Type 2 Diabetes: Medication Beliefs, Treatment Complexity, and Non-Adherence - Essay Example

Article Critiquing Table of Contents Task Critical Analysis of the Articles 3 Task 2: Matrices of Evidence 15 Use of Holland and Rees Framework 15CASP TOOL 19 References 21 Task 1: Critical Analysis of the Articles Quantitative Article 1: “Medication Beliefs, Treatment Complexity, and Non-Adherence to Different Drug Classes in Patients with Type 2 Diabetes” by Vries & et. al. (2014) Focus Holland & Rees (2010) argued that focus is a major criterion in judging whether the quantitative method applied is appropriate in the context of the research issue concerned, which is again dependent on identifiable measurable variables and the importance of the topic being studied. Applying the criterion to the context of this article, it becomes apparent that Vries & et. al. (2014) had their focus concentrated on measuring the relationship between patient’s beliefs of medication with the varying degrees of treatment complexities amid type 2 diabetes patients. Hence, the variables considered by Vries & et. al. (2014) can be critiqued as identifiably measurable holding considerable significance in the nursing approaches to the domain. To be noted in this regard, with proper recognition of the relationship amid the two measurable variables, practitioners would be able to enhance effectiveness of the cure facilities by upholding positive beliefs amid type 2 diabetic patients concerning medication, which in turn would be useful in reducing treatment complexities. This in turn suffices a key requirement of quantitative researches, as was highlighted in Parahoo (2006: pp. 50) that “quantitative research is primarily concerned with measurement”. Background Another criterion highlighted in the Holland and Rees model is the broadness and significance of the research issue concerned, based on the perceptions of the researcher. Vries & et. al. (2014) argue that because of treatment complexities, fallacies and risks of ineffectiveness increase in the cure mechanism for type 2 diabetic patients, stressing upon the worthwhile characteristics of the study. As negative medication beliefs amid patients provoke them towards non-adherence to the routine care mechanism, the problem does signify a major issue in the domain. The issue has been a point of discussion in previous studies as well, which indicates its widespread nature and considerable significance as well. However, Vries & et. al. (2014) can be criticised for providing insignificant attention towards an elaborated literature review that hinders its reliability to a certain extent. Contradictorily, the significance of the article increases as the researchers have provided considerable attention towards defining the variables with clarity and detail. Aim The aim considered for the study in Vries & et. al. (2014) concentrated on the identification of relationship between medical beliefs among type 2 diabetic patients and treatment complexities because of their non-adherence tendencies. In the words of Vries & et. al. (2014: pp. 134), the objective of the study was “To assess the relationship of patients medication beliefs and treatment complexity with unintentional and intentional non-adherence for three therapeutic groups commonly used by patients with type 2 diabetes”. Methodology or Broad Approach The quantitative method followed in Vries & et. al. (2014) was based on a survey conducted within type 2 diabetic patients, which was well aligned with the research issue concerned. Tool of Data Collection Self-administered questionnaire survey was used as a tool for data collection in Vries & et. al. (2014). As argued by Popat & et. al. (2010) and Rosecrance & et. al. (2002) along with many others, reliability of self-administered questionnaires has been a major concern among researchers who prefer quantitative methods. Irrespective of the fact, no pilot testing evidence was obtained from the study in Vries & et. al. (2014). The researchers also lack proper elaboration of the reliability and validity of the data collection method used in the absence of adequate justification for the selection. Certainly, administered questionnaire survey, supported by medical reports and detailed literature review could have been suitable as an alternative method in this context (Parahoo, 2006). Method of Data Analysis and Presentation P-value was used for this study, although the researchers do not provide any detail about the use of SPSS or any other computer aided technique in performing the analysis. Even though a table has been included in the paper, pie-charts, graphs and other forms of data interpretation was absent in Vries & et. al. (2014). Sample A total of 257 type 2 diabetic patients were considered as the sample in Vries & et. al. (2014). The reliability of the data collected was again dependent on the validity and accuracy of the Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT) database. The response rate as fair with a 52% score (i.e. 133 respondents out of 257 took part in the survey voluntarily), although the