The most common factors causing therapeutic compliance - Research Paper Example

?CRITIQUE TEMPLATE FOR A QUALITATIVE STUDY NURS 6125 Week 5 Application Assignment: Critiquing a Qualitative, Quantitative, or Mixed-Methods ResearchStudy (due in Week 7) Date: 10/20/11 Your name: Michelle Odeh Article reference (in APA style): Jin, J., Sklar, G.E., Sen Oh, V. M., & Li, S. C. (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and Clinical Risk Management. 4(1) 269-286 URL: http://www. QUALITATIVE RESEARCH CRITIQUE 1. Research Issue and Purpose The purpose of the study and the research questions are very important and integral to the conduct of the research. This is because whereas the purpose of the research outlines the general reason why the researcher wants to conduct the research, the research questions acts as a tool for helping the researcher achieve the research aim. It is expected therefore that in stating the research questions, the researcher relates the research question to the purpose of the study (The Research Assistant, 2011). In the research work understudy, the researcher had a purpose of exploring and evaluating the most common factors causing therapeutic compliance. The research question that guided the research purpose was “What are the common types of non-compliance encountered in clinical medicine?” Critically, the researcher related the research question directly to the research purpose. The research purpose and the research questions are therefore judged as appropriate for the attainment of the research aim. 2. Researcher Pre-understandings Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem? The research problem is a discussion of therapeutic compliance among patients. This means that the research has to do with pharmaceutical issues. Coincidentally, all four researchers have professions relating to pharmacology. With a research problem that relates to the professional background of the researchers therefore, it was highly expected that the researchers would display personal pre-understandings of the research problem. Reading through the research article however, it can be seen that almost all ideas, findings and philosophical analysis presented in the research work were taken from secondary sources without any prelude to researchers’ existing knowledge or experience. The researchers worked around three major pharmaceutical terms, which were treatment refusal, patient compliance, and patient dropouts. All these are terms that relates to everyday patient-pharmacists interactions. It was expected therefore that the researchers would give broader overview of their personal understandings and previous experiences as practicing professional in this regard but this did not happen. 3. Literature Review Generally, the quality of the literature review will be said to be outstanding. The general approach adapted by the researchers was to conduct research searches to come out with expected results on factors leading to the achievement of the research purpose. In this regard, it was expected that the researchers would conduct a thoroughly researched literature review. On the whole, “a total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process” (Jin, Sklar, Oh and Li, 2008). A critical assessment of the 102 articles that were eventually selected and used by the researchers show that most of the articles were not more than a decade old. Some of these include Benner et al 2002, Apter et al 2003, Opolka et al 2003, Spikmans et al 2003, Butterworth et al 2004, Kaplan et al 2004, Dominick et al 2005, Horne and Weinman 1999, Ghods and Nasrollahzadeh 2003 and Senior et al 2004. With such current literature works, the researchers were sure to have an updated portfolio of information to work with. In pharmaceutical circles, research on drugs and patient behavior keep changing by the day. For this reason, when researches are conducted with literature sources that are very old, some of the information collected tends to be outmoded and inaccurate to the research problem at hand. In the current research, there were however some literature used that were very old. Examples of some very old literature sources used were Norman et al 1985, Degoulet et al 1983, Chuah 1991; Shea et al 1992, Swett and Noones 1989 and Turner et al 1995. In general however, not much of the literature used were too outmoded to be accepted. Speaking of the relevance of the literature review conducted by the researcher, one can easily notice a remarkable effort made by the researchers to ensure that their literature review was in line with the research goals. This was seen in the fact that the researchers took time to break the research problem into sub themes. These themes reflected on the research question and goal. To a large extent therefore, the literature review was very relevant because it all centered round the research problem. On the critique of the literature reviewed by the researchers, it can be noticed that the researchers were less critical of the issues raised by the reviewers, whose works they reviewed. For example there were no contrasting opinions raised by the researchers, facts presented by individual researchers were not crossed and counteracted with those of other researchers and the researchers hardly passed qualitative judgmental assessments on the works reviewed. There is an impression that this lack of critical review happened because the researchers assumed the position of fact finders on the factors that led to patient non-compliance rather than undertaking and analytical or problem solving research. 