The Perceptions of Stroke in the General Public and Patients - Essay Example

? Critique and Appraisal of a Research Paper Teacher Introduction (Word Count=2,391) A research study on strokes was chosen for this essayin critically evaluating the research process contained in this paper. The aim of this study was to determine the perceptions of stroke in the general public and patients who had already had strokes as well as carers. Carers are those who take care of others that have had strokes and are unable to care for themselves. The study was conducted in New South Wales, Australia in late 2001 (Yoon & Byles 2002). Background Qualitative research in all areas of medicine are becoming more frequent, especially with the development of technological tools which make it easier to keep records, record data and to conduct analyses of data obtained from studies. Aside from conducting actual research studies, research can also be conducted on the repositories of previous studies to understand the design and methods of obtaining information and looking for unseen trends from those times. It also allows for a guideline of how to develop more in-depth research in today’s environment to account for cultural and economic changes that have occurred since previous studies (Poses & Isen 1998). While qualitative research is evidence-based, there are many more variables to consider when conducting this type of research and it can be that variables have not been connected properly to get other pictures of the information. Therefore, clinical qualitative research can also be applied to the social side of the information, the background of what the information is (Cote & Turgeon 2005). This, in turn, provides another dimension of information, the ‘biopsychosocial’ side of the data which cannot be answered by a quantitative study. The qualitative study provides not only the clinical answers but those for individual viewpoints, motivations and how respondents relate to their environment socially and economically. A number of hypotheses should also be developed, based on past research in order to conduct future research (Barnett-Page & Thomas 2009). The study on strokes was done to find out knowledge and perception levels of a sampling group of the population using those who already had experienced strokes, those who care for stroke victims and those who have not experienced a stroke (officially diagnosed). Invitation letters were sent to 87 members of a heart and stroke register in Hunter Area Health Authority and of those, 56 were returned and 27 of those agreed to participate in the study. In this group, 14 who had had a stroke and 10 carers attended the study. A snowballing technique was used to recruit 11 people who had not had a stroke and they also recommended others for participation in the study. A final total of 35 people participated in the study (Yoon et al 2002). David Ross (2000) discusses how to create a biopsychosocial formulation for understanding a case when doing a patient history. This process of developing the formulation can also be used in research study development and design in looking for more than just the ‘yes and no’ answers typically found in questionnaires. As Ross explains it, a nurse or doctor can take down the symptoms that a patient is undergoing and also get a background history of what is going on in the patient’s life at the same time. In his example of Mr. J, who is 34 years old, depressed since his wife left two months before, Ross presents the case analysis in two different ways. The first shows that Mr. J has also had anhedonia and insomnia during the past two months. He has no history of drug or alcohol abuse and has hypothyroidism, currently being treated with l-thyroxine. His older sister has a history of major depression which she is being treated with fluoxetine (Prozac). He had a happy childhood but since his marriage three years ago, his wife has become increasing critical of him in regards to doing chores around the house. Yet his job and his friends have provided a good measure of satisfaction. Only the marriage has been an issue (Ross 2000). The first formulation, a poor one as Ross (2000) puts it, states the facts surrounding the patient as given above and looks at checking the thyroid status and also treating with antidepressants and psychotherapy. The second formulation, the good one according to Ross (2000), gives the same basic information but expands on details, noting that Mr. J was probably used to his mother doing everything around the house and that was the basis of his knowledge about what women should do. His wife, on the other, may have had an entirely different upbringing and expected more out of him. Consequently, through no fault of either one, they were at odds with each other but it became an unhealthy situation of her nagging more because now he was doing less, a passive-aggressive response to her criticism. Consequently, he felt rejected, especially after she left. Medication is indicated in this formulation but marital counselling is also indicated or if rejected, individual psychotherapy is recommended to allow him to grow stronger again (Ross 2000). The point of bringing up this example is that in research, the data is sometimes looked at in a straight-forward manner, rather than exploring underlying issues. In the case of the Yoon et al (2002) strokes research study, there are several factors that were not pursued in this study that a more in-depth study might bring to light (Curtis, Gesler, Smith & Washburn 2000). While the aim of the research was to find out what people knew about strokes and their perceptions of having a stroke, there was not any attention paid on backgrounds of people, whether they tried to live a healthy