Research Guide

For every dollar spent in health and medical research, approximately $2.17 is returned in health benefits. The creation of knowledge through research activities underpins improvements in Australia’s health service delivery and intervention. Research activities attempt to create this knowledge through the systematic investigation of a topic, guided by research questions. This new knowledge then needs to be effectively translated into changes in clinical practice and policy to benefit the population of interest, in this case, children and adolescents who live with obesity and their families.

HWQld delivers collaborative, action-based clinical and research leadership for childhood obesity. HWQld host a team of dedicated clinicians and researchers who specialise in obesity prevention, treatment and research. If you would like guidance on research in childhood obesity, or if you would like to partner with us, please contact: POHT.C@hw.qld.gov.au

Research is a careful consideration of study regarding a particular concern or problem using scientific methods. The short answer is, yes! Research is everyone’s business. Anyone can do research, provided they have the right support, resources and tools. If you work in any capacity within a health service across Queensland, you can contribute to and lead research.

Finding a gap

A research “gap” is simply an unanswered question in the research literature. A research gap is an area that is yet to be explored or hasn’t been explored thoroughly. Gaps can be related to any aspect of research, such as a specific population, research method, an intervention or innovation, types of data collected, data analysis methods or other conditions.

The first step to finding a gap is to conduct a literature review. You could do this by searching for journal articles, books or grey literature (reports, government documents, policy statements) in your area of interest. It may be useful to create a search strategy to help you. You may also be aware of gaps simply from practising as a clinician. It’s important to confirm your practice gap is a research gap by thoroughly searching for any existing evidence about your gap.

Research question, aims and hypothesis

A good research question is the foundation of all research. It clearly states the problem you are trying to solve, whether that be a knowledge or practice problem.

How and What statements are typically the most useful.

Two examples of good research questions related to childhood obesity are:

1. How does consumption of sugar-sweetened beverages in adolescents with overweight or obesity change after completing a 4-week health professional-led educational intervention?
2. What are enablers and barriers for parents in completing an online prevention program for childhood obesity?

Build your team

Every team needs an experienced leader, especially a research team. An experienced research leader may hold a Honours or Masters degree, or a PhD, hold a Research Fellow or Officer position, be affiliated with universities/academia and/or be an expert in research processes, such as ethics and governance. A strong research leader can help to guide you through the major and minor details of research, right from developing your research question and applying for ethical approval, to writing a journal article and translating your findings into practice.

It’s important to first identify what your research needs are and who is best placed to support these. Research needs may relate to:

• Expertise in paediatric obesity
• Equipment e.g. scales, stadiometer
• Partnership with other services or organisations, particularly leaders in tackling paediatric obesity
  • Health and Wellbeing Queensland
  • The University of Queensland
  • Griffith University
• Ability to search electronic databases for literature e.g. EMBASE, PUBMED, Web of Science
• Funding
• Research assistance
• Ethical and governance approvals (see section below)
• Statistical support
• Translating your research into practice
• Publishing or presenting your research results
• Evaluating your research

There are many different types of research studies and it’s important to choose the type that best answers your research question. Here are some examples:

Sources of funding are numerous and varied. Liaise with your local clinical service, University and philanthropic organisations (such as the Children’s Hospital Foundation, The Smith Foundation) to find out what grant or funding opportunities may be available to apply for. The Queensland Government Grants Finder is a good place to start.

Before applying for funding, it’s important to understand what exactly you might need funding for. Here are some typical funding considerations:

• Research staff, including:
  • Research Leaders
  • Postdoctoral Research Fellows
  • PhD students
  • Research Assistants
• Clinical staff
• Administration support
• Clinical trial manager
• Study equipment
• Software or other licence purchasing
• Participant reimbursement fees
• Publication fees
• General dissemination of study findings
• Digital development
• Access to population datasets or independent datasets
• Transcribing recorded interviews or focus groups
• Conference registration and attendance
• Website design and ongoing maintenance costs

Yes – if you’re doing human research. Human research is research conducted with or about people, or their data or tissue. Participation in research involves taking part in surveys, interviews or focus groups, undergoing psychological, physiological or medical testing or treatment, undergoing observation by researchers, researchers having access to personal documents or other materials, the collection and use of body organs, tissues or fluids or access to information as part of an existing published or unpublished source or database.

