Combining Qualitative and Quantitative Methods: An Essential Tool for Nursing Research

Introduction

Qualitative and quantitative articles are useful in research. Noyes (2019) indicated that quantitative methods rely on what variables will be measured in advance while qualitative articles produce a narrative understanding of the study of interest. The author indicated that using qualitative and quantitative articles is significant because they help in identifying the problems in research and find evidence-based practice changes that can be generalized in specific populations and nursing interventions. The purpose of this paper is to appraise two qualitative and two quantitative research articles by identifying the practice problem and PICOT question, reviewing the background of study of the articles, method of study, results of studies, ethical considerations, and the connection of the research articles to propose an EBP change.

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Practice Problem and PICOT Question

Diabetes type 2 is a common ailment affecting different individuals globally. The state is often characterized by a wide range of dysfunctions that exhibit themselves in the form of hyperglycemia that results from a combination of three factors (Knowler et al., 2002). The three common causes of hyperglycemia on the affected individuals is due to the resistance of insulin action, inadequate secretion of insulin as well as the excessive or glucagon being produced in an unreasonable amount (Knowler et al., 2002). Most individuals with type two diabetes display various signs and symptoms such as excessive thirst, blurred vision, as well as lower extremity paresthesias (Knowler et al., 2002). Different diagnostic criteria can be used in the diagnosis of type two diabetes. The conventional methods include the use of fasting blood sugars, random blood sugars, and glycosylated hemoglobin (HbA1c). Thus, the nursing practice problem is the management of type 2 diabetes to alleviate the symptoms. Nurses are in a position to educate patients on self-management of type 2 diabetes. To better understand the practice problem, two peer-reviewed qualitative and quantitative articles will be used in this paper. The PICOT question is does lifestyle changes for patients with type 2 diabetes who comply with nurse-led lifestyle changes reduce HbA1c value (p & I) compared to those that do not comply (c) with nurse-led lifestyle changes within 6 months (o & t)? Furthermore, two quantitative articles, Azami et al. (2018) and Waller et al. (2019) correlate to the PICOT intervention and control populations by identifying patients with type 2 diabetes who practice self-management activities such as foot care, physical activity, taking medications and diet. Both studies use the control and intervention groups to determine the efficacy of self-management activities. Moreover, two qualitative articles, Wu et al. (2019) and Reyez et al. (2017) correlate to the PICOT question because they both discuss the self-management practices in people with type 2 diabetes and identify the outcome, which is to reduce the HbA1c values.

Background of Qualitative and Quantitative Articles

The first qualitative article by Wu et al. (2019) examined the problem of self-management practices in middle-aged and older adults. The significance of the article to nursing practice is to educate patients about self-management activities to manage their diabetes condition. The study aimed to explore the self-management experiences of older adults with type 2 diabetes. The objective of the research was to put the participant in focus groups then compare their experiences with self-management practices such as diet, physical activity, and taking medications. Researchers intended to answer the research question, what are the experiences of self-management practices by older adults? The second qualitative article by Reyes et al. (2017) examined the problem of engaging in self-management practices by medically underserved patients. The significance of the article to the nursing practice problem is to reach the medically underserved patients with type 2 diabetes to educate them on their condition. The study aimed to identify factors that influence self-management practices in medically underserved patients with type 2 diabetes. Additionally, the objective of the research was to select samples from low-income areas and put them in control and intervention groups to compare diabetes self-management in people with good verses poor glycemic control. They intended to answer the question does diabetes self-management affect glycemic control and HbA1c values?

The first quantitative article by Azami et al. (2018) discussed complications and mortality that arise due to diabetes type 2. Therefore, the significance of the article to nursing practice is to prevent complications and mortality in patients who have diabetes type 2. Through EBP, nurses can help to promote clinical guidelines that would reduce diabetes complications and mortality. The purpose of the study by Azami et al. (2018) was to investigate the effects of nurse-led diabetes self-management education program on patients with type 2 diabetes within 12 weeks. The objective of their research was to discuss the way nurse-led education programs control the HbA1c values of patients with type 2 diabetes. the research question of the article was whether self-management practices reduce HbA1c levels. Furthermore, the second quantitative article by Waller et al. (2019) discussed the problem of the lack of access to diabetes education. Thus, the significance of the article to the nursing practice is to increase diabetes education to ensure patients know all aspects of their condition. The purpose of the study by Waller et al. (2019) was to discuss a diabetes text messaging intervention to improve the health outcomes of people living with type 2 diabetes within a 24 weeks. The objective of the research was research was to discuss the improvement of self-management practices such as diet and physical activity to improve the HbA1c values of the patients through text messages. The research question was whether DTEXT intervention improves HbA1c values and self-management.

