Factors Influencing Adherence To Treatment Procedures: A Critical Appraisal Of A Qualitative Research Essay.

1. Appraise the quality of evidence from clinical trials, (or)
2. Appraise the quality of evidence from qualitative research studies
The purpose of this assessment is to enable postgraduate students to their learning of conduct a critical appraisal of a specified published journal article and incorporate the following learning outcomes:
Apply critical appraisal techniques to a range of research methodologies;
Critically appraise research for its application to practice Details

Critically appraise one of the two papers (below) that are available on the unit vUWS site for this assessment item. The critique should focus on the methodology, results, overall quality and implications for clinical practice and further research. Please choose the correct critique check list for the research design of the study being evaluated.

1. Barriers and facilitators to treatment engagement among clients in inpatient substance abuse treatment.
2. Murawski et at. (2018). Randomised controlled trial using a theory-based m-health intervention to improve physical activity and sleep health in adults: the Synergy Study protocol.

Importance of Effective Treatment Procedures

For the purpose of improvement in the health of the patient, there is a need to utilize effective treatment procedures. However, despite the importance of treatment, there lies the presence of several barriers as well as facilitators which can act as major determinants of the adherence of the patient to the concerned patient. The highlighted qualitative research conducted by Yang, Perkins and Stearns (2018), with the purpose of uncovering key aspects influencing patients to abide by or avoid engagement in a particular treatment procedure, which paves the way for health professional engaged in future research, to consider necessary aspects during the task of formulating effective treatment programs (Yang, Perkins & Stearns, 2018).

Hence, the aim of this report, is to critically appraise the qualitative research conducted by Yang, Perkins and Stearns (2018), using the COREQ Checklist, for the purpose of associating the effectiveness of research conductance performed by the authors with its implications during integration of possible future research by health professionals. Hence, the importance of the selected research lays in the future formulation of treatment procedures considering the facilitating and determining factors influencing patient participation, the credibility of which this report, attempts to appraise critically.

The participants form the cornerstone of importance in any qualitative research. For the purpose of successful conductance of a research with qualitative characteristics, there is a need for researchers to establish intimate yet, professional relationships with the concerned subjects through clarified communication concerning their designations, professional identities, goals of the research and the expected beneficial outcomes. Hence, this leads to obtaining results which are strongly valid due to clear participant knowledge concerning the importance of their responses which are reflected in the findings (Booth et al., 2014). Hence for this study, the research group who conducted the interview clearly stated their credentials with two of them holding an experienced PhD, and the rest being research assistants at the graduate level. The research was headed by a PhD researcher with two years of experience who extensively trained the graduate research assistants through conductance of previous pilot studies. One of the researchers was female. Of the three researchers who conducted this study, there was no mentioning of their respective occupational details, other than the fact that they were involved in extensive PhD researchers. Hence, as evident from the selected study, the researchers highlighted extensive experience in their field of study, which is a beneficial requirement for conductance of qualitative researches, which places great importance on the research methodology and patient concerns, for which extensive researcher expertise is required (Wills et al., 2016).

Qualitative Research Conducted by Yang, Perkins and Stearns (2018)

The performance of a highly successful research based on qualitative terms is dependent on the establishment of sound relationships between the participants as well as the researcher, through the usage of empathy, patience and concern, coupled with just the required amount of professionalism, in order to avoid personal biases as well as maintain credibility. An absence of this can yield disastrous effects on the results of the research, due to the possibility of wrong responses giving by the participants with the added burden of reduced theoretical and research concept by the concerned researcher (O’brien et al., 2014). The researchers aimed to adopt a patient-centric relationship to their research, through the exploration of the psychology underlying the participants’ perception of substance abuse treatment programs along with the factors which strengthen or weaken the adherence to the treatment. This is a highly credible requirement for successful healthcare qualitative research since it places the participant at a position of utmost priority, hence allowing production of accurate responses which would pave the way for future research possibilities by health professionals (Kuntz et al., 2014). The researchers in this study also conducted the interviews with utmost privacy along with obtaining consent, which are key factors to be maintained for successful patient-centric approach intrinsic to qualitative research. The participants were informed concerning the purpose of the research along with researcher credentials. For successful qualitative research, there is a need for authors to establish empathetic relationships with the subject, which the researchers in this study successfully executed through the execution of personal rapport-building questions concerning their histories, interests and backgrounds. The researchers also used examples to clearly and succinctly explained the questions and purpose of the research to the subjects – an essential part of the COREQ checklist. There is a need for the participants to gather a clear understanding of the purpose behind the conductance of research by the concerned research, in accordance to the COREQ Checklist (Thomas, 2017). In this study, the authors successfully implemented this decision through clear explanation of the research and interview details to the participants along with assurance that the inclusion or exclusion of their participants which yield no influence on their treatments. The presence of researcher bias is a major detriment to any qualitative research, due to its participant-centric approach, which may hinder results (Roulston & Shelton, 2015). While the researchers did not engage in bias in this study, they however did not consider the importance of gender focus concerning treatment procedures received by a patient – which poses as a major limitation in this research.

