Chapter 3 ​Introduction to Quantitative Research

43
■ S​ AM​ PLE
The convenience sample [nonrandom sampling method] ​MS retained by advertising for subjects at three
state   ​un​iversities in the southwest [setting]. Despite the sensitive nature of the study, 22 [sample size]
usable interviews were obtained. The sample included women (population) between the ages of 18 and
39 years (mean = 28 years, ​SD = 6.5 years) who were identified as survivors of child sexual abuse
(sample criteria). The majority of these women were white (91%) and students (82%). A little more than
half (54%) were single, seven (32%) were divorced, and three (14%) were married​. Most (64%) had no
children. A small percentage (14%) was on some form of public assistance and only (14%) has been
arrested. Although 27% of the subjects had stepfamily members, the parents of 14 subjects (64%) were
still married. Half the fathers were working class or self-employed; the rest were professionals.
Mothers were either working class or self-employed (50%), homemakers (27%), or professionals (11%).
Most subjects (95%) had siblings, and 36% knew or suspected their siblings also had been abused
[sample characteristics]. (Hulme & Grove, 1994, pp. 523-524)
Methods of Measurement
. ; * is the process of assigning “numbers to
:r events or situations) in accord with some
iaplan, 1964, p. 177). A component of mea-
ts instrumentation, which is the application
rules to the development of a measure-
■te or instrument. An instrument is selected
a specific variable in a study. Data gener-
2​E instrument are at the nominal, ordinal,
or ratio level of measurement. The level of
,ea:. with nominal being the lowest form of
rat and ratio being the highest, determines
statistical analyses that you can perform
:r of an instrument requires extensive
of its reliability and validity. Reliability
s® consistently the measurement technique
i . i ncept. The validity of an instrument
tc which it actually reflects the abstract
■err examined. Chapter 15 introduces the
*​ measurement and explains the differ-
it reliability and validity for instruments.
r​
§“ vides a background for selecting mea-
ner hods for a study. Hulme and Grove
•fed the following description of the ASI
that was used to measure their study
■ ​MEASUREMENT METHODS
The ASI Questionnaire contains 10 sections: demographics; family origin; educational history,
occupational history and public assistance; legal history; characteristics of the child sexual abuse
(duration, perpetrator, pregnancy, type, and threats); past and present other victimizations; past and
present physical symptoms; past and present psychosocial symptoms; and relationship with own children.
Each section is followed by a response set that includes space for “other.” Content validity was
established by Brown and Garrison (1990) using an in-depth review of 132 clinical records.... For this
descriptive correlational study, content validity of the ASI questionnaire was examined by asking an
open-ended question: Is there additional information you would like to share or think is important for
describing your experience? (Hulme & Grove, 1994, p.524)
  
Developing a Plan for Data Collection
and Analysis
Data collection is the precise, systematic gathering of information relevant to the research purpose
or the specific objectives, questions, or hypotheses
of a study. The data collected in quantitative studies are usually numerical. Planning data collection
will enable you to anticipate problems that are likely
to occur and to explore possible solutions. Usually,
detailed procedures for implementing a treatment
and collecting data are developed, with a schedule
that identifies the initiation and termination of the
process (see Chapter 17).
Planning data analysis is the final step before the
study is implemented. The analysis plan is based on
(1) the research objectives, questions, or hypotheses; (2) the data to be collected; (3) research design;
(4) researcher expertise; and (5) availability of
computer resources.
Several statistical analysis techniques are available to describe the sample, examine relationships,
or determine significant differences within studies.
Most researchers consult a statistician for assistance in
developing an analysis plan.
 Implementing the Research Plan
Implementing the research plan involves treatment
or intervention implementation, data collection, data
analysis, interpretation of research findings, and,
sometimes, a pilot study.
.44
Unit ONE IntroductioiLto Nursing Research
 
Pilot Study
A pilot study is commonly defined as a smaller version of a proposed study conducted to refine the
methodology (Van Ort. 1981). It is developed much like the proposed study, using similar subjects, the
same setting, the same treatment, and the same data collection and analysis techniques. However, you
could use a pilot study to develop various steps in the research process (Prescott & Soeken, 1989). For
example, you could conduct a pilot study to develop and refine an intervention or treatment, a
measurement method, a data collection tool, or the data collection process. Thus, a pilot study could be
used to develop a research plan rather than to test an already developed plan.
Some of the reasons for conducting pilot studies are as follows (Prescott & Soeken, 1989; Van Ort,
1981):
1. To determine whether the proposed study is feasible (e.g., are the subjects available, does the
researcher have the time and money to do the study?).
2. To develop or refine a research treatment or intervention.
3. To develop a protocol for the implementation of a treatment.
4. ​To identify problems with a study design.
5. To determine whether the sample is representative of the population or whether the sampling
technique is effective.
6. To examine the reliability and validity of the research instruments.
7. To develop or refine data collection instruments.
8. To refiné the data collection and analysis plan.
9. To give the researcher experience with the subjects, setting, methodology, and methods of
measurement.
10. To try out data analysis techniques.
Hayward et al. (2007) believed that conducting a pilot study improved the strength of their study design
and directed their development of a quality proposal for a large multisite trial that received external grant
support. Thus, as a researcher you conduct pilot studies to improve the development and implementation
of your future major studies.
 
