Sickle-Cell Patients and Hydroxyurea: Examining Methodology and Design


Methodology and Design

In their study, Walker, Farzan, Gaydos, DeCastro, and Jonassaint (2016) discussed the perceptions of Hydroxyurea among patients suffering from the sickle-cell disease (SCD). Since the authors of the study focused primarily on the qualitative aspects of the issue, the qualitative research method was preferred. Particularly, an analysis of Facebook posts within the Sickle Cell Unite Group was performed to identify current trends in patients’ understanding of Hydroxyurea. In order to conduct the evaluation, Walker et al. (2016) used the content analysis framework to create deductive codes that would help define the recent changes in the perception of the proposed treatment strategy. The analysis was also based on the “health belief model, shared-decision making model, and social support concepts” (Walker et al., 2016, p. 318). Thus, the changes in patients’ attitude toward the choice of the treatment framework were assessed. In the article, the use of a mixed method would have helped evaluate the extent of the change in patients’ perceptions, thus providing additional information for further research. Moreover, the use of quantitative tools would have made the outcomes of the analysis less subjective, which was the key flaw of the initial design, particularly, the use of interviews.

Internal and External Validity

The methods that the authors use allow for a significant amount of external validity. Particularly, the outcomes of the study help define the general trend in SCD patients’ attitude toward the adoption of a Hydroxyurea-based treatment. Put differently, the study has rather high levels of ecological validity, which makes its outcomes applicable to other settings as the means of improving the quality of care. Similarly, the research can be characterized by a rather impressive population validity level. By refusing to categorize patients based on their culture, ethnicity, or social status, Walker et al. (2016) have created the framework that is flexible enough to apply to resolve the needs of different patients. However, the internal validity of the research is rather low since the independent factors affecting patients’ attitudes toward Hydroxyurea are far too numerous to embrace in a single study. Walker et al. (2016) focus on the general assessment of the change without deviating into the analysis of a vast array of influences, which is a reasonable choice yet also the reason for internal validity rates to drop.


Methodology and Design

Assessing the effects that Hydroxyurea has on patients with SCD is crucial to the improvement in their recovery rates and the overall increase in the quality of care. Therefore, the research by Lê et al. (2015) is an important addition to the general analysis of the effects that the proposed treatment has on SCD patients. Since there was a need to quantify the results to compare the effects of the traditional treatment and the application of Hydroxyurea, Lê et al. (2015) chose the quantitative method as the research design. The authors used the cohort analysis as the study design to compare patient outcomes in people receiving traditional treatment and patients treated with the help of Hydroxyurea. In retrospect, the adoption of the mixed research design would have helped to determine the key trends in patients’ health status.

Internal and External Validity

Because of the focus on the quantitative aspect of the issue, Lê et al. (2015) established a very strong control over independent variables, thus, restricting the impact of extraneous ones to the maximum. As a result, the levels of internal validity can be deemed as comparatively high. Specifically, Lê et al. (2015) considered the age of the participants by choosing infants as the target demographic. In addition, the degree of external validity of the study is quite high since the results of the analysis can be generalized to fit any other healthcare environment and satisfy the needs of other patients with SCD.


Methodology and Design

The issue of patient education and, particularly, the provision of crucial information resources to vulnerable populations has recently become of high significance for nurses across the globe. While innovative technologies provide the basis for expanding the patient-nurse dialogue, they also imply certain restrictions regarding the time management and the availability of the relevant data. Therefore, Lebensburger, Grosse, Altice, Thierry, and Ivankova (2015) ought to study the ways of understanding and increasing the efficacy of educating patients with SCD. In their research, the authors deployed a mixed method due to the necessity to incorporate both qualitative and quantitative factors affecting patients’ ability to acquire new knowledge. The application of a purely qualitative approach, however, might have made the study more focused and, thus provide more coherent results.

Internal and External Validity

Despite being focused on a particular aspect of nursing care, the study provides the results of rather high external validity. Particularly, after minor modifications, the conclusions made by the authors regarding patient education can be applied to any other area of healthcare. For instance, the research specifies that, when provided with a certain impetus for nurses, patients start seeking the required information themselves. Consequently, the research results support the idea that patient education can be fostered in any environment, which is of crucial relevance to a number of areas of nursing (). The internal validity of the research is, in turn, of medium scale since the influences experienced by patients were numerous, yet researchers managed to control most of them.


The articles analyzed above provide a rather clear example of why the choice of research methodology is defined by the questions or hypotheses posed by its authors. Indeed, the use of qualitative, quantitative, or mixed research techniques hinges on the perspective from which a certain nursing issue is scrutinized. There is a distinct connection between the choice of the research subject and the selection of a corresponding method. For instance, the study that focused on the analysis of the attitudes among patients toward the newly deployed framework for managing SCD was based on the qualitative design, the paper that defined a correlation between the provision of Hydroxyurea and the outcomes utilized the quantitative approach, and the research that targeted both was based on the mixed method. Although the studies restrict the number of issues explored during the analysis by selecting a particular methodological tool, they provide the results that can be characterized by high rates of internal and external validity. Thus, the results of the analysis can be used to encourage further research and facilitate faster recovery.


Lê, P. Q., Gulbis, B., Dedeken, L., Dupont, S., Vanderfaeillie, A., Heijmans, C.,… Rozen, L. (2015). Survival among children and adults with sickle cell disease in Belgium: Benefit from hydroxyurea treatment. Pediatric Blood & Cancer, 62(11), 1956-1961.

Lebensburger, J. D., Grosse, S. D., Altice, J. L., Thierry, J. M., & Ivankova, N. V. (2015). Understanding and improving health education among first-time parents of infants with sickle cell anemia in Alabama: A mixed methods approach. Journal of Pediatric Hematology/Oncology, 37(1), 35-42.

Walker, A. L., Farzan, R., Gaydos, L. M., DeCastro, L., & Jonassaint, C. (2016). Assessing perceptions of hydroxyurea among sickle cell disease stakeholders using social media. Blood, 128(22), 318.

Appendix A: Methodologies Beneficial for the Studies

Article Lebensburger et al. (2015) Lê et al. (2015) Walker et al. (2016)
Methodology Qualitative Quantitative Mixed
Design Deductive codes Controlled trial Surveys (quantitative) and interviews (qualitative)
Benefits Extensive and detailed information Accurate correlations between the variables Wide range of factors embraced
Limitations Possible subjectivity Possible underrepresentation of the target population Lack of focus