CRITIQUE OF STAR ARTICLE 11
Critiqueof Star Article
Thetitle of the article is good because it clearly shows the reader whatto expect in the content of the article. The title has clearlydefined the key variables in the article for instance, it hasprovided the meaning of the term STAR (staying healthy takingantiretroviral regularly). Besides, the title has been in a positionto define the key variables because it has indicated clearly thatthere are results that a reader should expect. However, the title hasnot indicated the study population. A reader has to read further inorder to understand the population under study.
Theabstract of the article does not clearly and concisely summarize thekey features of the report. Although the abstract provides a briefintroduction concerning what the reader should expect, in terms ofwhat the study involved, it does not provide a concise summaryconcerning the methods, results and conclusion. Nevertheless, theabstract has provided some details concerning the number ofindividuals involved in the study and a brief summary of the resultsthat the reader should expect.
Statementof the Problem
Theproblem has clearly been stated ambiguously and it is easy toidentify. From reading the first few sentences after theintroduction, it is easy to identify the chief problem. The problemstated in the article concerns non-adherence to antiretroviraltherapy, which is noted as one of the greatest health challenge thatis associated with the management of HIV/AIDS. The problem statementbuilds a strong and persuasive argument for the new study because itprovides evidence of study that has already been done, and clearlyshows the results that were obtained with a given population.Besides, the problem statement builds a strong persuasive argumentbecause it has provided the methodology that was used in coming upwith the results of the study. The problem discussed in the articlehas a significance for the nursing profession because individuals inthe nursing profession can use the study to add more understanding ingiving advice to the HIV/AIDS patients for instance, theprofessionals can use the knowledge from the study in advisingHIV/AIDS patients to comply with antiretroviral therapy in themanagement of HIV/AIDS. There is a good match between researchproblem and paradigm and methods used because the method used showsclearly how the research problem was investigated and analyzed.Besides, the method used is clearly indicated, which provides asupport for the results that were obtained. This offers a matchbetween the research problem and the method used. The quantitativeapproach is appropriate in this article because it has provided amathematical approach in analyzing the problem under study. Thequantitative approach is appropriate because it has been in aposition to provide an analysis to the problem being discussedthrough the use of numbers.
Hypothesesor Research Questions
Inthe article, the research questions were explicitly stated. Twohypotheses were clearly stated in the article. One of the hypotheseswas that patients assigned to the intervention condition were likelyto be adherent to the antiretroviral medications compared to patientsin the standard care condition (Murphy et al, 2007). The otherhypothesis was that patients assigned to the intervention conditionwere likely to report improved mental health and affective status,behavioral intent for adherence, levels of social support, andself-efficacy. The hypotheses are appropriately worded with clearspecifications of key variables and study population. Besides, thehypotheses are consistent with the literature review and theconceptual framework because whatever is provided in the literaturereview and conceptual framework has a relationship with thehypotheses presented.
Theliterature review comes from both primary and secondary sources. Theprimary sources involve the studies that were conducted in order tocome up with the results, while the secondary sources come frominformation concerning studies that were conducted earlier. Theliterature review is not up to date because most of the sources usedwere based on information that was obtained in 2006 going downwards.As a matter of fact, there is no source that has been used in theliterature review that shows that the information has been providedrecently. The review provides a state-of-the art synthesis ofevidence on the research problems since different sources have beenused in showing an analysis of the problems discussed in the article.The literature review also provides a solid basis for the new studythrough using other studies that have been conducted in the past.Through this reference, the literature review provides a solid basisfor the new study. For instance, the literature review has usedinformation from Fogarty et al in showing adherence interventions.