Data Collection
In quantitative research, data collection involves obtaining numerical data to address the research
objectives, questions, or hypotheses. To collect data, you must obtain consent or permission from the
setting or agency where the study is to be conducted and from potential subjects. Frequently, the subjects
are asked to sign a consent form, which describes the study, promises the subjects confidentiality and
indicates that the subjects can stop participation at any time (see Chapter 9).
During data collection, the study variables are measured through a variety of techniques, such as
observation, interview, questionnaires, scales, and physiological measurement methods. In a growing
number of studies, nurses measure physiological variables with high-technology equipment. The data are
collected and recorded systematically for each subject and are organized to facilitate computer entry.
Hulme and Grove (1994) identified the following procedure for data collection:
Although the tool can be self-reporting, it was administered by personal interview to allow for
elaboration of “other” responses. The interviews lasted about one hour and were conducted in a private
room provided by The University of Texas at Arlington. Each interview started with a discussion of the
study benefits and risks and included signing a consent form. Risks included possible painful memories
and embarrassment during the interview as well as emotional and physical discomfort after the
interview. Sources of public and private counseling were provided to assist subjects with any difficulties
experienced related to the study. (Hulme & Grove, 199, pp. 524-525)
 
Data Analysis
Data analysis reduces, organizes, and gives meaning to the data. The analysis of data from quantitative
research involves the use of (1) descriptive and exploratory procedures (see Chapter 19) to describe
study variables and the sample, (2) statistical techniques to ​test proposed relationships (see Chapter 20),
(3) techniques to make predictions (see Chapter 21), and (4) analysis techniques to examine causality
(see Chapter 22) Computers are used to perform most analyses. So Chapter 18 provides a background
for using computers in research.
The choice of analysis techniques implemented is determined primarily by the research objectives
questions, or hypotheses; the research design; and the level of measurement achieved by the research
instruments. Hulme and Grove (1994) chose frequencies, percentages, means, standard deviations and
Pearson correlations to answer their research questions.
Chapter 3 ​Introduction to Quantitative Research
45 .
Results
The first search question focused on description of the patterns of physical and psychosocial
symptoms,
Six physical symptoms occurred in 50% or more of the
subjects :insomnia. sexual dysfunction, overeating, drug
Abuse severe headache, and two or more major surgeries eleven psychosocial symptoms occurred
in
75% or more of the subjects: depression, guilt, low selfesteem, inability to trust others, mood swings,
suicidal
Thoughts, difficulty in relationships, confusion, flashbacks of the abuse, extreme anger, and memory
lapse....
Self injurious behavior was reported by eight subjects (33%) hulme & Grove, 1994, pp. 527-528) The
second research question focused on the relationships among the number of physical and
psychosocial Symptoms and three contributing factors (age abuse began, duration of abuse and
multiple victimizations). There were five significant correlations among study variables: physical
symptoms with multiple victimizations (r = 0.59, ​p ​= 0.002) physical svmptoms with psychosocial
symptoms (r = 0.56, p = 0.003), age abuse began with duration of abuse r = 0.50, p = 0.009),
psychosocial symptoms with multiple victimizations (​r ​= 0.40, ​p ​= 0.033), and duration of abuse with
psychososial symptoms (r = 0.40, ​p​ ​= 0.034). (hulme & grove, 1994, p. 528)
 
