DNP 602 Module 5 Mixed Methods Research Critique Example

Control, Convenience and a Likert Score: Critiquing a Mixed Methods Study of Postpartum Blood Pressure Self-Management

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 602: Evaluating Research for Practice

Instructor Name

Month Day, Year

Control, Convenience and a Likert Score: Critiquing a Mixed Methods Study of Postpartum Blood Pressure Self-Management

Introduction

This paper critiques "Implementing Self-Management: A Mixed Methods Study of Women's Experiences of a Postpartum Hypertension Intervention (SNAP-HT)" by Cairns et al. (2020). The study explored how women experienced blood pressure self-management after a pregnancy complicated by hypertension, within a pilot randomized trial.

Purpose and Rationale for Mixed Methods

The study aimed to explore the implementation of postpartum blood pressure self-management, including its proposed benefits and the constructs of normalization process theory, which explains how new practices become embedded in everyday life (May & Finch, 2009). A mixed methods approach was appropriate because the question had two parts: how women experienced self-management, best answered qualitatively, and whether perceptions such as sense of control differed between groups, which a scored measure could quantify. The rationale could have been stated more explicitly, but the logic is sound.

Design

The study is best described as a mixed methods study embedded in a randomized trial, with qualitative and quantitative data collected together in the same interviews. In the parent trial, women with gestational hypertension or preeclampsia needing medication after birth were randomized to usual care or self-management, which involved daily home blood pressure readings and medication reduction guided by telemonitoring (Cairns et al., 2018). Interviews were conducted at 4 weeks and 6 months postpartum. Embedding the study in a trial is a strength, because experiences can be compared across randomized groups.

Sample

Sixty-eight women, 34 from each group, completed at least one interview, producing 126 transcripts. Participation in interviews was optional, which may have favored women with stronger views or more time. The sample came from one region in England, and the study provides limited detail on ethnicity and social background, which limits transferability to my unit in Arizona, where many patients are Hispanic and covered by Medicaid.

Data Collection

Semi-structured interviews included questions developed from the intervention's proposed benefits and normalization process theory. For each question, women gave a score from 1 to 5 and were encouraged to explain their answers. This design collects both strands at the same time from the same people, which supports integration. A limitation is that scoring and discussing in the same interview may influence each other, and an interviewer aware of group assignment could shape responses.

Qualitative Analysis

Transcripts were analyzed using the framework approach, a structured method suited to applied research. Themes included control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. The themes are plausible and supported by quotations, but the article gives limited detail about how many coders were involved, how disagreements were resolved and whether participants reviewed findings, which affects judgments of credibility and dependability.

Quantitative Analysis

The scored responses were compared between groups with adjustment. Both groups reported feeling more in control after birth than during pregnancy, and women who self-managed reported greater control, with adjusted differences of 0.6 points at 4 weeks and 0.7 points at 6 months on the 5-point scale, both with confidence intervals excluding zero. These differences are statistically supported, but the clinical meaning of a difference under one point on a single Likert item is uncertain, and single items have unknown reliability.

Integration

Integration is the defining feature of mixed methods. Here, the qualitative theme of control and the scored control item point in the same direction, which strengthens confidence in the finding. Women also described self-management as more flexible and responsive, enabling more targeted reduction of medication, which helps explain the scores. However, the article reports the strands largely side by side; a joint display table linking each score to its related theme would make integration clearer, a technique recommended in mixed methods guidance (Creswell & Plano Clark, 2018).

Rigor and Ethics

The study used a theory to guide interview questions, a clear analytic framework and data from both randomized groups, all strengths. Rigor is limited by optional participation, single-item scores and limited reporting of qualitative procedures. The trial was prospectively registered, and women consented separately to interviews, which supports ethical conduct.

Usefulness for Practice

The study adds an important perspective to trial evidence: women generally found self-management acceptable, felt more in control, and reported less anxiety about blood pressure, even though a few had expected monitoring to increase anxiety. For my unit, these findings support offering home blood pressure monitoring after hypertensive pregnancies and suggest that teaching should address control and confidence, not only technical steps. Because the sample may differ from our population, I would gather feedback from our own patients when implementing it.

Conclusion

Cairns et al. (2020) present a useful mixed methods study that shows how women experience postpartum self-management. Its integration of themes and scores supports its conclusions, though clearer integration methods and fuller reporting would strengthen it.

References

Cairns, A. E., Tucker, K. L., Crawford, C., McManus, R. J., & Powell, J. (2020). Implementing self-management: A mixed methods study of women's experiences of a postpartum hypertension intervention (SNAP-HT). Trials, 21(1), 508. https://doi.org/10.1186/s13063-020-04394-z

Cairns, A. E., Tucker, K. L., Leeson, P., Mackillop, L. H., Santos, M., Velardo, C., Salvi, D., Mort, S., Mollison, J., Tarassenko, L., & McManus, R. J. (2018). Self-management of postnatal hypertension: The SNAP-HT trial. Hypertension, 72(2), 425-432. https://doi.org/10.1161/HYPERTENSIONAHA.118.10911

Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE.

May, C., & Finch, T. (2009). Implementing, embedding, and integrating practices: An outline of normalization process theory. Sociology, 43(3), 535-554. https://doi.org/10.1177/0038038509103208