Saturday, August 8, 2020

Internal and External validity in Research

A study suggested that standardized mortality of patients with epileptic disorder in world bank defined HIC (High income countries) is found to be 4 - 15 times greater than that of  low and middle income countries (LMIC); frequent cause of death is reported to be secondary to disease such as drowning, head injury, burn etc. What do you think of this finding ? does it look valid / logical ? Go through the article to get your answer.
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Validity is a way of finding out whether or not a test or an experiment accurately measures what it claims to. If a finding of research is having good internal as well as external validity, that is definitely considered strong enough to generate evidence by scientific community. But depending upon the type of research design we chose as well as nature of research itself, there would be unequal distributions in these two validity measures.

Why Does Research Need to be Validated ? 

Fundamental question to be answered is 'what is the objective of our research work ?' We want to test the effectiveness of some new intervention or trying to observe the consequences of any exposure in long run or simply want to make any positive changes in the field. Regardless of the intentions, we have very limited control over the activities we are performing, specially for the studies conducted in human beings. All the research guidelines, SOPs, Protocols, regulatory requirements and scientific appraisals are in place to make sure that our activities are to add something new to knowledge and society by following the current rules and regulations. It Simply means, Validity is needed in every steps. 

What Does Internal Validity Suggests ?

When any causal relationship between the cause and effect is inferenced, internal validity always tells us that result is not influenced by any external factors but research environment is solely accountable for it. In order to claim good internal validity of the research work, procedural aspects of research should be followed without any fail such as correct choice of methodology, protocol adherence, subject selection criteria and data analysis. following the appropriate scientific and regulatory measure controls all the confounding variables,  enhancing the internal validity, also increase the chances being recognized by renowned journals. 

What Is External Validity ? 

It is the extent to which finding of one research can be reproducible in real world. Once Internal validity of the study is assured, then researcher should think of external validity of his work because ultimately intention of any research work to bring about the positive changes in the field. Most of the epidemiological and Psychological studies confront this issue than Interventional studies. Here are the common reasons / examples why any studies with even good internal validity fails to prove external validity and could be misleading if applied.

  1. Patient Characteristics: With vast distribution of geography, culture, ethnicity and economic structures, genetic tendency of a individuals responding to a particular trigger may be entirely different from others. Therefore, Incidence and prevalence of a disease or an outcome is different from country to country. Validity of Case control and Cohort studies conducted in a particular country may be  insignificant in other country.
  2. Settings: Research setting not only refers to the environment but also technological advancement as well healthcare system of that particular country with equal importance. When studies are conducted based upon the registries and national statistics provided by the government, there is very high chances that real data is being missed; official judgement as well as rules and policies created on the basis of such data could be misleading too. Now apply this concept to above mentioned example. 
  3. Time: time affects the people's perceptions, their competency and vulnerability. for example: studying effect of climatic factors in peoples health would not be as relevant 20 years back as it is today. Similarly epidemiological as well as ecological studies conducted in the past lose their external validity over the time and needs to be redefined by conducting much comprehensive studies. 
What If You Are Not Able To Validate Your Study ?

The first problem researcher will face is to publish his work in journals because there would be too much of probing from the reviewer and editors. In this scenario, if internal validity is found to be compromised, that is complete wastage of the resource and time. On the top of that, chances of research participants being affected negatively is very high in poorly conducted study. Such deviated and poor quality data not only be unable to draw any conclusion but also misleading in case got succeeded. 

Few of the methodologically sounding published research Works also carry a potential to be misleading if we do not consider confounding factors behind. In such cases, cross conductance of study and regular update of new information from regulatory authority as well research institutes can help to apply appropriate rules and health policy. 
                                                                 
                                                                                     Thank You !!!

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