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Developing a framework for critiquing health research

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Journal of Health, Social and Environmental Issues (2005) Vol 6, No 1

Developing a framework for critiquing health research

Kay Caldwell, BSc, PhD, RN, RNT, PGCHE, ILTM, Head of the Institute of Nursing and Midwifery,
School of Health and Social Sciences, Middlesex University
Lynne Henshaw, BA, MPhil, RN, RGN, RNT, CertED, Senior Lecturer in Nursing, School of Health and
Social Sciences, Middlesex University
Gina Taylor, BA, MSc, PGDip, RN, DN, CertED (FE), Senior Lecturer in Health Studies, School of
Health and Social Sciences, Middlesex University

Abstract knowledge of society and health, or address an existing

health care problem. Undergraduates of health related
A new framework for critiquing health-related research studies therefore have to consider health research in its
is presented in this article. More commonly used existing broadest sense.
frameworks tend to have been formulated within the
quantitative research paradigm. While frameworks for A common method of assessing understanding both of
critiquing qualitative research exist, they are often the subject area and the research methodologies utilized
complex and more suited to the needs of students within that subject area is the presentation of a detailed
engaged in advanced levels of study. The framework critique of a piece of published research. Our experience
presented in this article addresses both quantitative and in teaching students across a range of programmes in
qualitative research within one list of questions. It is Nursing, Health Sciences/Studies, Health Promotion
argued that this assists the ‘novice’ student of nursing and Health Policy programmes has taught us how
and health-related research with learning about the two difficult many of our students find this task. With the
approaches to research by giving consideration to aspects help of funding from the Learning Development Unit we
of the research process that are common to both undertook a project to develop, implement and evaluate
approaches and also that differ between quantitative and a research critique framework that students could use as
qualitative research. a guide.

Key words This article analyses the content of frameworks that are
commonly used to critique quantitative research and
Research critique; critique framework; heath research. frameworks that are commonly used to critique
qualitative research and then presents a single
Introduction framework that addresses both research approaches.
This new framework is currently being used to assist
When undertaking an undergraduate programme in teaching and learning activities relating to the critical
health related studies, as in many other academic appraisal of published research. As such, it is still in the
disciplines, students are required to demonstrate the developmental stage and as teachers we continue to
ability to read, understand and critique research reports. reflect on the application of this framework to our
teaching. Feedback from students is essential to this
Health research was at one time guided by the ‘medical development and the article presents evaluations from
model’. However, though this model remains influential, students who have been involved in learning activities
Polgar & Thomas (2000) suggest that there have been during the early developmental stage of the framework.
changes in the role and status of other health This evaluation is continuing and we would also welcome
professionals that have brought different perspectives, comments from our colleagues.
and require different approaches to research. A more
holistic approach now influences how health care is The need for a research critique
conceptualized, and how research is conducted. The framework
methodology of social research has become an accepted
part of health research. The need for able and competent health care
practitioners is self-evident. One way of ensuring
Green and Thorogood (2004) state that “health research competence is through evidence based practice and
includes any study addressing understandings of health professionals are expected to be intelligent
human health, health behaviour or health services, consumers of research, and this entails the ability to
whatever the disciplinary starting point” (p5). They read, understand and apply published research
further suggest that health research may expand (Murdaugh et al, 1981).A change of culture arose

