Research problem research in caregiving for patients with heart failure is not sufficient to prioritize intervention areas. Records indicate that caregivers of heart failure patients face increased mental and physical health challenges. However, no guiding models or frameworks exist on the caregiving of heart failure. A need for consistent measures is imperative for this aspect. Many scholars know that a correlation exists between caregivers’ age and their perceived control over the management of the health problem. Therefore, the research sought to clarify this association. Additionally, little is known about the exact association among caregivers’ perceived control, caregivers’ perceived outcomes, general and mental health, and difficulty of tasks.
The key research question is: “What are the most relevant measures in caregiving for patients with heart failure?” (Bakas et. al. 2006). The researchers sought to identify these measures using a heuristic model. Three minor research questions were identified. The first was “What relationship exists among perceived difficulty with tasks, perceived mental and general health of the caregiver perceived control over the management of the heart problem, age and perceived outcomes.” The second one was “How do caregivers describe their perception of control over heart failure management”. Thirdly, “Which outcomes and tasks do caregivers perceive as being most negative and difficult?.”
Bakas et. al. (2006) employed convenience sampling as their strategy of choice. They used a list of patients that were already enrolled in another clinical trial for computerized interventions. These were all outpatients of the Veteran Affairs Medical Centre. Bias might have arisen in such an approach as no attempt was made to balance out the research subjects. Additionally, the sample size is quite small since only 21 subjects were involved. Nonetheless, the authors likely chose such a method because this was a preliminary study. They merely wanted to identify trends in caregiving for patients with heart failure. It is difficult to obtain information about caregivers hence the reliance on affiliation to a medical center.
Appropriateness of measures used
The authors decided to administer questionnaires concerning all the parameters under analysis. This was an appropriate technique because it coincided with the quantitative nature of the study. Some of the variables in the study were difficult to define. For instance, the element of perceived control means different things to different people. The investigators identified certain questions like how much control one feels over the situation and whether they have taken the right steps. These are factors that are vulnerable to different interpretations by respondents.
Summary and appropriateness of research design
The researchers decided to use quantitative research as their primary data collection strategy. However, items in the selected scales may not include issues that affect some of the participants. Descriptive designs need to include opinions from participants, so a mixed-method approach would have been a good idea. Nonetheless, the positivist approach in data collection was suitable for the research questions as they attempt to answer questions that start with ‘what’ rather than ‘why’. However, one may question the conclusiveness of the cause-effect relationships in the study owing to the descriptive dimension of the research design.
Threats to internal validity
Maturation is a threat to this study’s internal validity. The participants may change their ratings of perceived task difficulties or perceived general and mental health after prolonged caregiving. As a consequence, a longitudinal study would be effective in ascertaining that the maturation threat is eliminated. Experimenter expectancy may also impede the applicability of this research. Most of the variables are related to one another. Therefore, the presence of one may affect outcomes in another. The authors noted that their small sample size prevented them from making direct associations between caregiver perceptions of mental and general health. Some of their inferences emanated from their expectations before the study.
Ways to improve internal validity
The investigators should do a longitudinal study to minimize the maturation threat. They should also expand the size of their sample size to minimize experimenter expectations. Bakas et. al. (2006) ought to use other investigators to minimize their influence over the subjects.
Threats to external validity
The biggest threat to the external validity of this study is population validity. The authors did not select a representative sample of heart failure caregivers. Their subjects were homogenous in terms of race, income, age, gender, and social status. Ecological validity also constrained the application of findings because of selection bias in terms of age. Many of the participants may have reacted to the experimental arrangement and offered insights that seemed permissible to the authors.
Ways to improve external validity
The authors should make their samples more representative by using sampling strategies that account for demographic differences. They should also avoid any cues that might cause subjects to change their answers. Investigators should be altered in a second experiment.
Participants needed to give out information about their financial background as well as other personal issues. They needed to let their guard down to tell the investigators about perceived control. Some of the participants may have altered their responses owing to their discomfort with the research questions.
The key author of the article seems to have a bias towards her work as the caregiver-perceived-difficulty measure, perceived outcomes, and general health scales were partly created by Tamilyn Bakas. Other scholars have worked on heart failure, and their input should be considered in the selection of measuring scales.
Other ways in which the study could have been improved
The authors should improve on their sampling technique. First, they should increase their sample size and focus on a heterogeneous sample. The participants were predominantly female, unemployed, white, mature, and middle income. These results may not apply to younger participants or male caregivers. Therefore, a different strategy like purposive sampling should be used. Additionally, the researchers should have relied on scales written by different authors. In the BCOS measure, they should have focused on item-level analysis for caregivers’ perceived items. Longitudinal research will also ascertain that changes in time are noted.
Indication of what the study adds to the research literature
The research has contributed towards caregiving literature for patients with heart failure. Now stakeholders know that a caregiver’s age affects their perception of caregiving management. Additionally, readers of the article will learn that caregivers have a poorer perception of their general and mental health if the perceived difficulty of tasks is high. Stakeholders also know about the most pressing tasks in the management of heart failure. They will also learn about the effects of caregiving on caregivers. Some of them include deteriorated health, low emotional well-being, poor financial welfare, and declining social life
Bakas, T., Pressler, S., Johnson, E., Nauser, J. & Shaneyfelt, T. (2006). Family care giving in heart failure. Nursing Research, 55(3), 180-188.