Process of Critical Appraisal | Nursing

CRITICAL APPRAISAL
Name of the Student
Name of the University
Author Note

Table of Contents
Introduction................................................................................................................................2
Tool Selection............................................................................................................................2
Critical appraisal........................................................................................................................3
Quantitative research study....................................................................................................3
Qualitative research study......................................................................................................5
Ethical issues..............................................................................................................................8
Summary....................................................................................................................................9
References................................................................................................................................11
Appendix 1...............................................................................................................................12
Appendix 2...............................................................................................................................12

Introduction
This paper will follow the process of critical appraisal for two papers by analysing the
strength, weakness, and understanding of the social impact in various fields (Marcus 2018).
Any article associated with a critical appraisal has been found to play an important role in the
Evidence-based practices associated with various research studies. This paper will critically
appraise two research papers, qualitative and quantitative respectively. One quantitative study
and one qualitative study will be critically appraised in this paper involving the critical
appraisal checklists available online (CASP tool). The standards and quality of the papers are
to be determined by the research checklist used for the study.
Tool Selection
Opie et al. (2019) have performed a randomized controlled trial associated with the
discretion in food consumption changes while the promotion of vegetables and food. This
paper used the ShopSmart study randomized controlled trial in order to calculate the mean
and standard deviations associated with the P values for quantitative analysis of the chosen
topic. The mediatory variable analysis was done with eleven variables, which made it a
quantitative study. CASP (Critical Appraisal Skill Programme) has been used for the critical
appraisal of this quantitative paper. RCT has been used for this study because control group
and intervention group were selected for this study. Out of the selected participants, one
group has been kept as control and the other group has been studied for the increase in
consumption of vegetables and food after their promotion in the diet and consuming less
discretionary food after this intervention is applied.
Youngwanichsetha and Phumdoung (2016) use a semistructured interview to analyse
the experience of blood glucose self-monitoring among pregnant women in gestational
diabetes mellitus in a qualitative way. The use of semi-structured in this research study has
made it qualitative and thus involved the use of the CASP tool qualitative checklist in this
study.

Thus, it can be stated that both qualitative and quantitative research articles will be
analysed by the use of CASP checklists for quantitative and qualitative study purposes in this
paper.
Critical appraisal
Quantitative research study (Opie et al. 2019)
Appendix 1
Question 1
Answer- Yes. The randomized has been found to address a clearly focussed issue associated
with discretionary in the consumption of food changes occurring with the promotion of fruits
and vegetables. The study aimed at the identification of discretionary consumption of food
decline with a focussed intervention on the promotion of vegetable and food consumption
(Opie et al. 2019).
Question 2
Answer- Cant tell. Not applicable to this study. Questions that are inapplicable for the
research study cannot be answered in the context of this study.
Question 3
Answer- Yes. All the women taken as participants for the study were properly accounted for
at the conclusion. Two hundred and twenty-five women have been selected as the participants
for the study. Yes, this study is worth continuing (Opie et al. 2019).
Question 4
Answer- Cant tell. Nothing has been stated about the author the blindness of the participants
to the treatment. Questions that are inapplicable for the research study cannot be answered in
the context of this study.
Question 5

Answer- Yes. The groups were similar to the start of the trial because only a moderately
large group of women has been selected for the study. 116 intervention and 109 controls were
selected for the study. All of them were similar to the start of the trial (Opie et al. 2019).
Question 6
Answer- Yes. Two groups were formed after the use of 225 women as the participants for the
study. 116 were selected as the intervention group and 109 were selected as the control
groups. Thus, it has been said that both groups were treated equally by the author (Opie et al.
2019).
Question 7
Answer- The effect of the treatment can be stated to be very large because this study proved
that an intervention focussed on the promotion of fruit and vegetables among the socio-
economically challenged participants has reduced the intake of unhealthy discretionary items
even in limiting conditions of food. Thus, it can be stated that the treatment has a vast effect
in a major section of the society (socioeconomically challenged part) (Opie et al. 2019).
Question 8
Answer- A precise estimation of the treatment effect will consist of the socioeconomically
disadvantaged section of the society selected for the study. After performing the study, it was
found that all the people who belonged to the group (socio-economically challenged) were
found to not to be taking any discretionary food materials on being promoted by food and
vegetables (Opie et al. 2019).
Question 9
Answer- Yes. The results can be applied to the local population since the study was
performed by selecting women from the local population of Melbourne, Australia. Since the
initiation of the research study was associated with 225 women as the participants and the
conclusion stated that the socioeconomically challenged section of the population will be the

