400755 Evidence Based Nursing 1

Quantitative Research 2

Prepared by: Olayide Ogunsiji & Liz Halcomb 2008

1
 Objectives
● By the end of this session & with additional
readings you will be able to;
– identify the various levels of measurement
– states methods used to collect data in
quantitative research
– understand basic quantitative data
analysis

2
 Quantitative data collection
● Aims
– To ensure that data is collected objectively
– To ensure consistency in the data collected from
all the participants (Fisher & Schneider, 2007).

● Methods of Data Collection

– Physiological or biological measures
– Structured tool
– Questionnaire / survey
– Medical Record audit

The readings will provide you with self-explanatory information about data
collection considerations.

3
 Purpose of Data Analysis
● Data analysis is undertaken to allow the
researcher to;
– Describe the sample
– Answer the research question
– Interpret the results
● Data (variables) is turned into numbers.
● The level of measurement determines the
statistical test used.

It is important that study design incorporates consideration of the types of data

being collected and the way that this will be able to be analysed.

4
 Data Types
● Nominal Data
– the assignment of numbers to classify
characteristics into categories.
– Example: Male = 1 & Female = 2
● Ordinal Data
– Ranking objects on the basis of their relative
standing.
– Example: 1 = Completely dependant
2 = Needs some assistance
3 = Completely independent.

5
 Data Types
● Interval Data
– Both the rank ordering and distance between
objects is specified.
– Example: A score of 40/50 is higher than
30/50, which is in turn higher than 20/50.

● Ratio Data
– Has a rational, meaningful zero.
– Example: Fahrenheit temperature scale,
Weight.

6
 Statistical Analysis
Aims, to:
– Describe
– Predict
– Examine associations/relationships

Two types
● Descriptive statistics
● Inferential statistics
(Polit & Beck, 2006)

Descriptive statistics = Describe or synthesise data

Inferential statistics = Infer that the results from the sample are
generalisable to the entire population / Infer from the sample to a
theoretical model
The type of statistical analysis will depend on the way that variables have
been measured.

In nursing you need to be able to critique a quantitative study in order to

determine its merit for use in the health care setting.
• Need to be able to identify the statistical procedure that was used
in research.
• Judge the appropriateness of the analysis to the research problem
and data collection
• Understand the data analysis section
• Judge the authors interpretation of the results

7
 Descriptive Statistics
● Four statistical procedures can be used to
describe data:
- Frequencies
- Measures of central tendency (spread)
- Measures of dispersion (variability)
- Measures of shape

8
 Critical Data
● Sample size calculation – were there enough
participants to demonstrate a difference?
● Baseline data (prior to intervention)
– Demographic data – (age, gender)
● Withdrawals, loss to follow up (how many and
why)
● Results of outcomes being measured (size of
wounds)

9
 Measures of Central Tendency

● Mean - the average score

● Mode - most frequently occurring score
● Median - the middle score

A measure of central tendency is a single central score that enables us to

summarise the distribution of a dataset.

10
 Example

We ask 21 people what level of pain they are

experiencing on a scale of 1-10 (Likert Scale)

0, 0, 1, 1, 2, 2, 2, 2, 2, 2, 2, 3, 3, 4, 5, 7, 7, 7, 9, 9,10

What is the mean, mode and median?

11
 Answers
0,0,1,1,2,2,2,2,2,2,2,3,3,4,5,7,7,7,9,9,10

Mean = 4, Median = 2, Mode = 2

How did we do it?

Mean = add all numbers and divide by 21
Median = put all numbers in order and find the
middle number
Mode = see which score occurs most often

12
 Measures of Variability

● Range - difference between the highest and

lowest score. e.g. 1-10

● Standard Deviation - how much the scores

deviate from the mean.

13
 Standard Deviation (SD)
● One SD on either side of the mean, 68% of
all scores in the sample.

● Two SDs of the mean, 95% of all scores

● Three SDs on either side of the mean, 99%
of all scores.

Dixon N. The Medical Audit Assistant’s Manual 1990.

Mean (sd) the sd is reporting one standard deviation above and below the mean.
Eg mean = 13, sd=8, then 68.3% of all scores will be found between the ranges
of 5 and 21. Thus you get a measure of the variability or spread.

14
 STANDARD DEVIATIONS

-3 -2 -1 mean +1 +2 +3

15
 Normal Distribution
It is generally assumed that data are normally
distributed. That is, the mean, mode and median are all
the same.
NORMAL DISTRIBUTION

mean, median, mode

16
 Data not Normally Distributed

● Some data will not be normally distributed eg

age of family members having lunch
– 10 years
– 10 years Mean age = 34 years
– 20 years Median age = 20 years
– 60 years Mode = 10 years
– 70 years

17
 Skewed Distribution
Sometimes scores at one extreme of a scale ‘pull’ the
mean toward this extreme eg stress prior to surgery.

