1

Advanced Quantitative
Methods
William L. Holzemer, RN, Ph.D., FAAN
Professor, School of Nursing
University of California, San Francisco
bill.holzemer@nursing.ucsf.edu
2
Objectives
Develop your definition of nursing science
Use the Outcomes Model to think about
your area(s) of interest
Review quantitative methods
Think about how we build knowledge to
improve health and nursing practice.
3
Assignments
PhD Students -individual assignments
MS Students group assignment
Mini-literature review
Outcomes Model
Substruction
Synthesis Tables
Summary
4
Nursing = Nursing Science?
Definition of Nursing

American Nurses Association:

Nursing is the assessment , diagnoses,
and treatment of human responses
5
Definition of Nursing
Japan Nurses Association

Nursing is defined as to assist the
individual and the group, sick or well, to
maintain, promote and restore health.
6
Definition of Nursing
International Council of Nurses
Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or
well and in all settings. Nursing includes the
promotion of health, prevention of illness,
and the care of ill, disabled and dying
people. Advocacy, promotion of a safe
environment, research, participation in
shaping health policy and in patient and
health systems management, and education
are also key nursing roles.

7
Common Elements:
Definitions of Nursing
Person (individual, family, community)
Health (Wellness & Illness)
Environment
Nursing (care, interventions, treatments)

8
Nursing Science
The body of knowledge that supports
evidence-based practice
9
Nursing Science Uses Various Research
Methodologies
Qualitative
Understanding
Interview/observation
Discovering frameworks
Textual (words)
Theory generating
Quality of informant more
important than sample size
Rigor
Subjective
Intuitive
Embedded knowledge
Quantitative
Prediction
Survey/questionnaires
Existing frameworks
Numerical
Theory testing (RCTs)
Sample size core issue in
reliability of data
Rigor
Objective
Public
10
Types of Research Methods:
(all have rules of evidence!)
Quantitative
Non-Experimental or
Descriptive
Experimental or
Randomized Controlled
Trials
Ethnography
Content Analysis

Models of analysis:
Parametric vs. non-
parametric


Qualitative
Grounded theory
Ethnography
Critical feminist theory
Phenomenology


Models of analysis: fidelity
to text or words of
interviewees

11
Outcomes Model for Health Care Research
(Holzemer, 1994)
Inputs+
1970s
Processes +
1980s
Outcomes
1990s
Client
Provider
Setting
12
Outcomes Model
Heuristic
Systems model (inputs are outputs,
outputs become inputs)
Relates to Donabedians work on quality of
care (Structure, Process, and Outcome
Standards)
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Outcomes Model: Nursing Process
Inputs+ Processes + Outcomes
Client Problem

Outcome
Provider Intervention
Setting
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Outcomes Model for Health Care Research
Inputs+
(Covariate,
confounding
variable)
Processes +
(Independent
Variable)
Outcomes
(Outcome
Variable)
Client
Age, gender,
SES, Ethnicity
Severity of Illness
Self-care
Adherence
Family care
Quality of Life
Pain control
Pt. satisfaction
Pt. falls,
Provider
Age, gender,
SES,
Education,
Experience,
Certification
Perc. Autonomy
Interventions
Care
Talking, touch, time
Vigilance,
communication
Quality of Work life
Turnover
Errors
Satisfaction
Setting
Resources
Philosophy
Staffing levels
Actual staffing ratios Mortality
Morbidity
Cost
15
Outcomes Model: Your assignment
(Think about a project or program of research)
Inputs+
z
Processes +
x
Outcomes
y
Client
Provider
Setting
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Where Should We Find Evidence-
Based Practice Guidelines?
Clinical practice guidelines
Nursing Standards/ Procedural Manuals
Great demand, low level of delivery (Great
demand, growing level of delivery)
Knowledge base from research literature

17
Types of Evidence:
How do we know what we know?
Clinical expertise
Intuition
Stories
Preferences, values, beliefs, & rights
Descriptive/quasi-experimental studies
Randomized clinical (controlled) trials
(RCTs) - the gold standard
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Summary: Introduction to Research
Think about nursing research nursing science
Outcomes Model designed to put boundaries
around your area of study and expertise (very
difficult challenge in nursing!)
Variable identification
Understanding rigor correct methods for any
type of research design
Enhance enjoyment in reading research articles
Understand the challenge of the words so easily
used, evidence-based practice.

19
Some Challenges:
Think about developing your definition of nursing
science.
Use the Outcomes Model to help you think about
your program of research.
Enhance your understanding of rigor in all types
of research designs.
Increase your enjoyment of reading research
articles.
Understand the complexities of evidence-based
practice.

