, or practice that leads to a need for the
study.
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 Statement of the problem….
 Effective problem statements answer the question
– Why does this research need to be conducted?
– What is the main question you want to answer?
 Describe the problem at Global, regional, national and study
area's local levels in terms of:
 Magnitude
 Severity
 Associated factors (predictors)
 Efforts that were made to solve it/explain it (existing
theories/controversies in explaining it)
 What is missing (unknown) in the effort to solve the problem
 What this study will contribute to this solution.
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 Literature Review

 Enables to share with the reader the results of other

studies that are closely related to the study being reported.
 Relates a study to the larger, ongoing dialogue in the
literature about a topic, filling in gaps and extending prior
studies.
 Provides a framework for establishing the importance of
the study, as well as a benchmark for comparing the results
of a study with other findings.
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Use of literature review
 It prevents you from duplicating work that has been done
before.
 It increases your knowledge on the problem you want to
study and this may assist you
in refining your "statement of the problem".
 It gives you confidence why your particular research
project is needed.
 To be familiar with different research methods
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Sources of information
ƒ Card catalogues of books in libraries
 Organizations (institutions)
 Published information (books, journals, etc.)
 Unpublished documents (studies in related fields, reports,
etc.)
 Computer based literature searches such as Medline
 Opinions, beliefs of key persons

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Some examples of resources where information could be
obtained are:ƒ

Clinic and hospital based data from routine activity statistics

Local surveys, annual reports

ƒ Scientific conferences

Statistics issued at region and district levels

Articles from national and international journals (e.g., The

Ethiopian Journal of Health

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…..
Development, The Ethiopian Medical Journal, The East
African Medical journal, The Lancet, etc.)

Internet

ƒ Documentation, reports, and raw data from the Ministry

of Health, Central Statistical

Offices, Nongovernmental organizations, etc.

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References that are identified:

 Should first be skimmed or read

 Then summaries of the important information in each of

the references may be recorded on separate index cards

 These should then be classified so that the information can

easily be retrieved

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 …..
Organization of information on index cards
The index cards should contain:
 Key words
 A summary of the contents of books or articles which is relevant to
one's own study
 A brief analysis of the content, with comments such as:
- how information from that particular study could be used in one's
own study
 Information obtained from key persons could also be summarized on
the
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…..
 After collecting the required information on index cards,
the investigator should decide in which order he/she wants
to discuss previous research findings:
 From global to local
 From broader to focused
 From past to current

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 …..
 In conclusion, while reviewing a literature, all what is known
about the study topic should be summarized with the relevant
references.
 This review should answer

How much is known?

What is not known?

What should be done based on what is lacking?

 Overall, the literature review should be adequate, relevant and
critical.
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…..
 Appropriate referencing procedures should always be
followed in research proposals as well as in research reports.
 While reviewing a literature give emphasis to both positive
and negative findings and avoid any distortion of information
to suit your own study objectives.
 Finally, after an exhaustive literature review, summarize the
findings and write a coherent discussion by indicating the
research gap which supports the undertaking05/01/2024
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of your study.
OBJECTIVES
Why research objectives?
 Research objective is a statement that clearly depicts the goal
to be achieved by a research project.
General objectives: aim of the study in general terms

 Example: In a study on missed opportunities for EPI in

Addis Ababa the general objective was: “to assess missed

opportunities for EPI in Addis Ababa”.

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…..
Specific objectives: measurable statements on the specific
questions to be answered.
 Unlike the general objectives, the specific objectives are
more specific and are related to the research problem
situation.
 They indicate the variable to be examined and
measured.

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…..
For the above study specific objectives can be:
 To assess the magnitude of missed opportunities for
children who attend OPD, MCH, CDD, etc. in Addis
Ababa,
 To identify the reasons for children not being immunized
while attending the OPD, MCH, CDD, etc. services.

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…..
 The formulation of objectives will help us to:

Focus the study (narrowing it down to essentials)

Avoid collection of data that are not strictly necessary for

understanding and solving the identified problem

Organize the study in clearly defined parts

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…..
 The explicit formulation of study objectives is an essential

step in the planning of a study.

