A Qualitative study by Forte et al, (2015) on opportunity to involve men and families in chronic disease management in Chiapas, Mexico and a quantitative study by Goncalves et al, (2017) on knowledge of individuals with DM in the family health strategy in Brazil were selected. Both papers are taken from Latin American country, Brazil and Mexico which has the highest prevalence of diabetes than any other country in the region ( Chapa,2017 ; Telo et al,2016).
In the United Kingdom (UK), there is a high prevalence of diabetes specially among ethnic minority groups (Diabetes UK, 2019) which is costing the nation 8.8 billion per year ( NHS England, 2020). Diabetes is a global issue with a significant impact on individuals, economy of the country and the health care system ( WHO, 2020), therefore the finding of both types of research can be applicable to the UK nursing practise.
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Critique paper 1
Goncalves et al, ( 2017) conducted a cross-sectional study with a quantitative approach using stratified sample of 222 individuals with T2DM from five families health strategy ( FHS) unit of Itau de Minas, Brazil, to examine the knowledge of the subjects on the disease. The research was carried out from October 2013 till May 2014 . This method appeared to fit well with the inquiry, as the data are collected at a single point of time to examine the knowledge of chosen participants on T2DM ( Nieswiadomy,2008). Kesmodel ( 2018) suggested that there can be a systematic bias in a cross-sectional study due to systemic differences between participants who were selected and who did not get selected, however Burns and Grooves (2011) argued that due to increasing in the representativeness of stratified sample, it reduces the possibility of systematic bias.
Goncalves et al, (2017) used Diabetes Knowledge Scale questionnaire ( DKN-A) which is self-administered questionnaire(SAQ) with 15 multiple choice questions on different elements connected to the general knowledge of Diabetes as a research tool as it is proven to have validation and demonstrated reliability and internal consistency (Eigenmann, Skinner and Colagiuri, 2011). However, Polit and Beck (2014) argued that for SAQ to be effective, respondent must be able to understand the questionnaire as different individuals may have different level of literacy. If the respondents skip the question, it will result in gathering incomplete data which can affect the validity and reliability of the tool (Burns and Grove, 2011). Similarly, Goncalves et al, (2017) also acknowledged that they observed difficulties in data collection due to respondents not being able to understand the questions and their confusion regarding choice of answers provided and mentioned that few other studies in the past had experienced similar problems due to the use of SAQ. This suggest that the questionnaire was not easy to understand, and the wording were confusing and unfamiliar to the respondents. Therefore, this demonstrated tool of data collection was not appropriate instead face to face interviews should have been used to yield more reliable and valid data ( Boswell and Cannon, 2014).
Goncalves et al,( 2017) analysed the collected data in the Statistical Package for Social Science ( SPSS) version 15 and presented them in a descriptive way in frequencies and percentages using descriptive statistics which is fairly straightforward and valuable ( Selvanathan, Selvanathan and Keller, 2017). Age and time of the diagnoses were presented as a mean and standard deviation and reported that 81.5% of the participants had satisfactory knowledge about T2DM , and the results were presented in the text and the table. This method is deemed appropriate for this cross-sectional study as it describe and summarise data from the sample ( Roberts and priest, 2010), beside summarising the data it reduces a large amount of data and present it precisely ( Holcomb, 2017).
Goncalves et al, (2017) had a sample recruited from five FHS, out of 524 individual enrolled in the computerized system of Registration and Monitoring of Individuals with Systemic Arterial Hypertension and Diabetes Mellitus ( HIPERDIA), Individuals with gestational diabetes, type 1 diabetes, who declined to complete questionnaire and declined to be involved in the research were excluded, hence only 222 individuals with T2DM were selected as a representative sample, which is appropriate for the cross -sectional quantitative research as it can be representative of the population being examined provided that there is minimal missing data (Nieswiadomy,2008). However due to possibility of incomplete data as the result of data collection tool, the suitability of the sample size is questionable. Using stratified sample has helped researchers to compare groups and generate valid interpretations from the sample of the population used, however, due to the research being carried out in a small geographical area with predominantly female participants, generalization of the finding to the global population is questionable (Eysenck,2015).
In addition to the study being approved by the Ethics Committee ( CEPE) of the University of Franca, all participants signed the informed consent term and the Individual who refused to participate were excluded from the study demonstrated the ethical issues were considered (Brooks et al, 2014). However, the remaining participants were not explained their right to leave the study or withdraw their consent and data, which should be explained to them in order to respect their human right ( Nieswiadomy,2008). Dyson and Norrie ( 2010) stated that the participants have right to expect that the information collected from them is kept securely and confidently, however Goncalves et al, (2017) failed to mention where and how the data will be held and there is no mention of debriefing the participants or advising them of the ways of contacting the researchers, which puts the ethical rigor in questioning ( Harvey and Land, 2017).
Critique paper 2
Forte et al, ( 2015) has used the interpretative phenomenological method to explore why male participants were not involved in health promotion activities and to develop strategies to involve them in chronic disease management and this method fits well with the level of the inquiry as this method explores people’s experience and how they understand their living world (Glasper and Rees , 2016) .