20
When thinking about your research
problem:
Is it significant?
Are you really interested in it?
Is it novel?
Is it an important area?
High cost, high risk?
Can it be studied?
Is it relevant to clinical practice?
21
Where do ideas come from?
Literature reviews
Newspaper stories
Being a research assistant
Mentors/teachers
Fellow students
Patients
Clinical experience
Experts in the field

Build your area of expertise from multiple sources.
22
Uses of Substruction
Critique a published study
Plan a new study
23
Substruction
A strategy to help you understand the
theory and methods (operational
system) in a research study
Applies to empirical, quantitative
research studies
There is no word, Substruction, in the
dictionary. It has an inductive meaning,
constructing and a deductive meaning,
deconstructing
Hueristic
24
Substruction
Theory
(Theoretical
system)
Construct
+
Concept
Deductive
+
+
+
(qualitative)



Methods
(Operational
System)
Measures
+
Scaling/Data
analysis
+
+
+
(quantitative)



Inductive
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Substruction:
Building Blocks or Statements of Relationships
Construct
Pain
4
+axiom Construct
quality of life
4
Concept
Intensity
4
+proposition Concept
functional status
4
Measure
10 cm scale
+hypothesis Measure
mobility scale
26
Statements of Relationships
Construct:
Postulate:
Statement of
relationship
between a
construct and
concepts
Pain consists of three
concepts
Concepts:
Intensity
Location
Duration
27
Substruction:
Research Design Perspective
Focus of Study (RCT?)
Co-variates Z
Severity of illness
for risk adjustment
(analysis of covariance)

Independent Variable X
treatment
how measured?
Dependent Variable Y
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Substruction: Theoretical System,
an example
Pain Intervention Study
Post Surgical
Patient Severity of
illness
age
gender
Pain Management
Intervention
Patient communication
Standing PRN orders
Non pharmacological tx
Pain Control
Length of stay
Patient Satisfaction
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Substruction: Operational
System
Pain Intensity
Instrument:
VAS 10 cm scale
(low to high pain)


Functional Status
Instrument:1-5 Likert
scale, 1=low & 5=high
function

Scale: continuous or
discrete?
Scale: continuous or
discrete?
30
Scaling
Discrete: non-parametric (Chi square)
Nominal gender
Ordinal low, medium, high income
Continuous: parametric (t or F tests)
Interval Likert scale, 1-5
functionality
Ratio money, age, blood
pressure


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Issues
What is the conceptual basis of the study?
What are the major concepts and their
relationships?
Are the proposed relationships among the
constructs and concepts logical and defensible?
How are the concepts measured? valid?
reliable?
What is the level of scaling and does it relate to
the appropriate statistical or data analytical
plan?
Is there logical consistency between the
theoretical system and the operational system?
32
Is there a relationship between touch and
pain control, accounting for initial amount
of post-operative pain? rx,y.z
Inputs+
Z
Processes +
X
Outcomes
Y
Client Post
operative
pain
Pain
Control
Provider Therapeutic
Touch vs NL
care
Setting
33
Literature Review
We review the literature in order to
understand the theoretical and operational
systems relevant to our area of interest.
What is known about the constructs and
concepts in our area of interest?
What theories are proposed that link our
variables of interest?
34
Literature Review
What is known?
What is not known?

Resources
The Cochran Library
Library Data Bases
PubMed
CINYL

35
Literature Review:
How to combine, synthesis, and demonstrate
direction?
Study 1 Study 2 Study 3
Topic
36
Literature Review
Study 1 Study 2 Study 3
Topic
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Table 1. Outline of study variables related
to your topic


Studies
Covariates


Z
Interventions
Independent
variable
X
Outcomes
Dependent
Variable
Y
Smith (1999)
Jones (2003)
Etc.
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Table 2. Threats to validity of research
studies related to topic
Author
(year)
Type of
Design
Diagram Statistical
Conclusion
Validity

Construct
Validity of
Cause &
Effect
Internal
Validity
External
Validity
Smith
(1999)
RCT O X
1
O
O X
2
O
O O
n/a
Jones
(2003)
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Table 3. Instruments

Studies
Instrument #
items
Validity Reliability Utility
Smith (1999)
McGill Pain
Questionnaire
Jones (2003)
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Table 4. Power analysis for
literature review on topic.

Studies
Sample
Size
Alpha Power Effect
Size
Smith (1999)
32 exp
40
cont
0.05 0.60 Est. at
medium
Jones
(2003)
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Literature Synthesis
Synthesis - what we know and do not
know
Strengths rigor, types of design,
instruments?
Weaknesses lack of rigor, no RCTs,
poorly developed instruments
Future needs what is the next step?