45
Developing a framework for critiquing health research

following the move of colleges of nursing into the further to quantitative research (Sandelowski, 1986). This can
and higher education sector, resulting in an educational result in students attempting to analyse qualitative
culture where critical enquiry and evidence-based research within a quantitative framework and thus can
practice is accorded greater priority (Benton, 1999). Most lead to unjustified criticism, for example, quantitative
students are introduced to research methods and critical frameworks for critique will direct students to raise
appraisal during their undergraduate education, or questions concerning reliability and validity, rather than
preparation for professional practice. Yet McCaughan et confirmability, dependability, credibility and
al (2002) report that qualified nurses reported problems transferability. These activities, which may lead to
in interpreting and using research. MacAuley et al (1998) students appropriating the language of quantitative
highlighted how GPs who had been introduced to a research when critiquing qualitative research, can only
model of critical reading were shown to have applied a serve to perpetuate the view of qualitative research as a
more appropriate appraisal to studies than those who ‘soft science’ and detract from its value as a research
relied on critical appraisal skills acquired previously. approach in its own right that aims to acquire
Whilst literature in relation to the ability to critically information that is different from that acquired by
appraise research is abundant in relation to nursing and quantitative research (Leininger, 1994).
to a lesser degree in medicine, there is an emerging body
of evidence in relation to other health care professionals. There has been considerable debate concerning whether
Chalen et al (1996) identified several barriers to quantitative and qualitative research can be assessed
research-mindedness in radiographers, including a lack using the same criteria (Mays & Pope, 2000). While
of knowledge of research methodologies. Domholdt et al there are many criteria that will be common to both
(1994) noted that this group had particular difficulty in research approaches such as the identification of an
identifying concerns with construct validity. appropriate question, the choice of an appropriate
research design, the conduct of a thorough and relevant
Work in the field of health and health care is multi- literature review, there are also discrete areas of
disciplinary and involves a variety of approaches to difference. For example, variables are not always given
research. Further the range of such research is wide, operational definitions in qualitative research as
from concerns with the relationship between the health sometimes the aim of the research is to seek definitions
needs of a population to aspects of the provision of health of the concepts from the viewpoint of the informants.
services (Bowling, 2002). Government policy and
professional guidance insist that professional practice Various frameworks were reviewed and the common
should be based on evidence (Gomm & Davies, 2000). features that relate to quantitative and qualitative
While Pearson & Craig (2002) elaborate on the need for research were identified. In general guidelines tend to
nursing practice to be evidence-based, the need for reflect the philosophies of the respective approaches in
evidence-based health promotion has been highlighted that guidelines for quantitative research tend to be in the
by Perkins, Simnett & Wright (1999), who also point out form of checklists, whereas guidelines for qualitative
that the achievement of the targets of ‘Our Healthier research tend to be more discursive.
Nation’ depend on the commissioning and
implementation of effective health promotion Frameworks for critiquing
programmes. quantitative research

Given the primacy placed on the use of evidence in the The framework presented by Sajiwandani (1996)
field of health and health care, it is important that provides a useful checklist covering points that are
students are enabled to critique published research in appropriate for critiquing quantitative research relevant
order to determine the usefulness of that research in to nursing and health care students and provides an
their chosen field of work. By ‘critique’ we mean the explanation and rationale for critique. Polgar & Thomas
ability to critically appraise published research by (2000) also provide guidelines specific to the critical
identifying the strengths and weaknesses of the research evaluation of quantitative research papers. Benton &
and forming judgements concerning its overall quality Cormack (2000) offer criteria for critical evaluation of
and applicability. research but do not state that their criteria are intended
for use with a particular research approach, however, the
Research in the fields of nursing, health studies, health criteria are written within the quantitative framework in
promotion and health policy can be of a quantitative or so far as they refer to hypothesis, operational definitions,
qualitative nature: both research approaches provide validity and reliability of any instruments or
valuable information for the disciplines and often questionnaires. Treece & Treece’s (1986) classic text
complement each other. As such, students are required offers a comprehensive list of questions to aid critical
to read and critically review quantitative and qualitative evaluation, but again it is written within the quantitative
studies. However, many of the available frameworks for paradigm.
conducting a critical review are written within the
quantitative paradigm (e.g. Benton & Cormack, 2000; The website of cybernurse
Polgar & Thomas, 2000). There has been a tendency to (http://www.cybernurse.org.uk/research/Reading_and
evaluate qualitative research against criteria appropriate _Critiquing_Research.htm) offers a framework for the

