Research Methods in Health Promotion

Laura F. Salazar, Richard Crosby, Ralph J. DiClemente

• Publisher: Jossey-Bass
• Year: 2015
• ISBN:
  9781118448427
• Edition: 2
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

The bestselling textbook to understanding health research, updated and expanded

Research Methods in Health Promotion provides students and practitioners with essential knowledge and skills regarding the design, implementation, analysis, and interpretation of research in the field of health promotion. Now in its second edition, this bestselling textbook has been updated with more recent research methodologies and additional information on sampling, participatory and survey research, and qualitative data analysis. The entire research process is covered, with specific points relating to both qualitative and quantitative research. By breaking the daunting process of research into simple and well-defined steps, this user-friendly text encourages students to think about research as a sequential process and provides explanations that facilitate better understanding of each step in the research process. A separate set of chapters cover the more quantitative methodological areas including designs, measurement, sampling, and data analysis in depth, giving readers the understanding they need to apply in practice.

This book also provides applied chapters that illustrate the practical aspects of the research process, along with other critical information including grant writing and scientific writing.

• Evaluate the ethics, design, analysis, and interpretation of research
• Identify and understand the key components of research studies
• Analyze and interpret the results of experimental and survey research designs
• Understand the process of publishing a research report and constructing a grant proposal

Research Methods in Health Promotion is ideal for both undergrad and graduate methods courses in health promotion and public health.

Part One

Foundations of Health Promotion Research

Chapter 1

Key Steps in the Research Process

Richard A. Crosby
Laura F. Salazar
Ralph J. DiClemente

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Learning Objectives

• Understand how the health promotion discipline constitutes a paradigm shift in terms of its emphasis on preventing disease.
• Understand the nine-step model and be able to apply this to your own research project.
• Understand the importance of rigor in health promotion research and how to achieve greater rigor.
• Consider issues in scholarship, grantsmanship, and ethics that are part of the research process.

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Health promotion has become a cornerstone of efforts designed to prevent morbidity and premature mortality (Smedley and Syme, 2000). Indeed, many nations have embraced health promotion as an approach to enriching and extending the lives of their people. Core tasks of health promotion include the primary and secondary prevention of disease and health-compromising conditions. These tasks are reflected in two overarching goals established by the United States Department of Health and Human Services: to “increase the quality and years of healthy life” and to “eliminate health disparities” (Department of Health and Human Services, 2010). Of course, the broad scope of these tasks presents an enormous challenge to the discipline of health promotion. This challenge demands that the efforts and resources of health promotion practitioners be firmly grounded in the context of research findings.

To begin, it is important to state that health promotion research is the harbinger of effective health promotion practice. Accordingly, a great deal of time and attention should be devoted to research agendas before health promotion programs are designed and widely implemented. Moreover, successful research endeavors must ensure rigor, which is the hallmark of scientific inquiry. Rigor is properly thought of as a quantity—it exists (or fails to exist) in varying degrees. Although no study can be “perfect” in rigor, studies can have a high degree of rigor. As rigor increases, confidence in the findings also increases. Therefore rigorous studies have great potential to shape health promotion practice.

Although this book focuses on the application of research methods to health promotion, there are at least two frameworks that address the broader set of issues relevant to the conceptualization, design, implementation, and evaluation of programs. In particular, one framework, the RE-AIM model (Glasgow, Vogt, and Boles, 1999) can be used as both a design and an evaluation tool for health promotion planning. The acronym stands for five stages. The first is Reach, which represents the level of spread or diffusion of a health promotion program within a given population. The second is Effectiveness, which represents the utility of the program to make a difference when used in ordinary circumstances. The third is Adoption, which is the uptake of the program by health promotion professionals. The fourth is Implementation, which describes the fidelity of program use among those adopting it. The final stage is Maintenance, which represents the ongoing and correct use of the program such that substantial changes to morbidity and mortality can occur.

The second framework, the PRECEDE-PROCEED model (Green and Kreuter, 2005), is a comprehensive model for organizing the health promotion planning process from its inception to its widespread implementation and ongoing evaluation. This planning model is one that should be firmly understood by anyone engaged in health promotion and, by extension, anyone engaged in health promotion research. The two models are depicted in Figures 1.1 and 1.2, which provide overviews of their logic and utility for health promotion.

Figure 1.1 The RE-AIM Model

Figure 1.2 The PRECEDE-PROCEED Model

Source: Green & Kreuter (2005), with permission.

Without question, the rewards of health promotion research are the excitement generated by evidence-based conclusions along with the associated implications for widespread implementation and ultimately the effects on public health. We may think of health promotion research as a journey down the research highway that reveals insights into human behavior pertaining to health and wellness. This exploration into people's lives should never be taken for granted; indeed, the opportunity provides health promotion practitioners a partial blueprint for the design, implementation, and justification of behavioral and structural interventions.

As with any journey, however, there are many decisions to make and myriad options from which to choose. Each leg of this research journey will have consequences (both good and bad) and, depending on the path taken, may result in reaching a crossroads or even a dead end, so it is important to consider each decision point and plan your journey carefully. Because you may not have been on this type of journey before, you won't be expected to travel alone. We will be your tour guide for this journey, walking you through the research process, helping to identify salient points of interest, and warning you of any potential dangers.

In this journey, the mode of transportation will be the methodological paradigm applied to your research. From the Greek word paradeigma, paradigm literally means model, pattern, or example; however, this rather simple definition can be expanded to encompass a “worldview” that may be influential in shaping the development of a discipline. A methodological paradigm is a discipline's view of which research techniques and practices are promoted and should be practiced. A discipline's methodological paradigm has strong implications for how the discipline as a whole will progress. Thomas Kuhn, a twentieth-century professor in philosophy and the history of science, is credited with popularizing the term paradigm. He wrote a provocative book, The Structure of Scientific Revolutions, in which he describes the history of science as being composed of “a series of peaceful interludes punctuated by intellectually violent revolutions” (Kuhn, 1970, p. 10), which can change profoundly the existing worldview and result in a paradigm shift. He articulated the importance of paradigms in shaping and guiding a scientific discipline:

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paradigm

a way of viewing the world around you; this includes the way in which disciplines conduct research

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A shared commitment to a paradigm ensures that its practitioners engage in the paradigmatic observations that its own paradigm can do most to explain. Paradigms help scientific communities to bind their discipline, in that they help the scientist create avenues of inquiry, formulate questions, select methods with which to examine questions, define areas of relevance, and establish or create meaning. A paradigm is essential to scientific inquiry [Kuhn, 1970, p. 142].

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The establishment of health promotion as a discipline can be viewed as a paradigm shift in that health promotion researchers and practitioners place an emphasis on improving health and well-being and preventing disease, where previously the focus had been on treating disease. To truly have an impact on the health of the public, prevention requires a body of knowledge generated by rigorous research to help inform its efforts. As was ancient Rome, rigor is built “one brick at a time.” Fortunately, clear blueprints exist for building rigorous studies. In fact, successful research can be characterized by a series of well-defined steps, all of which are essential. Following the steps sequentially is equally important. In this chapter, we provide an overview of the research process (the “journey”) beginning with discovery of the idea; we then illustrate each of the essential and sequential steps in detail. We also emphasize the...