Assessing the Quality of Qualitative Research in Nursing: A Study on Parental Perceptions of Child Vaccination in Singapore

This study assesses the quality of qualitative research in nursing by exploring parental perceptions of child vaccination in Singapore. The study examines the relevance of the research question to nursing practice, ethical considerations, methodology, data collection, participants, research findings, study limitations, and applicability to clinical practice.

Research Methodology in Nursing
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Part 1: Assessing the quality of qualitative research
Question 1: Study Purpose/Question
(a) Did the study have a clearly stated purpose/research question?
Yes
(b) Explain your response below:
At the end of the introduction and background section, purpose of the was clearly
mentioned. Purpose of the study was mentioned after through literature survey. From the
literature survey, it was evident that parental views were not explore on their children’s
vaccination. Hence, purpose of this study was to explore the perceptions of parents on
their child’s vaccination in Singapore to identify gaps in current healthcare practice and
therefore help develop future programmes to improve parents’ experiences regarding their
children’s vaccination (Kurup et al., 2017).
Question 2: Relevance to nursing/midwifery practice
(a) Explain how this question was relevant to nursing/midwifery practice.
Interaction of nurse with parents during immunization and for immunization of children is
crucial aspect. Nurse can play significant role in improving parent’s perception for
adherence to immunization and influencing others for immunization. Nurse can reduce
parents anxiety while delivering painful injection to their children and educating them and
improving their knowledge about the immunization (Holland, 2014).
Question 3: Ethics
(a) What were the possible risks of participating in the study?
Parents perceptions like effect of vaccination on their child’s growth, issues related to
vaccination, past negative experiences and religious beliefs were the risks associated with
parents for the participation in the study (Kurup et al., 2017).
(b) Were these risks clearly identified by the authors?
Yes
(c) If risks were identified by the authors, how did they propose to minimise risk?
Risk minimisation strategy was not mentioned for the all the risks. Risk minimisation
strategy was mentioned only for risk like issues related to vaccination. Most of the
children might face problem during vaccination. Child might feel pain and might cry
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during vaccination. Authors suggested strategies to reduce risks. Strategies to minimize
risk mentioned by the authors can be considered as valid strategies because these were
mentioned with relevant literature support. Pain during vaccination can be reduced by
using distraction techniques. Moreover, authors also suggested use of topical anaesthetics
for pain management. However, there was no standardised anaesthetic is available for use
during immunization (Kurup et al., 2017).
(d) Did the authors state that they had approval from an ethics committee to undertake the
study?
Yes
(e) How did the authors obtain informed consent from participants?
Written consent was obtained from the participants for voluntary participation and
confidentiality of data. This written consent was taken individually after providing
information related to study both in verbal and written format (Kurup et al., 2017).
(f) Did you identify and potential risks associated with the study that were not identified by
the authors and if so, what were they?
There were no identified potential risks other than identified by the author.
Question 4: Study Methodology
(a) What the chosen methodology for this study?
Descriptive qualitative method was employed in this study. Descriptive study can be helpful in the
describing the health-care and nursing related phenomenon. Qualitative research designs are being
used widely for the gaining insights of the poorly understood phenomenon (Gray et al., 2013).
Descriptive qualitative method can be useful for obtaining information in the form of description
and in the form of interviews or questionnaires. In this type of descriptive qualitative analysis,
usually thematic analysis being used. In this study, also thematic analysis was being used.
However, care should be taken that it should get confused with the content analysis (Chesnay,
2014).
(b) Was this choice suitable for the given research problem/question?
Yes
(c) Explain your response to (b):
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Qualitative research methods are being used for the comprehensive summation of the
experience of the people related to particular phenomenon. Information related to patient
experience can be gathered either through observation or interview. In this research study,
information related to parent’s perception about their children’s immunization need to
collected. This information was collected by conducting interviews of parents in person
and through telephone. Moreover, this research method can fulfil the aim of the study.
Hence, this research methodology is suitable for this research study (Morris, 2015; Bell,
2014).
Question 5: Data Collection/Rigour
(a) Describe how the data was collected for this study (interview, observation, etc).
In descriptive qualitative studies, data can be collected through different methods like interview
using interview guide, surveys, observations and filed notes. In this study, data was collected
through interview using interview guide. Suitability of the interview and interview guide was
confirmed by carrying out pilot study. There were two types of interviews like structured and semi-
structured in which closed and open questions can be asked. In open questions, fixed information
can be obtained and in closed questions, variable information can be collected based on the
individual participant. Both structured and semi-structured interviews can be used effectively for
collection of data in qualitative research (Fisher, 2011). In this study, semi-structured interview
was conducted. In this study, both face-to-face and telephone interviews being used. Each
interview process was lasted for about 10-30 minutes. These interviews were audio-recorded.
These audio-records of the interview can be useful in demonstrating more details of interview,
accurate analysis and monitoring of the interview process. Moreover, these audio-records can be
achieved for later reference. Outcome of the interview based qualitative study based on the
sampling of the participants because participants need to express their feelings and experiences.
