Research Critique

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment (or two new articles based on instructor feedback in Topic 1) to complete this assignment.

In a 1,000–1,250-word essay, summarize two quantitative studies.

Use the “Research Critique Guidelines – Part II” document to organize your essay.

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Answer

Research Critique

Tuberculosis (TB) remains a significant global health concern, with non-adherence to treatment being a considerable barrier to TB prevention and control (Adisa et al., 2021). Two recent articles have explored the factors influencing TB treatment adherence in different contexts: one focusing on patient perceptions in Brazil and the other examining health facility factors in Eritrea. This paper aims to synthesize and compare the findings of these two studies to identify common barriers and enablers to TB treatment adherence and propose evidence-based strategies to improve adherence.

PICOT Question

In patients with tuberculosis (P), what are the effective strategies to improve treatment adherence (O), considering individual and social vulnerabilities, such as economic precariousness, stigma, medication side effects, and lack of knowledge (I), compared to standard care alone (C) within the first six months of treatment (T)?

Background of Studies

The first article is a qualitative study that explores patients’ perceptions regarding the influence of individual and social vulnerabilities on their adherence to tuberculosis treatment. The study was conducted in a large municipality in the Northeast of Brazil, where tuberculosis is prevalent among vulnerable individuals with poor living conditions and limited access to healthcare services. The study involved 13 participants diagnosed with tuberculosis between March and June 2015. The study found that social exclusion, stigmatization, economic precariousness, and poor access to transportation were significant obstacles to adherence to tuberculosis treatment. However, social support and directly observed treatment were critical enabling factors that helped patients overcome these obstacles and adhere to treatment. The findings of this study have significant implications for nursing practice, as nurses play a critical role in providing social support and facilitating adherence to tuberculosis treatment among vulnerable patients. The research question is “What is the patient’s perception regarding the influence of individual and social vulnerabilities on adherence to tuberculosis treatment?”

The second study aims to assess the factors influencing adherence to tuberculosis (TB) treatment in selected health facilities in Asmara, Eritrea. The study used a qualitative approach, conducting in-depth interviews with 12 TB patients, three focus group discussions with one group comprising eight patients, and key informant interviews with three health workers. The study found that lack of knowledge, income loss, stigma, social support, medication side effects, and prolonged treatment duration were significant barriers to treatment adherence. Short distances to health facilities, good communication, and accepting attitudes of health care providers were found to be enablers for adherence. The research question to the study was, “What are the factors that influence adherence to tuberculosis treatment in selected health facilities in Asmara, Eritrea?” The study’s findings can inform the development of effective interventions by nurses to improve TB prevention and control.

How Articles Support the Nursing Practice Problem

The two articles provide valuable insights into the factors influencing adherence to tuberculosis treatment among vulnerable patients. The first qualitative study highlights the significance of social support and the importance of links with family members and health professionals in reducing social exclusion and promoting individual and family empowerment to encourage adherence to tuberculosis treatment. The second qualitative study identifies lack of knowledge, loss of income, stigma, lack of social support, medication side effects, and prolonged treatment duration as significant barriers to adherence. These findings can inform the development of effective interventions by nurses to improve TB prevention and control. They can help answer the PICOT question by identifying effective strategies to improve treatment adherence considering individual and social vulnerabilities. The two articles discuss interventions and comparison groups relevant to the PICOT question. Both studies emphasize the importance of identifying and addressing individual and social vulnerabilities, such as economic precariousness, stigma, medication side effects, and lack of knowledge, to improve adherence to tuberculosis treatment.

Method of Studies

The first article used a qualitative descriptive cross-sectional study design to investigate patients’ perceptions about the influence of individual and social vulnerabilities on adherence to tuberculosis treatment. The study covered all tuberculosis cases diagnosed between March and June 2015 in a large Paraíba, Northeast Brazil municipality. The sample size was determined based on response saturation criteria. Data was collected using audio-recorded interviews with 13 participants, and data analysis was carried out using the hermeneutic dialectic method and the theory of Generative Route Sense. One benefit of this method is that using a qualitative descriptive cross-sectional study design allows for an in-depth exploration of complex phenomena and provides rich, detailed data. However, one limitation is that the study design did not qualify for examining causal relationships between individual and social vulnerabilities and adherence to tuberculosis treatment.

On the other hand, the second article employed a qualitative study design. It involved in-depth interviews with 12 TB patients, three focus group discussions with eight patients in one group, and key informant interviews with three health workers in selected health facilities in Asmara, Eritrea. Data analysis was conducted using the thematic framework, involving transcription and translation of the interviews and focus group discussions. One benefit of this method is that the inclusion of key informant interviews with health workers allowed for a deeper understanding of the health system’s perspective on factors influencing adherence to tuberculosis treatment. However, one limitation is that the small sample size may limit the generalizability of the findings to other settings beyond Asmara, Eritrea.

Results of Studies

The first qualitative study revealed that social stigma, prejudice, and discrimination from family members and friends were significant barriers to adherence. Adverse effects from medication, work incapacity, malnutrition, and alcoholism were also identified as significant barriers. Conversely, support from family members, health professionals, and faith and religiosity were enabling factors for adherence. The study highlights the importance of health professionals paying close attention to patients’ needs to reduce social exclusion and strengthen adherence to treatment.

The second study found various factors influencing adherence to TB treatment in Asmara, Eritrea, including a lack of knowledge about the disease, transportation issues, loss of a source of income, social factors, drug side effects, and extended periods of treatment. The study highlighted the importance of social support, as those who had financial or emotional support from their families and communities were more likely to adhere to the treatment regimen. The findings of the two studies suggest that nursing practice should prioritize providing individualized care that addresses patients’ social and emotional needs and focus on enhancing social support and patient education to improve adherence to TB treatment regimens.

Ethical Considerations

Maintaining ethical considerations is crucial in research to respect participants’ dignity, rights, and welfare. Two important aspects are obtaining informed consent and safeguarding participants’ confidentiality and privacy. Informed consent allows participants to understand the research’s nature, risks, benefits, and right to withdraw. Confidentiality and privacy protect participants’ data and identities from being disclosed without consent, fostering trust between researchers and participants (Barrow et al., 2022). Both studies discussed in the articles adhered to ethical guidelines by obtaining informed consent, preserving participants’ anonymity, and storing data in secure locations. Research ethics committees also approved the projects, and participants were informed of their right to withdraw at any time.

Conclusion

The studies provide valuable insights into the factors influencing adherence to tuberculosis treatment among vulnerable patients and emphasize the importance of identifying and addressing individual and social vulnerabilities to improve adherence. However, the limitations of the study designs and small sample sizes may limit the generalizability of the findings to other settings beyond the study locations.

 

References

Adisa, R., Ayandokun, T. T., & Ige, O. M. (2021). Knowledge about tuberculosis, treatment adherence, and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centers in southwest Nigeria. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10698-9

Barrow, J. M., Khandhar, P. B., & Brannan, G. D. (2022, June 22). Research ethics. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459281/

Da Silva, R. D., de Luna, F. D. T., de Araújo, A. J., Camêlo, E. L. S., Bertolozzi, M. R., Hino, P., Lacerda, S. N. B., Fook, S. M. L., & de Figueiredo, T. M. R. M. (2017). Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: A qualitative study. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4752-3

Gebreweld, F. H., Kifle, M. M., Gebremicheal, F. E., Simel, L. L., Gezae, M. M., Ghebreyesus, S. S., Mengsteab, Y. T., & Wahd, N. G. (2018). Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: A qualitative study. Journal of Health, Population and Nutrition, 37(1). https://doi.org/10.1186/s41043-017-0132-y

 

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