researchers do not mention the rate to be based on the randomised controlled trial basis. To be mentioned in this regard, although the data collection method was reasonable to an extent, the researchers ignored mentioning the inclusion and exclusion criterion used to select the participants, wherein the inaccuracy of the GIANTT database could have obstructed the degree of reliability of the information gathered. Nevertheless, it is apparent that the results may apply to type 2 diabetic patients and medical practitioners even though the researchers do not mention about the sampling strategy used and the chances of biases therewith. Ethical Considerations The study in Vries & et. al. (2014) was conducted following the Code of Ethics of the World Medication Association and was approved by The Medical Ethics Committee of the University Medical Center Groningen in the Netherlands, which limited the need for any ethical approval. Informed consent from the participants and confidentiality was also given utmost priority in this study and thus, the study can be asserted as ethically rigorous. Main Findings The study findings in Vries & et. al. (2014) depicted positive association within the measuring variables, with apparent and rationale alignment to the determined research aim. In the words of Vried & et. al. (2014), “Treatment complexity was related to non-adherence in general. Beliefs about necessity were not strongly associated with non-adherence, while patients concern beliefs may be associated with intentional non-adherence. However, the role of these determinants differs per therapeutic group”. Conclusion and Recommendations Vries & et. al. (2014) provided a succinct elaboration of their findings in justification to their aim with clear recommendations provided to the targeted audiences. However, as the study did not consider hypothesis testing and was rather based on P-value calculation, the researchers ignored accepting of rejecting the assumption but provided an elaborative account in justification to the research findings. Overall Strengths and Limitations Elaborative account of the study findings and the method used for data collection as well as testing in addition to definitions of the measurable variables can be identified as the overall strengths of Vries & et. al. (2014). On the contrary, absence of proper justification to the research method selected and a literature review can be signified as its weaknesses or limitations. Application to Practice The results in Vries & et. al. (2014) identify that with positive belief, type 2 diabetic patients can reduce treatment complexities showing greater adherence to the medication, while negative beliefs indicated a situation vice-versa. However, furthermore researchers are required to ensure that the study findings are reliable and provide with accurate data. Quantitative Article 2: “Differences in the Perceptions of Self-Care, Health Education Barriers and Educational Needs between Diabetes Patients and Nurses” by Wu & et al. (2014) Focus The topic of the study in Wu & et. al. (2014) focused on examining the linkage between the differences persisting amid nurses and diabetic patients concerning their self-care activities, which in turn act as a barrier to the participation of the patients in health care programs. The measurable variables are clearly identifiable as the “differing perceptions of diabetic patients and their nurses” and “barriers to participation in diabetes health education” in Taiwan. Notably, although the study topic is broad, its concentration on Taiwan limits its widespread nature to a substantial extent. Background Wu & et. al. (2014) argue that the research is worthwhile, emphasising the challenges often faced by the practitioners in encouraging patients for self-care and likewise, yielding benefits through health education. The seriousness of the issue has been recently identified in previous studies such as Peyrot & Rubbin (2011) and Peyrot & et. al. (2006). Wu & et. al. (2014) also provides an elaborated literature review based on the topic, bringing together the various aspects related to the measuring variables. The researchers also provide detailed definitions of the variables to justify their measuring techniques. Aim The objective of the study was to “examine the differing perceptions of diabetic patients and their nurses regarding the and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patients’ educational needs to promote better health care for patients with diabetes in Taiwan” (Wu & et. al., 2014, pp. 187). Methodology or Broad Approach Within the quantitative method, Wu & et. al. (2014) emphasised the application of a cross-sectional survey, which seems to be suitable in this context. Tool of Data Collection Questionnaires were used for data collection in this study by Wu & et. al. (2014) based on a cross-sectional survey. Cross-sectional survey has been used in many previous studies indicating high reliability of the process (Olsen & George, 2004). Hence, pilot testing was not deemed as mandatory in this study. The researchers also