Critical Appraisal of Research on Inpatient Substance Use Treatment

This assignment presents a critical appraisal of a research paper investigating the facilitators and barriers to effective treatment of inpatient substance use clients. The appraisal employs the Consolidated Criteria for Reporting Qualitative Research (COREQ) to evaluate the study by Yang et al. (2018), which utilized thematic analysis on a sample of 60 participants. The appraisal covers the research team's reflexivity, study design, data collection, and analysis. Key facilitators identified include peer inspiration and perceived treatment needs, while barriers encompass organizational issues and a lack of trust and counselor rapport. The critique also discusses the limitations of the original study, such as the male-only sample and the potential for alternative data collection methods, while highlighting the strengths of the thematic analysis approach and coding procedures. This assignment is available on Desklib, a platform offering study tools and resources for students.

Running head: CRITICAL APPRAISAL OF A RESEARCH PAPER 1
Critical Appraisal of a Research Paper
Name
Institution

CRITICAL APPRAISAL OF A RESEARCH PAPER 2
Abstract
The study aimed at investigating the factors that act as facilitators and barriers to effective
treatment of inpatient substance use clients. The consolidated criterion for reporting qualitative
research (COREQ) is applied to undertake the critical appraisal. Based on the analysis, the
scholars adopt a thematic analysis to evaluate the barriers and facilitators of treatment among
inpatients seeking substance abuse remedies. A sample of 60 participants was adopted to analyze
the facilitators and barriers to effective treatment of inpatient substance use clients. The site of
the research was an inpatient public funded treatment initiative conducted in association with the
Sheriff’s Office in one of the mid-sized city located in the southern part of the United States of
America. While interviewing was used as the primary method of collecting data, one-on-one
semi structured interviews were implemented to recruit eligible participants for this research.
Coding was used to facilitate the processes of data analysis. Peer inspiration, perceived treatment
needs, organizational barriers and trust and counselor rapport were considered as the major
facilitators and barriers to effective treatment engagement encountered by inpatients seeking
remedies for substance abuse in the clinical settings.
Keywords: substance use, thematic analysis, coding, facilitators, barriers

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Critical Appraisal of a Research Paper
Introduction
Substance use is a critical public health crisis that calls for dire attention (Krasikova,
Lester and Harms, 2015). Substance abuse remedies play a significant role in minimizing the
symptomatic effects associated with recurrent use of drugs. According to O'Leary‐Barrett et al.
(2017), persistent substance users are faced with clinical and functional impairments as well as
alterations in their abilities to accomplish societal functions. Researchers and practitioners
dealing with drug addicts have strived to advance proper ways of fostering improvements in the
processes of delivering effective services (Neger and Prinz, 2015). Despite the efforts adopted,
Yang, Perkins and Stearns (2018) reveal that premature dropout among the targeted populations
is considered to be the greatest impediment to effective adoption of the therapeutic initiatives se
to target drug addicts. For instance, Sullivan, Messer and Quinlivan (2015) report that inpatient
rehabilitation programs encounter dropout rates ranging between 20% and 70% with the first
month being considered as a critical period and determinant of the efficacy of the treatment
initiatives put in place. As a consequence, Yang et al. (2018) establish a research aimed at
investigating the factors that act as facilitators and barriers to effective treatment of inpatient
substance use clients. The current study applies the consolidated criteria for reporting qualitative
research (COREQ) to analyze the article by Yang et al. (2018).
Domain 1: Research Team and Reflexivity
The study was conducted by three researchers; Yang Yang, David R. Perkins and
Elizabeth Sterns. Yang and Perkins are assistant and associate professors of Psychology at the
University of Louisiana at Lafayette. On the other hand, Elizabeth Stearns is an assistant
professor in the Department of Criminal Justice at the University of Louisiana at Lafayette.

