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Global Health and Health Policy 99: Research Methods in Global Health and Health Policy Harvard University

Faculty of Arts and Sciences Spring 2012 Course Syllabus Instructors: Keren Ladin (kladin@fas.harvard.edu) PhD Candidate in Health Policy (Ethics) Prachi Sanghavi (sanghav@fas.harvard.edu) PhD Candidate in Health Policy (Evaluative Sciences & Statistics) Sorapop Kiatpongsan (ksorapop@gmail.com) PhD Candidate in Health Policy (Decision Sciences) Alecia McGregor (amcgreg@fas.harvard.edu) PhD Candidate in Health Policy (Political Analysis) Dorothy Romanus (romanus@fas.harvard.edu) PhD Candidate in Health Policy (Decision Sciences)

Office hours to be posted online

Meeting Time and Place: Wednesdays 4 - 6 PM in Sever Hall 214

General Overview Global health and health policy are interdisciplinary fields of study that apply the theories and methods of statistics, sociology, political science, economics, management, decision science, and philosophy to study population health and health care. Research from these fields influence a variety of policy settings. For example, the Patient Protection and Affordable Care Act, drew upon health policy research to develop programs for improving quality of care and lowering costs. Similarly, global health research informs international institutions, such as the World Health Organization, to determine health guidelines for all countries. At the local level, global health and health policy research can inform practices inside hospitals, initiate programs for diseases like HIV, and regulate the restaurant industries. In this course, we will: (1) introduce you to the fundamentals of research design and methods in global health and health policy, (2) assist you in developing your research projects, and (3) help you craft policy recommendations that can impact health care systems and public health. By understanding these fundamentals, you will also become a more discerning consumer of published research.

Course Objectives By the end of this course, we hope that you will have learned to:

Develop your own research questions and hypotheses, grounded in a thorough literature review Execute your own research plans by collecting data, analyzing data, developing conclusions, and identifying health policy implications Articulate your research findings both in oral presentations (in informal class settings and in a formal conference setting) and in written presentation Critically evaluate empirical and theoretical papers in the global health and health policy literature Provide useful and critical comments to peers and colleagues Participate in research discussions by asking questions and sharing your evaluations of relevant global health and health policy topics

Course Participants Course enrollment is limited to seniors in the global health and health policy secondary field, or juniors in the global health and health policy secondary field who receive prior permission from the course head. GHHP 99 does not meet the distributional requirements for the secondary field, but it satisfies the GHHP research requirement.

Course Requirements Students will be expected to complete assigned readings and participate in class discussions. They will also develop an original piece of health policy research, and submit the final paper on May 3, 2012 summarizing their project. Format requirements and expectations are listed below and will be discussed later in the semester. Students will also be asked to complete a small number of shorter assignments and present preliminary research findings to the class.

Research Paper and Presentation The final research paper should include:

A synthesis of relevant empirical literature and theoretical perspectives (6-8 pages) A clear discussion about how the research project fills gaps in existing knowledge or improves our understanding about the problem/field, statement of hypotheses, and description of the conceptual model (2-4 pages) A thorough description and justification of all research methods used (including sampling procedures and instruments used, if applicable) (3-4 pages) A presentation and analysis of results from the investigation, (4-5 pages)

A discussion section that includes 1) implications for health policy and/or future research and 2) a thorough description of all relevant study limitations (4-6 pages)

Students should use section headers to break up the paper. The final paper should be a minimum of 25 pages (a maximum of 30 pages) of text, excluding references and appendix sections. Students should use 12-point Times New Roman font and the paper should be double-spaced with 1-inch margins. Three quarters of the way through the semester, students will give a short presentation on their research projects and receive feedback from their classmates and the instructors. Faculty and students affiliated with the Global Health and Health Policy secondary field will be invited to attend the presentations.

Class Protocol Students are expected to attend all classes and actively participate in group activities. Please email all of the instructors if you expect to be absent. During class, cell phones must be turned off or set to vibrate mode. During class, laptops are prohibited unless approved by instructors on an individual basis.

Course Grading Final grades in the course will be based on class participation, small group engagement, assignment completion, midterm presentation, and final paper. Class participation Assignments CITI Training Topic, Research Question, Hypothesis Methods Homework Research Proposal Midterm Presentation Final Paper 15% 25% 3% 5% 5% 12% 20% 40%

Assignments are due at the beginning of class. Late materials will not be accepted without prior discussion and permission from the instructors.

