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My practice problem will be on: Under diagnosis of diabetes: cause, effect and risk factors
Download the Johns Hopkins Research Evidence Appraisal Tool and the Johns Hopkins Individual Evidence Summary Tool located in the Student Resource Center under “Project & Practicum Resources.”
Select one of the eight practice problems that burden the overall health of the United States. Conduct a library search for two qualitative research studies addressing this problem. Appraise the two qualitative research studies using the Johns Hopkins Research Evidence Appraisal Tool.
After appraising and determining the Level of Evidence and Grade of Quality for your selected qualitative studies, summarize your findings on the Johns Hopkins Individual Evidence Summary Tool.
Include your completed Johns Hopkins Individual Evidence Summary Tool that includes your two qualitative research studies as an attachment with your initial post. Also, include PDF versions of your selected two qualitative research studies with your initial discussion post. Our faculty team will review both your two research studies and Johns Hopkins Individual Evidence Summary Tool.
Analyze the evidence summary of the two research studies to address the following.
- Does the research design answer the research question? Explain your rationale.
- Were the study sample participants representative? Why or why not?
- Compare and contrast the study limitations in these two studies.
- Based on this evidence summary, would you consider either or both of these qualitative research studies as support for your selected practice problem? Explain your rationale.
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Appendix E
Appendix E
Appendix E
Appendix E
Research Evidence Appraisal Tool
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Evidence level and quality rating: |
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Article title: |
Number: |
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Author(s): |
Publication date: |
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Journal: |
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Setting: |
Sample (composition and size): |
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Does this evidence address my EBP question? Yes No-Do not proceed with appraisal of this evidence |
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Is this study: QuaNtitative (collection, analysis, and reporting of numerical data) Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis.
Go to QuaLitative (collection, analysis, and reporting of narrative data) Rich narrative documents are used for uncovering themes; describes a problem or condition from the point of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or semi structured), and participation/observations. Sample sizes are small and are determined when data saturation is achieved. Data saturation is reached when the researcher identifies that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for studies when little research exists; may use results to design empirical studies. The researcher describes, analyzes, and interprets reports, descriptions, and observations from participants. Go to Section II: QuaLitative Mixed methods (results reported both numerically and narratively) Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process. Go to Section III: Mixed Methods |
Johns Hopkins Nursing Evidence-Based Practice
©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Appendix E
Research Evidence Appraisal Tool
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Section I: QuaNtitative |
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Level of Evidence (Study Design) |
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A Is this a report of a single research study? |
Yes |
No Go to B |
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1. Was there manipulation of an independent variable? |
Yes |
No |
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2. Was there a control group? |
Yes | |||||||||||||||||
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3. Were study participants randomly assigned to the intervention and control groups? |
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If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study. |
LEVEL I |
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If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and No to questions 2 and 3, this is quasi-experimental. (Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group). |
LEVEL II |
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If No to questions 1, 2, and 3, this is nonexperimental. (No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data). |
LEVEL III |
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Study Findings That Help Answer the EBP Question |
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Skip to the Appraisal of QuaNtitative Research Studies section |
Appendix E
Research Evidence Appraisal Tool
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Section I: QuaNtitative (continued) |
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B Is this a summary of multiple sources of research evidence? |
Yes
Continue |
No
Use Appendix F |
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1. Does it employ a comprehensive search strategy and rigorous appraisal method? If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F). |
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2. For systematic reviews and systematic reviews with meta-analysis (see descriptions below): |
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a. Are all studies included RCTs? |
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b. Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only? |
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c. Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only? |
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A systematic review employs a search strategy and a rigorous appraisal method, but does not generate an effect size. A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from studies to generate a new statistic: the effect size. |
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Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section |
Appendix E
Research Evidence Appraisal Tool
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Appraisal of QuaNtitative Research Studies |
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Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge? |
No |
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Was the purpose of the study clearly presented? |
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Was the literature review current (most sources within the past five years or a seminal study)? |
No | |||||||||||||||||
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Was sample size sufficient based on study design and rationale? |
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If there is a control group: · Were the characteristics and/or demographics similar in both the control and intervention groups? |
N/A |
