This is a quantitative research critique on a study conducted in 2008 in the northern province of Chiang Rai, Thailand. The study investigates the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies, and health-related quality of life (HRQOL) in people living with HIV/AIDS (PLWHA) in the northern region of the said country. Four hundred twenty-two subjects were selected to participate in the research and from them data were collected with the use of four different questionnaires. The results revealed that symptom experience had a significant negative direct effect on the HRQOL as opposed to age, social support, antiretroviral treatment and self-care strategies which had significant positive effect on the HRQOL. Furthermore, it was seen that social support and antiretroviral treatment had an indirect effect on the HRQOL through self-care strategies. With these findings, it was recommended that promotion of social support and adherence to antiretroviral treatment must be achieved to enhance the quality of life of people living with HIV/ AIDS.
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The title is laconically stated which included a minimal number of words but still adequately describes the contents of the paper (Day & Gastal, 2006). It is concise yet does not compromise its relevance and does not sound uninteresting. It is briefly put together but still is reasonably extensive to explain the research without overwhelming readers with too much information. Moreover, the title is formulated in a strong and simple manner which is very important in ensuring readers will not be distracted or confused. The title presents the subject of the research which is the health-related quality of life in people living with HIV/ AIDS in the northern region of Thailand.
The researchers of this study are Thitiarpa Tangkawanich, Jintana Yunibhand, Sureeporn Thanasilp, and Kathy Magilvy. Thitiarpa Tangkawanich, RN, Msc, Jintana Yunibhand, RN, Msc, PhD, and Sureeporn Thanasilp, RN, Msc, DNS are members of the Faculty of Nursing in Chulalongkorn University, Bangkok, Thailand while Kathy Magilvy, RN, PhD, FAAN is a professor of the College of Nursing of the University of Colorado, Denver, Colorado, USA. With all these academic credentials and qualifications, the researchers can be considered credible personalities in their respective fields of specialties. The research was made by respected professors and registered nurses. All of them have master’s degree while Tangkawanich is the only one without a doctoral degree.
The article uses an indicative or descriptive abstract to provide a brief summary of the main points of the research (Day & Gastal, 2006). Since the research studies a social happening in a quantitative approach, the researchers used this kind of abstract as it describes what transpired during the entire research process. The abstract mentions the condensed form of the research aim, which is to find out the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies and health-related quality of life. The methodology used in conducting the research is mentioned although some information was excluded as they were discussed in detail in the succeeding parts of the research. Four different questionnaires were used to collect data from the 422 respondents chosen for the study. Using the Likert rating scale, the data were analyzed and were then subjected to statistical treatment with SPSS and LISREL. The abstract also reports the major findings (Day & Gastal, 2006) which show that symptom experience has a significant negative effect on the HRQOL while the other remaining variables had a significant positive effect. Additionally, social support and antiretroviral treatment were also found to have an indirect effect on HRQOL via self-care strategies. Lastly, the abstract of the study suggests a recommendation for the health-care team, together with the family and community, to promote social support and ensure antiretroviral treatment to enhance the quality of living in people living with HIV/ AIDS considering the research findings. It also illustrates the study’s significance to clinical practice.
The research problem is clearly presented in the introduction of the article as it explains the rationale behind the conduct of this study (Walsh & Wigens, 2007). The aim in this study is to investigate the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies and the HRQOL in people living with HIV/AIDS in northern Thailand. It examines whether or not relationships between these factors exist, what kind of relationships exists if there are any and how does it implicate the people with the infection and the probable interventions to be taken by health care team as well. The introduction was also able to give a situation about how people with HIV/AIDS in the involved study setting live their lives. It gave a brief discussion about HIV/AIDS which significantly provides a good jumpstart in explaining the entirety of the research. The introduction states the scarcity in research material that focus on the relationships among the variables identified, HRQOL and PLWHA, establishing the need for the study to be conducted. Although the introduction was able to discuss the major points and variables in the study, it did not include the limitations. Additionally, the introduction also did not explain the main topic from a bigger international scope to a narrow and more specific level (Day & Gastal, 2006). In sum, the introduction was able to establish a clear logic, an analysis of previous works, background information and the main purpose of the research (Walsh & Wigens, 2003).
