Determinants of duration of disability and return-to-work after work-related injury and illness: challenges for future research

BACKGROUND: The purpose of this review was to identify critical data and research needs in addressing the following question: What are the primary factors that affect the time lost from work, return-to-work (RTW), subsequent unemployment, and changes in occupation after disabling illness or injury? METHODS: Review of the literature to identify research challenges originating from the multitude of disciplines, data sources, outcome measures, and methodological and analytical problems. RESULTS: About 100 different determinants of RTW outcomes were identified. Their impact varies across different phases of the disablement process. Recommendations are provided for addressing five selected research challenges. CONCLUSION: Interdisciplinary research needs to develop a comprehensive conceptual framework. Priority should be given to studies on specific domains of risk factors meeting five selection criteria: amenability to change; relevance to users of research; generalizability across health conditions, disability phases, and settings; "degree of promise" as derived from qualitative exploratory studies; and capacity to improve measurement instruments. Combining qualitative and quantitative research methods is necessary to bridge existing knowledge gaps.     

Qualitative Environmental Health Research: An Analysis of the Literature, 1991–2008

Background

Recent articles have advocated for the use of qualitative methods in environmental health research. Qualitative research uses nonnumeric data to understand people’s opinions, motives, understanding, and beliefs about events or phenomena.

Objective

In this analysis of the literature, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health.

Data sources

A primary search on ISI Web of Knowledge/Web of Science for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Inclusion and exclusion criteria are described.

Data extraction

Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health.

Data synthesis

Ninety-one articles met inclusion criteria. These articles were published in 58 different journals, with a maximum of eight for a single journal. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health, with most studies relying on one-on-one interviews. Details of the analyses were absent from a large number of studies. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures.

Discussion and conclusions

Qualitative data are published in traditionally quantitative environmental health studies to a limited extent. However, this analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.     

城市社区家庭医生签约服务绩效评价指标体系构建研究

目的:构建城市社区家庭医生签约服务绩效评价指标体系,以便对家庭医生签约服务实施效果进行评估。方法:以家庭医生签约服务绩效评价概念框架为理论基础,采用德尔菲法、层次分析法确定城市家庭医生签约服务绩效评价体系。以广州市为例进行实测模拟检验。结果:在家庭医生签约服务"结构、投入、过程、产出、结果"绩效评价概念框架基础上拟定城...     

From waste product to blood,brains and narratives: developing a pluralist sociology of contributions to health research

The aim of this paper is to examine the meaning of the concept of donation in health research. Drawing on a set of narrative interviews with people invited to donate biosamples for research and a range of other studies, we identify several conceptual themes that speak to the complexity of the current landscape of critical thinking about donation. These conceptual themes are: the language of ‘donation’; a hierarchy of biosamples; alternative informational value; narratives as donation; coincidental donation, convenience and degree of invasiveness; and rights, consent and benefits of research participation. We call for a reconceptualisation of research donation to encompass not only the numerous types of sample readily classed as donations, but also other types of data and contributions, including narrative interviews, psychometric data, patient‐reported outcome measures, record‐linkage, and time and effort. We argue for the development of a pluralist sociology of research donations, and suggest that a ‘sociology of research contributions’ might better capture this complexity.     

Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care

Interest in how qualitative health research might be used more widely to inform health policy and medical practice is growing. Synthesising findings from individual qualitative studies may be one method but application of conventional systematic review methodology to qualitative research presents significant philosophical and practical challenges. The aim here was to examine the feasibility of synthesising qualitative research using qualitative methodology including a formative evaluation of criteria for assessing the research to be synthesised. Ten qualitative studies of adult patients' perspectives of diabetes were purposefully selected and questions proposed by the critical appraisal skills programme (CASP) adapted and used to assess papers prior to synthesis. Each study was reviewed independently by two experienced social scientists. The level of agreement between reviewers was determined. Three papers were excluded: one because it turned out not to be qualitative research, one because the quality of the empirical work was poor and one because the qualitative findings reported were also recorded in another paper already included. The synthesis, which had two distinct elements, was conducted using the meta-ethnographic method. Firstly, four papers containing typologies of patient responses to diabetes were synthesised. Secondly, six key concepts were identified from all seven papers as being important in enabling a person with diabetes to achieve a balance in their lives and to attain a sense of well-being and control. These included: time and experience, trust in self, a less subservient approach to care providers, strategic non-compliance with medication, effective support from care providers and an acknowledgement that diabetes is serious. None of the studies included in the synthesis referenced any of the early papers nor did they appear to have taken account of or built upon previous findings. This evaluation confirmed that meta-ethnography can lead to a synthesis and extension of qualitative research in a defined field of study. In addition, from it a practical method of qualitative research assessment evolved. This process is promising but requires further testing and evaluation before it could be recommended for more widespread adoption.     

