NURS 8201 Article Critique

Grey, M., Whittemore, R., Jaser, S., Ambrosino, J., Lindemann, E., Liberti, L., Northrup, V., … Dziura, J. (2009). Effects of coping skills training in school-age children with type 1 diabetes. Research in nursing & health, 32(4), 405-18.

The article Effects of Coping Skills Training in School-age Children with Type 1 Diabetes by Grey et al. (2009) sought to determine the efficacy of two interventions on the management of TID by school-going children. Using a stress adaptation model, the authors wanted to establish the physiological and psychosocial adaptation degree of the sample to the stress of living with type 1 diabetes. Under the hypothesis that coping strategy training influences people’s response, context, and adaptation, Grey et al. ( 2009) purposed to “determine the effect of group-based
CST for school-aged children with T1D and their parents compared to an attention-control
group receiving supplemental general diabetes education (GE) over a period of a year on
children’s metabolic control, QOL, depressive symptoms, coping, self-efficacy, and family
functioning at 12-month follow-up” (p. 4 ) using a randomized clinical trial. In order to accomplish this, the authors created a two group experimental design whose sample consisted of children between the ages of 8-12 and who had insulin resistance. They initially targeted a sample size of 100 children who would become subjected to coping skills training and group education as the intervention methods for the study. Using SAS 9.2 (SAS Institute, Cary, NC), Grey et al. ( 2009) analyzed the data collected on metabolic control, child quality of life (QOL), child depressive symptoms, coping, self-efficacy, and family function variables.

The results of the study revealed non-significant outcomes as they did not add any new concept to the existing literature on the subject. However, the authors noticed that both group education and coping skills training led to the improvement of the group over a period. Consequently, the participants demonstrated enhanced impact of diabetes, fewer depressive symptoms, better T1D self-efficacy, improved diabetes coping, and substantially reduced parental control. Thus, the authors proffered that the findings implied that the group-based strategy possessed a better intervention outcome for the sample in question. Having said that, the study also revealed that CST intervention did not produce the desired effect of enhanced metabolic control, family functioning, self-efficacy, coping, depressive symptoms and quality of life, in contrast to the study’s hypothesis. In conclusion, the study recommends future research to examine the efficacy of CST on subjects of racial, ethnic, and socio-economic diversity in addition to children of elevated HbA1c levels as well as those with multifarious family functioning and psychosocial adjustment.

Strengths and Weaknesses of the Study

The researchers postulate that they employed the usage of a randomized trial approach for the study. During the study, the authors used trained research assistants to collect data at baseline, and 1, 3, 6, and 12 months after randomization. Thus, the researchers describe the data collection method in sufficient details as expected of a randomized trial study. Indeed, the design and sample of the study received considerable attention from the researchers. As evidenced from the article, minimization of bias occurred in the study since the research assistants became blinded to the group assignments. Pursuant to observations made by numerous studies on the significance of blindness in randomized control trail, the elimination of bias in a study makes it an important aspect of RCT and gives it the edge over other methodologies in research studies (Mansournia, Higgins, Sterne, & Hernán, 2017). In other words, the credibility of the study received a major boost because of the fact that the study design had some level of blindness.

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Moreover, the study design utilized in the present article allowed for the existence of a controlled group allocation for both the CST and GE samples. As a consequence, the study enhanced the similarity of baseline features since the participants of the study possessed similar baseline features such as similar ages (8-12 years), suffering from T1D and underwent insulin treatment for at least 6 months, as well as free of other significant health conditions. The existence of these commonalities in the study sample allowed the researchers to establish a basis for their statistical hypothesis (In Asche, 2016). Therefore, the study design elected for this research enabled the research to

The approach adopted by the researchers in writing the discussion has consistency with the characteristics of a good research article. Mack (2018) postulates that a discussion section offers readers specific guidance regarding the accomplishments of the study, its scientific significance, as well as the next course of action that researchers should undertake. This article started its discussion by revisiting the purpose of the study. Indeed, the authors continued by stating that the intention of the CST intervention that formed the foundation of the study involved offering a preventative intervention for children going to school who may have type 1 diabetes. In addition, the discussion section needs to address the limitations of the study with regards to numerous aspects such as study design. In the article, the authors highlight several limitations that the study experienced. Key among these limitations include factors such small sample size and the absence of racial and economic diversity as the participants predominantly came from White, upper class children. Therefore, the study’s discussion demonstrates certain points of strengths that adhere to standard procedures for scientific and journal research articles.

The study as conducted by Grey et al. (2009) wanted to establish the role of CST in the management of type 1 diabetes in adolescent students. The authors shared important results regarding the application of CST vis-à-vis GE in the process. However, the authors admitted to having a small sample size in the range of 100 students initially. Due to various factors, the final number (82) of the participants reduced the sample size even further. Specifically, the article points out that 24% of the projected participants did not participate in group-based intervention due to scheduling bottlenecks, which resulted in an absence of exposure leading the researchers to eliminate them from the study. Consequently, the small sample size negatively impacts the generalizability of the study results.