life, especially those who had already had a stroke. There are many different symptoms and most people have a dislike of just running to the doctor with any kind of health issue that crops up, especially if it doesn’t feel threatening enough (Family Health n.d.). In the study, the general response was that maybe they should just take a nap for a while and the symptoms would hopefully go away. When speaking about symptoms in reference to strokes, most said they would go to the hospital. When other stroke symptoms were brought up without reference to stroke, then people were far less likely to go to the doctor (Yoon et al 2002). The respondent’s background and cultural environment profile could provide more information on why they do not go to the doctor (Cote et al 2005). Some research study has also shown that physical activity is essential to recovery from a stroke when a person has already been physically active and is in good shape (Gallanagh, Quinn, Alexander & Walthers 2011). Those who do not fare so well in recovery are those who are sedentary, working at jobs where one sits all the time, or just laying around the house without moving much (Gallanagh et al 2011). The research focused on why people did not know very much about strokes and what their symptoms were and it was concluded that there was not enough information available to the public regarding symptoms and what to do about it (Greenhalgh 2003). They also were not aware of the organizations out there that had information available for them. Methodology The methodology for conducting this research study was to select groups of people who had already had a stroke and those who were carers of those who had had strokes. These were two separate groups. Then there was another set of the general population which had not had a stroke and these were divided into two groups as well. In the first group, there were 14 respondents who had already had a stroke. The other group consisted of 10 carers in their own group. The remaining general population chosen by invitation and a snowballing technique, by which those invited, also invited others, with a final total of 11. The total group of all attendees was 35 (Yoon et al 2002). A discussion guide was created, based on findings from other previous research studies, and six factors addressed risk criteria, symptoms, reactions, treatments and information resources (Huston & Rowan 1998). Questionnaires were provided first and then collected. These focused on the descriptive information such as age, race, gender, marital status, employment, salary and current risk factors such as smoking, blood pressure and family history of stroke. Then the focus groups were conducted after getting consent forms for taping the interviews and allowing for a final review of the transcripts and analyses. The same two moderators worked with each group in the focus sessions and they were also the researchers for the study, thus ensuring that all points of the discussion guide were reviewed and talked about during the meetings. These lasted from 60 to 90 minutes and a break was also provided for 30 minutes during which refreshments were provided and an opportunity for informal conversation (Yoon et al 2002). The recordings done during the focus groups were transcribed verbatim and then put through a sorting of like-minded statements and given specific codes for upcoming analyses. A number of themes and issues were determined from these responses and the software package Ethnograph 5.0 was used for the analysis part of the study (Yoon et al 2002). Results The results of the discussions were that many thought that stroke was caused by blood clots or some type of bleeding in the brain, shutting down blood circulation, thus causing problems in other parts of the body, including a malfunction of a part of the brain. Many considering worrying about stroke or other illness as a waste of time and many really did not know much about the symptoms of stroke, being far more worried about heart attacks or cancer. Most stated that they knew what risk factors triggered strokes such as stress, high blood pressure, high cholesterol, smoking and other criteria (Yoon et al 2002). Fig. 1 (Yoon et al 2002) Recognition of stroke symptoms from general public respondents showed that they viewed stroke as a loss of movement or paralysis, possible loss of vision, tremors, pain and dizziness, headaches and blurred vision. Those who had a stroke previously said it was like being out of control emotionally with crying and laughing, headaches, face looked strange, right side was falling, walking around like one was drunk, lost use of left arm, loss of balance and double vision. This provided a good overview of what respondents viewed as criteria in the process of having a stroke (Lingard & Kennedy 2010). Reviewing qualitative research often reveals where operations are inadequate in helping patients (McInnes 2011). For those who did receive further treatment, it consisted of occupational therapy, drug therapy for dissolving blood clots or even an endarterectomy to remove a clot. There was a certain amount of dissatisfaction about being involved in decision-making processes as some felt they were not involved enough and others felt incapable of being involved in management of their situation (Yoon et al 2002). Most who had not had a stroke felt that any symptoms they might have had was just from something they ate or that they had the flu if there was vomiting. In general, unless it was really severe and obvious, most would not go to the hospital for treatment. In differentiating between heart attacks and stroke, some respondents thought it was a matter of where the blood clot ended up. If in the heart, and caught in time, the body was