It is important in my thought process when doing research that I know why I am doing what I'm doing and/or why each step is necessary and how it will benefit me overall. For this explanation and to help me write this review, I sought out help from our dear friend Helen Aveyard (the book).
These questions really helped me focus my reviews and criticisms and I feel like I will carry these questions in the back of my mind from now on when doing research.
What is your research question? Have you decided to change it at all? And, if you have, how do I know that the way in which this question is formulated is appropriate to conduct a literature review with a systematic approach?
Original Question: With a new leader in power, how will the structure of American Healthcare change? Is it possible or even plausible for the US to shift to Universal Healthcare as most countries have?
Revision 1: What changes or adaptations can policymakers create to ensure universal coverage for all American citizens?
Current Question: What changes or adaptations can policymakers create to ensure quality, affordable health coverage for all American citizens?
The definitions still remain pretty much the same...
policymakers --> anyone in the healthcare field that can create a change within policy and law
affordable health coverage --> access to care not be overwhelming/fits the needs based on parties/not excessive/ focus on riding wastes rather than eliminating access
ALL AMERICAN CITIZENS --> no loopholes, no non insured citizens, EVERYONE
Also, I changed the way I searched for things... (Below)
List the source in APA;
o Tell me what kind of source it is;
o Explain exactly how that kind of source is relevant to your research question;
o Speculate how the source will be used in the results section of your literature review;
o Add one interesting thing you found out by working with the source.
You still need an approximately five minute audio in which you detail all research-related decisions that occurred that week, plus pictures that snapshot significant moment of your research process.
Article #6
Paul, H. (1957). Public Health Administration in the United States and England—Baltimore and Birmingham Compared. American Journal of Public Health and the Nations Health, 47(11 Pt 1), 1399–1404.
Cross-sectional studies compare different groups with a similar variable. This study allows readers to determine for themselves if one group's ideas are better than the other or if ideas from both can be combined. Specific to my research question, it took an existing universal care system and compared it to a current US system to see if the US would benefit from a specific type of Universal Health Care. Cross-sectional studies are also able to assess causation and association. Particularly in this study, I could identify public opinions with types of care to see if there was an association. This is an article that I go back and forth upon using and I may want to consider replacing it in the synthesis/matrix, not just because it is dated but because I don't know if the information is very strong in its results or if it would serve any true value to my argument. The book does state however that relevant research does not have to be current! However, I just do not know yet if I feel that this study will add to my overall goal and represent my question fully as the study concluded that it was difficult to compare the two based on differences of peoples/needs. If I do use it though, I will use it to show a working universal system to show that it is possible to create one to fit societal needs. One interesting thing I found in this study was that the US knows more about English Healthcare than England knows about the US.
Article #7
Shaffer, E. R. (2003). Universal Coverage and Public Health: New State Studies. American Journal of Public Health, 93(1), 109–111.
This study is practice literature. It is relevant to my research because it analyzes current systems from expert views and methods. It is also an analysis that took place in California and contains relevant information about the US systems. I will definitely be using this article because it takes information from an area with the highest amount of uninsured individuals to apply it to healthcare reform. It has a higher ration of strengths to weaknesses and it details HOW to improve the system based on US current findings. One interesting thing I found in this study was that California, a majority democratic area (those who favor UHC) was the state with the highest amount of uninsured. I also found interesting that the article stressed the need for reform to focus first on education and outreach programs.
Article #8
Shi, L. (2000). Type of health insurance and the quality of primary care experience. American Journal of Public Health, 90(12), 1848–1855.
This is a case-control study published in 2000. Case-control studies again allows readers to compare different groups and analyze findings. This study allowed me to examine the association between type of insurance and quality of care between insured people and uninsured people. This study directly relates to my research question to show the differences in care. I speculate that I will use this studies findings to outline the need for policy revisions and the lack of equality in healthcare. One interesting thing I found in this study was that it demonstrated how providers level of care changes depending on insurance statuses, which I think is somewhat unfair. This demonstration of the quality of care changing depending on "financial status" is exactly why I chose my research question.
