Qualitative Research Analysis
Brittany M. Hicks, Jared Banasak, & Jessica Hetrick
Lakeview College of Nursing
Nursing Research (N-302)
September 25, 2012

Summary
In the article, “Implementing the MOVE! Weight Management Program in the Veterans Health Administration,” the author used a holistic case study design to implement the “MOVE” at the veteran’s health administration (Weiner, Haynes-Maslow, Kahwati, Kinsinger, & Campbell, 2012). Move! is a weight management program implemented from evidence based practice, to help prevent chronic diseases. The question in this research article was to see what factors assisted with fulfilling the new weight management program (Weiner et al., 2012). Move! was implemented  because many of the patients are obese (Weiner et al., 2012). The question is what organizational factors aided or inhibited the implementationof MOVE! in 10 Veterans Health Administration medical facilities. 
The authors used a holistic case study that consisted of 68 interviews. These interviews were conducted with several professionals including: coordinators, physicians, managers overseeing the program, clinicians from their multidisciplinary team, and primary care providers (Weiner et al., 2012). The sample was 10 veteran health facilities that implemented the MOVE! Program. A conceptual framework was used to help influence the study. Data collection was done with semi-structured interviews over the phone, which helped collect information about staffing, structure, operations, and barriers (Weiner et al., 2012). Analysis was done in three steps: Using software to code data, conducting facilitators and barriers at each facility, and lastly establishing a matrix to cluster the data collected (Weiner et al., 2012). The results included that all 10 selected facilities has identified facilitators and barriers to implementing the program. (Weiner et al., 2012).
Problem/Purpose
	In the article, “Implementing the Move," the problem was clearly stated. The research was conducted on the basis that 1/3 of all veteran health patients were obese (Weiner et al., 2012). The purpose of the study was to flourish the existing program. The program helped the patients manage their weight and reduced the risk for developing chronic diseases (Weiner et al., 2012). Obesity is a national problem and a modifiable risk factor to a number of diseases. Nurses should advocate patients to be healthy to prevent obesity.
Conceptual Framework
This study was based on conceptual framework; the framework is created by the original structure where concepts and relationships are used (Rebar, Gersch, Macnee, & McCabe, 2011). It is clearly stated within the article (Weiner et al., 2012). This framework is adequate for the research that has been conducted. It helped with the problem in question by interviewing the facilitators and the barriers with the program (Weiner et al., 2012). The goal of this research is to see what facilitators and barriers there were to help Move! grow. 
Review of the Literature
	The review of literature for this article was explained, thorough, and organized within the introduction. They looked into the hospitals, talked with the facilitators, and tried to overcome barriers. The background research that is commented on is that they used National Institutes of Health as well as “other literature” (Weiner et al., 2012). The literature is minimal but well critiqued. The gaps that surround the problem overcoming barriers within the program, is what the current research is based upon (Wiener et al., 2012). The goal of this research was to expand the program. Was the literature that was used current?
Research Question/ Hypothesis
The research questions and hypothesis are not clearly stated. “Research questions can be broadly categorized as questions that seek to describe or understand, questions that seek to connect or relate, and questions that that seek to predict or study the effects of manipulation,” (Rebar, Gersch, Macnee, & McCabe, 2011). If the research question were to be inferred, it would state, “What are the barriers and facilitators associated with the MOVE! implementation?” Was it inferred though? I think your paper says the question straight out. The question is researchable as inferred. The question does relate logically to the problem, discussion and framework of the article. However, the literature review does not correspond as well. It gives a background on the MOVE! program, but does not examine the elements of the research question.
Variables
	The variables of this study were clearly identified. The variables were the organizational facilitators and the barriers of the MOVE! program. These variables are defined conceptually. A variable that is stated conceptually is not  clearly measurmeasurable (Rebar, Gersch, Macnee, & McCabe, 2011). These variables cannot be clearly measured because the results are based on interview and are difficult to measure. There are no extraneous, intervening, or controlled variables identified.
Design
	This study used a case study design. Case study methods are suited for studying implementation processes. These processes tend to be fluid, nonlinear and context-sensitive (Weiner et al., 2012). Since the objective of the research was to “examine the organizational facilitators and barriers of the MOVE! program” ((Weiner et al., 2012) this approach was appropriate for the research problem. Internal validity was not addressed in this study.
Sample
The sample size is appropriate and representative of the population. The researchers invited 126 VHA facilities that had to have at least 30 MOVE! participants in 2006. Of the 14 facilities that accepted the invitation, the researchers selected 10 to reflect diversity in geographic region, organizational site and complexity (Weiner et al., 2012). The sampling method is appropriate. The sample size is adequate. Ten facilities provided the researchers with 68 different interviews that helped to compose their study. Protection of the subjects is addressed in this study. “This study was reviewed for human subjects’ protection and approved by all participating VHA facility institutional review boards and by the review boards of the 2 coordinating centers (Weiner et al., 2012).”
