Quantitative Critique Essay
Quantitative Critique Essay
Critical analysis of research studies is one of the most important steps towards incorporation of evidence into practice (Burns & Grove, 2007). This paper is an attempt towards achieving this goal. The paper critically analyzes the article “Group prenatal care and preterm birth weight: Results from a matched cohort study at public clinics” by Ickovics et al.(2003). This aim will be achieved by sequentially critiquing the research problem, the literature review, principles of research ethics employed in the study, the underlying theoretical framework, the research hypothesis, the sampling technique, the research design, data collection methods, the analysis, and the recommendation proposed by the authors. Finally, the paper will end with an overall appraisal of the strength and limitations of the study. Quantitative Critique Essay
The problem:
The problem studied by Ickovics et al. (2003) is that, whether group prenatal care has a significant impact on the perinatal outcome like birth weight, and gestational age. This problem is extremely significant to nursing, for a number of reasons. The first reason as described by Ickovics el al. (2003), is the significant relationship of these perinatal outcomes with “neonatal morbidity and mortality” (p. 1052). Neonatal mortality is one of the areas of concern for nursing due to high mortality rates around the world and especially in developing countries (Straughn et al.,2003). Quantitative Critique Essay
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Purpose:
The purpose for conducting the study has been explicitly stated by Ickovics et al. (2003). The stated purpose can be accomplished very well because both the outcomes that are birth weight and gestational age, are measureable and thus the research problem is testable (Haber & Cameon, 2005). A quantitative approach is suitable for this study as the variables are quantifiable and can be described objectively in numbers. Ickovics et al. (2003) have introduced the problem statement after giving a brief background of the importance of the adequate prenatal care, and the factors that determine the adequate prenatal care. They then introduce the subject of group prenatal care as a “structural innovation” in the domain of prenatal care (Ickovicd et al., 2003, p. 1052), and then share the problem statement that this innovative method of provision of prenatal care has not been tested yet.
The authors have stated the underlying assumptions of the study. Ickovics et al.(2003) believe that more time the pregnant women spent together, the better will be their understanding of the health behaviors, and they will receive more social support from each other. This will reduce their risk behaviors for instance smoking leading to low birth weight. The limitations of the study have also been discussed explicitly in the article Ickovics et al. (2003) admit that their study is limited because of non-random selection of the women for group prenatal care. The limitation is realistic because the practice was already in place and researchers wanted to observe the outcomes in relation to the two different approaches to care. Moreover, this is an inherent feature of the cohort design that the groups are selected on the basis of their exposure or non-exposure to a particular phenomenon which is not controlled by the researcher, rather the choice is made by the subject themselves. This feature of the cohort design makes it prone to “selection bias.”(Rochon et al., 2005)Quantitative Critique Essay.
Review of Literature
The review of the literature presented by Ickovics et al., (2003) is comprehensive. It starts by emphasizing the importance of adequate prenatal care in terms of perinatal outcomes. It then focuses on the factors that make the prenatal care adequate. The authors then describe the group prenatal care as a structure innovation designed to make the prenatal care adequate, and they appreciate that this new approach has not been tested yet for its efficacy in improving prenatal outcomes. The review then proceeds with a brief description of Centering Pregnancy Program and its components, which finally leads to the statement of purpose of the study. The review ends with a rationale for the selection of study population that is black and Latinas women who are vulnerable for adverse perinatal outcomes. There is an evident relationship of the review with the purpose of study in that the authors have presented only those studies that are pertinent to perinatal care and that have established the efficacy of group care in other population. The review includes a mix of recent and old studies. As this study was accepted for publication in 2003, most of the studies cited in the review were not current, that is those studies were not published in the last five years of the date when this study was accepted for publication (Burns & Groove, 2007); and there are only 10 out of 26 studies, that were current and were published in the last five years of the date of acceptance of the study under consideration, for publication. The review clearly indicates that the other interventions that have been planned to augment prenatal care were not found to be effective in improving the women’s perinatal outcome.
Ethical Consideration: Quantitative Critique Essay
The study has been designed in a manner that there are minimum risks to the subjects. Since this is a non experimental study and only intends to observe the impact of an intervention that is already in progress without manipulating any of the variables, therefore there are minimal risks associated with it (Rochon et al, 2005). However, the researchers have not made any extra effort to maximize the benefits for the subjects. There is no mention of how and when informed consent was attained from the subjects, but this may have not been reported as it was an observational study and most likely was related to quality improvement and do not need consent. The researchers have obtained the approval of research from institutional review boards at these clinics. Also, at one point, the authors have described their efforts to maintain anonymity of the subjects. The authors explained that while selecting matched cohort for the study they entered all the information needed to select the cohort, except for the patient identification information.