Interpreting research Outcomes 
The results obtained from data analysis require
interpretation to be meaningful. Interpretation of
Research outcomes involves (1) examining the results
From data analy​sis, (2) exploring the significance of
the findings (3) forming conclusions, (4) generalizing the findings
(5)considering the implications for nursing and (6) suggesting further studies. Data analysis yields five
types​ ​of results: significant as predicted by
The researcher,nonsignificant, significant but not predited by the researcher, mixed findings, and
unexpected findings. The study results are then translated and interpreted to become findings, and
these findings are synthesized to form conclusions. The conclusions, provide a basis for identifying
nursing implications, generalizing findings, and suggesting further studies (see chapter 24) In the
excerpts that follow, Hulme & grove (1994) discuss their findings, with implications of nursing and
suggestions for further study.
Discussion
While this study may have limited generalizability due to the relatively small nonprobability
sample, the findings do support previous research.... In addition, the findings support browne
and Finkelhor’s (1986) framework that a wide range of behavioral manifestations (physical and
psychosocial symptoms) comprise the long-term effects of child sexual abuse. (Hulme & Grove, 1994, p.
528) Brown and Garrison’s (1990) ASI Questionnaire was effective in identifying patterns of physical and
psychosocial symptoms in women with a history of child sexual abuse.... As data on the behavioral
manifestations (physical and psychosocial symptoms) and the effect of each of the contributing factors
accumulate, hypotheses need to be formulated to further test Browne and Finkelhor’s (1986) framework
explaining the long-term effects of child sexual abuse.... With additional research, the ASI Questionnaire
might be adapted for use in clinical situations. This questionnaire might facilitate identification and delivery
of appropriate treatment to female survivors of child sexual abuse in clinical settings. (Hulme & Grove,
1994, pp. 529-530)
Communicating Research Findings
Research is not considered complete until the findings have been communicated. Communicating
research findings involves developing and disseminating a research report to appropriate audiences; the
research report is disseminated through presentations and publication (see Chapter 25). The Hulme and
Grove (1994) study was presented at a national nurse practitioner conference and published in the ​Issues
in Mental Health Nursing​ journal.
TYPES OF QUANTITATIVE RESEARCH
This text describes four types of quantitative research: (1 ) descriptive, (2) correlational, (3)
quasi-experimental, and (4) experimental. The level of existing knowledge for the research problem
influences the type of research planned. When little knowledge is available, descriptive studies are often
conducted. As the knowledge level increases, correlational, quasi-experimental, and experimental studies
are implemented. This section identifies the purpose of each quantitative research approach and presents
an example of the steps of the research process from a published quasi-experimental study.

Descriptive Research
The purpose of descriptive research is to explore and describe phenomena in real-life situations. This
approach is used to generate new knowledge about concepts or topics about which limited or no research
has been conducted. Through descriptive research, concepts are described and relationships are
identified that provide a basis for further quantitative research and theory testing. The study by Hulme and
Grove
46
Unit ONE Introduction to Nursing Research
(1994) on the symptoms of female survivors of child sexual abuse, which we used earlier in the chapter to
illustrate the basic discussion of the steps of the quantitative research process, is a combined descriptive
and correlational study. The descriptive aspects of this study can be clearly identified in its purpose,
research questions, design, data analysis, and findings.
 
Correlational Research
Correlational research examines linear relationships between two or more variables and determines the
type (positive or negative) and degree (strength) of the relationship. The strength of a relationship varies
from -1 (perfect negative correlation) to +1 (perfect positive correlation), with 0 indicating no relationship.
The positive relationship indicates that the variables vary together—that is, the two variables either
increase or decrease together. The negative or inverse relationship indicates that the variables vary in
opposite directions; thus, as one variable increases, the other decreases. The descriptive correlational
study conducted by Hulme and Grove (1994), presented earlier in this chapter, provides an example of
the steps of the quantitative research process for correlational research.
 
Quasi-Experimental Research
The purpose of quasi-experimentai research is to examine cause-and-effect relationships among selected
independent and dependent variables. Quasi- experimentai studies in nursing are conducted to determine
the effects of nursing interventions or treatments (independent variables) on patient outcomes (dependent
variables) (Cook & Campbell, 1979). Artinian et al. (2007) conducted a quasi-experimentai study to
determine the effects of nurse-managed telemonitoring (TM) on the BP of African-Americans. The steps
for this study, which were introduced earlier in this chapter, are described here and illustrated with
extracts from the study.
STEPS OF THE RESEARCH PROCESS IN A QUASI-EXPERIMENTAL STUDY
■ 1​ : RESEARCH PROBLEM
Nearly one in three, or approximately 65 million adults in the United States have hypertension, defined as
(a) having systolic blood pressure (SBP) of 140mm Hg or higher or diastolic blood pressure (DBP) of at
least 90 mm Hg or higher, (b) taking antihypertensive
medication, or (c) being told at least twice by a physician or other health professional about having high
blood in pressure (BP) (American Heart Association (AHA) ​2004; AHA Statistics Committee & Stroke
Subcommittee [AHASC], 2006; Fields et al.2004. Estimated direct and indirect costs associated with
hypertension total $63.5 billion (AHA. 2004; the crisis of high BP (HBP) is particularly apparent among
African Americans; their prevalence of HBP is among the highest in the world.... Unless healthcare
professionals can improve care for individuals with hypertension, approximately two thirds of the
population will continue to have uncontrolled BP and face other major health risks (Chobanian et al.,
2003).... There is a need to test alternative treatment strategies. (Artinian et al 4 2007, pp. 312-313)