Participants in Qualitative Research

For successful implementation of qualitative research, there is a need for the researchers to clearly state the key steps undertaken to fulfill the stated research objectives and the resultant study findings. In the selected study, the researchers clearly stated that the theory of framework used was interpretative phenomenology, which is highlighted by the extensive exploration of the experiences undertaken by the respective participants along with the meanings they associate with it (Lewis, 2015). The researchers have also stated the usage of thematic analysis in their respective study, for the purpose of provision of structural aspects required in the identification of data patterns (Crampton, Reis & Shachak, 2016).

There is a need for researchers to clearly state the sample size of the respective participants recruited, since it will clearly highlight the diversity of response obtained further leading to successful gathering of expansive and varied data outlining various opinions (Palinkas et al., 2015). In the following study, the researchers successfully selected participants, in their statement of selecting a total of sixty participants for their study. In accordance to the COREQ Checklist for successful performance of qualitative research, researchers should clearly specify the number of participants who were excluded from the respective research. Stating the reasons for such exclusion is of utmost importance since it would reduce the possibilities of receiving invalid criticism from opposing participants (Tong, Sainsbury & Craig, 2007). In this research, the authors successful met this criteria, as they clearly stated that a total of thirteen subjects were removed from their researchers, which a mention of their reasons citing as urgent priority towards conductance of discharge related formalities, and detrimental health conditions. For a qualitative research to be successful, the concerned researchers should clearly state the methods of sample selection used, of which, the usage of purposive sampling has been highlighted as appropriate since it involves selection of participants with similar experiences related to the research question, hence leading to valid results production (Seitz, 2016). In this study, the authors clearly stated that they used purposive sampling by recruiting subjects prior to discharge who had undergone treatment, so that they could successfully state their experiences associated with treatment procedures.

An appropriate qualitative research should clearly state the background or setting in which the research was conducted, as this clearly highlights the reasons behind the nature of responses from certain participants (Wang et al., 2015). In this research, the researchers stated that the participant interviews were carried out in a clinical hospital setting, due to the nature of the research question concerning hospital treatment procedures. A qualitative research should also state the presence of participants not included in the study, since a presence of such non-participants can lead to negative or restrained response from subjects due to feelings of distress or concern (Lee, Seong & Lim, 2016). In this research, the authors clearly stated that the interviews were conducted in a confidential private room, in the absence of non-participants, for the purpose of comfort and validity to participant responses. A successful clinical research should also clearly state the detail of the concerned subjects in accordance to demographic features, for the purpose of obtaining varied perceptions in response to the research problem (Costa, 2016). In this research, the authors elaborately discussed demographic details in tabular form, mentioning that their sample sized comprised of mainly male participants, with ethnical backgrounds of African American (29%), Whites (66%) and others (5%). Hence, this research successfully followed the COREQ Checklist with respect to research settings.

