Critical Analysis of an Analytical Cross-Sectional Study in Nursing Research

This paper aims to perform a critical analysis of an analytical cross-sectional study in nursing research using the JBI Critical Appraisal tool. The study focuses on the factors that influence the quality of life of older people living with HIV. It discusses the importance of nursing research and the role of critical analysis in improving evidence-based practice in nursing.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The following paper aims to perform a critical analysis of an analytical cross-sectional
study with the help of critical analysis guidelines of Joanna Briggs Institute (JBI) Critical
Appraisal tool. The paper is divided into three sections. The first section deals with
highlighting the importance of nursing research this will be followed by the second part that
will focus on the importance of the critical analysis and quality of JBI tool. In the third and
the last part, the paper will do critical analysis of the selected research article. The paper will
help to understand different methodological specification of a cross-sectional study in nursing
research.
Section one
Research is defined as a systematic investigation of the scientific hypothesis or
theories. A hypothesis is single assertion or a proposed explanation based on the available
evidences or some facts that are yet to be explained (Curtis et al., 2017).
Research holds prime importance in nursing practice. Nurses work under different
healthcare settings such as nursing homes, hospitals, community health care centres and
under the residential settings. However, the nurse’s primary goal is to be an advocate of the
healthcare service users while providing optimal care to the client based on the available
evidences. Research in the field of nursing is important for the generation of the evidence-
based practice. Research in nursing does not fall under the traditional responsibilities of the
entry-level nurses (Curtis et al., 2017). However nursing research is a growing field in which
the nursing professionals can contribute a variety of skills and experience to enrich the field
of nursing science. Earlier there was a perception that researches are mainly important in the
field of biology, chemistry, biochemistry or genetics that are contributed under the

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laboratories (Curtis, Comiskey and Dempsey 2015). However, evolution in the field of
nursing increased the importance of research in nursing. Nursing and research can be
combined and the optimal level of nursing care is inclined with the latest research findings in
the field of nursing (Curtis, Comiskey and Dempsey 2015). Nursing research is not a
replacement of traditional research, instead it enhances the traditional research. The role of a
nurse researcher is to conduct studies and to analyse or share data within healthcare
communities. The nursing researcher also contributes to the development of scientific articles
and information for grant proposals in order to fetch the required funding from the
government. The research conducted in the field of nursing provides immediate benefits to
the patients. The findings of nursing research is used to deliver more effective nursing care
and thereby help to improve the overall QoL of the patients suffering from chronic illness
(Curtis, Comiskey and Dempsey 2015).
The author’s field of practice is adult nursing. The study that has been selected is a
cross-sectional research and the aim of the research is to analyse the factors that influences
the QoL of the older people living with Human Immuno Deficiency Virus (PLHIV) (Catalan
et al. 2017). Cross-sectional study is a type of observational study in medical or social
research. It helps to analyse data from a population or a representative subset of population at
any specific point of time. It is different from the case-control studies that aim to study or
evaluate data from individuals’ perspective often tiny or minority from the rest of the
population (Creswell and Creswell 2017). The cross-sectional studies are of three types:
descriptive, analytical and ecological. The entire variables are measured at the same time
(Lewis et al, 2014). In a descriptive cross-sectional study diseased condition and potentially
related factors are measured for a defined population at specific point in time. In analytical
cross-sectional studies, prevalence of both exposure and health related outcomes are studied

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for comparing differences between exposed and unexposed health outcomes. In ecological
cross-sectional studies the unit of observation is community
Catalan et al (2017 study is an analytical type of cross sectional study, hence using the
specified JBI analytical framework. A cross-sectional study helps to study some specific
feature of a population. For example, in medical science, cross-sectional study helps to study
the prevalence of illness or to support cause and effect relationship (Creswell and Creswell,
2017). The topic is selected because in United Kingdom (UK) more than 25,000 people who
are aged 50 years and above are living with HIV (Yin et al., 2014). Analyzing the perspective
of HIV patients in health related quality of life (HRQoL) will help to improve the process of
early implementation of the nursing interventions in addition to improving the overall
outcome of care of the older adults with HIV (Althoff et al., 2016). The selection of cross-
sectional study design will help to get perspective of QoL from the thought process of
communication. They used a grounded theory in collecting quantitative data. Grounded
theory is a systematic methodology used in research involved in construction of theories for
gathering of information. It does not follow any traditional model of research where authors
choose an existing model of research (Althoff et al., 2016). The authors here used
quantitative collection of research data to study the cause and effect relationships to help
establish the relationship between the dependent variable and independent variable. The
independent variable in the chosen research is HRQoL and dependent variables in the
research are factors that promote HRQoL.
Emlet et al. (2015) are of the opinion that PLHIV with access to antiretroviral (ARV)
treatments at present are growing older and living healthier lives in comparison to the HIV
survivors in mid 1990s. While the healthcare improvements along with an increase in the
survival rates are welcomed, the social and the psychological consequences of ageing and its
relation to the prognosis of HIV are complex (Emlet et al., 2015) Although the individual