 It is said that “a question well-stated is a question half-

answered”, but a question that is poorly stated or unstated

is unlikely to be answered at all.

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 How should we state our objectives?
We have to make sure that our objectives:
 Cover the different aspects of the problem and its
contributing factors in a coherent way and in a logical
sequence
 Are clearly expressed in measurable terms
 Are realistic considering local conditions
 Meet the purpose of the study
 Use action verbs that are specific enough to be measured
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…..
Examples of action verbs Avoid the use of vague non-action
are: verbs

 to determine
 to understand
 to compare
 to verify  to appreciate
 to calculate
 to describe  to study
 to find out
 to believe
 to establish

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 RESEARCH METHODS

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Types of study design

 A study design is the process that guides researchers on how

to collect, analyze and interpret observations.
 It is a logical model that guides the investigator in the
various stages of the research.
 Research design is a blue print for the conduct of a study
that maximizes control over factors that could interfere with
the study’s desired outcomes

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Elements:
 Description of subjects (Who):Who are you going to
interview? – study population
 Observations of variables (What):What questions are you
going to ask participants?
 Why are you doing this project?
 Measures of time (When):When is the period of time for
which you want to collect data?-
 Selecting of setting (Where):Where is your study area?-
setting
 Role of the investigator
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The choice of design is influenced:
 Experience of researcher and level of knowledge
 The research question
 Feasibility factors such as
 Time frame you have to conduct the study,
 The level of funding,
 The type of data required and
 The resources available.
 Availability of subjects and equipment
 Ethical consideration
 Application
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 Types of study design

Study design

Observational study design Experimental study design

Descriptive Analytical
study design study design Clinical trial

Case Report, Cross Case

Case series sectional control
Cohort

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Observational study design:
 Observational studies collect information on events that
are happening or have happened, over which we have
no control.
 Data can be collected from populations or from
individuals.
 The researcher just observes and analyses researchable
objects or situations but does not intervene

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 Descriptive studies
 Generate hypotheses
 Answer what, who, where, and when
 Describes the general characteristics of the distribution of
a disease, mainly related to person, place and time, what
populations are affected, in what geographic location and
how the frequency of occurrence varies over time.
 Descriptive research designs help provide answers to the
questions of who, what, when, where, and how associated
with a particular research problem;

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…..

 Information such as age,sex, race, marital status, occupation,

medication use, consumption of foods, geographic

distribution of a disease, seasonal patterns in disease onset

are example of the kind of data that can be collected.

 They can be done quickly and easily as such information is

usually available
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 Types of descriptive studies
 There are three main types of descriptive
studies:
I. Case reports or case series and
II. Cross-sectional studies.

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 Case Reports and Case Series
 The case report is the most basic type of descriptive study of
individuals.
 They are usually used to describe a new or unusual condition
or circumstance and are often the first reported indications of
a problem.
 Case series are collections of individual case reports in a short
period of time.
 Usually indicate the beginning or presence
of an epidemic.

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 Case Series
Clinical case-series: usually a coherent and consecutive set of
cases of a disease (or similar problem) which derive from the
practice of one or more health care professionals or health care
setting.

Clinical case-series are of value in epidemiology for:

• Studying predictive symptoms, signs and tests
• Creating case definitions
• Clinical education, audit and research
• Health services research
• Establishing safety profiles
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Case series…
 What to look for
• The diagnosis (case definition) or, for mortality, the
cause of death
• The date when the disease or death occurred (time)
• The place where the person lived, worked etc (place)
• The characteristics of the population (person)
• The size and characteristics of the population at risk
• Strong publication bias favoring positive results
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 Cross-Sectional study design
 In cross-sectional studies exposure and disease status are
assessed at the same time in a defined population.
 The presence or absence of both the exposure and the disease
are determined at the same time point.
 Used to learn about the characteristics of a population at one
point in time (like a “snap shot”)
 No comparison group, it may not be possible to distinguish
whether the exposure preceded or followed the disease, and
thus cause and effect relationships are not certain.
 Produces estimates of the prevalence of the population
characteristic of interest

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Cross-sectional designs….
 Cross-sectional studies provide a clear 'snapshot‘ of the
outcome and the characteristics associated with it, at a
specific point in time.
 Unlike an experimental design, cross-sectional designs focus
on studying and drawing inferences from existing differences
between people, subjects, or phenomena.
 Entails collecting data at and concerning one point in time.