Content of the interview is important aspect because it should align with the aim and purpose of the
study and outcome of the study also based on the content of the interview questions. Content which
is interview guide in this study can be considered as robust and valid resource because it was
developed based on the literature and two experts opinion were taken. However, details of the
experts like expertise and experience were not mentioned in this study (Morris, 2015; Erlingsson &
Brysiewicz, 2013).
In interview based data collection, accurate demographic data can be collected because participants
can not give false data related to age and gender. In interview based data collection both verbal and
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non-verbal ques can be obtained from the participants. Level of knowledge and comfort level in
expressing it can be easily assessed in interview based data collection. Specific information can be
collected by avoiding distractions in interview based data collection. Interview based data
collection can be helpful in assessing emotions and behaviour of the participants (Levickis, 2013).
(b) Did the researchers provide the participants with the opportunity to check the collected data
or research findings?
No
(c) Did the researchers continue recruiting people to the study until data saturation was
reached?
No
(d) Did the study use multiple data collection methods (eg collect data from more than one
source)? No
(e) Explain how the points in (b), (c) and (d) contribute to the trustworthiness of the overall
research findings.
Collected data should be blinded from the participants. It can be helpful in reducing
biasness in the data collection and also can helpful in improving rigour of the collected
data. Participants were recruited at the start of the start by considering inclusion and
exclusion criteria (Isaacs, 2014; Braun et al., 2014). Recruitment of data in the later phase
of the study until getting saturation of data can result in the recruitment of participants
with variable characteristics. It can result in the collection of variable data. There were
less chances of biasness in this study because data was collected by one senior researcher
who was not part of the intervention to the children. Moreover, variability in the data
collection was reduced by employing the single researcher for data collection. All these
factors helped in improving trustworthiness of the research findings (Fisher, 2011).
Question 6: Participants
(a) How many participants were included in the study?
In this study, 22 participants were recruited; however, data was collected for 19 participants. One
participant was participated in the pilot study and two participants were withdraws due to
scheduling constraints. No of participants could have been mentioned in the sampling section of the
article; however, it was mentioned in the data collection section of the article.
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(b) What were the inclusion and exclusion criteria?
Sample universe can be effectively defined and decision making in sample selection can
be improved by incorporation of inclusion and exclusion criteria in the sample selection.
Variability in the outcome of the study can be reduced and robust and valid data can be
obtained by considering inclusion and exclusion criteria prior to initiation of the study.
The inclusion criteria included a parent who: (i) had a healthy child aged 0–18 months
undergoing vaccination, (ii) was the main caregiver of the child and (iii) was able to
speak and read English. The exclusion criteria were parents who had: (i) visual and/or
hearing impairments and/or (ii) cognitive impairment (Kurup et al., 2017).
(c) Explain how the participants were recruited.
In this study, purposive sampling method was used for the recruitment of the participants. In this
purposive sampling method, recruited participants would be specific purpose. In this study,
participants whose children would receive immunization and these participants would express their
perception. These participants were recruited from different ethnic groups. Inclusion and exclusion
criteria were considered prior to recruitment of participants. Initially, 44 participants were
approached for participation. Out of these 16 were unwilling to participate in the study and 6
participants didn’t met inclusion criteria. 22 participants were recruited in the study; however, data
was collected from the 19 participants (Kurup et al., 2017).
(d) Describe the setting in which the study took place (hospital, community, etc).
This study was conducted in an immunization clinic in Singapore. In this clinic school
going children used to receive vaccines.
Question 7: Research Findings (outcomes)
(a) What were the main findings of this study? (provide a dot point summary)
Most of the participants exhibited adherence to redocumented vaccination schedule and
also took up optional vaccination schedule.
Parents exhibited trust in the Government and healthcare sector regarding vaccination. It
helped in improving their trust in the in vaccination and standard practices of
administration of vaccines. These participants mentioned positive aspects like preventive
measures of vaccination for their children and community against disease.
Participants stated that vaccines are easily available at the affordable prices, freely
available and with relevant subsidies.
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Most of the participants adhered to vaccination due to fear of possible revaccination to
their children and possible adverse effects of occurrence of diseases due to non-adherence
to vaccination.
Few of the participants mentioned negative aspects of vaccination. Few participants
delayed vaccination schedule and didn’t take optional vaccination. These participants
mentioned various reasons like impact of vaccines on their child’s growth, issues in
administration of vaccines, past negative experience of vaccination and religious belief
for delay or split in vaccination. These participants delay or split vaccination due to
possible allergy, fever, pain and crying.
Some participants scheduling constraints as the reason for their non-adherence for
vaccination because it was difficult for them to maintain balance between work balance
and vaccination schedule.
Few of the participants avoided optional vaccination because its non-availability and less
severity of the disease.
Participants well fed their children and considered homeopathies for preventing adverse
effects of vaccination.
Participants took part in vaccination process by handling the child and observing the
vaccination procedure.
