5. Critiquing research articles
Key Points
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• Research is rarely conducted under perfect conditions and so weaknesses can be found in most published research. This means that, just because a piece of research has been published, it is not above constructive criticism.
• Critiquing research articles should be accomplished using a systematic approach. This chapter has provided two critique frameworks: one for quantitative research articles, and the other for qualitative articles. As these two designs are based on different principles, it is important that the criteria for judging one form are not applied to the other.
• A critique should have a balance between description – what the researcher(s) did, and analysis – how well it was done. Undertaking a critique provides a sound basis for establishing evidence-based practice as it ensures that published research is carefully evaluated and not accepted on face value.
The main purpose of midwifery research is to increase the quality of care through the application of evidence-based knowledge gained from systematic data collection and analysis. There is a problem, however, and that is research does vary in quality. The perfect research project is almost impossible to achieve as researchers seldom have ideal conditions in which to carry out their work and so find themselves making the best of a bad job. So how does the midwife reading research distinguish between the good, the misleading and the dangerous? Developing critiquing skills is part of the answer. This chapter clarifies the meaning and purpose of critiquing. The skill of critiquing is illustrated with the aid of two critiquing frameworks; one for qualitative research articles and the other for qualitative research. Some of the details within both frameworks are based on information in later chapters. This means that you may need to look at these for more details on certain points. This chapter appears at this point in the book as critiquing is a skill that should be developed early in gaining an understanding of research.
Some research skills all midwives need to develop, and critiquing is one of them. This is because, as Lavender (2010) emphasises, it is no good relying on others to critique research for you as they may have a different agenda and interpret studies differently. You must be able to do this for yourself. According to Burns and Grove (2009: 598), critiquing, or critical appraisal, means the systematic, unbiased careful examination of all aspects of a study in order to judge the merits, limitations, meaning and relevance to practice. Although the word critique sounds like the word ‘criticise’, it is meant to be a constructive evaluation, and should be objective, unbiased and impartial. It should take a balanced view of both the content and process of research as followed by an author. It is a way of using critical skills to reflect on not only the whole process in which the research was undertaken, but also the thinking and assumptions on which the research was based.
Critiquing is a skill that requires practice, so read this chapter with a research article that is not too complex by your side. This will help you become familiar with applying the critique framework. In the first section you will need a quantitative study, where the results are presented in the form of numbers, and in the second part, a qualitative study where dialogue, quotes or descriptions of events are used.
Applying a critiquing framework
Before starting to critique it is useful to consider the words of McCarthy and O’Sullivan (2008), who suggest that as time is so short and so much evidence available, we should firstly consider if an individual paper is worth reading. How do we tell? The first of two criteria that will help is to limit your effort to peer-reviewed articles. This will indicate it is from a reliable source, such as a well-known professional journal that first gets experts to check that the study is worthy of publication. Secondly, consider the title and its relevance to the topic you are exploring. Once you have chosen your article, there are three questions that need to be answered:
• What does it say?
• Can I trust it?
• Will it contribute to practice?
The first question relates to comprehension and is a description of what the authors examined. How did they justify the need for the study? How did they carry out the study? What did they find? What did they conclude? The second question relates to an assessment of the rigour applied to the research process – how well was it thought through, and what steps were taken to reduce problems of bias, reliability and validity. This second question requires knowledge of some of the kinds of issues and techniques of research covered throughout this book. The third question relates to an evaluation of the study’s contribution to professional practice – does it provide clear evidence for continuing, adapting or challenging practice. Who might benefit from the study, and in what way?
Starting with the question of comprehension and what the research says, we might feel that if we read through an article we will know what it says. This is not necessarily the case. For instance, have you ever started reading at the top of a page, but by the time you have reached the bottom you have no recollection of what you have just read at the top? This is because most of us read passively a great deal of the time. Reading research articles is very different from reading a novel as they require a far more active, analytical and reflective approach.
To help us improve our active reading and analytical skills we need two things; first of all, we need to separate a research article into its component parts. This will allow us to see the overall outline of the research, and understand how all the pieces fit together. Secondly, to be an active reader we need questions to which we actively seek answers. Box 5.1 provides such a framework and a list of questions for quantitative research articles. The following sections will add detail to the framework.
BOX 5.1
Framework for critiquing quantitative research
You should not expect to get answers to every question in each section, as what is important will vary from study to study. The questions provided here are to give you some guidance.
1. Focus
In broad terms, what is the theme of the article? What are the key words you would file this under? Is the title a clue to the focus? How important is this for the profession/practice?
2. Background
What argument or evidence does the researcher provide to suggest this topic is worth exploring? Is there a review of previous literature on the subject, or reference to government or professional reports that illustrate its importance? Are gaps in the literature or inadequacies with previous methods highlighted? Are local problems or changes that justify the study presented? Is there a trigger that answers the question, ‘why did they do it then’? Is there a theoretical or conceptual framework that helps us to see how all the elements in the study may be related?
3. Aim
What is the aim of the research? This will usually start with the word ‘to’, e.g. the aim of this research was ‘to examine/determine/compare/establish/etc’. If relevant, is there a hypothesis? If there is, what are the dependent and independent variables? Are there concept and operational definitions for the key concepts?
4. Study design
What is the broad research approach? Is it quantitative or qualitative? Is the design experimental, descriptive or correlation? Is the study design appropriate to the aim?