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Cross-sectional designs….
 Cross-section studies are capable of using data from a
large number of subjects
 Can estimate prevalence of an outcome of interest
because the sample is usually taken from the whole
population.
 Because cross-sectional designs generally use survey
techniques to gather data, they are relatively inexpensive
and take up little time to conduct.
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Analytic studies
 Analytic studies test hypotheses about exposure outcome
relationships

 Measure the association between exposure and outcome

 Analytic study designs are used for testing the hypotheses

formulated by descriptive studies.

 These studies enable comparison among groups, determining

whether or not the risk of disease is greater in individuals
exposed or not exposed to a known risk factor.
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
 Analytical studies….
 Include a comparison group

 Answer why and how

Example

Hypothesis: People who smoke shisha are more likely to get lung

cancer than people who do not smoke shisha.

 Exposure?

 Outcome?
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COHORT STUDIES
 Cohort
 a group of people who share a common experience or
condition
 E.g. Birth cohorts, cohort of smokers, occupational
exposures
 Cohort studies
 Participants classified according to exposure status and
followed-up over time to ascertain outcome
 The observation of a cohort over time to measure
outcome(s)
 The exposure can be a personal characteristic, behavior,
exposure to anything,

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COHORT STUDIES....
 At the time exposure status is defined, all subjects must be
free of disease under investigation.
 All participants are then followed up to assess the
occurrence of the outcome.
 Longitudinal, follow-up or incidence studies
 Cohort studies are useful to evaluate disease etiology,
prognosis (natural history of disease)and incidence of a
disease,
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 COHORT STUDIES....
 All subjects in both groups(exposed and non-exposed) are free of
disease at the beginning of the study.
 Can be used to find multiple outcomes from a single exposure
 Appropriate for rare exposures or defined cohorts
 Ensures temporality (exposure occurs before observed outcome)

They have 2 primary purposes:

 Descriptive: to describe the incidence rates of an outcome
 Analytic: to analyze associations between the outcomes and risk
factors
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COHORT STUDIES....

 Begin with a group of people free of disease who are

classified into subgroups according to exposure to a

potential cause of outcome and the whole cohort is followed

up to see how the subsequent development of outcome

differs between the groups with and without exposure

(figure 1)
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An example :Does exposure to smoking
associate with outcome lung cancer?

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Prospective vs. Retrospective (Concurrent vs. Non-
concurrent)
 Depending on temporal relationship between initiation of the
study /timing of data collection/ and occurrence of the disease
 Cohort studies have been called prospective studies, but this
terminology is confusing and should be avoided
 the term “prospective” refers to the timing of data collection and not to
the relationship between exposure and effect

Thus, there can be both prospective and retrospective cohort

studies

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Prospective cohort
 Exposure and outcome data is collected after start of the study
 Cohorts are identified in the present
 Exposure status or possible explanatory/prognostic factors
determined in the present
 Cohorts followed-up to identify outcome
 Ascertainment of outcome done in future
 Group participants according to past or current exposure and
follow-up into the future to determine if outcome occurs
 The groups of exposed and unexposed individuals have been
assembled but the disease has not occurred yet.
 The researcher must follow the patients up for a certain period to
ascertain the outcome of interest
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 2011 2011 2015
Fig. Design of prospective cohort studies
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 Retrospective cohort
 All the exposure and effect data have been collected before
the actual study begins
 This type of investigation is called a historical cohort study
 Costs can occasionally be reduced by using a historical cohort
(identified on the basis of records of previous exposure)
 This sort of design is relatively common for studies of cancer
related to occupational exposures
 At the time that the study is conducted, potential exposure and
outcomes have already occurred in the past
 For example, records of military personnel exposure to radioactive
fall-out at nuclear bomb testing sites have been used to examine
the possible causal role of fall-out in the development of cancer
over the past 30 years

