NURSING RESEARCH APPRAISAL: Critical Analysis of Vaccination Study

This report provides a critical appraisal of a qualitative research study examining parental perceptions of child vaccination in Singapore. The study's purpose was to understand parental views and identify gaps in the healthcare system to improve vaccination programs. The methodology involved semi-structured interviews with 19 parents, employing a descriptive and qualitative approach. Key findings revealed factors promoting vaccination, such as mandatory programs and trust in healthcare, and factors hindering it, including concerns about side effects and misconceptions. The study's limitations include its single-clinic setting and exclusion of non-English speakers. The report evaluates the study's ethical considerations, methodology, findings, and relevance to nursing practice, concluding that while the results offer valuable insights, the limitations should be considered when informing evidence-based practice. The study provides evidence under Level VI-Evidence pyramid from a solo descriptive or qualitative research.

Running head: NURSING RESEARCH APPRAISAL
Nursing Research Critical Appraisal
Name of Student
Name of University
Author Note

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Assessment 1
Article 2: Qualitative Research Analysis
Question 1: Study Purpose/Question
(a) Did the study have a clearly stated purpose/research question?
Yes / No
(b) Explain your response below:
The main purpose of the paper was to study the concepts of child vaccination among the
parents of Singapore, and correlate the gaps that were present in the healthcare system of the
country and develop vaccination management programs across the country (Luthy et al.
2015). The authors described vaccination referencing the world health organization as the
process of immunizing or developing competence in an individual against a disease that is
deemed infectious. This is basically carried out when a vaccine is administered. Given that
there are diseases that can be controlled or avoided from the community; vaccination is
therefore among the most cost-effective interventions of healthcare that can be adapted to
prevent the occurrences of these diseases. The researchers conducted the study which helped
them realize that to increase a country’s rates of vaccination, it is very important to fully
comprehend the perceptions of the parents in reference to the vaccination of the child.
Question 2: Relevance to nursing/midwifery practice
(a) Explain how this question was relevant to nursing/midwifery practice.

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The nursing and midwifery staffs play an important role to act as mediator for
communication between the practitioner and the patients (Rosen et al. 2015). The practitioner
provides the instruction for a treatment or care, which the nurses carry forward to achieve
improved health outcome. The nurses and midwives occupationally spend more time with
patients, or in this case, with the parents of infants. This provides a solid platform to develop
trust with the child’s parents and help them understand the importance of vaccination. The
study will help nurses and midwives in Singapore will able to communicate with the parents
and teach about the importance of vaccination from an early stage and inhibit any future
diseases progression.
Question 3: Ethics
(a) What were the possible risks of participating in the study?
The possible risk factor, which was evident in the paper, was the reluctance from the
participants (Klabunde et al. 2013). Some of the participants pointed out that at times they
would make changes in their kid’s vaccination schedule. They said they could choose to split
or delay the vaccinations since they had concerns related to some effects of vaccination.
These effects may be on the growth of their children, vaccine-related issues, religious beliefs
as well as negative past experiences. Some had concerns with the vaccines saying it could
cause fever or dangerous allergic reactions and also the possible delay in the child’s
development.
(b) Were these risks clearly identified by the authors?
Yes / No
(c) If risks were identified by the authors, how did they propose to minimise risk?

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The addressed the issue or previous negative vaccination experiment, reluctance by reaching out
to the parents and providing assurance that their privacy would do be jeopardized (Shiono et al.
2014). In order to manage the pain or crying and other outcomes that may not be pleasing, a
number of parents used different methods to counter such incidences. During the whole
vaccination process, some parents employed distraction techniques such as phones, offering
sweets and cakes or even playing videos and once done some parents would breastfeed their
children in order to calm them. Other parents went further ahead by rescheduling their work
involvements in order to stay at home to take care of their kids.
(d) Did the authors state that they had approval from an ethics committee to undertake the study?
Yes / No
(e) How did the authors obtain informed consent from participants?
The authors documented written consents from all the participants by engaging in interpersonal
communication (Lewis 2015). The participants were ensured on the maintenance of privacy
concerning the participation of the parents and their opinions will not be revealed.
(f) Did you identify and potential risks associated with the study that were not identified by the
authors and if so, what were they?
Yes
The researchers failed to contemplate the situation where the parents who were not of English
speaking background, would not be able to clearly understand the implications of vaccination.
Additionally, the authors did not contemplate that not all participants will be ready to show
enthusiasm.