one to be affected the most, the local population can be affected by the results of this paper
(Opie et al. 2019).
Question 10
Answer- Cant tell. This question cannot be associated with this research study. Questions
that are inapplicable for the research study cannot be answered in the context of this study.
Question 11
Answer- Yes. The benefits of this research study have been found to be directly linked to the
local population of a country, especially the population consisting of socio-economically
challenged people. Since the authors found that the intake of discretionary food can be
decreased by promoting the use of food and vegetables as food in the socio-economically
challenged section of the population, benefits of the study can be stated to worth the harm
and costs of performing the study (Opie et al. 2019).
Qualitative research study (Youngwanichsetha and Phumdoung 2016)
Question 1
Answer- Yes. There is an observable clear statement of the aims and objectives of the study.
This study aimed at exploring and describing the living experiences of the monitoring of
blood glucose among Thai women who are suffering from gestational diabetes mellitus. This
part has been clearly stated in the abstract ad the body of the research paper written by
Youngwanichsetha and Phumdoung (2016). This aim was selected for this study because
diabetes has become a major worldwide public health problem.
Question 2
Answer- Yes, the research paper has been found to follow an appropriate methodology
involving a qualitative analysis of the study. The process of qualitative data analysis was
performed using Colaizzi’s method (Youngwanichsetha and Phumdoung 2016). The

methodology of this study consists of a descriptive phenomenological study that was
associated with the experiences of pregnant women associated with GDM.
Question 3
Answer- Yes. The research design is appropriate to address the research aims. The design of
this study was a descriptive phenomenological study performed to gain more knowledge
about the life experiences of blood glucose. Phenomenology is the design that has been stated
to aim at the revealing of essential meanings present in the phenomenon selected for the
study (Van Manen 2016). Since this study aimed at understanding the experiences of blood
glucose self-monitoring in pregnant women associated with gestational diabetes mellitus, a
phenomenological study design can be stated to be appropriate for this study
(Youngwanichsetha and Phumdoung, 2017).
Question 4
Answer- Yes. Potential participants for this study were approached and asked to participate
by the staff nurses. Informed consent was obtained first by the team of researchers. Thirty
women who were pregnant were diagnosed with GDM during their gestation period of 24 to
30 weeks. Then they were interviewed to collect the data. Thus, it can be stated that the
strategy of participant recruitment was appropriate for this qualitative study
(Youngwanichsetha and Phumdoung, 2017).
Question 5
Answer- Yes. The selected setting for the collection of data has been justified and semi-
structured interview has been selected as the procedure for the collection of data. The
associated author has also justified the chosen method. There was no modification of the
research method associated with the study and the collected data was clear and justified.
Since the topic of this study was to gather knowledge about the experiences of the
participants in the field of the selected topic. Thus, it can be said that the collected data
indirectly addressed the research issue (Youngwanichsetha and Phumdoung, 2017).

Question 6
Answer- No. There is no statement in the study that states that the researchers critically
examined their roles in discussing the potential bias and influences during the formulation of
questions and collection of data. However, the researchers successfully conducted the
interview as per the research design and also responded to the events associated with the
study (Youngwanichsetha and Phumdoung, 2017).
Question 7
Answer- Yes. All the ethical issues were considered for the study since there are sufficient
details for the explanation of the research design (interviews) to the participants (women) in
order to assess the ethical standards. The Institutional Review Boards and ethics committees
of the Faculty of Nursing and Faculty of Medicine of the associated university approved the
project and collection of data in order to get ethical approval for the study. Informed consent
was then obtained by the team of researchers from the participants before starting the
research (Youngwanichsetha and Phumdoung, 2017).
Question 8
Answer- Yes. The analysis of data can be stated to be sufficiently rigorous. The analysis of
data showed that pregnant women participants who were undergoing BGSM have been
experiencing satisfaction with their pregnancy condition. A major section of them was found
to achieve better glycemic control without any complications with diabetes. An in-depth
discussion of the analysis process was performed in this research study and sufficient data in
the form of interview results has been placed in order to support the findings
(Youngwanichsetha and Phumdoung, 2017).
Question 9
Answer- The findings showed that the participants were worried about diabetes and doing
blood tests after they were diagnosed with diabetes. Then they were found to try to control