Article #9
Prentice, J. C., Pebley, A. R., & Sastry, N. (2005). Immigration Status and Health Insurance Coverage: Who Gains? Who Loses? American Journal of Public Health, 95(1), 109–116. http://doi.org/10.2105/AJPH.2003.028514
This is a cross-sectional study. This kind of source is relevant to MY research because it examines different groups and compares their insurance status. My research is based on equality in care and this outlines the lack thereof. I imagine using this source as well to outline the current system failing to provide for ALL citizens. I also think I can use it to show how to improve care to immigrants, which make up a fairly decent percentage of the total uninsured. The one thing I found interesting in this study was that the researchers actually conducted interviews in Spanish to those who spoke it.
Article #10
Bodenheimer, T. (2003). The Movement for Universal Health Insurance: Finding Common Ground. American Journal of Public Health, 93(1), 112–115.
This is an example of policy literature. This kind of source is directly related and relevant to my research as my question is policy based. It proposes a reform by discussing prior policies and current stakeholders. It focuses on merging beliefs of opposing views on the current system to develop a more plausible, better system. I imagine I will use this article to show just how policymakers can change the system to better fit the needs of all. One interesting thing I found in this study was that it included a call for action urging those to pay attention to legislation and vote. I also found interesting the fact that employers were made to provide healthcare to their employees in 1971 by an act created by President Nixon.
Anything else interesting happen?
My research question keeps changing to fit my needs and better fit my actual research. I also changed how I was searching for articles.
What is your topic? Or what are your key words thus far?
Universal Health Care
UHC
Private Insurance
policy
I start a lot of my initial research either on the UNR KC website of the AJPH. As noted above in the picture, I need to really start thinking about inclusion/exclusion factors because when I simply look up policy + _something___ a lot of variety comes up. Maybe I can include only current studies.... 1990 and greater. I can exclude non American results to focus on solely our information and funnel my question down again.
What is your research question? Have you decided to change it at all? And, if you have, how do I know that the way in which this question is formulated is appropriate to conduct a literature review with a systematic approach?
Original Question: With a new leader in power, how will the structure of American Healthcare change? Is it possible or even plausible for the US to shift to Universal Healthcare as most countries have?
Revised: What changes or adaptations can policymakers create to ensure universal coverage for all American citizens?
This shifts my question away from possible bias, away from current government issues, but still focuses on the issue of the system itself. This narrows down my search significantly while opening up more literature instead of things published in relation to election (I mean this as saying there probably isn't enough research right now since Trump JUST took office)
And what are the definitions on which it depends?
My question depends on a few terms...
policymakers --> anyone in the healthcare field that can create a change within policy and law
universal coverage --> riding the system of private insurers -or- creating universal coverage backbone while allowing others to opt into private care... having a basic plan insuring ALL and private for MORE benefits
ALL AMERICAN CITIZENS --> no loopholes, no non insured citizens, EVERYONE
What is your hierarchy of evidence? And how do I know you going about finding the most appropriate evidence/method for your research question?
My question mainly relies on policy literature, but through researching, I was greatly interested in practice literature to see how certain models of structure were working in current times. This allowed me to compare and contrast different systems and answer my question fully. I also came across quite a few random clinical trials testing patients reactions to different types of health care and the qualities of their care. This will also help my research overall to be able to decide IF the system should change.
Policy
Practice
RCT
How do I know that the remit of the method itself is selecting the research, rather than just you on a whim? + 1 thing you found interesting + how you imagine using the source
Article #1
Martin, D. P., Diehr, P., Price, K. F., & Richardson, W. C. (1989). Effect of a gatekeeper plan on health services use and charges: a randomized trial. American Journal of Public Health, 79(12), 1628–1632.
This is a random clinical trial, and though lower on my hierarchy of evidence chain, it still has extremely relevant information. This method is rather different for my policy analysis approach but will greatly influence my paper's argument. It demonstrates just how certain people feel on certain plans and how they feel their treatment is. It also analyzes costs of different structures and many other important aspects when deciding to change policy. I found most interesting that many Americans didn't want change... even though we know the system is failing.
