Critical Appraisal of a Quasi-Experimental Design Nursing research is an essential part of a nurse’s profession; it has a remarkable influence on current and future evidencebased practice (Tingen, Burnett, & Murchison, 2009). Therefore, it is vital that nurses develop the skill of critiquing a research paper to know how to read and understand those reports. Because evidence-based practice is embedded in the foundation of nursing, it is vital that nurses develop the ability to recognize research that is trustworthy, current, and relevant to practice.
Introduction Quasi-experimental Evaluation of a Telephone-Based Peer Support Intervention for Maternal Depression was written by Letourneau et al. (2015). The authors evaluate the effect of telephone-based peer support (TBPS) on maternal depression and social support quantitatively. The abstract gives a clear summary regarding the overall paper. However, the authors elude that the paper will concentrate on postpartum depression (PPD) as a global issue, however, it takes on more of a rural based focus in New Brunswick (NB).
This critique will evaluate not only the authors’ ability to convey their intended information, but will also consider the effectiveness of the study design. Research Problem Rebar and Gersch (2015) recognize a research problem as a gap in knowledge that needs to be addressed. Letourneau et al. identified that prolonged maternal depression is a global health concern, which if left untreated, can have adverse effects on the mother-child relationship. This problem is expanded to suggest that TBPS needs to be tested on maternal depression up to 24 months postpartum.
However, TBSP has already been proven effective for mothers up to 24 weeks postpartum (Dennis et al. , 2009). The initial research problem gives the impression that the study will focus on the mother-child relationship. However, there is no further mention of this. Instead, the information primarily considers the effectiveness of the TBPS calls and the influence on the Edinburgh Postpartum Depression Scale (EPDS) scores. A box that accompanied the introduction suggests that it is important for nurses to be aware of the symptoms and effects of PPD and to find ways to help mothers overcome the barriers they experience regarding PPD.
Purpose Letourneau et al. identified the purpose of this study as a need “to evaluate the effect of TBPS on maternal depression and social support” (p. 1587). The authors state that “[rates of PPD range) from 6. 5-30% around the world” (p. 1589), which helps the reader understand PPD is a global health concern; however, there was no additional information connecting this study to global health. Additionally, the purpose statement does not address the research problem, particularly the mother-child relationship. Despite these negative aspects, Letourneau et al. uccessfully communicate the importance of developing strategies that will reduce many of the barriers that prevent mothers from getting PPD support. Literature Review A literature review is a summary and explanation of published information related to the study problem (University of Guelph, n. d. ). Letourneau et al. articulate the importance of developing an accessible and desirable means for mothers with PPD to get support. A variety of relevant articles were used to identify characteristics of mothers with PPD, and why of those mothers may be reluctant to seek support.
Although several primary sources were used, some of the information in the article appeared to be outdated; specifically, the global PPD rates cited from 2000 and 2004. Additionally, ample evidence was provided to support the claim that TBPS can effectively prevent and reduce many of the symptoms associated with PPD. The authors did not clearly articulate a hypothesis or a theoretical framework. Sampling Plan In a quasi-experimental study, it is challenging to match the subjects to the population of interest.
This is because there is a risk of selection bias due to the lack of a randomized control group; however, researchers can overcome this weakness and improve the reliability of a study by collecting objective eligibility criteria (Glazerman, 2002), such as the EPDS, a specific age range, and language requirements. Mothers were recruited through a provincial ‘tele-health’line and in toddler clinics, which the researchers acknowledge contributed to selection bias.
The recruitment process screened mothers (n=2. 15) over an 18month period, of which only a small portion of mothers (n=64) were a part of the study at the time of intake. Most of the participants were first-time mothers (n=31), with a mean age 26. 25 (SD 6. 74), and more women preferred to speak English (n=53). The study experienced a retention rate of 53 percent (n=34) due to experimental mortality, affecting the internal validity and external validity of the study, therefore, impacting the ability to generalize the findings to other populations.
Ethical Considerations Ethics are an integral part of research and ensure the safety and protection of the participants. There was only a general statement that indicated the procedures and policies regarding the ethical treatment of participants were followed. This vague statement did not provide enough information for me to understand how the rights of the participants were protected. Moreover, it was unclear if precautions were in place to protect a peer volunteer from experiencing a relapse of depressive symptoms triggered by the TBPS calls.
Research Design A quasi-experimental design describes a quantitative, nonrandomized, pretest-posttest intervention and is typically used when it is unethical to have a randomized control trial (Eliopoulos et al. , 2004). Based on the largely rural setting of NB and implied lack of services available to the residents, this is an effective design for this setting. Data collection was obtained through testing that was performed at the intake (pretest), the midpoint, and the final (posttest) phases of the study. This ongitudinal design allowed researchers to evaluate the effectiveness of TBPS at established intervals, strengthening the rigor of the study. Nevertheless, internal validity may be threatened by pretest questions that are associated with depression because they may magnify the participant’s awareness of their emotions. Additionally, a pretest may affect external validity because it cues the participant of the potential posttest questions (Rebar & Gersch, 2015). However, the authors ensured reliability and validity by using dependable, trusted, and valid instruments.
This included the EPDS, Social Provisions Scale (measures social support), and a peer satisfaction survey. It is clearly explained how each instrument applies to the study and what is being measured, demonstrating strong content validity. The reliability of the data collected was strengthened by using a recode check of randomly selected data revealing a low error entry rate. Analysis of the data was performed with nonparametric tests, such as Kendall’s Tau Correlation. This test was used to accommodate for the small sample size and determine if there is a correlation between social support and depression at various intervals.
Main Results, Limitations, and Conclusions The results section of a quantitative research paper explains the phenomenon of interest and enables the reader to understand what could happen to other comparable groups (Rebar & Gersch. 2015). The result section in the article contained information about the sample. However, a combination of grammatical errors and a lack of descriptive information made it confusing and difficult to interpret the statistical significance of the data. It is not until the limitations section that the reader is clearly informed that some mothers experienced a relapse of depression.
The limitations section goes on to acknowledge that information in the study may have been limited by factors such as the rural location, history of mental illness, and concurrent depression treatments. Conclusions describe the knowledge that can be acquired from the study. Moreover, conclusions can be used to guide practice (Rebar & Gersch, 20115). Letourneau et al. use this section to introduce new ideas regarding PPD monitoring and, unfortunately, do not speak about any of the information that emerged from the study. However, several practical suggestions that can be applied to nursing practice were provided.
Significance to Nursing This study has the potential to have a positive influence on nursing practice. The authors draw awareness to the impact that PPD has on women and the many barriers that prevent some women from getting support. Letourneau et al. suggest that nurses who care for mothers should regularly incorporate mental health care into their assessments and learn how to recognize factors that may contribute to the development of PPD. Doing this will reduce the stigma associated with maternal depression and make support more accessible.
Strengths and Weaknesses This article is useful for those seeking information related to the characteristics of women with PPD in NB. Trustworthy instruments such as the EPDS and a reported low error entry rate can give confidence in the study; however, in spite its strengths, this article does have limitations. For example, the article appeared to be addressing a global population but instead focused on a rural population. Additionally, numerous numerical/grammatical errors made it difficult to read the article and develop a clear understanding of the intent of the study.
Closing Remarks It is essential for nurses to develop the skill of reading research and translating the information into evidence-based practice. Critiquing a research paper has enabled me to develop an appreciation for many of the instruments and data analysis methods that ensure credibility and validity of the information observed. This skill will benefit me not only as a student but as a nurse because now I have greater confidence in my ability to read research and recognize the strengths and weaknesses of the paper.