the condition of diabetes by monitoring their levels of blood glucose. All these findings
statements were clear in this research study and were evidenced with the help of relevant
sources (Youngwanichsetha and Phumdoung, 2017).
Question 10
Answer- This research study is of very much significance since diabetes has been found to be
one of the most significant diseases in the human community. Pregnant women have been
found to be directly exposed to gestational diabetes mellitus. This research also found that
self-monitoring of blood glucose in pregnant women has successfully helped them in giving
birth to a healthy child and staying healthy throughout the gestational period
(Youngwanichsetha and Phumdoung, 2017).
Ethical issues
Ethical considerations are the most significant requirements for any research study
and approval from an organization for the same is essential also. Ethical research practices
have been best justified by the guidelines stated by the national statement on Ethical Conduct
in Human Research (NHMRC 2018). Both the studies Opie et al. (2019) and
Youngwanichsetha and Phumdoung (2016) has been observed to be granted ethical approval
from their respective organizations and comities for both the research studies.
However, many details were not provided for the ethical issues of the research study
performed by Opie et al. (2019). No information about the basic protection of secondary data
collected from the research papers has been involved in the studies. There are no such
inclusion criteria for this study (NHMRC 2018). This study has also failed to comply with the
anonymity protection of the study individuals (NHMRC 2018).
Informed consent was the only ethical approval considered in the paper written by
Youngwanichsetha and Phumdoung, (2016) because this paper was based in a semi-
structured interview. As a researcher, it’s his responsibility to let the participants know about
the purpose of the study, risks and benefits, procedures and obtaining consent before asking

them to get involved in the research study. Informed consent for a research study has to
include three significant elements consisting of information or disclosure, voluntary nature of
the prevention of information disclosure, maintaining the competency of the participant to
make decisions and associating a voluntary nature of decision making (Guttmann, Shouldice
and Levin 2019). Since the research design of this paper is based on semi-structured
interviews, informed consent is the most important because it gives the participants an
opportunity to be informed about the health care decisions, nature, and procedure associated
with the experiment.
Summary
Both the papers Opie et al., (2019) and Youngwanichsetha and Phumdoung, (2016)
has been found to show a clear aim and objective of the research study. The research
questions were also justified since they expressed every aspect which can be expected from
the research studies.Thus, it can be stated that the aims and objectives of the research study as
been properly met by the research. However, this paper failed to identify the specific
mediators associated with the discretionary food intake and the other mechanisms by which
the interventions must affect the future progress of the research study. After reading the
research papers, the readers will have the urge to learn more about the research studies which
will lead to the further continuation of the research.
Opie et al. (2019) have demonstrated an intervention associated with the promotion of
vegetables and fruits consumption in the socioeconomically challenged participants was
effective in reducing the consumption of discretionary food intake. Thus, it can be stated that
the aims and objectives of the research study as been properly met by the research. However,
this paper failed to identify the specific mediators associated with the discretionary food
intake and the other mechanisms by which the interventions must affect the future progress of
the research study.

According to Youngwanichsetha and Phumdoung (2016) women affected with
gestational diabetes have been found to be worried about high blood glucose. Thus they have
been found to use the self-monitoring strategy for blood glucose to overcome and tolerate the
difficulties associated with the study. The findings of this study have been used in order to
guide various nursing practice assessments for blood glucose monitoring during gestational
diabetes. Thus, it can be stated that a good glycaemic control among the pregnant women
affected by gestational diabetes mellitus can be earned by self-blood glucose monitoring
strategy.
Both the articles complied with the study outcomes however, both of them failed to
discuss the existence of statistical biases in their study. Alternatives to the stated procedure
were also not discussed in the studies. Thus, these were the major drawbacks of the research
in both the papers.

References
CASP – See Critical Appraisal Skills Program
Critical Appraisal Skills Program 2017, ‘CASP Qualitative checklist’, Better Value
Healthcare, retrieved 11 Jan 2019 https://casp-uk.net/wp-content/uploads/2018/01/CASP-
Qualitative-Checklist-2018.pdf
Guttmann, K., Shouldice, M. and Levin, A.V., 2019. Informed Consent and Deception.
In Ethical Issues in Child Abuse Research (pp. 29-42). Springer, Cham.
Marcus, G., 2018. Deep learning: A critical appraisal. arXiv preprint arXiv:1801.00631.
Opie, R.S., McNaughton, S.A., Crawford, D., Abbott, G. and Ball, K., 2019. How and why
does discretionary food consumption change when we promote fruit and vegetables? Results
from the ShopSmart randomised controlled trial. Public Health Nutrition, pp.1-10.
Van Manen, M., 2016. Phenomenology of practice: Meaning-giving methods in
phenomenological research and writing. Routledge.
Youngwanichsetha, S. and Phumdoung, S., 2017. Lived experience of blood glucose self‐
monitoring among pregnant women with gestational diabetes mellitus: a phenomenological
research. Journal of clinical nursing, 26(19-20), pp.2915-2921.

