Langabeer et al. Practice Critique 4

docx

School

University of Texas, Arlington *

*We aren’t endorsed by this school

Course

5366

Subject

Statistics

Date

Feb 20, 2024

Type

docx

Pages

Uploaded by lovebug83

1 Student Name: INSTRUCTOR Critique 4 Answer Sheet: Data Analysis 1. List the statistical procedures performed to describe the sample. Statistics used to describe the sample were mean, standard deviation, and percentage (%), as seen on Table 1 (Langabeer et al., 2018). Chi-square analysis were used to assess differences between the two groups for nominal variables, such as sex and race. This is an appropriate statistical test to describe a sample (Gray et al., 2017). 2. List the statistical procedures performed to answer the research question(s). Student t-tests were used to test for differences between groups for continuous or ratio level variables, such as systolic BP, BMI, and QOL scores. Multivariate linear regression was used to see if the changes in BP over time were significant. 3. Discuss the appropriateness of the statistical procedures for the level of measurement of the data collected, and to answer the research questions. According to Figure 21-7 in Gray et al. (2017), t-tests are appropriate for independent samples, when there are two groups, and when the data is interval or ratio level. In this study, the samples were independent, meaning they did not know each other, and there were two groups. Additionally, systolic and diastolic blood pressure and BMI scores are interval/ratio level data. The same could be said for the scores on the QOL measurement tool, although a lack of information on this measure makes this conclusion uncertain.

2 Finally, multivariate linear regression is appropriate for more than one independent variable to be entered into the analysis (Gray et al., 2017). This is assuming the data had a normal distribution with little or no multicollinearity. Langabeer et al. (2018) entered nine variables into the regression equation; age, sex, ethnicity, BMI, stroke, diabetes, heart failure, medication, and change in QOL. The outcome variable was change in systolic and/or diastolic BP. Again, according to Figure 21-7, multiple linear regression is appropriate for ratio/interval level data, but sex, ethnicity, and stroke are not ratio/interval data, but ordinal level. It may be that Spearman rank-order or Kendall’s tau would have been more appropriate for lower level data. 4. Describe how the researcher(s) addressed any problems with missing data. The researchers did not address missing data or what they did to address that problem. 5. Describe the level of significance (alpha) set for this study. The researchers set the level of significance at p<0.05 to determine significance. 6. Discuss the clarity of presentation of study results (if tables or figures were used, briefly describe them & discuss if/how they made the presentation more understandable). The researchers did not include any hypotheses or clear research questions in their report. They only said they were looking to assess changes in BP over time. On page 3 (Langabeer et al., 2018), the authors state that there was significant improvement in mean systolic BP, with a similar improvement in diastolic BP. The regression model showed that only BMI and QOL were significantly correlated with BP. All other demographic variables were non- significant, meaning that they are not related to BP levels in adults at risk for heart disease.

3 The authors included one table and one figure to describe their results. Table 2 shows the changes in systolic BP, diastolic BP, and QOL, with p values for each comparison. It would have been much clearer if they also showed the BP numbers at both time points for the comparison group. The intervention group data is only significant when compared to that of the control group. The figure shows graphically how the BPs declined over time during the study. This helps the reader get a quick idea of improvements in BP, which was the goal of the study. Researcher Interpretation of Findings 1. Describe the key findings of the study in relation to purpose/question/hypothesis. Since there were no hypotheses, it is difficult to know if the researchers answered important research questions or not. They did clearly state that both systolic and diastolic BP went down in the intervention group, with an improvement of 5.5% and 6% respectively (Langabeer et al., 2018). This appears to be the most important finding. An additional finding is that only BMI and QOL can predict BP changes in this population. 2. Discuss the clarity of the authors’ explanation of key findings, including statistically significant & non-significant findings. In Table 2, the researchers clearly label the significance values for change in BP and QOL as less than 0.001. This shows that the main study findings were statistically significant. 3. Discuss whether the key findings were clinically significant or clinically important. Changes in systolic and diastolic BP were the most important findings. The authors claim that BP went down by 5% to 6% (Langabeer et al., 2018). According to Table 2, the average systolic decrease was 7.6 mmHg, and average diastolic decrease was 4.6 mmHg.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 These decreases could be clinically important, as improvements of 5 or more mmHg would be helpful for adult with HTN. On the other hand, for adults with a BP more than 7.6 mmHg over the healthy range, this intervention alone would not be sufficient to bring the BP down to 130/80, the target for a controlled BP. This intervention could be coupled with dietary, exercise, and medication interventions to achieve a healthy BP. 4. Describe which findings were consistent with those expected, and any which were unexpected. The reduced systolic and diastolic BPs were consistent with what was expected from this intervention. A logical hypothesis would be that adults who self-monitor their BP at home are more likely to have a lower BP, which is what the researchers found. Something that was unexpected would be the lack of association between medication compliance and BP reduction. A researcher would probably hypothesize that getting this intervention from patient navigators, including education and coaching, should improve medication compliance and therefore improve BP, but this was not the case. If medication compliance did not improve, then the researchers do not know why the intervention worked. Taking their BP alone would not improve BP, so something else in the intervention must have made that difference. The change in BP could have been from better diet, better exercise, or some other aspect of self-care. 5. Describe the implications for practice identified by the authors. The authors describe their results, and results of similar studies, that have shown an improvement in BP when “the physician care team is extended outside of the office,” including nurse educators or patient navigators (Langabeer et al., 2018, p. 4). They also describe study

