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A CRITICAL APPRAISAL OF TWO ARTICLES June 27, 2009 Journal Article Review Introduction This paper presents a critical appraisal of two articles, A randomized controlled trial of a health education intervention provided by nurses to mothers of sick children written by Chan S. and Lam T. H. and Minority ethnic women and cervical screening: a matter of action or research? written by Chiu L. F. using the appropriate CASP guidelines. Chan S. & Lam T.H.
(2007) A randomized controlled trial of a health education intervention provided by nurses to mothers of sick children. Hong Kong Medical Journal, 13 (Suppl 4), 25-27 Introduction The authors of the study were concerned with the environmental tobacco smoke, representing a serious health hazard and being considered one of the most significant risk factor for acute respiratory diseases in children. Chan S. & Lam T.H. claim that carcinogenic and toxic effects of environmental tobacco smoke and smoking cause lung cancer, bronchitis, pneumonia and other serious illnesses among children whose parents smoke putting them at higher risk compared to children whose parents are non-smokers. However, not all parents are aware of the risk occurring from passive smoking.
Therefore, the authors placed high emphasis on the importance of health education intervention and advanced hypothesis that nurses should provide effective health education for mothers-smokers to reduce health risks in children. Did the study asked a clearly focused question? There was a clear statement of the aims of the research. The study was conducted with the main objective to evaluate the potential effectiveness of a nurse-led health education for mothers to educate them about serious health risks of passive smoking for their children, to reduce exposure to environmental tobacco smoke and to provide mothers with necessary educational resources to help their spouses to quit smoking. The research was very important as cigarette smoking remains the single most preventable cause of premature mortality and morbidity. (Chan S. & Lam T.H., 2007) Changing smoking attitudes and behaviors can help to reduce children exposure to the environmental tobacco smoke and to reduce health risks associated with it. The study asked a clearly focused question, as the question was clearly focused in terms of the population studied, namely, the mothers and their children exposed to environmental tobacco smoke in result of passive smoking.
The question was also focused in terms of the intervention given as the intervention offered by Chan S. & Lam T.H. consisted of two-step education program. The first step foresaw nurses providing materials and standardized health advice (two purpose-designed booklets) to non-smoking mothers of sick children suffering from negative effects of environmental tobacco smoke, while during the second step of the education program mothers were expected to provide these educational materials and advice to smoking fathers, encouraging them to quit smoking. Mothers in the intervention group were followed by a phone call one week after the first step of education program was completed, while the mothers from the control group were getting only advice and usual care from the nurses. Was this a randomized controlled trial (RCT) and was it appropriately so? The study was a randomized control trial due to following reasons. The participants of the study were allocated at random to get one of the two interventions.
One of these interventions was the standard of control (standard practice). Similar to any randomized control trial, this quantitative, controlled and comparative experiment was aimed to assess and compare the outcomes after the mothers from two groups receive the interventions. As far as the outcomes of this study were measured, this was a quantitative study. Is it worth continuing? After careful examination of the study it appears obvious that the researchers have conducted an important experiment that is worth continuing. The recruitment strategy was appropriate to the aims of the study. The researchers explained how the participants were selected and provided brief explanation why the participants they selected were appropriate. Were participants appropriately allocated to the intervention and the control groups? The participants of the study were appropriately allocated to the intervention and the control groups and the process was truly random.
The method of allocation was described. The method was used to balance the randomization. The randomization schedule was generated as follows: all participants of the group were non-smoking mothers who were assigned to a pediatric ward of one of the 4 major acute care hospitals. Additional criteria for inclusion into the group of participants were as follows. The childs father had to be a current smoker; both parents and a child had to live together in the same household; and the mother had to be able to speak and read Chinese/Cantonese. The sample size of the experiment was estimated to be 513 mothers in each group and, according to the researchers, the number of participants was based on the number of fathers expected to quit smoking (Chan S. & Lam T.H., 2007; Adair-Bischoff & Sauve, 1988; Chan, Lam, & Betson, 1999). A total of 1483 women were eventually randomized into the control (731) and intervention (752) groups (Chan S.