46
Journal of Health, Social and Environmental Issues (2005) Vol 6, No 1

areas that should be considered when critiquing a include the relationship between the researcher and the
research report. There is no indication regarding which participants and rigour in relation to data analysis.
research approach this framework can be used for, but in Greenhalgh & Taylor (1997) provide an overview of the
terms of data analysis only statistical analysis is nature of qualitative research and again suggest a
mentioned, yet hypotheses are not mentioned. In framework for critique based on nine questions with
addition, there are many important omissions, for supporting guidance. In terms of being specific to
example, research design, recommendations, qualitative research, the authors refer to the need to
limitations. acknowledge the researcher’s perspective, a detailed
description of methods used for data collection, quality
While considering a range of frameworks focusing on control measures in data analysis and the credibility of
quantitative research the areas that appeared most the results and the transferability of the findings to other
consistently were in relation to the research design; settings. Forchuk & Roberts (1993) claim that there is a
hypothesis, operational definitions, population and paucity of guidelines for examining qualitative work and
sampling, sampling methods, validity and reliability of provide a framework for this purpose, which is aimed at
data collection, data analysis and generalizability. undergraduate nurses and other health professionals.
However, there were a plethora of critique frameworks The authors cover Leininger’s (1990) criteria for rigour,
that focused on very specific designs, rather than on but with minimal explanation. Overall the guidelines are
generic quantitative research, and these of necessity had relevant and useful for qualitative studies, but the journal
far more detailed guidelines for critique. The website of may not be readily accessible to all health studies
the University of Wales students.
(www.uwcm.ac.uk/library/critical_appraisal/forms)
offers different frameworks for appraising systematic Highly specialized texts exist that offer advice, discussion
reviews; randomised control trials; trials without and debate, concerning the evaluation of qualitative
randomisation; cohort (longitudinal) studies; case- research (Leininger, 1994; Morse & Field, 1996; Kuzel &
control studies and cross-sectional studies. This in itself Engel, 2001), and, inter alia, refer to issues like the
pre-supposes a level of research design awareness that is context of the research and the need for an audit trail.
likely not to be evident in undergraduate students during
the early stages of their programmes of study. Frameworks for critiquing both
quantitative and qualitative
While there appears to be some degree of consensus
research
concerning the areas that should be addressed when
critiquing quantitative research the situation is less clear Gomm, Needham & Bullman (2000) provide questions
when it comes to qualitative research. to be asked concerning quantitative research, in terms of
three sections: Questions to ask about data collection
Frameworks for critiquing instruments; questions to ask about experiments;
qualitative research questions to ask about surveys, case finding (or ‘clinical
epidemiological’) studies and case control studies. They
Hammersley (1992), writing specifically concerning also provide questions to ask about qualitative research
ethnography, provides criteria for assessing in which attention is drawn to the setting of the research,
ethnographic studies. Questions are raised concerning the researcher’s role in the research and the relationship
the extent to which new theory is produced, how far is the of the study to other research in the field.
theory developed and how novel are the claims made. He
also refers to the credibility and transferability of the Stevens, Schade, Chalk & Slevin (1993) provide a chapter
findings, as well as the influence of the researcher on the on evaluating research in a book aimed at health care
findings. Mays & Pope (2000) refer to the increase in professionals. This is perhaps one of the most misleading
interest in assessing the quality of qualitative research guides in terms of evaluating qualitative research. A
and, drawing on the earlier work of Hammersley (1992), framework for research evaluation is provided and at the
identify two broad criteria: validity and relevance. These beginning it is acknowledged that qualitative research is
authors acknowledge that these concepts can also be not necessarily performed and presented in the same
used when assessing the quality of quantitative research, format as quantitative research. It is further stated that,
but when used in relation to qualitative research they in the light of this, reference will also be made to
need to be operationalized differently to reflect the qualitative research. Though reference is made to
distinctive goals of qualitative research. qualitative studies, it is inadequate and sometimes
misleading, for example, in the methods section
The website of the Public Health Resource Unit reference is made to validity and reliability in measuring
(http://www.phru.nhs.uk/~casp/qualitat.htm) presents instruments, but qualitative methods are ignored.
a framework for critically appraising qualitative research Further, in the results section qualitative findings are not
built around ten questions, with supporting detailed mentioned.
guidelines. Areas that are specific to qualitative research

