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Posted: February 3rd, 2025
Nursing statistics. Find a published research study on a topic that you could use for your DNP project that used a chi-square test and find this information from the study:
A Multilevel Empowerment Approach to Prevent Relapse and Improve Quality of Life of People with Mental Disorders
Agustin Widyowati1,2, Bhisma Murti3, Aris Sudiyanto4, Suminah2
This research focuses on a critical area within mental health nursing, addressing relapse prevention and quality of life improvement. It’s important to consider how these findings might translate into practical interventions.
Give the purpose/objective/aim of the study exactly as it is written in the study.
“To examine the effectiveness of a multilevel empowerment approach to prevent relapse and improve quality of life (QoL) among people with mental disorders.”
This objective clearly outlines the study’s focus on evaluating a specific intervention’s impact. Understanding the effectiveness of such interventions is crucial for evidence-based practice.
What is the population in the study?
“People with mental disorders who had experienced at least one relapse in the past year and were receiving outpatient care at a mental health hospital in Indonesia.”
This population is specifically defined, which is important for understanding the study’s scope and generalizability. The inclusion criteria are clear and relevant to the research question.
What is the independent (treatment or intervention) variable (IV)?
“A multilevel empowerment approach, consisting of individual, family, and community-based interventions.”
This intervention is multifaceted, targeting different levels of influence on an individual’s mental health. It’s important to understand the specifics of each component of this intervention.
What is the dependent (outcome) variable (DV)? If there are multiple dependent variables, choose only one for the focus of this discussion.
“Relapse rate within 6 months following the intervention.”
While the study mentions Quality of Life (QoL) as an outcome, we will focus on relapse rate for this analysis. This specific focus allows for a more in-depth examination of the chosen variable.
What is its level of measurement (nominal, ordinal, interval, ratio)? Is it a categorical or continuous variable? You can determine this as you read the Methods section of the report for how the DV is measured.
Nominal. Relapse (yes/no) is a categorical variable.
The dichotomous nature of the relapse variable makes it straightforward for chi-square analysis. This simplifies the statistical interpretation of the results.
If a hypothesis was stated in the article for the independent t-test, give it here and label it as a Ho or Ha. Write the stated hypothesis as an equation. Write the other hypothesis (the Ho or Ha that was not given) in words and an equation. If a hypothesis was not stated, then restate the purpose/objective/aim as a null hypothesis in words and equation format. Do this for both a null and alternative hypothesis. Again, focus on only one independent variable and one dependent variable. Use the format for the chi-square equation provided on p. 301 of Kim et al. (2022) and the handout attached to the announcement this week.
Hypotheses were not explicitly stated in the article. Therefore, we will restate the objective as null and alternative hypotheses:
Null Hypothesis (Ho): There is no significant difference in relapse rates between the group receiving the multilevel empowerment intervention and the control group. χ² = 0
Alternative Hypothesis (Ha): There is a significant difference in relapse rates between the group receiving the multilevel empowerment intervention and the control group. χ² ≠ 0
These hypotheses are crucial for guiding the statistical analysis and interpretation of the findings. They provide a framework for determining whether the intervention had a demonstrable effect.
What are the assumptions for the chi-square test (Kim et al., 2022, p. 301)? Are they met in this study? Provide information given in the study that can be used to determine whether each assumption is or is not met. What information is not given?
Independence: The observations must be independent of each other. The study mentions randomization, which suggests this assumption is likely met, but it is not explicitly discussed.
Expected Cell Frequencies: All expected cell frequencies should be greater than 5. The study does not provide enough information to assess this assumption. The actual cell frequencies are not provided.
Categorical Data: The data must be categorical. The relapse variable (yes/no) is categorical, so this assumption is met.
These assumptions are critical for the validity of the chi-square test. Without confirming these assumptions, the results of the test should be interpreted with caution.
What alpha level (level of significance) was used?
The alpha level is not explicitly stated in the abstract or readily available portions of the article.
Without knowing the alpha level, it is impossible to definitively interpret the statistical significance of the findings. This information is crucial for decision-making based on the research results.
What are the groups that were tested?
The study used two groups: an intervention group that received the multilevel empowerment approach and a control group that received usual care.
Clearly defining the comparison groups is essential for understanding the study design and interpreting the results. It helps to clarify what is being compared.
Give the frequencies for the outcome variable for the groups.
The abstract does not provide the specific frequencies of relapse in each group.
The absence of this data makes it difficult to fully assess the impact of the intervention. Knowing the raw numbers of relapses is important for understanding the clinical significance of the findings.
Give the chi-square statistic and p-value for the difference in frequencies for the DV.
The abstract states that the multilevel empowerment approach was effective in reducing relapse (p < 0.05). However, the exact chi-square statistic is not provided.
This information is crucial for evaluating the strength of the association between the intervention and relapse. The precise p-value and chi-square statistic allow for a more nuanced interpretation.
Specifically state the p-value rule for the results of this study to determine whether to reject or fail to reject the null hypothesis.
Since the p-value is less than the conventional alpha of 0.05 (p < 0.05), the null hypothesis is rejected.
This decision rule is fundamental to hypothesis testing. It provides a clear criterion for determining whether the observed results are statistically significant.
Based on the decision made about the null hypothesis, what type of error is possible (Kim et al., 2022, pp. 131-132 and Table 7-2)
Since the null hypothesis was rejected, a Type I error (false positive) is possible.
Understanding the types of errors is essential for interpreting research findings. It helps to acknowledge the possibility of drawing incorrect conclusions.
What are the usual causes of this type of error? Are any of them present in the methodology for this study?
Type I errors can occur due to chance variation, inadequate sample size, or problems with the study design. The abstract does not provide enough information to determine if any of these are specifically present.
Identifying potential sources of error is important for evaluating the validity of research findings. It helps to critically assess the methodology and consider alternative explanations for the results.
The effect size for chi-square results is reported as a Phi or Cramer's V statistic (Kim et al., (2022), pp. 308-309. Give this value, if given in the study, and interpret what it means in terms of the magnitude or clinical meaningfulness (clinical significance) of the result. If not given, determine the clinical significance of the difference in frequencies by using your knowledge, critical thinking, and experience with your patients and setting. Would you incorporate the intervention or treatment into your practice? Is your evaluation of the clinical significance of the findings consistent with the statistical significance for the findings and the value of the effect size? Explain your rationale.
The abstract does not provide the Phi or Cramer's V statistic. While the study found a statistically significant difference in relapse rates, the clinical significance is unclear without more information. A multilevel approach addressing individual, family, and community factors aligns with best practices in mental health care, therefore, if the intervention details are robust and reproducible, it is likely to be incorporated into practice, especially in resource-limited settings where family and community support systems are vital. Further research with more detailed methodology and effect sizes is necessary.
Evaluating clinical significance requires careful consideration of multiple factors, including the magnitude of the effect, the feasibility of implementing the intervention, and the specific needs of the patient population. Integrating research findings into practice requires a balanced assessment of statistical significance and clinical relevance.
Evaluating the Effectiveness of a Multilevel Empowerment Approach in Relapse Prevention for Individuals with Mental Disorders
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