Article #2
Akhter, M. N. (2003). APHA Policies on Universal Health Care: Health for a Few or Health for All? American Journal of Public Health, 93(1), 99–101.
This source is directly relevant to my research question, as it is actually analyzing healthcare policy. It discussed the risk vs rewards of changing the current system and discusses thoroughly what would need to change and how we can make certain laws adapt to fit growing needs. It matches directly with my questions and I can see myself really diving deep into this article because of the quality of in-depth analysis and actual results. The most interesting thing to me was definitely realizing just how much is spent on a failing system.
Article #3
Tooker, J. (2003). Affordable health insurance for all is possible by means of a pragmatic approach. American Journal of Public Health, 93(1), 106–109. doi:10.2105/ajph.93.1.106
This is my "dream article" as it directly states just how America can make UHC work and why its beneficial. It discusses the fact that the American HealthCare system could flourish if they switched to universal coverage. It also discussed major benefits to citizens if the switch were to happen and how exactly the government can make these happen. It spoke on lessons we can learn from past policy and current issues. This specifically relates to my article because it shows the steps to make UHC successful and the benefits in doing so, which is what my article will overall be about. I can see myself using this as the main argument and even supporting facts from other articles. The most interesting thing to me was just the strong language used and the call to action.
Article #4
Ottersen, T., & Schmidt, H. (2017). Universal health coverage and public health: Ensuring parity and Complementarity. American Journal of Public Health, 107(2), 248–250. doi:10.2105/ajph.2016.303590
This is another policy review that fits well with my current research question. It discusses how we can keep equality within the healthcare system even when it is changing and after. It will be great evidence supporting the backbone to my argument and provides clear insight to the "ensuring the coverage of all Americans" that my question really focuses on. The most interesting thing to me while also being the most important part of this article is how well it defined many health terms relating to coverage that I fear many Americans and those not well educated do not know. I can also seeing myself defining these in my paper to ensure the reader understand just what I am talking about.
Article #5
Leavell, H. R. (1953). The basic unity of private practice and public health. American Journal of Public Health and the Nations Health, 43(12), 1501–1506. doi:10.2105/ajph.43.12.1501
I went back and forth on deciding if the information in this article was important enough to include. I am going to include it at this moment because I feel like I chose a rather hard concept to write my paper on and that my audience might need some background information and defining of key terms that I will use throughout my entire paper. It discusses the meaning behind private practice within public health and how it evolved over time. I am also hoping that this helps me relate to our current system needing a "face-lift" per say and hopefully convince the audience that our system needs to evolve again to match competing countries and ensure the health of again, ALL CITIZENS.
Anything else interesting happen?
My research question keeps changing to fit my needs and better fit my actual research. I am learning so much in how to shape a question and how to structure a systematic review of a ton of different, related sources. Also, really looking in depth into every source helps me funnel down information I see needed for my paper and helps me decide what is most important in my research and in my overall discussion.
An analysis of four different research studies about my topic: Universal Health Care. Each article found should be a different type of study as defined by (Aveyard 2014) and in class (google doc).
How do you reference this journal in an APA work cited?
Martin, D. P., Diehr, P., Price, K. F., & Richardson, W. C. (1989). Effect of a gatekeeper plan on health services use and charges: a randomized trial. American Journal of Public Health, 79(12), 1628–1632.
What method is being used?
RCT, random clinical trial
How do the authors use the method? What do they use it for? What specifically does the method enable them to do? Why did they choose this method rather than another? What was it about this research agenda/topic that led them to choose this particular method? Answer a handful of these. They all get at similar thing. But I want blocks of texts.
The authors wanted to test two different types of healthcare plans to determine which is more beneficial to Americans and HealthCare as a whole. They used on with a physician as a "gatekeeper". The UHC plan is with a "gatekeeper" while the alternative is without. Participants on both trials were randomized to ensure no bias occurred. This method allows researchers to test the amount of referrals, hospitalizations, money spent, quality of care, and patient attitudes towards coverage, amongst many others. They chose this method to see if UHC would be plausible in the US. By this I mean, if using a gatekeeper forces more Americans to go to hospitals and get procedures, instead of a UHC with a gatekeeper plans to lessen after-care and instead focus on preventative care.