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· If multiple settings were used, were the settings similar? |
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· Were all groups equally treated except for the intervention group(s)? |
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Are data collection methods described clearly? |
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Were the instruments reliable (Cronbach’s [alpha] > 0.70)? |
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Was instrument validity discussed? |
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If surveys or questionnaires were used, was the response rate > 25%? |
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Were the results presented clearly? |
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If tables were presented, was the narrative consistent with the table content? |
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Were study limitations identified and addressed? |
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Were conclusions based on results? |
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Complete the Quality Rating for QuaNtitative Studies section |
Appendix E
Research Evidence Appraisal Tool
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Appraisal of Systematic Review (With or Without Meta-Analysis) |
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Were the variables of interest clearly identified? |
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Was the search comprehensive and reproducible? · Key search terms stated |
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· Multiple databases searched and identified |
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· Inclusion and exclusion criteria stated |
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Was there a flow diagram that included the number of studies eliminated at each level of review? |
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Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)? |
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Were methods for appraising the strength of evidence (level and quality) described? |
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· Results were interpreted |
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· Conclusions flowed logically from the interpretation and systematic review question |
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Did the systematic review include a section addressing limitations and how they were addressed? |
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Complete the Quality Rating for QuaNtitative Studies section (below) |
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Quality Rating for QuaNtitative Studies |
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Circle the appropriate quality rating below : A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn. |
Appendix E
Research Evidence Appraisal Tool
| Section II: QuaLitative | ||
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A Is this a report of a single research study? |
Yes this is Level III |
No
go to II B |
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Complete the Appraisal of Single QuaLitative Research Study section (below) |
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Appraisal of a Single QuaLitative Research Study |
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Was there a clearly identifiable and articulated: · Purpose? |
❑Yes |
❑No |
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· Research question? |
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· Justification for method(s) used? |
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· Phenomenon that is the focus of the research? |
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Were study sample participants representative? |
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Did they have knowledge of or experience with the research area? |
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Were participant characteristics described? |
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Was sampling adequate, as evidenced by achieving saturation of data? |
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Data analysis: · Was a verification process used in every step by checking and confirming with participants the trustworthiness of analysis and interpretation? |
❑Yes | ❑No | ||||||||||||||||||||||||||||||||||||||||||||
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· Was there a description of how data were analyzed (i.e., method), by computer or manually? |
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Do findings support the narrative data (quotes)? |
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Do findings flow from research question to data collected to analysis undertaken? |
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Are conclusions clearly explained? |
Appendix E
Research Evidence Appraisal Tool
Skip
to the
Quality Rating for
QuaLitative
Studies
section
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B For summaries of multiple quaLitative research studies (meta-synthesis), was a comprehensive search strategy and rigorous appraisal method used? |
Yes Level III |
No
go to Appendix F |
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Complete the Appraisal of Meta-Synthesis Studies section (below) |
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Appraisal of Meta-Synthesis Studies |
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Were the search strategy and criteria for selecting primary studies clearly defined? |
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Were findings appropriate and convincing? |
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Was a description of methods used to: · Compare findings from each study? |
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· Interpret data? |
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Did synthesis reflect: |
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· New insights? |
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· Discovery of essential features of phenomena? |
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· A fuller understanding of the phenomena? |
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Was sufficient data presented to support the interpretations? |
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Complete the Quality Rating for QuaLititative Studies section (below) |
Appendix E
Research Evidence Appraisal Tool
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Quality Rating for QuaLitative Studies |
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Circle the appropriate quality rating below:
No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1. A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: · Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated. · Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence. · Verification: The process of checking, confirming, and ensuring methodologic coherence. · Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations. · Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated. · Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality. |