Data Collection
The data collection for this study was appropriate. Of the 74 participants selected for the study only 5 did not respond to the recruitment emails, and one was unreachable due to maternity leave (Weiner et al., 2012). The 68 remaining participants were interviewed over the phone. The interviews were semi-structured and the researcher used semi-structured interview guides informed by the study’s conceptual framework (Weiner et al., 2012).  The semi-structured interview was described adequately and all of the questions asked were included and listed in the appendix of the study. The semi-structured interview asked several questions in 6 distinct categories in regards to a potential facilitator or barrier to implementation. The reliability and validity of the tools were not addressed in this study and the authors did not mention either in the article.  
Data Analysis 
The first step of data analysis involved putting the data acquired from the interviews into a qualitative data analysis program to be coded. The data was then coded using a codebook informed by the conceptual framework. Any coding discrepancies were reconciled through discussion until consensus was reached (Weiner et al., 2012). The second step involved a within-case analysis of facilitators and barriers for each facility. Once the facilitators and barriers were identified as either positively or negatively affecting implementation, a conceptually clustered matrix was developed to “enable a between-case analysis of facilitators and barriers by construct (Weiner et al., 2012).”  The matrix is included and clearly presented within the study and labeled as Table 4. In addition to table four, there are three other tables that chart the demographics of the facilities sampled, the number of interview participants by role, and the organizational factors associated with implementation.  The data analysis procedures appropriately answered the research question in table three, and classify each of the six categories as a facilitator, barrier, or a mixed result in regards to implementation of the MOVE! The program was done at each specific facility. 
Findings
The article found that all 10 of the VHA medical facilities encountered facilitators and barriers to implementing the MOVE! Program. Six organizational factors were examined in this study. The most consistent facilitators to implementing the MOVE! Programs were the organization’s readiness for change, and the presence of an innovation champion (Weiner et al., 2012). The other four variables were identified as being either a barrier to implementation or exerting mixed effects on implementation (Weiner et al., 2012). Although many institutions reported a mixed affect, the most common barrier to implementing Move! was limited availability of resources (Weiner et al., 2012). The research question set out to determine what were the facilitators and barriers to implementing MOVE! and they were properly identified. What are the other three barriers? There were several limitations to this study. The first limitation is that “case study research emphasizes depth over breadth and insight over generality (Weiner et al., 2012).”   Another limitation is that the ten facilities studied are not a strong basis to generalize the results to all VHA facilities (Weiner et al., 2012).  The frequency and distribution of facilities and barriers of all VHA facilities was not known, because no study was conducted. In case studies like this one, investigator bias in interpretation may have been present as well as “an irreducible element of expert judgment (Weiner et al., 2012).” The results are not generalizable to all VHA facilities as stated above, due to the small sample size. There were no implications for nursing addressed, but this study may be applicable to nursing in regards to identifying potential facilitators and barriers to programs like this one for patients. There are two directions for future research stated and they are “The theory and practice of the multilayered complexities of management support need to be understood (Weiner et al., 2012).” It should be explored and noted whether the innovation champions were formally appointed or informally appointed (Weiner et al., 2012). The researchers believe that the presence of informally appointed innovation champions may indicate the facility’s deficit for program implementation (Weiner et al., 2012).
Overall Evaluation
This article was well organized, well written, and made sense. Any information desired was easily found and located within the text of the article. Limitations do decrease the usefulness of the research to practice, but valid information regarding the facilitators and barriers are identified and the research question is answered. Future studies can use the data from this study to guide future research on the subject matter. This article is not formally related to nursing practice, but should be considered in regards to implementing any health based programs and what facilitators and barriers there are to developing health based programs. Despite several limitations to this study, this was a good article and the research question was properly answered.  
References
Rebar, C., Gersch, C., Macnee, C., & McCabe, S. (2011). In Understanding Nursing 			Research. Philadelphia, PA: Lippincott Williams & Wilkins.
Weiner, B. J., Haynes-Maslow, L., Kahwati, L. C., Kissinger, L. S., & Campbell, M. K. 	(2012). Implementing the MOVE! Weight-Management Program in the Veterans		 Health Administration, 2007-2010: A Qualitative Study. Preventing Chronic 	Disease, 9. doi:http://dx.doi.org/10.5888/pcd9.110127