Course Outline # 1 Date 1/25/12 Title Course Introduction broad course requirements and logistics and how to think about a good research question; Hypothesis generation How to conduct a health policy study: Getting started! (Research question, hypothesis, literature review, research design) In-class group work Topic, Research Question, Hypothesis (due Monday February 6, 2012 at noon) CITI training (due February 15, 2012 at noon) Assignment Due



4 5 6

2/15/12 2/22/12 2/29/12

Ethical considerations in research Quantitative methods - descriptive inference; cost-effectiveness analysis Quantitative methods - causal inference

Homework (will be posted, due February 29, 2012 at noon) Research Proposal (due Monday, March 19, 2012 at noon)


Qualitative methods

8 9

3/14/2012 Spring Break NO CLASS 3/21/2012 Scientific Writing

10 3/28/2012 Case Study - Article critique 11 4/4/2012 In Class Presentations (Round 1) In Class Presentation In Class Presentation

12 4/11/2012 In Class Presentations (Round 2) 13 4/18/2012 Research in practice, translating research into policy 14 4/25/2012 Course wrap-up

Final Research Paper (25 pages) Due: Thursday, May 3rd.

Week 1: 1/25/2012

Exploring and Generating Health Policy Research Ideas and Research Sorapop Kiatpongsan and all Instructors

Description In this session, we will review the syllabus, course objectives, and motivations behind the course design. We will also introduce you to ways of generating research ideas and transforming them into good research questions. Readings (Suggested): The New England Journal of Medicine Webpage (The Health Policy Session: http://www.nejm.org/health-policy-and-reform) The Health Affairs Journal Webpage (http://www.healthaffairs.org/) Cummings SR, Browner WS, Hulley SB. Conceiving the Research Question. Pp. 17-24 in: Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB. (Eds) Designing Clinical Research. An Epidemiologic Approach, 2nd Ed. Lippincott, Williams & Wilkins: New York, 2001. (http://www.med.mcgill.ca/epidemiology/courses/EPIB660/2008/EPIB%20660%20%202008%20-%20session%202%20-%20pdf%201.pdf) Lipowski EE. Developing great research questions. Am J Health-Syst PharmVol 65 Sep 1, 2008.(http://www.ashpfoundation.org/MainMenuCategories/ResearchResourceCenter/Fosteri ngYoungInvestigators/AJHPResearchFundamentalsSeries/Developinggreatresearchquestions. aspx)

Week 2: 2/1/2012

How to Start a Research Project -- Conducting a Literature Review, Formulating a Hypothesis and Choosing a Study Design Alecia McGregor and Keren Ladin

Description: After youve formulated a research question, how do you go about looking for answers? In this session, you will learn how to effectively conduct the research involved in putting together your literature review, as well as what constitutes an excellent literature review. We will also consider which types of research designs might be appropriate to answer your research question, and how might you go about collecting or accessing data, depending on the type of question at hand. Readings: Boote DN & Beile P (2005). Scholars Before Researchers: On the Centrality of the Dissertation Literature Review in Research Preparation. Educational Researcher, Vol. 34, No. 6 (Aug. - Sep., 2005), pp. 3-15. (Available through J-STOR). Creswell, John W. Research Design: Qualitative, Quantitative, and Mixed-Methods Approaches 3rd Edition. Los Angeles: Sage Publications, 2009. Chapter 1. (To be posted online)

Week 3: 2/8/2012

In-Class Group Session All Instructors

Description: In this session, you will have a chance to offer feedback on your peers research topics, as well as to receive feedback on your own chosen topic. Readings: Read your partners topic, research question, and hypothesis and come to class prepared with three comments and suggestions. ** Assignment Due Before Class on February 8th: Brief description (limited to 1 page) of a potential research topic in health policy, why you are interested in studying that topic, your research question, and your hypothesis statement. If you have more than one topic in mind, please rank them in order by excitement or interest in the topic.

