Unit 1 - Study Session 5: Search and Review Relevant Literature (Assignment 1)

Introduction

In each unit, the final study session focuses on a different aspect of the assignments. This study session guides you through Assignment 1. You will submit it and get feedback which you may incorporate into your second assignment - the final report. Take another look at Section 3.3 in the Module Introduction (on Draft Assignments) before you proceed. Remember also that you have an example of a Literature Review as Appendix 1 at the end of this Module Guide.

In this study session, you will begin by analysing the assignment as a whole. Once you are clear on its requirements, you can proceed to Task 1. Assignment 1 requires you to familiarise yourself with the problem presented in the dataset in section 3.6 of the Module Introduction. Once you have a good grasp of what the dataset represents, you need to locate as much relevant literature as is available on this issue. This literature may take the form of research reports, articles in journals, comparative data, annual reports or any other sources of information. Remember that finding relevant literature can take time, so start straight away. You must use the Internet for your search in order to get up to date studies.

You should then read this literature, select relevant material from it and critically review the literature in 2 - 3 pages. Here you should be selective, focusing on the issues in the literature which are relevant to the dataset. You should then submit this draft literature review to your lecturer for comment.

While you read the literature, you are urged to take notes which will feed into Assignment 2. This involves going beyond simply reviewing the literature and recording any insights you gain from the literature about the dataset. It is part of developing a systematic summary of your observations as you proceed.

Contents

1. Learning outcomes of this session
2. Readings
3. Assignment scenario
4. Clarify the assignment requirements
5. Scrutinise the dataset and describe the problem
6. Search for health information
7. Develop your review while you read
8. Critically review health information
9. Session summary

1. LEARNING OUTCOMES OF THIS SESSION

2. READINGS

Refer to all the readings listed in the preceding study sessions.

Refer to the assignment information in the Module Introduction (section 3) and use the dataset provided in the Module Introduction (section 3.6). 

3. ASSIGNMENT SCENARIO

4. CLARIFY THE ASSIGNMENT REQUIREMENTS

Before plunging into your assignment, take a few moments to clarify what you hope to achieve, by when, and the resources available to you. A plan like this will help you to work systematically through all aspects of this task.

TASK 1 – PLAN THE PROCESS OF UNDERTAKING YOUR ASSIGNMENTS

After reading the assignment scenario above, use the Module Introduction, sections 3 and 4 and the last session of each unit to complete the table below.

1. Identify the marks allocated and due dates of the assignments. Write the draft and final submission dates onto your Work Plan.
2. Identify the main components of the Report required for the assignment.
3. Identify what you must do to complete each of these components.
4. Identify any resources that may help you with the assignments.

You could wait until later to clarify the actions to be taken for Assignment 2. They will become clearer after you have done an initial review of the literature, and clarified an outline for Assignment 1.

FEEDBACK

Hopefully this gives you a sense of the process that lies ahead: the compulsory hand-ins are Assignment 1, Draft Assignment 2 and Final Assignment 2. You should add the required actions to this table as you work through this session, (e.g. search for comparable studies on Internet), and return to this table it to remind yourself of the process that lies ahead.

You have received an Assignment Schedule from the Student Administrator. The components of the Report required for each assignment is set out in the Module Introduction and explained in the final sessions of each unit.

Some of the resources that may be helpful include provincial or local authority annual health reports, the Health Systems Trust’s annual South African Health Review, World Health Organisation (WHO) reports or UNICEF documents. These might provide you with a basis for comparing your dataset with similar data from other sources.

In order to get a feel for the final report that you must produce, take a look at Chapter 12 of Vaughan and Morrow (1998), on different ways to present health information. The checklist provided at the end of Chapter 12 may also be particularly useful.

Before you even start the literature review, make sure that you have a good grasp of the nature of the problem represented by the dataset.

5. SCRUTINISE THE DATASET AND DESCRIBE THE PROBLEM 

The purpose of Task 2 below is to get a rough understanding of the problem represented by the dataset and to conceptualise how you will go about understanding it better. This will make it easier to handle and interpret, and also help you decide what kind of literature would be helpful.

In Unit 1, Session 2, you were provided with a conceptual framework to analyse a health status problem which included questions like: Where did these health events occur? Use these questions to help you get to grips with the dataset.

TASK 2 – EXAMINE THE PROBLEM AND IDENTIFY THE MAIN CHARACTERISTICS OF THE DATA

1. Look at the data provided to determine what is there.
2. Get an initial impression of the data using the questions from the conceptual framework (Unit 1 Session 2).
3. Summarise the problem you see in the data.

FEEDBACK

What does the data contained in the dataset represent? What diseases, conditions or Public Health problems have resulted in the problem presented in the data? You may find that there are categories or groups of data that are similar. What are these overall groups or sub-headings?