42
Research Designs

43
Research Design: Qualitative
Ethnography
Phenomenology
Hermeneutics
Grounded Theory
Historical
Case Study
Narrative
44
Rigor in Qualitative Research
Dependability
Credibility
Transferability
Confirmability
45
Types of Quantitative Research
Designs
We will focus on RIGOR:

Experimental

Non-experimental
46
X,Y, Z notation
Z = covariate
Severity of illness

X = independent variable (interventions)
Self-care symptom management

Y = dependent variable (outcome)
Quality of life
47
Types of Quantitative Research
Designs
Descriptive X? Y? Z?
What is X, Y, and Z?

Correlational r
xy
.
z
Is there a relationship between X and Y?

Causal X Y?
Does a change in X cause a change in Y?
48
Rigor in Quantitative Research
Theoretical Grounding: Axioms & postulates
substruction-validity of hypothesized
relationships
Design validity (internal & external) of
research design; Instrument validity and
reliability
Statistical assumptions met (scaling, normal
curve, linear relationship, etc.)

(Note: Polit & Beck: reliability, validity,
generalizability, objectivity)
49
Literature Review Study Aims

Study Aims Study Question

Study Question Study Hypothesis
50
Aim, Question, and Hypothesis
Study Aim: To explore if it is possible to reduce
patient falls for elderly in nursing homes.
Study Question: Does putting a sitter in a
patient room reduce the incidence of falls?
Study Hypothesis:
Null: H
0
: There is no difference between patients
who have a sitter and those who do not in the
incidence of falls.
51
Experimental Designs

52
Definition: Experimental Design
1. There is an intervention that is controlled
or delivered
2. There is an experimental and control
group
3. There is random assignment to groups
53
Classic Experimental Design
O
1exp
X O
2exp
7
R

O
1con
O
2con


(pretest) (posttest)

O=observation
1 = pretest or time one; 2 = posttest or time two
X = intervention
R = random assignment to groups
54
Classic Experimental Design
O
1exp
X O
2exp
7
R

O
1con
O
2con


(pretest) (posttest)

The RCT is the Gold Standard for
Evidence-Based Practice
55
Randomization
1. Random assignment to groups
(internal validity issue) equals Z
variables in both groups

2. Random selection from population to
sample (external validity issue)
equals Z variables in the sample that
are true for the population
56
Goal:
Statement of Causal Relationship
57
Conditions Required to Make a
Causal Statement: X causes Y
1. X precedes Y
2. X and Y are correlated
3. Everything else controlled or
eliminated. No Z variables impacting
outcome.
4. We never prove something, we
gather evidence that supports our
claim.
58
Controlling Z variables:
1. Minimize threats to internal
validity
2. Limit sample (e.g. under 35
years only) to control variation
3. Statistical manipulation
(ANCOVA)
4. Random assignment to groups
59
Dimensions of Research Designs:
Groups & Time
O
1exp
X O
2exp

Groups (n=2 experimental & control)
+
O
1con
O
2con
-----------------------------------------------
Time (n=2)
(repeated measures)




60
Dimensions of Research Designs:
Groups & Time
Groups = between factors

Time = within factors
61
Types of Designs
O - descriptive, one time

O
1
O
2
O
3
- descriptive, cohort, repeated
measures)


O
1
X O
2
(not an experimental design!) - pre-
post-test




62
Types of Designs
O
1
X O
2
O
1
O
2

RCT randomized controlled trial


63
Types of Designs

O
1
O
2
O
3
X O
4
O
5
O
6
O
1
O
2
O
3
O
4
O
5
O
6

O
1
X O
2
X
no
O
3
X O
4
X
no
O
5

(repeated measures vs. time series designs)


64
Types of Design
O
1
X
1
O
2
R O
1
X
2
O
2
O
1
O
2

# of groups? ___
# points in time? ___
65
Types of Designs
Post-test only design:

X O
2
O
2

What is the biggest threat to this
post-test only design?


66
Types of Research Design
Experimental (true)

Quasi-Experimental (quasi)
No random assignment to groups
67

Design Validity
Statistical conclusion validity
Construct validity of Cause & Effect (X
& Y)
Internal validity
External

68
Design Validity
Statistical Conclusion Validity rxy?
Type I error (alpha 0.05)
Type II error (Beta) Power = 1-Beta,
inadequate power, i.e. low sample size
Reliability of measures

Can you trust the statistical findings?
69
Design Validity
Construct Validity of Putative Cause &
Effect (ZX ZY?)
Theoretical basis linking constructs and
concepts (substruction)
Outcomes sensitive to nursing care
Link intervention with outcome theoretically

Is there any theoretical rationale for why X and
Y should be related?
70
Design Validity
Internal Validity
Threat of history (intervening event)
Threat of maturation (developmental change)
Threat of testing (instrument causes an effect)
Threat of instrumentation (reliability of measure)
Threat of mortality (subject drop out)
Threat of selection bias (poor selection of
subjects)