most likely to make a full recovery. But if the clot went to the brain, then there could be a problem with the brain coming back to its full strength (Yoon et al 2002). Interpretation The overall results from this particular research study showed that there really was not enough information available for people to understand what was happening to them if incurring the onset of a stroke or if actually in the middle of one. Going to the hospital seem to occur only when a person was having massive symptoms and knew that something was very wrong but not necessarily what it was (Neergaard, Olesen, Andersen & Sondergaard 2009). It is suggested that personal doctors and nurses consider having talks with their patients, particularly if seen at risk for a stroke, based on their case history. Some other possible methods of disseminating information to the general population would be through advertisements or special service announcements that outlined risk factors and what to do if any of these symptoms occurred, would be beneficial to those who are at risk and for those who live with others who can call for help upon recognizing the symptoms (Alberts, Perry, Dawson & Bertels 1992). What is the most important part is that people who even suspect they are having a stroke, need to know that getting to the hospital is vital to get the needed treatment and supervision so that they will come out of it without any problems (Reynolds, Kizito, Ezumah, Mangesho, Allen & Chandler 2011). Without getting help, the results could prove disastrous including, but not limited to, total disability with around-the-clock care for the rest of one’s life. In researching this article, not enough was said about the analyses done on the data obtained for this study. One would have liked to have seen more of an in-depth analysis of variables between the respondents’ background as relates to responses. It is possible that these variables were not connected in the actual data gathering method and so this type of analysis was not available (Sofaer 2002). The questionnaire and the guideline for the research study were also not made available so it was hard to understand all the questions asked in this study except by the returns provided in the study. While certain answers gave readers an overview of how responders felt about what they did know of stroke symptoms and factors involved for likelihood of having a stroke, it would have been interesting to know if those people who had a stroke already were more active or less active, what their dietary intake was on a daily basis, and what other factors may have contributed to their stroke (Friedman, Cosby, Boyko, Hatton-Auer & Turnbull 2011). Likewise, the same would be true of those who had not had a stroke yet, how they viewed their lifestyle and overall health (Cote et al 2005). Appendix: CASP Appraisal: Qualitative (CASP 2010) Yoon, SS & Byles, J 2002, Perceptions of stroke in the general public and patients with stroke: a qualitative study, British Medical Journal, vol. 324, no. 1065, Downloaded from http://www.bmj.com/content/324/7345/1065 1.Was there a clear statement of the aims of the research? The study to was to find out what the current level of knowledge on stroke was and to provide more education to the community. This also helped with developing strategies for the medical field in providing more information to those who should have it. 2.Is a qualitative methodology appropriate? The qualitative methodology was appropriate because it allowed for thorough discussions and collecting of information which was later analyzed. 3.Was the research design appropriate to address the aims of the research? A discussion guide was developed on the factors for strokes with six items dealing specifically about risk factors, symptoms, treatment, resource information and reactions to stroke. The study was done through anonymous questionnaires first that asked descriptive questions about age, gender, marital status, education, income and other criteria. This was to also help with development in hypotheses and discover the range of answers from the participants in knowledge and perceptions. 4.Was the recruitment strategy appropriate to the aims of the research? Invitation letters were sent to 87 members of a heart and stroke register in Hunter Area Health Authority and of those, 56 were returned and 27 of those agreed to participate in the study. In this group, 14 who had had a stroke and 10 carers attended the study. A snowballing technique was used to recruit 11 people who had not had a stroke and they also recommended others for participation in the study. A final total of 35 people participated in the study. 5.Were the data collected in a way that addressed the research issue? Information was first collected through a questionnaire and then focus groups were done in two groups: one group consisted of those who had already had a stroke and carers of those who had had a stroke; the other group consisted of the others from the general public who had not had a stroke. 6.Has the relationship between researcher and participants been adequately considered? The respondents were all unknown to the research team and this was handled by medical personnel in an informal setting. The paper did not mention if any release forms were signed for confidentiality or whether this research study was approved by a supervisory medical group. 7.Have ethical issues been taken into consideration? There was no mention of confidentiality agreements or obtaining permissions from a supervisory medical board. 8.Was the data analysis sufficiently rigorous? The questionnaire data was moved into a database and the recordings of the focus group were transcribed and then responses given a code which allowed for the information to be put into the same database for the final analysis process. 