Week 4: 2/15/2012

Research Ethics: The Harvard IRB, Informed Consent, and Other Ethical Quandaries in Health Policy Research Keren Ladin

Description: This class will review the components of the IRB proposal for GHHP 99 and discuss relevant details, such as informed consent and ethical data collection procedures. We will also discuss some of the ethical challenges of health policy research using a case study. Readings: IRB-Proposal for GHHP 99 (To be posted on class website). Kass, NE. An Ethics Framework for Public Health. American Journal of Public Health. 2001; 91(11):1776-1782. (http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.91.11.1776) Bhutta, ZA. Ethics in international health research: a perspective from the developing world. Bulletin of the World Health Organization 2002;80:114-120. http://www.scielosp.org/pdf/bwho/v80n2/a06v80n2.pdf Case: Reverby, SM. Listening to narratives from the Tuskeee syphilis study. Lancet. 2011; 377(9778):1646-1647. Reverby, SM. Hasting Center Report Blog. 10/06/2010. http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4919&blogid=140 Minogue K and E Marshall. Guatemala study from 1940s reflects a dark chapter in medicine. Science. 2010; 330(6001):160. http://www.sciencemag.org.ezpprod1.hul.harvard.edu/content/330/6001/160.full.pdf *For this session, all students are required to complete the online CITI training, available at this website: http://www6.miami.edu/citireg/

Week 5: 2/22/2012

Quantitative Methods - Descriptive Inference and Cost-Effectiveness Analysis Prachi Sanghavi, Dorothy Romanus

Description: This first hour of this class will introduce students to descriptive statistical inference and survey design. During the second hour, students will be introduced to the methods and applications of decision analysis and cost-effectiveness analysis in health care technology assessment, health policy analysis, and health resource allocation. Readings: Alan Zaslavsky, Notes on Research Design and Data Collection, 1995. (To be posted online) Super Crunchers. Ian Ayres. Bantan Dell. New York, NY. Chapter 4. How should physicians treat evidence-based medicine? (to be posted online) Sue J. Goldie, Jeremy D. Goldhaber-Fiebert, Geoffrey P. Garnett. Chapter 18: Public health policy for cervical cancer prevention: The role of decision science, economic evaluation, and mathematical modeling. Vaccine 24; S3: 155- 163. http://pdn.sciencedirect.com.ezpprod1.hul.harvard.edu/science?_ob=MiamiImageURL&_cid=271205&_user=209690&_pii=S 0264410X06006591&_check=y&_origin=browse&_zone=rslt_list_item&_coverDate=200608-21&wchp=dGLzVlS-zSkzS&md5=c0e3521a1e55fe8f95160f11c1e88ea4/1-s2.0S0264410X06006591-main.pdf Joanna E. Siegel, Milton C. Weinstein, Louise B. Russell, et al. Recommendations for Reporting Cost-effectiveness Analyses. JAMA, 1996; 276: 1339 1341. http://jama.ama-assn.org.ezp-prod1.hul.harvard.edu/content/276/16/1339.full.pdf+html Please skim through this applied example of cost-effectiveness analysis: Sue J. Goldie, M.D., M.P.H., Lynne Gaffikin, Dr.P.H., Jeremy D. Goldhaber-Fiebert, A.B., Amparo Gordillo-Tobar, M.D., Ph.D., Carol Levin, Ph.D., Cedric Mahe, Ph.D., and Thomas C. Wright, M.D., for the Alliance for Cervical Cancer Prevention Cost Working Group. CostEffectiveness of Cervical-Cancer Screening in Five Developing Countries. NEJM 353;20: 2158 2168. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMsa044278

Week 6: 2/29/2012

Quantitative Methods: Causal Inference Prachi Sanghavi, Dorothy Romanus

Description: In this class, students will be introduced to causal statistical inference. We will discuss randomized experiments and then discuss quasi-experimental analyses, which offer solutions for conducting research when experiments are not possible or feasible. Readings: Dowd B, Town R. Does X Really Cause Y? AHRQ. September, 2002. http://www.academyhealth.org/files/FileDownloads/DoesXCauseY.pdf

Read: 1-10, Skim: 11-18 William R. Shadish, Thomas D. Cook, Donald T. Campbell, Experimental and QuasiExperimental Designs for Generalized Causal Inference, Boston: Houghton Mifflin, 2002. Read Chapter 1: 1-26; Chapter 8: 246-269; Chapter 2: 53-63; Chapter 3: 83-93; Chapter 4: 103-110, 115-118, 128-130; Chapter 5: 135-144, 156-161. Gary King, Emmanuela Gakidou, Kosuke Immai, Jason Lakin, Ryan T. Moore, Clayton Nail, Nirmala Ravishankar, et al. 2009. Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme. Lancet 373(9673): 1447-54. http://dash.harvard.edu/bitstream/handle/1/5130448/spi.pdf?sequence=1 Please skim this example paper of an experimental design. A. N. Trivedi, A. M. Zaslavsky, E. C. Schneider and J. Z. Ayanian. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med 2005;353:692-700. http://www.nejm.org/doi/pdf/10.1056/NEJMsa051207 Please skim this example paper of a quasi-experimental design.

