Quantitative Study Critique Using Guidelines for ...



Quantitative Study Critique Using Guidelines for Quantitative Designs

Angela M. Baird

Ferris State University

Abstract

The article, Development and Testing of the Survey of Illness Beliefs in Heart Failure Tool, was chosen for this quantitative study review. The article will be reviewed and critiqued using the grading criteria for a quantitative research study as outlined in the Nursing 350 syllabus and using the Foundations of Nursing Research, guidelines for critiquing a quantitative research study as provided by Nieswiadomy (2008). The article will be reviewed for the purpose and problem statements and whether they were clearly stated and clear to the reader. Objectives, goals, feasibility, and significance of the study will be identified. Any use of a review of literature, theoretical framework will be determined and its appropriateness for the study. Hypothesis or research questions will be analyzed for being concise and clearly stated. Also the type of hypothesis will be discussed. The sample size, design of the research study, and data collection methods will be analyzed for appropriateness in the study. Reliability and validity of instruments used in the study will be described and analyzed. Data analysis, discussion of findings, conclusions, and implications will be discussed. Any recommendations for further research will be reviewed and documented.

Quantitative Study Critique Using Guidelines for Quantitative Designs

In the article, Development and Testing of the Survey of Illness Beliefs in Heart Failure Tool, a review of the study was done using the guidelines for use in critiquing research reports outlined in Foundations of Nursing Research, 5th ed., 2008. This study was able to develop a tool from the Common Sense Model of Illness theoretical framework developed in 1996 and revised in 2002. The framework uses the term illness representation (REP) to determine how people think about a certain medical disorder (Albert & Zeller, 2007). It also helps identify what image the individual has of the disorder related to a danger or threat. It has been used to test people with chronic illnesses but not on heart failure (HF). The authors of the framework encourage that it be adapted to diseases as each disease has unique characteristics. This helps play a role in understanding an individual’s perceptions and beliefs of the disease being studied (Albert & Zeller, 2007). Authors of this study were able to use the framework to develop a tool to determine individual’s heart failure illness representation (HF REP). The tool is called The Survey of Illness Beliefs in HF tool. This study is quantitative and was performed using 104 participants from cardiology telemetry ward and HF clinic patients at a large urban, tertiary health care center in the northern Midwest United States (Albert & Zeller, 2007). Each individual had a diagnosis of HF and was given the tool as a questionnaire to fill out. Most of these were done while in the hospital and took approximately seven minutes to complete. Through analysis of the data collected and any redundant answers removed the participants of this sample believed that HF was a serious condition that caused disability. They also believed that the medications prescribed to them treated HF and believed they had little control over the course of their condition (Albert & Zeller, 2007).

Quantitative research description

This type of research is involved with the objectivity, controls over the research situation, and the ability to generalize the findings. Quantitative research uses the literature review to build on what has already been determined to develop an approach for a new study. Results of the study are displayed using a theoretical framework and statistics of a particular topic or situation. Taking into consider a study on individuals living with chronic pain, quantitative research is concerned with the level of pain they are experiencing in contrast qualitative research is concerned with what it means to be living with chronic pain (Nieswiadomy, 2008).

Researcher Qualifications

There was no particular section on the qualifications of the researchers in this study, but you can get a clear picture that researchers were RN’s (registered nurses) with a basic knowledge of HF. It was written by two RN’s that had advanced education and certifications. At the end of the study there was acknowledgment to all the RN’s that assisted in the research and data base entry. Also physicians and RN’s provided comments of the applicability of the research tool used. The research was presented in 2004 by Nancy Albert, PhD, RN at the 53rd Annual Sessions of the American College of Cardiology (Albert & Zeller, 2007).

Title

The title of the research article was clear and concise. The focus of the study was represented within the title of the article and the variables were outlined. The population of the study was not directly stated so this may cause confusion at first glance but it can be picked up within the content of the article. The title is short as it should be less than 15 words and does not contain any extraneous words like “A study of…,” “The relationship between…,” and “The effects of …” (Nieswiadomy, 2008).

Abstract

There was no abstract section identified in this article.

Introduction

The introduction to the research article explains a little about HF, how many individuals it affects in the United States and how many deaths are attributable to HF. It also incorporates recommendations from the AHA/ACC (American Heart Association/American College of Cardiology) on education for individuals with HF. The introduction points out the importance of healthcare workers understanding inaccuracies an individual may have about HF, and this leading to assertiveness in educating patients (Albert & Zeller, 2007).