Are any Z variables causing the observed
changes in Y?
71
Design Validity
External Validity
Threat of low generalizability to people,
places, & time

Can we generalize to others?
72
Building Knowledge
Goal is to have confidence in our
descriptive, correlational, and causal data.
Rigor means to follow the required
techniques and strategies for increasing
our trust and confidence in the research
findings.
73
Sampling
[Sample selection, not assignment]
74
Terms
Population

Sample

Element
- All possible subjects


-A subset of subjects


- One subject
75
What do we sample?
People (e.g. subjects)

Places (e.g. hospitals,
units, cities)

Time (e.g. season, am
vs. pm shift )
76
Sampling: What do we do?
Random Assignment

-is designed to equalize
the Z variables in
the experimental and
control groups
Random Selection

-is designed to equalize
the z variables that
exist in the population
to be equally
distributed in a
sample
77
Types of Probability Sampling
Probability
Simple random sampling using a random
table of numbers
Stratified random sampling divide or stratify by
gender and sample within group
Systematic random sampling take every 10
th

name
Cluster sampling select units (clusters) in
order to access patients or nurses

78
Types of Non-probability sampling
Convenience first patients to walk in the
door
Purposive patients living with an illness
Quota equal numbers of men & women
(volunteers)
(convenience)
79
Types of Samples
Homogeneous: subjects are similar, all
females, all between the ages of 21-35

Heterogeneous: subjects are diverse, wide
age range, all types of cancer patients
80
Sampling Error
Population (n=1000)

Mean Age:
36.5 years





Samples (n=50)

Mean Age: 34.6 yrs 37.1 yrs 36.4 yrs.

81
How to control sampling error?
Use random selection of subjects
Use random assignment of subjects to
groups
Estimate required sample size using
power analysis to ensure adequate power
Overestimate required sample size to
account for sample mortality (drop out)
82
Sample Size and Sampling
Error

small


Sampling
Error



large
small large
Sample Size

83
Sample Size Calculations
Type of design
Accessibility of participants
Statistical tests planned
Review of the literature
Cost (time and money)
84
Strategies for Estimating Sample Size
Ratio of subjects to variables in
correlational analysis. 3:1 up to 30:1
subjects to variables. 30 item
questionnaire requires 90 to 900 subjects.
Chi square cant work if less than 5
subjects per cell


85
Power Analysis
Power - commonly set at 0.80
Alpha - commonly set at 0.05 or 0.01
Effect Size - based upon pilot studies or literature
review; small, medium, large
Sample Size - # subjects required to ensure
adequate power

Power is a function of alpha, effect size, and
sample size.
86
Power Analysis Programs
SPSS Pakcage
nQuery Adviser Release 4.0 (most
recent?)
http://www.statsolusa.com
87
Power
Power is the ability to detect a difference
between mean scores, or the magnitude of
a correlation.
If you do not have enough power in a
study, it does not matter how big the effect
size, i.e. how successful your intervention,
you can not statistically detect the effect.
Many studies are under powered.
88
Effect Size
Effect size can be thought of as how big a
difference the intervention made.
Statistical significance and clinical
significance are often not the same thing
89
Effect Size
Small (correlations around 0.20)
Requires larger sample size

Medium (correlations around 0.40)
Requires medium sample size

Large (correlations around 0.60)
Requires smaller sample size
90
Effect Size


Meanexp Meancon
Effect Size =
SD e & c
91
Eta Squared (
2
)
In ANOVA, it is the proportion of
dependent variable (Y) explained.
Estimate of Effect Size
Similar to R
2
in multiple regression
analysis.


92
alpha
alpha relates to hypothesis testing and how
often you are willing to make a mistake in
drawing a conclusion
alpha is equivalent to Type 1 error or
saying that the intervention worked, when in
fact the effect size observed, is just due to
chance
alpha of 0.01 is more conservative than 0.05
and therefore, harder to detect differences
93
Hypothesis Testing:
Is it true or false?
Null hypothesis: H
0
Mean (experimental) = Mean (control)

Alternative hypothesis: H
1
Mean (experimental) =/= Mean (control)
94
Hypothesis Testing and Power
Goal:
Reject H
0
REALITY REALITY
Null H
0
True
H
0
:Mc=Me
Null H
0
False
H
0
:Mc=/=Me
DECISION Reject H
0
Type I Error Power
(1-Beta)
DECISION Accept H
0
Correct
Decision
Type II Error
(Beta)
95
Quiz:
If sample size goes up, what happens to power?
If alpha goes from .05 to .l01, what happens to
required sample size?
If power falls from .80 to .60, what type of error
is most likely to occur?
If effect size is estimated based upon the
literature as large, what effect does this have on
the required sample size?
96
Sample Loss in RCT
N=243
N=91
N=105
N=118
N=89
N=110
N=122
6 months
1 month
Randomization
97
Measurement
If it exists, it can be measured

