Education section – What does the question mean?
In an earlier issue of the Journal of Evidence Based Medicine, we considered an important component in question formulation for a research study: choosing the comparison (1). In this issue, we return to the topic of formulating the research question, by looking more deeply at the words within the question. This shows how something that, at first sight, seems like a fairly simple question might have multiple meanings. Unless the researchers, those who take part in their research and those who use it are sharing the same meanings, this can lead to confusion, misunderstanding and waste in research. In this short piece, we consider the meaning of each word and in the next issue of the Journal, we will return to this question to consider how it might need to be expanded to provide the basis for a research study. The question has been chosen to illustrate the challenges, not necessarily because of its importance to health and social care. It is Do green sweets make people happy? Considering each word in turn. Do: the use of “Do” implies that we are seeking an answer for the present but, in fact, we might be most interested in the future, such that the word should be “Will”. However, after completing a research study, whether it is prospective, such as a randomised trial, or retrospective, such as a systematic review, we will end with have an answer to a past tense question, for which the first word should be “Did”. This word would probably seem strange to a person using the research to help them make a decision or choice. It might make them think that the research is a deliberate attempt to provide a historical analysis, rather than an attempt to provide evidence for the future. Therefore, if the study was intended to help decision makers in the present and future, we assume that the answer from the past will be valid in the future. This is a key assumption and will probably be true in most circumstances, at least for the recent past. However, researchers and users of research still need to consider the issues carefully, because it impacts on the length of time that the results from the past are valid. Green: our first assumption when we see this word is probably that it relates to the colour of the sweets. If so, we would still need to decide what colours are acceptable. The colour that we imagine for a field of grass after fresh rain might be obviously green, but there are many
shades of colours. We may need to draw boundaries on the spectrum of coloured light, to separate yellow from green from blue. Perhaps the most objective approach would be to define the colour according to specific wavelengths of light, but we should consider the challenges of people with different perceptions of colour, who might disagree on whether something is “green”. We should also consider whether green is regarded as merely a colour or has particular associations, with for example national identity or good, or bad, fortune or sentiments. Furthermore, “green” is now widely used to indicate that something is “environmentally friendly” and one can imagine “green” sweets that are not the colour green but were produced in ways that minimise impact on the release of carbon dioxide into the atmosphere. Sweets: in some cultures, the word “sweet” will bring to mind small treats for eating, which contain a relatively large amount of sugar. In other cultures, it might be thought of as a “dessert” or “pudding”, which would be a larger item and, in some cases, might be salty or savoury, rather than sweet flavoured. Make: this is an important word for any research study because it means that the question is about the green sweets causing people to become happy. It shows that the question is not about whether being happy makes people likely to choose to eat green sweets (ie. their happiness causes them to eat green sweets) or whether happy people are more likely to eat green sweets (ie. that there is an association, but not necessarily causation, between happiness and green sweets). People: by not defining a narrower population, this word implies that the research would seek an answer for all people. Women and men? Old and young? With and without comorbidity? It also says nothing about the emotional state of people before their green sweet: were they sad, or were they neither happy nor sad? Happy: as well as requiring the researcher to consider carefully the most appropriate means for measuring happiness, so that their answer to this question is reliable for users of their study, the use of this word also suggests that their interest is in whether or not people reach the emotional state of being happy. It is different to posing a question with the word “happier”, which would encompass people who are unhappy becoming less unhappy, or people who are already happy becoming happier.
C 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd JEBM 7 (2014) 65–66
65
Education section
This careful consideration of each word can be applied to any research question. It should help to ensure that the final question, and the study itself, will meet the needs of researchers, participants, and users. This section was prepared as part of the work of the All-Ireland Hub for Trials Methodology Research, which is funded by the UK Medical Research Council. The Hub is
66
helping improve the quality of clinical trials, through the conduct and dissemination of research relevant to the methods for trials and other evaluations in health and social care.
