Research Critique

Research Critique of “African American Women’s Experience of Infection
With HIV in the Rural Southeastern United States”

October 15, 2012
This essay is a critique of qualitative nursing research. In it I will review the research article African American Women’s Experience of Infection with HIV in the Rural Southeastern United States. The article is written by Mallory, who is an associate professor at Mennonite College of Nursing, Illinois State University (Mallory, 2008). In her article Mallory (2008), indicates that there is little research into why African American women account for the majority of HIV/AIDS diagnosis among women in the United States. This led Mallory to question why extensive campaigns to promote HIV prevention were not effective with African American women. The purpose of the author doing this research was to explore African American women’s experiences of infections with HIV in the rural U.S. The research also sought to find out if interventions to prevent HIV infection among African American Women require more understanding of the circumstances that cause the infection. Mallory’s research is valid in that different interventions should be made to help protect African American women from HIV/AIDS, but the sample for this study was too small. This essay will provide an analysis of Dr. Mallory’s article and research starting with strengths, limitations, interpretation of the research and ending with the relevance of the research done.
Mallory’s study is one of the few studies that have addressed the rate of HIV infection in African American women. It is a study that has not been under researched there are ample areas for the researchers to explore. The study used descriptive research to get firsthand knowledge of the women that had contracted the virus, but a limitation is that there are few sources to draw upon for evidence based research.
A literature review gives you current theoretical and scientific knowledge about the particular topic that the subject of a research study and gives you what is known what is not known about the topic. The researchers should give a description of the knowledge; identify the gaps in the knowledge and what the current study brings to the body of knowledge (Burns & Grove, 2011). In Mallory’s study the literature review clearly states what is known about women living in the rural areas of the U.S. with HIV in several electronic databases. The gaps in this knowledge is that there is only one study published dealing with African American women that used qualitative data.
Problem statements in research articles are statements that give a description of the problem that is in need of addressing. This problem is brought up to the researchers and should address what the problem is, who has the problem, where the problem is, and why the problem exists. Mallory’s problem statement states, “Despite evidence that the rate of HIV infection among women has risen sharply in the rural south (“Southern women apparently face,” 2001), there remain a limited number of published studies related to prevention of HIV among African American women living in the rural south.” (Mallory, 2008). This is Mallory’s gap in the knowledge of the research topic.
The literature review is fairly consistent with the gap in the knowledge base. The problem statement about Dr. Mallory’s study shows that in all the literature there has been only one study using qualitative data. It shows a lack of knowledge about HIV in relation to African American women.
Purpose statements declare and summarize the topic and goal or goals of a document. It will state what can be gained from reading the research article (Burns & Grove, 2011). It should not be a general or obscure statement. It should be concise, clear and goal oriented. The purpose statement of this research article is to explore African American women’s experiences of infection with HIV in the rural U.S.
The problem, or gap in knowledge, of this research article is that little is known about why African American women account for the majority of HIV/AIDS diagnosis among women in the United Sates. To fill this gap in knowledge the researchers want to study why this phenomenon happens despite interventions making the purpose statement relevant and consistent with the gap in knowledge.
The target population for this study was rural African American women that were infected with HIV, marginalized by poverty, and use drugs. The criteria used for inclusion were women of African descent, at least 18 years of age, living in a town with a population of 20,000 or fewer, infected with HIV, and having a history of drug use living at or below the poverty line (Mallory, 2008).
A sample is a smaller part of the population to be tested for a study. The members of a sample are the test subjects or participants of the study (Burns & Grove, 2011). In quantitative studies the members are called subjects, and in qualitative studies the members are called participants. The research done in this article was done using a descriptive, qualitative method. The sample participants in this study were chosen based on the inclusion criteria and on their ability to discuss and articulate their experiences with HIV. The inclusion criteria being at least 18 years of age, living in or near a town with a population of 20,000 or fewer, infected with HIV, a history of drug use and living at or below the poverty line. The actual sample that was used were between the ages of 30 and 64, they had 1 to 11 children, and had 10 15 years of education with limited income. All the women were African American and heterosexual, and been living with HIV from 3 to 14 years.