The wide literature review used in the research was able to give a good background about the major points in the study. However, many other materials still could have been used to further strengthen the study’s literature review. It is noteworthy that the study is supported by up to date information which makes it more timely and relevant. The literature review utilised articles from many other researchers whose research outputs have greatly provided helpful data to the study. The description of the present living conditions of the respondents (Sukati et al., 2005), the self-care strategies that they use (Panuwatsuk, 1998), the symptoms and their correlation to HRQOL (Dodd et al. 2001), the current antiretroviral treatment (Heckman 2003), all these and others, were taken from researches conducted from year 2000 through 2007. The literature is able to present in text the theoretical structure from which the study was anchored. With the amount of referenced articles presented in the literature, the balanced evaluation of supporting and opposing materials for the proposition is demonstrated. Since only few researches studies were made regarding the indirect effect of the many factors identified on the HRQOL in PLWHA, the necessity to develop a model that could present the direct and indirect effects of the predictors on the HRQOL in PLWHA has clearly risen as stated in the literature review. Moreover, important references were acknowledged accordingly to further reinforce the soundness of the study. Notwithstanding, it may have given an extensive overview on the study, but still it was not able to present a few significant points. Although the literature illustrated a comprehensive background on the study and the variables involved, it did not overtly cite the fundamental theoretical framework.
The study is a quantitative research which tries to explain a social phenomenon. This connotes that no alteration of the environment was made and the respondents were not subjected to any form of controlled setting, thus, variables involved are limited. Since this is a quantitative research, it must have a sound hypothesis which will serve as its backbone. But it is not stated instead, an implied hypothesis was used to see whether or not relationships exist among the predictors: age, antiretroviral treatment, social support, self-care strategies and symptom experience on health -related quality of life in people living with HIV/AIDS. This is an example of a non-directional hypothesis (Wood & Haber, 2006), where the hypothesis being tested is two-sided but can be tested by acquiring data and subjecting them to statistical analysis.
The researchers used words that are mostly clear and understandable. They did not use too many jargons in the stud. Abbreviations like HRQOL, PLWHA and HIV/AIDS are also clearly defined to avoid confusion. Terms also have consistent and coherent definitions throughout the study, especially those operationally defined for this research (Walonick, 2005).
The study uses a cross-sectional quantitative study with a non-experimental research design in identifying the respondents’ level of HRQOL in relation to their age, antiretroviral treatment, social support, symptom experience, and self-care strategies. It means that an observational study using a collection of data on one occasion was made with a specific group of population all at the same time (Walsh & Wigens, 2003). It is the appropriate method to be used as it gives a snapshot of what happens in a chosen target group or a phenomenon at one point in time (Babbie, 2010). It is also fit for this research as it is commonly used in social and medical science. However, it also has its weakness or limitation since it only captures the data at one specific time as opposed to longitudinal studies which involve a series of measurements taken over a period of time (Babbie, 2010). Being a non-experimental research, no manipulation of the variables was done and there was no attempt made to change the condition, behaviour or the environment of the variables as they are measured and analysed as they are. The respondents were just made to answer questionnaires that will reflect their own personal experience and at the same time provide data for the researcher’s perusal.
The subjects chosen for the study are 422 people living with HIV/AIDS who visited eight chosen outpatient hospitals in the province of Chiang Rai in the northern part of Thailand. Of which, 188 are males and 234 are females, with ages ranging from 21 to 51 years old. The number of respondents may not be sufficient to completely represent the target population in the research setting but in many circumstances, a smaller sample size may be more significant and usable in investigating a situation in depth from different perspectives, while a large sample would be insignificant especially in social researches (Myers, 2000).
The researchers employed the lottery method without replacement in randomly selecting eight hospitals out of the seventeen hospitals in the northern province of Chiang Rai, Thailand. A random sampling method was then made to determine the 422 subjects who will be part of the study. They are people living with HIV/ AIDS who visited the eight chosen outpatient hospitals. The use of lottery method in conjunction with simple random sampling makes the selection of respondents more effective and valid as it ignores repeat selections of element and gives more precise estimators (Kalton, 1983). Clearly, the approach used in sample selection and the sample size are undoubtedly stated.
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The researchers were able to methodically discuss the procedure undertaken in data collection. They used four questionnaires to gather data from the participants: social support questionnaires, symptom experience questionnaire, self-care strategies questionnaire and health-related quality of life questionnaires. Each of these questionnaires has been carefully chosen and drafted for the study. The three questionnaires for social support, self-care strategies and health-related quality were all adapted from previous research while the questionnaire for symptom experience was drafted basing on the review of literature. The validity and reliability of the questionnaires were greatly anchored on the internal consistencies used for each questionnaire. The questionnaires are meticulously reviewed by the researcher to ensure its ability to measure what it intends to measure (Foddy, 1993). However, no mention about pilot testing was made and this may be considered one of the study’s weaknesses.
