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Does Qualitative Research Provide More Useful Evidence in Clinical Practice, than Quantitative Research?

Introduction to Diabetes and Its Management

One of the chronic medical disorders that attributed to a buildup in glucose levels in the bloodstream is diabetes (Brackney, 2018). There has been a spike in diabetes diagnosis globally. According to Haak et al. (2017) insulin help to moves the glucose by decreasing amount in the blood and impaired functioning can lead to diabetes. One of the interventions is self-monitoring technique for blood glucose level by the patients that decrease the dependency over other individuals. In this, patients measure their glycaemia with the aid of a glycemic reader that will help to keep a record. The studies have adopted both qualitative and quantitative designs by using the Critical Appraisal Skills Program tool. The aim is to discuss each paper’s findings and to support the position of this paper with another relevant article

Qualitative Perspective

For the qualitative design, the first study reviewed was that of Ong, Chua and Ng (2014). The study explores the obstruction and facilitators to SMBG in type 2 diabetes patients and how it can affect the blood glucose level. Although SGBM helps in improving glycemic control and empowerment among the patients its uptake has remained low. The study seeks to interpret the actions of patients as to whether they use SGBM or not. The article has utilized the qualitative methodology for the study and the individuals from a primary care clinic were recruited to participate in the study. The researchers used purposive sampling focusing on maximum variation sampling considering demographic factors. All the participants had practised SGMB followed by the Semi-structured interviews and in-depth interviews that help in the data collection.

The researchers obtained ethical approval by the Medical Ethics Committee of the University Malaya, the study also maintained confidentiality and privacy in the study with respect to participant. In preparation for data analysis, the researchers carried out a comparison of the transcripts and utilized Text Analysis Markup System Analyzer that is an qualitative analysis software. The study results evaluate that SMBG is primarily used by patients to confirm symptoms and not as a routine basis. The qualitative methodology helped identify that the cost of SMBG was a major barrier for persons (strips used were too expensive) and that in Malaysia, incentives should be provided for the patients. Other barriers identified included; complexity, pain associated with SMBG and family motivation.

The second study was propped by Peel, Parry, Douglas and Lawton (2004) who aimed to evaluate the advantages and disadvantages of blood glucose level monitoring in diabetes type 2 patients perspective. The scholars note while some studies opine that SMBG improves glycemic control, others indicate that it is not necessary for type 2 diabetes patients who does not utilize insulin. This study adopted the qualitative approach as it allows for the exploration of cultural attitudes and a deeper understanding of the meanings that patients attach to SMBG. The participants of the study were selected from four health care cooperatives and three hospitals inclusion criteria are patients diagnosed with type 2 diabetes in the past six months.

The participation recruitment in the study was done through face-to-face communication with the patients or by a letter. Purposive sampling was used to ensure that demographic characteristics of the patients were aptly captured. The recruitment approach was appropriate given the aims of the research. Data collection conducted through interviews and they were taped with informed consent from the participants. The researchers opted for hypothesis testing which is applicable in quantitative studies. The findings of the study identified that SMBG can have an adverse psychological impact on persons especially when results are counterintuitive.

The third qualitative study was by Brackney (2018) who have investigated practical understanding of SMBG in self-management from the perspective of non-insulin-requiring type 2 diabetes patients. Researcher argues for the diabetes patients to practice SMBG effectively, they require some level of medical knowledge. This justifies the author’s discussion of theoretical concepts in the implementation of SMBG intervention. Further, the qualitative approach adopted by the research is appropriate considering the objective of the study. The researcher used three A1C categories to invite participants for the study and out of the 15 participants invited, 11 agreed to participate in the study.

Sampling was conducted until saturation was achieved to the satisfaction of the researcher and advisory team as directed recommended in qualitative studies. For data collection, interviews were used and the privacy and confidentiality of the participants were protected by the researcher participant were allowed to discontinue the interview whenever they felt uncomfortable with continuing. Data analysis was conducted effectively taking into consideration that the results obtained from the interviews were coded during the analysis. The study concludes that focused listening is essential in addressing illness experience among type 2 diabetes patients. Further, the research identified about SMBG and how it can be modelled by the nurse to guide patients to more positive decision-making concerning management.

Quantitative Perspective

The first study was by Davis, Bruce and Davis (2006) they aimed to determine whether SMBG is associated with controlled glycemic control in type 2 diabetes. The outcome of the study is whether SMBG contributes to controlled glycemic control in type 2 diabetes. It is a longitudinal observational study and the participants included in the longitudinal study were properly accounted for after the research. From the study, oral hypoglycemic agents treated patients had insignificant glycemic benefits related with a median SMBG frequency four times per week. The second intervention was to provide blood glucose meters for free. This “increased the average SMBG in sulfonylurea treated patients from 0.5 to 2.0 tests per week.” However, there was no significant reduction in A1C. When the testing was increased by six times a week that directly affected A1Cwhich get reduced by 0.28%. The third intervention was diabetes education for the patients. Patients “who attended the diabetes education were five times more likely to self-monitor” These results apply to the local populations and clinically important outcomes were considered. These outcomes justify the study.

The second quantitative study for this comparative analysis was by Haak et al. (2017) who sought to understands the efficacy of the glucose-sensing technology to replace SMBG given that the latter has remained challenging to most patients. The assignments of patients for treatments were randomized and the patients who entered the trial were type 2 diabetes patient. The interventions included SMGB and flash glucose-sensing technology with primary finding was the disparity when compared the test group with the control groups at six months in HbA1c but no difference were detected in both groups.