The strengths of the sample group are pretty evident from the start. Using a qualitative study led to getting more accurate information from each participant in the study. Some limitations were the number of participants in the study. Only 10 women participated in the study and as a sample this is a very small number. I feel that larger numbers would need to do further studies to obtain a better idea of the experiences of African American women with HIV are.
Sampling procedure includes a purpose, a series of actions, and a goal (Burns & Grove, 2011). There are three different forms of sampling process, problem-oriented, nursing, and research. Problem-solving process involves identification of a problem, determining what the goal is related to the problem, possible approaches to achieve the goals, implementation, and evaluation. The nursing process is assessment, diagnosis, planning, implementation, evaluation and modification of the plan. Research process is the most complex, its process a broader focus in that it focuses on large groups of individuals or populations. In Mallory’s article the process used was the research process. The focus is on the population. The researchers chose their sample group based on this type of sampling procedure.
The strength of using the research process of sampling will allow the knowledge gained to be added to a pool or body of knowledge and provide sound knowledge for evidence for nursing practice. Some of the limitations of the research process of sampling are the need for greater precision and control of the study due to its being shared with a larger number of people due to publication of the study.
Variables are qualities, properties, or characteristics of persons, things, or situations that change. Independent variables stimulate activity that by the dependent variable. The researcher can change or manipulate the independent variable to see what affect it has on the dependent variable. The dependent variable is the outcome or response to the independent variable. In qualitative studies there are no independent and dependent variables. Qualitative studies are subjective to the person or persons being studied. The study generally describes the life experiences of human emotions, and human emotions are hard to put into variables. Mallory’s study with the African American women living with HIV is a qualitative study, and does not have an independent or dependent variable (Burns & Grove, 2011).
Research design is a blueprint of a study. It gives focus and control over factors that can interfere with the study (Burns & Grove, 2011). The design will depend on the research question. This will direct the selection of population, procedures for sampling, methods of measurement, and plans for data collection and analysis. The research design used in Mallory’s study is more of an ethnographic type of study. Ethnographic studies focus on and explore phenomenon that happen within a culture (Goodson & Vassar, 2011). Malloy’s research focuses on cultural life experiences of African American women with HIV.
The ethnographic study has emphasis on obtaining cultural knowledge with the society the study is about. This research helps to understand the participant’s ways of living, believing, and adaptation to the environment. Limitations with this type of study are sample size, subjectivity, and the time required to view or interview the sample population. The sample size can be a problem due to generalizing the culture. It is hard to generalize an entire culture. The time it takes to interview the sample can make the test harder to perform due to budget constraints. Finally the subjectivity can be a problem among researchers due to personal interpretation of the notes gathered on the participants.
Conceptual framework, or analytic study, is used to determine what course of action should be taken on a body of qualitative research. Mallory’s study uses grounded theory methodology. Grounded theory methodology is uses analysis of qualitative data to discover a theory. In Mallory’s article used to construct descriptions from interviews of the participants and report descriptive results.
Data collection is the gathering of information for a body of research. In this research article data collection was done first by establishing who the target population was. This was done by determining the inclusion criteria. According to Mallory (2008):
To maximize the generation of detailed reports of their experiences, women were selected initially based on inclusion criteria and on their abilities to articulate their experiences of becoming infected with HIV. Principles of emergent design (Lincoln & Guba, 1985) guided decisions about length, frequency, and content of interviews. (p. 30)
The outcome measures of a body of research give the determination and evaluation of the quality of the result of the study. They measure change in meaningful ways that can be distinguished from other characteristics. In this study outcome measures were done by performing multiple interviews with the participants until theoretical saturation on the major descriptors was satisfied.