4. Theoretical or Conceptual Framework Unlike other research articles, there was no clearly stated section of the research report that was dedicated to theoretical or conceptual framework discussion. However, a closer look at the research report shows that the researchers used a lot of conceptual and theoretical frameworks. These were frameworks were digested and incorporated in the literature review. There were also seen in the themes set for the literature review. By and large, the frameworks were not borrowed but directly related to nursing and pharmaceutical practice. Some of the frameworks considered were Patient-centered factors, Therapy-related factors, Healthcare system factors and Disease factors. The fact that the frameworks related to the professional practice of the researchers, it gave them an upper hand on the discussions on the frameworks. 5. Participants On the whole, participants used were patients who had undergone the need to be on medication. The research however employed a wild range of patients. This is to say that there was no static classification of patients. The researchers used patients of different ages, educational background, ethical background, gender and marital status. The research adequately described the participants in the sense that with each demographic factor considered by the researchers, the researchers divided the demographic factors into identical groupings. For example with respect to age, there were identities such as the old age, middle age and young. With ethnicity, the researchers identified Caucasians and minorities. This was done with all the other participants. The setting of the participants, which had to do with patients, was very appropriate for the research problem. This is because the research problem was healthcare related and therefore needed to be in line with healthcare. The sample strategy used by the researchers was purposive sampling technique. This means that the researchers sampled from the articles used, those that contained the participants that they needed. This was done purposively and non-probably. Considering the fact that the researchers had several articles in hand, using purposive sampling was the only and best way the researchers could sample participants needed for the study. This purposive sampling could however not make the researchers have a specific number of participants under each demographic factor. This is because the researchers had to use what was available in the articles they selected. 6. Protection of Human Research Participants The research work did not state any specific ways by which the researchers ensured the adherence to academic and professional ethics. This is unusual and different from the stipulated requirement whereby researchers must be specific on how they ensured ethical practice and the adherence of human rights. Again, the researchers might have committed this oversight with the mentality that they did not conduct any primary research but only secondary research where they did not have any direct contact with respondents. The fact that they referenced their sources is however a minor justification that ethical issues on plagiarism were obeyed. 7. Research Design The research design employed by the researchers was case study. This means that they identified a specific situation or case and decided to study their set variables on the case. Specifically, the research design was modeled from previous research. This makes the research design highest qualitative. 8. Data Collection/Generation Methods The data collection method used can be described as a segmentation data collection method. This is because the researchers sampled as many articles that related to the research problem as possible. “Literature searches were undertaken through the Medline database from 1970 to 2005” (Jin, Sklar, Oh and Li, 2008). Out of these articles, the researchers conducted a segmentation process to group the articles according to identified themes. These themes were created according to factors, predictors and determinants on the why there is non-compliance among drug users. The themes used for the segmentation were patient-centered factors, therapy-related factors, healthcare system factors, social and economic factors, and disease factors. The segmentation also sought to eliminate factors such as AIDS, bioethics, history of medicine, space life sciences and toxicology. Through the segmentation process, the researchers came to identify as many factors and causative elements as position that answered their research question. 9. Credibility According to the researchers, “clinical trials were excluded since they were carried out under close monitoring and therefore the compliance rates reported would not be generalizable (Jin, Sklar, Oh and Li, 2008). Clearly, primary data collection offers more credibility than secondary data collection as used by the researchers. This is because in secondary data collection, the researchers have to rely on the credibility of the sources used rather than their own insurance of credibility. The general credibility of the data used by the researchers is therefore suspect. 