Healthcare Scientific Merit

Scientific Merit Paper
This paper will analyze Doekhie and coworkers’ 2018 research work titled “The different perspectives of patients, informal caregivers, and professionals on patient involvement in primary care teams. A qualitative study”. This analysis will entail an evaluation of how the research work contributes to scientific knowledge and research theory, its dependability and credibility, approaches to deal with any ethical concerns relating to the research, and how the researchers applied different techniques of inquiry.
Advancement of the scientific knowledge base
The research work adds to the literature on the subject through examining the issue of patient participation in the health-related decision?making process in the course of primary care team interactions with patients and their informal caregivers within the primary patient care setting. Here, patient participation is no explicitly established idea; instead, the concept is coproduced using interactions and discussions of primary patient care practitioners, reciprocally, with patients and their informal (or family) caregivers. This renders it essential to concentrate on patient participation as members of primary care units (Swan et al., 2012). Generation of theories which can explain, with certainty, phenomena generalizing beyond the specific is a long- term scientific objective. Science produces cumulative knowledge through developing, refining, and even sometimes replacing theories.
This study by Doekhie and colleagues (2018) will add significant value to healthcare practice as well as the relevant knowledge pool. It offers salient details on public health initiatives and measures, care patterns, and healthcare implementation from the point of view of a few of the sector’s key stakeholders, namely, practitioners, patients, and informal caregivers. Hence, this research work aids mutual understanding and offers vital details on the negative impacts and effectiveness of clinical initiatives through controlling variables having the potential to affect research outcomes. Furthermore, the research affords a chance for feedback thanks to the actual clinical experience of these entities, which proves critical to the comparison and improvement of medication, medical device, diagnostics, and vaccine usage. Lastly, it is imperative to document and evaluate clinical practice experiences for developing best practice guidelines and guaranteeing superior quality healthcare delivery for patients.
Health sector policies in industrialized nations like America should be in line with the national value system as well as fundamental facts about healthcare and societal health. It may be a tricky task to attain such compatibility because individual value-linked differences might crop up in policy discussions. Hence, such studies prove essential, since they offer evidence-based facts that may be applied in order for establishing a framework to structure the national healthcare discussion. In the end, the defining issues aren’t, for instance, whether or not high deductible healthcare plans have the desired impact, what prescription medication benefit plans ought to cover, or why it is recommended to rely on health maintenance institutions (Brook & Vaiana, 2015). Instead, the main issue is how to reform the healthcare system and attain ideal results in accordance with stakeholder views.
The study involves a logical, orderly, and methodical set of procedures, raising readers’ level of thought, and reinforcing ideas through a critique and reflection of techniques already employed in the field of healthcare, by presenting the views of healthcare consumers (i.e., patients) and their informal caregivers that, despite their significance, are typically neglected. The study furthers knowledge on the subject, and more significantly, creates room for the formulation of novel hypotheses and strategies to improve healthcare delivery techniques and approaches through ensuring the engagement of all stakeholders. The study primarily serves to pose new questions and generate new knowledge. Moreover, it aids future practice and developments.
The research constitutes an instrument for facilitating learning and knowledge building. To be more specific, it aids in building healthcare knowledge and, particularly, patient caregiving knowledge, through asserting that patient participation occurs within complex interactions of patients and their informal caregivers with diverse healthcare providers; the expectations and views of involved parties may be incompatible with one another in such an instance (Young, 2015). Acknowledging patient and informal caregiver contributions to primary patient care teams can enable healthcare practitioners to understand them and their needs better, thereby reducing the possibility of challenges cropping up during team interactions.
Contribution to research theory
Researchers, while discussing the research function, suggest a close link between research and theory. To put it more clearly, the original motivation underlying research is a quest for theory. The formulation of theories is dependent on research, which, in turn, and reciprocally, is dependent on theories. Hence, this linkage is of a dialectic nature, a transaction by which theories help decide what information to gather, with research findings challenging accepted theories. Thus, this study has a pivotal part to play in adding to the theory revolving around patient participation in decision- making during interactions in the primary care setting.
This study contributes significantly to theoretical advancement, particularly concerning patient engagement in care-related decision making. With time, patient care transformed from being solely the role of practitioners with no or scant patient, family, and informal caregiver input (Eccles et al., 2005). As studies are done where the need arises to understand something or gain new information on a topic, the need for determining patient engagement effects resulted in this study. Scientific research aims at improving insights, a goal achieved by adding to the existing information pool, and testing theories. Research efforts help generate the necessary knowledge and data for decision- making and issue resolution. These efforts may be segregated into applied and basic/ pure research for distinguishing between research performed for furthering knowledge and research attempting at applying existing knowledge to actual, practical challenges. This study is a form of applied research in the field of healthcare for facilitating provider problem-solving and decision-making.