Reliability of data deals with the consistency of the measures of the study; it is not an all or nothing phenomenon. For example in the case of this study the participants should have similar data collection from interviews that had multiple sessions. In this type of qualitative study it is hard to have multiple interview sessions due to schedule conflicts with the participants and limited time to collect the data by the researchers.
The validity of a research article is determined by how well the abstract idea or concept is studied. Again the validity of a qualitative body of research is hard to measure. The researchers used multiple interview sessions with the participants to obtain information and determine the validity of each participant’s information.
The data collection process of this study was to first obtain a target population. Once this was done the researchers selected women based on the inclusion criteria and on the women’s ability to communicate. Women that met the criteria were contacted and those that were interested in the study were interviewed receiving $20 for each interview. In the interviews requested that the participants provide demographic information and HIV risk data. The study’s strengths are the way in which the data was obtained. Data was obtained by interviews with the participant’s first hand life experiences. The strength of this study is also its weakness. The number of participants interviewed was very small to represent the larger the population. And finally there could have been more interviews with each participant to avoid. The smaller a sample is the less likely the conclusions will actually happen in the target population (Burns & Grove 2011).
Research studies need to protect the privacy of its participants, especially in a qualitative study where each participant is interviewed individually. Private information includes any information that includes a person’s attitudes, beliefs, behaviors, opinions, and records. In order to protect each participant’s privacy informed consent was obtained from each participant and each full name were not used for data recording within the published study. To make the protection stronger for each participant the study could have used different first names, or just used initials of the names. In Mallory’s study the subjects were protected by only using first names of the subjects.
The process of data analysis for grounded theory studies uses constant comparison process. This process compares concepts from other studies and integrates it into the study and theme of the current study. Within this Dr. Mallory’s study 10 women were interviewed. The interviews were performed in each woman’s home. All the inter views took place over the course of the spring, summer, and fall of 1999. Each woman was requested to provide demographic information about their HIV infection and biographical information. The participating women were asked to discuss the events that led to them contracting HIV. After the interviews the transcripts were read and summarized to get each interview’s general tone and content. The data was then compared using constant comparative process.
Constant comparative process was used to ensure the analysis was interpreted accurately. The constant comparative method compares new data with previous data from one or more studies in a continuous procedure. This helps to form theories that can be enhanced or discounted by the new data. It is constantly compared by coding. Coding is the process of breaking data down into smaller parts that can be labeled and used to compare with other sources of data. This process was used to produce an abstract description of the qualities of the study. Also, member checks were used to make sure saturation of the major topics were complete.
The strengths of the constant comparative process are that it uses data that had been used in previous studies. In this way it has strength in that it already has a base to build upon, although there are some weaknesses as well. There are few studies that this study can be compared to. Thus its base is not that strong. Also as qualitative studies may not have methodology in any detail and therefore not have much structure (Reed & Runquist, 2007).
The study findings were that evidence of sexual decision making among African American women is a complex process with the influencing factor mainly being trust. Six of the 10 women tested were in serial a monogamous relationship, one of which had been faithful to her partner and was diagnosed with HIV. The trust issues were that the women did not want to discuss possible HIV infection or contraception use because of fear of causing their partner to being angry of a lack of trust and leaving. Current interventions of monogamy are not protecting African American women from HIV infection.
The findings are believable because to me because the type of study that was done. The firsthand accounts of the participants indicate that there is a gap in the knowledge of what African American women in the participant’s situation are going through as well as emotional needs.
The limitations of this study are the lack of other studied that address interventions for this population. The study indicates that there is a need for more testing to develop interventions director toward the test population. There are also major barriers to conducting this kind of research because of the geographical distance, and the African American community being sensitive to the issues of exploitation.