N 302 – Evaluation Criteria for Critique

Name____Group 3______________	                              Total points_____96______/100  

1. Summary of the article							(10)___9____

2. Problem/Purpose							(10)_____10___
   a. Is the problem clearly & concisely stated?
   b. Is the problem researchable (answerable with empirical data)?
   c. Is the problem significant to Nursing – “So what?”

3. Conceptual Framework						 	 (5)____5____
   a. Was the study based on a framework?
   b. Does the framework fit the problem?
   c. Are the concepts and relationships identified?

4. Review of the Literature						(10)___9_____
   a. Is the review appropriate, thorough, organized?
   b. Is current research included?
   c. Is the literature well critiqued?
   d. Are there gaps in the knowledge re: the problem

5. Research Question/Hypothesis					10)____10_____
   a. Are research questions/hypotheses clearly stated?
   b. Is the question/hypothesis researchable as stated?
   c. Does the question/hypothesis relate logically to the 
	problem, discussion, literature review, framework?

6. Variables								 (5)_____5____
    a. Are the concepts/variables clearly identified? 
    b. Are there conceptual & operational definitions?
    c. Are there extraneous/intervening variables identified? Controlled?

7. Design								 (5)_____5____
    a. What design was utilized?
    b. Is the design appropriate for the research problem?
    c. Is internal validity addressed?

8. Sample								  (5)______5___
   a. Is the sample described & representative of the population?
   b. Is the sampling method appropriate?
   c. Is the sample size adequate?
   d. Is protection of subjects addressed?

9. Data Collection methods						(10)_____10____
   a. Is the data collection approach appropriate?
   b. Are the tools/instruments described adequately?
   c. Are reliability & validity of the tools addressed?

10. Data analysis							(10)____10_____
   a. Are the analysis procedures appropriate for the level of measurement?
   b. Do the data analysis procedures answer the research question?
   c. Are the results clearly presented? Tables? Figures?
11. Results, Conclusions, Discussion of Findings			 (5)____3___
   a. Are findings & interpretations differentiated?
   b. Is the research question answered?
   c. Are limitations of the study identified?
   d. Are implications for nursing addressed?
   e. Are the results generalizable? To whom?
   f. Are recommendations for future research identified:

12. Overall evaluation of research report				(10)_____10__
   a. Was the article well-written, organized, and made sense?
   b. Did limitations or errors decrease the usefulness of the research to practice?
   c. Should this article be used in nursing practice?
   d. Is this article good or poor?

13. Format & writing (Grammar, composition, APA, etc.)		 (5)_____5___