Patient-Centric Approach to Research

For the successful conductance of a qualitative research, the concerned researchers should aim for the provision of the questions or prompts used in their research methodology, for the purpose of encouraging individuals reading it to gain understanding of the research purpose along with the participant adherence to the concerned questions (Booth et al., 2014). In this study, the researchers have mentioned the questions conducted in the interview, as stated in the usage of rapport building questions assessing patient individualities and interests, along with experiences and shortcomings encountered during treatment procedures. Further, the researchers also stated conductance of pilot test through their graduate research assistants. Authors must state the conductance of repetition in their methodology, as this is intrinsic for the development of positive client relationships along with gathering highly valid data (Tong, Sainsbury & Craig, 2007). In this study, the authors did not conduct repeat interviews. However, it is stated that participants were probed extensively with the interview questions for the purpose of gathering information pertaining to experiences associated with treatment practices. The researchers also engaged in recording the respective responses of the participants digitally, which has been outlined as a credible method in the COREQ Checklist (Elliott, 2017). The authors also stated that the interview duration ranged from ten to forty seven minutes - which is required due to its dependency on the quality and quantity of information gathered. However, this research mentions no information on the aspect of data saturation, which is essential to assess the possibilities of obtaining further novel data (Fusch & Ness, 2015). Hence the selected qualitative research focused on not all, but most of the Checklist aspects pertaining to data collection.

It is of utmost importance for researchers to state in their qualitative research, the descriptive aspects of the coding tree and coding methods used, along with usage of software for this purpose, as this indicates that the researchers engaged in a broader and deeper platform for the required research, further making their findings credible (Ranney et al., 2015). The researchers in this study successfully fulfilled this, by stating the identification of ten primary codes by a team of five coders along with usage of ATLAS.t software designed for this purpose, which further impacted thematic analysis required to uncover the interpretation of these codes. The coding tree was however, not mentioned by the authors. The researchers did not engage in participant feedback – an important checklist stated in COREQ for the purpose of honest representation of the participants’ responses, without interference by the researchers (Berger, 2015). Upon conductance of the appropriate coding, the major themes of peer inspiration, trust and counselor rapport, perceived treatment needs and trust and counselor support were derived by the authors.

Research Methodology and Findings

The authors adhered to the COREDQ Checklist, by adding relevant quotations of participant statements, with due confidentiality – which is important to generate valid and transparent data. Upon reading, one can find consistency between results and the findings stated, as mentioned in the form of key major themes of organizational barriers, peer inspiration, perceived treatment needs and trustworthiness with counselor rapport, presented in writing as well as diagrammatically. The study also clearly presented the minor themes of treatment motivation and importance, life event impact, peer and counselor rapport along with inspiration, and factors pertaining to organization, hence leading to a discussion of diverse themes with the help of quotations in addition to minor theme discussion. Hence, the reporting COREQ Checklist was fulfilled which is required to aid in improved understanding for readers studying a qualitative research (Elos et al., 2014).

Conclusion: Health Implications and Future Research 

Hence, to conclude, the selected qualitative research was successfully evaluated with the help of the Consolidated Criteria for Reporting Qualitative Research. Upon conductance of these findings it was observed that the authors successfully implemented all the checklist factors pertaining to the establishment of successful researcher and participant relationships along with successful statement of the research team credentials. The theoretical framework along with the demographic details were also clearly mentioned. However, there was a lack of mentioning concerning presence of data saturation or the returning of interview transcripts to subjects for approval. Despite the fulfilling of criteria by the research concerning coding, analysis and reporting, the authors did not use any participant feedback methods, which is important in the COREQ Checklist.

To conclude, the research presented the key themes of support, counseling and peer involvement required, which is essential for developing more inclusive and supporting treatment procedures in the future. However, there is a need for conducting future research, especially concerning subjects to departed treatment before course completion, to assess factors required to further improve treatment. Health professionals also need to conduct future research on the influence of an individual’s gender considering the response towards healthcare treatment procedures, along with further research conducted in mixed-gender environments for development of future treatment procedures sensitive to an individual’s gender.

References:

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Booth, A., Hannes, K., Harden, A., Noyes, J., Harris, J., & Tong, A. (2014). COREQ (consolidated criteria for reporting qualitative studies). Guidelines for Reporting Health Research: A User's Manual, 214-226.

Sample Selection and Background Setting

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Yang, Y., Perkins, D. R., & Stearns, A. E. (2018). Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment. Qualitative health research, 1049732318771005.