R. Cronbach
98
What we measure:
Knowledge, Attitudes, Behaviors
(KAB)
Physiological variables
Symptoms
Skills
Costs
99
Classical Measurement Theory:
Measurement:

Reliability


Observation = Truth (fact) +/- Error


Validity

100
Type of Measures
Standardized evidence as follows:
1. Systematically developed
2. Evidence for instrument validity
3. Evidence for instrument reliability
4. Evidence for instrument utility time,
scoring, costs, sensitive to change over time
Non-standardized
101
Types of Measurement Error
Systematic - can work to minimize
systematic error due to poor instructions,
poor reliability of measures, etc.

Random - can do nothing about this,
always present, we never measure
anything perfectly, there is always some
error.
102
Validity
Question: Does the instrument
measure what it is supposed to
measure?
Theory-related validity
Face validity
Content validity
Construct validity
Criterion-related validity
Concurrent validity
Predictive validity

103
Theory-related Validity
Face validity
participant believability
Content validity (observable)
Blue print
Skills list
Construct validity
(unobservable)
Group differences
Changes of times
Correlations/factor analysis

104
Criterion-related Validity
Concurrent
Measure two variables and correlate
them to demonstrate that measure 1 is
measuring the same thing as measure 2
same point in time.

Predictive
Measure two variables, one now and
one in the future, correlate them to
demonstrate that measure 1 is
predictive of measure 2, something in
the future.
105
Reminder:
Design Validity
Does the research
design allow the
investigator to answer
their hypothesis?
(Threats of internal
and external validity)
Instrument Validity
Does the instrument
measure what it is
supposed to
measure?
106
Instrument Reliability
Question: can you trust the data?

Stability change over time
Consistency within item agreement
Rater reliability rater agreement


107
Instrument Reliability
Test-retest reliability (stability)
Pearson product moment correlations
Cronbachs alpha (consistency) one point in
time, measures inter-item correlations, or
agreements.
Rater reliability (correct for change agreement)
Inter-rater reliability Cohens kappa
Intra-rater reliability Scotts pi

108
Cronbachs alpha
( )
1
1
2

n
X m
n
n
SD =
( )
(
(
(
(

2
1
2
1
1 SD
items SD
n
n
n
alpha =
109
Cronbach alpha Reliability Estimates:
> 0.90
Excellent reliability, required for decision-
making at the individual level.
0.80
Good reliability, required for decision-making
at the group level.
0.70
Adequate reliability, close to unacceptable as
too much error in the data. Why?
110
Internal Consistency: Cronbachs alpha
Person A: Internally consistent
Person B: Internally inconsistent

Item
All the
time
Much of
the time
A little of
the time
Rarely
1 4
A
3 2 1
B
2 4
B
3
A
2 1
3 4 3
A
2
B
1
4 4
A
3
B
2 1
111
Error in Reliability Estimates

Error = 1 (Reliability Estimate)
2

If alpha = 0.90, 1-(0.90)
2

1-0.89 = .11 error
If alpha = 0.70, 1 (0.70)
2

1-.49 = .51 error
If alpha = 0.70, it is the 50:50 point
of error vs. true value
112
Reliability Values
Range: 0 to 1
No negative signs like
correlations
Cohens kappa and Scotts pi
are always lower, i.e. 0.50,
0.60
113
Utility
Things you would like to know about an
instrument.
Time to complete (subject fatigue)?
Is it obtrusive to participants?
Number of items (power analysis)?
Cultural, gender, ethnic
appropriateness?
Instructions for scoring?
Normative data available?

114
Reporting on Instruments
Concept(s) being measured
Length of instrument or number of
items
Response format (Likert scale, etc.)
Evidence of validity
Evidence of reliability
Evidence of utility
115
Quiz:
Can a scale be valid and not reliable?

Can a scale be reliable and not valid?
116
Scale Development
Generation items from focus groups/interviews
Scaling decisions capture variation
Face validity - check with experts and
participants
Standardize scale (evidence for validity,
reliability, & utility)
Estimate correlates of concept
Explore sensitivity to change over time

117
Translation
Forward translation (A to B)
Backward translation (B to A)
Conceptual equivalency across
cultures
Using of slang, idioms, etc.

