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Education Research in Primary Care: Co-creating a Project Plan

Abigail Woodward12 July 2022

This post is written by Sophie Park (Professor of Primary Care and Medical Education)  and Dr Emily Owen (Research Assistant, Community Pharmacy and General Practice) 

The Society of Academic Primary Care (SAPC) in its 50th year, have collaborated with the Association for the Study of Medical Education (ASME) to host a joint conference event. Our SAPC Education Research Special Interest Group (SIG) met on Tuesday 5th July 2022 to discuss spaces for practitioner-informed research and enquiry.

It is sometimes hard to know where to start. You are a practitioner and have an area of keen interest, but feel the topic is so vast, any firm plans about research feel beyond reach. At the SIG, a group of scientists and practitioner ‘insider researchers’ met to discuss ways of beginning to bring a research idea into focus.

Stakeholder & Patient and Public involvement (PPI)

As practitioners, we often hold a view or perspective which relates to our own embodied experience and meaning-making processes about particular events. Reaching out at the outset of the project is crucial. Attentive listening to how others experience an issue is important, to help understand what others feel the key and important problems are. Continuing these conversations then enables a dynamic movement between inductive (emergent) response to generated data and deductive (pre-determined) focus on the data, embracing a range of views and concerns.

Once you start to have conversations, consider how PPI/stakeholder perspectives might shape how you approach the literature and data about this topic. How might this focus your project and analysis? We shared an on-going review (PROSPERO: CRD42022314280) exploring collaborative and integrated working between General Practice and Community Pharmacies. Having conversations with PPI/stakeholders is informing possible ways of thinking about patient care (access, help-seeking behaviour, psychological safety, continuity); working with and across multi-disciplinary colleagues; and professional development and education. These conversations support an explicit and reflexive movement between experiential priorities and the existing evidence data, helping to prioritise ways of drawing together analytical categories.

Rather than feeling anxious about the impact of your own and others’ experience on the production of data, celebrate your growing insights and understandings about these experiences, and be reflexive about how they are shaping your views during the production of the research protocol, project, and analysis. You will not be able to incorporate all PPI/stakeholder views and agendas, so establish clear expectations about the purpose of your conversations. Enjoy the contrast of views and note how these differences emerge. Might this provide you a new avenue to explore your topic?

Theory

We tend to think that whatever view we hold is ‘normal’. It is helpful, therefore, to share and discuss your ideas with others. These discussions will make visible areas of ‘cognitive dissonance’ or tensions and help to build insight about the particular theories or evidence-base you are using. Start to consider contrasting perspectives. How do these differ from yours? Is your view still helpful to hold, or might you begin to transition to a different position in your approach? This curiosity and movement between different ‘ways of knowing’ are the basis of ‘critical thinking’. These help to cultivate an appetite to understand other positions, supporting you to build a rationale for why you are approaching your research in a particular way, and how you plan to produce particular forms of knowledge outputs or artefacts.

Methods

Some approaches to research will feel more comfortable than others. Be brave and consider multiple options before you plan your project. Consider what it is you want to know, then how a different approach might enable you to know about this topic in a different way. How might each contribute to your overall aims about contribution to practice and policymaking, and moving your disciplinary knowledge field forwards? For example, do you want to create an evaluation project? These often aim to measure the effectiveness of an ‘intervention’, then perhaps make comparative claims. Instead, you might want to conceptualise it as a process, making visible the nature of that process through more exploratory or in-depth qualitative methodologies.

There is no ‘right answer’, and each project/approach will contribute in different and particular ways. What is important, is that you consider these aspects in advance, so that you can plan and anticipate the challenges and opportunities of each theoretical and practical approach from the outset.

Be Realistic

At the beginning, it can feel completely over-whelming. The planning process can feel endless: you want to move onto the practical ‘doing’ of the project as soon as possible. Be patient. Use your enthusiasm to move through the processes above: engagement and dialogue with stakeholders/PPI; reading, and re-reading literature to identify your gap; and mapping the available methods and potential knowledge outputs. Second, keep the project feasible. A focused project will enable you to progress to the next project. Ask yourself what is most important to you at this moment in time and start from there.