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impact of growing older with HIV infection can be positive, the hurdles experienced by the
older adults include high level of social stigma, ongoing concerns of the disclosure of the
diseased state and concerns about the overall dependence on benefits (Stonewall, 2019).
Other concerns include uncertainty of treatment and heath ageing and the treatment effects.
The study conducted by McGowan et al. (2014) highlighted that the overall QoL of the older
adults suffering from HIV-AIDS is poor in comparison to the younger population with the
infection (Grodensky et al. 2015).
Melhem et al. (2015) is of the opinion that the role of the nurses is to improve overall
QoL of the patients. The QoL encompasses both mental and physical health of the people.
Tailoring care to the exact needs of the patients, requires nurses and the patients have
identical understanding about the QoL of the patient. The study by Köberich and Farin (2015)
stated that there is a difference between the understanding of the QoL of the nurses and the
QoL of the patients. This stated difference will facilitate an understanding of the older adults’
perspective of their QoL. In addition, this will help the nurse to identify the priority of care
and thus designing person-centred implementation of the older adults living with HIV.
HIV and cancer are a global burden (Shiels and Engels, 2017). Nursing in the
oncology or the virology unit is accountable for delivering safe and effective person-centred
care (Shiels and Engels, 2017). In order to ensure their (nurses) nurses’ accountability and
improvement in the HIV care, advancement of nursing practice is important. and can be done
through evidence-based research (So, 2016). The study conducted by Horne et al. (2019)
showed that anti-retroviral therapy (ART) can improve life expectancy of individuals
suffering from HIV, but has some negative impact on their overall QoL of the individuals
such as weight gain occurs. Weight gain, along with an immuno-suppressed system,
decreases the QoL of patients. The HIV infected people in UK are exposed to smoking and

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drinking which further decreases their QoL. Moreover, HIV patients are more vulnerable
towards developing cancer and cardiovascular complications (So 2016). However, majority
of the factors that decrease the QoL of the older adults with HIV are obtained from the
perspective of the physicians and from the basis of physiological parameters. No study has
been conducted to study the perspective of the survivors (Jeffries et al. 2017). Analysis of the
study by Catalan et al. (2017) will help to understand the sociological or the mental health
concerns of the people with HIV. Understanding perspective of PLHIV will help to design
evidence-based practice guidelines and interventions in adult nursing.
Section two
Whenever a study is conducted in nursing research, there are three possible
explanations behind the generation of the result. First, are the findings true; second do the
findings represent random variations; and thirdly, are the findings influenced by systematic
error (bias). Random error includes deviation from the truth and thus representing false
positive results (Grove, Gray and Faan, 2019). The systematic distortion of the estimated
interventions hampers the overall validation of evidence-based practice. Numerous studies
have been conducted to show that bias can obscure at least 60% of the quality of intervention
in healthcare (Grove, Gray and Faan 2019). A mounting body of evidences has stated that
biased results generated from the poorly designed studies mislead the overall process of
decision making in all level of healthcare (Grove, Gray and Faan, 2019). Thus, critical
appraisal of the articles is important in order to judge the methodological quality of the
research and to estimate the level of risks or degree of bias associated with the study. This
helps to judge the reliability, validity and trustworthiness of the research. A reliable, valid
and trustworthy research with credible findings helps to increase the value of the results. The

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reliable data coming from research in turn help to design quality evidence-based practice
(Grove, Gray and Faan 2019).
The analytical cross-sectional study conducted by Catalan et al. (2017) will be
critically appraised using the JBI (Joanna Briggs Institute Critical Appraisal) appraisal
checklist for analytical cross sectional studies. The JBI framework facilitates judging the
methodological quality of the results and help with understanding the credibility of the
results. The JBI framework was developed for evidence-based practice, therefore is ideal for
cross-sectional studies because it is known to be accessible, easy to understand, and has 8
separate set of questions designed specifically to assess the methodological quality of a cross-
sectional study (Williams, Boylan and Nunan, 2019). The first question will help in
appraising the inclusion and the exclusion criteria used for selecting the study’s sample size.
The second question helps to analyse the nature of the sampling or the population included in
the study such as demographics or the location or time-period. A detailed tabulation of the
characteristics of the population helps to improve the quality of the research (Williams,
Boylan and Nunan, 2019). There are also specific questions to analyze the reliability and
validity of the study such as exploring confounding factors, measurement of the outcomes
and use of appropriate statistical analysis used in the research (Noble and Smith, 2015). All
the questions are marked in four scales that is yes, no, unclear and not applicable. However, a
study is deemed of medium level credibility when a score of ‘yes’ is recorded in at least 4 out
of the total 8 questions and of higher credibility when scoring more than 50%, and thus an
important research for evidence-based practice (Elwood, 2017).
Section 3
Answer 1
No.

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According to the JBI (2017) framework, authors must provide a clear description of
the inclusion and exclusion criteria before the process of recruitment of the study participants.
The JBI critical analysis tool specifies that inclusion and exclusion must be specific such as
stage of the disease. The only inclusion criteria used in this study was the age of the
participants. The people who are above 50 years of age and are suffering from HIV with
ongoing was included in the study. The median age of the people was 56. However the
inclusion and the exclusion criteria of the study failed to mention whether the selection of the
candidates for the study considered parameters such as co-morbidities. The study conducted
by Lorenc et al. (2014) over the population of the London Borough sated that with the advent
of the ART, the deteriorating condition of people with HIV have improved. People are now
expecting normal lifespan, however, the prolonged lifespan and extended exposure to disease
is increasing the risk of developing other complex health-related conditions such as liver
disease, heart disease, neurodegenerative disease and cancer. This is known as co-morbidity.
Co-morbidity in HIV is defined as disease that is outside the scope of HIV/AIDS (Acquired
Immuno-Deficiency Syndrome) illness such that it has no-direct relationship with the
prognosis of HIV/ AIDS. The presence of the additional disease burden apart from HIV
AIDS hampers the QoL. Lorenc et al. (2014) stated that renal complications, substance abuse,
sexually transmitted infections such as herpes simplex virus, syphilis and gonorrhoea along
with psychiatric disorder (depression, anxiety, cognitive impairment and schizophrenia) are
higher among HIV patients and such co-morbidities increase the mortality rate of HIV
patients. Taking into consideration of the prevailing co-morbidity among the HIV patients,
might have helped getting a comprehensive scenario of the factors affecting QoL of older
PLHIV. Thus the inclusion and the exclusion criteria of the article is not clearly designed.
The study sample was recruited through London-based HIV community organizations
and HIV clinics (Catalan et al., 2017). The staff s and volunteers reviewed the records of the

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patients in order to identify who satisfied the study’s inclusion criteria, that is, having been
diagnosed with HIV for at least 12 months and not suffering from any acute psychological
symptoms. However, the development of the psychological symptoms can occur within one
week or during the course of an entire month (Haynes, Smith and Hunsley 2018). A detailed
psychological status of an individual can be obtained only by having a psychological
assessment of the patient through mental health professionals like by the use of the mental
health assessment tool (DSM V) [Diagnostic and Statistical Manual of Mental Disorders].
Thus the study’s inclusion criteria is flawed. Furthermore, the study failed to specify which
HIV clinics it considered for the recruitment of the population. Choosing London-based HIV
community organizations for the selection of the main population in the study can be
regarded as selection bias (Certo et al., 2016). Selection of the HIV patients from London
leads to the selection of patients only from the city who have more healthcare access unlike
the people living in rural areas. However, this leads to bias analysis of the factors associated
with HRQoL (Wilson et al., 2017). Selection bias can be minimised by using rigorous criteria
in order to avoid confounding bias results. A well-designed study might help to avoid
selection bias at the time of enrolment (Althubaiti, 2016).
Answer 2
Yes.
The JBI critical analysis tool (2017) for an analytical cross-sectional study, state that
the authors must have a clear description about the population that is recruited in the study
such as proper description of the demographic details, location of the population along with
the time period. The description of participant selection mainly focused on the description of
the participants such as their characteristics, their sexual orientation and age (Catalan et al,
2017). The study included a total of 100 PLHIV who were over 50 years of age and
consisting of 73 men and 27 women. Among them, 76 completed interviews and 24 were on-

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line participants who completed self-administered questionnaires. Catalan et al. (2017) also
sub-divided the population based on ethnicity of the included population, such that 57 were
White British, 13 White other, 28 Black African, and 2 were Black other. Of the total selected
population, 51 were men who had sex with men (MSM) and 45 heterosexual and 4 bisexual.
The maximum age limit was 87 years and 56 as median age.
The description of the sexual orientation was important because HIV is a sexually
transmitted disease. According to NHS England (2019), a high rate of HIV is reported in gay
men in the UK. During the year 2015, 101,000 people in the UK were reported living with
HIV. The selection of participants is mainly dominated by MSM. This is beneficial for
designing targeted interventions to improve QoL for the bisexuals and homosexual (men)
(Wilson et al. 2016).
The demographics presented in the study by Catalan et al. (2017) described ethnicity
of the selected population. The sample recruited population from different ethnicity which
helps to avoid the chances of selection bias. However, the authors did not highlight the exact
location or the residence of the population during the recruitment process. This can be
regarded as one of the limitation of the study. Wilson et al. (2017) are of the opinion that the
HIV infected people who reside in the rural or the remote areas become victims of
stigmatization and social exclusion along with poor access to healthcare services in order to
which hinders managing the associated health complications arising from HIV. These barriers
hamper the overall QoL. Lack of specification of the residence of the recruited sample
restricted the comprehensive analysis of the factors that influence HRQoL of the PLHIV.
Answer 3
No.

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As per the criteria of question three, JIB (2017) framework highlighted that a standard
cross-sectional study must clearly describe the method of measurement of exposure. The
validity and the measurement of the exposure mainly highlight suitability of the current
measure. The reliability refers to the process used in the epidemiological study to check the
repeatability of the measurement of the exposures (JIB, 2017). This mainly includes the intra-
observer reliability and inter-observer reliability. The WHOQOL-HIV BREF, a self-reported
31-item questionnaire was used by Catalan et al. (2017) for the collection of data. The Every
Day Memory Questionnaire (EMQ) is another self-reported questionnaire that was used for
the collection of the data for the establishment of the subjective perception of the cognitive
failure.
The use of the self-reported questionnaire hampers the overall reliability and validity
of the study (Harmon-Jones, Bastian and Harmon-Jones, 2016). A measurement is said to be
reliable or consistent if the measurement can replicate similar results if used again under the
same circumstances (Harmon-Jones, Bastian and Harmon-Jones 2016). The reliability of self-
reported questionnaire used for the psychometric tests can be assessed by the use of split half
method. This involves splitting a test into two parts and having the same group of participants
performing in both tests (Francis, Osborne-Crowley and McDonald 2017). However, Catalan
et al. (2017) failed to conduct a split half method in order to check the reliability of the self-
reported questionnaire such as EMQ used for cognitive analysis.
Validity refers whether the study examines what it propose to examine. Self-reported
questionnaire often scores less in validity, because participants may give false responses or
fake answers (Harmon-Jones, Bastian and Harmon-Jones, 2016). For assessing the validity of
the self-reported questionnaire, it is important to compare the results of the self-reported
questionnaire conducted on the same topic. The approach is known as concurrent validity
(Chu et al., 2015). However, in this study, Catalan et al. (2017) failed to use concurrent

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validity approach to improve the validity of the research. No over-arching strategies were
used by Catalan et al. (2017) such as asking the participants whether they would give true
answers free from biased responses or making them understand the importance of honest
responses.
Since the mode of data collection was done in English, only English speaking
candidates were recruited in the study leading to recruitment bias. Consequently, restricted
access of opinion of the non-English speaking people limited a broader prospective of data
analysis (Althubaiti, 2016).
Answer 4
No.
The staff and volunteers reviewed records for identifying the patients who matched
the inclusion criteria. The decision of a particular volunteer group of staffs was not cross-
validated by another group of researchers, thus increasing chances of observer or
experimenter or research bias (Catalan et al., 2017). It is not mentioned that whether the
recruiter of the sample was blinded about the outcome of the study (Catalan et al. 2017).
The study is based on a specified diagnosis that is prevalent in older adults 50 years
old or more and are diagnosed with HIV at least 12 months before. Other criteria include, the
selected group of individuals must not have any psychological complications. The assessment
of the psychological status of the recruited population was done based on the data given in
the London-based HIV community organizations (Catalan et al., 2017). No additional tool or
assessment was conducted in order to analyse the mental health status of the recruited
candidates. Lack of proper psychological assessment hampered recruitment of candidates
who have identical psychological co-morbidities (Noble and Smith 2015).

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Catalan et al. (2017) stated that there were no differences between the participants
who completed the survey post-interview and online interview using parameters such as QoL
scores, memory related concerns, depression, anxiety, living alone, attending support groups,
paid employment and time since the diagnosis of the disease. However, their study used no
separate anxiety and depression assessment tool (Catalan et al., 2017). Therefore, there was
no uniformity in the recruitment of the candidates in the interview session (Noble and Smith
2015).
Answer 5
No.
The fifth question of the JBI tool (2017) examine if the study identified confounding
factors. Confounding bias occurs when the estimated intervention exposure effect is biased
by the presence of certain difference between the comparison groups excluding the exposure
being investigated or is of interest. The confounders include the baseline characteristics,
concomitant exposure and prognostic factors (JBI, 2017).
Giles, Gartner and Boyd (2018) are of the opinion that HIV patients have a tendency
of developing smoking habits. Furthermore, the rate of smoking among the older adults with
HIV AIDS is 2 to 3 times higher than the general population which increases the higher
incidence of the non- ‘HIV’ related morbidity and mortality among the (PLHIV) (Giles,
Gartner and Boyd 2018). Smoking increases the risk of developing other non-HIV
malignancies along with the vulnerability of developing cardiovascular diseases among
PLHIV. The smoking related mortality and morbidity associated with PLHIV increase in the
chances of developing COPD (chronic obstructive pulmonary disease) along with increase in
the chance of developing Pneumocystis jiroveci pneumonia (Giles, Gartner and Boyd, 2018).
O’Cleirigh et al. (2015) argued that evidence suggest that smoking of tobacco has negative

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mental health related outcomes among the PLHIV. It also decreases the attendance in the
follow-up sessions in ART centres and the medical visits as they remain engrossed in the
intoxication of smoking or financial crisis due to substance abuse (O’Cleirigh et al., 2015).
Nguyen et al. (2016) are of the opinion that smoking cigarettes increase the rate of social
exclusion among the mass and decreases the level of support that they receive from their
family members and this hampers the QoL of adult PLHIV.
Smoking falls under the concomitant exposures (Giles et al. 2018). However, during
the selection of the participants from the London-based HIV community organizations and
HIV clinics, staff and volunteers failed to scrutinise the smoking habits of the PLHIV
(Catalan et al. 2017). A different definition of what constitutes QoL and the factors
influencing QoL may exist among PLHIV and having smoking habits. The gap in taking into
consideration the smoking habits of the recruited individuals can be considered as
confounding bias under the category of the concomitant exposures. (Giles et al., 2018).
The prognostic factors modifying disease development for PLHIV includes onset of
the illness (early or late onset), type of disease (severe or chronic), response to the treatment
such as development of other immunogenic diseases or other infectious diseases that are
common among people with immunosuppressed systems (Trickey et al., 2016). All these are
illness prognostic factors, apart from these there are patient prognostic factor. The patient
prognostic factor behind the development or modification of the disease outcome includes
gender, marital status, pre-morbid personality, illicit drug abuse and compliance to
medication (Trickey et al., 2016). Bibas and Castillo (2014) are of the opinion that PLHIV
and are female have poor QoL in comparison to males. The people who are married, and are
suffer from HIV for a prolonged period of time, suffer from depression for not having a
healthy sex life with their partner. Moreover, PLHIV face verbal assault from their spouse for
developing sexually transmitted disease (STD) along with lack of support coming from the

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other family members. This further hampers QoL of the people. The giving of ART in a
periodic manner also impose high financial burden over the entire family. However, in the
absence of proper financial support, people experience crisis in meeting the basic amenities
of life and thereby decreasing the QoL of the PLHIV. Kimaroet al. (2017) stated that HIV is
largely managed from primary care clinics. Patients who have CD-4 (Cluster of
differentiation) count greater than 350 cells/mm3 are supposed to be under the third clinical
stage of HIV as per WHO guidelines, and thus are eligible for the ART. The follow-up visits
of ART occurs after every month and then after two months. The monthly visits to ART
centres create a financial burden over the people with HIV.
The study by Catalan et al. (2017) highlight financial constrains as an important
modifying factor behind determining the QoL of the PLHIV. However, during the
recruitment of the study candidates, the authors failed to highlight the financial status and the
job status of the candidates along with the marital status, thus, increasing the prognostic
confounding bias.
The male and the female ratio in the study was also not equivalent. Out of 100 total
population, 73 were men and 27 women. This lack of parity between the male and the female
population highlight the recruitment bias (Bibas and Castillo, 2014). Moreover, Bibas and
Castillo (2014) stated that there is a separate set of complications among the females (both
psychological and physiological) in comparison to the males, thus, again increasing the
chance of the confounding bias.
The study sample was mainly London-based and included only few participants from
the rural environment of which, the exact percentage of the participants from the rural
environment is not mentioned). The people living in the rural areas of UK might have
experienced greater level of isolation thus decreasing their QoL (Hunt and Manji, 2015;

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Bughra, 2016). This can be regarded as another confounding factor. Non-White and non-
Black ethnic groups such as the South Asians and the people who are from the Black
ethnicity (such as the Black Caribbean) are also under-represented in the total sampling
(Ellis, Bailey and McNeil, 2015). The people from minority ethnic background might
experience higher disease burden due to health and social inequalities resulting in limited
access to healthcare services from fear of discrimination and stigma which negatively impact
their QoL (Bhugra, 2016; Whitehead, 2017). The participants were recruited through HIV
clinics and other community organizations and thus excluding the recruitment of the
prospective participants who are not directly engaged with the services given by support
groups and perhaps going through a poor QoL (Bariola et al, 2015; Catalan et al. 2017).
Answer 6
Yes.
This question will explore if the study stated the strategies used to deal with
confounding factors. The strategies that are used to deal with confounding factors are
associated with the study design and the process of data analysis (JBI, 2017). JBI (2017) are
of the opinion that by using stratified sampling or matching sampling of the participants, the
effect of confounding factors can be simultaneously reduced or adjusted.
In stratified sampling, the total population is divided into smaller groups or strata
complete the sampling procedure. It is mainly a part of probability sampling where the main
population group is divided into various subgroups based on age, gender, job, nationality and
educational level (Corlay and Pagès, 2015). Stratified sampling is used when researchers
want s to compare or to understand the existing relationship between two groups. In this
research, Catalan et al. (2017) highlighted age and gender as the characteristics of the
population. However, the researchers failed to mention the educational criteria and financial

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status of the recruited individuals for the survey. The authors did not conducted stratified
sampling to reduce the chances of confounding factors. One part of the sample conducted
self-reported interview and online test while the other group of the sample conducted only the
self-reported online test. However, Catalan et al. (2017) failed to mention how this division
was done within the total sample size to create two new groups.
Multi-variative regression analysis is used for the reduction of confounding factors
(Chatfield, 2018). Catalan et al. (2017) used multivariate analysis in a step wise manner in
order to identify the best combination of exposure variables for predicting the QoL scores. In
addition, they used a detailed table to illustrate the findings of the regression analysis with the
help of binary demographic socio-economic and other social support variables. In the
bivariate analysis the exposure of the variable was p < 0.5. The main parameters used for
confounding factors analysis include psychological health of the PLHIV, level of
independence, social relations, environmental health, and spirituality along with the everyday
memory score. This helped to reduce the confounding factors that might be associated with
the social life. For example people having poor social life and poor psychological health
might be associated with improper HRQoL (Wu et al. 2015).
Answer 7
No.
JBI (2017) reported that in order to increase the reliability and the validity of the
outcome, existing or established methods or assessment tool must be used for the
measurement of the outcomes. The main outcome in this study is HRQoL. Alsayed et al.
(2017) stated that HRQoL is the measurement of both physiological and psychological well-
being. The physiological well-being deals with the physical parameters and psychological
well-being deals with the mental health of the individuals. The physical parameters measured

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in order to ascertain the physiological well-being of PLHIV include rate of occurrence of the
infectious disease, presence of anaemia, level of oxygen saturation in body, complete blood
count and level of sepsis within the body (if any). A nurse or other qualified healthcare
professionals’ or pathologist carries out the physical assessment (Alsayed et al. 2017). The
psychological assessment is done in order to analyse the status of the mental health of the
patients. Psychological assessment for PLHIV is done based on the level of anxiety, stress
and depression. Trained mental healthcare professionals make use of the face to face
counselling and use DSM V in order to provide a detailed overview of the psychological
health status of the people with HIV (George et al., 2016). Catalan et al. (2017) study failed
to use any established assessment tool for the measurement of the outcome. Self-reported
questionnaire is used to access the HRQOL of the PLHIV (Catalan et al., 2017). The use of
self-reported questionnaire leads to over or under-reporting of the actual condition and
decreasing the validity and reliability of the outcome (JBI 2017). The authors also failed to
mention the actual qualification of the people who conducted the interview session. It is also
not mentioned clearly in the study whether there was more than one data collector with
similar level of education or clinical experience. This again questions the validation of the
interviewer’s view (JBL 2017).
Answer 8
Yes.
The last question of the JIB critical analysis tool focuses on the appropriateness of the
statistical analysis used in the research. JBI (2017) stated that in case of reviewing the quality
of data retrieved through statistical analysis; consideration must be given on whether there
was any alternative yet appropriate statistical method that could have been applied to conduct
analytical procedures including regression or stratification analysis. In Catalan et al. (2017)
study, the data analysis was done with the help of the Social Science version 18.0 (SPSS –

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Chicago, Illinois, USA). Independent samples t test was used for comparing the scores for
each of the QoL domain. The p value taken was < 0.05 (Catalan et al. 2017). Cronk (2017)
stated that SPSS is the most established statistical tool in the research for the conduction of
the regression analysis. Taking the p value < 0.05 help to increase the value of the confidence
interval and thus helping to increase the probability of replicating the same results with the
same population setting. Catalan et al. (2017) used stepwise regression analysis that helped to
avoid getting bias result or outcome and in explaining the distribution of variables. The high
confidence interval and use of the regression analysis helped in evaluating that proper
statistical analysis was used in the study. The strength of the statistical method is high
confidence interval. The limitation of the statistical method is it did not use any placebo that
control for the measurement of the QoL and thus limiting comparative analysis (Cronk 2017).
Ethical significance
Ethical issues defined the basic rights of the subjects of the research. The main ethical
issues in research are: i) Getting Informed consent, ii) Beneficence that is not harming
anyone during the study iii) Respecting anonymity and confidentiality of the participants iv)
Respecting privacy of the participants. The ethical issue are important for the research
conducted over the human participants in order to secure safety of the participants. It also
helps in ensuring that no mis-treatment is received by any of the participants (Yip, Han and
Sng 2016). The study received ethical approval from Keele University and from the NHS-
Research Ethics Committee in London as mandated by the World Medical Association
Declaration of Helsinki first adopted in 1964 (World Medical Association, 2003; Catalan et
al., 2017). However, the study failed to discuss the ethical measures undertaken by the
authors to secure the participants ethical rights to autonomy, confidentiality and right to
withdraw from the research. Informed consent was acquired from the participants before the

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start of the interview sessions but the authors did not disclose details of the process. It is not
clear how they addressed the dependent relationship that the PLHIV had with the London-
based HIV community organisations and HIV clinics. Thus it’s difficult to ascertain if
participants felt compelled to agree to participate. Fatema et al. (2017) stated that informed
consent is one the important concerns of the study involving human participants or in
research in which data collection is done through interview process. It helps to secure the
right of autonomy of the participants. The authors further stated the provision of research
funding with no further details of the funding process. However, they were also able to
declare having no competing interests to the study (Catalan et al. 2017).
Conclusion
Thus from the above discussion, it can be concluded that the selected study score only
points (1 point) in question 2, 6 and 8. In rest of the five other questions, the article gained
zero points as the answer was No. A score of 3 out of 8 resulted in failing of the selected
article to qualify for the methodological significance, accordingly had it been a score of 4
‘yes’ out of 8, it would have been of medium level credibility (JBI, 2017). The research,
however, followed the required ethical guidelines for conducting the research with human
participants. The overall recommendation is due to gaps in the methodological execution of
the study conducted by Catalan et al. (2017), it is not suitable for nursing evidence-based
practice.

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