5. Data collection method
Which tool of data collection has been used? Has a single method been used or triangulation? Has the author addressed the issues of reliability and validity? Has a pilot study been conducted or tool used from previous studies? Have any limitations of the tool been recognised?
6. Ethical considerations
Were the issues of informed consent, confidentiality, addressed? Was any harm or discomfort to individuals balanced against any benefits? Did an ethics committee approve the study?
7. Sample
Who or what makes up the sample? Are there clear inclusion and exclusion criteria? What method of sampling was used? Are those in the sample typical and representative of the larger group, or are there any obvious elements of bias? On how many people/things/events are the results based?
8. Data presentation
In what form are the results presented: tables, bar graphs, pie charts, raw figures, or percentages? Does the author explain and comment on these? Has the author used correlation to establish whether certain variables are associated with each other? Have tests of significance been used to establish to what extent any differences between groups/variables could have happened by chance? Can you make sense of the way the results have been presented, or could the author have provided more explanation?
9. Main findings
Which are the most important results that relate to the aim? (Think of this as putting the results in priority order; which is the most important result followed by the next most important result, etc. There may only be a small number of these.)
10. Conclusion and recommendations
Using the author’s own words, what is the answer to the aim? If relevant, is the hypothesis accepted or rejected? Are the conclusions based on, and supported by, the results? What recommendations are made for practice? Are these relevant, specific and feasible?
11. Readability
How readable is it? Is it written in a clear, interesting style, or is it heavy going? Does it assume a lot of technical knowledge about the subject and/or research procedures (i.e. is there much unexplained jargon)?
12. Practice implications
Once you have read it, what is the answer to the question, ‘so what’? Was it worth doing and publishing? How could it be related to practice? Who might find it relevant and in what way? What questions does it raise for practice and further study?
Focus
The first thing we need to identify is the broad topic the research covers, so we can put it in the context of existing knowledge. This should be stated in a few words that include the key concepts or variables covered in the article.These might be found in the title, and most certainly in the aim. Ask yourself what is the basic theme of this article? The answer might be ‘making informed choices’, ‘care of the perineum’, or ‘breastfeeding support’. Notice that these are not questions, nor are they long or detailed. We are looking at the broad canvas of which this study forms a part.
Background
The opening to an article should provide a convincing justification for choosing the topic area. Here we should expect a clear argument or evidence as to why the topic is a problem, the nature and implications of that problem, and how it has been examined in the literature. A study should start with the identification of a problem.
The author may use the subheading ‘Review of the literature’ (or ‘Literature review’) in which previous studies are examined. Some articles may contain only a summary or synopsis of previous work. Where possible, however, an author should provide a critical review of the literature. This should draw attention to both strengths and weaknesses of individual studies, and the literature overall. In this section the author may explicitly or implicitly draw together the theoretical or conceptual framework of the study. This will answer the question, ‘which concepts or variables are seen as linked for the purpose of this study’. The review of the literature section should open with some indication of how the search for appropriate literature was conducted, for example the databases, key words and time frame used (see Chapter 6). These will help identify if a comprehensive review was conducted.
Aim (terms of reference)
The background should prepare the way for the aim or ‘terms of reference’, which is the question the data will be collected to answer. There are two places where the aim can usually be found. The first is in the abstract, sometimes found underneath the title. The second place is just before the subheading, ‘method’. Although the aim usually begin with the word ‘to’, sometimes because of the grammatical construction of the sentence we might have to insert it ourselves (e.g. if it says ‘this study examines the problem, etc. we would insert ‘to examine’ the problem, etc.’). If the work is experimental there might also be a hypothesis or assumption the researcher is testing. The author’s stated aim and hypothesis will help us identify if these were achieved or answered.
With the aim, and the hypothesis if present, it should be possible to identify which of the three levels of research question has been used (see Chapter 2). The study variable(s) should also be clear at this stage. Where the research question is level three, there will be dependent and independent variables, and the researchers should provide a concept and operational definitions for the variables. (It may be helpful to return briefly to Chapter 2 for a reminder of these terms and their meaning.)
In writing or producing a critique, it helps to use the author’s own words, rather than paraphrase them, to avoid change their meaning. Try to both describe what you have found under each heading in the critique framework, and also say how well you feel the author has accomplished each aspect. In other words, it is not simply what they said but how well they said it. This will result in a critical analysis of the article.
Methodology
This section indentifies the research design of the project, and matches its suitability to the research question. The first stage is to classify it under one of the following:
• experimental design with an experiment and control group,
• correlation, where the researcher searchers for patterns or associations between variables,
• a survey where the purpose is description,
• a qualitative design where the purpose is to gain insights into people’s perceptions, beliefs, or behaviour.
Do you feel there is a match between the design and the aim? Within the broad research approach, you will identify which tool of data collection has been used. What are some of the strengths and weakness of the tool of data collection that makes it appropriately chosen here? Are the limitations of that tool recognised? Has triangulation been used, where the author has used more than one method of data collection to look at the same variable? Has the researcher attempted to strengthen the accuracy or ‘reliability’ of the tool? For instance, has the researcher used a pilot study to check the consistency of the tool of data collection?
The critique will consider the ethical issues related to the tool of data collection. Here, we consider the principles of research governance (see Chapter 8
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