How to Reply to Thread This is

How to Reply to Thread This is part of a discussion board Citation: Braun LA, Kennedy HP, Sadler LS, Dixon J, Womack J, Wilson C. US Navy Women’s Experience of an Abnormal Cervical Cancer Screening. J Midwifery Womens Health. 2016 Mar-Apr;61(2):249-56. doi: 10.1111/jmwh.12378. Epub 2016 Feb 5. PMID: 26849103. Title: The title does explain what the article is about. There is some inconsistency with use of plurals. “Women” is plural, therefore their experiences of abnormal screenings should also be plural. The same phrase is repeated with improved use of plurals later in the introduction. Introduction: The introduction was well structured and included a wide range of information on the study’s purpose, the problems investigated, descriptions of the study’s design and methodology, samples and metrics, and findings. They also gave many descriptive statistics to better illustrate the problem. For example: the rate of people that didn’t receive necessary care was 27-28%. That’s more than a quarter of the affected population! There is a clear sense that there may be several significant problems at play. Problem, purpose, research question(s): The problem is clearly stated (minimal research on challenges or strategies in preventative health screening and follow-up for US military women). The purpose statement is clear and succinct. While the study population is well-defined and narrowed, the sample size in the study is very small. They are attempting to draw conclusions on the experiences of women in the US military as a whole, but their study only looks at 73% of the affected population at one particular facility. A much larger study would be needed to draw more accurate conclusions. The problem includes both challenges and strategies, but only challenges are discussed in the research. A focused question is not specifically stated separate from purpose statements. This is a qualitative study, so it would not be appropriate to have a hypothesis. However, they seem to list hypotheses with the sentence: “Military members [often experience factors] impacting timely follow-up care or treatable health conditions,” and again with, “Improvement in gender-specific health care may enhance military operational readiness.” The topic of this study could potentially be a useful basis for improving women’s experiences with screenings and follow-up care in the military health care system. Done on a larger scale, this type of research could help identify areas in the military health care needing improvement, which would benefit the health of women in this system as well as “enhance military operational readiness,” as stated in the article. Variables, operational definitions, assumptions, limitations: Qualitative research does not define independent/dependent variables. This study qualitatively describes individual experiences with military healthcare following preventive screenings. Researchers operationalized by assigning numerical values to demographic characteristics and analyzed interviews using Labovian Sociolinguistic Approach in conjunction with thematic analysis. Several assumptions are explicitly stated, whether the author realized or not. The author assumes that military factors “impact timely follow-up care for treatable health conditions,” “impact adherence to recommended follow-up care,” and that, “improvement in gender-specific health care may enhance military operational readiness.” None of these thoughts seem to be supported or explained, and all act as hypotheses that are inappropriate for qualitative research. Overall, they make broad and sweeping statements and assumptions in the introduction about military women’s healthcare as a whole and the causes of presumed issues, while the study focuses only on a specific part of the care of a very small group of women. The study was limited to one military treatment facility in one branch of the armed forces. It was further limited to only women that had had abnormal cervical screening results requiring colposcopic follow-up. With this study’s design, only some of the women that successfully had a follow-up colposcopy were interviewed. This excludes women that didn’t have a successful follow-up, therefore excluding participants who faced challenges so great they were unable to have follow-up care, which may be important to understanding the challenges at hand (survivorship bias). They also only asked about specific aspects of the screening/follow-up (info on notifications and scheduling). Additionally, only certain personal factors were explored. Did they all have the same provider? Different providers? Were all providers operating under the same protocols for notification and scheduling? Was the schedule booked out, which would diminish the timeliness of scheduling anyway, regardless of extraneous challenges? This would likely vary from facility-to-facility as well. How do these protocols differ from women who had normal results? The assumption is that they were notified and informed of their normal results and whether any follow-up was needed, but they could have been left wondering/uninformed like some of the abnormal screen participants were. What about scheduling the initial screening to begin with? Did anyone have this experience with other types of appointments, or is it specific to cervical cancer screening? Review of the literature & conceptual frameworks/model: The majority of referenced literature was used to support the introduction. A rather odd amount of new information was also referenced in the conclusion, rather than restating or summarizing information from the introduction. The author was able to utilize relevant primary sources and government data to illustrate the problems at hand, as well as background information and statistics that help to further understand the scope and impact of the topic. Sample: The methodology section did outline the type of women that were chosen for the study. The study was based on women who received abnormal cervical screening results and needed a follow up colposcopy. Women who had normal screening results were disqualified from the study. One bias I identified was the study was only conducted on one military base. This was a qualitative study so a power analysis was not appropriate.The sample size was small and limited to only one location. Ethical considerations: The author does address protection of the human participants. Individuals were able to choose to participate after an explicit explanation from their provider. The interviews were conducted by a military professional who dressed in civilian attire to help make the participants feel more comfortable. Permission was obtained by Yale University and the Department of Defense. A written consent was obtained by the female participants and the study in compliance with the Department of Defense guidelines. Methodology: – design The study design was well-described and gave a clear picture of the interview and data collection process. They included a table that further describes the Labovian Sociolinguist Approach used. A breakdown was given on how they operationalized pieces of information. The explanation of how they coded that information to be analyzed was somewhat unclear. Their process could be replicated, but the responses to interviews would be unique to each participant. Methodology: – instrumentation and data collection procedures This was a qualitative study that was cross-sectional, this study received ethical approval from Yale University, the women who participated in this study were reviewed for accuracy. Labovian Sociolinguist Approach and thematic analysis were utilized as standardized tools for analyzing interview responses. Atlas.ti a scientific Software Development was used to organize,manage and assist in analysis of the qualitative data. The interviews were analyzed exhaustively using a third-party professional reviewer. The process could pretty easily be replicated from the information given and expanded to other facilities or branches of the military. Results: The results were given as grouped themes that emerged in the interview responses. They were written in an understandable way that detailed unique individual experiences while showing a pattern in participants’ ideas. The women’s responses on their experiences were relatable and were written verbatim. As it is a qualitative study, it does not have a hypothesis. Data analysis: There was one table in the study which outlined the makeup of the demography of women who participated in the study. The different women in the study were listed by age, ethnicity, race, education, family status, military rank and years of service. The table was easily understood but was not helpful in describing the results, it only shows that the women were from different backgrounds. The method of the data analysis was appropriate in theory but not thorough in this study. Summary and conclusions: The author did a great job convincing me that more research needs to be done on the issues they brought up, but a poor job convincing me that the conclusions of this individual study are meaningful. The results of this study can show us what may be areas of difficulty for this particular facility or these particular providers, but much more information would be needed to draw conclusions about US military healthcare as a whole. Significance for your study problem: In a very general sense, both of our study problems focus on an area of women’s knowledge about health care services available to them. I could see their study being scaled larger to get results that would be more meaningful. The authors suggested that it could be expanded to other branches of the military, or serve as a basis for informing future changes to patient education or health care policy. They may uncover trends in challenges to accessing appropriate care that could be compared to challenges faced by my population that I would like to study further. Additional Areas to Critique: There were some sentences that didn’t make any sense. “An estimated 15% of military and civilian women receiving military health care are lost to diagnostic evaluation for abnormal cervical screenings, which can delay early treatment.” What does that mean? What do they mean by “lost?” Lost in the system? Have these people died? “Detailed memos within the program provided an audit trail of the coding progression and decisions throughout the analytic process.” Was this written with the expectation that peers would have the background knowledge to understand what this means?

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