Creswell (2003) stated that ethical issues arise most commonly in data collection where confidentiality and anonymity are in careful scrutiny. These concerns are recognised and acted upon by the researchers by ensuring respondents were given due protection and their safety is not abridged. The researchers acquired the approval of the Ethical Review Committee for Research Involving Human Subjects and/or Use of Animals in Research, Health Science Group of Faculties, Colleges and Institutes, Chulalongkorn University, and the Ethical Review Committee for the Biomedical Group, Chiangraiprachanukroh Hospital, Thailand. With human subjects involved in the study, such approval was obtained. The purpose and methods of the study were explained to the participants through the informed consent which acknowledges the participants’ rights are protected (Creswell, 2003).
The results of the study were presented clearly in graphical form and text. The results of the statistical treatment of the data were explained in four concise yet highly informative paragraphs while the demographics of the subjects were presented in a more visual and understandable table (Kumar, 2005). The internal consistencies of the data, using the Cronbach’s alpha were also presented accurately, for social support 0.8, for symptom experience which was clustered into six symptoms, fatigue 0.88, nausea 0.92 , diarrhoea 0.93, depression 0.92, neuropathy 0.93 and anxiety 0.92; for self-care strategies 0.77 and finally for HRQOL 0.85. Given all these figures, readers are assured that the results are well calculated and analysed to ensure that high level of validity and reliability is achieved.
Four different and highly-structured questionnaires (Overseas Learning Faculty 2004) were used in collecting data. The use of questionnaires is the appropriate technique in obtaining data for cross-sectional designed research or social surveys as it acquires first-hand information from the subjects without alteration or manipulation of their responses (Bryman & Bell, 2003). On the other hand, SPSS and LISREL, statistical computer programs that perform higher calculations and structural equation, were used for statistical analysis. Statistical treatments done with the said statistical tool are considered highly correct (Norwegian School of Management, 2009). The results of the data analysis show that path relationships between the variables were investigated to ensure that significant differences are not attributed to variations in other relevant variables. It can also be noted that the data analysis adequately showed the complete information with the test value, degree of freedom and probability for each identified variable, thereby giving more established results.
The discussion of the research findings ties together all the pieces of the study and gives a picture of the study as a whole. It relates and translates the figures to literature review thus making it more comprehensible and balanced (Russel, 2002). The researchers were able to go back to literature and discuss that most of their research findings are consistent and similar with the works previously done by other researchers on HRQOL in PLWHA. It also tackled the implications of the subjects’ socio-economic status, gender, age, social support, antiretroviral treatment, and symptom experience and self-care strategies to their health-related quality of life. The limitation of the study was also acknowledged where the use of cross-sectional model was perceived to be the model’s weakness since it only gives a snapshot of the existent observable fact at one point in time (Wood & Haber, 2006). Thus, it was suggested that future studies should be conducted to further establish the causal relationships between the variables longitudinally over a longer period of time to acquire enduring and more reliable research results.
The conclusion coheres with and is supported by the results obtained. The researchers conclude that a causal model of HRQOL in PLWHA indicate that most factors have direct and indirect effects on the HRQOL. Consequently, age, social support, antiretroviral treatment, symptom experience, and self-care strategies are considered to be significant factors in explaining and predicting the HRQOL in Thai PLWHA. Furthermore, self-care strategies link social support and antiretroviral treatment with HRQOL in Thai PLWHA. The researchers also presented the implications of the study which are very instrumental in the study’s final recommendations.
With the findings and conclusions at hand, the researchers strongly recommend feasible propositions to help people living with HIV/AIDS achieve a higher quality of living as they hurdle challenges of immense proportions, including HIV-stigma, lack of social support, and mental health issues such as depression (Jiraphongsa et al., 2009). The researchers gave motivation on the promotion of social support from the family and the community as it was found to be positively correlated with a better quality of life (Fogel, 1998). Observance to antiretroviral treatment, early symptom detection and prompt intervention and practice of self-care strategies must also be ensured to achieve a higher quality of living. The researchers also pointed out the need to conduct future research on this topic to overcome the limitations they met in conducting this academic work for stronger and more reliable results.
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