■ 2: RESEARCH PURPOSE
The purpose of this randomized controlled trial with urban African Americans was to compare usual care
(UC) only with BP telemonitoring (TM) plus UC to determine which leads to greater reduction in BP from
baseline over 12 months of follow-up, with assessments at 3, 6, and 12 months postbaseline. (Artinian et
al, 2007, p. 313)

■ 3: REVIEW OF LITERATURE
The literature review for this study included relevant current studies that summarized what is known about
the impact of TM on BP. The sources were current and r​ anged in publication dates from 1998 to 2005,
with the majority of the studies published in the last 5 years. The study was accepted for publication on
May 31. 2007 and published in the September/October 2007 issue of ​Nursing Research. Artinian et al.
(2007, p. 314) summarized the current knowledge about the effect of TM on BP by stating “Although
promising, the effects of TM on BP have been tested in small, sometimes nonrandomized, samples, with
one study suggesting that patients may not always adhere to measuring their BP at home. The influence
of TM on BP control warrants further study.”
■ 4​ : FRAMEWORK
Artinian et al. (2007) developed a model that identified the theoretical basis for their study. The model is
presented in Figure 3-4 and indicates that nurse-managed TM is an innovative strategy that may offer
hope to hypertensive African Americans who have difficulty accessing care for frequent BP checks.... In
other words, TM may lead to a reduction in opportunity costs or barriers for o ​ btaining follow-up care by
minimizing the contextual risk factors that interfere with frequent healthcare visits… Combined with
information about how to control hypertension, TM may both help individuals gain conscious control over
their HBP and contribute to feelings
Chapter 3 ​Introduction to Quantitative Research
47
Theoretical basis for the effects of teiemonitoring on blood pressure. 
definitions are often found in the methods section under
measurement methods and intervention headings.

 Independent Variable: TM Program

Conceptual Definition
TM program is an innovative strategy that may offer
hope to hypertensive African Americans to reduce
their opportunity costs and barriers for obtaining
follow-up care for BP management (Artinian et a!.,
2007).

Operational Definition
TM “refers to individuals self-monitoring their BP
at home, then transmitting the BP readings over exist-
ing telephone lines using a toll-free number” (Artinian
et al., 2007, p. 313). The readings were reviewed by the
care providers with immediate feedback provided to the
patients about their treatment plan.

 Independent Variable: SBP

Conceptual Definition
. SBP is an indication of the patient’s blood pressure
control and ultimately the management of his or her
hypertension.
48
Unit ONE Introduction to Nursing Research
Operational Definition
The outcome of SBP was measured with the electronic BP monitor (Omron HEM-737 Intellisense,
Omron Health Care, Inc.). (Artinian et al., 2007)

■   DESIGN
7:
A randomized, two-group, experimental, longitudinal design was used. The treatment group received
nurse- managed TM and the control group received enhanced UC. Data were collected at baseline and
3-, 6-, and 12-month follow-ups. (Artinian et al., 2007, p. 314)

■  8: SAMPLE
African Americans with hypertension [population] were recruited through free BP screenings offered at
community centers, thrift stores, drug stores, and grocery stores located on the east side of Detroit
[natural settings]. (Artinian et al., 2007, p. 315) The sample criteria for including and excluding subjects
from the study were detailed and provided a means of identifying patients with hypertension. The sample
size was 387 (194 in the TM group and 193 in the UC group) with a 13% attrition or loss of subjects over
the 12-month study.

■  9: PROCEDURES
Artinian et al. (2007) detailed the nurse-managed TM intervention that was presented earlier in this
chapter and provided in entirety on pages 315-316 in the research article. The BP was measured with the
electronic Omron BP monitor after a 5-minute rest period; at least two BPs were measured, and the
average of all was used for analyses. Participants wore unrestrictive clothing and sat next to the
interviewer’s table, their feet on the floor; their back supported; and their arm abducted, slightly flexed,
and supported at heart level by the smooth, firm surface of a table. (Artinian et al., 2007, pp. 316-317)
Most of the data were collected during 2-hour structured face-to-face interviews and brief physical
exams, which were conducted by trained interviewers in a private room at one of the project-affiliated
neighborhood community centers. Mailed postcards provided interview' appointment reminders 1 week
before the scheduled interview'; telephone call reminders were made the evening before the interview....
Participants were compensated $25.00 after the completion of each interview. (Artinian et al., 2007, p.
316) The study was approved by the Wayne State University Human Investigation Committee and all
participants signed consent forms indicating their w'illingness to be subjects in the study.

