The following research critique is aimed at critically reviewing Prochaska et al.’s quantitative study “Efficacy of initiating tobacco dependence treatment in inpatient psychiatry” to determine its validity and thus assess its value for the nursing practitioners. The scientific rigor, minimization of research bias, and logical interpretation of the results are necessary to confirm the applicability of the findings. Thus, the paper explores the ethical background of the study, the appropriateness of the data collection methods, the analysis process, and the logic behind the authors’ conclusions in separate chapters to either confirm or disprove the findings of the research team.
Protection of Human Participants
The authors do not explicitly identify either risks or benefits of participating in the study. However, since all the participants are inpatients of mental health facilities, and the exclusion criteria list the high violence risk. Considering the fact that the participation was negotiated orally and the criteria for defining the possibility of violent behavior is not specified in the paper, it is possible to assume that the risk of violent outbursts existed during the study. The benefits, while not specified by the authors, are evident from the introduction section: a better understanding of the treatment of smoking in persons with current mental illness is the key advantage of the study (Prochaska, Hall, Delucchi, & Hall, 2014). Informed consent was obtained from the participants, although it is worth noting that in some cases the hypersomnolence or severity of psychiatric symptoms restricted the research team from obtaining it. In these cases, another attempt was made after some time to avoid the lack of comprehension. The researchers mention that the participants were interested ion the study, which means that the participation was voluntary. The approval obtained from the institutional review board of the University of California, San Francisco is specified at the end of the paper (Prochaska et al., 2014).
The paper specifies both the dependent and the independent variables. The former include intervention versus control condition and those which differed by condition at baseline or predicted attrition (Prochaska et al., 2014). The latter are “demographic variables, tobacco use, psychiatric symptoms, and substance use as potential covariates of treatment effects” (Prochaska et al., 2014, p. 1559). The descriptive data was collected using printouts which were filled by the participants. The data included the dependent variables, such as housing stability, income, employment, education, and marital status, among others. The participants were also interviewed extensively on their substance abuse behavior with several credible tests, including the Thoughts about Abstinence scale, Fagerström Test of Nicotine Dependence, the 12-item Short Form, and the and the Drug Abuse Screening Test 10, among others. The outcome data was measured based on the reports by the patients.
The claims of those who reported abstinence were biochemically verified “with an expired air carbon monoxide (CO) sample analyzed by a Bedfont Smokerlyzer” (Prochaska et al., 2014, p. 1559). On the occasions when the participants failed to report their abstinence status for some reason, the data was obtained from the informants. Finally, the information on hospitalization was queried orally and recorded using an electronic billing system at Langley Porter Psychiatric Institute. The authors do not provide justification for the selected methods of data collection, but considering the voluntary nature of participation, it is possible to assume that the non-binding methods were preferred to reduce pressure on the participants and avoid adverse reactions. The data was collected in a 29-month period (July 2006 to December 2008) on a weekly basis. A sequence of data collection consisted of the one-time descriptive inquiry in the beginning, a weekly oral report on the abstinence and possible hospitalization (or a proxy data collection in cases when he was not able to report on his own), a biochemical confirmation of the claimed abstinence, and a verification follow-up on the third, sixth, twelfth, and eighteenth month (Prochaska et al., 2014).
Data Management and Analysis
Two data analysis methods were used in the course of the study. For the descriptive data, which described the extent of delivery of the intervention and stratification of sample characteristics, a simple comparative method was used: the treatment conditions were compared to the baseline descriptive characteristics to propose to control for predictors of attrition. For the primary outcome data (the abstinence rates) a generalized estimating equation model was utilized. Finally, for the secondary outcomes (the hospitalization rate) a logistic regression analysis was implemented. To complete the analysis, the demographic data was matched with the psychiatric symptoms, tobacco, and other substances use to establish if any of them can be viewed as covariates of treatment effects. To ensure the reliability of the results, a statistical software was used, namely PROC GENMOD logit link function from the SAS version 9.2 of the SAS Institute, Cary, North Carolina (Prochaska et al., 2014). Also, several steps aimed at minimizing the effects of research bias were taken. First, the associations of secondary were tested in univariate analyses to locate and include the significant variables into the final analysis. Second, a computer-generated random assignment program was used to randomize the sample. Third, the researchers were blinded to the schedule of randomization. However, the use of literature to verify the abstinence rates and examine any missing data could serve as a potential source of bias.
Findings / Interpretation of Findings: Implications for Practice and Future Research
The researchers suggest two primary conclusions of the findings. First, the patients with psychiatric illnesses can enter treatment and show significant improvement in quitting smoking. Second, the tobacco cessation treatment does lead to the positive outcome, although the effect is not thoroughly consistent. In other words, the study confirms the hypothesis that it may decrease the risk of hospitalization, although the magnitude of the effect is smaller than was previously expected. We can safely conclude that despite minor discrepancies the study was conducted with the required scientific rigor and consistency, and its results are thus valid and indicative of reality. There were no logical inconsistencies in interpreting the results. Finally, the results are consistent with the previous findings. However, several limitations were identified by the research team. First, the sample size, while bigger than that of the other studies, is still insufficient for the conclusive results. Second, the sample was restricted to a single inpatient psychiatry unit. While there is allegedly no reason to expect the generalization of results, the researchers suggest to replicate the study using a more diverse demographics. Nevertheless, the results can be applied to the nursing practices aimed at treatment of smoking among the inpatients of the mental health facilities.
Throughout the critique, no signs of inconsistencies were detected. Thus, we can conclude that the results are reliable enough to be safely utilized in the nursing practice. The tobacco cessation treatment was previously yielding controversial results, and its efficiency was debated. While it was thoroughly researched, its effect on the mentally ill remained questionable. The sensitivity to stress associated with it is particularly undesirable for these patients. Thus, the findings of the research increase our understanding of the effects of cessation practices and open up new opportunities for a successful treatment. On a separate note, the decreased chance of rehospitalization is particularly useful for the organizational nursing practices, since the hospitalization is a time- and resource-consuming process and should be avoided. Finally, the critical analysis skills gained in the process of the analysis are useful for utilizing in similar under-researched situations.
Prochaska, J. J., Hall, S. E., Delucchi, K., & Hall, S. M. (2014). Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: a randomized controlled trial. American Journal of Public Health, 104(8), 1557-1565.