47
Developing a framework for critiquing health research

Nieswiadomy’s (1998) guidelines for critique appear to with thoroughly and do provide useful guidelines for the
follow the quantitative paradigm, however, she does more advanced students. They make useful cross-
stress that not all studies require a hypothesis and that references to other chapters in the book. Hek (1996)
“studies of a purely descriptive nature” (p342) may not highlights the importance of critical evaluation as a
contain hypotheses, in which case research questions means by which nurses can practice knowledgeably, and
may be used. Also, under the section headed ‘Research stresses the importance of developing critical evaluation
Design’, Nieswiadomy states that quantitative designs skills, recommending a six-stage process. Quantitative
and qualitative designs are evaluated using different and qualitative research are both addressed within a
criteria. However, limited advice is offered to guide specific guide to the sections of the research that should
qualitative critique. Valente (2003) provides a be considered, but the complex integration of
framework that mentions quantitative and qualitative quantitative and qualitative critique might be confusing
research in some sections, for example, method, but to the novice student. Some essential components, such
refers solely to quantitative in others, for example, as setting, population and sample are omitted. Further,
analysis. Overall, the framework is heavily biased the guide is presented in textual format and so some
towards quantitative research, and when both detail can be lost.
approaches are discussed it is not clear which approach
is being addressed. Burns & Grove (2001) offer frameworks for both
quantitative and qualitative research in nursing,
The website of the University of Wales College of Medicine acknowledging the need for differing approaches to the
(www.uwcm.ac.uk/library/critical_appraisal/forms) critique of different types of studies. While their
provides a series of guides on critical appraisal of framework for quantitative research includes the
research studies, all taking the format of a table that standard topics like research objectives, questions or
identifies a question and directs the reader to answer by hypotheses, the definition of variables, the identification
ticking ‘yes’, ‘no’ or ‘can’t tell’, but with no guidance as to of independent and dependent variables, validity of
what should be considered when answering the question. instruments, statistical procedures, when it comes to
The questions are focused towards critically appraising qualitative research, other questions are raised. Burns
the research for the purpose of ascertaining its relevance and Grove thus refer to ‘descriptive vividness’, looking
to practice, and assumes a high level of knowledge of for clarity and factual accuracy of the researcher’s
research methods in order to be able to answer the account of the study. The context must be clear as data
questions, so would be difficult for undergraduates to use are context-specific. Rigour in qualitative research
effectively. demands a clear account of the study elements, e.g. the
philosophy, the role of the researcher, the process.
Parahoo (1997) takes account of both quantitative and Auditability and a decision trail are also required and any
qualitative approaches to research and provides a list of theory derived from the study must reflect the data.
broad headings that encompass both approaches. The DePoy & Gitlin (1998) provide ‘guiding questions’ to
guidelines are comprehensive in terms of quantitative critically evaluate quantitative and qualitative research
research, but less so for qualitative research. Each point studies. They present two adjacent lists, headed
for critique initially addresses quantitative strategies and ‘experimental-type’ and ‘naturalist inquiry’, each with
is followed by a paragraph suggesting a different very similar questions except for the entry for
approach for qualitative work. For example, Parahoo quantitative research concerning validity and reliability,
states “in qualitative studies, researchers may not want where its qualitative counterpart refers to
to be influenced by previous research. They should, trustworthiness.
however, give a rationale and make reference to the
relevant literature” (p363). However, qualitative Polit & Hungler (1999) offer separate guidelines for
research is addressed with less rigour than quantitative quantitative research and for qualitative research. These
research and the less discerning student may well are thorough and complex and are presented in sections,
confuse the two approaches. The guidelines fail to clearly for example, guidelines for critiquing research problems,
set out the different criteria for each strategy, for research questions and hypotheses; guidelines for
example reliability and validity are discussed, but critiquing research literature reviews, and so on. The
confirmability, dependability, credibility and guidelines for quantitative research vary little from those
transferability are not referred to. However, attention is already reviewed. The guidelines for qualitative research
also drawn to the need for rigour and an audit trail. include reference to the research tradition within which
the study is carried out and highlight that the research
In a book written for nurses, LoBiondo-Wood & Haber question and methodology should be consistent with the
(1994) provide two separate chapters for quantitative research tradition. Again, an accurate description of the
and qualitative critique. Dealing with the two strategies research design is required, as is trustworthiness of the
in different chapters could be difficult for the novice data. Credibility, transferability, dependability and
student who is still trying to internalize the difference confirmability are included in the guidelines. In terms of
between the two approaches. However, both are dealt data analysis, Polit and Hungler state that the themes