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Question 4: Study Methodology
(a) What the chosen methodology for this study?
The authors formulated a descriptive and qualitative method of study, which was aimed to
address the concern of vaccinations.
(b) Was this choice suitable for the given research problem/question?
Yes / No
(c) Explain your response to (b):
The authors chose this form of methodology, because this provided room for the participants to
engage in interpersonal communication and improve the misconceptions of vaccination. The
interviews mainly evolved on four main issues from the guide: healthcare support and needs,
general experiences, vaccination decisions and concerns/difficulties.
Question 5: Data Collection/Rigour
(a) Describe how the data was collected for this study (interview, observation, etc).
The author engaged in interpersonal interview sessions with the participants after documenting
the written consent and privacy policy. The interview method was semi-structured with either by
personal interview sessions or telephone calls at convenient settings. The interview was audio
taped for data analysis. The analysis f the data was conducted by using open coding system by
the primary author until a mutual decision was made.
(b) Did the researchers provide the participants with the opportunity to check the collected data

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or research findings?
Yes / No
(c) Did the researchers continue recruiting people to the study until data saturation was reached?
Yes / No
(d) Did the study use multiple data collection methods (e.g., collect data from more than one
source)?
Yes / No
(e) Explain how the points in (b), (c) and (d) contribute to the trustworthiness of the overall
research findings.
The author and the group collected data from parents of the age group 27-40, irrespective of
gender to minimize research bias. The research group also included people from Chinese, Malay,
Indian and other ethnic identities to include representation of the common population. In order to
promote rigour, the researchers employed several strategies such as making reviews on the
transcripts and using own words of the participants, written reflections, investigator
triangulation, audio recordings, developing an audit trail, field notes, interview transcripts and
how coding, themes and subthemes were found and also the use of verbatim quotes. The above
strategies were meant to basically support the findings
Question 6: Participants
(a) How many participants were included in the study?

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The researchers approached 44 parents from which 16 decided not to participate and another
6 not meeting the inclusions requirements. A further 2 withdrew their participation and 1
participant went for the pilot interview which was not included in the final analysis.
Therefore there was 19 audio-recorded interviews for the analysis each lasting between 10-30
minutes
(b) What were the inclusion and exclusion criteria?
Inclusion criteria: the parent must-
 Participants must have a healthy child between the age of 0-18 months who is
under vaccination treatment
 Participant being questioned have to be the main caregiver of the said child
 Participants have to be able to read and communicate in English
Exclusion criteria: those parents who-
 Participants with visual and/or hearing impairment will not be considered
 Participants with cognition impairment were excluded.
(c) Explain how the participants were recruited.
The authors attended the clinic, which virtually seemed to be accessed by multiple ethnicities in
Singapore. The author devised purposive sampling to recruit the participants and the sample size
determined by saturation.
(d) Describe the setting in which the study took place (hospital, community, etc).
The author selected a vaccination clinic which was accessed by many children of the age of
going for pre-schooling in Singapore.
Question 7: Research Findings (outcomes)
(a) What were the main findings of this study? (provide a dot point summary)

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The main findings of the study are provided in the following bullets:
 Factors that promote vaccination: mandatory promotion of vaccination programs,
health care services trust, promoting child immunity, ease of access and availability
and stigmas that are known about the side effects of vaccinations.
 Factors that impede vaccination conformity: health risk and side effects of
vaccination was a major concern among the parents. Previous trauma due to wrong
care affected their mindset; rigidity about vaccination schedules, limitations that
come with accessibility and alternatives for vaccination was a major concern,
misconceptions about severity of the diseases.
 Parents who provided supportive roles: some parents made sure that their child were
nutrition sufficient, some parents were exceptionally well at handling their child in
difficult situation than others, like in times of pain management which helped in the
vaccination process.
 Improvement in service, information and communication: short waiting list, quick
access to appointment made it easier for parents to get their child vaccinated.
Availability and accessesibility of vaccines and proper information exchange helped
parents be motivated to get their children vaccines.
From the above data, the researchers were able to make the following results/findings
 All those who took part in the study were married
 Their ages ranged from 26-47 years
 There were ten fathers and nine mothers
 Ethnicities: Chinese n=11, Malay n=4, Indian n=4 and a Jewish categorised under others
n=1
 12 participants had only one child
 The maximum number of children was 6