& Lam T.H., 2007). The groups were well balanced and there was no significant difference between the groups at entry to the trial reported. Were participants, staff and study personnel blind to participants study group? It appears that the participants, staff and study personnel were not blind to participants study group, however, it should be mentioned that blinding is not always possible and it hardly matters in this study. Were all of the participants who entered the trial accounted for at its conclusion? All participants who entered the trial accounted for at its conclusion. All participants were followed up in each study group; none of the intervention-group participants got a control group option or vice versa; all of the participants outcomes were analyzed by the groups to which they were originally allocated. Were the participants in all groups followed up and the data collected in the same way? The participants in all groups were not followed up in the same way.
As it was already mentioned, the mothers from the intervention group were followed up by a phone call 1 week after they have received standardized materials and health advice, while the mothers from the control group received only advice and usual care from the nurses. At the same time, the data for all the participants in all groups was collected in the same way (Fiore, Bailey, & Cohen, 2000; Klesges & DeBon, 1994; Prochaska & Goldstein, 1991). The data was obviously collected in a way that addressed the research issue. The setting for data collection was justified. It was clear how data were collected and the researchers have succeeded to make the methods explicit. The methods were not modified during the study.
The researchers assessed outcomes at 3, 6, and 12 months after the intervention was over. The form of data was clear. A standardized telephone follow-up questionnaire was used. The main aspects of interest were to find out the fathers quit rate; the mothers attitude towards environmental tobacco smoke, and to find out whether any changes occurred in the familys smoking habits. The main outcome measures for both groups were the US Clinical Practice Guideline, and the 7-day point prevalence quit rates at 3, 6 and 12 months. The researchers also recorded consecutive and sustained prevalence quit rates in both groups. For both groups of participants, information was analyzed by intention-to-treat analysis (carry-forward method).
Did the study have enough participants to minimize the play of the chance? As far as total of 1483 women were randomized into the intervention and the control group, the study had enough participants to minimize the play of the chance. How are the results presented and what is the maim result? The results of the study were presented in has shown no significant differences between the intervention and the proportion and as a difference. According to the researchers, baseline comparison control groups in sociodemographic characteristics of mothers, children or fathers, mothers attitude to protect children from environmental tobacco smoke exposure or fathers smoking behaviors. However, the result was quite meaningful, as there were evident short-term effects in terms of educating mothers about hazards and risks of exposure to environmental tobacco smoke, helping fathers to quit smoke and reducing the exposure to environmental tobacco smoke in children. The data analysis was sufficiently rigorous. The authors provided an in-depth description of the analysis process.
The sufficient data were presented to support the findings and the findings were explicit. How precise are these results? The results were precise enough to make a decision. Despite some positive changes in fathers behavior these short-term effects are not likely to be sustained on a long-term basis with no posterior intervention and further reinforcement. Were all important outcomes considered so the results can be applied? In the present study, all important outcomes were considered so the results can be applied. Yet, as mothers lived in Hong Kong, the participants included in the trial might be different from other populations in ways that produce different results. Local settings may also differ much from that of the trial, as this experiment was conducted for Hong Kong population. However, the same treatment can be provided in any other settings, including international healthcare settings with no evident difficulties. The research was valuable.
The researchers discussed the contribution the study makes to existing knowledge and understanding. The outcomes of the experiment were valuable from the viewpoint of policy makers, health care professionals, families, carers, individuals and wider community. Yet, as far as this study confirmed only short-term outcomes, no policy or practice should be changes as a result of the evidence contained in this trial. Chiu L.F. (2004) Minority ethnic women and cervical screening: a matter of action or research? Primary Health Care Research and Development, 5, 104-116 Introduction The study approaches the problem of cervical screening among minority ethnic women. Cervical screening is a complex social process especially when it comes to screening minority ethnic women. The research in this area was focused mostly on communication deficit of women and failed to address social context, leading to difficulties in theoretical understanding of the problem and developing ineffective practices in this area.
The researcher also claims that traditional health promotion practices and research focusing on information, culture and language are inefficient and unproductive. According to the research, applying the participatory action research (PAR) approach to this problem, the Woman-to-Woman project was aimed to involve both women and health ....
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