Journal Article Critique
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (Centers for Disease Control and Prevention [CDC], 2013). According to the CDC (2013), the virus, primarily types 16 and 18, is the cause of cervical cancer in women. There are vaccines on the market today that can prevent HPV, but less than 26 percent of females have had at least one dose of the three doses required for complete inoculation against the virus (Reiter et al., 2009).
Aware of the enormous role of parents in ensuring that their adolescent daughters get vaccinated, Reiter et al. (2009) conducted a study to examine whether the health beliefs of parents have an impact on the vaccination behavior of their adolescent daughters, particularly HPV vaccination. According to Reiter et al. (2009), there is a growing body of literature on parents’ health beliefs and HPV vaccine acceptability and intent to vaccinate. However, their study is the second of two studies to examine the correlates of parents’ health beliefs and HPV vaccine initiation.
The study involved 899 parents with adolescent daughters (n = 624 Whites, n = 206 African-Americans, and n = 59 from other races) from communities with high rates of cervical cancer in North Carolina. Using as a theoretical framework the Health Belief Model (HBM), Reiter et al. (2009) found that parents’ beliefs about HPV vaccination are highly correlated with their daughters HPV vaccine initiation.
Critique of the Literature Review
In quantitative studies such as this that are published a journal articles, the literature review is typically placed in a separate section called “Related literature” following the introduction (Creswell, 2009). The literature review in this study was not placed in a separate section, but rather threaded throughout the report with substantial number of citations (27 out of 39) in the introduction of the study. Though the literature cited was appropriate, the quantity of the citations in a single sentence appeared excessive. In more than two instances, multiple citations (more than four citations) were contained in a single sentence. The citations were sometimes longer than the length of the sentence. It is not inappropriate to have multiple citations, but excessive citations make the readability of the study difficult.
Let it be noted that of the 39 citations in the study, eight citations were not within 5 years of the study publication. The study was published in 2009, but one citation went as far back as 1974. The remaining seven citations are within 10 years of the study publication.
The research problem was clearly articulated in the introduction with sufficient justification for the study. For example, Reiter et al. (2009) stated that their study was the second such study to examine parents’ health beliefs and their daughters HPV vaccine initiation. The first study had a much smaller sample size (n = 153). Reiter et al. (2009) used a larger sample size (n = 899) for a higher statistical power than the first study.
The theoretical framework of the study was clearly stated. Reiter et al. (2009) used the Health Belief Model to explain the correlates of parents’ health beliefs and their daughters’ HPV vaccine initiation.
The research question was not clearly stated in the study. However, the goals of the study were clearly stated. Reiter et al. (2009) wanted to determine whether there is an correlation between parent’s health beliefs and their adolescent daughters’ HPV vaccine initiation and whether there was a racial and geographic difference in behavior. One can perhaps assume that the research question is implicit in the goals of the study.
Critique of the Methods/Research Design
The study participants were sufficiently described in the study. A total of 899 parents were included in the study. Their characteristics include age (27.6 percent less than 40 years, 72.4 percent above 40 years), gender (93.9 percent female, 6.1 percent male), race (70.2 percent non-Hispanic White, 23.2 percent non-Hispanic African American), education (78.6 percent with some college or more, 21.4 percent with high school or less), marital status (84.4 percent married, 15.6 percent with other arrangements), and residence type (50.8 percent urban, 49.2 percent rural) (Reiter et al., 2009). The inclusion criteria and sampling strategy were also stated. Participants had to be living in areas of the state with high rates of cervical cancer (incidence > 10 cases per 100,000 and mortality rate > 4 cases per 100,000 from 1994 to 2004). The African American population had to be more than 20 percent, and there had to be at least 1500 girls with the age of 10 – 18 years. Eleven counties in the state met the inclusion threshold from which fives counties were randomly selected (Reiter et al., 2009).
The sample was representative of the population. African Americans comprised about 20 percent of the population of the counties selected, and 23 percent of the study participants were African Americans. The rest of the population of the selected counties is largely non-Hispanic Whites. The study participants were 70.2 percent non-Hispanic Whites. Let it be noted that only 6 percent of male parents were included in the study. According to Reiter et al., (2009) female parents were preferred but no explanation was provided for such preference. The study did not provide explanation as to the statistical power of the sample size and how the sample size was derived.
