Allison Erickson
Final Project
Directions: Read the article "Case management educational intervention with public health nurses;
cluster randomized controlled trial," and then answer the following questions. Keep your answers brief.
None should be longer than a few sentences. When asked to do a hypothesis test, make sure you define the parameters, state the hypotheses, and state the technical and non-technical conclusions.
1. (4 pts) In a short paragraph, summarize the aim, method, and conclusion of this study.
The aim of the study was to evaluate the effectiveness of case management educational intervention among Public Health Nurses (PHNs) in Taiwan. The investigators determined this effectiveness through reaction, learning, and performance among the nurses. Using a cluster randomized controlled trial with pre and posttests, the investigators used the Collaborative Case Management Continuing Professional Education (CCMCPE) program. This program consisted of four half-day sessions every two weeks for the experimental group. There were four areas in which the investigators evaluated: Case management knowledge, case management skills, case manager role activities, and demographic data and evaluation data. Concluding remarks state that the CCMPCE program could be considered an evidence-based educational resource for nursing education. However, further research is needed to increase the validity of the results.
2. (4 pts) Every study begins with a review of previous studies. The authors note several gaps, or limitations, of previous studies. Briefly summarize these gaps and limitations.
Out of the 19 studies reviewed by the authors, many of the limitations were related to evaluation methods. Throughout the majority of reviewed articles, the programs that were implemented by the investigators were designed for hospital nursing staff, but few specifically evaluated the program on PHNs. Also, studies evaluated had smaller sample sizes and none had been completed in Taiwan. Continuing, the majority of the studies (15) had pre and posttest study designs and four had quasi-experimental designs. However, the participants were not randomized to experimental or comparison groups. Lastly, the effect of case management continuing professional education (CMCPE) programs on a participant’s knowledge, skills, and practices caused a limitation in how conclusions could be drawn due to lack of comparison groups.
3. (6 pts) The authors describe this study as "a cluster randomized controlled trial with pre- and post-test."
a. What are the clusters? How many clusters were initially available? How many were used for the pilot testing? How many were put in the experimental group? How many were put in the comparison group?
The clusters in this trial were the health centersselected for study. There were 12 clusters initially available and two of the twelve health centers were used for the pilot test. The remaining ten health centers were randomly selected to be in the experimental or comparison group. Therefore, each group (experimental and control) had five health centers.
b. Describe how the clusters were randomly assigned to either the experimental group or the comparison group.
The clusters were randomly assigned using ten cards containing the names of the health center. Researchers used a third partly at random to allocate one card to each health center to determine whether the center would be part of the experimental or comparison group.
c. Briefly describe what is meant by pre- and post-test in this study?
The pre-test in this study means that the CCMCPE program questionnaire was given prior to the intervention and the post-test means it was then given after the intervention for the experimental group. Also, the pre-test gathered baseline knowledge and information about the participants prior to the educational program.
d. How many total participants were in the experimental group? How many were in the control group?
In total, there were 85 nurses in the experimental group and 76 nurses in the comparison group. The experimental group started with 87 nurses, but two retired, therefore only 85 finished the program.
4. (2 pts) In chapter 2 of the textbook, we defined an experimental study as one in which something is done to a group. Briefly describe what the "something done" to the experimental group is in this study.
The “something done” to the experimental group was the CCMCPE that was conducted over four-half day sessions every two weeks and was done over eight weeks. Using the Donabedian’s structure-process-outcome quality evaluation method, the researchers focused on case management process and related activities performed by the PHNs. Researchers used instructional aids such as visual aids, lectures, written handouts, stories, and case management examples to help with learning the material. The final strategy was an interactive activity that was designed to allow the PHNs to integrate the new learning from the intervention into their daily practice as case managers.
5. (6 pts) On page 2238, the authors discuss validity and reliability. Read the short paper "Reliability and Validity" by Michael J. Miller.
a. Describe in your own words what are meant by reliability and validity.
Reliability means that any type of measurement, whether a test, observation, or a questionnaire, will produce the same results when repeated on different trials. It means that the data remains consistent over different trials and time. Also, reliability allows a measurement to be stable, consistent, and equivalent when performed with the same group multiple times.
Validity means that the measurement measures what it is supposed to measure. If a researcher wants to measure the level of job satisfaction of employees at a particular company, they would not ask questions about the employee’s favorite food or exercise because that would not be appropriately measuring job satisfaction.
b. Describe why each idea is important in a measurement instrument.
Each idea is important in a measurement instrument because when asking a research question, the instruments used to answer that question must be, simply, able to answer the question in a significant fashion. Using valid and reliable instruments during research creates more quality data.
6. (6 pts) On page 2241, the authors discuss study limitations and bias. Read the definitions of different types of bias given at the Statistical Analysis Handbook.
a. In your own words, summarize the five types of bias defined.
-Selection bias: When the subjects being studied do not accurately and appropriately represent the population of interest.
-Recall bias: When results between a comparison and experimental group appear to be distorted due to differential recall.
-Estimation bias: When the true value of a population parameter is different from the sample parameter.
-Systematic bias: When study instruments used for statistical analysis are not calibrated correctly. This could result in bias from study instrument error.
-Observer bias: When the investigators or administers of a study design influence the results from observation of study subjects, which typically occurs unintentionally.
b. Which of these types of bias do the authors of the study identify as possibly being present?
The authors identified recall bias in how the data collection method was self-reported, which could have created social bias. Also, the participants might have changed their responses to over or under-represent their knowledge and understanding to impress the administrators. Also, the authors indicate that systematic bias could occur because of the data collection procedures and how participants were not blinded to the intervention.
7. (6 pts) Table 2 on page 2240 is titled "Descriptive statistics and pre-test differences in outcome variables."
a. Briefly describe what the purpose of this table is. Specifically, what is the purpose of the hypothesis tests?
The purpose of this table is to show the statistics of the intervention effects when comparing the experimental to comparison group and the difference in variables when comparingthe comparison and experimental group pre-test scores.The purpose of the hypothesis test is to show the statistical significance of the intervention when comparing the comparison to the experimental group.
b. Based on the given results, is there any significant difference between the experimental group and the comparison group in terms of mean pre-test scores? Briefly describe how you came to this conclusion.
There appears to be no significant difference between the experimental group and comparison group because all the p-values are greater than alpha level of .05.
Please see Excel Workbook attached in separate document for questions 8-13.