SKEWED DISTRIBUTION

mode median mean

For skewed data, the median is the most reliable measure of central tendency

18
 Does distribution influence data analysis?
● Different statistical tests are used for
normally distributed (parametric) and not
normally distributed (non-parametric) data.

● Check with an expert if not sure.

19
 Hypothesis Testing
● Variables Dependent (DV), Independent (IV)
● Null Hypothesis
– Researcher seeks to reject null hypothesis
● Errors
– Type I = null hypothesis rejected when it should
be accepted
– Type II = null hypothesis accepted when it
should be rejected
● Significance

The most common use of inferential statistics in experimental studies is for

hypothesis testing.
It is not possible to directly show that the scientific hypothesis is correct….but it is
possible to show that the null hypothesis has a high possibility of being incorrect.
Making inferences about the population from the findings of a study involves the
possibility of sampling error because we cannot assume that the sample is an
exact representation of the entire population. Whilst random assignment creates
a more equal distribution of differences between groups it does not ensure exact
representation.
2 types of errors can occur when making decision to accept or reject the null
hypothesis.
• Type I
• Type II
The researcher does not know when an error is made. The truth or falseness of a
null hypothesis can only be determined by collecting data from the whole
population….if this is done there is no need for statistical inference.
The probability of sampling error is expressed as level of significance. Probability
is given the symbol p and is expressed as a proportion between 0 (the event will
not occur) and 1 (the event will occur).

Statistical significance is different to clinical significance.

20
 Hypothesis testing
(adapted from Polit & Beck, 2006, p. 366)
The null hypothesis is:

True False

True
Correct Type II error
(Accept null
decision
hypothesis)

False

(Reject Null
Type I error Correct
hypothesis) decision

Type 1 error when we reject null hypothesis when it is true

Eg We concluded that the intervention to improve breastfeeding rates was
effective when in fact the group differences were due to sampling fluctuations.

Type II error when we accept the null hypothesis when it is false

Eg We concluded that the number of days breastfeeding were due to sampling
fluctuations when in fact the intervention did have an effect.

True and false only completely ascertained by collecting information from entire
population but then there would not be any reason for inferential stats

21
 Hypothesis Testing: Significance

● Significance level: (alpha level ɑ)

– probability of committing a Type I error
– set before analysis begins
– Most common ɑ = 0.05 or ɑ = 0.01

● Type of research determines significance level

acceptable

As the researcher does not know when an error has been made, the degree of
risk in making an error is controlled by the researcher by selecting a level of
significance, alpha.
The most commonly used level of significance is alpha=0.05. This means that we
are accepting the risk that out of 100 samples a true null hypothesis would be
rejected 5 times.
With an alpha=0.01 the risk of making a type I error is lower, with only 1 out of
100 samples rejecting a true null hypothesis.
Although researchers would like to reduce the chance of making either error,
lowering the risk of making a type I error increases the risk of making a type II
error. The stricter the criteria we use for rejecting a null hypothesis, the greater
the probability that we will accept a false hypothesis.
Type II error is generally related to sample size. A power calculation can be used
to estimate the sample required for a particular study and the risk of committing a
type II error.

22
 Interpretation: p value
● The probability of the statistic (p) is compared to
the level of significance (α)
● If p is lower than α then the results are
significant (p<0.05 or p<0.01)
● That is, the difference occurred was probably
NOT due to chance
● The null hypothesis is rejected

The p value (from the t-test) is then compared to the level of significance.
For example, If p<.05 when alpha was set at .05 then the result is significant, so
there is a difference between groups

23
Tests of Statistical Significance
● t-test
● Z score
● Pearson’s Chi Square tests (2)
● McNemar’s 2
● Fisher’s exact test
● and more

24
 Interpretation of Data

It is important to distinguish between establishing

the statistical significance of an outcome and the
process of interpreting the importance and
implications of the result.
Polgar & Thomas, 1991.

25
Statistics still tell more than one story  sometimes we can make them show us
what we want to see, rather than the complete picture of what is happening.

26
 References
1. Fisher, M., & Schneider, Z. (2007). Analysing data in quantitative
research. In Z. Schneider, D. Whitehead, D. Elliot, G. LoBiondo-
Wood & J. Haber (Eds.), Nursing & midwifery research: Methods
and Appraisal for evidence-based practice (3rd ed.) (pp. 225-247).
Sydney: Mosby.
2. Polgar, S. & Thomas, S. (2000). Introduction to Research in the
Health Sciences. Edinborough: Churchill Livingstone.
3. Polit, D.F., & Beck, C.T. (2006). Essentials of Nursing Research:
Methods, appraisal and utilisation (6th ed.). Sydney: Lippincott
Williams & Wilkins.

27