A Cost-Effectiveness Analysis of a Community-Based Diabetes Prevention Program in Sweden by Johansson et al - Article Example

Guided Critical Review of a Journal Article Name Course Name and Code Institution Name Instructor’s Name Date Context of the paper What was the question that the research was designed to answer? The statement which is used to identify issues to be studied in a research is referred to as the research question or research problem (Johansson, Ostenson, Hilding, Andersson, Rehnberg, & Tillgren, 2009, p. 356). Research problem is the situation which compels the research to feel apprehensive of carrying out the study. The research question that this study was designed to answer was to determine the effectiveness of a community based stroke prevention program in (1) improving knowledge about stroke; (2) improving self health monitoring practice; and (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. Research method What research design did the research use? Was this appropriate? Why/why not? This study used a quasi-experimental design. Quasi-experimental design entails selection of groups, upon which a variable is tested, without any random pre-selection processes. In this study, participants were not randomized into control and intervention groups. Group allocation was based on the use of an alternating participant recruitment exercise, with the subjects recruited in the odd numbered exercise allocated to the intervention and subjects in the even numbered exercise to the control group which is typical of quasi-experimental design. This design was appropriate because the researchers were unable to randomize the study subjects (Huang & Ren, 2010, p. 321). A strict experimental design would require including all patients to have been diagnosed with minor stroke by doctors to be included in the study irrespective of their age, medical stability, daily activities, cognitive status, language used and treatment being received (Johansson et al. 2009, p. 353). This would have resulted in many ethical issues arising in the study. In addition, such design would make it difficult to employ data collection methods utilized in this study: questionnaires and interviews (Schmid, Kapoor, Dallas & Bravata, 2010, p. 160). The study did not also include pre-screening of individuals to determine individual subjects’ hospital records to determine the accuracy of medical information. This reduced the time and resources needed for experimentation which is ideal in quasi-experimental design. Thus, the design was appropriate in this study. Describe the treatment the intervention and the control group received during the study The intervention group received both conventional medical treatment and the community based stroke prevention program while the control group received only conventional medical treatment. The intervention program consisted of eight weekly two-hour sessions, with the aims of improving the participants’ awareness of their own health signals and of actively involving them in self-care management of their own health for secondary stroke prevention. What are the independent and dependent variables in this study? why? The independent variable in this study was the community based stroke prevention program (Schmid et al. 2010, p. 160). Subjects in intervention group received the community based stroke prevention program while those in control group did not. Independent variable is usually measured, manipulated or selected by the experimenter to determine its relationship to an observed phenomenon (Johansson et al. 2009, p. 357). In this case researchers used community based stroke prevention program to determine its relationship to knowledge on stroke warning signs, treatment seeking response in case of a stroke, medication compliance, self blood pressure monitoring and lifestyle modification of dietary habits. Dependent variable in the study included the knowledge on stroke warning signs, treatment seeking response in case of a stroke, medication compliance, self blood pressure monitoring and lifestyle modification of dietary habits. Thus, this was the independent variable in the study (Braveman, Egerter, Woolf & Marks, 2011, p. 61). Dependent variable is what investigators measure because of manipulating independent variable (Huang & Ren, 2010, p. 326). In the study the researchers measured knowledge on stroke warning signs, treatment seeking response in case of a stroke, medication compliance, self blood pressure monitoring and lifestyle modification of dietary habits. Thus, these were dependent variables in the study. How was the data collected? Data in this study was collected using structured questionnaires and face-to-face interviews. The questionnaires had four sections: demographic profile; lifestyle habits such as smoking, drinking, self-health monitoring practice, exercise and dietary habits; medical compliance and stroke knowledge. External validity of the study Who were the study participants? Study participants include 190 human subjects. How was the sample selected? Was this appropriate? Why/why not? Selection criteria included individuals who were aged 18 and above; were diagnosed to have had minor stroke by doctors; medically stable; independent in activities of daily living; cognitively intact; able to communicate in Cantonese; were at the time living in the community and were not receiving or had pending surgical treatment. The study participants excluded individuals with congenital cerebrovascular abnormality, hemorrhagic stroke and those experiencing stroke like syndromes from other cause. This selection was appropriate because individuals aged below 18 years and who are not mentally and medically stable could raise ethical issues. In addition, such individuals could not be able to provide the required data via data collection methods employed in the study: structured questionnaires and interviews. How were the participants allocated into groups? was this appropriate? why/why no? Subject allocation was randomized by time slot. Subjects were allocated to the intervention group in the first, third and fifth recruitment exercises. Subjects in the second, fourth and sixth recruitment exercises were allocated to the control group. This was not appropriate because this does not reflect complete randomization of subjects into intervention and control group that is more appropriate. Randomization could have been applied in each subjects recruited in each exercise. Were there any differences between the participants in the intervention group and the control group? There was no significant differences between the control and intervention groups with respect to demographic characteristics, except more subjects in the intervention group lived alone than those in the control group. What (if any) information is given about non responders/dropouts that would help the reader to decide if they were in some way different to those who remained in the study Among those who dropped from the study included those who were hospitalized and those who were away from Hong Kong seeking medical treatment in mainland china. This is indicative that these patients were not medically stable hence differed from those who remained in the study who were medically stable. This is based on the fact that determination of medical stability of participants did not involve pre-screening. Can the study findings be generalized to other settings? Why/why not? These study findings cannot be generalized to other settings (Schmid et al. 2010). This is because of variation in cultures. In addition, the