Bias in Research

Bias in research
Smith, J., & Noble, H. (2014). Bias in research. Evidence-Based Nursing, 17(4), 100-101.
https://doi.org/10.1136/eb-2014-101946
Published in:
Evidence-Based Nursing
Document Version:
Peer reviewed version
Queen's University Belfast - Research Portal:

Link to publication record in Queen's University Belfast Research Portal
Publisher rights
© 2014 BMJ.
This work is made available online in accordance with the publisher’s policies. Please refer to any applicable terms of use of the publisher.
General rights
Copyright for the publications made accessible via the Queen's University Belfast Research Portal is retained by the author(s) and / or other
copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated
with these rights.
Take down policy

The Research Portal is Queen's institutional repository that provides access to Queen's research output. Every effort has been made to
ensure that content in the Research Portal does not infringe any person's rights, or applicable UK laws. If you discover content in the
Research Portal that you believe breaches copyright or violates any law, please contact [email protected].
Download date:28. Sep. 2022

Evidence Based Nursing: Research Made Simple Series
Title: Bias in research
Authors
Joanna Smith1, Helen Noble2

1
Dr Joanna Smith, Senior Lecturer Children’s Nursing, School of Human and Health
Sciences, University of Huddersfield, Huddersfield, UK.
2
Dr Helen Noble, Lecturer Health Services Research, School of Nursing and Midwifery,
Queens’s University Belfast, Belfast, UK.
Correspondence
1
Dr Joanna Smith, Senior Lecturer Children’s Nursing, School of Human and Health
Sciences, University of Huddersfield, Huddersfield, UK.
e-mail [email protected]
JS/HN FINAL July 2014 1

The aim of this article is to outline types of ‘bias’ across research designs, and consider
strategies to minimise bias. Evidence based nursing, defined as the ‘process by which
evidence, nursing theory, and clinical expertise are critically evaluated and considered, in
conjunction with patient involvement, to provide the delivery of optimum nursing care’,1 is
central to the continued development of the nursing professional. Implementing evidence
into practice requires nurses to critically evaluate research, in particular assessing the rigour
in which methods were undertaken and factors that may have biased findings.
What is bias in relation to research and why is understanding bias important?
Bias is defined by the Oxford Dictionary as: ‘an inclination or prejudice for or against one
person or group, especially in a way considered to be unfair’; ‘a concentration on an interest
in one particular area or subject’; ‘a systematic distortion of statistical results due to a factor
not allowed for in their derivation’ (http://www.oxforddictionaries.com). Understanding
research bias is important for several reasons: first, bias exists in all research, across
research designs and is difficult to eliminate; second, bias can occur at each stage of the
research process; third, bias impacts on the validity and reliability of study findings and
misinterpretation of data can have important consequences for practice. The controversial
study that suggested a link between the measles-mumps-rubella vaccine and autism in
children2 resulted in a rare retraction of the published study because of media reports that
highlighted significant bias in the research process.3 Bias occurred on several levels: the
process of selecting participants was misrepresented; the sample size was too small to infer
any firm conclusion from the data analysis; and the results were overstated which suggested
caution against widespread vaccination and an urgent need for further research. However, in
the time between the original publication, and later research refuting the original findings, the
uptake of measles-mumps-rubella vaccine in Britain declined, resulting in a 25 fold increases
in measles in the 10 year period following the original publication.
Although different study designs have specific methodological challenges and constraints,
bias can occur at each stage of the research process (Table 1). In quantitative research the
validity and reliability are assessed using statistical tests that estimate the size of error in
samples and calculating the significance of findings (typically p-values or confidence
intervals). The tests and measures used to establish the validity and reliability of quantitative
research cannot be applied to qualitative research. However, in the broadest context these
terms are applicable, with validity referring to the integrity and application of the methods
and the precision in which the findings accurately reflect the data, and reliability referring to
the consistency within the analytical processes.4

Table 1: Types of research bias
Design Poor study design and incongruence between aims and methods increases the
bias likelihood of bias. For example exploring HIV testing using a survey is unlikely to obtain
in-depth rich data about individuals’ experiences. Bias can occur when a researcher’s
personal beliefs influence the choice of research question and methodology. For
example a researcher working for a pharmaceutical company may choose a research
question which supports the usefulness of the drug being investigated.
Selection / Selection bias relates to both the process of recruiting participants and study inclusion
participant criteria. Successful research begins with recruiting participants that meet the study aims.
bias For example recruitment bias could occur if participants were invited to participate in a
survey posted on the internet, which automatically excludes individuals without internet
access.
Inclusion bias in quantitative research typically relates to selecting participants that are
representative of the study population, and where applicable allocation of participants to
ensure similarity between comparison groups. In addition, accounting for the differences
between people who remain in a study and those who withdraw may be important in
some study designs. For example, an evaluation of a weight loss programme may be
affected by participant withdrawal; participants who become disillusioned because of not
losing weight may drop out, which may bias the findings towards more favourable
results. Confounding bias can also occur because of an association between ‘cause’
and ‘effect’. For example, comparing treatment outcomes for similar conditions between
general and specialised centres may find higher mortality rates at specialised centres yet
patients referred to these centres are more likely to have high risk factors and more
complex needs.
In qualitative research it is usual to recruit participants with a range of experiences in
relation to the topic being explored; therefore accounting for biases in relation to the
sampling strategies is essential. For example recruiting parents from a parent and
toddler group is likely to be biased towards mothers; the findings are unlikely to
represent both mothers’ and fathers’ perspectives.
Data Data collection bias can occur when a researcher’s personal beliefs influence the way
collection information or data is collected.
bias and
In quantitative studies, measurement bias can occur if a tool or instrument: has not be
measurem
assessed for its validity or reliability (for example using a shared decision-making tool
ent bias
that measures patient satisfaction rather than decision-making); is not suitable for the
specific setting or patient groups (for example using an adult verbal pain assessment
tool with young children); an instrument not calibrated properly may consistently
measure inaccurately (for example weighing babies with poorly calibrated weighing
scales).
In retrospective studies, for example when completing questionnaires about eating
habits when data collection relies on recall, participants may not remember and report
events accurately.
In qualitative research, interviewing is a commonly used method of data collection; how
questions are asked will influence the information elicited. For example a leading
question, ‘Do you find the health service poor?’, is likely to receive a closed yes or no
response, and not gain insight into participants experiences and could be replaced with;
‘Please describe your last visit to hospital?’
Analysis When analysing data the researcher may naturally look for data that confirms their
bias hypotheses or confirms personal experience, overlooking data inconsistent with personal
beliefs.
Publicatio Published studies nearly always have some degree of bias. For example in quantitative
n bias research, studies are more likely to be published if reporting statistically significant
findings.5 Non-publication in qualitative studies is more likely to occur because of a lack
of depth when describing study methodologies and findings are not clearly presnted.6