■  10: RESULTS
The hypothesis was supported partially by the data. Overall, the TM intervention group had a greater
reduction in SBP (13.0mm Hg) than the UC group did (7.5 mm Hg; ​t = -2.09, ​p = 0.04) from baseline to
the
12-month follow-up. Although the TM intervention group had a greater reduction in the DBP (6.3 mm
Hg) compared with the UC group (4.1 mm Hg), the differences were not statistically significant ​(t =
-1.56, ​p​ = 0.12). (Artinian et al., 2007, pp. 317-318)

  ​11: DISCUSSION
E
The nurse-managed TM group experienced both clinically and statistically significant reductions in SBP
(13.0 mm Hg) and clinically significant reductions in DBP (6.3mmHg) over a 12-month monitoring period
[study conclusions)
The BP reductions achieved here are important which, if maintained over time, could improve care and
outcomes significantly for urban African American with hypertension.... This may mean that an
individual could avoid starting a drug regimen or may achieve BP control using a one-drug regimen
rather than a two-drug regimen and thus be at risk for fewer medication side effects [implications of the
findings for nursing practice] Future research needs to determine if this intevention effect maintained
over time leads to reducing the number of complications associated with uncontrolled BP and if it leads
to reducing the number of drugs necessary to achieve BP control. (Artinian et al., 2007, pp. 320-321)
 
Experimental Research
The purpose of experimental research is to examine cause-and-effect relationships between independent
and dependent variables under highly controlled conditions (Campbell & Stanley, 1963). The researcher
exerts high control over the planning and implementation of experimental studies, and often these studies
are conducted in a laboratory setting on animals or objects. The Graves et al. (2005) study introduced.
earlier in this chapter is an experimental study of the effect of a diet supplemented with 0.5% conjugated
linoleic acid (CLA) on muscle mass in mice with cancer that was conducted in a laboratory setting. To
improve your understanding of the steps of the research process, read this study and identify the steps of
quantitative research process outlined in this chapter.
 