The National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research guides all research involving human participants.

For research involving children and young people, there are unique ethical concerns such as:

• Their capacity to understand the research
• Possible coercion to participate in the research by parents, peers or researchers
• Conflicting values and interests of parents and children

Other ethical concerns involving children and young people living with overweight or obesity include:

• Understanding weight stigma
• The discussion of weight and its potential impacts
• The physical and psychological complexities associated with living with overweight or obesity

A Human Research Ethics Committee (HREC) reviews research proposals that involve human participants to ensure they comply with ethical standards. A HREC decides if it is ethical for you to conduct your proposed research. In Australia, these ethical standards are part of the National Health and Medical Research Council’s (NHMRC) National Statement on Ethical Conduct in Human Research. It outlines the national standards for the ethical design, review and conduct of human research.

Ethical reviews by HREC’s are undertaken at various risk levels, depending on the degree of risk to human participants in your research, or if you are conducting research in priority populations, such as children and young people or Aboriginal and Torres Strait Islander peoples.

If you’re unsure, contact your local HREC to discuss your research proposal risk level and what is required to submit a research proposal for ethical review. Working closely alongside your respective HREC for the duration of your study allows for greater flexibility in the in the conduction of research and collection of research outcomes.

Research governance refers to the processes used to ensure that research is conducted in-line with ethical principles, guidelines for responsible research, legislation and local and institutional policy. Elements of research governance include:

• Ethical approval
• Compliance with legislation, regulations, guidelines and codes of practice
• Legal matters including contracts and insurance
• Financial management including site-specific assessments and allocation of funding
• Institutional policy and procedures for responsible research conduct
• Management of collaborative research, especially important for multi-site research
• Reporting requirements

If you’re unsure, contact your local Research Governance Office and Research Governance Officer. Your local HREC will be able to point you in the right direction.

Public health organisations are required to conduct Site-Specific Assessment (SSA) of each research project to ensure that the organisation is a suitable site. This includes consideration of physical resources, staffing, insurance and indemnity requirements, and funding.

The SSA and HREC ethical review may occur at the same time, but decisions on SSA approval will only be made after the HREC has granted ethical approval. Each state or territory has a specific SSA form to be completed and submitted to the relevant research officer.

Research agreements are required for research with multiple partners, e.g. Universities, Research Organisations, private companies, or external health organisations. The agreement will outline the conditions of any collaboration for research, and the requirements of all parties in meeting their obligation in relation to the research project. The completion of this agreement is a collaboration between researchers and the governance officers, using the protocol and agreed processes to guide the details. A signed copy of the research agreement will be required to ensure approval of the SSA.

A research protocol is essential to produce high quality research outcomes. Protocols generally follow a conventional layout outlining the following details of the project:

The preparation of a protocol is important in the planning phase of a research project as:

The Children’s Health Queensland Hospital and Health Service research and education subsection provides a generic protocol template, aiming to offer medical, nursing, midwifery and allied health researchers a generic guide suitable for a broader range of clinical and scientific research enquiries.

Here is an example of a published research protocol in obesity in Australia.

Outcome measures

Outcome measures are directly related to your research question – what is it that you’re trying to determine, and what exactly do you need to measure to do this? Measuring outcomes is crucial to understanding the effectiveness of something.

Relevant to obesity and chronic disease, outcome measures may be measurable changes in:

• Health or health indicators, such as BMI;
• Dietary intake; or
• Physical activity patterns or psychosocial indicators, such as health-related quality of life.

Outcome measures may also refer to economic indicators, such as:

• Measuring the cost of delivering an intervention or service; or
• Its cost per positive outcome – indicators of value-based healthcare.

They may also be collected narratively (i.e. qualitative) – a research participant’s thoughts, attitudes and beliefs towards an aspect of your research are outcomes, and equally important in understanding the impact of your research impact.

This guide provides a simple, useful overview of different methods of data collection and analysis, and is a good first step to understanding the process of data analysis ^[2].

Engaging with a Biostatistician from the early stages of research project development can help to set your project up for success. Biostatisticians can provide valuable advice and input across all stages of the research lifecycle, from concept development to writing a methodology, collecting data, analysing data and presenting data in simple, relatable and accurate ways.