quasi-experimental design lacks proper randomization and hence statistical tests can be meaningless (Johansson et al. 2009, p. 354). The findings in this study cannot therefore stand up to rigorous statistical scrutiny because the researcher needs to control other factors that may have affected the results. Thus, the findings cannot be generalized to other settings. Internal validity Define the concept of reliability and discuss how reliability has/has not been demonstrated in this study Reliability is the extent to which results are consistent over time and an accurate representation of the total population under study (Huang & Ren, 2010, p. 317). If the results of a study can be reproduced under a similar methodology, then the research instrument is said to be reliable. The results in this study can be reproduced using similar methodology. For instance, dietary findings in the study are said to be consistent with previous studies. This implies that there is some consistency of the findings in this study and previous findings hence this demonstrates that study results are reliable. Define the concept of validity and discuss how validity has/has not been demonstrated in this study Validity has two parts: internal validity and external validity (Huang & Ren, 2010, p. 311). Internal validity entails whether the results of the study are legitimate because of the way the groups were selected, data was recorded or analysis performed. From the article, there were no significant differences between the control and intervention groups with respect to demographic characteristics, except more subjects in the intervention group lived alone than those in the control group (Johansson et al. 2009, p. 357). Thus, the study can be said to be internally valid. External validity is the generalization of the findings and it involves whether the results given in the study are transferable to other groups. This study is not externally valid because of the variation in cultures and given that the quasi-experimental design used lacks proper randomization and hence statistical tests can be meaningless. Results/data analysis The results of The findings showed that there was an increase in knowledge of stroke warning signs among intervention group as opposed to control group. In addition, the results indicate that self-BP monitoring practice among intervention group improved drastically as compared to that of control group. However, both intervention and control group reported no significant improvement in smoking and alcohol drinking habits. There was also insignificant improvement in walking exercise in the intervention group even though walking exercise was better maintained in the intervention group than the control group. What type of data analysis was used? Was this appropriate? Why/why not? Statistical package for social sciences (SPSS) version 11.0 was used to analyze all the data in the study. Baseline characteristics in the experimental and control groups were compared using summary statistics. Intention-to treat analysis was used to compare changes over the three time points. Non-parametric statistics were also performed. Friedman test for continuous data and Cochran’s Q-test for dichotomous data were also performed for within group comparison. NQuery Advisor was also used to calculate effect size for continuous data. Furthermore, percentage change was calculated for dichotomous data. This type of data analysis is appropriate since it is simple and is the most used by health researchers. Using all of the information from your analysis so far decide whether or not the results of the study should be used to inform clinical practice? The researchers were able to identify an appropriate research question for their study (Johansson et al. 2009, p. 352). They aimed at establishing the effectiveness of a community based stroke prevention program in (1) improving knowledge about stroke; (2) improving self-health monitoring practice; and (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. The research methodology employed was quasi-experimental design which appropriately addressed the study objectives. The design allowed reduced the time and resources needed for experimentation. However, the design did not allow randomization that is seen in experimental design (Braveman et al. 2011, p. 62). The intervention group received both conventional medical treatment and the community based stroke prevention program while the control group received only conventional medical treatment. This was appropriate for addressing the study questions (Elo & Kyngas, 2008, p. 114). The independent variable in this study was the community based stroke prevention program. Dependent variable in the study included the knowledge on stroke warning signs, treatment seeking response in case of a stroke, medication compliance, self blood pressure monitoring and lifestyle modification of dietary habits. Thus, the dependent variable and the independent variable in the study were appropriate since they were related to study question. Data in this study was collected using structured questionnaires and face-to-face interviews. This was appropriate since it was able to answer the study question appropriately. Study participants include 190 human subjects who were aged 18 and above; were diagnosed to have had minor stroke by doctors; medically stable; independent in activities of daily living; cognitively intact; able to communicate in Cantonese; were at the time living in the community and were not receiving or had pending surgical treatment. This sample is appropriate for the setting of the study. There were no significant differences between the control and intervention groups with respect to demographic characteristics, except more subjects in the intervention group lived alone than those in the control group (Schmid et al. 2010, p. 160). In spite this, the findings of the study cannot be generalized in other settings because of variations in culture and the quasi-experimental design lacks proper randomization and hence statistical tests can be meaningless. The results in this study can be reproduced using similar methodology (Schmid et al. 2010, p. 161). Even though the study was internally valid, it was not externally valid. There was a significant difference in the results obtained from intervention group and the control group. The analysis of data employed SPSS version 11.0 which is appropriate for health related studies. Therefore, even though the results cannot be generalized in other settings but can be used to inform clinical practice. This is because some of the results obtained are consistent with previous results in different settings. Reference Braveman, P., Egerter, S., Woolf, S., & Marks, J. (2011). When do we know enough to recommend action on the social determinants of health? American Journal of Preventive Medicine, 40(1), S58-S66 Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115 Huang, Y., & Ren, J. (2010). Cost-benefit analysis of a community-based stroke revention program in Bao Shan District, Shanghai, China. International Journal of Collaborative Research on Internal Medicine & Public Health, 2(9), 307-31 Johansson, P., Ostenson, C., Hilding, A., Andersson, C., Rehnberg, C., & Tillgren, P. (2009). A cost-effectiveness analysis of a community-based diabetes prevention program in Sweden. International Journal of Technology Assessment in Health Care, 25(3), 350-358 Schmid, A., Kapoor, J., Dallas, M., & Bravata, D. (2010). Association between stroke severity and fall risk among stroke patients. Neuroepidemiology, 34, 158-162 Read More