Examining Methodology and Design

DNP Method and Design
Three studies relating to the PICOT of this proposed study are the qualitative research study Ong, Chua and Ng (2014) on barriers and facilitators of self-monitoring sugar levels for diabetes patients, the quantitative study by Stevens, Shi, Vane, Nie and Peters (2015) on the experiences of diabetes patients receiving home care, and the mixed-methods research study of Wildeboer, du Pon, Schuling, Haaijer-Ruskamp and Denig (2018) on sharing decision making among general practice staff and diabetes patients. Each study utilized a different research and method to obtain data on topics related to diabetes research. These studies are compared in this paper and their methodologies and designs discussed, their internal and external validity issues evaluated, and possible methodologies and designs are identified that the researchers could have used to make their studies more beneficial.
Comparing Methodologies and Designs
Ong et al. (2014) conducted a qualitative method study, the design of which focused on identifying barriers and facilitators that patients suffering from type 2 diabetes face when they are attempting to monitor their own blood sugar levels. The method of collecting data was the interview method. Semi-structured interviews were conducted by the researchers with diabetes patients and transcripts of interviews were analyzed to identify themes that could help to explain what helped and hindered patients in the course of self-monitoring.
Stevens et al. (2015) conducted a quantitative method study, the design of which focused on evaluating the quality of life among diabetes patients receiving home care in Los Angeles. A method consisting of a cross-sectional longitudinal survey was conducted in order to obtain the data for the study. Data was measured using a primary care tool and quality of life was measured as well. Statistical significance was found among the correlations between home care and quality of life for the diabetes patients in the sample.
Wildeboer et al. (2018) conducted a mixed-methods study, the design of which focused on how general practice staff thought about the use of a patient?oriented treatment decision aid in shared decision making for patients with type 2 diabetes. The method included interviews and self-reported surveys which were collected from the general practice staff. Findings showed that various factors impacted whether staff members viewed the decision aid as helpful or not, but mostly the staff viewed them favorably.
External and Internal Validity Issues
The research appears to have conducted correctly in each of the three studies and thus all three can be said to have internal validity. However, when it comes to external validity, it is not as easy to say that the same findings would be found in other settings. For example, the study by Ong et al. (2014) was conducted in a hospital setting in Malaysia among diabetes patients there. The obstacles to self-monitoring and the supports that the same sample population encountered in the Malaysian hospital might not be the same as a population in the U.S. because of support networks, culture, and environmental factors.
The external validity of the study by Wildeboer et al. (2018) likewise suffers from the same issues, as the findings stem from a small sample of practitioners in a specific region. Cultural factors might make the outcome of this study different in different parts of the world. The internal validity of the study is decent, as the steps taken to collect data are clearly described and the factors and variables analyzed are relevant to the issue examined. However, the use of self-reported data for the survey might weaken the validity of the findings because of the nature of self-reported data having a subjective quality to it.
The study by Stevens et al. (2015) has the strongest external validity of the three, as the sample population is based in Los Angeles which is a region with a considerably diverse population and thus the findings are likely to obtained in different setting as well.
Additionally, the sample size is large enough to be meaningful, and that helps with the external validity. Internal validity for the study is strong, as the steps taken to obtain data are defined well and the variables identified are relevant to the study’s research question and the issue being addressed.
How Different Methodologies and Designs Might Have Been Beneficial
Ong et al. (2014) might have used a systematic review of existing literature to augment their study’s design or as the basis of a new methodology altogether. This would have allowed them to identify themes from findings across a broad swath of diverse populations instead of from just one small population in Malaysia and thus this would have helped to bolster their study’s external validity.
For the study by Stevens et al. (2015), a qualitative method with a design focusing on how diabetes patients receiving home care defined their experiences in their own words could have been beneficial in helping the researcher to understand other variables and factors not thought of by the researcher in determining the extent to which quality of life was experienced by the patients.
Likewise, Wildeboer et al. (2018) might have benefited from adopting a strictly quantitative design that instead of using self-reported survey data method used direct observation data to cut down on the subjectivity of the data. This would have strengthened the study’s internal validity. The external validity of the study could have been improved by including a systematic review of literature across a variety of settings to help make the findings resonate across a wider demographic.
Conclusion
Qualitative, quantitative and mixed-methods research designs all have their benefits, but each offers different insights into a study. Qualitative methodologies tend to provide better ideas about what variables and factors are meaningful regarding a topic. Quantitative methodologies provide statistical data that can be analyzed using tests. Mixed-methods provide both data sets and insights but can be time consuming and may have a smaller sample size and thus lack external validity. Each of these approaches should be considered when identify the right approach for this study.

References
Ong, W. M., Chua, S. S., & Ng, C. J. (2014). Barriers and facilitators to self-monitoring
of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Preference and Adherence, 8, 237.
Stevens, G. D., Shi, L., Vane, C., Nie, X., & Peters, A. L. (2015). Primary care medical
home experience and health-related quality of life among adult medicaid patients with type 2 diabetes. Journal of General Internal Medicine, 30(2), 161-168.
Wildeboer, A., du Pon, E., Schuling, J., Haaijer?Ruskamp, F. M., & Denig, P. (2018).
Views of general practice staff about the use of a patient?oriented treatment decision aid in shared decision making for patients with type 2 diabetes: A mixed?methods study. Health Expectations, 21(1), 64-74.


Appendix
Comparison Table.
Title
Author
Source
Year
Research Topic
Research Method
Sample Population
Findings

Barriers and facilitators to self-monitoring
of blood glucose in people with type 2 diabetes using insulin: a qualitative study
Ong, W. M., Chua, S. S., & Ng, C. J.
Patient Preference and Adherence, 8
2014
Barriers and supports for self-monitoring of blood sugar
Semi-structured interviews (qualitative)
Malaysian type 2 diabetes patients
Emotions, pain, cost and support network are key factors in determining barriers and supports in self-monitoring experiences

Primary care medical
home experience and health-related quality of life among adult medicaid patients with type 2 diabetes
Stevens, G. D., Shi, L., Vane, C., Nie, X., & Peters, A. L.
Journal of General Internal Medicine, 30(2)
2015
Quality of life among diabetes patients receiving home care
Cross-sectional survey method (quantitative)
Home care patients in Los Angeles
Home care was found to be associated with a higher quality of life among diabetes patients

Views of general practice staff about the use of a patient?oriented treatment decision aid in shared decision making for patients with type 2 diabetes: A mixed?methods study.
Wildeboer, A., du Pon, E., Schuling, J., Haaijer?Ruskamp, F. M., & Denig, P.
Health Expectations, 21(1)
2018
How general care providers view patient-centered care + shared decision making for diabetes patients
Mixed-methods: interviews and self-reported survey
Routine diabetes care providers
Sharing decision making with patients using the decision aid was viewed favorably by care providers