Participants aged 65 years and above, there was a pronounced drop in the test group compared to the test group. The sensor glucose reading indicated a similar drop in HbA1c in comparison with other regularly used methods in blood glucose testing. Compared with SMGP, there were no safety concerns over the new technology and technology was also associated with a highly significant reduction in hypoglycemic measures. These outcomes can affect the decision to include glucose-sensing technology in the glycemic management of type 2 diabetes treated by intensive insulin therapy.

The last quantitative study in this analysis was by O’Kane et al. (2008) who assessed the impact of self-monitoring device for the blood glucose concentrations on glycemic control and psychological condition of the newly diagnosed patient. The study was randomized control trial of the self-monitoring and no-monitoring (control) groups. All the participant in the study were aware about the conclusion and the group was not similar at the beginning of the trial given that it included different ages and diabetes type 2 patients who had experienced other chronic illnesses in the past six months. From the analysis, HbA1c fell within each group and there was no “difference between the groups at any point.” SMGP helps in maintaining the glycemic control and improve the patients’ experience of diabetes.

Comparison

The study by Ong et al. (2014) identifies factors such as cost, complexity in administration, and pain as some as the barriers to SMBG. However, these findings are in contrast with Peel et al. (2004) findings in which the authors opine that the barriers to SMBG are not compounded by practical ease of the procedure or economic factors but the psychological impact of monitoring. To enhance the theoretical understanding of SMBG, the study by Brackney (2018) found that for the best outcome, nurses should use model SMBG to guide patients in collaborative decision-making surrounding its application. These findings supported those of the quantitative study conducted by Davis, Bruce & Davis (2006) whose study indicated that diabetes education intervention was likely to enhance self-monitoring among patients. Haak et al. (2017) introduce flash glucose-sensing technology as a more reliable approach compared to SMBG. However, the study by O’Kane et al. (2008) indicates that SMGP is the most reliable approach in improving glycaemic control.

Authors

Title

Research strategy

Research design

Sample

Results

For/Against

Ong, W. M., Chua, S. S., & Ng, C. J. (2014)

Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study

Qualitative

Interviews

15

The cost was a common barrier to SMBG but pother factor include participant emotion and SMBG process

For SMBG, but against the Malaysian government’s approach to it

Peel, E., Parry, O., Douglas, M., & Lawton, J. (2004).

Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients' perspectives.

Qualitative

Interviews (two-rounds) Grounded Theory

40

Monitoring can negatively affect patients’ self-management when readings are counter-intuitive.

Against SMBG in some limited circumstances

Brackney, D. E. (2018).

Enhanced self‐monitoring blood glucose in non‐insulin‐requiring Type 2 diabetes: A qualitative study in primary care

Qualitative

Semi-structured interviews and photographs of logbooks

11

Blood glucose checking strengthens positive disease management relationships

For SMBG

Davis, W. A., Bruce, D. G. & Davis, T. M. (2006).

Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients?

Quantitative

Used cross-sectional and longitudinal data to determine SMBG is associated with better glycemic control in type 2 diabetes

1286 + 531

Neither SMBG testing nor its frequency was associated with glycemic benefit

Against SMBG in terms of some of the reported benefits

O’Kane, M. J., Bunting, B., Copeland, M. & Coates, V. E. (2008)

Efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

Quantitative

RCT, SMBG versus no SMBG

184

No significant differences but SMBG was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01

Against SMBG

Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J. P., & Rayman, G. (2017).

Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial.

Quantitative

RCT using blinding

224

(149 intervention, 75 controls)

No significant difference was observed in HbA1c change and decreased hypoglycemia 

Against SMBG, Flash glucose-sensing Technology preferable instead

Conclusion

While each of the two methods is needed, it is argued here that qualitative studies (and qualitative experiences, such as learning from induction) can have a more powerful impact on readers as new phenomena are identified and discussed. However, at the same time, formal guidelines of clinical practice tend to be based on the quantitative study which tends to have research standards that are based on positivism. Both qualitative and quantitative studies provide useful evidence in the management of type 2 diabetes using SMBG. While qualitative approach yields in-depth discussions, the quantitative approach is statistically representative. For instance, the study by Ong, Chua and Ng (2014) offers an in-depth discussion on the barriers to SMBG. However, the study by Davis, Bruce & Davis (2006) statistically proves that patient education on SMBG significantly influences the uptake of this strategy among type 2 diabetes patients. This effectively helps solve some of the barriers on how to manage the pain related with the tests, which is a barrier to SMBG.

References

Brackney, D. E. (2018). Enhanced self‐monitoring blood glucose in non‐insulin‐requiring Type 2 diabetes: A qualitative study in primary care. Journal of clinical nursing, 27(9-10), 2120-2131.

Davis, W. A., Bruce, D. G., & Davis, T. M. (2006). Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients? the Fremantle Diabetes Study. Diabetes care, 29(8), 1764-1770

Guyatt, G. H. Sackett, DL. and Cook, DJ. (1993). Users’ guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? JAMA, 271, p59-63.

Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J. P., & Rayman, G. (2017). Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Therapy, 8(1), 55-73.

O’Kane, M. J., Bunting, B., Copeland, M., & Coates, V. E. (2008). Efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): Randomized controlled trial. BMJ, 336(7654), 1174-1177.

Ong, W. M., Chua, S. S., & Ng, C. J. (2014). Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient preference and adherence, 8, 237.

Oxford Centre. (2020). Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd. Retrieved from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Randomised-Controlled-Trial-Checklist-2018.pdf

Oxman, A. D., Sackett, D. L., Guyatt, G. H., Browman, G., Cook, D., Gerstein, H. & Brill- Edwards, P. (1993). Users' guides to the medical literature: I. How to get started. JAMA, 270(17), 2093-2095.

Peel, E., Parry, O., Douglas, M., & Lawton, J. (2004). Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients' perspectives. British Journal of General Practice, 54(500), 183-188.

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