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Retrospective cohort…
Conduct

Identify cohort in the past using

records/databases
Determine exposure or prognostic factors in the
past using again records or databases then
Identify outcome in past or present or future (in
case of mixed cohort)
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 Present past
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70
Advantages of cohort studies
1. Ethically safe.
2. Subjects can be matched.
3. Timing and directionality of events can be established.
4. Rare exposures can be examined by appropriate selection of
study
5. Multiple outcomes can be studied for any one exposure.
6. Incidence of disease can be measured in the exposed and non-
exposed groups.
7. If prospective, minimize bias in the ascertainment of exposure.
8. Eligibility criteria and outcome assessments can be standardized.
9. Easier and cheaper to manage than a randomized controlled
trial.
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Disadvantages of cohort studies
1. Controls may be difficult to identify
2. Exposure may be linked to a hidden confounder
3. Blinding is difficult
4. Randomization not present
5. For rare disease large sample sizes or long follow-up is
necessary
6. Very expensive and time consuming
7. If retrospective requires the availability of adequate records
Validity of results can be affected by losses to follow-up
8. Changes over time in exposure status and diagnostic criteria
can affect the classification of individuals according to
exposure and disease status.
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Case-control
 It is a type of observational study in which two existing groups
differing in outcome are identified and compared on the basis of
some supposed causal attribute.
 The studies are often used to identify factors that may contribute
to a medical condition by comparing subjects who have that
condition/disease (the 'cases') with patients who do not have the
condition/disease but are otherwise similar (the 'controls').
 Usually less expensive
 Sampling from source population
 Can usually calculate only the ratio of incidence rates or risks
 Convenient for studying many exposures

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 Advantages of case-control
studies
1) Quick and cheap.

2) Only feasible method for very rare disorders or those with

long time gap between exposure and outcome.

3) Can investigate a wide range of risk factors.

4) Fewer subjects needed than in cross-sectional studies.

5) Consistency of measurement techniques maintained.

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Disadvantages of case-control studies
1. Bias in determining exposure (recall bias, interviewer bias,
missing data, lack of standardization of pre-recorded data
2. Bias in choosing controls (inappropriate source, over-
matching)
3. Problems in sorting out sequence of events (because
retrospective).
4. No estimate of absolute risk.
5. Only one end-point (disease).
6. Not suitable for investigating rare exposures (unless only
cause of disease).
7. Cannot estimate disease incidence

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Experimental study design
• Experiment is a scientific investigation that makes observation
and collected data according to the explicit criteria.
• Investigation may be physiological, psychological or
educational or combined.

• It is called as methodological design or the quantitative design

to test causality.
 in which the researcher manipulates objects or situations and
measures the outcome of his manipulations

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Uses :-
 Obtain true representation of the cause and effect.
 When greatest amount of control is required with least
possible error.
 Eliminate all factors influencing the dependent variable
other than the independent variable under study.
 Prevent other element to introduce during observation of the
specific cause and the effect under study

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Characteristics of experiment research
design:
• Randomization: Refers to random assignment of number of
group. Participant has equal chance to be in control or
experimental group.
• Manipulation: It is the process of manipulating
• In experimental designs, the causative variable must be
amenable to manipulation by the researcher that is “does
something”, to subjects in the experimental condition.
• Control: Experimenter introduces one or more controls over
the experimental situation including the use of a control
group. It means introduction of one or more constraints into
experimental situation acquired by manipulating casual or
independent variable, preparing experimental protocol and by
using comparison to a group.
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Randomized trials
 These are cohort studies where allocation to treatment and
control groups is achieved by a
random process.

