TranscriptsLectureApproachingaPHProblem.pdf

Approaching a Public
Health Problem:

Finding Research and Using Models

Approaching a Public Health Problem: Finding Research and Using Models

1

What does this lecture cover?

TIPS FOR FINDING
ARTICLES

TIPS FOR READING
ARTICLES

PUBLIC HEALTH
MODELS

This lecture focuses on tips for finding articles and tips for reading articles. I will use
the terms, “scholarly,” “academic” or “scientific” articles, and I use these
interchangeably to refer to articles that are written by researchers and published in
peer-reviewed academic or scholarly journals. Finally in this lecture, we will be
covering some public health models with a focus on our example model, the
PRECEDE-PROCEED Model.

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Why do we care about
scholarly articles?

8/26/2020

Before we dive in, I’d like you to ask yourself this question: why do we care about
scholarly articles?

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Take a look at this slide. I’ve clipped two different news articles from websites that
have health information on them, and each one is about napping. In the top image,
we see a woman reclining on a couch, and the headline of the article is “The
Overwhelming Benefits of Power Napping.” If you were to read this, you might think,
“Wow! Napping is really great! Maybe I should nap more.” However, the bottom
image shows another woman taking a nap, but the headline of this article is,
“Afternoon naps linked to premature death, research suggests.” If you were to read
this article, you would think, “Oh my goodness! I should never nap again, because
somehow, it’s going to kill me.” If you were to read both of these articles together,
you might be left feeling somewhat confused. One of the reasons we have articles
like this is because journalists or science writers will take a small or limited study and
use those findings and try to apply them to the whole population. This makes for eye-
catching headlines, but leads to confusion. What we can do as public health
professionals is to, instead of trust the headline, go to the source. We need to be able
to review scholarly articles and how the data was generated in to understand
the claims and their limits.

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Scholarly Sources Are:

• Original research

• Published in a scholarly/academic journal

• Journal is peer-reviewed

• Journal is indexed by MEDLINE

8/26/2020

Scholarly articles are original research, and of course this is not limited to
experiments. Original research includes research efforts such as creating a meta-
analysis or literature review. They are published in a scholarly or academic journal.
That journal is peer-reviewed, and that journal is indexed by a credible indexing
source. Since we’re in public health, health articles are indexed by MEDLINE, which is
provided by the National Library of Medicine. We’ll talk more about MEDLINE on the
next slide. However, know that if you happen to review articles for another discipline,
MEDLINE may not contain them. Agricultural articles, for example, would be indexed
by a library provided by the US Department of Agriculture. Whatever topic you’re in,
try to find a reputable indexing source that uses expert review to include journals in
its database.

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Tips for Journals

How can I tell if a journal is indexed in the National
Library of Medicine’s Medline?

1. Go to https://www.ncbi.nlm.nih.gov/

2. Search within the NLM Catalog

3. Type in the name of the journal with [jo] after the name

4. Scroll down to the “Current Indexing Status” section

Medline uses an expert committee to decide if a journal
should be included (link). If your journal is not indexed, it may
not be from a reliable/scholarly journal.

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Our first tip is indexing, and we’re going to take a look at MEDLINE, which is part of
the National Library of Medicine at the National Institutes of Health. The way you can
do this is to go to ncbi.nlm.nih.gov. Once you find an article you’re interested in using,
and you want to see if it’s indexed, find the name of the journal in which it was
published. Head to the website and search within the NLM catalog. All you need to
do is type in the name of the journal that you found, and then type in brackets [jo]
after the name. This will return information about the journal itself rather than
articles within the journal. Scroll down to the “Current Indexing Status,” and you can
see if it’s indexed by MEDLINE. MEDLINE uses a committee of experts to decide if
journals should be in this database, so if your journal is indexed, there’s a good
chance the article you found in that journal is trustworthy. If your journal is a health
article, but it’s not indexed, there’s a chance it’s not from a reliable journal.

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Tips for Journals

How can I tell if a journal is peer reviewed?