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While Yang and Stearns are females, Perkins is a male. Elizabeth Stearns boasts of her long
research interests in Corrections as well as Women & Criminal Behavior and Feminist
Criminology. The fact that the three researchers share a similar workplace reveals that their
relationship was established before the commencement of this study. The participants carried out
the research to foster the advancement of knowledge and to contribute to the advancement of
clinical practice when dealing with substance use clients.
Domain 2: Study Design
Research approach
The study established by Yang et al. (2018) proceeds with the aim of exploring the
factors that impede or expedite short-term treatment inpatient treatment programs among clients
exposed to substance use. To attain the desired levels of effectiveness, the scholars adopted a
thematic analysis to evaluate the barriers and facilitators of treatment among inpatients seeking
substance abuse remedies. The scholars’ move to analyze crucial organizational factors such as
inadequacies in the treatments offered, the inability of these institutions to include remedies and
infrastructure that are gender responsive and poor communicational strategies adopted by the
nonclinical members of staff acts as an eye opener to players such as hospital administrators and
physicians to uphold organizational cultures that aimed at fostering positive collaborations and
teamwork. Similarly, the study acts as an operational blueprint aimed at facilitating the efficacy
of caregivers working with patients suffering from substance use disorders in strengthening the
institutional activities that facilitate treatment engagements through peer inspiration as well as
the trust and affinity among the physicians.
Yang et al. (2018) adopt a qualitative approach based on thematic analysis to investigate
the factors that act as treatment impediments and facilitators among inpatient substance use

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clients. According to Lewis (2015), qualitative approaches play an effective role in demystifying
the possible causes of the challenges faced by patients in clinical settings based on their optimal
levels of efficacy in fostering explorations that depict higher degrees of patient centeredness.
Similarly, Bryman (2017) commends qualitative approaches due to their inherent abilities in
availing recovery experiences that embrace higher degrees of validity.
Methodological orientation and theory
Thematic analysis was applied to foster the advancement of the premises on which the
study would be anchored. According to Rauch, van Doorn and Hulsink, W. (2014), thematic
analysis is one of the most effective instruments of fostering the processes of analyzing
qualitative data. Similarly, Cresswell and Cresswell (2017) applaud this approach based on its
higher levels of efficacy in allowing the researchers to gather systematic information and
knowledge concerning certain designated situations, institutions and cultures. On the other hand,
Braun, Clarke and Terry (2014) demystify that the thematic approach guides scholars by
narrowing their investigations from a broader viewpoint of data while moving towards a narrow
emphasis of the information collected based on a certain specified research question.
An analysis of the methodological approach applied by Yang et al. (2018) reveals the
scholars’ effectiveness in moving from a broader substance use perspective to a narrower
research question that is aimed at establishing the impediments and facilitators to treatment
among substance use inpatients. Further, the strength of the thematic approach adopted by the
researchers emanates from their inherent abilities to adopt and apply coding. According to Braun
and Clarke (2014), coding does not only allow the researchers to implement modifications in
qualitative studies in ways that are iterative and explicit but also play a critical role in revealing
the qualitative wealth of the phenomenon under investigation. Similarly, Braun and Clarke

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(2016) demystify that the codes adopted in thematic analyses form the bases of the themes that
are analyzed by the researchers.
Participant selection
In their study, Yang et al. (2018) adopt a sample of 60 male participants. One of the
greatest strengths reveal by the composition of the respondents used in the investigation is the
ability of the scholars to recruit based on multiple characteristics. According to Bryman (2017),
adoption of a sample space comprising of multiple characteristics plays an essential role in
broadening the topic of study based on the variations in viewpoints.
Setting
The site of the research was an inpatient public funded treatment initiative conducted in
association with the Sheriff’s Office in one of the mid-sized city located in the southern part of
the United States of America. The participants in this study were classified based on their racial
boundaries, marital statuses, number of children, educational attainments and history of
incarceration. However, the weakness of the sample used for this study emanates from the fact
that the scholars only adopted male participants. There are tendencies that inclusion of a
population comprising of female and transgender participants would yield different results. On
the other hand, the sample size (n = 60) was a bit narrow to guarantee higher levels of validity
and reliability of the results obtained. Similarly, Creswell and Creswell (2017) explain that a
smaller sample size limits the efficacy of a study to be used in making generalizations. The fact
that the scholars did not embrace distinct inclusive and exclusive criteria when recruiting the
participants reveals its weakness. There are tendencies that some of the respondents adopted for
the scholarly work may not have met certain set policies and guidelines set to underscore clinical
investigations.