Peer Support

Lastly, utilise peer support during your research planning. Enjoy the creative production of your project and share your challenges. Colleagues may have experienced something similar or be able to highlight where you are identifying something innovative in your area of expertise. Through presenting your ideas to an audience, you can shift your thinking about a project: having been immersed in a particular topic, it is sometimes helpful to realise which areas are new or interesting to others. These conversations can also help you to focus your dissemination and spaces for impacting future research, practice, and policy.

Thank you to all who attended the SIG, we look forward to meeting again soon.

Researcher Tips for Conducting Remote Research in Older Populations

Megan Armstrong16 December 2021

Tasmin Rookes

This blog is written by Tasmin Rookes, Research Assistant for the PD-Care programme. Tasmin also runs a Research Assistant group – if you’d like more information about this group please email Tasmin here: t.rookes@ucl.ac.uk

Since the COVID-19 pandemic research activity, such as identifying, consenting, and assessing participants has been conducted online and remotely. With many clinical populations being older adults, without consistent levels of technology knowledge, this has introduced some challenges. Reflecting on the PD-Care feasibility study, I share our experience and learnings of conducting remote research with people with Parkinson’s.

Identifying potential participants

On the morning of clinics, send reminder emails to the clinical teams to remind them to approach potentially eligible participants with a copy of the participant information sheet.

When following up with a phone call to discuss further, have a loose script with the key information points participants need to know, including the next steps involved to get them enrolled.

Where relevant, recruit or include participants carers or family members to assist with explaining the study, setting up technology or assisting with future research activity, particularly if the person has mild cognitive impairment.

Consenting participants

If obtaining consent online, follow-up with phone calls or emails to reminder people to complete the consent form and keep it at the forefront of their mind. Older people often aren’t used to managing an email inbox, so sometimes resending the link to the consent form can help.

If obtaining written consent, via the post, follow-up after one week of posting to determine if it has arrived and if they have any questions. Be prepared for postal delays and always offer to resend out if participants have waited a long time.

If obtaining verbal consent, ensure you have posted or emailed a copy of the consent form, so participants can follow along. Ensure they are engaged by asking them to state their name and date for the recording. Read through each statement clearly, asking participants to confirm they consent to each statement. Be prepared for questions and consider that your answers are being audio recorded. Save audio recording in a secure location and complete a consent form stating verbal consent was obtained, to send a copy to participants, GPs, and upload to patient notes.

Completing assessments

Be aware of potential risk and safeguarding. If a participant discloses something concerning, follow the guidance in the study protocol and ask for advice from senior colleagues. Keep records of all decision making and collect the participants GP and clinical team contact details for future use.

Completing assessments can be lengthy and is more tiring when completed on a screen. Be transparent about how long they will take and offer comfort breaks or break into shorter sessions where appropriate. Also, providing a written copy of the assessments to participants can help them to follow along with the questions as they are being asked. Allow plenty of time for the assessment and give participants time to think and respond.

Consider whether the assessments you want to do can be completed remotely. If not, consider self-report measures or look for measures that have been adapted to be delivered remotely.

It is inevitable that some assessment appointments will be missed by participants. Send reminder letters, emails, or phone calls to prevent this from happening and provide them with your contact details, so they can inform you if they can no longer attend. Try to reschedule as soon as possible, particularly for follow-up assessments where timelines can be tight.

Be prepared for technical issues and understand how to talk someone through joining calls using the chosen software. Get an understanding of how confident they are, so you can support them and factor this into the time allocated.

Key messages

Most people are happy to conduct research remotely and on the whole older populations are comfortable using technology if they are supported.

Have a clear process in place and test with the team or PPI members before starting to recruit, to iron out any potential issues.

Allow plenty of time at every step, being patient, friendly and calm. You may be the only person they speak to that day, or they may be anxious about using the technology or completing the assessments, so this may help put them at ease.

Consider all potential impairments participants may have, including vision, hearing and speech, and have strategies in place to overcome these and be inclusive. These include, offering study documents in large print, providing contact through email or letter, and having a carer or family member present to support.

Be organised, keep logs of what has been done and what is still to do, so recruitment and follow-up schedules are adhered to.

As we develop more digital interventions and conduct research activity remotely, adapting our approach and using the tips outlined above, successful research conducted remotely with older populations is not only feasible, but can be successful and beneficial.