Quantitative research quality Assessment

Assessing the quality of quantitative research Question 1: Study purpose/question (a) Did the study have a clearly stated purpose/research question?                                                     Yes  (b) Explain your response below:  The study was designed to evaluate the feasibility of the mobile service so as to determine the most suitable sample size and to refine the study design prior to rolling out the randomized controlled study.

The study also had the dual purpose of gathering feedback from parents on the SMS reminders after the intervention.  Question 2: Relevance to nursing/midwifery practice (a) Explain how this question was relevant to nursing/midwifery practice. The research is extremely relevant in terms of achieving some of key objectives of nursing/ midwifery practice; the objective of reminding/ alerting parents about certain obligations they have to fulfil on a given date via mobile texts. The mobile phone has revolutionized many aspects of day-to-day life.

The SMS (Short Message Service) technology has proven useful in the delivery of health care to the public. Feature phones and smartphones have become ubiquitous in our society. The fact that almost everyone has a phone that can receive and send text messages has enabled health care professionals to deliver important communication to members of the public especially in the area of disease prevention. Multiple studies have been done to investigate this usefulness of text messaging technology in disease prevention. Most of the studies have reported positive results.

One of the most prominent uses of text messaging technology in health care is in helping remind parents about their children’s vaccination dates. This has helped to get more children fully immunized against different types of infections. However, there are still millions of infants around the globe who still do not complete their vaccination series putting them at risk of suffering serious but vaccine-preventable diseases.

One of the barriers that is preventing these children from receiving immunization is the lack of proper communication between health care providers and parents with regards to the need for timely vaccination of children. It is thought that mobile telephony especially the use of text messages can help reverse this situation (Domek et al., 2016).

Question 3: Ethics (a) What were the possible risks of participating in the study? Possible disruption of network/ phone service Software limitations (b) Were these risks clearly identified by the authors?                                                                           Yes (c) If risks were identified by the authors, how did they propose to minimise risk? The possible disruption of network service was identified by the authors as a serious risk.

To address the risk, the authors argued that there was a need to have more communication channels with the parents. The authors also argued that there was a need for back-up systems that could convert the SMSs to other media such as email, letters or voice messages so that the messages could still get to the parents in case of disruption of phone service. The mobile telephony software used in the study was also thought to be a possible risk.

This was because it was not integrated with electronic medical records meaning all the information that was entered into the system was keyed in manually and not automatically. There was also no automatic calendar functionality to enable the software to send the reminders automatically. They had to be sent on the actual day.

Furthermore, there was no alert system to inform the health professionals that a mother or father had not received the text reminder that was intended for them.  (d) Did the authors state that they had approval from an ethics committee to undertake the study? Yes (e) How did the authors obtain informed consent from participants? The participants were asked for their consent through forms and text messages.  (f) Did you identify and potential risks associated with the study that were not identified by the authors and if so, what were they?  Some studies may cause inconvenience, discomforts or even harm on the participants.

Some of the inconveniences include filling forms.  There is also discomfort in the fact that one may feel hurried up by the text reminder to do something that he or she did not plan to do on that particular day. There is also anxiety that may be triggered by having to appear for an interview.  The most serious risk however is the fact that researchers or their assistants may be involved in some form of misconduct.

This could be in the form of fraud or taking advantage of the vulnerable parents National Health and Medical Research Council, 2018). Question 4: Study design (a) Describe the chosen study design for this study The study was a randomized controlled trials (RCT). Randomized controlled trials form an important part of evidence-based medicine and are important for investigating the usefulness of research data on the ground. In terms of the study design, RCTs are regarded by many to be the best tool for assessing effectiveness in clinical research.

The data or conclusions from RCTs are usually adopted by many health care professionals for the delivery of evidence-based interventions. Unlike non-experimental research studies such as case reports and cross-sectional reviews, randomized controlled trials often lead to high-quality insights with causal inferential value and are therefore considered to be at the core of evidence-based medical care (Spieth et al., 2016).   (b) Was this a suitable study design for the given research question? Yes (c) Explain why the chosen study design was suitable.