Appendix 1
CASP Checklist: 11 questions to help you make sense of a Randomised
Controlled Trial
How to use this appraisal tool: Three broad issues need to be
considered when appraising a trial:
Are the results of the study valid? (Section A)
What are the results? (Section B)
Will the results help locally? (Section C)
The 11 questions on the following pages are designed to help you think
about these issues systematically. The first three questions are screening
questions and can be answered quickly. If the answer to both is “yes”, it
is worth proceeding with the remaining questions. There is some degree
of overlap between the questions, you are asked to record a “yes”, “no”
or “can’t tell” to most of the questions. A number of italicised prompts are
given after each question. These are designed to remind you why the
question is important. Record your reasons for your answers in the spaces
provided.
About: These checklists were designed to be used as educational
pedagogic tools, as part of a workshop setting, therefore we do not
suggest a scoring system. The core CASP checklists (randomised
controlled trial & systematic review) were based on JAMA 'Users’ guides
to the medical literature 1994 (adapted from Guyatt GH, Sackett DL, and
Cook DJ), and piloted with health care practitioners.
For each new checklist, a group of experts were assembled to develop
and pilot the checklist and the workshop format with which it would be
used. Over the years overall adjustments have been made to the format,
but a recent survey of checklist users reiterated that the basic format
continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.:
Critical Appraisal Skills Programme (2018). CASP (insert name of checklist
i.e. Randomised Controlled Trial) Checklist. [online] Available at: URL.
Accessed: Date Accessed.

©CASP this work is licensed under the Creative Commons Attribution –
Non-Commercial-Share A like. To view a copy of this license, visit
http://creativecommons.org/licenses/by-nc-sa/3.0/ www.casp-uk.net
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net

Paper for appraisal and reference:
Section A: Are the results of the trial valid?
1. Did the trial address a
clearly Yes
HINT: An issue can be ‘focused’ In
terms of
focused issue? Can’t Tell • the population studied
• the intervention given
No  the comparator given
• the outcomes considered
Comments:
2. Was the
assignment of
patients to
treatments
randomised?
Comments:
Yes
Can’t
Tell
No
HINT: Consider
• how this was carried
out
• was the allocation sequence
concealed from
researchers and
patients
3. Were all of the patients Yes
who entered the trial
properly accounted for at Can’t Tell
its conclusion?
No
HINT: Consider
• was the trial stopped
early
• were patients analysed in the
groups to which they
were randomised
Comments:
Is it worth continuing?

2

4. Were patients, health Yes
workers and study
personnel
‘blind’ to treatment? Can’t Tell
No
Comments:
5. Were the groups similar at Yes the
start of the trial
Can’t Tell
No
HINT: Consider
• other factors that might
affect the outcome, such as;
age, sex, social class
Comments:
6. Aside from the
experimental Yes
intervention, were the
groups
treated equally? Can’t Tell
No
Comments:
Section B: What are the results?

3

7. How large was the treatment effect? 
HINT:
Consider what
outcomes were
measured
 Is the primary outcome clearly
specified
 what results were found for
each outcome
Comments:
8. How precise was the estimate of the
treatment
HINT:
Consider
effect?
 what are the confidence
limits
Comments:
Section C: Will the results help locally?
9. Can the results be applied
to Yes HINT: Consider whether
the local population, or in
 the patients covered by the trial
are
your context? Can’t Tell
similar enough to the patients to
whom
you will apply this
No  how they differ
Comments:
10. Were all clinically
important Yes HINT: Consider whether
outcomes considered?
 there is other information you
would
Can’t Tell like to have seen
 if not, does this affect the decision
No
Comments:

4

11. Are the benefits worth
the Yes HINT: Consider
harms and costs?
 even if this is not addressed by
the
Can’t Tell trial, what do you think?
No
Comments:

5

Appendix 2
CASP Checklist: 10 questions to help you make sense of a Qualitative
research
How to use this appraisal tool: Three broad issues need to be
considered when appraising a qualitative study:
Are the results of the study valid? (Section A)
What are the results? (Section B)
Will the results help locally? (Section C)
The 10 questions on the following pages are designed to help you think
about these issues systematically. The first two questions are screening
questions and can be answered quickly. If the answer to both is “yes”, it
is worth proceeding with the remaining questions. There is some degree
of overlap between the questions, you are asked to record a “yes”, “no”
or “can’t tell” to most of the questions. A number of italicised prompts
are given after each question. These are designed to remind you why the
question is important. Record your reasons for your answers in the
spaces provided.
About: These checklists were designed to be used as educational
pedagogic tools, as part of a workshop setting, therefore we do not
suggest a scoring system. The core CASP checklists (randomised
controlled trial & systematic review) were based on JAMA 'Users’ guides to
the medical literature 1994 (adapted from Guyatt GH, Sackett DL, and
Cook DJ), and piloted with health care practitioners.
For each new checklist, a group of experts were assembled to develop
and pilot the checklist and the workshop format with which it would be
used. Over the years overall adjustments have been made to the format,
but a recent survey of checklist users reiterated that the basic format
continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.:
Critical Appraisal Skills Programme (2018). CASP (insert name of checklist
i.e. Qualitative) Checklist. [online] Available at: URL. Accessed: Date
Accessed.