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 15 participants had attained university education.
 15 participants had received education related to vaccination within a period of the last 1-
18 months at different timings while 4 participants had not.
 Main sources of information were from the internet and healthcare professionals.
 9 boys were undergoing vaccination with ages of between 1-18 months.
 Of all the participants, only 4 could not remember how many vaccinations their children
had received while the rest reported that their children had received from 1-9
vaccinations from birth.
 Household and monthly incomes levels were from between less than S$ 2,000 to more
than S$10,000. Other specific 14 parents had a monthly income of over S$ 3,000.
Question 8: Study limitations
(a) What were the limitations of this study stated by the author/s?
 The authors conducted the study in only one clinic where the participants came to get
their children vaccinations (Palinkas et al. 2015)
 The authors did not include non English speaking demographic which excludes a
majority of the Singaporean population. This provides a gap in the communities of
Singapore and the people who are challenged due to socio-economic determinants of
health will be left out.
 The authors excluded the parents who commenced delayed vaccination for their children.
(b) Explain why these are study limitations.
 Carrying out a research study in only one site limits the comparison of the findings and
transfer of information between multiple settings (Palinkas et al. 2015).
 Leaving out those who could not communicate in English, which implicates that a
majority of the population who have less education will be excluded from the
programme.

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(c) Did the researchers disclose any personal ideas, experiences or knowledge (bias) that
might influence the conduct and outcomes of the study?
Yes / No
(d) Explain why personal ideas, experiences or knowledge (bias) may reduce the validity
of the study
Involving the researchers own ideas and preferential bias would jeopardize the authenticity of the
research methodology (Simon and Goes 2013). The data would be focused to the preference of
the researcher and the holistic approach to research outcome would not be achieved. Including
people irrespective of gender, ethnic or racial background would provide conceptions from
multiple backgrounds.
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?
The paper provides evidence under the Level VI- Evidence pyramid from a solo descriptive or
qualitative research (Murad et al. 2015).
(b) Overall, should the outcomes of this study be used to inform evidence-based practice?
Yes / No
(c) Explain your rationale for your responses to questions (a) and (b).

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It is important o understand the repercussion that would follow if a child is not exposed to
vaccination during their growing years. The maturity of the immunity will be deprived and the
child will be susceptible to various diseases, which might cause harm in the future (Goldstein
MacDonald and Guirguis 2015). Nurses are required to teach the child’s parents the information
and reassure them about the outcome that would be received from vaccination.
Assessment 2
Reflection
The critical analysis of the two chosen articles provided information about utilizing the
practice of evidence based research. I was immunized as a kid, which helped me improve my
immunity, so I was exposed to the concept of vaccination from a young age and my choice of
career provided more insight into the importance of vaccination (Healy Montesinos and
Middleman 2014). I had both life experience and experience gained from secondary sources on
issues related to vaccination. These sources included books and from the internet. Vaccination
has always been a large area of concern for all communities and most specifically to the health
sector (Kuruvilla et al. 2016). I did have an idea when it comes to immunization in children as I
already mentioned and these article provided information of how I can engage the patients to get
their children vaccines on time. I gained the knowledge as a part of my academic curriculum and
since I am assigned as a nurse in the pediatric department, I was aware of the concept of
vaccination but not regarding the social stigma that comes with it (Sobo 2015). I did not have
any such social or religious preferences that would direct me against this practice, my profession

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and my academic background cemented my thoughts about the importance of medical science on
population. Having myself undergone vaccination on timely basis at an infant stage, I am not
opposed of the opinion obligatory and firmly imposition of vaccination should be maintained
(Grabenstein 2013). I would like to advocate my idea regarding vaccination as it helps in
minimizing the chances of contracting diseases and by so doing; it increases the chances of
survival for an infant. The ideas gathered from this study have further increased my support
towards vaccinations. Most of my concerns have been addressed and well explained on how best
to manage my fears on issues related to vaccination. The paper addressed the issue where the
parents expressed their concerns about the availability and accessibility of vaccines, which is an
important factor in healthcare. I would be careful to let the parents know about the alternative
methods for vaccines and where they can find them. I would ensure that proper communication
helps them clear their misconceptions about the safety and efficacy of vaccines. Providing proper
information, like febrile conditions is normal after vaccinations in some children will also help
the parents understand the process of vaccination. The paper helped me understand the
importance to teach a parent’s the importance of vaccination, which I previously thought was a
personal opinion. Sometimes, interventions like in article one, is important to gain better patient
outcome (Ylitalo Lee and Mehta 2013). I also learned that by including the parents in the
information outlet it could be made sure that their fear for negative impact of vaccination or
other related misconceptions are reduced.

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