118
Data Analysis
119
Data Analysis: Why?
Capture variability (variance) how the
scores vary across persons
Parsimony data reduction technique,
how to describe many data points in
simple numbers
Discover meaning and relationships
Explore potential biases in data (sampling)
Test hypotheses
120
Where to begin:
After data is collected, we begin a long
process of data entry & cleaning
Data entry requires a code book be
developed for the statistical program you
plan to use, such as SPSS.
Data codebooks allow you to give your
variables names, values, and labels.
121
Data Entry & Cleaning
Data entry is a BIG source of error in data
Double data entry is one strategy
Cleaning data looking for values outside
the ranges, e.g. age of 154 is probably a
typo.
We examine frequencies, high score, low
scores, outliers, etc.
122
Coding Variables
Capture data in its most continuous form possible.

Age: 35 years - get the actual value
vs.
Check one: _<25
_ 25-35
_ 36-45
_ >45
123
Dichotomous Variables
Do not do this:
1 = Male
2= Female

Do this!
1 = male
0 = female

Why? Add function
124
Dummy Coding
Ethnicity
1 = Black; 2 = White; 3 = Hispanic

N-1 or 3-1 = 2 variables
Black: 1 = Black; 0 = White and Hispanic
White: 1 = White; 0 = Black and Hispanic

125
Missing Data
SPSS assigns a dot . to missing data
SPSS often gives you a choice of
pairwise or listwise deletion for missing
values.

Mean Substitution: give the variable the
average score for the group, e.g. age,
adds no variation to the data set.
126
Missing Data
Pairwise: just a particular correlation is
removed, best choice to conserve power

Listwise: removes variables, required in
repeated measures designs.
127
Measures:
Central Tendency

Relationships

Effects
128
Measures of Central Tendency
Mean arithmetic average score
Standard deviation (SD) how the scores
cluster around the mean
Range high and low score.

(Example: M = 36.4 years
SD= 4.2
Range: 22-45)
129
Formulas
N
X
n
n

1
Mean =
SD =
( )
1
1
2

n
X m
n
n
130
Measures of Central Tendency
Mean arithmetic average
Median score which divides the
distribution in half (50% above and 50%
below)
Mode the most frequently occurring
value

When does the mean=median=mode?
131
Normal Curve: very robust!
M +1 +2 -1 -2
34% 34%
2.5% 2.5%
132
Normal Curves
133
Normal Curve
(Mean=Median=Mode)
50% 50%
Mean
Median
Mode
Frequency
134
Non-Normal Curves

Y
-
A
x
i
s
X-Axis
Y
-
A
x
i
s
X-Axis
135
Scaling
Discrete
(qualitative)
Nominal
Ordinal

Continuous
(quantitative)
Interval
ratio

Non-parametric
(no assumptions
required; Chi square)


Parametric
(assumes the normal
curve, e.g. t and F
tests)
136
Degrees of Freedom
Statistical correction so one does not over
estimate
137
Degrees of Freedom for ball 1?
138
Degrees of Freedom for ball 2?
139
Degrees of Freedom for ball 3?
140
Degrees of Freedom
Sample size (n-1)
Number of groups (k-1)
Number of points in time (l-1)
141
Relationships or Associations

142
Measures of Association: Correlations
Range: -1 to 1
Dimensions:
Strength (0-1)
Direction (+ or -)
Definition: a change in X results in a
predictable change in Y; shared variation
or variance.

143
Correlations
Sample specific (each sample is a subset
of the population)
Unstable
Dependent upon sample size
Everything is statistically significant with a
very large sample size; may not be
clinically significant.
Expresses relation not a causal statement
144
Types of Correlations
Pearson product moment r
continuous by continuous variable
Phi correlation
discrete by discrete variable (Chi square)
Rho rank order correlation
discrete ranks by ranks
Point-biserial
discrete by continuous variable
Eta Squared
145
Estimate the value of the
correlation
Y
-
A
x
i
s
X-Axis
Y
-
A
x
i
s
X-Axis
Y
-
A
x
i
s
X-Axis
r = ?
r = ?
r = ?
146
Variance
Area under the curve = SD
2
Variance
147
Shared variance r
2
If r = 0.80, r
2
= 0.64
64%
148
Shared variance r
2
If r = 1, 100%
If r = 0, 0%
149
Types of Data Analyses
Descriptive X? Y? Z?
Measures of central tendency

Correlational rx,y?
Is there a relationship between X and Y?
Measures of relationships (correlations)

Causal X Y?
Does a change in X cause a change in Y?
Testing group differences (t or F tests)
150
Testing Effects of Interventions

151
Testing Group Differences
t tests
F tests (Analysis of Variance or ANOVA)

(t tests are F tests with two groups)
152
Types of tests of group differences
Between groups
(unpaired)

Within groups
(paired or repeated measures; if two groups it
is also test-retest)
requires identified subjects
153
Classic Experimental Design
O
1exp
X O
2exp
7
R

O
1con
O
2con


(pretest) (posttest)

Group: Between Factor
Time: Within Factor

154
Tests of Significance
3 4
1 O
1
X O
2
2 O
1
O
2
155
Testing Group Differences
Between Variance
F (or t) =
Within Variance
156
Examining Variance
M
c
M
e
Between
Variance
Within
Variance
157
Examining Variance:
No difference between the means
M
c
M
e
158
Examining Variance:
Big difference between means
M
c
M
e
159
Examining Variance: Three groups
M
c
M
e2
M
e1
160
Types of Designs

O
1
O
2
O
3


change within group over time, repeated
measures design


161
Types of Designs
O
1e
X O
2e

O
1c
O
2c

change within group from O
1e
to O
2e

change between groups O
2e
and O
2c
162
How to analyze this design?