You need to identify what the data is that you are looking at before you begin your literature review. The categories of data and the individual items of data will provide a set of Key Words for you to use in your literature search in Task 3.

6. INTRODUCE THE REPORT

As part of Assignment 1, you should introduce your report covering a few key issues: first of all you should define key concepts, succinctly state the problem studied by the survey or data, explain the context in which it exists and establish why it is worth tackling.

TASK 2 – THE PURPOSE OF THE INTRODUCTION

What would you say is the purpose or role of an Introduction in a Research Report?

FEEDBACK

Take a look at this example of an Introduction by one of SOPH’s past students from Tanzania, Jeremiah Mazala (2004) which is reproduced with his permission.

The dataset that he studied was concerned with:

THE SEXUAL AND DRUG RELATED RISK BEHAVIOUR IN ADOLESCENTS AGED 11 AND 15 YEARS IN REGION X.

Introduction 

There are different definitions of risk behaviour by different writers. Richard (1998) defined it as behaviours that can directly or indirectly compromise the well being, the health and even the life course of young people. The World Health Report 2002 suggests that risk is “… the probability of an adverse outcome, or a factor that raises this probability” (WHO, 2002: 21). In other words any behaviour that will raise this probability is a health risk.

Teenagers are at peak of risky behaviour because of their curiosity. They constantly experiment and test varieties of behaviours. In doing this, they become dangerously exposed to all kinds of behaviour associated risks. Amongst others, these include cigarette smoking, alcohol drinking, unsafe sex, marijuana smoking, use of cocaine and mandrax, etc. Since the young population is higher than other age groups in most of populations, the future working and economically viable population will be in jeopardy if these risky behaviours are left unchecked. This has an impact on future adult productiveness economically, socially and politically. So knowing the extent of the problem is important for productive interventions.

This introduction achieves all of these things, but the context could, in a real situation, be presented more specifically.  Now try to draft an introduction to your report, submit it with your Literature Review, and revise it as your report develops.

6. SEARCH FOR HEALTH INFORMATION

In order to start your literature search, you must be fairly familiar with the dataset and the Public Health problem that it represents. Ask yourself what information is required to understand this health problem more deeply. This is the motivation for exploring relevant literature. You are trying to find out what is already known about this issue. Search for information about the condition, about other interventions which have been made to address this problem. Ask yourself: what other information may be important? This search for information might be divided into sub-sections or themes, e.g. risk factors for this condition or comparable interventions. 

The purpose of Task 3 below is to get started on your search for relevant literature or background information on the Public Health problem represented in the dataset. Your literature search will be guided by your description of the problem from the previous section. It could include an exploration of the kind of social and biomedical risk factors that may have an influence.

You will need access to a library and the Internet (if possible) for this task.  It could take a few weeks to gather the information you need, so start early. Begin by identifying key words that will help you to locate appropriate literature, e.g. if the data focused on HIV/AIDS, you could search for literature using the keywords HIV/AIDS and Risk Factors. If the dataset focused on women with HIV/AIDS only, you would use Women + HIV/AIDS + Risk factors. You should search for these words and related terms on the Internet in established electronic databases such as MedLine, MedInfo and others. See section 2.4 of the Module Introduction for additional websites.

TASK 3 - SEARCH EXISTING DATABASES FOR LITERATURE

Here are some tips to get you started:

• Use your key words to search for information on this health problem.
• Ask colleagues for help in locating other more local sources of information relevant to the dataset.
• As you search for literature, look out for comparable studies by other researchers.
• Copy down or print out the reference details and abstracts of articles that seem to be useful.
• Record full reference details immediately using a standard reference style like Harvard.
• Save or request copies of the complete articles that appear to be particularly relevant.

FEEDBACK

You could use the list of variables included in the sample dataset and any synonyms that seem relevant as key words to begin with. Refer also to resources you have encountered previously such as the SA Health System Review, Department of Health Annual Reports and articles in the local medical literature. Remember that you must be selective. You are trying to narrow down your search to literature that will be relevant to this particular problem. “How many references will be needed?” is a question that is often asked. In a data or research report for a busy manager, you would generally expect to have 8 - 15 references.

Remember also that your Literature Review must have an alphabetical Reference List at the end of it, with full reference details, set out correctly, with accurate punctuation. You may use any style of referencing as long as you are consistent. We recommend, however, that you follow the Harvard Method of referencing which is explained in your SOPH Academic Handbook.

7. DEVELOP YOUR REVIEW WHILE YOU READ 

You should already be aware that a Literature Review is more than just a summary of selected articles about a health problem. From Session 4, you have learnt the importance of critically reviewing what you read. However, a literature review must also be an integrated discussion of the literature on a topic. To write an integrated discussion, you need to know the contents of the literature well enough to select relevant information, and secondly you need to conceptualise an overarching framework for your review in the early stages of reading. This enables you to identify relevant points while you read, rather than reading everything and then trying to put it all together. Here is an example.