Forte et al, ( 2015) recruited 9 males with diagnosis of hypertension and/or T2DM, who had limited or no participation in health education program, 6 families in which at least 1 family member had diagnosis of T2DM and/or hypertension and 9 health care providers from 4 different health centres of the secretary of health in Chiapas, Mexico. All 3 subpopulations were interviewed in Spanish, on disease self-management activity, barrier to participating in health promotion activities at the health centre. Interviews were audio-recorded and transcribed into a separate word document in Spanish. In-depth semi structured interviews were used, which was appropriate for this research as it permits flexibility where the interviewer has sets of guiding questions but does not have to rely on the pre-set questions (Wilson,2012). This is because the interviewer can inquire further according to the participants responses, which can generate powerful data that provides insights into the participants' experiences, feelings or views (Peter and Halcombe,2015). However, the researchers failed to mention their rationale for conducting face to face interviews in the university and clinics, as they represent more of the formal environment, which can be daunting and intimidating for some participants (Glasper and Rees, 2016) and some may not be comfortable talking about their personal life and experience in a formal setting (Harvey and Land ,2017). The researcher did not mention how long the interview lasted, how the researcher ensured participants were made comfortable to speak about themselves and to develop rapport with each participant as gaining true information is vital ( Glasper and Rees, 2016). However, due to the presence of the researcher to clarify questions and seek clarifications from the participants during the interview, the validity of the response is enhanced (Parahoo, 2014).
Researcher used General Inductive Analysis (GIA) approach to identify themes related to male’s limited involvement in health promotion activities, how the family was involved in disease management and recommendation for both which demonstrate methodological rigour as it produce reliable and valid findings, using a systematic approach (Lui, 2016) therefore, it is appropriate to use GIA for this research. All transcripts from the interviewees were entered into ATLAS. ti version 7 which is a software program that aids in analysing qualitative data (Nieswiadomy,2008). To avoid misinterpretation, three Spanish speaking analysts used open coding and focused coding to produce an initial list of codes; that was analysed collectively and converted into an agreed set of codes which were then reviewed by two members of research team, this demonstrates trustworthiness and authenticity of the data ( KO, 2011). Use of Eco maps and Genograms are appropriate for this research as they portray personal, family and social relationships and permit understanding and imagetic visualisation which would complement the interview questions ( Souza et al., 2016).
Researchers used Purposive sampling to facilitate a detailed analysis of the data produced. Participants were purposively selected to ensure an evenly homogeneous sample, which can offer rich data about their understanding and perceptions of their health conditions and management of disease ( Polit and Beck 2014) ; consequently, sampling is appropriate, however it is difficult to ascertain if sample size of 9 males,6 families and 9 health care professionals is the representative of the study population and data saturation was achieved or not as Beck and Polit ( 2014) stated that small sample sizes are not likely to represent the study population. Therefore, the validity and trustworthiness of the sample is questionable.. Furthermore, due to the male focus in the research within the small geographical area, it is questionable if it can be generalised to the wider population where cultural difference exists.( Eysenck,2015)
In addition to approval from the Institutional Review Board of the RAND Corporation, the Institute of Nutrition of Central America and Panama, and Health Institute of the State of Chiapas, this research is funded by the seed grant hence it is likely to assure ethics and ensure participants right were upheld. To ensure compliance and data protection, transcripts of the interviews and ATLAS.ti coded files are kept in the School of Nutrition of the University of Science and Arts in Chiapas, Mexico. Pseudonyms were used throughout the article also confirmed confidentiality. However, ethical rigour is questionable due to; participants not being aware of the procedures, debriefing was not carried out, participants were not informed of how to contact researchers, and participants rights to withdraw were not discussed. Even though participants consented to take part in the study they should have been explained their rights and procedure of the study (Nieswiadomy,2008)
Discussion
Both research articles were successful in responding to the research question generated in some aspect. Forte et al, ( 2015) focussed on how to identify strategies to involve males with hypertension and/ or T2DM and family of patient with T2DM in a health promotion and disease management. They were also able to recognise that the structure and relationship of the family of the patient can be diverse where, some had full support and some lacked support which is similar to the families in the UK (Gunn et al, 2012). Goncalves et al (2017) analysed knowledge of individuals with T2DM and found that health professionals must focus on effective educational actions and aim to improve patient’s health as increased knowledge can empower patients by improving their self-efficacy which can be a valued means for managing or preventing T2DM.
Suresh and Chandrasekhara ( 2015) suggested using satisfactory sample size with excellent data collection efforts will result in reliable, valid and generalizable results, but in both researches, data collection tool and sample are questionable. Even though questionnaires used in quantitative research and in- depth semi structure face to face interview used in qualitative research are a valid tool to collect data, they had some flaws in the study, which affected the validity and reliability of the finding, hence limit their contribution to UK nursing practice which requires the use of best available evidence (NICE,2020 ). Nevertheless, the finding of the both researches can be significant to increase the knowledge of the nurses on effective interventions and to develop strategies to improve self-efficacy on patients with T2DM. Saeedi et al, ( 2019) highlighted that it is imperative to develop and implement strategies to tackle T2DM as currently there are 3.8 million people living with diabetes in the UK and expected to be 5.5 million by 2030 ( Diabetes UK , 2019). Consequently, the findings of the both researches are noteworthy for UK nursing practice for theoretical knowledge to deliver effective health promotion to manage or prevent T2DM on patients as stated by the NICE guideline ( 2015), which emphasise on promoting health and educating patients to manage or prevent T2DM. However, it is also crucial to be aware that the findings of both researches are insufficient to meet the needs of patients due to their various needs and distinctiveness. Furthermore NHS (2020) highly emphasise on involving patients in their health care and delivering person centred care, this is further emphasised in the king’s fund report “no decision about me without me”. Both researches have emphasised on carrying out future research related to health promotion for management of T2DM.
Conclusion
This assignment has reviewed qualitative and quantitative research papers obtained from CINAHL and BND database. The research question was generated using PIO model and successfully identified the importance of evidence-based practice. The research assignment found that whilst ethical rigour was applied to both papers, both were lacking when it came to informing participants of their rights and some flaws with data collection tool and sample which questioned the validity and reliability of the researches. However, despite these shortcomings, both research articles showed that health promotion is crucial in managing and preventing T2DM. Whilst the research was conducted in Latin America clear parallels could be made with the UK nursing practice, given the global impact of diabetes.
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