Importance Of Adequate Prenatal Care Health And Social Care Essay
Critical analysis of research surveies is one of the most of import stairss towards incorporation of grounds into pattern ( Burns & A ; Grove, 2007 ) . This paper is an effort towards accomplishing this end. The paper critically analyzes the article “ Group prenatal attention and preterm birth weight: Consequences from a matched cohort survey at public clinics ” by Ickovics et al.
( 2003 ) . This purpose will be achieved by consecutive reviewing the research job, the literature reappraisal, rules of research moralss employed in the survey, the underlying theoretical model, the research hypothesis, the sampling technique, the research design, informations aggregation methods, the analysis, and the recommendation proposed by the writers. Finally, the paper will stop with an overall assessment of the strength and restrictions of the survey.
This peculiar research paper was analyzed as the construct of group prenatal attention has non been investigated in item yet. While reexamining the literature on the stated subject the limited supporting groundss for group prenatal attention was found. Merely 01 RCT ( Ickovics et al.2007 ) , 01 matched cohort survey ( Ickovics et al.2003 ) , and 03 pilot surveies with descriptive analysis were found ( Baldwin, 2006 ; Grady and Bloom, 1998 ; Rising, 1998 ) . The comparative analysis of all 05 surveies is shown in appendix 1. Chosen survey is the lone one which examined the impact of group versus single prenatal attention on birth weight and gestational age.
The job studied by Ickovics et Al. ( 2003 ) is that, whether group prenatal attention has a important impact on the perinatal result like birth weight, and gestational age. This job is highly important to nursing, for a figure of grounds. The first ground as described by Ickovics EL Al. ( 2003 ) , is the important relationship of these perinatal results with “ neonatal morbidity and mortality ” ( p. 1052 ) . Neonatal mortality is one of the countries of concern for nursing due to high mortality rates around the universe and particularly in developing states ( Straughn et al.,2003 ) .
The intent for carry oning the survey has been explicitly stated by Ickovics et Al. ( 2003 ) . The declared intent can be accomplished really good because both the results that are birth weight and gestational age, are measureable and therefore the research job is testable ( Haber & A ; Cameon, 2005 ) . A quantitative attack is suited for this survey as the variables are quantifiable and can be described objectively in Numberss. Ickovics et Al. ( 2003 ) have introduced the job statement after giving a brief background of the importance of the equal prenatal attention, and the factors that determine the equal prenatal attention. They so introduce the topic of group antenatal attention as a “ structural invention ” in the sphere of antenatal attention ( Ickovicd et al. , 2003, p. 1052 ) , and so portion the job statement that this advanced method of proviso of prenatal attention has non been tested yet.
The writers have stated the implicit in premises of the survey. Ickovics et Al. ( 2003 ) believe that more clip the pregnant adult females spent together, the better will be their apprehension of the wellness behaviours, and they will have more societal support from each other. This will cut down their hazard behaviours for case smoke taking to low birth weight. The restrictions of the survey have besides been discussed explicitly in the article Ickovics et Al. ( 2003 ) admit that their survey is limited because of non-random choice of the adult females for group antenatal attention. The restriction is realistic because the pattern was already in topographic point and research workers wanted to detect the results in relation to the two different attacks to care. Furthermore, this is an built-in characteristic of the cohort design that the groups are selected on the footing of their exposure or non-exposure to a peculiar phenomenon which is non controlled by the research worker, instead the pick is made by the topic themselves. This characteristic of the cohort design makes it prone to “ choice prejudice. “ ( Rochon et al. , 2005 ) .
Reappraisal of Literature
The reappraisal of the literature presented by Ickovics et al. , ( 2003 ) is comprehensive. It starts by stressing the importance of equal prenatal attention in footings of perinatal results. It so focuses on the factors that make the prenatal attention adequate. The writers so depict the group antenatal attention as a construction invention designed to do the prenatal attention adequate, and they appreciate that this new attack has non been tested yet for its efficaciousness in bettering antenatal results. The reappraisal so proceeds with a brief description of Centering Pregnancy Program and its constituents, which eventually leads to the statement of intent of the survey. The reappraisal ends with a principle for the choice of survey population that is black and Latinas adult females who are vulnerable for inauspicious perinatal outcomes. There is an apparent relationship of the reappraisal with the intent of survey in that the writers have presented merely those surveies that are pertinent to perinatal attention and that have established the efficaciousness of group attention in other population. The reappraisal includes a mix of recent and old surveies. As this survey was accepted for publication in 2003, most of the surveies cited in the reappraisal were non current, that is those surveies were non published in the last five old ages of the day of the month when this survey was accepted for publication ( Burns & A ; Groove, 2007 ) ; and there are merely 10 out of 26 surveies, that were current and were published in the last five old ages of the day of the month of credence of the survey under consideration, for publication. The reappraisal clearly indicates that the other intercessions that have been planned to augment antenatal attention were non found to be effectual in bettering the adult females ‘s perinatal result.
The survey has been designed in a mode that there are minimal hazards to the topics. Since this is a non experimental survey and merely intends to detect the impact of an intercession that is already in advancement without pull stringsing any of the variables, hence there are minimum hazards associated with it ( Rochon et al, 2005 ) . However, the research workers have non made any excess attempt to maximise the benefits for the topics. There is no reference of how and when informed consent was attained from the topics, but this may hold non been reported as it was an experimental survey and most likely was related to quality betterment and do non necessitate consent. The research workers have obtained the blessing of research from institutional reappraisal boards at these clinics. Besides, at one point, the writers have described their attempts to keep namelessness of the topics. The writers explained that while choosing matched cohort for the survey they entered all the information needed to choose the cohort, except for the patient designation information.
The survey is based on an implicit in model that is the focus oning gestation theoretical account. The implicit in premises of the survey are derived from the theoretical account that includes the belief that larning in groups promote shared support, alteration in behaviour, and job resolution accomplishments and it has important impact on the birth result ( Rising, 1998 ) . The principle for the usage of the model is apparent from the fact that the full construct of group prenatal attention is based on this theoretical account and implicit in premises. In fact, the research job and the intent are besides derived from the same theoretical account, because the intent of the survey is to analyze the impact of group antenatal attention.
The hypothesis to be tested by the survey is officially stated in the article. The hypothesis is derived from the research job and hence predicts that “ babies of adult females in group prenatal attention would hold significantly higher birth weight and be less likely to be delivered preterm compared with those who received single prenatal attention ” ( Ickovics et Al, 2003, p. 1052 ) . This is a complex hypothesis as it predicts the relationship between one independent variable ( proviso of group antenatal attention ) , and two independent variables ( birth weight and gestational age ) . The hypothesis can besides be categorized as directional hypothesis, as it predicts the expected way of the relationship between proviso of group prenatal attention, birth weight, and gestational age. Harmonizing to Polit & A ; Beck ( 2008 ) “ a directional hypothesis indicates that the research worker has rational committedness to the hypothesized result, which might ensue in prejudice. ” ( p.99 ) .
Haber & A ; Cameron ( 2005 ) hence suggest that directional hypothesis should merely be formed on the footing of sound literature groundss and theoretical footing. In this instance, Ickovics et Al ( 2003 ) have got sound literature support, and since group prenatal attention is one of the ways to augment the content of antenatal attention ; hence, the writers have hypothesized that group prenatal attention will take to improved birth weight and gestational age. Besides, there is sound theoretical base to this hypothesis, as it is based on the focus gestation theoretical account. The hypothesis is spelled out clearly and it objectively describes the result variables ( Polit & A ; Back, 2008 ) , that is perinatal results have been quantified and objectively described as birth weight and gestational age.
Ickovics et Al ( 2003 ) clearly described the population as “ Black and Hispanic pregnant adult females of low socioeconomic position, come ining antenatal attention at 24 or less hebdomads of gestation. ” ( p.1051 ) .The writers have besides described in item the features of the sample such as race, age, para, and metropolis of abode. The elaborate and comprehensive description of the sample gives an in deepness apprehension of the sample ‘s features and determines the generalisation of the findings to a specific population based on these features ( Haber & A ; Singh, 2005 ) . In this instance, looking at the features of the sample, the findings can be generalized to black and Latino pregnant adult females of low socioeconomic group, aged 25 or younger, as more than 85 % of the sample consisted of black adult females who were 25 old ages old or younger. Sample ‘s features help in determine heterogeneousness or homogeneousness of the sample ( Haber & A ; Singh, 2005 ) . In this instance, some of the sample ‘s features that had the possible to move as cofounders, for case age, race, para, history of preterm labour and entire figure of visits were matched in both the groups. This resulted in homogeneousness among the two groups in footings of the above mentioned features. The matching of the two groups on the footing of these features besides reduced the possible sampling prejudice that could hold resulted if the groups would ‘ve been different in footings of these features and the ensuing wellness behaviours. If the groups were non matched, these differences in groups could hold accounted for the differences in results, instead than intercession itself.
Ickovics et Al ( 2003 ) have described the sample choice procedure in item. They have besides indicated the possible sampling prejudice due to miss of randomisation while inscribing topics in group prenatal attention. Women, who voluntarily enrolled themselves in the group antenatal attention programme at the clinics, were recruited as participants in the group that received group prenatal attention. Ickovics et Al ( 2003 ) have besides comprehensively described the controls that they have utilized to minimise trying mistake or trying prejudice, that is, they have indiscriminately selected the comparing group through a computing machine programme on the footing of first available patient with closest bringing day of the month, by fiting some of the features of the intervention group.
The clinics from where the topics were recruited were besides selected by non chance trying method, choosing merely those clinics that served minority adult females from low socio economic background. The non chance trying method employed in the survey fits good with the degree of enquiry and design of the survey as Haber & A ; Singh ( 2005 ) supported “ non experimental surveies normally use non chance, purposive sampling method. ” ( p. 53 )
The sample size taken by Ickovics et Al ( 2003 ) , that is N=458 is sufficiently big. Each group had 229 research topics. The sufficiency of the sample size was assured by carry oning a power analysis that “ 229 braces had a power of 0.80 to observe a little effectaˆ¦reflecting the ability to observe a difference between the two intervention groups of 155 g. ” ( p. 1053 ) . Harmonizing to Burns & A ; Groove ( 2007 ) the power of 0.8 is the minimal acceptable degree of power for any survey.
Ickovics et Al ( 2003 ) have used cohort design, which is besides known as longitudinal prospective design. The cohort design, which is a non experimental design, is appropriate for the degree of enquiry of the survey. In this the research workers intended to analyze the difference between the results of the adult females who received group perinatal attention versus who received single attention. LoBiondo-Wood, Haber & A ; Singh ( 2005 ) supported that longitudinal design is rather appropriate for proving the difference between the two groups in footings of results variables. However, Ickovics et Al ( 2003 ) could hold used an experimental design for this survey, if they wanted to find the cause and consequence relationship between the group prenatal attention and perinatal results. This would besides hold assured randomisation of topics into intercession and control group and would hold given a higher degree of grounds. However, they may hold chosen non experimental survey design instead than experimental design to analyze the impact of group prenatal attention in a natural scene, and non in a control survey puting. As discussed in the sampling subdivision, possible effects of unwanted variables like race, age, para, metropolis of abode, history of preterm labour, and entire figure of antenatal visits have been controlled by Ickovics et Al ( 2003 ) by fiting the cohorts on the footing of these features, in order to guarantee important internal cogency of the survey ( Polit & A ; Beck, 2008 ) . Besides, Ickovics et Al ( 2003 ) have recruited a big sample to guarantee a power of 0.8 for the survey, which is besides one of the ways to maximise the internal cogency of the survey ( Polit & A ; Beck, 2008 ) .
Before informations aggregation the research workers have to operationalize the variables of involvement ( Sullivan-Bolyani, et al 2005 ) . Ickovics et Al ( 2003 ) have operationalized gestational age as term or preterm based on the hebdomads of gestation as measured by the last catamenial period and ultrasound.
Subjects ‘ demographics information and the figure of antenatal visits were obtained from the medical records of the clinic. It has non been mentioned that who determined gestational age through ultrasound, who measured the newborn ‘s weight, and who retrieved informations from medical records. It is truly of import to cognize who collected informations in order to set up its truth, as the expertness and preparation of the information aggregator has important impact on the rightness and preciseness of informations ( Sullivan-Bolyai et Al, 2005 ) .
Ickovics et Al ( 2003 ) have used both descriptive and illative statistics to analyze the information. Since the intent of the survey was to analyze the differences between the two groups, therefore the illative statistics was used that is McNemar trial, which is appropriate to the degree of enquiry due to fit groups. It is besides appropriate to the cohort design as this design besides intends to mensurate differences between the two groups, in footings of result variables ( Polit & A ; Beck, 2008 ) . The other illative statistical trial used is paired t-test which is besides appropriate for the survey as it is used to prove differences between the agencies of two groups that are matched or paired with each other on the footing of certain features ( Polit & A ; Beck, 2008 ) .
Another statistic used in the survey is the F statistic. It appears as if the writers have used F statistic when using multiple additive arrested development because F statistic has been used while bespeaking the interaction consequence between birth weight and preterm bringing ( p. 1054 ) . Linear arrested development is used to explicate how much variableness in result variable is attributable to the independent variable ( Burns & A ; Groove, 2007 ) .
The writers have used descriptive statistic to depict the distribution of demographic variables among the topics like age, race and para. They besides have used descriptive analysis to depict the distribution of demographic variables among the distribution of results variables ( birth weight and gestational age ) among the sample.
Ickovics et Al ( 2003 ) have used parametric every bit good as non parametric statistics, for case t-test for matched braces is a parametric trial while McNemar trial is a non parametric trial. As few variables have been measured on the ratio degree of measuring, for case figure of antenatal visits, hence Ickovics et Al ( 2003 ) had the autonomy to use parametric statistic. Ickovics et Al ( 2003 ) had measured the result variables of birth weight and gestational age on nominal degree. The birth weight was categorized as low birth weight ( less than 2500 g ) , and really low birth weight ( less than 1500 g ) and the gestational age was categorized as term or preterm ( less than 37 hebdomads of gestation ) . Therefore, research workers were besides able to use non parametric statistic that is McNemar trial ( Polit & A ; Beck, 2008 ) .