The major points of Dr. Mallory’s study indicates that there is a gap in knowledge of why African American women contract HIV/AIDS despite extensive campaigns to promote HIV prevention. The data was obtained by interviewing the participants one at a time, and used a qualitative, constant comparison process to obtain and analyze the data. After the data was analyzed it was then determined that monogamy as a model for reasonable protection for rural African American women living in the southeast United States should be called into question. For clinical considerations providers in these communities should re-evaluate their beliefs about HIV infection and was constitutes low risk when dealing with African American women who live in rural areas. The primary health care providers should offer these women the chance to get HIV testing and prevention counseling on an individualized basis. In conclusion this study shows that further testing should be done as very few studies have been done on this topic and better interventions should be adapted for African American women in small rural areas.
References
American Psychological Association. (2010). The Publication Manual of the American Psychological Association (6). Washington, DC.
Burns, N., Grove, S. (5). (2011). Understanding nursing research. Maryland Heights, MO: Elsevier Sounders.
Goodson, L., Vassar, M. (2011). An overview of ethnography in healthcare and medical education research. Journal of Educational Evaluation for Health Profession, 8 (4).
Mallory, C. (2008). African american women’s experience of infection with hiv in the rural southeastern united states. Journal of the Association of Nurses in AIDS Care, 19 (1), pp. 28-26.
Reed, P., Runquist, J. (2007). Reformulation of methodological concept in grounded theory. Nursing Science Quarterly, 20 (2).

Reflection on Research Article Critique Assignment
The purpose of this reflection is to discuss the research critique for Nursing Research 3303. I will describe the challenges associated with completing the project and ways I overcame those challenges. I will discuss insights regarding the research and of the study topic, along with ways that I can use this insight in the future. Some of the challenges I had with this project revolve around writing the paper. I have written papers before and have done ok on them. Mostly in MLA format for history classes. The first APA papers I’ve written are for this school in this program, and the first major one was for this class. This paper was hard for me to wrap my mind around and took me some time to complete. The way I managed it was to try to break the paper down into sections using the syllabus that listed the requirements that should be in the paper. The second challenge I faced was making sense of all the information in the article I picked. I had to break the article down and take the information in sections to understand what I was looking at. As a whole this was a new experience for me. Insights I gain from regarding evidenced based practice by completing this project were interpretation of evidence and to look at the manner in which it was observed. The interpretation of the evidence can be twisted in many ways by bias and a nurse must struggle to keep her own biases form twisted the evidence so that he or she might provide proper care. The manner in which evidence is observed or obtained must be taken into account or you might end up with data that is false or for example made up because the patient might say or do things just because the nurse is watching. New insights that I learned about the topic that I chose was an insight on how people view illness and how they look at health care within small communities. In the research topic I chose, “African American Women’s Experience of Infection With HIV in the Rural Southeastern United States,” the women living with HIV grew to accept the disease because they didn’t want to anger their partner. They also didn’t seek healthcare as often because of fear of what they would be told or just didn’t have the money for copays or money for the visit due to no insurance. The way in which I can use the knowledge that I gain from this paper in my future as a nurse is to ovoid the specific problems I mentioned earlier. Bias can distort and distract from what the heart of the matter is with a patient. Proper care and understanding has to be maintained in order to build trust in client to care provider. Finally ways that I can use the insight gained from the study topic to guide my future practice. Take time to interview the patient thoroughly and build up trust. Take into account the feelings of the patient, their financial difficulties, and the fear and stress of telling someone that isn’t from their community about illnesses. In the end I feel that genuinely caring the health and needs of any patient should come first if you are going to be able to help them medically.

References: American Psychological Association. (2010). The Publication Manual of the American Psychological Association (6) Burns, N., Grove, S. (5). (2011). Understanding nursing research. Maryland Heights, MO: Elsevier Sounders. Goodson, L., Vassar, M. (2011). An overview of ethnography in healthcare and medical education research Mallory, C. (2008). African american women’s experience of infection with hiv in the rural southeastern united states Reed, P., Runquist, J. (2007). Reformulation of methodological concept in grounded theory. Nursing Science Quarterly, 20 (2).