The Problem of HIV Medication Intake
Introduction
In order to properly select high-quality information for conducting a research, it is paramount to be able to assess a study carried out by one’s colleagues, in particular, a study published in an academic journal, for these publications most often report original research (Pyrczak, 2009). Therefore, in this paper, a research conducted by Kalichman, Catz, and Ramachandran (1999) will be evaluated; the evaluation of its literature review, methodology, results, and discussion sections will be provided, after which the overall assessment of the study will be provided.
The article deals with the problem of HIV medication intake among HIV-positive African Americans who have low levels of education and/or low rates of medical literacy. In a questionnaire, the participants assessed the main reasons for missing an intake, which allowed for drawing a number of conclusions pertaining to the provision of medical care to the persons who share similar traits with the members of the sample.
Critique of the Literature Review
Kalichman et al.(1999) provide a brief but rather comprehensive overview of the problem of HIV-medication adherence (although it is not identified by a subtitle “literature review”). The problem is clearly articulated and supported by evidence drawn from 22 sources, mostly research articles. The theoretical framework is present; the problem of non-adherence to anti-HIV drugs and its hazards is described, and its relationship to the study (i.e., the need to know factors associated with non-adherence) is emphasized.
Among the 22 used sources, 16 are related to HIV, and 6 are related to the factors associated with treatment-non-adherence; thus, the cited literature is relevant to the topic. However, 5 sources were older than 5 years at the time of the article’s publication. The citations are chosen judiciously: the references support the stated facts that are not general knowledge, and the number of citations is not excessive.
On the whole, the literature review provides a rather clear, non-prejudiced approach to the problem, and, although the research questions or hypotheses are not stated in the form of questions or hypotheses, it is easy to understand that the paper asks about the influence of low education on HIV treatment non-adherence, and presupposes that poor education exacerbates non-adherence (Kalichman et al., 1999, pp. 439-440).
Critique of the Methods and Research Design
The participants of the study by Kalichman et al. (1999) are not described comprehensively in the article; it is not indicated which population they represent, the inclusion/exclusion criteria are not given, and the sampling strategy is omitted. However, it is stated that “details of the participant recruitment procedure are reported elsewhere,” and a citation is provided (Kalichman et al., 1999, p. 442). The statistical power and its relation to the sample size are not mentioned (but many obtained results are statistically insignificant). While it is not stated that the IRB approval was received, it is stressed that the participants “completed informed consent in accordance with” IRB guidelines, and that certain measures for protecting their rights were taken (Kalichman et al., 1999, p. 442).
The procedures for conducting the study are described, although their use might require a certain number of additional details. The roles of the researchers in the study are explained; the scholars either administered the questionnaires of conducted interviews with illiterate participants. While the readability and validity of certain instruments are not clarified, for most of the tools it is stressed that they were tested in previous studies. However, to check the readability and validity of these tools, the reader has to search elsewhere.
The tools were used on the sample for which they were normed; even though not all the participants could read the questionnaires well enough, and the illiterate participants, for instance, had to be interviewed by the researchers, the questionnaires were aimed at assessing their educational levels, which was important for the study.
It appears that the research design is appropriate to answer the implied questions of the study, but because the research question and hypotheses are not formulated clearly, it might be hard to give an accurate judgment about their appropriateness (Campbell & Stanley, 1963).
The random assignment was not used; instead, the participants were grouped according to their responses to the questionnaires; this appears justified if one takes into account that it was necessary to classify the participants to obtain results for different groups. The problem of internal validity is relevant, therefore, addressed; however, the problem of external validity remains not handled, for it is unclear which population the sample is a part of.
Critique of the Results Section
The important characteristics of the sample, that is, the education levels of the participants and their performance on health literacy tests, are described in the results section of the study by Kalichman et al. (1999). The participation rates are not provided, although in the previous sections of the article it is stated that the participants were volunteers, so perhaps the participation rates were 100%.
It might be possible to state that the provision of descriptive statistics is not necessary in the study due to the nature of the questions; i.e., the quiz asked whether participants “missed at least on dose of the anti-HIV medication in the previous 30 days” rather than inquiring about the number of such misses (Kalichman et al., 1999, p. 443), so the calculation of e.g. means and standard deviations is impossible (Filed, 2013).
It is difficult to say whether the results address the research hypotheses, for they are not formulated explicitly. However, it is apparent that the implied research questions are addressed, for the anti-HIV medication adherence rates of individuals with low education levels and those with higher education levels are described in the section.
Tables and bar charts are used quite effectively in the article, providing the reader with an opportunity to see the results of the study immediately and clearly.
The p-values are reported for all the inferential findings; however, the effect sizes are not provided in the article.
Critique of the Discussion Section
The results of the study are discussed in the context of the literature review, providing possible answers to some questions outlined at the beginning of the paper. The methodological limitations of the study are described rather clearly in the article; for instance, the inability to obtain health records and relying on self-assessment when measuring mental health of participants are mentioned.
Whereas the implications for further research are not described, the implications for the practitioners are provided in the Conclusion section. For instance, it is stressed that materials which require literacy skills will most likely fail for persons with lower literacy skills, and it is recommended for practitioners either to use other forms of delivering the information to the low-literate HIV-infected persons, or to try to improve their medical literacy rates (Kalichman et al, 1999, p. 445).
Overall Evaluation
On the whole, the study provides rather a comprehensive review of the HIV-medication adherence, touching upon many aspects of this problem. However, the research has its limitations, which are clearly described in the Discussion section (Kalichman et al, 1999, p. 444).
The reliability and validity of the study are difficult to identify, which is due to the missing pieces of information; for instance, of the data pertaining to the population of the study.
It is worth stressing the article would be included as a piece of evidence primarily because of the comprehensive overview of the problem provided in it. Also, the findings of the authors may encourage health care providers to more efficaciously address the problems pertaining to low health literacy rates of African American patients with HIV, thus increasing the level of their medical literacy and, as a result improving their health outcomes.
References
Campbell, D. T., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Boston, MA: Houghton Mifflin.
Field, A. (2013). Discovering statistics using IBM SPSS statistics: And sex and drugs and rock’n’roll (4th ed.). Thousand Oaks, CA: Sage Publications.
Kalichman, S. C., Catz, S., & Ramachandran, B. (1999). Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education. Journal of the National Medical Association, 91(8), 439-446. Web.
Pyrczak, F. (2009). Evaluating research in academic journals: A practical guide to realistic evaluation (4th ed.). Los Angeles, CA: Pyrczak Publishing.