Moreover, the sample used for the study did not demonstrate diversity across various spectra. The moderators involved in determining the intervention efficacy in children suffering from type 1 diabetes included socioeconomic status, agent, and sex. According to the article, the study participants predominantly came from the middle-to-upper income family that reflected the clinic population. In contrast, previous research on the subject supports the usage of participants with variable socio-economic status, which provides a significance impact on psychosocial adjustment and metabolic control. Nevertheless, due to the absence of such variation in the sample, the achieved results, which were inconsistent with the study hypothesis, accrued. The absence of diversity in the present study sample does not confine itself to the socioeconomic status. According to the analysis of the study sample, the participants only came from the predominant White ethnicity. The absence of minorities in the study thus makes the applicability of the results questionable. Numerous researchers have discussed the significance of racial diversity in study samples such as ones related to the effect of certain interventions on long-term disease conditions. Conclusively, they assert that the presence of such diversity offers a study validity in terms of the applicability of the results since different ethnicities are impacted differently (Konkel, 2015). As a matter of fact, most of the interventions applied in the present study could produce significant results on minority children, which would have given the researchers a valuable insight into the matter. Nevertheless, the present study lacks this ethnic variation and the authors do not recommend it as a future area of interest for researchers. Therefore, the absence of variations in the socio-economic and racial status of the study participants negatively impacts the generizability and validity hence applicability of the study results.

The third weakness of the study could also have correlation to the statistical methodologies adopted to both gather and analyze data. An evaluation of the article reveals the absence of a comparatively robust demonstration concerning the construct reliability and/or validity. Research works such as Green et al. (2016) reveal that the absence of validity and/or reliability normally accrues from the instrument elected by the researchers. In the present article, the researchers chose to utilize several subscales to acquire data for the study mediators. In particular, the usage of DFBS Guidance and Control and Coping How Upsetting in the study negatively impacted the instrument’s internal consistency reliability. The presence of this phenomenon in the study thus resulted in increased measurement variance. In other words, the usage of DFBS Guidance and Control and Coping subscales lowered the internal consistence of the T1D scale hence leading to lowered reliability of the study measurement (Polit, 2014). Thus, a noticeable weakness appears in the statistical instruments adopted by the researchers.

Changes to Improve the Quality of the Study

The results of the study indicated that the usage of CST lacks considerable effect on the mediators of Type 1 Diabetes in school-going children of the middle to upper social classes. This observation does not align with the hypothesis presented by the article. Whereas several factors could lend an explanation as to why the researchers arrived at this conclusion, none do so more than the observed weaknesses of the study. Therefore, in order for the quality of the study to improve and make observations that will influence the nursing field, the authors may need to address some of the aforementioned weaknesses while capitalizing on the study’s strengths. Given that bias in the study was minimized during the participant selection process, the researchers will need to improve on the sample size (Mack, 2018). In order to do this, the study will have to increase the number of participants from 100 to 200. Similarly, the study needs to ensure that all the participants take part in the process. An evaluation of the article identified scheduling conflicts as one of the issues that reduced the participation of 24 children. Thus, through collaboration with the children’s parents, the researchers need to devise a schedule devoid of such conflicts to increase the level of participation.

Contemporary governance documents on research explore the need for the body of research evidence to demonstrate population diversity. Konkel (2015) suggests that determining who will benefit from an intervention regarding a certain disease condition largely depends on who makes the composition of the study. The absence of such diversity makes researchers to succumb to the fallacy that extrapolating the results that predominantly targeted one group to another group makes their works consequential. In the current article, the researchers will have to discover ways of diversifying the socio-economic status of the study sample as well as the racial composition of the participants so as to make an appealing generalizability regarding their results. To achieve this objective, the researchers may need to vary the settings for recruiting children. In the article, the participants exclusively came from a pediatric diabetes clinic from the Northeast, which implicitly reveals the lofty socio-economic status of the concerned parents hence the potential study participants. However, the researchers could remedy the issue by additionally recruiting study participants from similar clinics in minority areas. Barr (2014) observes that minority populations in the United States have historically registered lower socio-economic indices hence they form a good source of ensuring both racial and socio-economic diversity in a study. Hence, the inclusion of children from such regions alongside some from the study’s setting will ensure more diversity hence applicability of the study results.

Implications for Nursing Practice

The findings of the study on other aspects other than the hypothesis have substantial implications. The study revealed that 11% of the participants showed elevated depressive symptoms at baseline. Given that measuring for these symptoms form the health promotional undertakings of nurses, it follows that the study has revealed to nursing practice the significance of screening for depression symptomatology for school-going children suffering from type 1 diabetes. Further, the study also highlighted the positive impact of insulin pump in type 1 diabetes patients from the age group in question. Nursing practice can thus benefit from the recommendation as they strive to promote the health of T1D students. Lastly, the study elevates the currency of psyscho-educational interventions for school children suffering from T1D as well as their parents so as to improve the health of the latter group. Nursing practice thus benefits from the recommendation as the study has provided one more intervention for these types of patients. Therefore, the practice of nursing, particularly regarding their role in health promotion activities among students with T1D has received significant support from the study.

Reference

Barr, D. A. (2014). Health disparities in the United States – social class, race, ethnicity, an. Baltimore, MA: Johns Hopkins University Press.

Green, S. B., Yang, Y., Alt, M., Brinkley, S., Gray, S., Hogan, T., & Cowan, N. (2016). Use of internal consistency coefficients for estimating reliability of experimental task scores. Psychonomic Bulletin & Review, 23(3), 750-63.

In Asche, C. (2016). Applying Comparative Effectiveness Data to Medical Decision Making: A Practical Guide. Cham: Springer International Publishing.

Konkel, L. (2015). Racial and Ethnic Disparities in Research Studies: The Challenge of Creating More Diverse Cohorts. Environmental Health Perspectives, 123(12), A297-302.

Mack, C. A. (2018). How to write a good scientific paper. Bellingham, WA: SPIE Press.

Mansournia, M. A., Higgins, J. P., Sterne, J. A., & Hernán, M. A. (2017). Biases in Randomized Trials: A Conversation Between Trialists and Epidemiologists. Epidemiology (Cambridge, Mass.), 28(1), 54-59.

Polit, D. F., & Polit, D. F. (2014). Statistics and data analysis for nursing research. Harlow: Pearson.

NURS 8201 Article Critique