 Random allocation is helpful for reducing ‘selection bias’

and ‘allocation bias’, especially when combined with
allocation concealment. Because they are experiments,
randomized trials can also employ blinding of participants
and caregivers, which reduces ‘performance bias’.
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Qualitative Vs Quantitative
Qualitative Quantitative
 Understanding  Prediction
 Interview/observation  Survey/questionnaires
 Discovering frameworks  Existing frameworks
 Textual (words)  Numerical
 Theory generating  Theory testing (experimental)
 Quality of informant more  Sample size core issue in reliability
important than sample size of data
 Subjective-  Objective
 Embedded knowledge  Public
 Models of analysis: fidelity to text or  Model of analysis: parametric,
words of interviewees nonparametric

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What is sampling?
 Sampling involves the selection of a number of
study units from a defined study population.
 Sampling is a process of choosing a section of
the population for observation and study.
 The population is too large for us to consider
and collecting information from all its
members.

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Why sampling? Advantages of sampling
 To minimize the costs (money, manpower,
materials, time) of collecting the data, processing
and reporting on the results.
 The information collected is accurate (valid and
reliable).
 Greater speed and accuracy
 Feasibility (achievable) and practicability

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Dis-advantages of sampling
 There is always errors in sampling.
 Sampling may create a feeling of
discrimination with in the population.

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Errors in sampling
 When we take a sample, our results will not exactly equal
the correct results for the whole population i.e. our results
will be subject to errors.

Sampling error (Random error)

 Errors introduced due to errors in the selection of a
sample.
 Arise from the sampling process itself.
 Sampling error cannot be totally eliminated (avoided), but
it can be minimized by increasing the size of the sample.
When n = N ⇒ sampling error = 0
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Non-sampling error

 Also called systematic error or bias

 It is a type of systematic (methodical) error in the

design or conduct of a sampling procedure which

results in distortion of the sample, so that it is no

longer representative of the reference population.

 We can eliminate or reduce the non-sampling error

(bias) by careful design of the sampling procedure

and not by increasing the sample size.

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Common terms used in sampling

Target population (reference/source population)

 Is that population about which an investigator
wishes to draw a conclusion.

Study population (population sampled)

 Population from which the sample actually was
drawn and about which a conclusion can be
made.

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 For practical reasons the study population is
often more limited than the target population.
 In some instances, the target population and the
population sampled are identical.

Sampling unit
 The unit of selection in the sampling process.
 For example, in a sample of districts, the
sampling unit is a district; in a sample of
persons, a person, etc.
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Study unit
 The unit on which the observations will be collected.
 For example, persons in a study of disease
prevalence, or households, in a study of family size.
 N.B. The sampling unit is not necessarily the same
as the study unit.

Sampling frame
 The list of units from which the sample is to be
selected.

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Schematic figure to illustrate sampling
Reference Population Butajira District School
Children

School children in
Source Population Butajira Schools

Class (Student) Registers

Sampling Frame of schools

Sample Each 20 students

randomly selected from
Study Subjects each class in Butajira
School

Students who provide

information to the
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05/01/2024team
 Target population

Study population

Sampling unit

Study unit

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Sampling methods

There are two types of sampling methods:-

A. Non-probability sampling methods

B. Probability sampling methods.

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Probability sampling methods
 Involves random selection procedures to
ensure that each unit of the sample is
chosen on the basis of chance.
 All units of the study population should
have an equal, or at least a known
chance of being included/selected in the
sample.

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Advantages
• Reliable estimates can be produced.

• A sampling frame exists or can be compiled.

• Involves random selection procedures.

• Generalization is possible (inferences can be made from

sample to population).

Dis-advantages
• More complex

• More time consuming

• Usually more costly than non-probability sampling methods.

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 Most common probability sampling
methods:-
1. Simple Random Sampling
2. Systematic Sampling
3. Stratified Sampling
4. Cluster Sampling
5. Multi-stage Sampling

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Simple Random Sampling(SRS)
 This is the most common and the simplest of the
sampling methods.
 In this method, the subjects are chosen from the
population with equal probability of selection.
 One may use a random number or use techniques
such as putting the names of people into a hat and
selecting the appropriate number of names blindly.
 Recently, computer programs have been developed to
draw simple random samples from a given
population.
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Advantages of SRS

 It is easy to administer
 Is representative of the population in the long run.
 The analysis of data using such a sampling scheme is
straightforward.