1. Anon. Education section – choosing the comparison. Journal of Evidence Based Medicine 2010; 3(2): 134–35.
C 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd JEBM 7 (2014) 65–66
In an earlier issue of the Journal of Evidence Based Medicine, we considered an important component in question formulation for a research study: choosing the comparison (1). In this issue, we return to the topic of formulating the research question, by looking more deeply at the words within the question. This shows how something that, at first sight, seems like a fairly simple question might have multiple meanings. Unless the researchers, those who take part in their research and those who use it are sharing the same meanings, this can lead to confusion, misunderstanding and waste in research. In this short piece, we consider the meaning of each word and in the next issue of the Journal, we will return to this question to consider how it might need to be expanded to provide the basis for a research study. The question has been chosen to illustrate the challenges, not necessarily because of its importance to health and social care. It is Do green sweets make people happy? Considering each word in turn. Do: the use of “Do” implies that we are seeking an answer for the present but, in fact, we might be most interested in the future, such that the word should be “Will”. However, after completing a research study, whether it is prospective, such as a randomised trial, or retrospective, such as a systematic review, we will end with have an answer to a past tense question, for which the first word should be “Did”. This word would probably seem strange to a person using the research to help them make a decision or choice. It might make them think that the research is a deliberate attempt to provide a historical analysis, rather than an attempt to provide evidence for the future. Therefore, if the study was intended to help decision makers in the present and future, we assume that the answer from the past will be valid in the future. This is a key assumption and will probably be true in most circumstances, at least for the recent past. However, researchers and users of research still need to consider the issues carefully, because it impacts on the length of time that the results from the past are valid. Green: our first assumption when we see this word is probably that it relates to the colour of the sweets. If so, we would still need to decide what colours are acceptable. The colour that we imagine for a field of grass after fresh rain might be obviously green, but there are many
shades of colours. We may need to draw boundaries on the spectrum of coloured light, to separate yellow from green from blue. Perhaps the most objective approach would be to define the colour according to specific wavelengths of light, but we should consider the challenges of people with different perceptions of colour, who might disagree on whether something is “green”. We should also consider whether green is regarded as merely a colour or has particular associations, with for example national identity or good, or bad, fortune or sentiments. Furthermore, “green” is now widely used to indicate that something is “environmentally friendly” and one can imagine “green” sweets that are not the colour green but were produced in ways that minimise impact on the release of carbon dioxide into the atmosphere. Sweets: in some cultures, the word “sweet” will bring to mind small treats for eating, which contain a relatively large amount of sugar. In other cultures, it might be thought of as a “dessert” or “pudding”, which would be a larger item and, in some cases, might be salty or savoury, rather than sweet flavoured. Make: this is an important word for any research study because it means that the question is about the green sweets causing people to become happy. It shows that the question is not about whether being happy makes people likely to choose to eat green sweets (ie. their happiness causes them to eat green sweets) or whether happy people are more likely to eat green sweets (ie. that there is an association, but not necessarily causation, between happiness and green sweets). People: by not defining a narrower population, this word implies that the research would seek an answer for all people. Women and men? Old and young? With and without comorbidity? It also says nothing about the emotional state of people before their green sweet: were they sad, or were they neither happy nor sad? Happy: as well as requiring the researcher to consider carefully the most appropriate means for measuring happiness, so that their answer to this question is reliable for users of their study, the use of this word also suggests that their interest is in whether or not people reach the emotional state of being happy. It is different to posing a question with the word “happier”, which would encompass people who are unhappy becoming less unhappy, or people who are already happy becoming happier.
C 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd JEBM 7 (2014) 65–66
65
Education section
This careful consideration of each word can be applied to any research question. It should help to ensure that the final question, and the study itself, will meet the needs of researchers, participants, and users. This section was prepared as part of the work of the All-Ireland Hub for Trials Methodology Research, which is funded by the UK Medical Research Council. The Hub is
66
helping improve the quality of clinical trials, through the conduct and dissemination of research relevant to the methods for trials and other evaluations in health and social care.
1. Anon. Education section – choosing the comparison. Journal of Evidence Based Medicine 2010; 3(2): 134–35.
C 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd JEBM 7 (2014) 65–66