Purpose & Problem Statement

The purpose and the problem statement are different, and many reports only identify one of these steps in the research process (Nieswiadomy, 2008). The purpose of the article is clearly stated within the content of the article. The purpose of this article is to “report the reliability and validity of a new tool that measures the accuracy of patient’s HF illness beliefs and the level of certainty patients have for HF illness beliefs” (Albert & Zeller, 2007 p.64). In this article, the problem statement is not clearly identified, but through reading the title and the article the reader can start to determine what the problem is. The problem is development and testing of a tool for HF that identifies how individuals with HF view the disease. The tool was developed to be used in clinical research settings and results can be used to individualize patient education and to help to change a patient’s behavior (Albert & Zeller, 2007). The article has clear objectives and goals that are met. The study developed the Survey of Illness Beliefs in HF tool that was tested with actual patients with HF. This is the first tool documented that measures the accuracy of illness beliefs with HF patients (Albert & Zeller, 2007). To the author’s knowledge, this is the first documented tool used with HF patients and determines the tool is feasible and significant to the study and HF.

Review of the Literature and Theoretical Framework

There was no specific section titled review of the literature within this study. Excerpts noted in the content of the study imply that the researcher did review the literature for building on what had already been studied related to this study. For example, the beginning of the article has reference to the literature, and states the literature provides information that individual’s with HF have little accurate understanding of the disease (Albert & Zeller, 2007). This study is based on the Common Sense Model of Illness theoretical framework. This framework uses REP to describe how people think about medical illness or disorder. Illness REP uses five attributes that tests a patients knowledge base on a particular illness or disorder. The results from studies using this framework provides healthcare providers with evidence to help patients obtain goals for coping that assisted a patient change in behavior (Albert & Zeller, 2008). This framework is adequate and appropriate for this study because the researcher was looking for the knowledge base of individuals with HF.

Hypothesis (es) or Research Questions

A few research questions can be asked in this study. A hypothesis is stated in the title of the study, Development and Testing of the Survey of Illness Beliefs of Heart Failure tool. A study question is whether a tool could be developed and tested pertaining to individuals with heart failure to assist in the augmentation of an individual’s education and treatment to change behaviors that currently exist.

Definition of Terms

There is no definition of terms section in this study. Not all research studies provide this section due to space constraints. This is especially true if the article is published in a journal. When a section for definition of terms is provided the terms needed to be defined both conceptually and operationally. The conceptual meaning presents the overall meaning of the word and the operational meaning provides the observable and measurable phenomena associated with the study variables (Nieswiadomy, 2008).

Research Design

There was no mention to the exact research type in this article. After careful review of the study one can come to an assumption as to what type of research design the authors are using. A methodological study design is used in this research study. Methodological studies are concerned with development, testing, and evaluation of research instruments (Nieswiadomy, 2008). In this study the authors developed the Survey of Illness Beliefs in Heart Failure tool that proved reliable and valid to be used in the education of individuals living with heart failure.

Population, Setting, and Sample

Data were collected from telemetry and HF clinic patients from a large urban tertiary health center in the northern Midwest United States. Participants had chronic HF and ejection fraction of 33%. Mean age was 61.8 years. A majority of the participants were men, married, and either graduated from high school or college. Most were retired and received care from a cardiologist for HF. At the time of data collection, most had HF exacerbation or cardiac symptoms (Albert & Zeller, 2007). Other criteria included a willingness to complete the tool, have no history of dementia or psychiatric illness and no visual disturbances. Sample size was based on research of Sapnas and Zeller regarding adequate sample size. Sapnas and Zeller did an analysis of small and large sample sizes and it was determined that a sample size of 100 was more than adequate to represent and evaluate psychometric measures (Albert & Zeller, 2007). Records were reviewed by three RN’s to determine if participants could be included in the study. These nurses also helped to collect demographic and medical data before approaching patients. Patients were given the tool to fill out and encouraged to complete themselves without interruptions. The tool took about seven minutes to fill out.

Critique of Ethical Aspects of the study

Ethical aspects of the study were apparent to the reader by the authors obtaining proper permission prior to approaching individuals to participate and informed consent after subjects received a letter of introduction to the study. Participation in the study was voluntary and no vulnerable subjects were used. Individuals were allowed to ask questions about the study and the tool they were asked to fill out. No mention was made in regards to approval from a particular Institutional Review Board and readers may believe that participant’s rights were not protected. This study was beneficial to both participants of the study and other individuals living with HF. It provided valuable information on beliefs of the disease which allowed healthcare workers to assist individuals with HF to change any belief or behavior that may be contributing to noncompliance. This ultimately assists all individuals with HF live longer healthier lives with an incurable disease.

Data-Collection Methods and Instruments

After revisions and additions the Survey of Illness Beliefs in HF tool contained 33 accurately and inaccurately stated items of common sense illness beliefs about HF. Words like cure and control were used even though HF is a chronic condition without a cure. This way the accuracy and certainty of cure and control could be understood (Albert & Zeller, 2007). The tool used a 4-point likert scale that included strongly disagree, disagree, agree, and strongly agree to rate the accuracy and level of knowledge individuals had regarding HF. The rating design did not use statements like sometimes, neither agree or disagree, or not applicable to decrease the chance for ambivalent responses (Albert & Zeller, 2007). A mean score was tallied by summing up the responses and dividing by the number of statements. A score of 3.0 or higher meant individuals had an accurate HF REP and a mean score below 3.0 meant that the individual had an inaccurate view of HF (Albert & Zeller, 2007).