QFAB Bioinformatics is Queensland’s core facility for providing support in bioinformatics, biostatistics and biodata to health researchers across Queensland and provides analysis, training and coaching services to researchers and clinicians. If you are a member of their partner institutions, you can access these services.

For clinicians or researchers more familiar with data analysis, Laerd Statistics provides easy-to-understand statistical guides on performing various statistical tests, including a “Statistical Test Calculator” for figuring out which statistical test you might need to use.

It’s a common story – trying to get new evidence or a new guideline into routine practice, but realising just how difficult, complex and challenging it is, and not always knowing if you were successful.

Translating research into practice means transforming our understanding of science and research into meaningful changes in clinical practice or health policy – it addresses the “know-do” gap. Research translation is known by many different names – knowledge translation, research into practice, diffusion, dissemination, knowledge transfer and exchange (KTE) and knowledge implementation, as examples. The science of research translation is called implementation science.

Presenting your research

Conferences offer a great opportunity to develop your research career; providing a chance to network, learn about the latest research developments and understand the bigger picture in your respective field. Often you can begin to promote your work during the research phase at conferences ^[7]. Presenting your paper at a conference can be a valuable way of raising your profile as a researcher and obtaining valuable feedback to improve your research ^[8].

How to write an abstract

An abstract is one well-developed paragraph that covers all the essential academic elements of a full-length paper, including the background, purpose, focus, methods, results and conclusion of the research project. An abstract should be coherent and concise, able to be read as a standalone piece of information. Consider the following tips when writing an abstract ^[9]:

Research metrics – what do they mean?

Research metrics can provide evidence of influence or performance when applying for grants and promotions, quantify return on research investment when applying for grant renewals, highlight the research value in progress reports and identify who is using your published research(5). Examples include:

Social media

There are numerous social media platforms that can be utilised to promote your research. Check if researchers in your profession use a certain platform and focus your dissemination efforts there ^[7]:

Research and evaluation are often talked about in similar contexts. They both use methods to gather data and answer a question. However, both are different disciplines including different focusses and practices. Some of the key differences include ^[13]:

Evaluation

To be effective, evaluation of a service must be guided by a framework encompassing the following:

• A logic model containing; need, inputs, activities, outputs, short-term outcomes, medium-term outcomes,long-term outcomes.
• Evaluation questions including assumptions and external factors, linked to the logic model.
• A stakeholder map including upstream and downstream stakeholders.
• Criteria of merit including definitions and weighting.
• Evaluation map containing; the evaluation questions, criteria of merit, indicators, data sources and data collection methods.

Service evaluation seeks to assess how well a service is achieving its intended aims. It is undertaken to improve the quality of a healthcare service to maximise the benefit of the service users. Evaluation results are used mainly to inform local decision-making. Services need to consider the following questions to help direct their evaluations:

• How will we effectively measure the success and impact of our service?
• What data do we need to collect?
• How will we collect this data?
• Has this been done before in another service and what can we learn from them?

Although the actual outcome measures will differ depending on the location, target population, key health professionals involved and capacity of the service being delivered, below are some suggestions to consider:

Respect is key when working with children ^{[14] [15]}.

Involving children and young people in participatory research requires the researcher and clinician to consider and account for unique factors.

Below are key considerations for working with children and young people in research settings:

Participating in research

• Make sure you have choice, flexibility and adaptability in your research design
• Tell the child/young person and caregiver how the research will benefit them
• Have clear strategies for disengaging in research, and make sure the child/young person and caregiver is aware of these.
• Allow extra time during the consultation – invest time in getting to know the child as an individual
• Promote shared responsibility between the child and caregiver – they are collaborators in their child’s health

Ethics and consent:

• Be clear about the line between protection and safety versus participation
• Explain clearly everything that is involved in participating in the study, including risks and inconveniences, before asking for consent.
• Ensure children and young people can provide consent to participate in their own way, that is in line with ethical standards

Interacting with the child or young person:

• Be clear, honest, realistic
• Keep it simple
• Listen to what you are being told by children
• Assess health literacy of parents/caregivers and children prior to educating them
• Use picture-enhanced materials
• Include young children in some conversations
• Promote active participation – skills training, storytelling and characters
• Encourage children to be involved in their own education intervention
• Give supportive and timely feedback
• Ask the child or young person if they have any questions or feedback, encouraging them to share their feelings.