CRITICAL APPRAISAL OF A RESEARCH PAPER 7
Data collection
The scholars adopted interviewing as the major primary method of collecting data. One-
on-one semi structured interviews were implemented to recruit eligible participants for this
research. An analysis of the procedure adopted to collect data for this study reveals some levels
of inefficiencies. For instance, the one-on-one and face to face interviews adopted by the
scholars are time consuming (Creswell and Creswell, 2017). Such a position explains why the
sample space used in the study was limited (n = 60). There is need for future studies to adopt
other methods of collecting data such as the use of structured questionnaires. According to
Bryman (2017), questionnaires are not time consuming and are not bound the geographical
challenges revealed by interviews. On the other hand, the fact that questionnaires may be applied
for a larger population would increase the levels of validity and reliability of the results arrived
at.
Domain 3: Analysis and Findings
Data analysis
Coding was used to facilitate the processes of data analysis. The transcripts obtained
during the interview were loaded into the ATLAS.ti software following the de-identification
procedure. According to Braun and Clarke (2014), coding in thematic analysis plays a significant
role in fostering the modifications of the information collected as ideas emerge. Similarly, Braun
and Clarke (2016) reveal that the kind of codes adopted in a study form the bases of the themes
to be investigated by the scholar. The fact that the coding procedure adopted by Yang et al.
(2018) meets the aforementioned properties reveals the efficacy of the data analysis procedure
implemented.

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Braun and Clarke (2014) demystify that the codes adopted in hematic analysis need to be
audited by multiple agencies as a way of fostering integrity and minimizing the effects of biases
that may result from including a single researcher. According to Braun and Clarke (2016),
adoption of multiple analysts ensures the availability of adequate resources to read and re-read
the data; initiate double checking of the information gathered as a way of instilling higher levels
of validity and consistency. The study enhanced the levels of effectiveness of the analysis
procedure adopted by recruiting three authors to participate in the process of coding. Further, the
researchers adopted multiple strategies aimed at fostering qualitative analysis. For instance, the
philosophies of thematic analysis and interpretive phenomenology analysis were put in place to
foster optimal degrees of reliability. The coding procedure was brought to a halt after the three
authors adopted for this study had reached an agreement on the specific codes to be adopted for
thematic analysis.
Reporting
Following the analysis conducted by the scholars, four primary themes were considered.
Peer inspiration, perceived treatment needs, organizational barriers and trust and counselor
rapport were considered as the major facilitators and barriers to effective treatment engagement
encountered by inpatients seeking remedies for substance abuse in the clinical settings identified
by the scholars. The significance of treatment motivation among clients suffering from substance
abuse was considered as a key facilitator to the recovery initiatives put in place in inpatient
settings. Pertinent issues such as motivating the clients each time they take the efforts of
complying with the clinically recommended remedies was considered as a key facilitator to the
process of healing. On the other hand, the inability of the affected individuals to recognize the
availability of the problems they are facing was considered as a core barrier to the procedures

CRITICAL APPRAISAL OF A RESEARCH PAPER 9
set. Therefore, the aforementioned results reveal the importance of including client-centered
motivations as a way of advancing effective treatments among substance use inpatients.
Life events were found out to play an essential role in compelling substance use patients
towards seeking effective remedies in clinical settings. According to Yung, Eickhoff, Davis,
Klam and Doan (2015), some individuals do not comprehend the adverse effects of the
substances they consume at their early stages of life. However, understanding is established as
the patients are exposed to different scenarios and experiences in life emanating from the
psychological, social and health related risks associated with the substances they were initially
exposed to. Consequently, the study established by Yang et al. (2018) is in line with traditional
findings as it highlights on the importance of adopting age appropriate interventions when
fostering treatments. Similarly, the researchers reveal that counselor rapport and peer inspiration
act as critical contributors to the remedies adopted to target substance users. According to
Winters et al. (2018), the empathetic relationships established between the patient and the
counselors are highly effective in compelling the client towards seeking the desired medical
attention. However, organizational factors were considered as essential barriers in the process of
fostering treatments among addicts. Issues such as the unavailability of treatments that depict
higher degrees of gender responsiveness and the ineffectiveness of practitioners in availing the
opportunities needed to foster treatment discussions were considered as critical institutional
impediments to effective adoption of the desired remedies. While the study avails conclusive
findings concerning the promoters and barriers to effective treatment of these patients, it fails to
reveal the effects of personal, social and psychological factors in these procedures. As a
consequence, future studies need to underscore the efficacy of these factors in fostering
treatments.