SUMMARY
Nurses use a broad range of quantitative approaches—including descriptive, correlational
quasi-experimental, and experimental—to develop nursing knowledge.
Some of the concepts relevant to quantitative research are (1) basic and applied research,(2) rigor and
(3) control.
Chapter 3 ​Introduction to Quantitative Research
49
- Basic or pure research is a scientific investigation that involves the pursuit of “knowledge for
knowledgeor for the pleasure ‘s sake” or of learning and finding truth.
- Applied or practical, research is a scientific investigation ructed to generate knowledge that will
influence or improve clinical practice.
- Rigor involves discipline, scrupulous adherence to detail and strict accuracy.
- Control involves the imposing of “rules” by the researcher to decrease the possibility of error and
thus increase the probability that the study’s findings are an accurate reflection of reality.
- The quantitative research process involves conceptualizing a research project, planning and
implementing that project and communicating the findings.
- The steps of the quantitative research process are as follows :
1. Formulating ​a research problem and purpose i​ dentifies an area of concern and the specific goal
or aim of the study.
2. Reviewing ​relevant literature allows the researcher to build a picture of what is known about a
particular situation or phenomenon and identify the knowledge gaps that exist.
3. Developing a framework guides the development of the study and enables the researcher to link
the findings to the body of knowledge nursing
4. Formulating research objectives, questions, or hypotheses ​allows the researcher to bridge the gap
between the more abstractly stated research problem and purpose and the study design and
plan for data collection and analysis.
5. Operationalizing research variables involves developing a conceptual definition and operational
definition for each variable.
6. Identifying ​theoretical and methodological limitations i​ nvolve​s determining the restrictions in a
study that may decrease the generalizability of the findings.
7. Selection a research design directs the selection of a population, sampling procedure, methods
of measurement, and a plan for data collection and analysis.
8. Defining the population and sample​ determines
who will parcipate in the study.
9. Selecting methods of measurement involves determining the best method(s) to measure each
study variable.
10. Developing a plan for data collection and analysis d​ irects the precise, systematic gathering of
information relevant to the research purpose or
the specific objectives, questions, or hypotheses of a study and involves the selection of
appropriate statistical techniques to analyze the study data.
11. Implementing the research plan involves treatment implementation, data collection, data analysis, and
interpretation of research outcomes.
12. Communicating findings includes the development and dissemination of a research report to
appropriate audiences through presentations and publication.
• This chapter introduces four types of quantitative research: descriptive, correlational, quasi-
experimental, and experimental. Examples from published studies are used to illustrate the steps of the
quantitative research process.
REFERENCES
American Heart Association. (2004). ​Heart disease and stroke statistics: 2005 update.​ Dallas, TX: Author.
American Health Association Statistics Committee and Stroke Statistics Subcommittee. (2006). Heart disease and
stroke statistics: 2006 update. ​Circulation, 113(6),​ e85-el52.
Artinian, N. X, Flack, J. M„ Nordstrom, C. K., Hockman, E. M., Washington, O. G. M., Jen, K. C, et al. (2007).
Effects of nurse- managed telemonitoring on blood pressure at 12-month followup among urban African
Americans. ​Nursing Research,​ 56(5), 312-322.
Artinian. N. T., Washington, O. G., Klymko, K. W., Marbury, C. M., Miller, W. M., & Powell, J. L. (2004). What
you need to know about home blood pressure telemonitoring, but may not know to ask. ​Home Healthcare Nurse,
22(10), 680-686.
Artinian, N. T., Washington, O. G., &Templin, X N. (2001). Effects of home telemonitoring and community-based
 monitoring on blood pressure control in urban African Americans: A pilot study. ​Heart & Lung, 30(3),​ 191-199.
Bagiev, C. (1990). Development of a measure of unwanted sexual contact in childhood, for use in community health
surveys. ​Psychology Reports,​ 66(2), 401^102.
Bagley, C., & King, K. K. (1990). ​Child sexual abuse: The search for healing.​ New York: Travistock/Routledge.
Bond, E. E, & Heitkemper, M. M. (1987). Importance of basic physiologic research in nursing science. ​Heart &
Lung, 16(A),. 3​ 47-349.
Brown, B. E., & Garrison, C. J. (1990). Patterns of symptomatology of adult women incest survivors. ​Western
Journal of Nursing Research, 12(5),​ 587-600.
Browne, A., ​& Finkelhor, D. (1986). Initial and long-term effects: A review of the research. In D. Finkelhor (Ed.): ​A
source book on child sexual abuse​ (pp. 143-179). Beverly Hills. CA: Sage Publications.
Campbell, D. X, & Stanley, J. C. (1963). ​Experimental and quasi- experimental designs for research. Chicago:
Rand McNallv.
 Dismantling S​ trategy (Subtraction Design). I​ n dismantling strategy, the full version of the program is
compared with a reduced version in which one or more components have been removed. Criteria for
selecting components to delete vary but are often based on theory or on information from the literature.
Components that are expensive or difficult to provide may also be selected for deletion. Components are
removed one at a time and the reduced set is tested against the full version until a single base component
remains, when program are complex and include many components various mixes of components may
be tested.
Constructive Strategy. ​In constructive strategy, a base intervention is identified. A component that is
expected to increase the effectiveness of the base intervention is added, and the two interventions are
tested.
There must be a theoretical rationale for the selection of components to add to the base intervention.
The components are added one at a time, and each set of is tested for effectiveness until the full set of
possible combinations has been studied. With the use of the dismantling strategy in large programs,
various mixes of components may be tested.
Factorial ANOVA Designs. ​Commonly used in psychology, factorial ANOVA designs are potentially the
must powerfull way to examine all possible combinations of an intervention. Factorial designs used in
reals are usually limited to a 2 x 2 design, examining the presence or absence of two intervention
components. Factorial ANOVA designs usually involve a multisite project with a large ​sample size to achieve
adequate s​ tatistical power. The complexity of the design increases with the number of components in the
intervention
Hal 337
Fractional Factorial Designs. ​Fractional factorial design are simplifications of the factorial design. The
researcher systematically selects a portion of all possible intervention component combinations to
implement. Such a design requires the researcher to be willing to assume that the effects of higher-order
interactions (multiple combination effects) are negligible.
Response surface Methodology. ​With response surface methodology, the dose response can be applied to
more than one dimension of a treatment. If several interventions are constructed that represent a number
of combinations of differing levels of strenght for each component and the outcome is plotted for each
combination, the plotted figure is referred to as a response surface. Researchers can use this
methodology to determine which combination of components produces the optimum outcome.
Chapter 13 ​Intervention Research 337
Results of previous response surface analyses have shown that increasing the strength of a
component does not always increase its effectiveness. When two individually effective components are
combined, the resulting program may be more or less effective than each component alone or may not
change the effect. A researcher can improve a program sequentially by refining each component and then
studying the combined effects. Developing an optimal program is often an evolutionary process.

Field Tests 
Field tests are conducted in clinical settings in which the intervention will typically be implemented. Field
tests are ideal for graduate nursing student projects. These studies evaluate the effectiveness of the
intervention when implemented in uncontrolled situations. Rather than being controlled, patient
characteristics are allowed to vary and are measured. Sampling criteria are limited to the selection of only
those patients experiencing the problem. No other constraints are imposed.
The observation system is in operation, and patient characteristics, intervener characteristics, and
setting characteristics are measured. Outcome variables are measured at least once before the treatment
and once afterward. Repeated measures of outcome variables are often performed during the posttest
period (Fawcett et ah, 1994; Sidani & Braden, 1998). Design criteria against which the intervention is
judged are l​ isted in Table 13-15.