1. Go to the KSU library website:
https://www.library.kent.edu/

2. Under “Research Tools” go to the Journal Finder

3. Type in the journal name and search

4. The first page also shows where the article is indexed

5. Click on the result to see a detailed record (you can see
an example on the next slide)

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Next, let’s talk about peer review. You may know that scholarly journals are “peer
reviewed.” This means that before a journal publishes an article, it sends it to “peers,”
who are experts in the same topic as the article itself. They review the article for
scientific integrity, and sometimes they will suggest changes or reject the article
completely. To check this out, we’ll take a look at another resource within our
university. For this slide, go to library.kent.edu. There are tons of helpful research
resources at the Kent State University Library website! Many of them are under
“Research Tools.” Hover over that in the toolbar and go to the Journal Finder. Again,
you’re going to type in the name of the journal and press “Search.” The first page will
show where the article is indexed. If you click on the result, which we’ll see on the
next slide, you can see a detailed record.

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8/26/2020

Next, let’s talk about peer review. You may know that scholarly journals are “peer
reviewed.” This means that before a journal publishes an article, it sends it to “peers,”
who are experts in the same topic as the article itself. They review the article for
scientific integrity, and sometimes they will suggest changes or reject the article
completely. To check this out, we’ll take a look at another resource within our
university. For this slide, go to library.kent.edu. There are tons of helpful research
resources at the Kent State University Library website! Many of them are under
“Research Tools.” Hover over that in the toolbar and go to the Journal Finder. Again,
you’re going to type in the name of the journal and press “Search.” The first page will
show where the article is indexed. If you click on the result, which we’ll see on the
next slide, you can see a detailed record.

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Are these scholarly sources?

• https://www.cdc.gov/alcohol/fact-sheets/alcohol-
use.htm

•
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639933
/

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To practice screening sources, take a look at these two links. Pause the lecture to click
on these links yourself. Review each one, and ask yourself, “Are these scholarly
sources?”

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Are these scholarly sources?

• https://www.cdc.gov/alcohol/fact-sheets/alcohol-
use.htm

•
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639933
/

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X No! Although we love the CDC,
this is not a primary source. It is a
fact sheet on a web page.

✓ Yes! This recent paper is
published in a peer-reviewed
journal that is indexed by
MEDLINE.

For the first source, no. Although we love the CDC, this is not a primary source. It is a
fact sheet on a web page. For the second, yes. This is a recent paper. It’s published in
a peer-reviewed journal, and it’s indexed by MEDLINE. A good hint that gives this
away is that it is, just like the MEDLINE website, from the URL nlm.nih.gov, or in other
words, is available through PubMed, the NLM’s journal search service.

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Types of sources

I read the research that was
conducted by another person, and

this is my interpretation.

I am the researcher. I conducted the
experiment, and these are my

results.

Secondary

Tertiary

Primary

I read the report of someone who
read the original research, and this is

my interpretation.

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Let’s discuss types of sources. Primary sources are written by the researcher who
conducted the research activity whether it was an experiment or analysis of
literature, and they are writing about the of the scientific activity themselves. These
are scientific or scholarly journal articles, and they are the most reliable source of
information for you when you are citing information for a research paper. Secondary
sources are written by someone who read the original, primary research, but the
research was conducted by another person. Although many secondary sources are
reliable, such as a CDC fact sheet, they are not the first source of the information.
Tertiary sources would be someone who read a secondary source and are giving their
interpretation. Notice the gap in the graphics between each of these groups. Each gap
is where interpretation happens, and each place is an opportunity for
misinterpretation. Using primary sources means the only interpretation is being done
by you.

More info here: https://umb.libguides.com/PrimarySources/secondary

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Using Primary Sources

• When you are writing a paper, cite primary sources

• This removes the potential for others to make errors in
interpreting results

• Primary sources are original research articles that are
published in scholarly or academic journals

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If you’re writing a research paper, your citations should be primary sources. This
removes the potential for others to make errors in interpreting results. When you are
doing your own writing, you should be looking for papers that are original research
articles that are published in scholarly or academic journals.

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And to highlight why it’s so important to look at primary sources let’s go back to our
napping studies

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Misinterpretation

• Benefits article: cites two references. One is a link to
another page on the website, and one is to an Australian
study of how getting more sleep reduces the risk of motor
vehicle crashes for people with sleep apnea.

• Death article: cites a Daily Mail article. The Daily Mail article
discusses a research study which found a link between
people who regularly sleep more than 40 minutes per day
and diabetes and heart disease.

When we look at the benefits of napping article, it cites two references related to
sleep. One is a link to another page on that website so that makes the first reference
tertiary. The other reference is a link to an Australian study investigating if getting
more sleep reduces the risk of motor vehicle crashes for people with sleep apnea.
The only patients in the study where patients at a sleep clinic who had previously
shown signs of or had been diagnosed of a sleep breathing dis . The napping
death article cites a Daily Mail article, making it a tertiary source as well. If we go to
the Daily Mail article, it discusses a research study that found a link between people
who regularly sleep more than 40 minutes per day in the middle of the day and
diabetes and heart disease. The key take away is if you look at the primary research
behind both of these articles you’ll see there is no conclusive answer to whether or
not napping is beneficial, but you would not know that from reading these articles on
their own without looking at the source material.

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Tips for reading journal articles

1. Ensure it is a good source

2. Read the title

• Is the title relevant to my search?

• Do I understand the terms?

8/26/2020

Next up, let’s review some tips for reading journal articles. First, we want to ensure
it’s a good source. To do this, refer back to the previous few slides to make sure the
journal in which an article is published is indexed and peer-reviewed. The second step
is to really read the title. Is the title relevant to the search or to the topic at hand? Ask
yourself if you understand the terms. If you find that even in the title, there are a lot
of technical terms or jargon you don’t understand, it’s okay to skip that article for
now. Read up on the topic further, and don’t be afraid to get started in encyclopedia
pages to get familiar with the basics. After that, work up through other articles, and
eventually go back and tackle the more technical article.

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Tips for reading journal articles

3. Read the abstract

• What type of paper is this?

• How was it designed?

• What are the results?

4. Read the methods

• Do the methods make sense?

• Is there a control group?

• Have the researchers accounted for confounders,
covariables or other factors that may interfere with
results?

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Next, we’re going to read the abstract. Keep in mind that we’re going to work through
the sections of this paper by asking many questions, and as you answer them, you’ll
gain a better understanding of the paper. First, what type of paper is this? Is it an
experiment, is it a meta-analysis, is it a literature review? How was it conducted?
What are they key results? An abstract should follow the sections of the paper itself.
After reading the abstract, you may find that you don’t want to continue reading the
rest of the paper because it’s not a good fit for your research project or the paper
you’re writing. This is completely fine. Often you will find you need to read through
many abstracts to find papers that work for the project at hand. However, if you’re
going to continue reading this paper, it’s time to skip over to the methods section.
First, consider the question the researchers are asking, and think about the steps they
took to answer this question and if they make sense. Is there a control group, or is
there some sort of comparison the researchers are using? Have researchers
accounted for confounders, covariables or other factors that may interfere with the
results? This is a good place to ask as many questions as you can about any external
or even internal influences you can think of that could alter the results.

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Tips for reading journal articles

5. Read the discussion section
• How do the researchers interpret the results?
• What are the limitations of the research?
• What next steps do the researchers propose?

6. Read the tables
• Is there a demographics table? How do you characterize the

people who were studied?
• What are the detailed results? Are they significant?
• Look up any tests you do not understand such as significance

or post-hoc testing.

7. Read the background and review the paper as a whole

8. Look at the sources for further reading
• Which sources will you read next?

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Next, we’re going to read the discussion section. This should toward the end of the
paper. Ask yourself, “How are the researchers interpreting their results?” In this
section, there will be, as promised, discussion, and researchers will tell you what they
think happened in a study. If you’re new to a field or a topic, this is a great way to see
a plain language description of what happened in the study as well. The discussion
section should also include limitations of the research and steps the researchers
propose for future studies. Consider whether the limitations of the research project
sound acceptable. After this, we’re going to read the tables. These should be in the
results section, and they will be a detailed presentation of the research data. Look for
a demographics table and ask yourself, “How would I characterize the people who
were studied?” Sometimes you will find the population in a study is too different
from your own research topic, or sometimes the population is too narrow to apply to
a larger group of people. For example, if you want to write a a paper about all
Americans, but the study you found only looks at men over the age of 65. You have to
decide if this research is still relevant to your topic and if you can justify including it as
a citation. Next, look for the detailed results in table format. Examine how the
researchers report results. Do they show significance, odds, effect size? If you see any
types of tests or analysis you don’t understand, take some time to look these up. The
seventh step is to read the background section and review the paper as a whole. You

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should be able to summarize the paper in your own words, and you should be able to
answer the question, “Why was this written?” You should also be able to describe the
results of the paper and whether or not you agree with the authors’ interpretation of
the data. The final step is to look at the sources for further reading. Look to see if the
sources are recent, and as you become more of an expert on a topic and read many
papers, see if any of the author names or journal titles sound familiar. You can use
this section to find what to read next.

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The Models

8/29/19

Now we’re going to talk about some public health models and how to apply them to
research.

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Frameworks are like shelves

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Public health models are often called “frameworks.” They are ways to organize ideas,
theories and action plans into a single, cohesive project that you can use plan,
implement and/or evaluate a public health program. Think of a framework like a
bookshelf. If your public health project is like a storage closet, you can easily dump
tons of resources, facts, ideas, surveys, planning tools and research papers into it, but
it’s difficult to find them again. They might get lost or removed. If you first have
bookshelves to organize a public health project into a nice, tidy storage area, the
information will make sense to you and to everyone else involved. Researchers have
created many different types of frameworks. Think of these as styles of shelves. They
may look different, but each framework exists for the same purpose: to assist with
organization.

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How do you even begin?

• Public Health Models

• Variety of uses, ideas and methods

• For simplicity’s sake, we will use PRECEDE-PROCEED
as an example

• Let’s review other planning tools

• Theory is dynamic – use it however it is beneficial to
you

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Where to start? There are lots of public health frameworks out there with a lot of
uses, ideas and methods behind them. For simplicity’s sake, we’re going to look at
the PRECEDE-PROCEED Model as an example. We’re first going to broadly look at
other types of tools, so keep in mind theory is dynamic and always-changing. Use
these ideas and tools in a way that works for you. You don’t need to memorize them
or learn all of them, but know that in the future, when you have a public health
problem to solve, there’s no need to reinvent the wheel. You will be able to find an
existing strategy to help you make a plan.

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What’s out there?

• Logic Models (graphic)

• SWOT Analyses (planning)

• Frameworks (PPM, RE-AIM)

• Theories (TTM, Ecological, Health Belief)

• What have you learned about so far?

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What is out there when it comes to public health tools? We have logic models, which
are graphic or visual organizers and work well for visual-thinking people. We have
SWOT analyses, which are based on a quadrant and are helpful when you want to
begin to understand an issue. There are frameworks such as the PPM (PRECEDE-
PROCEED Model) or another similar model called RE-AIM. There are also theories
which are broader and more abstract. Consider if you have learned about any of
these tools before, and if so, which ones you like or do not like. It’s okay to play
favorites, as some tools work better for some people based on your style of thinking
and problem solving.

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8/26/2020

Here is an example of a logic model, so you can see how even drawing out a diagram
is one of the ways you can begin to solve a public health problem.

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Where do these things come from?

• Researchers (various papers)

• Various federal agencies (CDC, FDA)

• Various governing bodies of medicine (cardiology,
oncology, vaccines)

• Look at all of these!

• What is the point?

8/26/2020

We see that there are plenty of tools out there. How do they come into being? One
way is through researchers. Various papers, published in scholarly or academic
journals, have been written in to propose or evaluate one of these tools.
Federal agencies generate tools as well, such as the CDC and FDA. For very specific
topics, such as cardiology clinical trials evaluation, various governing bodies of
medicine create their own tools as well. The link here goes to the CDC’s Evaluation
Development Tools page which has dozens of documents, workbooks and tools. The
point of showing you all of these in such a brief way is to drive home the point that
whatever type of project you are planning, there is a tool you can use.

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PPM

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Next, we’re going to focus in on the PRECEDE-PROCEED Model as an example of
where a model came from, what is inside of it and how to apply it to a program. This
slide shows the original model from the original PPM paper in 1974.

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PPM: What is it?

• A planning model and framework. Not a theory.

• Developed by a DrPH from Stanford, Lawrence Green, in 1974

• Developed to create a cost-benefit analysis for social issues

• Borrowed by CDC in the 90s as “PATCH”

• Used in over 1000 papers according to Dr. Green’s website:
http://lgreen.net/

• Ecological approach; start with quality of life and work backward

• Medicine: Medical diagnosis

• Public health: Educational diagnosis

• 9 Phases: 5 diagnostic phases, 1 implementation phase and 3
evaluation phases

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The PPM is a planning model and framework. It is not a theory. Again, theories are
broader and more abstract. They tend to explain why things happen. This, instead, is
a is a step-by-step guide you can follow. It was developed Dr. Lawrence Green at
Stanford. He created it as a way to evaluate the cost-benefit ratios of social issues.
After he first published the paper, the CDC adopted it as “PATCH” in the 90s which
launched into much broader popularity. Dr. Green’s website indicates it has been
used in over 1000 papers! You can check out the list there. The PPM is based on the
ecological approach, meaning we are starting with a quality of life issue we want to
change or improve and working backward from there. Dr. Green points out that in
medicine, you get a medical diagnosis. Instead, the PPM uses its first five phases to
generate an educational diagnosis.

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8/26/2020

Here you can see the introduction to that very first PPM paper written by Dr. Green.
He laments that you have to justify public health projects in an economic sense. So if
you want money to do a project, you have to explain the cost benefit analysis. That’s
why he created this model originally, so hopefully you, too, can use this model in your
education and career to justify your own public health projects and help you plan
them.

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8/26/2020

On this slide, we have a figure from a paper by Crosby and Noar called “An
introduction to PRECEDE-PROCEED,” where you can see the original model has been
updated. Notice quality of life is both step 1 and step 9, as you work from your goal,
backwards through assessments and that educational diagnosis, and forwards
through implementation and evaluation. This is a more modern version of the PPM,
but the ideas are the same.

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PRECEDE

• Predisposing,

• Reinforcing and

• Enabling

• Constructs in

• Educational

• Diagnosis and

• Evaluation

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Here you can see the basic words that are used to describe PRECEDE. Keep in mind,
these are not steps. This is just an description of what the model does.

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PROCEED

• Policy,

• Regulatory, and

• Organizational

• Constructs in

• Educational and

• Environmental

• Development

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And here’s the PROCEED side of things. It is a way to analyze various constructs in
developing an educational and environmental plan. All you need to remember is
PRECEDE-PROCEED Model. The words, again, are a summary of what the model
does.

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Summary

When approaching a public health problem, use
scholarly sources to learn about it.

When designing a solution, use a model, such as the
PPM, to assist your design process.

Finally, remember to generate as many questions as
you can when considering your issue.

Here’s the summary of our lecture. Keep in mind, when you’re approaching a public
health problem, use scholarly sources to learn about it. When designing a solution,
use a model such as the PPM or whatever suits your personality and your unique
public health issue best. And finally, remember to generate as many questions as you
can when considering your issue. As you answer these questions, you’ll come closer
to a solution.

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