Dis-advantages
 It is costly to conduct.
 Requires sampling frame (difficult to obtain if the population is
large).
 Difficult if the reference population is dispersed.
 Minority subgroups of interest in the population may not be
present
99 in the sample in sufficient numbers for study.
Elias L.(MPH) 05/01/2024
How use simple random sample method?
 Make a numbered list of all the units in the
population from which you want to draw a sample.
 Each unit on the list should be numbered in sequence
from 1 to N (Where N is the Size of the population).
 Decide on the size of the sample
 Select the required number of sampling units using:-
 Lottery method
 Table of random numbers (TRN)

100 Elias L.(MPH) 05/01/2024

109 Elias L.(MPH) 05/01/2024
Systematic sampling (interval sampling)
 Individuals are chosen at regular
intervals from the sampling frame.
 We randomly select a number to tell us
where to start selecting individuals from
the list.

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Advantages Systematic sampling
 Less time consuming and easier to perform than
simple random sampling.
 Unlike SRS, systematic sampling can be
conducted without a sampling frame (useful in
some situations where a sampling frame is not
readily available).
 Sampling patients attending health center i.e.
when it is difficult to predict who will be
attending the health center.
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Dis-advantages
 There is a risk of bias, as the sampling interval
may coincide with a systematic variation in the
sampling frame.

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Stratified sampling
 It is appropriate when the distribution of the
characteristic to be studied is strongly affected
by certain variable (heterogeneous population).
 The population is first divided into homogenous,
mutually exclusive groups called strata
according to a characteristic of interest
(example: sex, geographic area, prevalence of
disease, income, age etc.).

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Allocation of sample size in stratified sampling

Proportional allocation
 If the same sampling fraction is used for each stratum.
 Allocate sample size to each stratum proportionately.

Non-proportional allocation
 If a different sampling fraction is used for each stratum
or if the strata are unequal in size and a fixed number
of units is selected from each stratum.

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Cluster sampling
 In this sampling scheme, selection of the
required sample is done on groups of
study units (clusters) instead of each
study unit individually.
 The sampling unit is a cluster, and the
sampling frame is a list of these clusters.

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Procedure
 The reference population (homogeneous) is divided into
clusters.
 These clusters are often geographic units (eg districts,
villages, etc.)
 A sample of such clusters is selected by SRS or
systematic sampling.
 All the units in the selected clusters are studied.
 It is preferable to select a large number of small clusters
rather than a small number of large clusters.

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 In such cases, clusters may be identified (e.g.
households) and random samples of clusters will
be included in the study; then every member of
the cluster will also be part of the study.
 This introduces two types of variations in the
data-between clusters and within clusters and
this will have to be taken into account when
analyzing data.

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Multi-stage sampling
 This method is appropriate when the reference
population is large and widely scattered.
 Selection is done in stages until the final
sampling unit (example:- households or
persons) are arrived at.

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 This type of sampling requires at least two or
more stages.
 The primary sampling unit (PSU) is the
sampling unit (usually large size) in the first
sampling stage.
 The secondary sampling unit (SSU) is the
sampling unit in the second sampling stage, etc.

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132 Elias L.(MPH) 05/01/2024
Non-probability Sampling Methods
 Every item has unknown chance of being
selected.
 Used when a sampling frame does not exist.
 No random selection (unrepresentative of the
given population).

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 Inappropriate if the aim is to measure variables
and generalize findings obtained from a sample
to the population.
 In non-probability sampling, since elements are
chosen arbitrarily (illogically), there is no way
to estimate the probability of any one element
being included in the sample.

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 There is an assumption that there is an even
distribution of a characteristic of interest
within the population.
 For probability sampling, random is a feature
of the selection process.
 Elements are chosen arbitrarily, and there is no
way to estimate the probability of anyone
element being included in the sample.

137 Elias L.(MPH) 05/01/2024

 Affected by bias
 However, it is quick, inexpensive and
convenient.
 Useful in circumstances when it is
unfeasible or impractical to conduct
probability sampling.