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Journal of Health, Social and Environmental Issues (2005) Vol 6, No 1

should represent the narratives and there should be features (Table 1). Following this the strengths of
evidence of accuracy of the researcher’s analysis and that individual research critique frameworks were identified.
the context of the research should be clear. Polit and This enabled us to develop a framework that had areas
Hungler’s framework for critiquing research is also that were common to both quantitative and qualitative
available on a web-site approaches, and areas that were specific to each (Figure
(http://www.sonoma.edu/users/n/nolan/n400/critique 1). To support the diagrammatic framework guidelines
.htm). This is a comprehensive framework, but complex are available and provide the teacher and the student
and not easily accessible for novices. with an extended explanation of each item. Examples of
these guidelines are as follows:
Development of a new framework

Having reviewed a range of published research critique

frameworks, the first step was to identify the common

Item in Research Critique

Framework Guideline

Is the literature review comprehensive and up-to-date? The literature review should reflect the current state of
knowledge relevant to the study and identify any gaps for
conflicts. It should include key or classic studies on the topic as
well as up to date literature. There should be a balance between
primary and secondary sources.

Quantitative: Both the method of sampling and the size of the sample should
Is the sample adequately described and reflective of be stated so that the reader can judge whether the sample is
population? representative of the population and sufficiently large to
eliminate bias.

Qualitative: Informants are selected for their relevant knowledge or

Is the selection of participants described and the experience. Representativeness is not a criteria and purposive
sampling method identified? sampling is often used. Sample size may be determined through
saturation.

Is the conclusion comprehensive? Conclusions must be supported by the findings. The researcher
should identify any limitations to the study. There may also be
recommendations for further research or, if appropriate,
implications for practice in the relevant field.

Table 1: Common features of research critique frameworks

Quantitative Qualitative
Research design Philosophical background

Experimental hypothesis Research design

Operational definitions Concepts

Population Context

Sample Sample

Sampling Sampling

Validity/reliability of data collection Auditability of data collection

Data analysis Credibility/confirmability of data analysis

Generalizability Transferability

49
Developing a framework for critiquing health research

Does the title reflect the content?

Are the authors credible?

Does the abstract summarize the key

components?

Is the rationale for undertaking the

research clearly outlined?

Is the literature review comprehensive

and up-to-date?

Is the aim of the research clearly stated?

Are all ethical issues identified and

addressed?

Is the methodology identified and justified?

Quantitative Qualitative
Is the study design clearly identified, and is the Are the philosophical background and study
rationale for choice of design evident? design identified and the rationale for
choice of design evident?

Is there an experimental hypothesis Are the major concepts identified?

clearly stated?
Are the key variables clearly defined?

Is the population identified? Is the context of the study outlined?

Is the sample adequately described and reflective Is the selection of participants described
of the population? and the sampling method identified?

Is the method of data collection valid and reliable? Is the method of data collection auditable?

Is the method of data analysis valid and reliable? Is the method of data analysis credible and
confirmable?

Are the results presented in a way that is

appropriate and clear?

Is the discussion
Are the results generalizable? comprehensive Are the results transferable?

Is the conclusion comprehensive?