Theoretical/Conceptual Framework: Quantitative Critique Essay
The study is based on an underlying framework that is the centering pregnancy model. The underlying assumptions of the study are derived from the model that includes the belief that learning in groups promote shared support, change in behavior, and problem solving skills and it has significant impact on the birth outcome (Rising, 1998). The rationale for the use of the framework is evident from the fact that the entire concept of group prenatal care is based on this model and underlying assumptions. In fact, the research problem and the purpose are also derived from the same model, because the purpose of the study is to examine the impact of group prenatal care.
Hypothesis: Quantitative Critique Essay
The hypothesis to be tested by the study is formally stated in the article. The hypothesis is derived from the research problem and hence predicts that “infants of women in group prenatal care would have significantly higher birth weight and be less likely to be delivered preterm compared with those who received individual prenatal care” (Ickovics et al, 2003, p. 1052). This is a complex hypothesis as it predicts the relationship between one independent variable (provision of group prenatal care), and two independent variables (birth weight and gestational age). The hypothesis can also be categorized as directional hypothesis, as it predicts the expected direction of the relationship between provision of group prenatal care, birth weight, and gestational age. According to Polit & Beck (2008) “a directional hypothesis indicates that the researcher has intellectual commitment to the hypothesized outcome, which might result in bias.” (p.99).
Haber & Cameron (2005) therefore suggest that directional hypothesis should only be formed on the basis of sound literature evidences and theoretical basis. In this case, Ickovics et al (2003) have got sound literature support, and since group prenatal care is one of the ways to augment the content of prenatal care; therefore, the authors have hypothesized that group prenatal care will lead to improved birth weight and gestational age. Also, there is sound theoretical base to this hypothesis, as it is based on the centering pregnancy model. The hypothesis is spelled out clearly and it objectively describes the outcome variables (Polit & Back, 2008), that is perinatal outcomes have been quantified and objectively described as birth weight and gestational age.
Sampling: Quantitative Critique Essay
Ickovics et al (200 3) clearly described the population as “Black and Hispanic pregnant women of low socioeconomic status, entering prenatal care at 24 or less weeks of gestation.” (p.1051).The authors have also described in detail the characteristics of the sample such as race, age, parity, and city of residence. The detailed and comprehensive description of the sample gives an in depth understanding of the sample’s characteristics and determines the generalization of the findings to a specific population based on these characteristics (Haber & Singh, 2005). In this case, looking at the characteristics of the sample, the findings can be generalized to black and Hispanic pregnant women of low socioeconomic group, aged 25 or younger, as more than 85% of the sample consisted of black women who were 25 years old or younger. Sample’s characteristics help in determine heterogeneity or homogeneity of the sample (Haber & Singh, 2005). In this case, some of the sample’s characteristics that had the potential to act as cofounders, for instance age, race, parity, history of preterm labor and total number of visits were matched in both the groups. This resulted in homogeneity among the two groups in terms of the above mentioned characteristics. The matching of the two groups on the basis of these characteristics also reduced the potential sampling bias that could have resulted if the groups would’ve been different in terms of these characteristics and the resulting health behaviors. If the groups were not matched, these differences in groups could have accounted for the differences in outcomes, rather than intervention itself.
Ickovics et al (2003) have described the sample selection process in detail. They have also indicated the potential sampling bias due to lack of randomization while enrolling subjects in group prenatal care. Women, who voluntarily enrolled themselves in the group prenatal care programme at the clinics, were recruited as participants in the group that received group prenatal care. Ickovics et al (2003) have also comprehensively described the controls that they have utilized to minimize sampling error or sampling bias, that is, they have randomly selected the comparison group through a computer programme on the basis of first available patient with closest delivery date, by matching some of the characteristics of the treatment group.
The clinics from where the subjects were recruited were also selected by non probability sampling method, selecting only those clinics that served minority women from low socio economic background. The non probability sampling method employed in the study fits well with the level of inquiry and design of the study as Haber & Singh (2005) supported “non experimental studies usually use non probability, purposive sampling method.” (p. 53)
The sample size taken by Ickovics et al (2003), that is N=458 is sufficiently large. Each group had 229 research subjects. The sufficiency of the sample size was assured by conducting a power analysis that “229 pairs had a power of 0.80 to detect a small effect…reflecting the ability to detect a difference between the two treatment groups of 155 g.” (p. 1053). According to Burns & Groove (2007) the power of 0.8 is the minimum acceptable level of power for any study Quantitative Critique Essay.
