1. Was there a clear statement of the aims of the research ? Yes. In the article, the aim of the research was to understand the experience of participants, their knowledge about type 2 diabetes, and the factors of medication adherence in Malaysia. According to Susan (2010), the five components of PICOT are population, issue, context, outcome, and time. According to Al-Qazaz et al (2011), the PICOT was presented by the researcher in the study were, P: Type 2diabetes patients with receiving of hypoglycemic medication. I: Identifying participants’ perception, and their knowledge about type 2 diabetes disease and medication. C: USM clinic of Malaysia, where the study took place.
O: It helps people living with type 2 diabetes to have a diverse understanding by relating with other people’s experiences. T: March and April of 2009. Qualitative PICOT is a framework to help in formulating effective clinical question in a step-by step manner (Melnyk and Fineout , 2010).
2. Is a qualitative methodology appropriate ?
Yes.Qualitative research is to study a person’s behavior and lived experiences related to what is being studied in the research (Denzin and Lincoln, 2011). The key characteristics of qualitative study in this article included a small sample size, in-depth interview (semi-structured), researcher involving during interview, non comparisons and non numerical. In qualitative study, sample size are usually small that achieve in-depth understanding of the experiences or feeling of the participants (Polit and Beck, 2012). Meanwhile, a semi-structured interview was used to collect data by codding participants’ ideas arising until no more new themes emerging.
According to Polit and Beck (2012), semi-structured interview can provide rich and detailed information during phenomenon study. In this study, a phenomenological approach was used to described the aim of the research. It is to understand the experiences of diabetic patients in Malaysia, and explore their knowledge about the medications that they have been taking. According to Judith (2007), qualitative research is characterized by its aims to understand the experiences and attitudes of patients. In brief, a qualitative methodology is appropriate to this research.
3. Was the research design appropriate to address the aims of the research ? Yes. According to NCBI (2014), a Phenomenological study can probably explore participant’s lived experience, beliefs about the efficacy of the medication, side-effects of drug and participants’ adherence to the treatment regime. By the square, in this article, the aim is to understand the participants’ experience and explore their knowledge and medication adherence related on type 2 diabetes. Therefore, phenomenological approach is appropriate to address the aims of the research. The advantages of Phenomenological study is to reveal patients’ beliefs and experiences by a flexible way to explore the respondents’ attitude, and allowing deep understanding about knowledge and feeling of participants (Polit and Beck, 2012). However, its limitation is that samples are often small band and the researchers are not attempting to generalize the findings.
4. Was the recruitment strategy appropriate to the aims of the research ? Yes.The researcher recruited participants from USM clinic and who were diagnosed type 2 diabetes while taking on hypoglycemic medications through a convenience sampling. According to HRDAG (2013), convenience sampling is to recruit participants from a particular clinical setting during data collection of a qualitative research. Moreover, convenience sampling is easy and efficient to extract the greatest possible information from the new cases in the sample, until there is no new data could be obtained and the redundancy of data saturation was achieved (Polit and Beck, 2012).
However, convenience sampling may not be a preferred sampling in qualitative research due to unable to bring out the most information-rich sources and the representative of the population (Polit and Beck, 2012). In this article, the data was only obtained in one specific clinic, that would affect the credibility of result, such as the adverse effects of medication, and the satisfaction rates from health providers. It would be better if the researcher use purpose sampling into the study.Purpose sampling is to choose participants based on specific purposes, and it is primarily used in qualitative research (Polit and Beck, 2012). it can achieve representativeness of the population and provide credibility of the result, because the researcher will not only focus on one clinic during recruitment of participants.
5. Were the data collected in a way that addressed the research issues ? Yes.A semi-structured interview was developed for data collecting of the research. Semi-structured interview is a paper-based interview guide which contain open-ended questions and the participant to follows (RWJF,2008). Moreover,Semi-structured interview provide rich, detailed information in the phenomenon study (Polit and Beck, 2012). In the study, the researcher has described in-depth interview to explore patients’ beliefs and experiences. Besides, a consent form was signed by participants before interview, a direct tell phone contact for arranging a time of interview. Further more, all the interview has been audiotaped, and the researcher did line by line analysis and coding the data to identify the key themes. The researcher interpreted to the participants who could not understand English during the interviewing by translating from a staff nurse to avoid bias that might affect the findings. In short, the data collected were fully addressed the research issue of this study.
6. Has the relationship between researcher and participants been adequately considered ? Yes. Qualitative researchers need to develop a strong relationships with participants in the study to establish credibility (Polit and Beck, 2012). In the article, all the participants were informed the purpose of this study, and a consent form was signed by each of them. The researcher also made phone call to arrange time and place that participants would like to choose for each interview. Besides, they are allowed to express their own views at the time of interview. From the analysis above we can see the participants have been fully respected by the researcher to gain their trust.
Therefore, the relationship between researcher and participants has been adequately considered in this study (Al-Qazaz et al 2011). However, there was no mention about reflexivity by the researcher in this article. According to RWJF(2008), it described that reflexivity is a process use to exam researcher’s relationship to the respondent that refers to how the researcher’s values, beliefs, acquaintances and interests influence his/her research. It would be better if it is mentioned about how the researcher located herself or himself in the study, the readers can identify how it affect the data obtaining, that will gain the findings of the research to be more credible (Polit and Beck, 2012).
