Katie Schlattmann
1. (4 pts) In a short paragraph, summarize the aim, method, and conclusion of this study.
The purpose of this study was to determine the effectiveness of collaborative case
management educational programs for public health nurses (PHNs) in Taiwan (Liu, Edwards, &
Courtney, 2010). To determine the effectiveness of the education programs, PHNs from 12
health centers were split into the control group or the experimental group. The experimental
group underwent a 16 hour education course on case management (Liu et al., 2010). Both groups
were tested before and after the study course on case management knowledge. Then, statistical
analysis was used to determine if a significant difference occurred between the groups (Liu et al.,
2010). Moreover, the study found that educational programs had a significant difference on the
PHNs and their case management skills.
2. (4 pts) Every study begins with a review of previous studies. The authors note several gaps,
or limitations, of previous studies. Briefly summarize these gaps and limitations.
The authors of this study made note of several limitations or gaps of previous studies of the
same nature. For example, most of the previous studies were designed specifically for hospital
based nursing staff and did not evaluate the effects of educational programs for PHNs (Liu et al.,
2010). Moreover, the study sizes were relatively small ranging anywhere from 5 participants to
150. Some of these studies were not randomized for selection of experimental and control groups
(Liu et al., 2010). In addition, many of the studies used single group design where the baseline
test results of the nurses was compared to the results upon completion of the education course
(Liu et al., 2010). Thus, several limitations or gaps existed in the previous studies on education
programs for nurses in terms of case management.
3. (6 pts) The authors describe this study as "a cluster randomized controlled trial with pre- and
post-test."
a. What are the clusters? How many clusters were initially available? How many were
used for the pilot testing? How many were put in the experimental group? How many were put in
the comparison group?
In this study the clusters were the 12 health centers in Taipei City, Taiwan. In pilot
testing two of the centers were used, one health center’s PHNs received the educational course
while the other did not (Liu et al., 2010). For the study, 10 remaining health centers were used.
The PHNs from 5 of the health centers were put in the experimental group and the remaining 5
health center PHNs were in the comparison group (Liu et al., 2010).
b. Describe how the clusters were randomly assigned to either the experimental group or
the comparison group.
The ten health center names were written on cards. These cards were then selected
randomly by a third party to be place in either the experimental group or the comparison group
(Liu et al., 2010).
c. Briefly describe what is meant by pre- and post-test in this study.
In this study pre- and post-test information was used. Before the experimental group began the
educational program both groups were tested with a four section questionnaire, the pre-test (Liu
et al., 2010). This information was used as baseline data. In addition, upon completion of the 16
hour education course, each group was tested again using the same procedure, the post-test (Liu
et al., 2010).
d. How many total participants were in the experimental group? How many were in the
control group?
The experimental group contained 87 PHNs; however, 2 dropped out of the study due to
retirement. The control group contained 78 participants none of which dropped out of the study
(Liu et al., 2010).
4. (2 pts) In chapter 2 of the textbook, we defined an experimental study as one in which
something is done to a group. Briefly describe what the "something done" to the experimental
group is in this study.
The experimental group in this study underwent the 8-week education course on case
management.
5. (6 pts) On page 2238, the authors discuss validity and reliability. Read the short paper
"Reliability and Validity" by Michael J. Miller.
a. Describe in your own words what are meant by reliability and validity.
Reliability, by definition, is consistent scores, observations, or results over a period of time.
Validity, by definition, is the strength in which the instrument in question measures what it
claims to measure.
b. Describe why each idea is important in a measurement instrument.
6. (6 pts) On page 2241, the authors discuss study limitations and bias. Read the definitions of
different types of bias given at the Statistical Analysis Handbook.
a. In your own words, summarize the five types of bias defined.
Five types of bias can occur in research studies. First, selection bias occurs when the
population being studied is not representative of the population in question (Miller, n.d.).
Second, recall bias can occur when participants must “recall” previous information (Miller, n.d.).
Participants may not accurately answer questions or over/under-estimate the results. The third
type of bias is estimation bias which is the difference between the true population value of the
parameter being estimated by the test population value (Miller, n.d.). Fourth, systematic bias is
the distortion of information that can occur as a result of poorly calibrated instruments (Miller,
n.d.). Last, observer bias occurs when administrators deliberately or unintentionally interfere
with the results of the study (Miller, n.d.).
b. Which of these types of bias do the authors of the study identify as possibly being
present?
In this study recall bias and observer bias may have occurred. Recall bias may occur due
to response distortion since the test were self-reporting questionnaires. In addition, the observer
bias may have occurred since the researchers were not blind to which group was the
experimental group and the control group.
7. (6 pts) Table 2 on page 2240 is titled "Descriptive statistics and pre-test differences in
outcome variables."
a. Briefly describe what the purpose of this table is. Specifically, what is the purpose of
the hypothesis tests?
The purpose of this table is to show that the groups were not statistically different in the
pre-test results. Therefore, one group would not have exaggerated results due to participating in
the educational course. The hypothesis test determine that there is no significant difference
among these two groups before the experiment began.
b. Based on the given results, is there any significant difference between the experimental
group and the comparison group in terms of mean pre-test scores? Briefly describe how you
came to this conclusion.
Based on these results there is no significant difference between the experimental group
and the comparison group in terms of the mean pre-test scores. The p-values for the hypothesis
testing were greater than 0.05. According to hypothesis testing, we do not reject the null
hypothesis when P > 0.05.
12. The fifth test in Table 1 under the heading "Years in public health nursing" is used to
compare the years in public health nursing one group to the other. The given test statistic and Pvalue are from a Mann-Whitney U-test. (Note that not enough data are given for us to replicate
these calculations.)
c. Based on the given P-value, is there a significant difference in years in public health nursing
between the two groups.
Based on the given P-value there is not a significant difference in years in public health nursing
between the two groups.
Liu, W. I., Edwards, H., & Courtney, M. (2010). Case management educational intervention with
public health nurses: cluster randomized controlled trial. Journal of advanced
nursing, 66(10), 2234-2244.
Miller, M. J. (n.d.). Reliability and Validity.
Smith, M. J. (2013). Statistical Analysis Handbook.