The integrated healthcare provision theory maintains that patients ought to be involved in decision-making. Patient engagement in healthcare/ therapeutic decision making is no new concept; however, in the present time, it has grown into a political prerequisite in several nations and healthcare systems worldwide (Eccles et al., 2005; Vahdat et al., 2014). The research work is salient owing to its contribution to the abovementioned theory via its scientifically quantifiable findings, which represent the actual status quo that subsequently attempts at corroborating theories and rendering them scientifically- reinforced facts. The study also contributes to theories of patient participation in healthcare decision making through its finding that patient engagement is shaped by complex interactions of patients and their informal caregivers with a variety of primary care practitioners with highly varying views on patient engagement.
Application of scientific methods of inquiry
The techniques of scientific inquiry in the case of this study are qualitative, with interviewing adopted as the chief information acquisition instrument. The use of this technique is associated closely with the form of research. Here, phenomenology aided researchers in acquiring an in-depth grasp of the individual clinical experiences of participating patients, their informal caregivers/family members, and healthcare providers when it comes to engaging patients within primary care in their respective “life-worlds” (i.e., interactions between providers, patients, and informal caregivers). Phenomenological research works aim at comprehending individual views and beliefs about a given situation. That is, they strive to find answers to the following question: How would you describe your experience? For example, researchers may look into experiences of those providing care to terminally or chronically ailing family members, homeschooling children, or facing domestic abuse (Leedy & Ormrod, 2019). This research work aims at openly examining the views of patients, primary care practitioners, and informal caregivers on patient participation in decision?making within the primary care context. 
Following research goal formulation, the subsequent step is research design preparation or laying down the conceptual framework for the study to be performed. Design preparation aids studies in attaining maximum possible efficiency when it comes to the acquisition of maximal data. That is, research designs serve to allow for the gathering of pertinent proofs with optimum time, money, and efforts (Leedy & Ormrod, 2019). However, how to achieve the above is mostly contingent on the research aim. This process proves crucial as one element of research works is utilizing the right techniques. The research entails controlled, methodical, exact, and valid examination and explanation of unknown aspects and establishing relationships and causations, which allow for precise result projections under a particular set of circumstances. The strength of findings hinges mainly on the way they were found.
The interviewing technique adopted in the form of an investigative instrument entails a social setting involving two or more individuals, and a psychological process that entails requiring the participating entities to respond to one another mutually. Interviewing’s social research aim requires diverse responses from involved entities. Here, there is a need for the establishment of rapport between the interviewee and the interviewer. In addition to the elimination of physical barriers of distance, cultural and social obstacles are also eliminated, facilitating free, reciprocal idea flow. Both entities make their impression on one another. The interview process brings both at one level, with the forging of an emotional bond between them. Interviews generally mean setting aside of all formalities, with avenues open for delivery into interviewees’ intellectual, subconscious, and emotional stirrings. Hence, the interviewee, here, goes to the extreme depths of her emotional pool, with the interviewer sometimes checking the accuracy of her responses.
The interview is an inquiry narrative which aims at delving into multifaceted, complicated phenomena — or in qualitative language, what has been dubbed as highly “rich phenomena” – through concentrating on the accounts and memories of those who have life experiences that are linked to such phenomena (Leedy & Ormrod, 2019). One key idea of narrative research is the three- dimensional narrative space” which is made up of the following elements: interaction, situation, and continuity and which recognizes how social and personal experiences (a) relate to each other, (b) are localized to given scenarios and settings, and (c) take place along particular time dimensions. Narrative research does not concentrate solely on current events; instead, it also attempts at understanding the past as well as future aspects of experiences and events.
In the research work being analyzed, interviews were conducted at the location preferred by the interviewee. The duration of each interview was 40 - 90 minutes. Before undertaking this research effort, no relationship existed between the research and participating patients, their informal caregivers/ family caregivers, and all but six primary practitioners. Informal patient caregivers attended the interview as well. The interview commenced with an introduction of the researcher, an explanation of the purpose of the study, and asking for the patient whether or not he/she provides permission (verbally) to make an audio recording of the conversation.
Further, informed consent was said to be given if the participant agreed to be interviewed and also completed the interview (Doekhie et al., 2018). Every participant accorded permission to make use of quotations, anonymously, from the interview. Participants could, at any point in the course of the interview, withdraw consent, which would mark an end to the interview. 
Credibility and Dependability of the Study
First, the study aimed to help improve patient care in healthcare settings by collecting the perspectives and views of informal caregivers, primary care professionals, and patients on issues surrounding the participation of patients in decision making in primary care settings. Given the focus of the research, the question was the involvement of patients in primary care teams as far as decision making is concerned, the likelihood that the researcher would have benefited financially, politically, or socially in a big way is low, and this leads to the credibility of the research. The primary aim of the research appears to add to the additional knowledge in the field. The knowledge added can be used for further improvement of practices in future interventions.
