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Critical review on qualitative research paper.

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Presentation on theme: "Critical review on qualitative research paper."— Presentation transcript:

1 Critical review on qualitative research paper.
Presented by: Sarah Hart Roberto Massari Christian Vaughan-Spruce Jaya Woodun

2 Learning Outcomes A critical review of the methodology analysing the advantages and disadvantages of semi-structure interview. Analysis of results, limitations of the study and our recommendations for further research. Clinical implications for physiotherapists and podiatrist.

3 Qualitative analysis of stroke patients’ motivation for rehabilitation.
Maclean, N. Pound, P. Wolfe., C. Rudd, A. BMJ 2000;321; Qualitative research semi-structured interviews. explore the attitudes and beliefs in stroke patients. either high or low motivation for rehabilitation. Participants 22 patients six weeks after stroke. undergoing rehabilitation; fourteen with high motivation, and eight with low motivation. Correlation found between practitioners approach and interaction with patients, and the outcome in rehabilitation.

4 Methodology Positive aspects Negative aspects
Clear background and reasons given to research. Semi-structured interview gives patient control over conversation. Interviews analysed for bias Good organisation of data, themes coded. Negative aspects Criteria to determine choice of patients Sample size Inclusion/exclusion criteria Reliability of Semi-structure interview Interviewer previous knowledge of patient motivation. How would this affect the interviewer? Brief overview – give some chat around as you can see we’ve highlighted some of the main points which we are now going to explore further…

5 Positive aspects Methodology
Qualitative approach is appropriate Clear objectives stated for research Details of similar previous studies given and their weaknesses noted Suitable patients chosen for study using ‘extreme case’ sampling

6 Positive aspects Interviewing techniques
Semi-structured interviews allow patients control and allow them to explain things in their own terms. ‘preferable for complex and sensitive issues’ Neutens and Robinson (2002) Interviews all conducted at the same time by the same interviewer. Interviews carried out over nine months until no new ‘themes’ emerged. All interviews transcribed and recorded. Interviews analysed for bias by second member of team.

7 Positive aspects Analysis of data
Organisation of data - emerging themes are coded and compared across interviews. “The researcher must find a systematic way of analysing data, e.g. by drawing up a list of coded categories” (Greenhalgh,1997). Care is taken not to distort patient’s meaning and examples given about how this is done. Quotes included from patients are all traceable to individuals. ‘Mixed messages’ included - “Deviant case analysis can help refine analysis until it can explain all cases under scrutiny.” Mays and Pope, (2000).

8 Negative aspects Methodology for sampling
Sampling (extreme case sampling) The level of motivation of patients decided subjectively by 12 professionals. Exclusion criteria Possible consequences of having a large group excluded. A research by Kauhanen shows that Post stroke depression (PSD) affects between 20-65% of post stroke patients. M.Kauhanen (1999) Sample size Small sample. Uneven sample. Interviewer awareness of motivation of patient prior interview. Polgare & Thomas(2000)

9 Negative aspects Semi-structured interview
Skills of the interviewer The outcome dependant largely on the skill of the interviewer. Britten (1995) Time consuming /expensive Length of time needed may be difficult to control, possibly leading to higher costs. Reliability The nature of the method makes it virtually impossible to reproduce the interview in exactly the same way, therefore it can be considered unreliable. Difficult to analyse Determining the relevance of the answers provided can be difficult. Neutens and Rubinson (2002) Skills of the interviewer The outcome dependant largely on the skill of the interviewer and his/her ability to direct the interview and gauge the information wanted while maintaining a professional attitude.

10 Analysis of Table Characteristics of sample of stroke patients
High motivation (n=14) Low motivation (n=8) Male  10  Median (range) age (years)  72 (38-86)  78 (54-85)  White  Black Caribbean  Black African  Asian  Median (range) Barthel score* at interview  14/20 (4-19)  7/20 (3-10)  Table is not explicit and clear – we believe that the table is not complete and is lacking relevant information. Table does not show any female statistics such as: age, ethnicity, median range, Barthel score - (explain table). *Barthel score: 0-14=moderate/severe disability; 15-19=mild  disability; 20=independent. 

11 Analysis of results Information being conveyed twice.
An overall lack of communication between patient and members of staff . Misconception of the term ‘Motivation’ and everything is based on clinical judgment. No follow-up.

12 Review of results Results must be independently and objectively verifiable. Greenhalgh (1997). According to Greenhalgh (1997), exposure to a lack of validity raises questions over accuracy and findings. Physiotherapy (CSP 2005) and Podiatry (SOCAP 2005) communicate effectively with other health professionals and relevant outside agencies to provide an effective and efficient service to the patient. More research should be undertaken: to define motivation and enhance clinical judgment and eventually get a better outcome. too much text on screen?

13 Advantages of the study
Investigating an under researched topic. The authors felt that a broad range of viewpoints had been covered due to age, sex and ethnicity in the sample. Whilst reviewing the paper we felt that there wasn’t a fair representation of all demographics as only 22 patients were interviewed. Figures on the website report (which commissioned the report) 110, ,000 people each year are diagnosed each year with a stroke.

14 Limitations of the study
Small sample. Ignore clients with depression. How to judge a patient motivated or unmotivated.

15 Clinical implications
Clinicians should direct patients to websites that are either government run or charity based. The entire MDT must work on their communication not only with each other but the patient as well. The clinician must involve the patient in goal setting. This counteracts the sense of helplessness that may give rise to depression (French 2005) The authors recommendations are availability of literature to patient and families. Asks that nursing staff do not send “mixed messages” to patients regarding rehabilitation. The clinician must be aware not to place all the responsibility solely on the client during rehabilitation

16 Further Research Several studies after this one cited this paper in their research the authors themselves two years after this study investigated the role of the clinician in motivation. From this our recommendations are:- To use a bigger sample size. Include patients with depression. Follow-up after initial interview. Need to define what “high” and “low” motivation is.

17 Conclusions Client and practitioner relationship.
Improve communication with the patient and within the MDT. Goal setting - should be as functional as possible.

18 References Britten,N. Qualitative research: qualitative interviews in medical research. BMJ:311, Grbich, C. (1999) Research in Health an introduction London. Sage Publications Ltd accessed 14/04/2007 Greenhalgh, T How to read a paper: papers that go beyond numbers (qualitative research) BMJ,1997:315, Greenhalgh,T Assessing the methodological quality of published papers. BMJ:315, French, S., Physiotherapy a psychosocial approach, 3rd Ed., Elsevier., London Kauhanen, M.L Quality of life after stroke (dissertation) Oulu Avalable at :(URL:htt:// )

19 References Maclean,N. and Pound, P A critical review of the concept of patient motivation in the literature on physical rehabilitation Social science and medicine, 50; Mays,N. and Pope,C Qualitative research in healthcare. BMJ:320,50-52 Neutens,J.J. and Rubinson.L. 2002, Research techniques for health sciences, 3rd ed., Benjamin Cummings. San Francisco. Polgrave.S. and Thomas. S. A. 2000, Introduction to Research in the Health Sciences. Churchill Livingstone. London Trochim,W.M.K Research methods knowledge base available at accessed 26/10.07

20 References accessed 25/10/07 accessed 25/10/07 accessed 19/10/07 accessed 19/10/07 accessed 19/10/07 accessed 5/11/2007

21 Thank you for listening Any Questions?

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