How is bias minimised when undertaken research?
Bias exists in all study designs, and although researchers should attempt to minimise bias,
outlining potential sources of bias enables greater critical evaluation of the research findings
and conclusions. Researchers bring to each study their experiences, ideas, prejudices and
personal philosophies, which if accounted for in advance of the study, enhance the
transparency of possible research bias. Clearly articulating the rationale for and choosing an
appropriate research design to meet the study aims can reduce common pitfalls in relation to
bias. Ethics committee have an important role in considering whether the research design
and methodological approaches are biased, and suitable to address the problem being
explored. Feedback from peers, funding bodies and ethics committees is an essential part of
designing research studies, and often provides valuable practical guidance in developing
robust research.
In quantitative studies selection bias is often reduced by the random selection of

participants, and in the case of clinical trials randomisation of participants into comparison
groups. However, not accounting for participants who withdraw from the study or are lost to
follow-up can result in sample bias or change the characteristics of participants in
comparison groups.7 In qualitative research purposeful sampling has advantages when
compared to convenience sampling in that bias is reduced because the sample is constantly
refined to meet the study aims. Premature closure of the selection of participants before
analysis is complete can threaten the validity of a qualitative study. This can be overcome by
continuing to recruit new participants into the study during data analysis until no new
information emerges, known as data saturation.8
In quantitative studies having a well designed research protocol explicitly outlining data
collection and analysis can assist in reducing bias. Feasibility studies are often undertaken
to refine protocols and procedures. Bias can be reduced by maximising follow up and where
appropriate in randomised control trials analysis should be based on the intention to treat
principle, a strategy that assesses clinical effectiveness because not everyone complies with
treatment and the treatment people receive may be changed according to how they respond.
Qualitative research has been criticised for lacking transparency in relation to the analytical
processes employed.4 Qualitative researchers must demonstrate rigour, associated with
openness, relevance to practice and congruence of the methodological approach. Although
other researchers may interpret the data differently, appreciating and understanding how the
themes were developed is an essential part of demonstrating the robustness of the findings.
Reducing bias can include respondent validation, constant comparisons across participant
accounts, representing deviant cases and outliers, prolonged involvement or persistent

observation of participants, independent analysis of the data by other researchers and
triangulation.4
In summary, minimising bias is a key consideration when designing and undertaking

research. Researchers have an ethical duty to outline the limitations of studies and account
for potential sources of bias. This will enable health professionals and policy makers to
evaluate and scrutinise study findings, and consider these when applying findings to practice
or policy.
References
1
Scott K, McSherry R. Evidence-based nursing: clarifying the concepts for nurses in practice.
Nursing in Critical Care, 2009: 3; 67-71 p 1089.
2
Wakefield A.J. et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive
developmental disorder in children. Lancet, 1998: 351; 637-641.
3
The Lancet. Retraction - Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and
pervasive developmental disorder in children. Lancet, 2010; 375; 445.
4
Morse J.M, et al. Verification strategies for establishing reliability validity in qualitative
research. International Journal of Qualitative Research, 2002: 1; 1-19.
5
Easterbrook P.J, et al. Publication bias in research. The Lancet, 1991: 337; 867-872.
6
Petticrew M ,et al. Publication bias in qualitative research: what becomes of qualitative
research presented at conferences? Journal of Epidemiology Community Health, 2008: 62;
552-4.
7
Sica G.T. Bias in research studies. Radiology, 2006: 3; 780-789.
8
Francis J. et al. What is an adequate sample size? Operationalising data saturation for
theory-based interview studies. Psychology & Health, 2010: 25; 1229-1245.

Bias in Research

Uploaded by

Copyright:

Available Formats

Bias in Research

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bias in Research

Uploaded by

Copyright:

Available Formats

Bias in research

Queen's University Belfast - Research Portal:

Take down policy

Download date:28. Sep. 2022

Title: Bias in research

Joanna Smith1, Helen Noble2

JS/HN FINAL July 2014 1

What is bias in relation to research and why is understanding bias important?

JS/HN FINAL July 2014 2

JS/HN FINAL July 2014 3

In quantitative studies selection bias is often reduced by the random selection of

JS/HN FINAL July 2014 4

In summary, minimising bias is a key consideration when designing and undertaking

JS/HN FINAL July 2014 5

You might also like