Therights of the study participants were not protected. During the studyprocess, the study participants were identified through referral fromthe physician and flyers. According to the study requirements, theparticipants were required to sign a written informed consent, whichincluded consent to medical record abstraction. Requiring theparticipants to avoid medication during the study was an indicationthat the rights of the study participants were not safeguarded. Thus,the right procedures for safeguarding the rights of the participantswere not followed. The study was subject to external review becausethe intervention sessions were led by a nurse and a cognitivebehavioral psychologist. On the other hand, the study was notdesigned with an intention of minimizing risks and maximizingbenefits to the participants because during the study, theparticipants were required to miss their medication at least once ina week in order to be eligible. This increased their risks instead ofminimizing them. Although the participants benefited from themonetary rewards that they received, they risked their life throughmissing their medications.
Giventhe purpose of the study, the research design used was not the mostrigorous. The research design did not ensure that there were pretestassessments for adherence measures and self-report adherence was notvalidated through viral load. Indeed, the research design ensuredthat there was posttest only. Different comparisons were made inenhancing the interpretability of the findings. The comparisons wereappropriate in enhancing the interpretability of the findings becausethey were associated to the problems being investigated in the study.The number of data collection points was not appropriate because onlytwo points were used. Since the design involved only posttests, therewas a likelihood of biases occurring. Besides, through paying theparticipants, it was easy to have biases and threats to the internaland external validity of the study.
Thepopulation used in the study was well identified and describedsufficiently because the article provides information clearlyconcerning those invited to participate and those that actuallyprovided data in the study. Information concerning these participantsis clear because the article provides data indicating why the 141patients met the eligibility criteria. The sampling design that wasused in the study involved the use of 2 (group: intervention vs.standard care) * 3 (time: baseline, 3-month, 9-month) between-withindesign for the mental health, cognitive, and substance use variables(Murphy et al, 2007). Besides, a mixed model approach was used in thestudy, which ensured that there was sample representativeness. Inorder to minimize sample bias in the study, repeated measures wereused. This ensured that group differences were evaluated. In thestudy, type 2 error was not guarded against through conducting poweranalysis. The sample size was not adequate given the number ofvariables being studied. Besides, given the importance of the study,a large sample should have been used in order to have a well-felteffect.
DataCollection and Measurement
Theconceptual and operational definitions of variables are congruent.This is because from the article, the conceptual and operationaldefinitions of the variables tend to match. For instance, for doseadherence, the conceptual and operational definitions match eachother. The key variables in the study were operationalized dependingon the need for the study. The variables were chosen using the bestmethod because it was possible to measure the variables. However,there was not enough justification for the variables used becauseother variables could still have been used. Nevertheless, thevariables used in the study fit best for the study because they werecapable of bringing results, which was the most vital aspect for thestudy. Some of the instruments in the study were not adequatelydescribed and evidences of reliability or validity were not provided.For instance, the article only provides that there was a consent formthat the participants were required to sign, but it does not fullydescribe the contents of the form, nor does the article provide thevalidity of such a form. Given the study population, such aninstrument was good because it is important to get the consent of thepatient prior to using him or her in a study. On the other hand,using the instruments was somehow a bad choice given that the rightsof the participants have to be safeguarded. From the article, theresults from the study were not accurate because patients were paidin order to participate in the study this could have influenced theoutcomes of the study. Besides, the results were not accurate becausethere were some other limitations for example, some patients missedscheduled appointments for pill counts or even forgot bringing theirpills, a move that could have affected the results.
Therewas an intervention in the study, which was well implemented throughpatient education. Through patient education, it was feasible toimplement the intervention since patients taking part in the studycould be taught the strategies of behavior change. The reportindicates that there were two intervention groups that received theintervention. In the study, there was no evidence of interventionfidelity because it was not mentioned or implied in the article. Thecollection of data in the study was done in ways that did not ensureminimization of bias. For instance, in the collection of data, thepatients were put into two groups. More than two groups could haveensured minimization of bias. On the other hand, the interventionistswere adequately trained because they followed a detailed content andprocedures manual for intervention delivery (Murphy et al, 2007).
