Question
Critically appraise the piece of literature/evidence (i.e. original research study), in relation to the health scenario provided. Using critical appraisal questions provided, answer these questions in the form of an academic essay, with APA referencing.
Solution
Critical Appraisal of Evidence
Psychological stress is a severe problem among university students. One of the commonly used interventions entails mindful exercise (Kar, Shian-Ling, & Chong, 2014; Phang et al., 2015). McConville et al. (2019) conducted the study under review using a thematic analysis strategy in exploring pre-clinic physiotherapy students’ experiences, who were taking part in a mindfulness program for six weeks. The program involved the use of two methods: sitting meditation and mindful movement. The assignment is a critical appraisal of the study by McConville et al. (2019), focusing on the identification of essential sections’ strengths and weaknesses, authorship, research question, research design, research methods, limitations, and results. Greenhalgh et al. (2020) suggest the importance of the review to provide quality evidence for use in practice. Furthermore, the assignment will include enablers and barriers to the adoption of the recommendations or findings in a specific scenario and clinical question.
Part A: Critical Appraisal
Authorship
Authorship in a scholarly work reveals the quality of a source of evidence. According to Biagioli and Galison (2014), the credibility of the author is essential and should focus on credentials and affiliations. The authors have educational qualifications, including masters and bachelor education in counseling and psychology, which qualifies them to conduct the research. They are also affiliated with reputable institutions (universities): Latrobe and Monash, which makes them reputable. The article addresses the issue of conflict of interest, which Bero (2017) defines conflicting aims between two or more researchers. McConville et al. (2019) indicate that their study was not funded, which eliminates the issue of conflict of interest.
Research Question and Justification
McConville et al. (2019) focused on answering the question: ‘Physiotherapy student experience of a mindful movement and a mindful stress-reduction intervention: A qualitative study’. They explored previous research on the use of mindful movement (MMov) to address mental stress and increase the ability to cope with psychological demands. For example, “a recent meta-analysis of 38 studies revealed a significant moderate effect on anxiety, depression, psychological distress, and stress from the use of mindfulness-based interventions for distress, wellbeing, physical health, and performance in HCPs and HCPs-in-training” (172). However, the review revealed limitations that informed the current research, such as a lack of conclusive evidence of the efficacy of MMov (Payne & Crane-Godreau, 2015). McConville et al. (2019) were unaware of “any studies that have specifically investigated mindfulness-based interventions for physiotherapy students” (173). Such limitations justified the current study, which aimed at exploring third-year physiotherapy students’ lived experience upon participating in a six-week mindful stress-reduction (MSR) intervention or MMov intervention. The authors justify their problem and current work through the noted increase in the level of stress among university students, and the gap in the research on the use and efficacy of MMov in reducing stress among physiotherapy students.
Research Design
The authors used a qualitative analytic method to conduct their study and collected data using semi-structured interviews. The aim informed their choice of the qualitative research design of their study, which was to collect the participants’ lived experience during the mindful stress-reduction (MSR) intervention or MMov intervention. Marshall and Rossman (2014) reveal that qualitative studies allow researchers to collect detailed narratives from participants, which would be impossible using a quantitative research design. It helps to explore a phenomenon from the perspective of the subjects. The approach enabled the authors to collect rich and detailed data relating to the experiences of the physiotherapy students taking part in the program. Besides, using Braun and Clark’s (2006) thematic analysis method, McConville et al. (2019) managed to identify, analyze, and report meaning patterns (themes) in the data set. The thematic analysis helps researchers to categorize data and find related meaning during qualitative data analysis (Marshall & Rossman, 2014). However, the study has some weaknesses, including the biased nature of qualitative studies. While the researchers do not suggest any step to address bias, they propose a solution for future research. For example, they suggest combining qualitative interviews with validated self-report scales, academic performance, stress biomarkers, and observer-rated scales to collect quantitative data. The study also used volunteers instead of a probability sampling method. However, they used a randomized method when assigning participants to the MSR and MMov program.
Research Methods
Sampling, data collection and analysis determine the quality of the findings. Moser and Korstjens (2018) recommend the use of methods that are relevant to answer the research question, test the hypothesis, or achieve the aim of the study. McConville et al. (2019) used volunteers of physiotherapy students, whom they later randomly assigned MRS or MMov group. Although the method provided a sufficient sample, it is prone to bias. They used qualitative interviews to collect data, which would provide detailed data, but is vulnerable to subjectivity due to lack of a way of quantifying the information. They analyzed the data using thematic analysis and reporting. However, the method generates subjective data. Although qualitative studies are prone to bias, Moser and Korstjens (2018) did not indicate the existence of any in their research.
Results and Limitations
The study organized findings in a theme (increased self-awareness, which is “being more aware of their physical, mental and emotional states”) and sub-themes: “(1) mental health, (2) self-care, (3) communication, (4) study engagement and (5) movement awareness” (179). Subjects in the two groups “increased self-awareness and improvement in mental health, self-care, communication and study engagement” (177). Self-awareness was a common theme across the two groups, which meant that using the mindful exercises students became aware of their occurrence of stress and could use strategies from the training to reduce “physical symptoms and feelings of stress and anxiety” (177). Self-care was another positive outcome reported by students, which was the ability to pay attention and kindness to self. In terms of communication, students indicated that the mindful exercise enabled them to remain focused and concentrate when communicating with others. In terms of movement, students reported that the mindful practice helped them to become more aware of their bodily and the potential for change when using the movements or teaching others, such as patients to do the same.