To conduct research successfully among vulnerable cultural populations, projects must include the following ^[16]:

1. A mix of consultation and engagement with the community across conception, evaluation design, data collection, analysis, report writing and dissemination.
2. Some form of needs and strengths assessment to understand the key issues in the community and the key enablers, barriers, supports and strengths that a good program would need to tap into or address in order to succeed.
3. Conceptualisation and design work prior to commencement, including leading involvement from an individual with in-depth knowledge of and connections in the Pasifika community, with evaluation expertise.

The following framework has been designed by researchers in the field as an indication of key factors to address when conducting research with Māori and Pacific Islander cultural groups: Te Whetu Rehua: A Guide to Deciding Appropriate Activities for He Oranga Poutama from Developmental Evaluation Exemplars: Principles in Practice ^[17].

An example from the field

The Healthy Kids, Healthy Families project is a community-based, face-to-face and culturally tailored obesity prevention program, targeting Māori and Pacific Islander families living in Logan. This program is part of the Good Start Program, a state-wide preventative health program that provides support for the health and wellbeing of Māori and Pacific Islander children and families. It is an initiative that aims to lower the levels of chronic disease and obesity of families using culturally-tailored education sessions and resources.

Delivered over 8-weeks, the Healthy Kids, Healthy Families program focusses on building the knowledge, skills and confidence of healthy eating, physical activity and positive parenting practices. The program is not only delivered by Multicultural Health Coaches identifying with a Māori and Pacific Islander cultural background, but it was also designed using a unique co-design methodology. This approach promotes equity and inclusion of all stakeholders, acknowledges and caters for diversity and creates a medium for openness, respect and shared purpose.

The co-design phase followed an evidence-based framework, with the following factors contributing to successful program development:

• Community engagement – suitable and identified consumers were recruited through community events, social media and staff networks. Without the networks already established by the Good Start team, including family and friends, recruitment would not have been as successful. This aspect is key to the success of the project.
• Needs assessment – the needs assessment was informed by Māori and Pacific Islander determinants of health, cultural protocol and practices and our previous experiences in community engagement. Survey questions were developed considering cultural appropriateness, health literacy and sensitivity of the topic. This ensured the collection of honest and truthful responses from consumers.
• Situational analysis – analysis of responses regarding knowledge, attitude and practice relating to nutrition, physical activity, finance, culture, family and accessibility to services, identified priority areas for the prevention program to address. Results were presented back to consumers to ensure findings were an accurate representation of the community.
• Collaborative design – the program was designed drawing from the knowledge, experiences and expertise of community consumers, cultural advisors and health professionals, conducted by face-to-face “talanoa” (tala = to talk/noa = without concealment) which follows in the traditional oratory customs of the Māori and Pacific Islander culture. The co-design has contributed to the development of program objectives, session plans, resources and evaluation tools. The collaborative design ensures the program includes the promotion of cultural practices including talanoa, Fala, Salu, Basikete and Karakia, and the cultural tailoring of the program content including the Taro leaf.
• Quality improvement – feedback on the program was collected from all stakeholders involved in the program co-design, prior to full-scale implementation. Ongoing quality improvement is practiced every three months as part of the program, including both positive and constructive feedback from participants. This helps to ensure integrity of the program, adapting and responding to community needs through continuous co-design.

Key learnings

• Conducted over 1-year, the co-design phase required substantial dedication from the team, involving flexibility to work outside usual work hours. This dedication has been well worth the time investment, with the development of highly-culturally tailored program.
• Consumers must own the program from the beginning, with strong community empowerment pivotal to the ongoing success of the program to change health behaviours sustainably within this population for many years to come.
• High emphasis must be placed on shared decision-making, including the negotiation and coordination of beliefs from both health professionals and consumers.