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Conclusion
The study aimed at investigating the factors that act as facilitators and barriers to
effective treatment of inpatient substance use clients. To achieve the desired results, the
researchers adopted a thematic analysis to evaluate the barriers and facilitators of treatment
among inpatients seeking substance abuse remedies. Peer inspiration, perceived treatment needs,
organizational barriers and trust and counselor rapport were considered as the major facilitators
and barriers to effective treatment engagement encountered by inpatients seeking remedies for
substance abuse in the clinical settings. The results of this investigation contribute to the nursing
profession by acting as an eye opener on the need for stakeholders to adopt patient centered
remedies aimed at fostering the advancement of clinical environments that promote inclusivity
when dealing with substance use patients.
References
Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing
researchers?. International journal of qualitative studies on health and well-being, 9.

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Braun, V., & Clarke, V. (2016). (Mis) conceptualising themes, thematic analysis, and other
problems with Fugard and Potts’(2015) sample-size tool for thematic analysis.
International Journal of Social Research Methodology, 19(6), 739-743.
Braun, V., Clarke, V., & Terry, G. (2014). Thematic analysis. Qual Res Clin Health Psychol, 24,
95-114.
Bryman, A. (2017). Quantitative and qualitative research: further reflections on their integration.
In Mixing methods: Qualitative and quantitative research (pp. 57-78). Routledge.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed
methods approaches. Sage publications.
Krasikova, D. V., Lester, P. B., & Harms, P. D. (2015). Effects of psychological capital on
mental health and substance abuse. Journal of Leadership & Organizational Studies,
22(3), 280-291.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches.
Health promotion practice, 16(4), 473-475.
Neger, E. N., & Prinz, R. J. (2015). Interventions to address parenting and parental substance
abuse: Conceptual and methodological considerations. Clinical psychology review, 39,
71-82.
O'Leary‐Barrett, M., Masse, B., Pihl, R. O., Stewart, S. H., Seguin, J. R., & Conrod, P. J.
(2017). A cluster‐randomized controlled trial evaluating the effects of delaying onset of
adolescent substance abuse on cognitive development and addiction following a
selective, personality‐targeted intervention programme: the Co‐Venture trial. Addiction,
112(10), 1871-1881.

CRITICAL APPRAISAL OF A RESEARCH PAPER 12
Rauch, A., van Doorn, R., & Hulsink, W. (2014). A Qualitative Approach to Evidence–Based
Entrepreneurship: Theoretical Considerations and an Example Involving Business
Clusters. Entrepreneurship Theory and Practice, 38(2), 333-368.
Sullivan, K. A., Messer, L. C., & Quinlivan, E. B. (2015). Substance abuse, violence, and
HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women
of color. AIDS patient care and STDs, 29(S1), S42-S48.
Winters, K. C., Botzet, A. M., Stinchfield, R., Gonzales-Castaneda, R., Finch, A. J., Piehler, T.
F., ... & Hemze, A. (2018). Adolescent substance abuse treatment: A review of evidence-
based research. In Adolescent Substance Abuse (pp. 141-171). Springer, Cham.
Yang, Y., Perkins, D. R., & Stearns, A. E. (2018). Barriers and Facilitators to Treatment
Engagement Among Clients in Inpatient Substance Abuse Treatment. Qualitative health
research, 1049732318771005.
Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2015). Internet addiction
disorder and problematic use of Google Glass™ in patient treated at a residential
substance abuse treatment program. Addictive behaviors, 41, 58-60.