Kirkpatrick's levels and education 'evidence'

Medical Education 2012: 46: 97–106 Objectives This study aims to review, critically, the suitability of Kirkpatrick’s levels for appraising interventions in medical education, to review empirical evidence of their application in this context, and to explore alternative ways of appraising research evidence. Methods The mixed methods used in this research included a narrative literature review, a critical review of theory and qualitative empirical analysis, conducted within a process of cooperative inquiry. Results Kirkpatrick’s levels, introduced to evaluate training in industry, involve so many implicit assumptions that they are suitable for use only in relatively simple instructional designs, short‐term endpoints and beneficiaries other than learners. Such conditions are met by perhaps one‐fifth of medical education evidence reviews. Under other conditions, the hierarchical application of the levels as a critical appraisal tool adds little value and leaves reviewers to make global judgements of the trustworthiness of the data. Conclusions Far from defining a reference standard critical appraisal tool, this research shows that ‘quality’ is defined as much by the purpose to which evidence is to be put as by any invariant and objectively measurable quality. Pending further research, we offer a simple way of deciding how to appraise the quality of medical education research.     

An in-depth discussion and illustration of partial least squares structural equation modeling in health care

Partial least squares structural equation modeling (PLS-SEM) has become more popular across many disciplines including health care. However, articles in health care often fail to discuss the choice of PLS-SEM and robustness testing is not undertaken. This article presents the steps to be followed in a thorough PLS-SEM analysis, and includes a conceptual comparison of PLS-SEM with the more traditional covariance-based structural equation modeling (CB-SEM) to enable health care researchers and policy makers make appropriate choices. PLS-SEM allows for critical exploratory research to lay the groundwork for follow-up studies using methods with stricter assumptions. The PLS-SEM analysis is illustrated in the context of residential aged care networks combining low-level and high-level care. Based on the illustrative setting, low-level care does not make a significant contribution to the overall quality of care in residential aged care networks. The article provides key references from outside the health care literature that are often overlooked by health care articles. Choosing between PLS-SEM and CB-SEM should be based on data characteristics, sample size, the types and numbers of latent constructs modelled, and the nature of the underlying theory (exploratory versus advanced). PLS-SEM can become an indispensable tool for managers, policy makers and regulators in the health care sector.     

Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods

OBJECTIVE: Qualitative research is increasingly valued as part of the evidence for policy and practice, but how it should be appraised is contested. Various appraisal methods, including checklists and other structured approaches, have been proposed but rarely evaluated. We aimed to compare three methods for appraising qualitative research papers that were candidates for inclusion in a systematic review of evidence on support for breast-feeding. METHOD: A sample of 12 research papers on support for breast-feeding was appraised by six qualitative reviewers using three appraisal methods: unprompted judgement, based on expert opinion; a UK Cabinet Office quality framework; and CASP, a Critical Appraisal Skills Programme tool. Papers were assigned, following appraisals, to 1 of 5 categories, which were dichotomized to indicate whether or not papers should be included in a systematic review. Patterns of agreement in categorization of papers were assessed quantitatively using kappa statistics, and qualitatively using cross-case analysis. RESULTS: Agreement in categorizing papers across the three methods was slight (kappa =0.13; 95% CI 0.06-0.24). Structured approaches did not appear to yield higher agreement than that by unprompted judgement. Qualitative analysis revealed reviewers' dilemmas in deciding between the potential impact of findings and the quality of the research execution or reporting practice. Structured instruments appeared to make reviewers more explicit about the reasons for their judgements. CONCLUSIONS: Structured approaches may not produce greater consistency of judgements about whether to include qualitative papers in a systematic review. Future research should address how appraisals of qualitative research should be incorporated in systematic reviews.     