Nonetheless, the study had some limitations. One of the limitations was the use of a quantitative interview as the only approach to collect data instead of including a quantitative method to acquire objective findings. Another limitation was the use of volunteers for the study, which would provide a biased sample because the sample of volunteers would have significant differences from non-volunteers, a reality that the researchers ignored. The limitations might affect the implementation of the research findings since qualitative data hinders generalizability (Leung, 2015). The results might not be applicable in other study settings since they are subjective to the current study. Although some aspects of the mindfulness studies were more useful than others, many subjects stopped practising the mindfulness after the follow-up. This limitation would hinder the efficacy of the entire program.
Part B: Enablers and Barriers
Reflecting on the scenario, describe two possible enablers and two potential barriers, that may impact on the adoption and use of the evidence (i.e. findings) in reference to the scenario provided.
Various barriers might affect the use of the findings on the study in practice. One of the enablers is the support of the mindfulness program by physiotherapy students who are expected to benefit from its implementation. For example, the positive view of Steve, who is a millennial student (born 2000), could act as an enabler in implementing the mindful exercise program at the physiotherapy educational setting. Steve supports the use of the program and believes that it can reduce stress and should be promoted in a learning environment. Another enabler of the program are educators who believe that it is an effective mechanism to help students to have better mental health outcomes because they are likely to support the program in practice. After all, the successful use of the mindfulness intervention should have a supportive curriculum, such as MSR and MMov (Song & Lindquist, 2015). The program will succeed through support from the individual and organizational levels.
Regardless of the enablers, the acceptance and use of mindfulness interventions in psychotherapy or clinical education setting could have some barriers. One of the chief obstacles is physiological students who have negative perceptions of the mindfulness intervention. For example, Debbie, who is one of Steve’s peers, believe that mindfulness is a millennial thing with little value in promoting wellbeing or reducing stress. Besides, the lack of faculty support to change such perceptions among students can also act as a barrier. Therefore, the successful implementation should use the results of the study to convince students about the efficacy of mindfulness exercise to reduce stress and improve the psychological wellbeing of physiotherapy students.
Conclusion
Medical and physiotherapy students experience high levels of stress due to the demand of their mental abilities. Stress can also cause another serious effect on mental abilities, such as stress. Therefore, it is necessary to implement effective interventions, such as mindfulness exercises, to help students overcome mental stress and gain self-efficacy. The appraised research supports the effectiveness of mindful activities to help physiotherapy students to overcome psychological stress. However, the study has limitations that should be addressed in future research, such as the need to include quantitative data and the use of a probability sampling method. Such recommendations are necessary to support the implementation and use of mindful interventions in medical education settings
References
Bero, L. (2017). Addressing bias and conflict of interest among biomedical researchers. Jama, 317(17), 1723-1724. doi:10.1001/jama.2017.3854
Biagioli, M., & Galison, P. (2014). Scientific authorship: Credit and intellectual property in science. New York: Routledge.
Greenhalgh, T. M., Bidewell, J., Warland, J., Lambros, A., & Crisp, E. (2020). Understanding research methods for evidence-based practice in health. John Wiley & Sons.
Kar, P. C., Shian-Ling, K., & Chong, C. K. (2014). Mindful-STOP: Mindfulness Made Easy for Stress Reduction in Medical Students. Education in Medicine Journal, 6(2), 1-5. doi:10.5959/eimj.v6i2.230
Leung, L. (2015). Validity, reliability and generalisability in qualitative research. Journal of Family Medicine and Primary Care, 4(3), 324-329. doi:10.4103/2249-4863.161306
Marshall, C., & Rossman, G. B. (2014). Designing qualitative research. London: Sage publications.
McConville, J., Lewis, D.. Chambers. R., & Hassed, C. (2019). Physiotherapy student experience of a mindful movement and a mindful stress-reduction intervention: A qualitative study. New Zealand Journal of Physiotherapy, 47(3). 1-7. https://doi.org/10.15619/NZJP/47.3.05
Moser, A., & Korstjens, I. (2018). Series: practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European Journal of General practice, 24(1), 9-18. https://doi.org/10.1080/13814788.2017.1375091
Payne, P., & Crane-Godreau, M. A. (2015). Meditative movement for depression and anxiety. In F.B. Schuch, N. Rocha, & E. L. Cadore (Eds.), Progress in physical activity and exercise and affective and anxiety disorders: Translational studies, perspectives and future directions (pp.50-64). Frontiers Media SA.
Phang, C. K., Mukhtar, F., Ibrahim, N., Keng, S. L., & Sidik, S. M. (2015). Effects of brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study. Advances in Health Sciences Education. 20(5), 1115-1134. https://doi.org/10.1007/s10459-015-9591-3
Song, Y., & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Education Today, 35(1), 86-90. https://doi.org/10.1016/j.nedt.2014.06.010
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