The researchers disclosed that consent was obtained from the study participants. A payment of $10 was paid to each participant for the phone interview. The institutional Review Board (IRB) at the University of North Carolina approved the study (Reiter et al., 2009). No procedures for protecting participant rights were included in the study.
The study was a cross-sectional design in which telephone interviews/survey was the primary data collection method. The interviews were conducted not by the researchers but by trained interviewers. Random-digit-dialing accounted for 5 percent of the households while 95 percent came from directory-listed residential numbers. The methods and sampling procedures are clearly defined in the report and can be replicated by any research scientist. The survey questionnaires were adopted from the scales developed by McRee et al, according to (Reiter et al., 2009). The choice of a cross-sectional study by the researchers indicates that internal validity (causality) was not the goal of the study. Correlation between variables was the goal. As such, the design was appropriate to address the research question since cross-sectional studies lack internal validity.
Critique of the Results section
The results of the study included descriptive statistics for all the variables, the generated significance levels in each analysis and its relationship to the criterion value (p <.05), and the relationship between variables. To simplify the complexity of the data, tables were used to show demographic characteristics of study participants, odd ratios, and frequencies. Tables were also used to show the health belief constructs with the strongest correlates of vaccine initiation among both non-Hispanic Whites and African American parents. For non-Hispanic White parents, doctor’s recommendation, perceived risk of daughters getting cervical cancer, perceived potential harms of the HPV vaccine, and belief about insurance coverage ranked the strongest correlates of vaccine initiation. For African American parents, doctor’s recommendation, perceived potential harms of the HPV vaccine, and perceived barriers to getting HPV vaccine were the strongest correlates of vaccine initiation (Reiter et al., 2009).
Critique of the Discussion section
The discussion section of the study gave rationale for the study and its contribution to the body of knowledge regarding parental health beliefs and their relationship to not only HVP vaccine initiation, but to all vaccine initiations in general. The discussion section expands on the results of the study and suggests implications for future research. It also suggests interventions that can facilitate vaccine initiation. For instance, doctor’s recommendation was the strongest correlates of vaccine initiation across all racial groups and between rural and urban participants. The importance of designing intervention for parental perceived barriers to HPV vaccine initiation among African Americans was stressed since this health belief had a significant correlation to vaccine initiation among African Americans than non-Hispanic Whites (Reiter et al., 2009).
The strengths and limitations of the study were also included. The strengths of the study are (a) the use of a large sample size from a population with a high rate of cervical cancer, (b) a high response rate, and (c) a sampling method that allowed racial and urban/rural groups comparison. Key limitations of the study include the use of parents who only had telephone and the lack of certainty in the external validity of the findings.
Overall, the study was well written and easy to understand. It included all of the components of a quantitative study. The introduction included the research problem, previous studies and their deficiencies, the significance of the study and the goals of the study. However, the purpose statement was not explicit. The study design, measures, and statistical analyses were discussed. The results and discussion sections used tables to simplify the complexity of the findings, and the discussion section listed the strengths and limitations of the study and the need for further research investigation.
It is important for a research study to be both reliable and valid. Reliability is concerned with consistency in the measurement, tests, and scale, while validity is concerned with accuracy (Frankfort-Nachmias, & Nachmias, 2008). Reliability and validity are proof of scientific vigor. In this study, the use of phone interviews with questionnaires adapted to the scale developed by McRee et al, the use of a large sample that is representative of the target population, and the use of a design method that is typical in social science research suggest the study’s reliability. Interestingly, the research design (Cross-sectional design) used in this study does not make causal inferences (Frankfort-Nachmias, & Nachmias, 2008). As a result, this study lacks internal validity. Furthermore, the use of Cross-sectional design and probability samples should increase the study’s external validity, but Reiter et al., (2009) were not certain of their study’s external validity, a limitation they listed in the discussion section.
Centers for Disease Control and Prevention. (2013). Retrieved from http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf
Creswell, J.W. (2009). Research Design: Qualitative, Quantitative, and Mixed methods approaches (Laureate Education, Inc., custom ed.). Thousand Oaks, CA: Sage Publications.
Frankfort-Nachmias, C., and Nachmias, D. (2008). Research methods in the social sciences (7th ed.). New York: Worth.
Reiter, P.L., Brewer, N., Gottlieb, S., McRee, A., & Smith, J. (2009). Parents’ health beliefs and HPV vaccination of their adolescent daughters. Retrieved from http://www.unc.edu/~ntbrewer/pubs/in%20press,%20reiter,%20brewer%20et%20al.pdf
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