provide a brief account of the reliability and validity of the method used along with the rationale behind the selection, based on which, it can be affirmed as a suitable choice. Method of Data Analysis and Presentation Wu & et. al. (2014) provided a detailed elaboration of the study findings through tabular formats and in discussion, although there was no mention about SPSS use or the use of other techniques to analyse the data. Graphs and charts were also included in the paper for data analysis and presentation. Sample 312 patients diagnosed with type 2 diabetes and 202 nurses participated in the study and thus were categorised as the samples. The response rate of the study was also found to be sufficient, confirming the reliability of the same being tested through Cronbach’s alpha method. The researchers implemented a convenience sampling strategy for this study, which although increases the chances of biases thereto. The researchers also elaborated the inclusion and exclusion criteria, which were reasonable enough in alignment with the research question. As the samples were limited to the Taiwanese context, it certainly limits the applicability of the study findings at the broader realm. Ethical Considerations The study received approval from Institutional Review Board of the National Taipei University of Nursing and the Health Science Ethics Committee. Both informed consent and confidentiality were considered with high priority by Wu & et. al. (2014). Hence, the study can be said as ethically rigorous. Main Findings The obtained answers in Wu & et. al. (2014: pp. 194) signified that the variables considered were indeed interrelated and dependent to a major extent, wherein “There were significant differences between the nurses’ and patients’ perceptions of diabetes nurses’ and patients’ perceptions of diabetes and health education needs”. Conclusion and Recommendations Wu & et. al. (2014) provided answer the determined aim in an elaborated manner, which although apparently hindered comprehensibility to a certain extent. Recommendations in Wu & et. al. (2014) were however presented in a precise, understandable and succinct manner. Overall Strengths and Limitations The overall strengths of Wu & et. al. (2014) indicated its elaborated explanation to the research method applied in justification to the aims and the analysis techniques used. On the other hand, its elaborative nature also inhibited its conciseness, which can be identified as one of its major limitations. Application to Practice Undoubtedly, the obtained results have high applicability in practice. Nevertheless, its results should be assessed in the context of other parts of the world as well to obtain generalizability of the examined facts. Qualitative Article 1: “A Model of Integration of Illness and Self-Management in Type 2 Diabetes” by Hornsten & et. al. (2010) Statement of the Aims of the Research The aims in Hornsten & et. al. (2010) was to “describe the process of illness integration and self-management among people with type 2 diabetes”. The objective is of considerable significance owing to its credibility in assisting practitioners to identify possible causes hindering self-management in the paradigm. Thus, the goal considered in this study can be measured as quite relevant as well. Appropriateness of Qualitative Methodology As Hornsten & et. al. (2010) focused on elaborating on a particular process, rather than measuring the variables concentrated on its effectiveness, the method applied can be considered as appropriate. Appropriateness of Research Design The research design applied to the study was sufficiently elaborated. Although due attention was provided in justification to the selection of qualitative method, the process of selection was not detailed in Hornsten & et. al. (2010). Appropriateness of Recruitment Strategy Participants for this study were recruited from four primary health care centers from rural as well as urban areas of the locality. Based on random sampling technique, 44 interviewees were selected as the sample size in Hornsten & et. al. (2010). The inclusion criteria for their recruitment focused on the participants’ characteristics of being “Swedish-speaking people, diagnosed with type 2 diabetes within the previous 2 years, ages 40–80 years, and with no other chronic illness or disability” (Hornsten & et. al., 2010: pp. 41). Data Collection Method The setting used for collection of data was appropriately justified by Hornsten & et. al. (2010). The researchers also provided sufficient elaboration of their selection process, which added to the reliability of the study. However, the form of data collection used for the interviews conducted with 44 respondents were not elaborated by the researchers and thus, can be identified as a major limitation. Relationship between Researcher and Participants Hornsten & et. al. (2010) lacked sufficient detail in this context which in turn hindered its reliability to a certain extent. The researchers also ignored critically assessing their roles and thus, their relationship with the participants