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Common types of non-probability sampling

1. Convenience or haphazard sampling

2. Volunteer sampling

3. Judgment sampling

4. Quota sampling

5. Snowball sampling technique

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 Sample size determination
 Sample size determination depends on:
 The objective of the study
 The study design
 Degree of precision required for generalization.
 Degree of confidence with which to conclude.
 Strategies For Determining Sample Size
Using a census for small populations
calculate the sample size

1. Using a computer package

2. Using formulas to calculate a Sample
Size
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 Using A Census For Small Populations

 Use the entire population as the sample.

 Attractive for small populations ( 200 or less).
 Eliminates sampling error and provides data on all the
individuals in the population.
 Financial considerations make this impossible for large

24
20
populations.

1,
ay
M
153
1. Using a computer package

 Packages available:

> Epinfo (download free from

http://www.cdc.gov/epiinfo)

- Sample Power

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 Using formulas to calculate a Sample Size

 Three criteria usually will need to be specified to determine

the appropriate sample size:

1. The level of precision:

2. The level of confidence or risk, and

3. The degree of variability in the attributes being measured

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Sample size - single proportion
 For making confidence limit statement (such as
prevalence study), the following formula can be
used to estimate minimum sample size:
2
 Z  P 1  P 
1
n  2 

d2
 For population <10,000, use finite population
correction
2
N  Z1  P1  P 
nf   2
2
d N  1   Z1  P1  P 
2
 2
Alternatively,
 If study population is less than 10,000,the final sample
size will be adjusted by using population correction
formula,

nf = ni
1+ni
N
 P= Population proportion
 d²- Margin of error: 5%
 CI: 95% confidence level.

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Sample size-two proportion
For test of significance study the following
formula can be used:
n
Z  Z   p 1  p   p 1  p 
2
2
1 1 2 2

 p1  p2  2

Parameters:
n - size of sample in each group
P1 ,P2 – estimated population prevalence in the
comparison groups
β = 1- Power (the probability that if the two
proportions differ the test will produce a
significant difference)
 Usually a power of 80% or 90% is used
 Single proportion cont…
 Parameters in the formula
 n is minimum sample size
 P is estimate of the prevalence rate for the population
 From available data, or Pilot study result, or 0.5 should be used to get the
possible minimum large sample size; if given in range, take the value
closest to 0.5.
 d is the margin of sampling error tolerated
 Z1-α/2 is the standard normal variable at (1-α )% confidence level
and α is mostly taken to be 5%
 Usually 95% confidence level is used = 1.96
 N population size
Data collection methods

 Data: is collection of information, facts and evidence

from which you can draw conclusions.

 Depending on the type of variables and the objective of

the study different data collections methods can be

employed.

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 Method of data collection
Questionnaires
Interviews
Focus group interviews
Observation
Documentary source

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 Questionnaires
Are means of collecting data but are difficult to design
and often require many rewrites before an acceptable
questionnaire is produced.

 Advantages:-
 Can be used as a method in its own right
As a basis for interviewing or a telephone
survey
 Can be posted, e-mailed, or faxed
Can cover a large number of people or
organizations
Relatively cheap
No prior arrangements are needed
No interviewer bias
 Disadvantages:
 Design problems
 Questions have to be relatively simple
 Time delay for waiting response
 Assume no literacy problem
 Historically low response rate
 Not possible to give assistance if required

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 Interview Method

 Interviewing is a technique that is primarily used to

gain an understanding of the under lining reasons

and motivations for peoples’ attitudes preferences or

behavior.
 Documentary sources
 Clinical and other personal records

 Death certificate

 Published mortality statistics

 Epidemic reports

 Census publications
Selection of data collection method is
based on :
 The resource required
 Acceptability of the method
 Coverage of the method
 Familiarization of the procedure
 accuracy
 Relevance
 Problem in gathering data

 Language barriers

 Lack of adequate time

 Expense

 In adequately trained and experienced staff

 Cultural norms

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