Research Questions and Review

¶ … Gouveia, Gouveia, Hale et al. (2017)

"Correlates of health-related quality of life in young-old and old -- old community-dwelling older adults"

Although the authors framed the research problem of interest in terms of the purpose of the study, the abstract does contain all of these basic elements. The acronyms, HRQol.,HRQol-SF and BMI, though, are not defined in the abstract and they are not defined until they are first used in the first three paragraphs of the introduction that follows, leaving readers to figure out what the terms mean (except perhaps BMI which is fairly commonplace) by either revisiting the title, searching elsewhere or reading ahead to determine their meanings. Moreover, the terms "young-old" (i.e., those aged 60-69 years) and "old-old" (those aged 70 to 79 years) are not defined until the authors describe the population in the methodology section that follows the introduction.

Introduction / Statement of the problem:

Although the statement of the problem is not specifically labeled as such, the introduction uses several paragraphs to provide the background of the study, including the known correlates of health-related quality of life among the elderly and why the authors believe that additional research is needed based on a cogent, persuasive argument in support of their rationale. Because it is not specifically labeled and the actual purpose of the study is not described until the end of the introduction, the problem of interest is not readily identifiable but it is stated unambiguously. Moreover, the research problem of interest in this study has widespread significance for clinicians of all disciplines, including professional nurses, who provide healthcare services for the elderly.

To their credit, there was good alignment between the articulated research problems and the methodology used to investigate the correlates of health-related quality of life factors among the community-dwelling elderly participants in this study and the researchers used to relatively large sample size (802 participants). Because the researchers used several questionnaires with known validity and reliability to develop the data needed to provide timely and accurate answers to their guiding research questions, a quantitative approach was appropriate and required.

Hypotheses or research questions:

There was no guiding hypothesis or null hypothesis used and the research questions are framed in terms of the overarching research purposes (i.e., "to examine the role of potential correlates of HRQol. in a large representative sample of older adults" and "to investigate whether the relationship between HRQol. and potential factors differ as a function of HRQol. component [physical vs. mental] and/or age cohort [young-old vs. old-old])" (p. 2) which are appropriately worded and include mention of the key variables of interest. The research purposes are also congruent with the conceptual framework and brief literature review that were provided in the introduction concerning past studies of correlates of quality of life factors among the elderly which highlighted gaps in the existing body of knowledge.

Literature review:

Although no specific literature review section is included in this study, the authors draw on relatively recent studies (e.g., ranging in dates from 1982 through 2016 with the majority being within the last 10 years) in the introduction and discussion sections that interpret the findings that emerged from their data analysis with previous studies. Of the 42 references used in this study, six were primary sources which provide a current synthesis of evidence concerning the issues of interest, and the brief literature review presented in the introduction provides a sound basis for the instant study.

Conceptual/theoretical framework:

The conceptual/theoretical framework and/or map used to guide this cross-sectional research were not specifically described as such, nor were their absence justified by the researchers; however, the key concepts involved in the study were operationalized at some point and the rationale in support of their study was thoroughly described.

Method:

The researchers report that all participants were volunteers and the study was approved by the Scientific Commission of the Department of Physical Education and Sports of the University of Madeira, the Regional Secretary of Education and Culture as well as the Regional Secretary of Social Affairs. In addition, Gouveia et al. also report that all participants were consented prior to commencement of the study which was also in compliance with the declaration of Helsinki concerning the protection of human rights in clinical studies.

There is no indication, though, that the study was ever externally reviewed by an institutional review board (IRB) or ethics review board. The authors do state, however, somewhat cryptically, that "All procedures were in accordance with the ethical standards of an institutional research committee" (p. 7) but do not specify which institutional research committee or even whether such a review actually took place. In addition, it should also be pointed out that while the administration of the self-report and face-to-face questionnaires in and of themselves did not necessarily present any particular threat to the well-being of the participants, the researchers also used two physical strength tests (i.e., an arm curl test to measure body strength and a 6-minute walk test to evaluate aerobic endurance levels) that may have represented a potential threat to the participants, especially those participants aged 70 years and over and there was no indication that were was an attempt to minimize these risks or maximize the benefits to the study's participants.

Research design:

While it is reasonable to suggest that virtually any study could be made more rigorous, given the study's purpose, Gouveia et al. used an appropriate and robust research design to develop the data needed to address the overarching study purpose. In addition, the researchers used a series of statistical analyses to compare the findings between the two age groups (i.e., young-old versus old-old) to enhance the interpretability of their findings. Based on the gap in the existing body of knowledge identified by the researchers in their introduction, the number of data collection points was also regarded as appropriate. There was no specific attempt, however, to minimize biases and threats to the internal, construct, and external validity of the study through the use of blinding and there was no indication that there were efforts made to minimize attrition.

Population and sample:

The researchers used proportional (geographic) representation through stratified sampling drawing on the 2001 census data provided by the Portuguese Statistics National Institute with sex and age cohort serving as the stratification variables to enhance the population sample's representativeness. There was no indication, however, that any efforts were made to minimize sampling biases. The sample size of 802 (m=401, f=401) participants (young-old = 412, old-old = 390), though, was deemed to be adequate for the study's purpose but there was no indication that a power analysis was used to develop an estimate of the requisite sample size but the authors did report that their sample size represented 2.1% of the older adults residing in the Autonomous Region of Madeira.

Data collection and measurement:

The operational and conceptual definitions used by these researchers were congruent and the key variables were operationalized using optimal methods including both self-reports on questionnaires as well as face-to-face interviews to complete the 16-item Baecke questionnaire and a socioeconomic questionnaire concerning demographic information. The instruments that were used for data collection have demonstrated reliability and validity and are adequately described. In addition, the rationale in support of their use was explained in terms of the study's research purpose.

Procedures:

The cross-sectional study did not use an intervention but was rather designed to collect and analyze data concerning the correlates of health-related quality of life factors among the two age cohorts (those aged 60-69 years and those aged 70 to 79 years). Beyond the statistical tests used for the data analysis, there is no indication that any attempt was made to minimize bias nor do the researchers discuss whether the staff members that collected the data were trained for this purpose.

Results (Data analysis):

Again, although specific research questions were not used and the study's purpose was used to guide the research, the data analyses and statistical tests that were used were appropriate given the level of measurement of the variables, number of groups being compared, and assumptions of the tests. In addition, Gouveia et al. also employed additional analyses of the data that emerged from the administration of the questionnaires to evaluate the relationship between health-related quality of life variables and the mental and physical components. Because there was no guiding hypothesis or null hypothesis used, there were no efforts made to minimize Type I or II errors.

Findings:

The researchers present their findings in two tables but do not provide any corresponding figures to highlight the differences between the young-old and old-old cohorts. The effect size for each of the correlates is discussed, though, and the findings are adequately summarized. These findings provide sufficient information for evidence-based practices and are reported in a fashion that facilitates future research including meta-analysis.