Randomized controlled trials are considered to be the gold standard in the evaluation of effectiveness/ efficacy of medical interventions. There are most often used in assessing the efficacy of drugs but are also appropriate for looking into how well tools or interventions perform in real-world situations as opposed to control circumstances. Hence, the use of randomized controlled trials for this study was extremely suitable considering there was an intervention whose success could be influenced by several known and unknown factors.

It also had to be randomized to remove bias (Houle, 2015).  Question 5: Sample (Participants) (a) How many participants were included in the study? Ninety participants out of the 125 approached were accepted and participated in the study. Out of the ninety, 40 were control participants.  (b) What were the inclusion and exclusion criteria? The inclusion criteria was broad. Mothers of newborns who could speak either Spanish or English and had a phone with SMS functionality were eligible for the study.

The study, however, excluded young mothers under the age of 18 years or did not want their children to be vaccinated for religious or personal beliefs.  (c) Explain how the participants were recruited  Mothers of newborns were enrolled from a local hospital by a research assistant. Only those mothers that wanted to seek paediatric care at the university health facility were recruited by the assistant.

Mothers who agreed to be recruited were asked to confirm their recruitment by sending the word “TRICKS” to a specific mobile number that was designated for the research.

Those who sent the SMS, received follow up messages asking them to send their children’s date of birth, name and sex.  (d) Describe the setting in which the study took place (hospital, community, etc).  The study took place in a mid-western metropolitan setting at the University Faculty and Resident Clinic for paediatric care.  Question 6: Methods/Intervention/Data collection  (a) Describe the intervention (eg. treatment, therapy etc) The parents of the newborns were divided into two groups the control group and the intervention group.

Those in the intervention group received appointment cards and SMSs on their phones a week before three vaccination dates; when the children turned 2, 4 and then 6 months old. The messages were sent using a computer software that was connected to the research mobile phone.  (b) What was the comparator (eg. alternative treatment or therapy; placebo etc) Mothers in the control group received regular communications on the vaccinations due. No text messages were sent to them.

(c) Was this intervention adequately described so that it could be replicated in practice?          Yes (d) Explain your response to (c) One of the most important parts of scientific research is making sure that the research is replicable. This adds value to the study and enables other interested researchers to repeat the study to confirm the validity of the results.

The process of making sure that research is replicable simple entails giving complete details and maintaining maximum transparency in the reports produced before and during the study (Douet et al., 2014). This particular research has implementation fidelity; the extent to which the intervention matches the intended purpose (Breitenstein et al., 2010).

This is because the details given appear to be complete and show that the study can be successfully translated into real-world situations for evidence-based practice.  (e) Describe the method/s used to collect data (you do not need to include basic demographic/sociographic data) When recruited, each participant was required to fill in a baseline questionnaire including those demographic information about themselves and their children. Participants were also required to fill in the Test of Functional Health Literacy in Adults.

The test was included in order to compare the parental health similarity between the study recruits and other parents that had participated in other studies before. Mothers in the intervention group got a text reminder a week to their child’s immunization date. Three days after the initial text they were sent another text asking them to confirm whether they will take their children for vaccination.

Sometimes a third text message was sent to those mothers who did not respond.  At the end of the randomized controlled trial, the Kansas Immunization Registry records for the children were reviewed by the researchers. The Kansas Immunization Registry record is an online database with complete and accurate immunization details for the citizens of Kansas. All incidences of vaccination were coded as a dichotomous variable. If a child received vaccination before the seven-month birthday, the vaccination was marked as received.

Those vaccinations that were received within 30 days of the vaccination appointment were considered to be “on time.” Additionally, mothers of newborns in the intervention group were interviewed through phone calls.

Some of the questions asked during the interviews included asking the mothers whether they thought the exercise was beneficial and if they experienced any barriers in using the SMS intervention.  Question 7: Research findings (outcomes)  (a) What were the main findings of this study? (provide a dot point summary) * Analysis of the research data showed that many children whose mothers were in the intervention group received their vaccination on time  * SMS vaccination reminders can really help parents to keep their children’s immunization appointments  * Parents are willing to give their mobile phone numbers to receive text message immunization reminders * Mothers in the intervention groups were satisfied with the text message reminders they received  * The software had multiple limitations but still worked  * Network disruptions affected the delivery of messages  Question 8: Study limitations (a) What were the limitations of this study stated by the author/s?  * Limited sample size  * Mobile network service disruption  * Absence of a backup system  (b) Explain why these are study limitations.