Data Analysis

Data analysis was analyzed with the assistance of the SPSS version 10.0. Analyses of data were displayed completely and accurately using descriptive and inferential statistics. Descriptive statistics were used to identify the characteristics, behaviors, and experiences of study participants (Polit, 1996). Data were displayed in both tables and graphs. Tables were used to identify demographic, medical background, heart failure illness beliefs statements, and low and high scoring items reflecting the accuracy and level of certainty of heart failure illness beliefs by patients. A scree plot was used identifying 14 items for factor analysis. The scree plot is a line segment that displays the eigenvalue for each factor and assists to determine which factors to retain. A graphic plot was used to represent accurate and inaccurate statements by the participants of the study, and the histogram graph was used to show mean scores of the 14 item Survey of Illness Beliefs in Heart Failure tool. The histogram also provided a clear frequency distribution of the data collected. The distribution was slightly skewed to the right which is an example of a positively skewed distribution (Nieswiadomy, 2008). This means that the majorities of similarities of the 14 factors were present at the beginning of the tool and then became less redundant toward the end of the tool. Inferential statistics is statistics that are concerned with the characteristics of populations and uses sample data to make an inference about a population (Nieswiadomy, 2008). Inferential statistics were utilized in choosing the participants of the study. Each participant had the same chance to be chosen to participate in the study as determined through the inclusion qualifications of the study. All possible participants had to have similar characteristics in order to participate in the study.

Discussion of Findings

The Survey of Illness Beliefs in HF testing had satisfactory results and can now be recommended for the use in research and clinical practice. The tool can help assist healthcare workers assume knowledge of the patients health beliefs in HF and then use this knowledge to promote patient-centered care, facilitate shared decision making, and guide management decisions (Albert & Zeller, 2007). Another literature source was identified under the discussion heading which was done by Krumholz and colleagues (2005). They reported that healthcare workers paid little attention involving patients in self care and learning what factors may improve patient accountability and compliance to care (Krumholz, Peterson & Ayanian, 2005). “Consideration must be given to doing a better job of measuring adherence and also learning more about factors that influence the effectiveness of preventive and treatment regimens”(Albert & Zeller, 2007, pg.69).

Conclusions, Implications and Recommendations

Implications for clinical research and practice were identified in the study, and recommendations for additional research were clearly stated. Use of the study in clinical research was important to determine the patients desire to comply and adhere to self-care behavior. Participants of this study believed that HF was a serious condition that caused disability, but they also believed that drugs would treat HF and that they had little control over the course of their condition (Albert & Zeller, 2007). With survey results this could increase patient education and self-care compliance. In using the HF specific tool to determine any deficiencies, a patient may have can give healthcare workers more knowledge and information to develop an education plan of care. In another study a revised Illness Perception Questionnaire was used to assess HF beliefs. In this study patient’s had inaccurate beliefs in all four attributes. Statements were specific to HF and a focused education plan could be developed for these patients from the study results (Cherrington, Lawson & Clark, 2006). The Survey of Illness Beliefs in HF can be useful in newly diagnosed, noncompliant, and those frequently admitted to the hospital (Albert & Zeller, 2007).

Conclusion

This study was successful in developing and testing a HF beliefs tool among patients diagnosed with HF. With the use of the Survey of Illness Beliefs in HF tool in additional in this study and additional studies helps the healthcare worker see exactly what the patient’s beliefs and coping measures are of this incurable disease. Determining beliefs of a patient with HF can help assist healthcare workers develop an accurate self-care plan and improve the quality of life of patients living with HF.

References

Albert, N. & Zeller, R. 2007. Development and testing of the survey of illness beliefs in heart failure tool. Progress in Cardiovascular Nursing, 22, 63-71.

Cherrington, C., Lawson, T. & Clark, K. 2006. Illness representation of patients with systolic heart failure. Progressive Cardiovascular Nursing, 21, 190-95.

Krumholz, H., Peterson, E. & Ayanian, J. 2005. Report of the national heart, lung, and blood institute working group on outcomes research in cardiovascular disease. Circulation, 111, 3158-66.

Nieswiadomy, R. (2008). Descriptive statistics. Foundations of Nursing Research. (5th ed.). New Jersey: Pearson & Prentice Hall.

Nieswiadomy, R. (2008). Inferential statistics. Foundations of Nursing Research. (5th ed.). New Jersey: Pearson & Prentice Hall.

Polit, D. & Beck, C. (2004). Nursing research: Principles and methods (7th ed.). Philadelphia: Lippincott Williams & Wilkins.

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