I. Title
At a word count of 17 words, the title is rather long for an average title length. Moreover, it skipped on important information that will let the readers know the jurisdictional or geographical limit of the study by not mentioning “North Carolina” in the main title. However, it does encapsulate the main variable (“brain health knowledge”) and the principal aim “establish baseline information” and rationale (“interventions to promote adaptation and successful aging”) of the study. Although, the part of the rationale (“promote adaptation and successful aging”) provides a clear declaration of the content of the study, it increased the word count by five words (two of which contain 10 words each). Alternatively, it could have opted to use a shorter three-word phrase “quality of life” (with no word containing more than six letters), which can adequately represent the content (and mentioned in the first sentence of the abstract) without sacrificing length and, simultaneously, allowing space for the state name in the main title.
II. Abstract
The American National Standard for writing abstracts requires the presence of four essential elements in the content: purpose, methodology, results, and conclusions (National Information Standards Organization [NISO], 1997). It allows collateral information. However, their addition should be done sparingly as not to distract from the main theme or false imbalance the abstract by giving more space from information of less relative importance. Even background information should be included only sparingly. The study abstract (Troutman-Jordan, 2014) provided a just summarized of the purpose, result, and conclusion. However, it skipped on the method, and spent inappropriately large space for the background and rationale, comprising four sentences of the entire seven-sentence abstract (i.e. more than half) and providing inordinate amount of focus on collateral information against the NISO standard.
III. Introduction
While the Introduction managed to clearly state and promptly introduced the quality of life problem associated with age among elderly Americans, it failed to explain mention the distinctive characteristics of North Carolinian elderly for this study and why North Carolina was chosen as the study locale and population. Is there any relevant racial mix that makes the state a preferable pilot state for this study? Is there a preponderant elderly population in the state that makes it their experience of age and assisted living especially valuable for the study?
In addition, the study background provided had adequately substantiated the existence, extent, and urgency of the problem being addressed in the study in a logical and compelling manner. The theoretical rationale had been explained adequately enough for the readers to appreciate the underlying elements involved in the problem and those that study had addressed. The conceptual framework explained this on the basis of the theory of successful aging.
Moreover, the conceptual framework section of the introduction adequately defined the concept of successful aging as well as its operational implication in the conduct of the study. The primary operational terms relevant to the study are “health promotion” (i.e. brain health promotion) and the “cognitive ability to self-appraise”. Although the research question directly answered the research problem, it is not located in this section but in the Methods. However, although discussion of the theory of successful aging used previous research, the Introduction includes no clear and distinct hypothesis. The nearest it came to stating a hypothesis is the general objectives (“purpose of this study”) and the recognition of the “vital role” of brain health and its promotion to the well-being of the elderly, both of which are inadequate to be called a hypothesis.
Furthermore, even after discussions on previous findings in the subject, there is no mention on how the current study will be able to extend findings from previous studies as can be found in the currently available literature on the topic.
IV. Methods
The study design is cross-sectional, descriptive, and quantitative. It is appropriate for this study when used to analyze and compare variables that do not change over time, such as race. However, it is inappropriate, in general, on those variables that change over time, such as education level and knowledge of brain health. Although, education level, it can be reasoned out, is unlikely to change among the elderly, the unlikelihood is not guaranteed. This is of particular relevance because the study intends to create baseline information for the elderly subjects.
The dependent variables, as stated in the design sub-section, are knowledge of brain health, race, and education level, all of which are valid measures of the research problem. The measurement used is only partially reliable in measuring broader perspective of brain health because it is designed specifically for Alzheimer’s disease. The independent variables include all conditions found in the assisted living communities (ALCs). The study recognized cognitive impairment as a confounding variable because it will interfere in the answering of the survey questionnaire (17-item brain health questionnaire), which it tried to control by subjecting the participants to two instruments: the Mini-Cog test and the Centers for Epidemiologic Studies Depression Scale.
The subjects are North Carolina ALC residents, age 52 to 100 with mean age of 79.37 years (inclusion criterion: 65 and older), able to speak and understand English, and without cognitive impairment. They are recruited using a nonprobability purposive sampling approach. There were 184 eligible participants, mostly female (79.3%) and Caucasian (76.6%). While the sample size as a group is large enough, the preponderance of Caucasians and females in the sample limits the interpretation of findings to these characteristics in the relative exclusion of males and the minority population.