What is the conclusion of the study? And how did the method enable them to reach that particular conclusion?
What was one interesting thing you discovered by leafing through this article?
The Universal Health Care system showed $21 less/per person per year than a plan with no gatekeeper. This was because there were penalties and incentives for patients and .3 fewer visits to specialists. Essentially, UHC cuts out the middle man and focuses on controlling problems as they arise instead of waiting for it to become more of a problem. This RCT structure allowed researchers to properly compare and contrast both types of care. The most interesting thing I discovered by reading this article was that enrollees were more happy with a no gatekeeper plan even though it costed more money than the UHC plan.
How do you reference this journal in an APA work cited?
Paul, H. (1957). Public Health Administration in the United States and England—Baltimore and Birmingham Compared. American Journal of Public Health and the Nations Health, 47(11 Pt 1), 1399–1404.
What method is being used?
cross-sectional
How do the authors use the method? What do they use it for? What specifically does the method enable them to do? Why did they choose this method rather than another? What was it about this research agenda/topic that led them to choose this particular method? Answer a handful of these. They all get at similar thing. But I want blocks of texts.
This was a little tricky for me to figure out but I ended up realizing that it is a cross-sectional study. It however, may fall between a few categories. I decided on the cross-sectional because it compares two different groups with many similarities to compare the healthcare systems and analyze if the system in one area could work in the other. They chose this method to see if the healthcare in one place (UHC) was able to be molded into a similar healthcare system that could work here in the US. They wanted to see if UHC is able to fit American needs. It was a very useful method in analyzing many aspects of the areas and what they see work in them. This is a very good step into figuring out how UHC might work in the US compared to how it is used in England.
What is the conclusion of the study? And how did the method enable them to reach that particular conclusion?
What was one interesting thing you discovered by leafing through this article?
The study ultimately concluded that both systems worked for a variety of different reasons. It showed how each healthcare system fit accordingly to what the country needed and the technology and research each had. The conclusion was that there was really no difference in birth rates, death rates, education, etc. It was surprising to me how there weren't many differences in statistics but the forms of healthcare were so vastly different....
How do you reference this journal in an APA work cited?
Akhter, M. N. (2003). APHA Policies on Universal Health Care: Health for a Few or Health for All? American Journal of Public Health, 93(1), 99–101.
What method is being used?
Policy Research
How do the authors use the method? What do they use it for? What specifically does the method enable them to do? Why did they choose this method rather than another? What was it about this research agenda/topic that led them to choose this particular method? Answer a handful of these. They all get at similar thing. But I want blocks of texts.
The author examines many policies that are current in today's healthcare system. The author also details what coverage is like for those insured and those uninsured. He demonstrates the need for UHC and what it can do for all Americans, really stressing the need for policy makers to finally adopt this system since there is such a growing need for more care. I believe change in the system led the author to use this type of research and it outline hard facts in current policy and calls for policymakers to implement a change to better fit citizens. By analyzing current policy the author was able to make a proposal with hardcore facts about current care and laws within it.
What is the conclusion of the study? And how did the method enable them to reach that particular conclusion?
What was one interesting thing you discovered by leafing through this article?
The study concluded that the current US healthcare system is in a state of crisis and isn't growing to fit the needs of the society. The author proposes a way to build off current policies to ensure the health of all. He also wants to work with current stakeholders in public health so that it doesn't just benefit patients but insurances, providers, etc. The author wants to build off current policies instead of completely starting over and feels this will dramatically change our suffering healthcare system. The most surprising thing to me about this particular study was that almost every other country has already done this and has seen significant improvements in the health of their citizens.... what was also a huge surprise was that the author noted that the US current healthcare system is THE most expensive in the entire world yet fails to provide the most basic coverage to MILLIONS of citizens.
How do you reference this journal in an APA work cited?
Shaffer, E. R. (2003). Universal Coverage and Public Health: New State Studies. American Journal of Public Health, 93(1), 109–111.
What method is being used?
Practice
How do the authors use the method? What do they use it for? What specifically does the method enable them to do? Why did they choose this method rather than another? What was it about this research agenda/topic that led them to choose this particular method? Answer a handful of these. They all get at similar thing. But I want blocks of texts.