Methodological quality assessment of review articles evaluating interventions to improve microbial food safety

Review articles are a means of summarizing the potentially vast volume of research on a topic. However, the methodological quality of review articles varies, and reviews on the same topic may reach different conclusions. We evaluated 65 review articles published between 2000 and 2005 that addressed the effectiveness of microbial food safety interventions, using criteria for methodological soundness developed in the medical field. Overall, the methodological quality of the review articles was poor, with none of the reviews providing information on the method of locating primary research studies or the inclusion/exclusion criteria for selecting primary studies. None of the reviews included a critical appraisal of the methodological quality of the primary studies. Less than half of the reviews stated a focused research question, explored possible reasons for differences in the results of primary studies, discussed the generalizability of results, or proposed directions for future research. There is a need to improve the methodological quality of review articles on microbial food safety interventions if they are to be of use in policy and decision making.     

Qualitative environmental health research: an analysis of the literature, 1991-2008

Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.     

A framework for the integration of ecosystem and human health in public policy: two case studies with infectious agents

Despite that a significant body of published literature exists in the complex area of interconnection among the environment, ecosystems, and human activity, relatively little attention has been paid to the integration and analysis of ecological and human health data in the form of a conceptual model. Human and ecological health protection generally have been treated as separate domains of policy, with significant differences in both the analytic methods used to characterize risks and the policies developed for risk reduction. Understanding the relationships among population growth, development, natural resource use, the environment, human health, and ecosystems is an important area of both scientific inquiry and environmental policy. The present paper focuses on the development of a conceptual model for understanding disease causation, particularly infectious disease, and the implications of such a model for public policy. The conceptual model incorporates ecological and human health risk assessment information applied to case studies of two infectious diseases. This article takes an initial step toward formalizing the conceptual model so that research and assessment procedures can be developed.     

Opinion polling and decision making: a critical appraisal of quality of life assessment

The relationship between quality of life (QOL) assessments and decision making, in relation to the delivery of health services, is subjected to critical appraisal. Three levels of decision making in the health care system are taken into account in the analysis. Criticisms of opinion polling provide the basis for the appraisal. Examples of criticisms considered are: Might the use of QOL information be manipulative? Could the interviews or questionnaires used to obtain QOL data influence personal opinions? Are the methods used sometimes defective and/or superficial? Will QOL information always be used in decision making in ways that are ascertainable and justifiable? It is concluded that the time has come for the main focus of critical appraisal in QOL research to shift, from an emphasis on evaluation of the quality of methods used for assessments of QOL, toward an emphasis on the practical usefulness of QOL data.     

Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals

Resource scarcity is the raison d'être for the discipline of economics. Thus, the primary purpose of economic analysis is to help decision-makers when addressing problems arising due to the scarcity problem. The research reported here was concerned with how cost-effectiveness information is used by the National Institute for Health & Clinical Excellence (NICE) in national technology coverage decisions in the UK, and how its impact might be increased. The research followed a qualitative case study methodology with semi-structured interviews, supported by observation and analysis of secondary sources. Our research highlights that the technology appraisal function of NICE represents an important progression for the UK health economics community: new cost-effectiveness work is commissioned for each technology and that work directly informs national health policy. However, accountability in policy decisions necessitates that the information upon which decisions are based (including cost-effectiveness analysis, CEA) is accessible. This was found to be a serious problem and represents one of the main ongoing challenges. Other issues highlighted include perceived weaknesses in analysis methods and the poor alignment between the health maximisation objectives assumed in economic analyses and the range of other objectives facing decision-makers in reality.     

Uncertainty in environmental health impact assessment: Quantitative methods and perspectives

Environmental health impact assessment models are subjected to great uncertainty due to the complex associations between environmental exposures and health. Quantifying the impact of uncertainty is important if the models are used to support health policy decisions. We conducted a systematic review to identify and appraise current methods used to quantify the uncertainty in environmental health impact assessment. In the 19 studies meeting the inclusion criteria, several methods were identified. These were grouped into random sampling methods, second-order probability methods, Bayesian methods, fuzzy sets, and deterministic sensitivity analysis methods. All 19 studies addressed the uncertainty in the parameter values but only 5 of the studies also addressed theuncertainty in the structure of the models. None of the articles reviewed considered conceptual sources of uncertainty associated with the framing assumptions or the conceptualisation of the model. Future research should attempt to broaden the way uncertainty is taken into account in environmental health impact assessments.