What is ResearchCHAPTER 1

A research refutes inadequate practices based solely on unscientific methods including tradition, authority, personal preferences, untested hypotheses or common sense. The research helps to generate evidence-based knowledge. Epidemiology provides an acceptable scientific method for public health and has been developed over a period of last few centuries, concomitantly with the growth of modern 4scientific researches. However, epidemiology is also criticised as being mainly confined to the biomedical or the clinical domain, focussing on the distribution and determinants of disease rather than having a broad community and ecologic perspective (Shy, 1997). Recently, efforts have broadened to include the social, economic, environmental and cultural determinants of health as a social epidemiology.

A research is often described as being theoretical research (i.e. developing, exploring or testing the theories or ideas) or empirical research (i.e. based on observations and measurements of reality) on the basis of philosophical approach (WHO, 2001). However, in reality, most researches are a blend of these two terms: a comparison of theories about how the world operates with observations of its operation. Many health researches are based on epidemiological designs and tend to be empirical.

The Epistemology is the philosophy of knowledge or of how you come to know, while a methodology is more focussed on the specific ways (i.e. methods) that you use to generate knowledge. That is why the methodology of a research can be broadly based on a theoretical framework. The theoretical framework should disclose the methods, methodology, theoretical perspective and epistemology. A research which is guided by behavioral, social, and organizational (or systems) paradigms and examines how individual, community and health system factors may affect the leprosy prevalence and leprosy control programs in a country, can be based on the theoretical framework of the Health Belief Model (Rosenstock et al., 1974). In fact, many researches related with preventive health behaviors including health promotion, with compliance with recommended medical regimens, and with health care visits are based on the Health Belief Model. Researches seeking to understand maternity service utilization can be based on the theoretical framework of Andersen's Behavior Model (Andersen, 1995; Karkee et al., 2014a; Titaley et al., 2009) or Ecological model, (Wild et al., 2010). A conceptual framework, such as the three delays framework for utilization of the institutional delivery services, has been drawn using such theoretical bases (Karkee et al., 2013a; Thaddeus and Maine, 1994).

Over the past centuries, the scientific method has refined itself and has made its base on: (i) Empiricism: the notion that enquiry ought to 5be conducted through observation and knowledge verified through evidence; (ii) Determinism: the notion that events in the world occur according to regular laws and causes.

The reasoning or the inference is the main characteristic of a research. The logic of a scientific reasoning can be a deductive or an inductive. The deductive reasoning starts from a broader theory and narrow down to hypothesis, specific observations and a conclusion (top-down), while the inductive reasoning starts from a specific observation, pattern, tentative hypothesis and to a broader theory (bottom-up). Thus, the deductive and inductive approaches are complementary making a cyclic process (Figure 1.1): the deductive sets out from a theory and hypothesis to a conclusion while the inductive sets out from an observation to a tentative hypothesis and a theory. A scientific hypothesis is a statement that specifies the expected nature of the relationship between two or more sets of variables and plays an important role in science. Note that a hypothesis can be induced from the observations or the measurements or be deduced logically from the statements and/or the mathematical models which specify the causal relationships postulated by the theories.

The inductive process is more open-ended, exploratory and emphasizes on ‘observation’ (i.e. empiricism/naturalistic); while the deductive process starts with a preoccupation (i.e. hypotheses 6or positivistic/rationalism) and tests the hypotheses by making observations (i.e. whether the hypotheses are falsifiable). The inductive process suits a qualitative research while the deductive approach is applied usually in a quantitative research. Historically, the scientific enquiry was built on the philosophy of deductive logic (i.e. quantitative paradigm). Epidemiology, the base of public health research, is largely quantitative. The purpose is to find possible causal relationships between exposure and outcome and to generalize the findings to a population. However, public health issues can be complex in nature and quantitative research findings alone are insufficient to support practitioners and policy makers in making evidence-based decisions. Human behavior, thoughts, opinions, interactions, and perceptions (i.e. questions on why and how) may need detail qualitative investigation. So, both processes may be necessary to investigate in a ‘pragmatic way’.

Research is an important aspect of health sciences. The term ‘health research’ can denote a broad range of research in health sciences, which can be conceptually distinguished into four groups on the basis of object and level of analysis as shown in Table 1.1: biomedical research, clinical research, epidemiological research, and health systems research (Frenk, 1993).