could not be adequately addressed in the study. Ethical Considerations The researchers provided a detailed elaboration of their process to obtain ethical soundness for this study. Correspondingly, Hornsten & et. al. (2010) obtain ethical approval from the Regional Ethical Review Board, wherein informed consent was considered important along with due attention towards minimised researcher bias when interpreting the data gathered. Data Analysis An elaborated data analysis was conducted in Hornsten & et. al. (2010). Although the study lacked application of precise quantitative analysis methods, the obtained findings were assessed in systematic progression, delivering adequate attention towards the precision and comprehensibility of data interpretation. Hence, the data analysis process in Hornsten & et. al. (2010) can be considered as sufficiently rigorous. Clear Statement of Findings Hornsten & et. al. (2010) lacks clarity in summarising its findings being presented in distorted manner. Hence, for readers, it might create a certain degree of problem in comprehending the findings obtained with the objectives of the study. Nevertheless, the study exhibits an elaborated discussion for evidence gathered and the researchers’ arguments. Furthermore, elaborating on the inclusion and exclusion criteria, as well as the limitations of the research method applied, the researchers have been successful in assuring credibility of the findings obtained. Value of the Research The issue considered in this study certainly has a broad applicability. However, Hornsten & et. al. (2010) pays insignificant attention towards discussing the contribution this study makes to future researches. Hence, it can be argued that the value of the study is highly dependent on the perceptions and understanding of the readers or its audiences. Task 2: Matrices of Evidence Use of Holland and Rees Framework The aforesaid framework has been used in relation to the article of ‘Medication beliefs, treatment complexity and non-adherence to different drug classes in patients with type 2 diabetes’ of Vries & et. al. (2014). Thus, the matrices of evidence in relation to the article based on the stated framework have been depicted in the following tabular representation: Author date/ Country of Origin Questions /Hypothesis / aims Methodology Data Collection Population and Sample Analysis Strategy Key findings (Results) Limitations Conclusions Implication For Practice Vries, S. T. D. & et. al., 2014 The aim of this research is to identify the relation persisting between the passive behavioural patterns and the treatment complexities within the adherent and the non-adherent categories of type 2 diabetic patients Majority of the analysed data was mainly collected from the GIANTT database depending on which the patients were either categorized as being adherent or non-adherent based on the projection of their intentional as well as un-intentional motives Data related to ‘Medication Adherence Report Scale’ and ‘Beliefs about Medicines Questionnaire’ were appropriately integrated with the medication prescription information as obtained from the GIANTT database A sample size of 257 type 2 diabetic patients were taken into concern for gathering relevant data In terms of techniques, it can be stated that the patients were specifically categorised as being adherent with unintentional motives and non-adherent with intentional motives. The ‘Medication Regimen Complexity Index’ was specifically implemented for calculating the treatment complexities by taking consideration of the factors such as medication intake frequency, medication dosage and direction of consumption Out of the sample of 257 respondents, only 133 positively responded to the analysis. Out of 133, 50% were reported as females. Higher intensity of intentional non-adherence was found in case of blood-pressure lowering drug, whereas, the treatment complexity score of the adherers appeared with unintentional motives remained low Specific focus towards identifying and analysing the intentional non-adherent population has been the major strength of this article, whereas, the analysis could have also been focused on the unintentional adherents. Thus, this might form a major weakness of this analysis Specific focus was provided in terms of identifying the treatment complexities associated with non-adherers. However, the intensity of passive beliefs in case of non-adherers appeared quite low which in actual terms should be high. This analysis is appropriately applicable for practice with the necessity of making certain modifications such as provision of equal balance for both intentional adherers and unintentional non-adherence. Source: (Burrows & Walker, 2012) The matrices of evidence in relation to the article of ‘Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses’ by Wu & et al. (2014) based on the above stated framework have been portrayed hereunder. Author date/ Country of Origin Questions /Hypothesis / aims Methodology Data Collection Population and Sample Analysis Strategy Key findings (Results) Limitations Conclusions