Week 7: 3/7/2012

Qualitative Methods Gillian Steel-Fisher, Ph.D., M.Sc., Research Scientist and Assistant Director of the Harvard Opinion Research Program (Guest Lecturer)

Description: Researchers that conduct qualitative research can provide unique and powerful perspectives on social science phenomena. In this session, we will discuss the fundamentals of qualitative research, the differences between qualitative and quantitative research, and the importance of maintaining high quality standards when employing these research methods. The specific techniques that well be reviewing include in-depth interviews and focus groups, among others. Readings: Miquel-Verges F, Woods SL, Aucott SW, Boss RD, Sulpar LJ, Donohue PK. Prenatal consultation with a neonatologist for congenital anomalies: parental perceptions. Pediatrics. 2009 Oct;124(4):e573-9. Epub 2009 Sep 7. Pope, Catherine and Nick Mays. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995. Vol. 311: 42-45. Mays, Nick and Catherine Pope. Rigour and Qualitative Research. BMJ. 1995. Vol. 311: 109-112. ***Assignment Due March 19, 2011: Students must email a research proposal--a document that includes both a draft Introduction (literature review, research question, hypothesis and significance) (5 pages) and a brief description of research methods (1 page) by 12:00pm on March 19, 2011.

3/10 3/18


Week 9: 3/21/2012

Scientific Writing: How to Communicate Your Research Effectively Guest Speaker: Donald Halstead ****NOTE-SPECIAL CLASS TIME: 6:15-8:15****

Description: This session will present ways to improve your academic writing skills. We will review some of the most common writing pitfalls, how academic writing differs from other writing forms, discuss IMRAD, and provide you with a set of tools that will allow you to effectively convey your findings. Readings: TBD

Week 10: 3/28/2012

A Case Study Sorapop Kiatpongsan

Description: A health policy article recently highlighted in popular media outlets (e.g., TIME magazine, New York Times and the Boston Globe) will be selected to be a model to discuss how health policy studies are communicated to and perceived by the public. Discussions will also focus on challenges in describing the methodology and presenting key findings. Reading:
The article will be assigned 1 week prior to the class time.

Week 11: 4/4/2012

Midterm Presentations Round 1 All Instructors

Description: Students will give short presentations of their research in progress, and receive feedback from their peers and instructors. One half of the class will present this week. Readings: None

Week 12: 4/11/2012

Midterm Presentations Round 2 All Instructors

Description: Students will give short presentations of their research in progress, and receive feedback from their peers and instructors. The remaining half of the class will give their presentations. Readings: None

Week 13: 4/18/2012

Research in Practice: How Research Guides Policy David Cutler, PhD, Otto Eckstein Professor of Applied Economics

Description: This session will illustrate the linkage between research and policy, and will illustrate the importance of evidence-based policies in todays health care environment. Readings: Cutler, David M. (2010) "The Simple Economics of Health Reform," The Economists' Voice: Vol. 7 : Iss. 5, Article 2. White, Chapin (2010). "The Health Care Reform Legislation: An Overview," The Economists' Voice: Vol. 7: Iss. 5, Article 1.

Week 14: 4/25/2012

Moving Beyond-- How Research and Health Policy Might Be Relevant to the Rest of My Life All Instructors

Description: Global health care leaders both use and create research daily. Our goal in this final session is to help you draw connections between the lessons discussed in class and your future career. Well discuss various career options within the field of health policy, and explore how individuals in these roles employ their research skills to affect political, social, and economic outcomes. Readings: Gawande, Atul, TESTING, TESTING. New Yorker, 12/14/2009, Vol. 85, Issue 41 Remarks of Bill Gates, Commencement 2007. Available online at: http://news.harvard.edu/gazette/story/2007/06/remarks-of-bill-gates-harvard-commencement2007/

***Assignment Due May 3, 2012 at 11:59pm: Final Research Papers