When presented with a dataset describing a high incidence of non-communicable or chronic diseases, this is a possible structure for the literature review:

1. Clarification of key concept/s, e.g. non-communicable diseases.
2. Global, national and local prevalences.
3. Physical and socio-economic impacts of chronic diseases.
4. Risk factors, including nutritional changes, physical exercise, etc.
5. Studies of Public Health interventions in this field, such a healthy eating campaigns.
6. Relevant methodologies used by other researchers, and critical reviews of available studies.

How did we arrive at these sub-topics or themes? Firstly there are some sub-topics that will be relevant to any epidemiological problem, e.g. physical and socio-economic impacts of chronic diseases. Then, you would need to discuss the effects or impacts of the problem in order to alert your manager to the scale or potential impact of the problem; and thirdly, you will want to know what others have done faced with similar problems: are there any lessons that you could learn from previous studies? Other topics will emerge iteratively as you study the dataset, and read articles relevant to this health problem.

A strategically sound way of preparing a literature review is to read purposefully, and selectively from the outset. The following readings by Mouton (2001) and Depoy & Gitlin (1994) explain that it is helpful to read with your sub-topics in mind, selecting information for the different sections of your literature review while you read. Depoy & Gitlin (1994) suggest two ways of “Charting the Literature”, or organising it: the first way is according to key concepts or topics that arise from the study, e.g. drug-related behaviours, depression and suicide. This is what we have done in the example above. Mouton (2001) also suggests this approach.

Another way of structuring the content of the literature review is to use the framework provided by scientific papers (Depoy & Gitlin, 1994). Here you could focus on links and contrasts between study population, then focus on the sampling strategies and study methods, then on the findings, and so on. Whatever way you decide to structure your literature review, you need to integrate the literature into a discussion, with the aim of showing what is relevant to your study, what contradicts it and whether there are gaps in the research. Take a look at these readings, and then choose a way of structuring your review that suits you.

TASK 4 – DEVELOP A FRAMEWORK FOR YOUR LITERATURE REVIEW 

Brainstorm a set of sub-topics for your literature review. Then read one of the texts you have found, and select information which fits into your structure. Every time you find something relevant, note it down with the page number, or code it clearly on the reading itself.

FEEDBACK

Amongst your sub-topics, you should at least have:

• Clarification of key concept/s.
• Global, national and local prevalences.
• Risk factors.
• Studies of Public Health interventions in this field.

In summary, choose subheadings to reflect the most important issues; organise the evidence or research findings in the literature in terms of the main themes, topics or questions you have identified. Then write an integrated summary of what the literature says about each of your thematic issues.

8. CRITICALLY REVIEW HEALTH INFORMATION

After you have assembled a set of relevant literature, try to systematically critique the studies. Being critical is difficult when you are not yet familiar with the topic. You will probably find that only once you have analysed your own dataset, will you really be able to comment critically on the other comparative texts you have found. Do as much as you can at this stage, but be prepared to revise your Literature Review after you receive feedback from your lecturer, when you are compiling the Final Report. 

TASK 5 – UNDERTAKE A CRITICAL REVIEW OF THE LITERATURE

Having written a draft of your literature review, try to develop a critical review section which focuses on the research studies that you have read. Read these texts with the critical questions you developed in Session 4 (Task 3) in mind. Be sure to assess the quality and appropriateness of the research methods used to generate the results, and to comment critically on the findings and conclusions.

FEEDBACK

Hopefully you have asked some of these questions:

• What question is being addressed in this study?
• Is the context of the study similar to that in my dataset?
• Was the study sample appropriate? 
• What were the limitations of the study, if any?
• What study design was employed?
• What were the most important features of the study design?
• Were the conclusions appropriate? Did the method bias the results?

It can also be useful to prepare tables that display the main findings from different researchers alongside each other.

It is now time to start finalising your first Assignment. Drafts are welcome as long as they are well ahead of the deadline. You will receive comments on your Literature Review, which will enable you to make improvements before final submission as part of the report (Assignment 2).

Remember that you should not simply repeat what was said in the articles you read. You must try to be selective, to analyse it and be critical as well, asking questions of the article and pointing out issues that have not been addressed. You should also comment, if possible, on the research methods used by the researchers. A variety of texts illustrate a systematic approach to critical journal reading. You may also refer to the Health Systems Research I module for further guidance.

8. SESSION SUMMARY

By now you should be well on your way to completing your first assignment. So far, it should have a Title, a short Introduction to the topic and problem, a Literature Review with proper in-text referencing, and a corresponding Reference List in the correct format. Have a look at the example which you will find as Appendix 1 at the end of this Module Guide.

Submit it in draft form as soon as possible for comment. Unit 2 will further develop your skills in understanding the uses of epidemiological data and provide preparation for Assignment 2.