Research article critique

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Williams et al.(2012) carried out a study with the aim of determining thefeasibility and influence of multifactorial MESMI to enhance bloodpressure control and medication adherence in adults with co-existingdiabetes and chronic kidney disease. MESMI is an acronym for MedicalSelf-Management Intervention. This paper criticizes thisinvestigation using various approaches.

Study design

The studyemployed therapy research question since it was testing theeffectiveness of the intervention for enhancing blood pressurecontrol. The independent variable is the variable that wasmanipulated by the investigators. In this case, it is theintervention, MESMI. The dependent variable is the outcome, bloodpressure. The study tested the impact of the intervention on bloodpressure. A true experimental approach is suitable for examining therelationship between the intervention and the blood pressure (Crosbyet al., 2011). The true experimental design provides theresearchers with the opportunity to manipulate the independentvariable. This study employed a true experimental design,particularly randomized controlled trial.

Williams etal. (2012) adequately described the intervention by stating itscomponents. Furthermore, they also described the control group.Randomization was employed when assigning the participants to theintervention and control groups. Comparison was done between the twogroups to determine the impact of the intervention. Blinding wasused, but was not successful since the data collectors came to knowthe group to which some participants belonged. The participants inintervention group could not be blinded. Therefore, they were toldnot to disclose their group to the research assistants.


The interventionwas operationalized in such a way that enabled the investigators tocreate strong statistical power. Various techniques such as blinding,training, and randomization were employed to enhance data precision.The intervention fidelity was ensured through training of theresearch assistants and education of the participants. Biases wereminimized through stratified random sampling and blinding. However,the study least considered the threats to internal validity such ashistory, attrition, and maturation. Williams et al. (2012)successfully matched the conceptualization of the intervention andthe methodology. There is no extraneous aspect evident in theintervention.


Williams et al.described the study population adequately. Eligible participants wererequired to be 18 years and above, mentally competent, and hadco-existing diabetes (Type 1 or Type 2) and CKD. The samplepopulation could not achieve construct validity. The Fischer modelfor sampling could be more effective (Antman &amp Sabatine, 2013).The sampling plan was based on the mean for two independent samples.The study employed stratification based on gender, age, and systolicblood pressure. Stratified block randomization was employed torecruit the participants. The random selection of the participantshelped in avoiding biases. The representativeness of the sample wasaffected by its small size. The investigators failed to describe theparticipant characteristics.

Data collection

The datacollection process was consistent with the aim of the study since themeasurements of dependent variable were taken before and after theintervention. This enabled the investigators to determine the impactof the intervention. The manipulation of study conditions wasaccording to the requirements. Appropriate instruments were selectedand used to study the variables and ensure the quality of data. Thedata collection procedures were adequately described in the report.Research assistants were trained to collect data. They were blindedto group assignments to improve data quality. The data was collectedfrom the participants at their homes during enrollment, and at 3, 6,9 months post-intervention. No other individuals are mentioned to bepresent during data collection.

Measurement and data quality

The variablesconceptualized in the research introduction were consistent with theway they were operationalized. The variable, the intervention, wasadequately operationalized. The rules of measuring the variable asindicated in the adherence scale and surrogate biochemical markerswere defined. The reliability level was stated to be at least 80%the minimum acceptable level for each prescribed medication. Thelevel was appropriate because it was required to determine theeffectiveness of the intervention and medical prescriptions. Theresults enabled the investigators to achieve their aim.


Antman, E. M., &amp Sabatine, M. S. (2013).&nbspCardiovasculartherapeutics: A companion to Braunwald`s heart disease.Philadelphia, PA: Elsevier/Saunders.

Crosby, R. A., DiClemente, R. J., &amp Salazar, L. F.(2011).&nbspResearch Methods in Health Promotion. New York,NY: John Wiley &amp Sons.

Williams, A., Manias, E., Walker, R., &amp Gorelik, A. (2012). Amultifactorial intervention to improve blood pressure control inco‐existing diabetes andkidney disease: a feasibility randomized controlled trial.&nbspJournalof advanced nursing,&nbsp68(11), 2515-2525.

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