The authors are public health professionals writing about new studies of healthcare plans in the state of California. It allows them to study effective methods actually being used, and practiced and assess their effectiveness. It also enables them to use their studies to see if it would work on a more broad area like the US as a whole. The authors have expertise in their fields and are able to properly analyze systems put in place to hopefully be able to implement their findings within the system. From practice literature, you can see what works and what doesn't. From that information you can either carry it out or tweak it to fit your area's needs for a more customizable healthcare plan/system.
What is the conclusion of the study? And how did the method enable them to reach that particular conclusion?
What was one interesting thing you discovered by leafing through this article?
The study concluded that the current healthcare system was simply not working in California, the area of study, where there are more uninsured people than anywhere else. It concluded that new steps needed to be in place to change this and cover more patients. It also noted that it was very important to have more educational outreach programs and mend the relationships between provider/patient. I think the most shocking thing in this article was the fact that if California revamped its health care system, included educational programs, drew on others' policies, and expanded coverage for many citizens, it could save 4.6 billion dollars in the first year just by converting failing private institutions to a public status!
What was the process by which you narrowed down potential topics to two appropriate ones? And how were these decisions made on the basis of either class discussion, or our required, course textbook (Aveyard 2014), or both?
I searched a lot of articles that were of interest to me in the American Journal of Public Health. The topics were about anxiety, mental health, universal healthcare, and policy reform. We discussed in class (also in book) how we needed to be truly invested in our topics because we are spending the entire semester on them and I narrowed them down to one main topic: universal healthcare. The book discussed how the articles needed to be peer reviewed, current, and have information relevant to many other studies.
What research question did you choose, and how are I can be sure you're making a reasoned, academic judgement on the basis of chapters 1-3 (Aveyard 2014)?
My research question is: With a new leader in power, how will the structure of American Healthcare change? Is it possible or even plausible for the US to shift to Universal Healthcare as most countries have?
This is very current with the new government and the question of what will happen to healthcare. Policies are always changing and I wanted to understand what exactly universal healthcare entails and if it is even plausible for the US to change to it. There is copious amounts of data from other countries and many different articles about my topic. The main articles cited other appropriate articles that were published in other peer reviewed journals and the article itself was cited over one hundred times. My "dream article" has tons of information about what UHC is, how we can change to it, how its worked in other countries, what has failed, etc.
What article (or articles) are you basing this question on, and what type of article is it (research, theory, policy, practice) (citation[s] in APA, please)?
Tooker J. Affordable Health Insurance for All Is Possible by Means of a Pragmatic Approach. American Journal of Public Health. 2003;93(1):106-109.
Trygve Ottersen and Harald Schmidt. Universal Health Coverage and Public Health: Ensuring Parity and Complementarity. American Journal of Public Health: February 2017, Vol. 107, No. 2, pp. 248-250.
Article Type: policy
How can I be sure that the key vocabulary of the question corresponds not only to literature in the field, but also to chapter 1-3 (Aveyard 2014)?
I searched through many articles relating to my topic in the AJPH and used their keywords listed to search for more articles.
Based on what your question is, what kind of literature are you going to need? Again, please explicitly reference the text (Aveyard 2014). What is your hierarchy of evidence?
In the order of importance going downward (cf. pg. 69 Aveyard):
Policy
Practice
How exactly did your research question arise out of "practice"?
From searching through a lot of articles I was able to determine what exactly I wanted to find out. I used a variety of articles and information to form my question.
How do you define your key terms, and how do these definitions link to key journals in the field?
Affordable Care Act ACA
America Public Health Association APHA
Universal Health Coverage (UHC)
Universal Healthcare
Public Health Initiatives
Healthcare Reform
Policy
Did anything unexpected happen? From you initial search, does it appear as though your research question will work? Or does the vocabulary and/or type of research sought need to be changed?
I noticed how I approached my question with initial bias so I had to take a step back and reword my original question and what I actually wanted to find out. My new, revised question will work.
Any final thoughts?
About four hours of initial research.