Thestatistics were done using t test and results tabulated. In order toprotect the statistics against type I error, Bonferroni adjustedalpha was used. In testing the hypothesis, t test was also used.Statistical methods were used appropriately in the study for thelevel of measurements of the variables. This is because the methodswere applied accordingly in order to avoid errors. Besides, thegroups were compared accordingly using the statistical methods, whichdepicted an appropriate use of the statistical methods. The analysishelped in the control of confounding variables because all thevariables were analyzed as per the measurements employed. Theintention to treat analysis was used for increased validity becauseit could make the participants well informed in ensuring that thechange process became implemented with ease. From the article, it wasevident that type 1 errors were avoided through using the t test withthe Bonferroni adjusted alpha (Murphy et al, 2007). However, type 2errors were not avoided.
Thefindings of the study are adequately summarized in the article.Tables and figures have been used in depicting the findings of thestudy. Information concerning statistical significance has beenpresented in the article. According to the article, no significantfindings were noted at the 0.01 level, when examining preexistinggroup differences at the initial time points. Besides, the issueconcerning confidence intervals was also presented in the article.The issue of confidence intervals was presented in the cases ofhealth-related anxiety, self-efficacy for adherence, behavioralintent, depression, and social support.
Allmajor findings have been interpreted and discussed within the contextof the study’s conceptual framework. This is because most thefindings have been based on the study that was carried out involvingthe patients. The interpretations are consistent with the results andwith the study’s limitations. This is because as it is expectedwith any study having limitations, the results are likely to becomebased on the limitations present. For instance, in the case of thisstudy, the limitations have led to the realization of results thatcannot be relied upon. From the article, the issue ofgeneralizability of the findings has not been addressed. Besides,there are no recommendations offered concerning the way forward onthe issues pertaining to the study under consideration (Murphy et al,2007). On the other hand, researchers have discussed the implicationsthat the study can have for the clinical setting. According to theresearchers, implications from this study can suggest that providersmay desire assessing patients’ self-efficacy for treatmentadherence early enough during the process of prescribingantiretroviral because it can help providers in establishing howlikely it can be that their patients would be successful (Murphy etal, 2007). Alternatively, patients having low self-efficacy mayrequire to be referred for case management services, which couldfocus on adherence intervention. These implications are reasonablebecause they can help clinical practitioners in providing care.
Thereport is well written because it has a good flow from theintroduction, the way the study became carried out up to theconclusion. Besides, the report is well written because it isprovides results that go hand in hand with the limitations present inthe study. The report is well organized for critical analysis becauseit has points that are well structured and detailed givingexplanations to researchers, and giving researchers an opportunity toask whether the study is valid or not, or whether it providesinformation that is not contradictory. The report has been written ina manner that makes the findings accessible to practicing nursesbecause it can be obtained from any point through downloading it.This makes it accessible to different practicing nurses. Researchers’clinical methodological qualification and experience enhance theconfidence in the findings and their interpretation because know howis needed in understanding how the study was carried out and therelation of the results with the findings. This knowledge would becritical in understanding the findings and the interpretations thatwould follow.
Thestudy findings appear to be valid, despite the limitations present.This is because the methodology used seems to give a true picture ofthe case presented. Besides, from the findings, the results seemvalid because statistical methods have been used in ensuring thattype I errors are avoided. In addition, from the findings, theresults appear valid because other sources have been used to supportthe information presented in the study, which would make the resultsvalid. The study is of meaningful application to the nursing practicebecause nurses can use this information in trying to understand theirpatients in a better way. Besides, the study can also be ofmeaningful application to statistics because one can use the study inunderstanding how to analyze data.
Murphy,A.D., Marelich, D.W., Rappaport, B.N., Hoffman, D. & Farthing, C.(2007). Resultsof an Antiretroviral Adherence Intervention: STAR (Staying Healthy:Taking Antiretrovirals Regularly). SantaMonica: Sage Publications.