7. Have ethical issues been taken into account?
Yes.In the study, a respect for human dignity was fully presented based on informing the participants about the purpose of study, distributing a consent form, and a direct phone contact before interview. The participants have been fully respected by the researcher to benefit as well as the individual’s rights. Besides, they are allowed to express their own views at the time of interview, and the participants can choose place where they feel more convenience to be interviewed. It gave researcher a chance to explore the depth-richness data from participants, and enhance the participants’ autonomy and anonymity in the study.
Further more, the study was also approved by the local ethics committee. In short, the ethical issues have been taken into the study as well. There was no coercion could be found in the study. However, the researcher did not mention about the confidentiality and how was data protected. Besides, they did not mention how many times participants understanding were checked before the consent form given. According to Polit and Beck (2012), it is described that it must deal with ethical issues if the studies involving human beings, because the human rights must be protected.
8. Was the data analysis sufficiently rigorous ?
Yes. In the study, the researcher has described clearly that a transcript of 12 audiotaped in-depth interviews were double checked for its accuracy. And the researcher identified the emerging themes via line by line data analysis and coding the relevant content data into categories until the data saturation was met and no more new data emerging from the interviews. According to Polit and Beck (2012), data saturation is a measurement of sample size that based on informational needs under the study. It is to achieve the rigour of data analysis until no more new information can be obtained. However, the researcher failed to mention about member checking in this study. It is not clear whether the researcher asked participants to review and comment on the case summaries or drafts of the research report. It will effect the credibility of the data. According to Polit and Beck (2012), member checking defined as the researcher confirm their data accuracy by providing a feedback to the participants during data are being collected to ensure that participants’ meaning were understood, and it is for enhancing validation of the research.
Further more, the researcher mentioned their data were analyzed by using means of a standard content analysis framework. Its aim was achieved by a appropriate phenomenological design in this study which have been discussed in question two. Moreover, the rigor and validity can also result in developing trustworthiness of qualitative research, and the five criterion for evaluation the trustworthiness in the research include in credibility, dependability, confirmability, transferability, and authenticity (Polit and Beck, 2012). In the study, a phenomenological design was conducted with a semi-structured interview of data collection, and coding method for data analysis. this can be sufficiently proved its credibility, dependability, and confirmability. Therefore, it can be said the data analysis of this study is sufficient rigorous.
9. Is there a clear statement of findings?
Yes. Four major themes were clear stated in the study which included (1). Participants’knowledge about type 2 diabetes and its medications; (2). Side-effects of medications; (3), adherence issues; (4), relationship with family on well-being (Al-Qazaz et al 2011). According to Polit and Beck (2012), the researchers interpret the data by rereading, categorizing and coding, then developing a data analysis to point out the themes into a unified whole. In this study, the researcher used qualitative design to consider increasingly the transferability of the findings to reflect the true experiences of the participants. It is relevance and accurately from the data, and give reader thought to the implications of the study for future research and practice. Meanwhile, the researcher are in the best position to demonstrate their limitations what they have been aware from the study. Consequently, it told readers that the researchers have done what they could do to guarantee the findings were clearly and accurately as well.
10. How valuable is the research ?
The purpose of qualitative research findings was described to explore participants’ experiences to develop a specific nursing intervention for improving a better outcomes of patients, and as a potentially applicable evidence influencing in future practice (NCBI,2011). Overview this study, a phenomenological approach that explore the aim of the research, it is to understand the experience of participants, their knowledge about type 2 diabetes, and the factors of medication adherence in Malaysia. Besides, it allows a deep understanding about knowledge and feeling of participants(Polit and Beck, 2012). Moreover, a semi-structured interview was used to provide rich and detailed information during the study for its validity(Polit and Beck, 2012).
Further, a convenience sampling recruited participants and extract the greatest possible information to achieve data saturation for its rigour. Meanwhile, the ethical issues has been taken into account by the researchers to benefit as well as the individual’s rights. On the other side, the researcher demonstrated their limitations what they aware of the study to enhance the findings more clearly and accurately. Regarding quantitative findings, it is not generalizable that can be applied to entire populations, however, it is generalizable in a way this particularly pertinent to nursing practice in which there is an expectation that scientific finding, and provide knowledge about human experiences to readers for future research.Thus it can be seen, the research is quite valuable.
Critical appraisal is a process to judge weather a research is usefulness or its findings are trustworthy(Young and Solomon, 2009). The Critical Appraisal Skills Programme (CASP) produced a simple critical appraisal checklist guide people developing their skills what they need to make sense of scientific evidence(Burls, 2009). All of above,by following the CASP checklist in quantitative research, it was presented a Randomized Controlled Trial Appraisal Tool, to evaluate the effectiveness of intervention , a large sample size and a blinding to achieve the reliability of the outcome and prevent bias, a intention-to-treat analysis to compromise the validity of the study. Moreover, generalizability of the study can be practices in other countries and helpful for further study.
However, in qualitative research, the CASP is helped to understanding people’s lived experience and explore participant’s experience of taking the drugs, beliefs about the efficacy of the drug, side-effects and the adherence of treatment regime. A phenomenological method has been used in the qualitative study through a semi-structured interview, convenience sampling and coding to reveal patient’s beliefs and experiences, and allowing understanding of the knowledge and coping strategies in which the quantitative research is unable to cover. More, in this qualitative study, sample size is tend to be small, and the finding is not generalized(Polit and Beck, 2012). Both of researchers have considered validity, findings, and its relevance. However, in the qualitative article, if the researcher use a purpose sampling method and mention about reflexivity and member checking during data collection, that will enhance validity of the findings to be more accurate.
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