The limited sample size is a very blatant limitation. There were only 90 participants and only 50 were actually part of the intervention group. The mobile network service disruptions and change of cell phone numbers affected the delivery of immunization reminders. The researchers had also noted that they realized the software had serious limitations. For example, they had to key in the messages every time they needed to send them out.

This, plus the fact that they did not have an alternative way of sending reminders made them feel as if they really needed a back-up communication system.  (c) Explain why bias may reduce the validity of the study. Insufficient randomization, variations for different settings and other factors may bring bias into the results and the conclusions of any study. Bias may lead to the underestimation of risks and overestimation of benefits leading to flawed conclusions that may decrease the validity of the study (Garattini et al., 2016).

Question 9: Applicability to clinical practice  (a) According to the Levels of Evidence pyramid, what level of evidence are the reported results from this paper?  Level II  (b) Overall, should the outcomes of this study be used to inform evidence-based practice?                   Yes (c) Explain your rationale for your responses to questions (a) and (b). The study design was a well-done randomized control trial. Randomized controlled trials (RCTs) are considered to be the gold standard of clinical intervention evaluation.

When carefully planned they can reveal the effects of an intervention or a treatment on real patients. RCTs comprise safeguards such as blinding and randomization to diminish the likelihood of bias in the study. This particular study had most of these elements meaning its conclusions are applicable in evidence-based practice.  Part 2 Reflection (approx. 500 words) Write a reflection on the learning that you have undertaken in Research Methodology relating to the questions below.

If you use supporting references you should reference as per the UniSA Harvard referencing system.  This should include: • Did you have prior ‘knowledge’ about immunisation safety for children/pregnant women prior to undertaking this assessment? Describe your understanding of this. Vaccination has for the longest time been one of the best methods of preventing childhood illnesses. The majority of mothers and fathers accept the method. However, there are a number of people who have safety, personal and religious concerns about vaccination.

The biggest issues is perhaps related to the safety. I fall in this group. I used to think that some vaccines are not exactly safe considering the reports that have been issued by several organizations against them. However, I have come to appreciate the value of immunization. I now understand how immunizations prevents infections not only for the child but also for the community in which he or she lives.

I now understand that childhood disease outbreaks have a lower likelihood of occurring if the majority of children in a community are immunized against them (the diseases). This kind of safety in numbers is referred to as herd immunity. It is now a crucial part of public health (NCIRS, 2017). I am now an advocate of on-time immunization to help keep babies and societies safe.

• How did you acquire this knowledge (what way/s of knowing/where did the information come from)? Online research and experience  • Did you have a personal opinion (bias) or concerns about the safety of immunisation for children/pregnant women prior to undertaking this assessment? I used to think that vaccines had some serious side “effects” such as pain, rashes and ugly marks. For this reason, I really did not like anything to do with immunization.

I also felt that the illnesses for which the vaccines were given were not serious illnesses. However, I have come to found that if left unchecked, these illnesses can be a threat to public health. I have also realized that the side effects were really exaggerated in my mind. That although some parents and individuals have concerns about vaccine safety, most vaccines are really safe.

I feel that if more people knew the kind of research and tests that vaccines go through before they hit the market, they (the concerned people) would be more willing to accept them for their children (Hendrix, 2015). • Has anything that you have learnt in the course changed your opinion (bias)/allayed you concerns/increased you concerns about the safety of immunisation for children/pregnant women? If so, why? Vaccination is considered to be one of the most important public health disease prevention measures.

However, more and more people are thinking it is unnecessary and unsafe. This is threatening the success of immunisation programs within the country and across the globe. In fact, some experts are saying that vaccine hesitancy is one of the main reasons why less parents are taking their children for vaccination. Researchers have concluded that if this trend continues, it could increase the threat of childhood disease outbreaks. Which could be sad considering the diseases are vaccine preventable.

This module provided details about vaccine hesitancy and its causes in first-world countries. Safety was one of the reasons discussed. Religious reasons were also discussed. Some parents just had personal beliefs against vaccination. However, some blatantly refused.