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Research design and methods

The main features of the study design and methods you select follow the question that has been posed. For example, you may be using a survey by questionnaire or interview; a case study of one or more persons or organisations; or a trial, which may be randomly controlled or use matched or waiting-list controls. It may be ethnographic, requiring time in the field to look at relationships, culture or communication; or action research, where practical problems are considered and where the feedback, changes and subsequent evaluation of change are all part of the research – rather like audit in its cyclical design.

Action research is a common mode of educational research. The primary purpose is to improve processes in order to improve the organisation, rather than to produce theoretical knowledge, which is a subordinate aim (Elliott, 1991). It appeals to those who like the idea of change and the feeling that the research they do actually contributes to it. It joins together both research and implementation, and is a much messier, more participative research method than most; so people who start it should not be those who demand precision or decimal points in their answers, and they should enjoy being involved with the teams and individuals who actually put the changes into practice (Somekh, 1995).

Participatory action research (PAR) goes a step further because it integrates the search for local solutions to real problems within an ethical framework that embraces the idea that those who are affected by a problem are in the best position to understand it. Thus, a key feature of participatory action research studies is collaboration with participants across every stage of the research process (identifying the problem, planning and carrying out the research, and analysing and applying the results). When situations are complex, PAR can contribute to advancing theory as well as achieving practical results (Whyte, 1989).

Research may also be cross-sectional or longitudinal; depending on what is the right way to answer the question and what resources are available. For example, cross-sectional designs can provide answers to the immediate success of a programme if success is seen in terms of, for instance, course satisfaction. They can also be used to see if different people are more or less satisfied depending on their learning preference, or to consider any other differences between them or between course presenters, or an interaction between both. But if you want to assess what really changed as a result of your educational intervention, then it has to be longitudinal.

Longitudinal design is expensive, not only because you have to have the researchers available over the length of the study, but also because you might have to spend funds on tracking your subjects over time. However, the benefits of longitudinal cohort studies are that you can answer more complicated questions. For example, if you were studying the impact of your programme on job satisfaction of nurses using a cross-sectional design, you would probably find that around a quarter were pretty dissatisfied. If you had a large enough sample, you could break it down into clinical contexts and see that one particular group (e.g. nurse practitioners) were very satisfied, while another (e.g.  mental health nurses) were very dissatisfied. You would be likely to conclude that the work role of mental health nurses has more factors likely to produce dissatisfaction than the role of nurse practitioners does. However, a longitudinal study might have assessed these nurses as students or in postgraduate training and looked at personality or at satisfaction then, and would probably have found that many of those who are disgruntled now were disgruntled then. This then allows us to see how much of the dissatisfaction is due to the person and how much is due to the job, which in turn means we may not need to continue to plough resources into the job alone, but also into individual intervention or selection issues.

Your research question and available resources will determine over what period you should assess and how many assessments you will need to make. Although it will vary according to the intervention made, where clinical interventions are the subject of research, patients are usually assessed during a baseline period, immediately after the intervention, a few weeks or months later, and after a year or two. Ideally, educational interventions would not differ much from this, but a minimum would be before, immediately after and 6–12 months later.

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