Collecting and Analyzing Data

Data from the observation system, pilot tests, the formal stud)', and field tests are collected and analyzed
continuously. Data analysis goes beyond testing for statistical significance. Two-way analysis of variance,
regression
TABLE ​13-15 ®​ Criteria for Intervention Design
E​

1. The intervention is effective.

2. The intervention is replicable by typical interveners.
3. The intervention is simple to use.
4. The intervention is practical.
5. The intervention is adaptable to various contexts.
6. The intervention is compatible with local customs and values.
Adapted from Fawcett, S. B., Suarez-Belcazar, Y., Belcazar, F. E.. White, G. W., Paine, A .L.,
Blanchard, K. A., et al. (1994). Conducting intervention research: The design and development
process. In J. Rothman & E. J. Thomas (Eds.), ​Intervention research: Design and development
for human service,​ (pp. 25-54). New York: Haworth Press.
338 Unit T ​ WO ​The Research Process
analyses, path analyses, and residual analyses are commonly used.
Exploratory analysis techniques provide important information for determining, for instance, when
initial interventions should be implemented and whether supplemental procedures are necessary.
Residual analyses may identify subjects who respond differently to the intervention. Qualitative analyses
are used when appropriate. Ongoing graphing of phases of the intervention and outcomes over time
provide critical information. Data from the project constitute an excellent source for secondary analyses
by nursing students.
 
Dissemination
Once field testing and evaluation are completed, your intervention is ready for dissemination. In nursing,
dissemination has traditionally involved presenting the findings at professional meetings, describing the
intervention in professional journals, and reporting studies documenting its effect on outcomes.
Researchers may report their results by traditional means throughout the process of developing and
evaluating the intervention. These contributions are vital to the development of science in nursing.
You should also consider a higher level of dissemination. Nurse researchers might think about viewing
the intervention as a product and its dissemination in terms of marketing and selling a product (Fawcett et
ah, 1994). This would be an important consideration if the user’s initial implementation required a
considerable investment of time, perhaps to consult with or request assistance from members of the
project team. In this case, the process of dissemination would involve choosing a brand name,
establishing a price, and setting standards for the intervention’s use.
 
Choosing a Brand Name
Give your intervention a name that is intuitively appealing. It may address the purpose, patients, or setting
of the intervention. The name may link the intervention to an established concept in a theory. Establishing
a brand name allows adopters to recognize the intervention and differentiate it from similar, but perhaps
less effective, interventions. The name of the intervention will come to be associated with its
effectiveness, dependability, or efficiency (Fawcett et al., 1994). Do you think “Simple Pleasures” was a
good brand name for Colling and Buettner’s intervention?
 Setting a Price
In setting a price for the intervention, determine or define the market for your product and the
discretionary budget of potential adopters. In this period of managed care, when health care corporations
are competing for patients by hospitals seeking Magnet status and demonstrating more effective
outcomes that their competitors, the motivation to purchase well designed interventions with
demonstrated positive outcomes is high. In 1994, the American Nurses Credentialing Center developed
the Magnet Récognition program to recognize facilities that provide excellent nursing care. To achieve
Magnet status, the facility must meet. 14 standards with 63 criteria.
Other factors that you and your research team must consider in setting the price are (1) the cost of
providing materials related to the intervention; (2 the costs of staff time for phone calls, mailing material,
maintaining files, and so on; (3) organizational requirements (4) the cost of training; and (5) the cost of
technical support that may be required after the intervention is implemented. If your goal is the
widespread adoption of the intervention with a simple training procedure and little need for ongoing
technical support, you might set the price very low, only sufficient to recover costs. However, you are
offering a comprehensive or complex treatment program that will require considerable involvement of
the researchers or other technical personnel, a higher price might be appropriate (Fawcett et al., 1994)
 Setting Standards for Use
The project team must establish guidelines for using the intervention correctly that adopters must egree
to before they receive it. Develop specifications regarding conditions under which the intervention can
be used. The project should be protected by a patent or copyright until your costs are recovered. T:_
ment helps ensure the integrity of the price
quality of the product (Fawcett et al., 199-

