Critical review on qualitative research paper. Presented by: Sarah Hart 0604985 Roberto Massari 0609274 Christian Vaughan-Spruce 0602457 Jaya Woodun 0626310.

Critical review on qualitative research paper.

Presented by:

Sarah Hart 0604985

Roberto Massari 0609274

Christian Vaughan-Spruce 0602457

Jaya Woodun 0626310

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.

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.

Qualitative analysis of stroke patients’ motivation for rehabilitation.

Maclean, N. Pound, P. Wolfe., C. Rudd, A. BMJ 2000;321;1051-1054

Methodology

Positive 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?

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

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.

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).

Negative aspectsMethodology 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)

Negative aspects

Semi-structured interview Skills of the interviewer

The outcome dependant largely on the skill of the interviewer. Britten (1995)

Time consuming /expensiveLength of time needed may be difficult to control, possibly leading to higher costs.

ReliabilityThe 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 analyseDetermining the relevance of the answers provided can be difficult. Neutens and Rubinson (2002)

Analysis of Table

Characteristics of sample of stroke patients 

CharacteristicHigh motivation (n=14) Low motivation (n=8)

Male  10  3 

Median (range) age (years)  72 (38-86)  78 (54-85) 

White  10  5 

Black Caribbean  2  2 

Black African  0  1 

Asian  2  0 

Median (range) Barthelscore* at interview  14/20 (4-19)  7/20 (3-10) 

*Barthel score: 0-14=moderate/severe disability; 15-19=mild  disability; 20=independent. 

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.

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.

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 stroke.org website report (which commissioned the report) 110,000-135,000 people each year are diagnosed each year with a stroke.

Limitations of the study

Small sample.

Ignore clients with depression.

How to judge a patient motivated or

unmotivated.

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

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.

Conclusions

Client and practitioner relationship.

Improve communication with the patient and within the MDT.

Goal setting - should be as functional as

possible.

References

Britten,N. Qualitative research: qualitative interviews in medical research. BMJ:311,251-253

Grbich, C. (1999) Research in Health an introduction London. Sage Publications Ltd

www.csp.org.uk accessed 14/04/2007 Greenhalgh, T. 1997 How to read a paper: papers that go

beyond numbers (qualitative research) BMJ,1997:315,740-743

Greenhalgh,T. 1997 Assessing the methodological quality of published papers. BMJ:315,305-308

French, S., Physiotherapy a psychosocial approach, 3rd Ed., Elsevier., London

Kauhanen, M.L. 1999 Quality of life after stroke (dissertation) Oulu Avalable at :(URL:htt://herkules.oulu.fi/isbn95142554279)

References

Maclean,N. and Pound, P. 2000 A critical review of the concept of patient motivation in the literature on physical rehabilitation Social science and medicine, 50;495-506

Mays,N. and Pope,C. 2000 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. 2006 Research methods knowledge base available at http://www.socialresearchmethods.net/kb/index.php accessed 26/10.07

References

http://64.233.183.104/search?q=cache:lVeJj2kHjs0J:www.sociology.org.uk/methfi.pdf+semi+structured+interviews&hl=en&ct=clnk&cd=2&gl=uk accessed 25/10/07

http://www.stroke.org.uk/information/index.html accessed 25/10/07

www.sociology.org.uk/methfi.pdf accessed 19/10/07 www.usc.edu/hsc/ebnet/res/Guidelines.pdf accessed

19/10/07 http://www.bmj.com/archive/7109/7109ed2.htm

accessed 19/10/07 http://www.podreg.health.nsw.gov.au/hprb/pod_web/pdf/

copcdec2005.pdf accessed 5/11/2007

Thank you for listening Any Questions?