10. Data Analysis Data analysis was exclusively through qualitative data analysis. Thorne (2000) advises that “in order to generate findings that transform raw data into new knowledge, a qualitative researcher must engage in active and demanding analytic processes throughout all phases of the research.” This means that the quality of qualitative data analysis is judged not by the mere fact that the researchers give their own opinion and interpretations of the data collected but then the researchers are expected to critically analyze the data that they collect. In their attempt to undertake the qualitative data analysis, the researchers undertook a comparative study of all the articles that contained the particular factors they were looking at. For example with the factor of medication side effect, the researchers took all articles that pointed to medication side effect as reason for non-compliance and presented the data and conclusions derived from all those articles and then gave their own interpretation of the results. A typical example of how data was analyzed is quotes as All of the seventeen studies on side effects factor found that side effects threaten patient’s compliance (Spagnoli et al 1989; Shaw et al 1995; Buck et al 1997; Dusing et al 1998;Hungin 1999; Kiortsis et al 2000; Linden et al 2000; Kim et al 2002; Dietrich et al 2003; Grant et al 2003; Loffl er et al 2003; Sleath et al 2003; Iihara et al 2004; Kaplan et al 2004; Ponnusankar et al 2004; O’Donoghue 2004). In a German study, the second most common reason for non-compliance with antihypertensive therapy was adverse effects (Dusing et al 1998). The effect of side effects on compliance may be explained in terms of physical discomfort, skepticism about the efficacy of the medication, and decreasing the trust in physicians (Christensen 1978). - Jin, Sklar, Oh and Li, (2008). 11. Findings The findins of the research revealed that there are varying factors and reasons why people would not stick to medical prescriptions. These factors have been summarized in the table below. Thematic Factors Corresponding Factors Patient centered factors Demographic Factors: Age, Ethnicity, Gender, Education, Marriage Status Psychosocial factors: Beliefs, Motivation, Attitude Patient-prescriber relationship Health literacy Patient knowledge Physical difficulties Tobacco Smoking or alcohol intake Forgetfulness History of good compliances Therapy related factors Route of administration Treatment complexity Duration of the treatment period Medication side effects Degree of behavioral change required Taste of the medication Healthcare system factors Requirements for drug storage Lack of accessibility Long waiting time Difficulty in getting prescriptions filled Unhappy clinic visits Social and economic factors Inability to take time off work Cost and Income Social support Disease factors Disease symptoms Severity of the disease Source: Jin, Sklar, Oh and Li, (2008). 12. Discussion of Findings Judging the discussion of findings is almost impossible. This is because the researchers used secondary data throughout their research. For this reason, it was not possible to identify if the findings of the research were consistent with previous studies. However, it would be said that to a very large extent, the findings from the researchers were expected. This is because most of the variables considered by the researchers are part of everyday experiences that nurses go through at the hands of patients. 13. Limitations The researchers rightly identified and addressed limitations to the study. As expected, these limitations were given at the concluding part of the research report in order that it embodied all challenges that were faced in the entire conduct of the research work. Again, the limitations identified areas of the research that were likely to be affected as a result of the limitations faced. 14. Implications The conclusions and implications drawn by the researchers warrant the research study. This was easily achieved because the researchers did not even include articles that did not contain the kind of data they were looking for. For this reason, there was no need to ignore findings that did not confirm their expectations because all the data sampled were purposively sampled. 15. Recommendations Surprisingly, the article did not contain any recommendations for future or further research. This means that the researchers did not admit any unattended segments of their research that needs to be attended to by other researchers. This also means that even though there were limitations stated by the researchers, these limitations were not cautioned to future researchers as to how they would avoid the limitations faced. 16. Research Utilization in Your Practice The research critique that has been undertaken and the research that has been reviewed will become of great and immense help to my practice as a student and professional. For instance the critique has brought me very close to the basic requirements in conducting an academic research and how adherence to these requirements can influence the results of a piece of research. On the research findings itself, it has enlightened me on the need to be extra vigilant with patient monitoring when it comes to compliance to medications. As direction for further research, it is suggested that future researchers look into ways of improving compliance now that the causative factors have been unveiled. REFERENCE LIST Jin, Sklar, Oh and Li, (2008). Therapeutics and Clinical Risk Management 2008:4(1) The Research Assistant (2011). The Relationship Between the Research Question, Hypotheses, Specific Aims, and Long-Term Goals of the Project. Retrieved October 23, 2011 from http://www.theresearchassistant.com/tutorial/2-1.asp Thorne S. (2000). Data analysis in qualitative research. Evidence Based Nursing 2000;3:68-70 doi:10.1136/ebn.3.3.68. available online at http://ebn.bmj.com/content/3/3/68.full Read More