Implication For Practice Wu, S. F. V. & et. al., 2014 Identification and analysing the differences persisting in the perceptions of the patients and the nurses regarding facilitation of heath care education Conducted a cross-sectional survey on medical facilities. Specific applicability of ‘convenience sampling’ was also used for selecting patient groups suffering from type 2 diabetes Structured questionnaires and ‘content validity indices (CVI)’ were used for collecting and analysing necessary data under the supervision of medication experts Total sample count - 514. Total count of patients - 312 and count for nurses - 202 The analysis also took consideration of appropriate questionnaire analysis and suitable indices like CVI as a part of data analysis The analytical data as obtained from the analysis proved the self-care behaviours of the patients to be much more in comparison with that of the perceptions of the nurses The strength of this analysis lies in its justifiability that patient’s perception regarding self care activities is much stronger in comparison with that of the nurses. However, its failure towards the attainment of an appropriate tool for changing the perceptions of the nurses can be duly considered as a potential weakness. The perception of nurse’s sample regarding the complicacies within healthcare education appeared weak. As a result, the behaviours and the perceptions of the patients regarding their self-care appeared much more fruitful. However as a recommendation, a balance between both the perception types will need to be achieved for attaining better outcomes. This analysis is appropriately applicable for practice with the necessity of paying utmost focus towards attaining a balance between the perceptions of the nurses and the patients Source: (Oxford University Press, 2014) CASP TOOL Similar to the framework of Holland and Rees, the matrices of evidence in relation to the article of “A model of integration of illness and self-management in type 2 diabetes” by Hornsten & et. al. (2010) have been presented in the following with the application of Critical Appraisal Skills Programme (CASP) tool: Screening Questions Did the overall research have a clear statement? Yes Cannot determine No Is the overall analysis appropriately qualitative? Yes Cannot determine No Did the research address all its aims and objectives? Yes Cannot determine No How effective was the research methodology? High Medium Low Was the data collection technique appropriate? Yes Cannot determine No Was the attained data rigorously analyzed? Yes Cannot determine No Did the analysis take consideration of the ethical issues? Yes Cannot determine No Are the finding statements of the analysis clear? Yes Cannot determine No Identify the level of research value High Medium Low Source (CASP UK, 2013) References Burrows, E. & Walker, S., 2012. Developing a Critiquing Tool for Expert Opinion. Introduction, pp. 1-5. CASP UK, 2013. CASP Checklists. Making Sense of Evidence. [Online] Available at: http://www.casp-uk.net/#!casp-tools-checklists/c18f8 [Accessed November 21, 2014]. Holland, K. & Rees, C., 2010. Nursing Evidence-Based Practice Skills. Oxford University Press. Hornsten, A. & et. al., 2010. A Model of Integration of Illness and Self-Management in Type 2 Diabetes. Journal of Nursing and Healthcare of Chronic Illness, pp. 41-51. Olsen, C. & George, D. M., 2004. Cross-Sectional Study Design and Data Analysis. The Young Epidemiology Scholars Program (YES). Oxford University Press, 2014. Frameworks for Critiquing Research Articles. Student Resources. [Online] Available at: http://global.oup.com/uk/orc/nursing/holland/01student/chapters/ch07/frameworks/ [Accessed November 21, 2014]. Parahoo, K., 2014. Nursing Research: Principles, Process and Issues. Palgrave Macmillan. Peyrot, M. & et. al., 2006. Patient and Provider Perceptions of Care for Diabetes: Results of The Cross-National DAWN Study. Diabetologia, Vol. 49, pp. 279–288. Peyrot, M. & Rubbin, R. R., 2011. Perceived Medication Benefits and Their Association with Interest in Using Inhaled Insulin in Type 2 Diabetes: A Model of Patients’ Cognitive Framework. Patient Preference and Adherence, Vol. 5, pp. 255–265. RA, P. & et. al., 2010. Reliability and Validity of Two Self-Administered Questionnaires for Screening Restless Legs Syndrome in Population-Based Studies. Sleep Med., Vol. 11, No. 2, pp. 154-160. Rosecrance, J. C. & et. al., 2002. Test-Retest Reliability of a Self-Administered Musculoskeletal Symptoms and Job Factors Questionnaire Used in Ergonomics Research. Applied Occupational and Environmental Hygiene, Vol. 17, No. 9, pp. 613–621. Vries, S. T. D. & et. al., 2014. Medication Beliefs, Treatment Complexity, and Non-Adherence to Different Drug Classes in Patients with Type 2 Diabetes. Journal of Psychosomatic Research, Vol. 76, pp. 134–138. Wu, S. F. V. & et. al., 2014. Differences in the Perceptions of Self-Care, Health Education Barriers and Educational Needs between Diabetes Patients and Nurses. eContent Management Pty Ltd. Contemporary Nurse, Vol.46, No.2, pp. 187–196. Read More