O
1e
O
2e
O
3e
X O
4e
O
5e
O
6e
O
1c
O
2c
O
3c
O
4c
O
5c
O
6c

Two group repeated measures analysis
of variance.
One between factor (group) and one
within factor (time) with six levels.

163
Post-test only design
X O
2e
O
2c
Unpaired t test

Null hypothesis:
H
0
: O
2e
=

O
2c

Alternative directional hypothesis:
H
1
: O
2e
> O
2c

164
Standard Deviation
how scores vary around a mean


Standard Error of the Mean
how mean scores vary around a population
mean
165
Standard Error of the Mean:
Average of sample SDs
Population (n=1000)

Mean Age:
36.5 years





Samples (n=50)

Mean Age: 34.6 yrs 37.1 yrs 36.4 yrs.
SD 3.4 3.8 4.1

166
Conceptual:
Mean
E
Mean
C
t =

standard error of the mean
167
Assumptions of ANOVA
Normal distribution
Independence of measures
Continuous scaling
Linear relationship between variables
168
3 X 2 ANOVA
O
1exp
X
1
O
2exp
7
R O
1exp
X
2
O
2exp


O
1con
O
2con

One between factor: group (3 levels)
One within factor: time (2 levels)

169
Omnibus F Test
O
1exp
X
1
O
2exp
7
R O
1exp
X
2
O
2exp


O
1con
O
2con

F test group: Is there a difference among the three
groups?
F test time: Is there a difference between time 1 and 2?
If yes to either question, where is the difference?
Interaction: Group by Time

170
Post-hoc comparisons
O
1exp1
X
1
O
2exp1
7
R O
1exp2
X
2
O
2exp2


O
1con
O
2con

Types: Scheff, Tukey control for degrees of freedom in different
ways; compares all possible two way comparisons

H
0
: O
2exp1
= O
2exp2
=

O
2con
If you reject Null, or F test is
significant, then you can look for two-way differences.
(O
2exp1
= O
2exp2
?) or (O
2exp2
=

O
2con
?)

or (O
2exp1
=

O
2con
?)



171
Tests of Significance
Non-parametric Parametric
Two-groups
Paired
Unpaired

Wilcoxin Rank
Mann-Whitney U

Paired t test
Unpaired t test
More than two-groups
Repeated measures
Independent groups


Friedman test
Kruskal -Wallis

ANOVA
Repeated measures
ANOVA
172
Galloping alpha
Danger in conducting multiple t tests or doing item-
level analysis on surveys

alpha = probability of rejecting the Null hypothesis

alpha 0.05 divided by number of tests, distributes
alpha over tests

If conducting 10 t tests, alpha at 0.005 per test
(0.05/10=0.005)

173
ANOVA
ANOVA analysis of variance
ANCOVA analysis of co-variance,
includes Z variable(s)
MANOVA multivariate analysis of
variance (more than one dependent
variable)
MANCOVA multivariate analysis of
co-variance, includes Z variable(s).
174
Multiple Regression Analysis
Correlational technique
Unstable values
Sample specific
Reliability of measures very
important
Requires large sample size
Easy to get significance with large
sample size
175
Multiple Regression Analysis
Attempts to make causal statements of
relationship

Y = X
1
+X
2
+X
3

Y = dependent variable (health status)
X
1-3
= predictors or independent variables
Health Status = Age + Gender + Smoking

176
Multiple Regression Questions:
What is the contribution of age, gender, and
smoking to health status?
How much of the variation in health status is
accounted for by variation in age, gender, and
smoking?

177
Multiple Regression Analysis
Creates a correlation matrix.
Selects the most highly correlated independent
variable with the dependent variable first.
Extract the variance in Y accounted for by that X
variable.
Repeats the process (iterative) until no more of
the variance in Y is statistically explained by the
addition of another X variable.
178
Health Status =
Age + Gender + Smoking
Health
Status
Y
Age
X
1
r
2
Gender
X
2
r
2
Smoking
X
3
r
2
Health
Status
Y
1 0.25
6%
0.04
0%
0.40
16%
Age
X
1
1 0.11
1%
.05
0%
Gender
X
2
1 .20
4%
Smoking
X
3
1
179
Multiple Regression: Shared Variance
Health Status
Smoking
Gender
Age
Gender 4%
Smoking 40%
Age 25%
180
Multiple Regression
Correlation results in a r
Multiple regressions results in an r
2

R squared is the total amount of the
variance in Y that is explained by the
predictors, removing the overlap among
the predictors.