Second, the author has extensive experience in both qualitative and quantitative research and holds two Masters Degrees earned from the Erasmus University Rotterdam in the Netherlands. Further, the author and the lead researcher are Ph.D. students at the same university studying quantitative research. Given that the author has such extensive personal experience and the fact that the author did the research herself, most notably the data collection part, this lends to the credibility and dependability of the report. The lead researcher’s responsibilities included data collection and adequate professional distance was present between the participants and the researcher as there was no personal relationship between them. The participants included informal caregivers, patients, and healthcare professionals. Nonetheless, it is noteworthy that of the 32 healthcare professionals participating in the study, six had been introduced to the lead researcher in professional settings before the research began.
Third, on the issue of financial conflicts, the research includes a clause declaring the absence of any conflict of interest. The research does not explicitly state the parties responsible for funding the research. Given the subject of the research, benefits accruing from the research are for the public good and are unlikely to accord disproportionate financial benefit to any particular institution even if they funded the project. Therefore, the failure to disclose the source of funding for the project does not affect the project’s credibility.
Fourth, the study can be replicated since the methods used in data collection have clearly been defined and outlined (Cutcliffe & McKenna, 1999). The sample had participants with a range of conditions, including Parkinson’s disease, rheumatic disorder, heart failure, stroke, and hearing disability. The range of caregivers relationally represented a cross-section of the population and included friends, sons, daughters, mothers, fathers, and spouses. Nonetheless, the patients involved in the study are not adequately representative of the patient population in the nation. The participant selection process was nonrandom, and selections were informed by recommendations made by professionals. Given this reality, a more representative sample that would have included patients who may have reservations about airing their views openly may not have been achieved. Such reserved participants would have provided unique insights that would have proven valuable to the study.
Fifth, given the process of inquiry the researchers employed, the study is stable (Thomas, 2017). MBS, JP, KD, and MS put the design of the study together. KD gathered the required data and did data analysis. With the help of JP, HB, MS, and MBS, KD arrived at the final themes and codes for the study. KD put together the first manuscript version of the study. All the authors involved read and gave their stamp of approval on the first manuscript.
Lastly, the research is complete as it covers the subject of study from all relevant angles and with an appreciation of the complexity of the topic. The topic of study has several nuances, and it is clear that the researchers appreciate this complexity, given how lengthy the research process was. This resulted in an in-depth study that covers the complete picture of the situation including phenomena such as participants’ perceptions, behaviors, and physical settings. The authors used quotations from participants to illustrate the themes of the study in the results section. Given the above information, the data and resulting findings, as described, are consistent.
Strategies for Addressing the Ethical Concerns in the Design
In any research study, participants’ and researchers’ interactions throughout the study pose ethical challenges for the researcher. The researcher is involved at various points in the study, and this makes it necessary to formulate strategies to address such ethical concerns. In this study, there was no existing personal relationship between the researchers and the participants. Some of the healthcare professionals had been introduced to some of the researchers in professional settings. Therefore, the risk of their being ethical concerns because of such familiarity is low. The introductions had been made during academic conferences, and a few were introduced to the researcher by a colleague explicitly for this study (Doekhie et al., 2018). The project made the participants aware that the information required of them was for a Ph.D. project of the researcher and that the researcher was a Ph.D. student at Erasmus University.
Further, the project clearly defined the goal of the research to the participants. The researchers stated that the goal was to get their perspectives on what patient involvement means to them. Moreover, another goal was how their opinion of such involvement had informed their interactions with healthcare professionals, informal caregivers, and patients.
Qualitative research methods are used to provide explanations and elaborations on various facets of the human experience. As such, since researchers take part in human activities, and they have a first-hand base of references to draw from, readers can trust their interpretations of qualitative data to be accurate. In this instance, the ‘no harm’ principle applies and the researchers should be wary of any kind of harm that may be inflicted on the participants (Sanjari et al., 2014). One of the ways participants may be harmed in a study like this is when sensitive information such as personal medical information gets leaked or mishandled. The study has taken steps to protect participants from such risk. The identity of the participants is protected, and the researchers have ensured that all information provided remains confidential. Further, the researchers took caution to get written consent from the participants in the study (Doekhie et al., 2018).
Qualitative employ narratives and multi-pronged interviews to get an account of experiences. This research study employed such tools, and the exercise posed an ethical challenge because of the likelihood of misrepresenting the information provided by the participants, given the subjectivity of qualitative data. This ethical concern can be addressed by the researcher keenly noting the feelings of the participants as well as how the participants interpret the comments or questions of the researcher. This study maintained an overt data collection process and provided a complete record of findings. Because confidentiality cannot be guaranteed in absolute terms in a scenario where complete written records are made of the information provided by the participants, consent is essential. Keeping a written record also helps participants decide what they want to be recorded. The authors stored the written records on the computer of the first author (KD) as per the rules and regulations guiding data management at Erasmus University Rotterdam (Doekhie et al., 2018).
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