Parents used distraction techniques to reduce pain and crying due to vaccination.
Participants mentioned that waiting time as the drawback for vaccination and instant
messaging helped them in reducing waiting time for their vaccination.
Participants had differing opinion regarding amount of information about vaccination.
Few of the participants had sufficient and remaining had insufficient information
regarding vaccination.
Few of the participants were satisfied with the knowledge and services of the healthcare
providers related to vaccination. However, participants were not satisfied with knowledge
and services offered by healthcare professionals (Kurup et al., 2017).
Question 8: Study limitations
(a) What were the limitations of this study stated by the author/s?
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This study was conducted at single healthcare setting. Hence, generalized applicability of
these findings is difficult. Information related to perceptions of the parents non-English
speaking parents were not collected in this study. This study considered parents with
children between 0 – 18 months. Hence, information related to perceptions of parents
with who delayed vaccination beyond 18 months was not collected (Kurup et al., 2017).
(b) Explain why these are study limitations.
Outcome of this study could not be considered as evidence because study outcome can be
considered as evidence because if large scale study was conducted at different locations.
Outcome of this study can not be considered for parents with low socioeconomic class
and less educated people (Harreveld, 2016)
(c) Did the researchers disclose any personal ideas, experiences or knowledge (bias) that
might influence the conduct and outcomes of the study?
No
(d) Explain why personal ideas, experiences or knowledge (bias) may reduce the validity of
the study
Personal ideas, experiences or knowledge (bias) can influence findings. It can also impact
data collection and analysis because in qualitative studies subjective data should be
collected. Personal bias can influence collection, analysis and interpretation of the
subjective, in case data is not being blinded or coded. It can lead lessened transparency in
the in the data collection and outcome. Hence, it may reduce validity of the results (Smith
and Noble, 2014).
Question 9: Applicability to clinical practice
(a) According to the Levels of Evidence pyramid, what level of evidence are the reported
results from this paper?
According to levels of Evidence pyramid, reported results in the paper are of level VI.
(b) Overall, should the outcomes of this study be used to inform evidence-based practice?
No
(c) Explain your rationale for your responses to questions (a) and (b).
These results can not be used as evidence-based practice because this study was
conducted at the single site and very less participants were incorporated in this study.
Moreover, rigour and biasness were not mentioned properly in this study. Rigour and
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biasness are the most important factors for considering these study as evidence-based
study (Dean et al., 2016).
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Part 2 Reflection
Prior to this, I had knowledge about the immunization safety to children and women. It is
evident that immunization procedures are painful to children and it can produce anxiety,
distress and fear in children and their parents. It is mainly due to fear due to needle pain,
parental nonadherence and avoidance of medical care. Reduction in pain and distress during
vaccination can be helpful in reducing fear of needle, needle phobia, noncompliance with
scheduled immunizations, and later avoidance of medical care (Faucette et al., 2015).
This information was gathered from internet sources, clinical online databases, professional
organisations. Most of the information was gathered by discussion with colleagues. Through
these discussions, along with getting information, analysis and interpretation of effect of
immunization on children and their parents was done. These decisions helped in clinical
decision making and it helped in augmenting confidence of me. Medical textbooks also
proved rich source of information. In medical textbooks, case studies were mentioned and
these case studies helped in getting information related to diverse aspects of immunization
like benefits of immunization, adherence to immunization, parents perceptions and barriers to
immunization. PubMed Clinical Queries in National Library of Medicine was used for
getting information. Different databases like Pubmed, PsycINFO, Web of Science, or
CINAHL were used for gathering information. Disease registers in the hospital, health
surveys and clinical trials data were also used to collect information related to immunization
in the children (Liu et al., 2013).
In pregnant women, there is possibility of alteration in the immune system. Due to alteration
in the immune system, these women are more susceptible for vaccine-preventable infections.
Immunization can be helpful in protecting these women from vaccine preventable infections
and in this process foetus also get protected. Immunization can protect the foetus and infant
through specific antibodies transferred from the mother during the pregnancy. Morbidity in
pregnant women and her foetus can be effectively reduced through vaccination to pregnant
women (Marshall et al., 2016). I feel there should not be question regarding safety of vaccine
because vaccine undergoes several safety and effectiveness tests prior to its approval for
marketing. Few of the children after taking vaccination might exhibit adverse reactions like
redness, pain, or swelling. These reactions would be minor and these can disappear in few
days. I have opinion that vaccines are safe and effective because vaccines were being giving
healthy life to millions of people including children (Kochhar et al., 2017).
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I learned that vaccine administration is associated with few of the drawback like pain to the
children and minor adverse reactions. These drawbacks can be easily managed. In
comparison to the wider benefits, these drawbacks should be considered. Nurse and parents
role are very important in effective immunization to the children. Nurse need to understand
perceptions of parents regarding vaccination to improve their adherence to immunization.
Immunization should be considered safe in children and pregnant women because evidence is
available for the safety of immunization through large scale clinical trials (Jones et al., 2016).
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