©CASP this work is licensed under the Creative Commons Attribution –
Non-Commercial-Share A like. To view a copy of this license, visit
http://creativecommons.org/licenses/by-nc-sa/3.0/ www.casp-uk.net
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare www.casp-uk.net

Paper for appraisal and reference:
Section A: Are the results valid?
1. Was there a clear
statement of the aims
of the research?
Yes HINT: Consider
Can’t
Tell
• what was the goal of the
research
• why it was thought important
No • its relevance
Comments:
2. Is a qualitative Yes HINT: Consider
methodology
Can’t Tell
 If the research seeks to interpret
or
appropriate?
illuminate the actions and/or
subjective
No experiences of research participants
 Is qualitative research the right
methodology for addressing the
research goal
Comments:
Is it worth continuing?
3. Was the research Yes HINT: Consider
design appropriate to • if the researcher has justified the
address the aims of
the Can’t Tell research design (e.g. have they
research?
No
discussed how they decided which
method to use)
Comments:

2

4. Was the recruitment Yes
strategy appropriate to
the aims of the Can’t Tell
research?
No
HINT: Consider
• If the researcher has explained
how the participants were
selected
• If they explained why the
participants they selected were the
most
appropriate to provide
access to the type of
knowledge sought by the
study
• If there are any discussions
around recruitment (e.g. why
some people chose not to take
part)
Comments:
5. Was the data collected in Yes
a way that addressed the
research issue? Can’t Tell
No
Comments:
HINT:
Consider
• If the setting for the data
collection was justified
• If it is clear how data were
collected (e.g. focus group, semi-
structured interview
etc.)
• If the researcher has justified the
methods chosen
• If the researcher has made the
methods explicit (e.g. for interview
method, is there an indication of
how interviews are conducted, or
did they use a topic guide)
• If methods were modified
during the study. If so, has the
researcher explained how and why
• If the form of data is clear
(e.g. tape recordings, video
material, notes etc.)
• If the researcher has
discussed saturation of data

3

6. Has the relationship Yes HINT: Consider
between researcher and  If the researcher critically
participants been Can’t Tell examined their own role,
adequately considered? potential bias and influence
No during (a) formulation of the
research questions (b) data
collection, including sample
recruitment and choice of
location
 How the researcher responded to
events during the study and
whether they considered the
implications of any changes in the
research design
Comments:
Section B: What are the results?
7. Have ethical issues been Yes
taken into consideration?
Can’t Tell
No
HINT: Consider
• If there are sufficient details of
how the research was explained to
participants for the reader to
assess whether ethical standards
were maintained
• If the researcher has discussed
issues
raised by the study (e.g. issues
around informed consent or
confidentiality or how they have
handled the effects of the study
on the participants during and
after the study)
• If approval has been
sought from the ethics committee
Comments:
4

8. Was the data analysis Yes HINT: Consider
sufficiently rigorous?
 If there is an in-depth description of
the
Can’t Tell analysis process
 If thematic analysis is used. If so, is
it clear
No
how the categories/themes were
derived
from the data
 Whether the researcher explains how the
data presented were selected from the
original sample to demonstrate the analysis
process
 If sufficient data are presented to
support
the
findings
 To what extent contradictory data are
taken into account
 Whether the researcher critically examined
their own role, potential bias and influence
during analysis and selection of data for
presentation
Comments:
9. Is there a clear
statement Yes HINT: Consider whether
of findings?  If the findings are explicit
Can’t Tell
 If there is adequate discussion of
the
evidence both for and against the
No researcher’s arguments
 If the researcher has discussed the
credibility of their findings (e.g.
triangulation, respondent validation, more
than one analyst)
 If the findings are discussed in
relation to
the original research
question
Comments:

5

Running head: NURSING
Section C: Will the results help locally?
10. How valuable is the HINT: Consider
research?  If the researcher discusses the
contribution the study makes to existing
knowledge or understanding (e.g. do they
consider the findings in relation to current
practice or policy, or relevant research-
based literature
 If they identify new areas where research
is necessary
 If the researchers have discussed whether
or how the findings can be transferred to
other populations or considered other
ways the research may be used
Comments: