Emergency.

2017; 5 (1): e52

E DUCATIONAL

Sampling methods in Clinical Research; an Educational

Review
Mohamed Elfil1 , Ahmed Negida2∗
1. Faculty of Medicine, Alexandria University, Egypt.

2. Faculty of Medicine, Zagazig University, Egypt.

Received: October 2016; Accepted: November 2016; Published online: 14 January 2017

Abstract: Clinical research usually involves patients with a certain disease or a condition. The generalizability of clini-
cal research findings is based on multiple factors related to the internal and external validity of the research
methods. The main methodological issue that influences the generalizability of clinical research findings is the
sampling method. In this educational article, we are explaining the different sampling methods in clinical re-
search.

Keywords: Research design; sampling studies; evidence-based medicine; population surveillance; education
© Copyright (2017) Shahid Beheshti University of Medical Sciences

Cite this article as: Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. Emergency. 2017; 5 (1): e52.

1. Introduction in the target population have equal chances to be selected

in the sample [1,2] and 2; non-probability sampling methods
In clinical research, we define the population as a group of
where the sample population is selected in a non-systematic
people who share a common character or a condition, usu-
process that does not guarantee equal chances for each sub-
ally the disease. If we are conducting a study on patients with
ject in the target population [2,3]. Samples which were se-
ischemic stroke, it will be difficult to include the whole pop-
lected using probability sampling methods are more repre-
ulation of ischemic stroke all over the world. It is difficult
sentatives of the target population.
to locate the whole population everywhere and to have ac-
cess to all the population. Therefore, the practical approach
in clinical research is to include a part of this population,
3. Probability sampling method
called “sample population”. The whole population is some- 3.1. Simple random sampling
times called “target population” while the sample population
This method is used when the whole population is accessible
is called “study population. When doing a research study, we
and the investigators have a list of all subjects in this target
should consider the sample to be representative to the target
population. The list of all subjects in this population is called
population, as much as possible, with the least possible error
the “sampling frame”. From this list, we draw a random sam-
and without substitution or incompleteness. The process of
ple using lottery method or using a computer generated ran-
selecting a sample population from the target population is
dom list [4].
called the “sampling method”.
3.2. Stratified random sampling
2. Sampling types This method is a modification of the simple random sam-
There are two major categories of sampling methods (fig- pling therefore, it requires the condition of sampling frame
ure 1): 1; probability sampling methods where all subjects being available, as well. However, in this method, the whole
population is divided into homogeneous strata or subgroups
according a demographic factor (e.g. gender, age, religion,
∗ Corresponding Author: Ahmed Negida; Faculty of Medicine, Zagazig socio-economic level, education, or diagnosis etc.). Then,
University, Zagazig, El-Sharkia, Egypt. Postal code: 44519; E-mails: the researchers select draw a random sample from the dif-
[email protected] and [email protected] Tel:
00201125549087 ferent strata [3,4]. The advantages of this method are: (1) it
allows researchers to obtain an effect size from each strata

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M. Elfil and A. Negida. 2

selection passed with two stages: firstly, the selection of eli-

gible clusters, then, the selection of sample from individuals
of these clusters. An example for this, if we are conducting a
research project on primary school students from Iran. It will
be very difficult to get a list of all primary school students all
over the country. In this case, a list of primary schools is made
and the researcher randomly picks up a number of schools,
then pick a random sample from the eligible schools [3].

4. Non-probability sampling method

4.1. Convenience sampling
Although it is a non-probability sampling method, it is the
most applicable and widely used method in clinical research.
In this method, the investigators enroll subjects according to
their availability and accessibility. Therefore, this method is
quick, inexpensive, and convenient. It is called convenient
sampling as the researcher selects the sample elements ac-
Figure 1: Sampling methods.
cording to their convenient accessibility and proximity [3,6].
For example: assume that we will perform a cohort study on
Egyptian patients with Hepatitis C (HCV) virus. The conve-
separately, as if it was a different study. Therefore, the be-
nience sample here will be confined to the accessible popu-
tween group differences become apparent, and (2) it allows
lation for the research team. Accessible population are HCV
obtaining samples from minority/under-represented popu-
patients attending in Zagazig University Hospital and Cairo
lations. If the researchers used the simple random sampling,
University Hospitals. Therefore, within the study period, all
the minority population will remain underrepresented in the
patients attending these two hospitals and meet the eligibil-
sample, as well. Simply, because the simple random method
ity criteria will be included in this study.
usually represents the whole target population. In such case,
investigators can better use the stratified random sample to 4.2. Judgmental sampling
obtain adequate samples from all strata in the population.
In this method, the subjects are selected by the choice of the
3.3. Systematic random sampling (Interval sam- investigators. The researcher assumes specific characteris-
pling) tics for the sample (e.g. male/female ratio = 2/1) and there-
fore, they judge the sample to be suitable for representing the
In this method, the investigators select subjects to be in-
population. This method is widely criticized due to the like-
cluded in the sample based on a systematic rule, using a fixed
lihood of bias by investigator judgement [5].
interval. For example: If the rule is to include the last patient
from every 5 patients. We will include patients with these 4.3. Snow-ball sampling
numbers (5, 10, 15, 20, 25, ...etc.). In some situations, it is
This method is used when the population cannot be located
not necessary to have the sampling frame if there is a specific
in a specific place and therefore, it is different to access
hospital or center which the patients are visiting regularly. In
this population. In this method, the investigator asks each
this case, the researcher can start randomly and then system-
subject to give him access to his colleagues from the same
ically chooses next patients using a fixed interval [4].
population. This situation is common in social science re-
3.4. Cluster sampling (Multistage sampling) search, for example, if we running a survey on street chil-
dren, there will be no list with the homeless children and it
It is used when creating a sampling frame is nearly impossi-
will be difficult to locate this population in one place e.g. a
ble due to the large size of the population. In this method, the
school/hospital. Here, the investigators will deliver the sur-
population is divided by geographic location into clusters. A
vey to one child then, ask him to take them to his colleagues
list of all clusters is made and investigators draw a random
or deliver the surveys to them.
number of clusters to be included. Then, they list all individ-
uals within these clusters, and run another turn of random
selection to get a final random sample exactly as simple ran-
5. Conflict of interest
dom sampling. This method is called multistage because the None.

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3 Emergency. 2017; 5 (1): e52

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