1
https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALIT
A
TIVE_RESEARCH.htm
2 Adapted from Polit & Beck (2017).
Appendix E
Research Evidence Appraisal Tool
| Section III: Mixed Methods | ||||
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You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before appraising the study in its entirety. |
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1. Evaluate the quaNitative part of the study using Section I. |
Level |
Quality |
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Insert here the level of evidence and overall quality for this part: |
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2. Evaluate the quaLitative part of the study using Section II. |
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3. To determine the level of evidence, circle the appropriate study design: |
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· Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the level of the quaNtitative part. · Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on the level of the quaLitative part, and it is always Level III. · Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of providing a more complete understanding of a phenomenon by merging both datasets. These designs are Level III. · Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each phase informing the next phase. These designs are Level III. |
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Complete the Appraisal of Mixed Methods Studies section (below) |
Appendix E
Research Evidence Appraisal Tool
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Appraisal of Mixed Methods Studies3 |
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Was the mixed-methods research design relevant to address the quaNtitative and quaLitative research questions (or objectives)? |
❑N/A |
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Was the research design relevant to address the quaNtitative and quaLitative aspects of the mixed-methods question (or objective)? |
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For convergent parallel designs, was the integration of quaNtitative and quaLitative data (or results) relevant to address the research question or objective? |
❑N/A | |
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For convergent parallel designs, were the limitations associated with the integration (for example, the divergence of quaLitative and quaNtitative data or results) sufficiently addressed? |
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Complete the Quality Rating for Mixed-Method Studies section (below) |
3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studie s included in Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from
http://www.nccmt.ca/
resources/search/232
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Quality Rating for Mixed-Methods Studies |
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Circle the appropriate quality rating below
A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant study design; relevant integration of data or results; and careful consideration of the limitations of the chosen approach. B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study design; moderately relevant integration of data or results; and some discussion of limitations of integration. C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components; study design not relevant to research questions or objectives; poorly integrated data or results; and no consideration of limits of integration. |
©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Practice Question:
Date:
>Article Number
Author and Date
Evidence Type
Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level, Quality
1
Fisher-Hoch,
2
015
Qualitative
2856 adult participants from the age of 18 years and above. The study involved Mexican Americans residing in the United States who are deemed as a disadvantaged population in United States. The samples were taken from Texas.
40 percent of diabetes cases among the population was undiagnosed, reflecting underdiagnoses of the disease. The risk factors associated to it were low income, low education levels. The cause identified was lack of insurance and access to healthcare facilities. The effects severe metabolic health challenges and increased number of heart diseases.
Over one third of the population has undiagnosed diabetes.
The main limitation to this research paper is its incorporation and representation of the entire population in United States. The research focuses on one of the minority population, Mexican Americans, in United States and thus, may not give a true picture of diabetes underdiagnoses in United States.
Level II
Gregg, 2004
Qualitative
The population was obtained from the five national surveys and comprised of a population between 20 and 27 years of age. The analysis was made to determine the percentage of undiagnosed cases of diabetes nationally in United States.
The research finds out that there is a substantial decrease in the number of undiagnosed cases of diabetes and an increase in diagnosis of diabetes over the last decades but the population of the undiagnosed cases is still high, indicating underdiagnoses. The underdiagnoses is attributed to lack of awareness, especially among people whose Body Mass Index is normal and thus, they may not detect the instances of diabetes as a result of high BMI.
There is a decrease in underdiagnoses of diabetes among people with high BMI but an increase of underdiagnoses on those with normal BMI.
The main limitations in the research paper is that it fails to give a clear statistic on the decrease or increase in underdiagnoses of diabetes among those with normal BMI. It also fails to give clear risk factors to the underdiagnoses of the diseases among those with normal BMI rates.
Level II
References
Fisher-Hoch, S. P., Vatcheva, K. P., Rahbar, M. H., & McCormick, J. B. (2015). Undiagnosed diabetes and pre-diabetes in health disparities. PLoS One, 10(7), e0133135.
Gregg, E. W., Cadwell, B. L., Cheng, Y. J., Cowie, C. C., Williams, D. E., Geiss, L., … & Vinicor, F. (2004). Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the US. Diabetes care, 27(12), 2806-2812.
Johns Hopkins Nursing Evidence-Based Practice
Appendix G: Individual Evidence Summary Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
2
Directions for Use of the Individual Evidence Summary Tool
Purpose
This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence.
Article Number
Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles.
Author and Date
Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date.
Evidence Type
Indicate the type of evidence reviewed (for example: RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review).
Sample, Sample Size, and Setting
Provide a quick view of the population, number of participants, and study location.
Findings That Help Answer the EBP Question
Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question.
Observable Measures
QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study.
Limitations
Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest.
Evidence Level and Quality
Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column.