The events sequence begins with participant recruitment, then followed by eligibility screening (including cognitive impairment testing), data collection by survey questionnaires, and data processing. The disclosed procedure is adequate for future replication. The data collection method, except for the limited internal validity of the BHQ in relation to the broader information about brain health, is adequate in obtaining the main dependent variable (brain health) although with bias towards Alzheimer’s disease. The validity and reliability of the measures, however, are specifically and clearly disclosed. Human subject protection came only in the form of an informed consent.
V. Results
In addition to the descriptive statistics used (e.g. mean, range, and standard deviation), the study used the t-test statistic to further analyze the variables in pairs (e.g. education level and race). This statistic is less appropriate for large samples (n ≥30) than z-test because t-test mathematically produces unequal variances; although it is more conveniently used with computer assistance (Weiers, 2014). These analyses, however, are reported clearly and adequately adhered to the statistical assumptions of the test used, such as the normality of the population distribution, which in this large sample size does not represent any serious problem.
Relationships mentioned in the research question explored and clearly reported include that between races and education level, brain health knowledge and races, and brain health knowledge and education level. Since the study is essentially exploratory in nature and no hypothesis was defined, the issue on error probability does not apply even if the researcher proceeded to use a statistical test in analyzing the data collected.
The two results tables, which consist of demographic and health characteristics, are adequately and understandably presented; although, the presentation can benefit from improvements to clarity. The author apparently did not rely on these tables to report the study outcomes. Results on the interacting variables had not been put in a table or tables. Figures cited in results such as standard deviations for the variables of interest cannot be found in tables to allow readers to look into these figures themselves and make their interpretations. The data found in the two tables cannot make suggestions in relation to the research questions.
VI. Discussion and conclusion
As reported, this study has no hypothesis to test. In the discussion of the findings, the author managed to relate it with previous literature and satisfactorily explained the relevance of the findings. However, no discussion occurred on the interaction between the findings and the conceptual framework. Moreover, the discussion made a sweeping generalization of the findings despite the composition of its sample population, which is predominantly female and Caucasian, and the survey questionnaire oriented more to Alzheimer’s disease and not to the broader characteristics of brain health. In the discussion, for instance, of the findings on the Black participants, the author generalized the results as if this minority race was adequately represented in the sample population and their number large enough to merit the assumption of significance when, in fact, they are not. Despite these shortcomings, the author failed to explain the situation to the readers, qualifying the results and implications objectively. These drawbacks and weaknesses are not clearly stated, particularly pertaining to males and the minority races. Meanwhile, the authors’ conclusions came from the results of the study. However, in the light of the abovementioned drawbacks and weaknesses, I can only agree with a grain of reservation to the results in relation to female Caucasian subjects.
VII. Overview
My overall impression on the article may be described as valuable only to a limited degree to female Caucasian elderly in North Carolina. Despite that, internal validity is limited to elderly with pronounced Alzheimer’s disease. The nonrandom sampling procedure limits the results capability for generalization outside North Carolina. The sample population characteristics also cannot generalize the result to male and minority elderly in North Carolina.
The research design can be improved by implementing the following changes: (a) random sampling for the sample population whether or not sampling should be conducted in all American states or within North Carolina alone; (b) clear definitions of research objectives; (c) clear decision on whether to have or not to have hypotheses; and (d) table presentations of analyzed data showing interactions between variables and probability information.
The findings and conclusions have limited relevance to clinical practice in the area of assessing mental health profiles of female and Caucasian ALC residents. And, to such extent, the study can contribute to the body of scientific knowledge in the nursing profession and find meaning in actual application in the assisted living settings within North Carolina.
Nonetheless, the knowledge I gained came in appreciating the many ways a study can be weakened by inadequate attention to important elements in protocol writing. The corrigible limits of nonrandomized sampling methods also emphasized the value of deciding at the onset of the study to aim for robust methodology in order to generate highly valuable and utilizable outcomes. This study, however, raised no additional significant questions outside the issues discussion already mentioned earlier.
VIII. References
Farrugia, P., Petrisor, B.A., Farrohyar, F., & Bhandari, M. (2010, August). Research questions,
hypotheses, and objectives. Canadian Journal of Surgery, 53(4): 278-281.
National Information Standards Organization. (1997). Guidelines for abstracts. Bethesda, MD:
NISO Press.
Troutman-Jordan, M. & Deem, N. (2014). Brain health knowledge in assisted living:
Establishing baseline information for interventions to promote adaptation and successful aging. Activities, Adaptation & Aging, 38(1): 188-199.
Weiers RM. (2014). Introduction to Business Statistics, 7th Ed. Pasig City, Philippines: Cengage
Learning Asia Pte Ltd.