5 outcomes that have shown that getting patients involved in their own care, or self-care/self- management, has shown improved outcomes. Unfortunately, some studies have not found significant changes in outcomes with these interventions, so research findings are mixed. If so- called ‘out of office’ measurements are going to be done by patients, the accuracy of their measurements must be addressed in some way. These findings imply that primary care in clinics or medical offices should incorporate patient education, follow-up by office staff, and self-monitoring of BP by the patients in their homes. All of these interventions would add a significant cost to health care, which is probably why they are not currently done very often. These interventions would require more nurse educators in clinics, more patient education to take BPs at home, and more data collection from patients at home. To be useful, those BP readings would have to be incorporated into the patient’s electronic medical record. 6. Summarize the suggestions for future studies identified by the authors. The researchers suggest that future studies could include other community-based programs with other ethnic populations, but no detail is given on these programs or populations. This is a weakness of this report, as this suggestion is very vague. Additionally, they recommend large- scale studies in other regions of the United States. This section of the report is very brief and lacks specific information. Overall Evaluation of the Study 1. Discuss two strengths of the study.

6 One strength of the study was the large sample size that was initially invited to enroll in the study. The researchers started with 8071 adults, which is a very large sample. Although only 65.7% completed the program, it is still a large sample size for research purposes. Another strength of the study is using non-clinical patient navigators in coaching and teaching roles within the intervention. Patient navigators may be more cost effective as compared to registered nurses or other health care providers, and they should be personally familiar with both the first language of the population, as well as cultural values and norms. This would make them more effective than a registered nurse or physician. 2. Discuss at least one weakness of the study, and whether/how that weakness could have been corrected. This study had multiple weaknesses. The authors claimed that it was a study about Hispanics, yet only 71% identified as Hispanic/Latino. The researchers should have made Hispanic ethnicity an inclusion criteria so that all others were excluded from the sample. If they had done that, then the findings would more closely apply to Hispanic populations. Another weakness is the high attrition rate from the study of 34.3%. If those adults had stayed in the study with their data included in the analysis, it could easily be that the intervention had no significant affect on BP. In other words, many or most of those people who dropped out could have had a higher than normal BP which would have skewed the results. 3. Discuss the credibility of the study findings and how much confidence can be placed in them. I believe the findings are fairly credible given the large sample size, and first and last measurements done in the clinic by professionals. Consumers of research can be fairly certain that the decrease in BP in the intervention group was accurate, so the intervention

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 must have had something to do with that. Unfortunately it is not clear how much education and coaching is needed to create this outcome. The authors state that the teaching at the office visit only took five minutes, but no numbers on how much other coaching or follow-up was involved. This is a weakness of this report. 4. Based on the previous research presented in the literature review and the findings of the study presented in this article, discuss whether the findings are ready for use in practice. Since this study, along with others in the discussion section, have found decreases in BP with this intervention, I believe it is ready to be used in practice. Even if some researchers have not been able to find a significant improvement after self-monitoring, the intervention is very low risk so there is no danger that it could have negative effects. If this had been the first study of its kind, then I would say it needed further study with larger samples before it should be used in practice.

8 Reference List Gray, J. R., Grove, S. K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Elsevier. Langabeer, J. R., Henry, T. D., Aldana, C. P., DeLuna, L., Silva, N., & Champagne-Langabeer, T. (2018). Effects of a community population health initiative on blood pressure control in Latinos. Journal of the American Heart Association, 7, 1-7. https://doi.org/ 10.1161/JAHA.118.010282

Langabeer et al. Practice Critique 4

Related Documents