Figure 1: - Research critique framework

50
Journal of Health, Social and Environmental Issues (2005) Vol 6, No 1

Use of the framework What did you like most about the framework?
In response to the first question, the responses can be
The framework is designed to be used both as a teaching grouped under two headings: ease of use and practical
tool and as an aid to assessment. One of the motivating application.
factors for producing a framework was to provide clarity
and to ensure fairness for those students undertaking a Ease of use
critical review of a research paper for assessment
purposes. During our experiences of helping students to Students liked the presentation of the framework and
perform such critical review we had found that some described it as straightforward, succinct and precise. The
students had been unable to discriminate between those fact that it fits on one page was pleasing to the students
questions that are appropriate to ask of quantitative and there were also comments relating to its simplicity
research and those that are relevant to qualitative and brevity.
research. We hoped that by placing the questions that are
appropriate for the respective research approaches in Practical application
one single framework we would be able to facilitate the
clarification of some of the theoretical positions that Students found the framework easy to follow and
inform the respective research approaches and thus, in understand, describing it as very easy and very helpful.
turn, aid understanding of the need to pose different They described the structure and the questions as good
questions. Thus, the framework can also be used in the and stated that the framework will help them to advance
classroom for facilitating learning, and as a tool for group their skills relating to the research process and methods.
activity. It was also felt that the framework provides a useful
guide for critiquing research.
Experience has demonstrated that it is the practice of
critically reviewing a research report that is valuable in What did you like least about the framework?
the learning process. Small group work provides the Some comments suggested that the framework was too
student with opportunities for rewarding engagements short and could be more elaborate, but eight students
(Quinn, 1995), it allows students to work independently stated that there was nothing they disliked about it.
and to discuss and clarify learning. In small groups
students have been provided with both quantitative and Discussion
qualitative research papers and have used the framework
and guidelines to produce their review. Feedback of the We recognise that the comments presented here
review to the larger group allows further discussion and represent the contributions of a small number of self-
development of knowledge and understanding. selecting students and there is a need for a more
systematic approach to the evaluation of this framework.
The critique framework was used in teaching sessions This will be undertaken as the framework continues to be
with two groups of under-graduate nursing and health used in classroom activities with students. However, the
studies students and one small group of post-graduate current contributions from students do provide some
students. Nineteen students completed an evaluation early indications of the potential value of the framework.
form. The numbers of students responding to particular
questions on a 0 – 5 scale are shown in Table 2. Students Overall, the students found the framework easy to use
were also asked two open questions: and useful in terms of covering both quantitative and
qualitative research and helpful when carrying out a
• What did you like most about the framework? critique of published research. Student responses to the
• What did you like least about the framework? framework were largely positive, suggesting that it is a
Table 2: Evaluation of the Framework for Research Critique
0 1 2 3 4 5
How easy was the framework to use?
2 5 5 7
0 = not at all easy; 5 = very easy
How useful is it to have a framework covering both
quantitative and qualitative research? 1 7 11
0 = not at all useful; 5 = very useful
As a learning tool, to what extent did the framework help you
to appreciate the features that:
4 8 7
a) are common to all research?
0 = not at all; 5 = to a great extent
b) are specific to quantitative research? 3 13 3
c) are specific to qualitative research? 5 8 6
To what extent did the framework help you to carry out a
critique of a piece of research? 2 8 9
0 = not at all; 5 = to a great extent

51
Developing a framework for critiquing health research

useful tool in aiding learning about research and in students. It can be used as a teaching tool and displayed
undertaking a research critique. The undergraduate on an overhead projector or on PowerPoint. It can also be
students who used the framework are required to easily copied as a one page handout for students to work
critique a piece of published research for their with in the classroom or to take away for study. Further
assignment in their research methods module and it is use of the framework is required, but the intention is to
evident that they felt that the framework would help place it on WebCT, with the guidelines available as
them with this task. ‘clickable links’. As such, it will also serve as a revision
aid and will allow students to test their own knowledge,
Students responded favourably to the questions relating clicking on those areas where they feel they need further
to the features that are common to all research, explanation. The next stage is to facilitate a more
quantitative and qualitative research. However, in this systematic evaluation of this framework: we also
brief evaluation it was not possible to explore this welcome comments from our colleagues.
further, for example, by asking them why their responses
were positive or what in particular they found helpful. References
This will form part of further evaluation as the
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Journal of Health, Social and Environmental Issues (2005) Vol 6, No 1

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53
 Developing a framework for critiquing health research

Kay Caldwell
Head of the Institute of Nursing and Midwifery
School of Health and Social Sciences
Middlesex University
Archway Campus
Furnival Building
10 Highgate Hill
London
N19 5LW
UK

Tel: +44 (0)208 411 6458

Email: k.caldwell@mdx.ac.uk

Lynne Henshaw
Senior Lecturer in Nursing
School of Health and Social Sciences
Middlesex University
Queensway
Enfield,
EN3 4SA
UK.

Tel: +44 (0)208 411 6474

Email: l.henshaw@mdx.ac.uk

Gina Taylor
Senior Lecturer in Health Studies
School of Health and Social Sciences
Middlesex University
Queensway
Enfield,
EN3 4SA
UK.

Tel: +44 (0)208 411 5383

Email: g.taylor@mdx.ac.uk

54

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