Ethical research with Aboriginal and Torres Strait Islander Peoples and communities should:

• improve the way all researchers work with Aboriginal and Torres Strait Islander people and their communities
• develop and/or strengthen research capabilities of Aboriginal and Torres Strait Islander people and their communities
• enhance the rights of Aboriginal and Torres Strait Islander Peoples as researchers, research partners, collaborators and participants in research ^[18]

What we know

Overweight and obesity is a contributing factor to chronic disease and contributes to the gap in life expectancy between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander peoples ^[19]. Childhood obesity is a significant public health concern leading to an increased risk of developing further chronic diseases later in life. In 2018, the Australian Research Alliance for Children & Youth (ARACY) estimated nationally childhood obesity affects 31.6% of young people (aged 5 – 24 years), however this figure is 40.1% for Aboriginal and Torres Strait Islander young people ^[20].

Engagement of Aboriginal and Torres Strait Islander healthcare workers in culturally based interventions is recommended, given that it is likely to improve receptivity and effectiveness of weight management interventions for children and their families ^{[21] [22]}. A survey completed by 45 Qld Aboriginal and Torres Strait Islander health workers (2019) indicated that 91.1% agreed that addressing childhood obesity was an important part of their role. The study also identified inconsistencies between current clinical practice behaviours of Qld Aboriginal and Torres Strait Islander health workers in relation to screening and identification of childhood obesity and current state guidelines.

Case Study

The Making Tracks in Children’s Health (MaTCH) project, a partnership between Griffith University, Qld Child & Youth Clinical Network, Children’s Health Qld Hospital and Health Service and the Aboriginal and Torres Strait Islander community, aims to address the gap in childhood obesity service delivery for Aboriginal and Torres Strait Islander children. This project has received funding through the 2018 Woolworths Nutrition-Related Health Services Delivery Grant and has been granted ethical approval through Children’s Health Queensland (HREC/18/QRCH/43015).

The project is being conducted in three phases under the advice of a Steering Committee with members of the Aboriginal and Torres Strait Islander workforce and community. Phase 3 is expected to be completed in 2020.

Program Development

Needs assessment

• Established a steering committee to provide overarching guidance and support to the research project to ensure cultural appropriateness with design and conduct. Membership included representatives from research, Queensland Health, Aboriginal and Torres Strait Islander health workers, local Elder, key stakeholders and family/consumer representative.
• Conducted a scoping review of the evidence: Aim – To synthesise the literature on cultural adaptation of nutrition interventions aimed at improving health for First Peoples

Community Consultation

• Aim – To consult key Aboriginal and Torres Strait Islander stakeholders to support the co-design of the multidisciplinary health service to be culturally appropriate for Aboriginal and Torres Strait Islander children to treat childhood overweight/obesity.
• Developed and delivered a training package for research assistants (eg. Aboriginal and Torres Strait Islander health workers, community members) to conduct consultations with the community.
  • The aim of this training was to ensure facilitators are familiar with focus group methodology and to provide an overview of the ethics requirements.
  • The training package was based on a review of the literature and was presented to the project team and steering committee for feedback.
  • The training package included: a written training booklet, Powerpoint presentation and associated training materials (eg. Consent forms for participants) and consultation talking points (developed by the steering committee) which will guide consultations.
  • Conducted a pilot training session.
• Conducting consultations using a multi-prong approach including community stakeholders, government and non-government health organisations/service providers. Examples may include community groups, local Elders, individuals, past service users, mums and bubs groups, school parents, health service providers and health workers.

Health Service Delivery Testing

• Aim – To evaluate the delivery (i.e. feasibility, preliminary efficacy and cost-effectiveness) of the redeveloped culturally appropriate health service for Aboriginal and Torres Strait Islander children to treat childhood overweight/obesity.
• Aim for 6-month service implementation.
• Evaluation will be quantitative and qualitative.

Key learnings

• The co-design process with Aboriginal and Torres Strait Islander community requires substantial time investment but this investment is crucial to establishing rapport and relationships with Aboriginal and Torres Strait Islander stakeholders. Initially this might include local Aboriginal and Torres Strait Islander health professionals, local Elders, key community groups, service providers and families.
• Preparation is key to conducting consultation. It’s important for research assistants to plan how they will run the session and how to adapt the consultation talking points to suit their own wording as well as for the type of consultation participants (eg. asking caregivers vs asking Elders).

Resources

• Lowitja Institute’s Researching Indigenous health: a practical guide for researchers
• NHMRC’s Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders