Research and Evaluation Skills

Research and CHW work

Research and evaluation may not be the initial considerations when thinking of CHWs. Many enter the field wanting to engage directly with people on the front lines. But data and research skills are crucial — they help improve healthcare quality by surfacing trends and the underlying factors affecting individual and population health.

Using these insights, healthcare and community health agencies can effectively conduct program evaluations and quality assurance. This lesson covers how CHWs can contribute to research and evaluation, and emphasizes the importance of involving community members — a crucial aspect that leverages the CHW's trusted role in the community.

Overview of the research process

Research is a systematic process aimed at uncovering new knowledge or understanding existing phenomena. It involves structured steps that guide methodically answering an important question. CHWs play a vital role in public health research — they gather data, engage with communities, and implement findings. Their unique insights and connections within communities are invaluable.

Six ways CHWs contribute to research

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The five phases of research

Types of research study designs

Descriptive Studies

Describe behaviors or phenomena in groups without delving into causes.

• Case Studies — Highlight unique, rare, or uncommon traits through detailed examination of individuals or groups. Findings are anecdotal but can reveal new diseases (HIV/AIDS was first identified through case reports of patients with unusual conditions).
• Cross-Sectional Studies — Quick, cost-effective snapshot of disease prevalence at a given time. Useful for planning resources. Can't prove causality; biases are possible, since a single time point doesn't reflect changes over time.
• Ecological Studies — Examine links between exposures and outcomes at a population level using existing data. Watch for the ecological fallacy — drawing conclusions about individuals from group data. (Example: a state-level correlation between firearm ownership and crime doesn't mean an individual's gun causes more violent crime.)

Analytical Studies

Dig into cause-and-effect by comparing different groups' exposure to factors.

• Observational Studies — Document existing relationships without intervention.
• Cross-Sectional (analytical variant) — Establishes a relationship between cause and outcome.
• Case-Control — Looks back from outcome to its cause, identifying cases and controls for comparison.
• Cohort Studies — Follow groups over time to see how exposures affect outcomes.
• Experimental Studies — Actively introduce changes in study participants to observe effects. Crucial for testing new treatments (controlled trials).

Data sources

• Electronic health records data
• Administrative data (e.g., hospital discharge data reported to AHRQ)
• Claims data (from government and commercial insurers)
• Patient/disease registries (Alzheimer's, cancer, diabetes, heart disease, asthma)
• Health surveys (national surveys assessing prevalence of common chronic conditions)

Before gathering anything, researchers map out a comprehensive data collection plan. A well-defined plan helps researchers verify findings and facilitates a systematic approach. A comprehensive data collection plan will typically include:

• Data sources — the specific records, registries, and surveys the data will be drawn from.
• Collection methods and tools — how the data will be gathered (surveys, interviews, chart abstraction, or direct measurement).
• Timeline — when and how often data is collected over the course of the study.
• Roles and responsibilities — who is responsible for gathering, entering, and managing each piece of data.
• Data management and storage — how data is recorded, secured, and kept confidential.
• Quality assurance — the checks that keep the data accurate, complete, and consistent.

A researcher observes a state-level correlation between firearm ownership and crime and concludes that an individual who owns a gun is more likely to commit a violent crime. Which error has the researcher made?

Match each study design to its defining feature.

In which phase of the research process do CHWs play an especially important role by bringing community issues and needs to the table early?

Engaging community in research

Historically, research has overlooked the involvement of communities and individuals impacted by its outcomes — treating diseases and results as detached from context. But context is crucial. Engaging community members isn't just ethical and empowering — it improves the quality of information and builds trust in findings.

Ethical principles for research

Clinical research aims to advance scientific knowledge and improve human health. But it's essential to recognize and prioritize the well-being of individuals who participate. Ensuring their safety is the top priority at every stage — from careful planning to comprehensive follow-up. The NIH outlines seven guiding principles.

The 7 NIH guiding principles for research

Recognizing the paramount importance of ethical conduct in clinical research, it's essential for CHWs to adhere to additional foundational principles that govern their involvement in research or evaluation efforts.

5 foundational ethical principles for CHW research

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Why these principles exist: Tuskegee

Which of the NIH guiding principles was most clearly violated when Tuskegee participants were misled about the study's purpose?

Enhancing ethical oversight in research

Failures like Tuskegee led directly to stronger safeguards. Today, ethical oversight is built into research from start to finish — designed to protect participants and hold researchers accountable.

• Institutional Review Boards (IRBs) — independent panels that review a study's design and ethics before it can begin, then keep monitoring it while it runs.
• The National Research Act (1974) — created the commission that established formal ethical guidelines and mandated review of federally funded human-subjects research.
• The Belmont Report — set the three principles that anchor research ethics today: respect for persons, beneficence, and justice.
• Ongoing monitoring and informed consent — participants must be fully informed, are free to withdraw at any time, and have clear channels to raise concerns throughout the study.