181
Multiple Regression
Types
Step-wise = based upon highest
correlation, that variable is entered first
(computer makes the decision), theory
building
Hierarchical = choose the order of entry,
forced entry, theory testing
182
Multiple Regression
Allows one to cluster variables into Blocks.
Block 1: Demographic variables
(age, gender, SES)
Block 2: Psychological Well-Being
(depression, social support)
Block 3: Severity of Illness
(CD4 count, AIDS dx, viral load, OIs)
Block 4: Treatment or control
1= treatment and 0 = control
183
Regression Analysis
Multiple regression: one Y, multiple Xs.
Logistic regression: Y is dichotomous,
popular in epidemiology, Y=disease or no
disease; odds - risk ratio (not explained
variance)
Canonical variate analysis: multiple Y and
multiple X variables: Y
1
+Y
2
+Y
3
=X
1
+X
2
+X
3

-linking physiological variables with
psychosocial variables.

184
Multivariate Regression Models:
Path Analysis and now Structural Equation
Modeling
Software program: AMOS
Measurement model is combined with predictive
model
Keep in the picture the multicolinearity of
variables (they are correlated!)
Allows for moderating variables (direct and
indirect effects.
185
Multiple Dependent & Independent
Path Analysis Modeling







Age
Gender
Social
Support
Severity of
illness
Cognitive
Ability
Adherence
to diet
Diabetic
Control
Relationships are based upon
the literature review and then
potentially explored, discovered,
tested, or validated in a study
186
Structural Equation Modeling
Intercep
t
Slope
Muscle
ache Month
0
Muscle
ache
Month 1
Muscle
ache
Month 3
Muscle
ache
Month 6
Intercept
Slope
Fatigue
Month 0
Fatigue
Month 1
Fatigue
Month 3
Fatigue
Month 6
187
Factor Analysis
Exploration of instrument construct validity
Correlational technique
Requires only one administration of an
instrument
Data reduction technique
A statistical procedure that requires artistic
skills
188
Conceptual Types of Factor Analysis
Exploratory see what is in the data
set

Confirmatory see if you can
replicate the reported structure.

189
Factor Analysis
Principal Components

(principal factor
or
principal axes)
190
Correlation Matrix of Scale Items:
Which items are related?
Item 1 Item 2 Item 3 Item 4
Item 1 1 0.80 0.30 0.25
Item 2 1 0.40 0.25
Item 3 1 0.70
Item 4 1
191
Factor Analysis:
An iterative process

Factor extraction
192
Factor Analysis
Factor I Factor II Factor III Communality
Item 1 0.80 0.20 -0.30 0.77
Item 2 0.75 0.30 0.01 0.65
Item 3 0.30 0.80 0.05 0.63
Item 4 0.25 0.75 0.20 0.67
Eigenvalue 2.10 2.05 0.56
% var 34% 30% 10%
193
Definitions:
Communality: Square item loadings on
each factor and sum over each ITEM
Eigenvalue: Square items loading down
for each factor and sum over each
FACTOR
Labeling Factors: figments of the authors
imagination. Items 1 & 2 = Factor I; Items
3 & 4 = Factor II.
194
Factor Rotation
Factors are mathematically rotated depending
upon the perspective of the author.
Orthogonal right angels, low inter-factor
correlations, creates more independence of
factors, good for multiple regression analysis,
may not reflect well the actual data. (varimax)
Oblique different types, lets factors
correlate with each other to the degree they
actually do correlate, some like this and
believe it better reflects that actual data,
harder to use in multiple regression because
of the multicolinearity. (oblimax)
195
Summary: Data Analysis
Measures of Central Tendency
Measures of Relationships
Testing Group Differences
Correlational
Multiple regression as a predictive
(causal) technique.
Factor analysis as a scale
development, construct validity
technique
196
Ethical Guidelines for Nursing
Research
Vulnerability a power relationship
between health care provider and
patient, family, or client.

Vulnerable participants in research
require more protection from harm.

197
Ethical Principles that Guide Research
Beneficence doing good
Non-malfeasances doing no harm
Fidelity creating trust
Justice being fair
Veracity telling the truth
Confidentiality protecting or safeguarding
participants identifying information

198
Ethical Principles that Guide Research
Confidential
names kept guarded

vs.

Anonymous
no identifiers


199
Best Wishes