9.Is there a clear statement of findings? In general for both groups, the perception of what happened in a stroke situation was that a clot entered the brain or some type of internal bleeding occurred which affected the brain and caused a part of it to become inactive. Most determined that the common factors of stress, diet, high blood pressure and smoking were the cause of most strokes. Few understood that it could occur without these factors in place. If they felt funny, they just decided to lie down rather than worrying about any symptoms. Going to the doctor was not considered necessary unless there were severe symptoms of something going wrong in the body. The hospital was not viewed as being a helpful place to go. 10.How valuable is the research? It was noted that most did not take their symptoms seriously and did not view themselves as ill or at risk of strokes. Those who had had strokes said their experiences in the hospital were less than satisfactory and that they were told to go home and do physical and mental exercises given to them by medical staff. What was determined was that more information was needed to be made available regarding symptoms of stroke and what one should do when going in to see the doctor, either at the emergency room or for a scheduled visit. Bibliography Alberts, MJ, Perry, A, Dawson, DV & Bertels, C 1992, Effects of public and professional education of reducing the delay in presentation and referral of stroke patients, Stroke, vol. 23, no. 3, pp.352-356, Downloaded from http://www.ncbi.nlm.nih.gov/pubmed/1542895 Barnett-Page, E & Thomas, J 2009, Methods for the synthesis of qualitative research: a critical review, BMC Medical Research Methodology, vol. 9, no. 59, Downloaded from http://www.biomedcentral.com/content/pdf/1471-2288-9-59.pdf CASP 2010, The Qualitative Research Checklist, Critical Appraisal Skills Programme, Making sense of evidence about clinical effectiveness, Downloaded from http://www.casp-uk.net/wp-content/uploads/2011/11/CASP_Qualitative_Appraisal_Checklist_14oct10.pdf Cote, L & Turgeon, J 2005, Appraising qualitative research articles in medicine and medical education, Medical Teacher, vol.27, no. 1, pp. 71-75, Downloaded from http://www.ambpeds.org/site/vlp/messages/MDocs/Appraising%20qualitative%20research%20articles%20in%20medicine%20and%20medical%20education.pdf Curtis, S, Gesler, W, Smith, G & Washburn, S 2000, Approaches to sampling and case selection in qualitative research: examples in the geography of health, Social Science & Medicine, vol. 50, pp. 1001-1014, Downloaded from http://www.utsc.utoronto.ca/~kmacd/IDSC10/Readings/sampling/approaches.pdf Family Health International n.d., Qualitative Research Methods: A Data Collector’s Field Guide, Module 1, Downloaded from http://www.fhi360.org/nr/rdonlyres/etl7vogszehu5s4stpzb3tyqlpp7rojv4waq37elpbyei3tgmc4ty6dunbccfzxtaj2rvbaubzmz4f/overview1.pdf Friedman, AJ, Cosby, R, Boyko, S, Hatton-Auer, J & Turnbull, G 2011, Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations, Journal of Cancer Education, vol. 26, no.1, pp. 12-21, Downloaded from http://www.ncbi.nlm.nih.gov/pubmed/21161465 Gallanagh, S, Quinn, TJ, Alexander, J & Walthers, MR 2011, Physical Activity in the Prevention and Treatment of Stroke, ISRN Neurology, vol. 2011, Downloaded from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263535/ Greenhalgh, T 2003, How to Read a Paper: The basics of evidence based medicine, BMJ Books, PDF, Downloaded from http://aajourkal.com/Knowledge-bases/tibi-books/medical-books/How%20to%20Read%20a%20Paper.pdf Huston, P & Rowan, M 1998, Qualitative Studies. Their role in medical research, Cancer Family Physician, vol. 44, pp. 2453-2458, Downloaded from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277956/ Lingard, L & Kennedy, TJ 2010, Qualitative Research Methods in Medical Education, Ch. 22, in Understanding Medical Education: Evidence, Theory and Practice, (Swanwick, T ed.), Wiley-Blackwell, Oxford, U.K. Downloaded from http://onlinelibrary.wiley.com/doi/10.1002/9781444320282.ch22/summary McInnes, E 2011, Challenges in conducting systematic reviews of qualitative research: Methods and analytical techniques, Nursing Research Institute, Qualitative Health Research Collaboration, Downloaded from http://sydney.edu.au/medicine/public-health/research/qhercevents/qherc_synthesis_McInnes.pdf Neergaard, MA, Olesen, F, Andersen, RS & Sondergaard, J 2009, Qualitative description – the poor cousin of health research?, BMC Medical Research Methodology, vol. 9, no. 52, Downloaded from http://www.biomedcentral.com/1471-2288/9/52 Poses, RM & Isen, AM 1998, Qualitative Research in Medicine and Health Care, Journal of General Internal Medicine, vol. 13, no. 1. Downloaded from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496891/ Reynolds, J, Kizito, J, Ezumah, N, Mangesho, P, Allen, E & Chandler, C 2011, Quality assurance of qualitative research: a review of the discourse, Health Research Policy and Systems, vol. 9, no. 43, Downloaded from http://www.health-policy-systems.com/content/9/1/43 Ross, DE 2000, A Method for Developing a Biopsychosocial Formulation, Journal of Child and Family Studies, vol. 9, no. 1, pp. 1-6, Downloaded from http://cchs.ua.edu/wp-content/cchsfiles/psych/BIOPYCHOSOCIAL.pdf Sofaer, S 2002, Qualitative Research Methods, International Journal of Quality Health Care, vol.4, pp.329-336, Downloaded from http://intqhc.oxfordjournals.org/content/14/4/329.full Yoon, SS & Byles, J 2002, Perceptions of stroke in the general public and patients with sroke: a qualitative study, British Medical Journal, vol. 324, no. 1065, Downloaded from http://www.bmj.com/content/324/7345/1065 Read More