The Cycle of Bias in Health Research: A Framework and Toolbox for Critical Appraisal Training

Abstract

Recognizing bias in health research is crucial for evidence-based decision making. We worked with eight community groups to develop materials for nine modular, individualized critical appraisal workshops we conducted with 102 consumers (four workshops), 43 healthcare providers (three workshops), and 33 journalists (two workshops) in California. We presented workshops using a “cycle of bias” framework, and developed a toolbox of presentations, problem-based small group sessions, and skill-building materials to improve participants' ability to evaluate research for financial and other conflicts of interest, bias, validity, and applicability. Participant feedback indicated that the adaptability of the toolbox and our focus on bias were critical elements in the success of our workshops.

Keywords:

• bias in research
• conflicts of interest
• evidence-based medicine
• industry sponsorship of health studies
• informed decision making
• research ethics

ACKNOWLEDGMENTS

The authors gratefully acknowledge the UCSF/CTSI Community Engagement consultants for advice on partnering with community groups, Maureen Boland for research assistance, and Lisa Hirsch for proofreading and editing. We give special thanks to our community partners: the Newcomers Health Program and the San Francisco Community Clinic Consortium at the San Francisco Department of Public Health, the Ohlone Herbal Center, Breast Cancer Action, the Disability Rights Education and Defense Fund (DREDF), the Kaiser Foundation Hospital Professional Performance Committee in Hayward, CA, the California Association of Retired Americans (CARA), the U.C. Berkeley Graduate School of Journalism, and the Northern California Association of Healthcare Journalists.

This project was funded by the Flight Attendant Medical Research Institute (FAMRI), Miami, FL, USA. This project was also supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

The project was approved by the Committee on Human Research at the University of California, San Francisco, approval numbers H2758-33589 and 10-02507.