Method of the Study

In the first qualitative article Wu et al. (2019) incorporated focus groups to explore the self-management practices of the older individuals who had type two diabetes. The focus group discussions were conducted in two sets which entailed individuals discussing issues of common interest in the presence of a moderator. The focus group discussions took place from May to October 2015 (Wu et al., 2019). Also, during the research, the purposive sampling method was employed in the selection of participants from the various outpatient facilities in Taiwan. For one to take part in the study, they had to be higher than 45 years of age. Additionally, the individual had to have been identified with T2DM in the past one year (Wu et al., 2019). The participants also had to be willing to share their personal experiences before being included in the study. Lastly, the participants had to be ready to be audio recorded while participating in the study (Wu et al., 2019). The focus group discussions took part every two weeks with each session lasting for about 60 to 90 minutes. All observations in the focus group discussion were recorded with the primary aim of ensuring all the crucial information was obtained (Wu et al., 2019). In the second qualitative article, In the study carried out by Reyes et al. (2017) focus groups to help in identifying, examining as well as having a better understanding of individual practices in the less privileged individuals (Reyes et al., 2017). The research was conducted through a partnership by the Iowa primary care Association and the Iowa Institute of clinical and translational studies. The study was aimed at improving the care given to diabetic patients as well as their outcomes. The study took place in the four largest health facilities approved by the federal government (Reyes et al., 2017). Eight focus group discussions were carried out in the rural and urban areas of deprived adults with T2DM. However, most of the patients in the study resided from urban areas. For an individual to be legible to participate in the study, they had to be a diabetic patient with an HbA1c value of more than 9%. The participants had to be receiving treatment from a federally approved health facility (Reyes et al., 2017). Lastly, individuals had to be uninsured to be legible to participate in the study (Reyes et al., 2017). One advantage of focus group discussion is that it allows room for the collection of detailed information; however, it has the main disadvantage is that it is time-consuming and expensive.

The first quantitative article by Azami et al. (2018), researchers randomized participants into two groups. researchers conducted the trials in single-center, observer-blinded, parallel-group (2 groups) randomized controlled trial. Eligible participants were grouped into the control and intervention groups. The control group (N=71) received usual diabetes care routines. The intervention group (N=71) received usual diabetes care plus 24 weeks of nurse-led diabetes self-management education. The study took place in Ilam city, Iran at a primary and secondary outpatient endocrine clinic located in a teaching hospital. In the second quantitative study, Waller et al. (2018), asserted that the study will use a randomized control trial and placing the groups in control and parallel arm. The control arm (N=171) received usual care while the intervention arm (N=171) received 1-3 months of text message, usual care, and 4-6 months of messages four times per week. Researchers intended to conduct the study in the Australian community dwellings.

Results of the Studies

In the study by Wu et al. (2019) a total of 33 individuals took part in the study. 12 out of the 33 were men while the rest were women. The age of the participants varied from 50 to 73 years. From the analysis, three essential themes were generated (Wu et al., 2019). The first theme comprised of listening to the voice as well as observing the physical changes in the body. From the analysis, the study further generated the subject of having a better understanding of diabetes as well as its associated challenges. Lastly, the study revealed some of the self-management implementation dilemmas (Wu et al., 2019). In the second qualitative article by Reyes et al. (2017), a total of forty-four participants took part in the study. Sixty-six percent of the participants in the study were Caucasian, while the remaining percentage comprised of African Americans native Americans and others (Reyes et al., 2017). The self-management tasks consisted of diet, exercise, medication, as well as the translation of crucial information to the providers. The participants were divided into two groups during the study period (Reyes et al., 2017). Findings from the study indicate that individuals in the control groups were hopeful and were willing to make the necessary changes in their lifestyles. According to Reyes et al., Most of the participants in the control groups stuck to the self-management recommendations from their providers as opposed to those in the intervention group (Reyes et al., 2017). Both groups indicated that diet alterations interfered with their social interactions. Findings from the study further suggested that the participants needed guidance on how to follow the stipulated recommendations (Reyes et al., 2017).