The consistence in the consequences of descriptive and illative statistics confirms the rightness of the findings ( Polit & A ; Beck, 2008 ) . There is a logical nexus between the statistical analysis and the findings of the survey. Besides, there is consistence in the consequences presented in Numberss and consequence presented in text, for case in the above illustration, the statistical consequence shows p & lt ; 0.01 which is statistically important, and this is good supported by the account that is birth weight was greater in babies of adult females who received group prenatal attention versus single prenatal attention. However, Ickovics et Al ( 2003 ) have non explicitly stated whether they have taken unvarying degree of significance for all the statistical trials performed or are different for each trial, and if so so what is the degree of significance for each trial.
The graphical and tabular presentations are accurate and appropriate and lucifers with the findings presented in text ( Sullivan-Bolyayi, et Al, 2005 ) . The statistics presented in these tabular arraies and the graphs are harmonizing to their appropriate degree of measuring. For case in table 2, mean and standard divergences have merely been calculated for the birth weight which is the lone ratio degree informations in that tabular array, the other variables that are at nominal degree of measuring were calculated in per centums ( Sullivan-Bolyayi, et Al, 2005 ) . The writers have non merely established the significance of findings, but they have besides described the clinical significance of the consequences.
Decision and Recommendations:
The consequences derived from informations analysis are clearly stated and explained with mention to the research inquiry and hypothesis. The findings are stated compactly and the writers have related their findings with the research intent and its implicit in premises. Ickovics et Al ( 2003 ) have discussed that the findings can be generalized among adult females who are vulnerable for preterm births. This seems to be an overgeneralization beyond the survey population, because the survey sample and the mark population was black and Latino adult females who were high hazard for preterm birth and were of low socioeconomic position. These findings may non be applicable to all the adult females who are at hazard of preterm births without stipulating their ethnicity and socioeconomic position. Ickovics et Al ( 2003 ) have besides discussed the possible benefits of implementing the findings. The writers have besides recommended that farther research needs to be done for finding the exact mechanisms involved in group prenatal attention that consequences in improved perinatal result. Another recommendation is to widely use group antenatal attention in future, nevertheless, the writers besides appreciate that it is non easy to present such large structural alterations.
Strengths and restrictions of the survey:
Overall, the survey is a good attempt in analyzing the impact of group antenatal attention on perinatal results. A good formulated hypothesis, relevant and comprehensive literature reappraisal, an in deepness history of sample ‘s features, good thought research design and statistical analysis are strengths of the survey. However, randomisation of topics at the clip of enlisting, employment of research moralss such as voluntary engagement and realistic generalisation of the findings would hold added more strength to it.
Pregnancy results: Group vs single prenatal attention
Results: Group Vs Individual Prenatal Care
OR ( 95 % CI )
Ickovics JR et Al ( 2007 ) .
0.67 ( 0.44-0.98 )
Preterm births in African American adult females
0.59 ( 0.38-0.92 )
1.73 ( 1.28-2.35 )
Less-than-adequate prenatal care*
0.68 ( 0.50-0.91 )
RESULTS ( P VALUE )
Ickovics JR et Al ( 2003 ) .
Matched cohort N=458
Birth weight ( g )
3228 V 3159 ( P & lt ; .01 )
Preterm birth weight ( g )
2398 V 1990 ( P & lt ; .05 )
Grady MA et Al ( 2004 ) .
Cohort survey with clinic comparing N=124 ( intercession )
Preterm births & lt ; 37 wk ( % )
10.5 V 25.7 ( P & lt ; .02 )
Low birth weight & lt ; 2500 g ( % )
8.8 V 22.9 ( P & lt ; .02 )
Breastfeeding at infirmary discharge ( % )
46 V 28 ( P & lt ; .02 )
Rising ( 1998 )
Descriptive analysis N=111
3rd trimester exigency room visits ( % )
26 V 74 ( P=.001 )
Baldwin ( 2006 )
2-group pre-/post-test design N=98
Change in antenatal cognition scoresaˆ
0.98 V 0.4 ( P=.03 )
CI, assurance interval ; NN T, figure needed to handle ; OR, odds ratio.
*Kotelchuck Adequacy of Prenatal Care Utilization Index, a validated marking graduated table embracing timing of induction of attention, figure of visits, and quality and content of antenatal attention. Kotelchuck M. An rating of the Kessner Adequacy of Prenatal Care Index and the proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994 ; 84:1414-1420.
Referee: Williams, K.J andA Kaufmann, L ( 2009 ) The diary of household pattern, 58, ( 7 )