 Identifying Potential Markets

To identify all of the potential markets for your intervention, you and your product team should answer
the​ ​following questions:
1. Which people can benefit personally from our intervention?
2. Who (with the use of the intervention) could contribute most to solving the problem ?
3. Is broad-based adoption our goal (I.e,, saturation of the market), or do we seek more restricted
by selected adopters?
4. Which market segments—types of health or human service organizations—would most likely
adopt and benefit from our intervention if they were aware of it?
Chapter 13 ​Intervention Research 339
Which media approach—public service annoucements, direct mail, or other strategies—would be most
appropriate and feasible for informing our targeted market segment?
Identifying potential early adopters may encourage others in the identified market to adopt the
intervention. Early adopters tend to have relatively greater resources, sophistication, education, and
willingness to try innovative practices. These characteristics may put them in more frequent contact with
their colleagues increasing the chances that other adopters will become aware of the benefits of using
your intervention (Fawcett et ak, 1994). See Chapter 27 for a discussion of early adopters.
=  Demand for the intervention 
Anyone marketing the intervention must persuade potential purchasers that it will actually benefit them.
Strategies resigned to market innovations include modeling the innovation, arranging sampling of the
innovation and its benefits, and advertising. Modeling involves showing experts, celebrities, or others
easily identifiable by the market segment using the intervention and benefing from its use.
In sampl​ing, ​allow potential purchasers to try out portions of the product. This process might consist of
demonstrations of the intervention and opportunities to review material at regional and national
professional
Advertising campaigns can highlight desired features of the intervention, such as its relative
effectiveness, low cost, and decreased time and effort for users. Incentives to encourage adoption, such
as describing support services available, can positively influence purchasers ultimately, however, these
strategies will work only if your product is more effective, is lower in cost, or requires less user time than
similar interventions on the market (Fawcett et ak, 1994).
 
Encouraging Appropriate Adaptation
Adaptation involves changing the intervention to fit local conditions and is sometimes referred to as
reinvention. Elements of the intervention may be modified or deleted, or new elements may be added.
There is a tension between maintaining the quality of an intervention and allowing others to adapt it.
Allowing adaption may increase the speed with which an intervention is adopted, but it may also diminish
the intervention’s effectiveness. The project team should permit (or even encourage) necessary
adaptation, but only under the condition defined by the team. Your team should be allowed to collect and
analyze data’
related to the adaptation or see reports of ongoing analysis by the adapting facility. It is important for the
team to determine whether the changed intervention continues to meet the established standards for the
intervention (Fawcett et ak, 1994).

Providing Technical Support for Adopters

The researchers and their staff are the primary' experts on the intervention. Adopters may require
technical support with troubleshooting or adapting the intervention to their specific needs (Fawcett et ak,
1994).
JUST YOU AND ME: IMPLEMENTING AN INTERVENTION THEORY STUDY ON A SMALL SCALE
Reading this chapter can be overwhelming. It may seem that unless you have a couple of million dollar
grants and a huge research team, you might as well forget doing an intervention theory study. And then
you think about the Simple Pleasures project. How feasible is it to consider using intervention theory
strategies to implement an idea that has been running around the comers of your mind as you read this
chapter?
We suggest considering it. You do need some partners who are as committed as you are. You must
realize that such a project requires a long-term effort. It is a series of studies and time invested in
theoretical thinking and theory development. It may require that you invest some time building your
knowledge in areas in which you are not yet well informed. You can start small and build as you begin
your first steps. Contact researchers who have been involved in intervention theory' work. They can help
you to avoid some of the mistakes they made. They may also be willing to guide you across time. The
nursing discipline needs more intervention theory projects. The potential contribution to the body of
knowledge for nursing is great.
SUMMARY
* This chapter describes a revolutionary new approach to intervention research that holds great promise
for designing and testing nursing.
* Nursing interventions are defined as “deliberative cognitive, physical, or verbal activities performed with,
or on behalf of, individuals and their families [that] are directed toward accomplishing particular
therapeutic objectives relative to individuals’ health and well-being” (Grobe, 1996, p. 50).
Data collection is one of the most exciting parts of research. After all the planning, writing, and
negotiating, you are ready for the real part of research the action part. There is a sense of euphoria and
excitement, an eagerness to start the study. However, before you leap into data collection, spend some
time carefully planning this adventure. It may save you difficulties later on as you implement the final
steps of the research process. Consider problems you might encounter while collecting data, and
develop srategies for addressing them. You must make careful plans for managing data as you collect it
this chapter is divided into three sections to assist you in planning data collection, collecting data, and
managing data for quantitative studies. Data collection strategies for qualitative studies are described in
chapter 23.
 
PLANNING DATA COLLECTION
A data collection plan details bow you will implement your study. The plan for collecting data is specific to
the study being conducted and requires that you consider some of the more commonplace elements of
research. You will need to map out the procedures you will use to collect data, anticipate the time and
cost of data collection. develop data collection forms that ease data entry, and prepare a codebook that
will help you to identify data to be entered in a database. This extensive planning increases the accuracy
of the data collected and the validity of the study findings. The strength of the findings from several
studies increases the quality of the research evidence that is available
for use in practice (Craig & Smith, 2007; Melnyk & Fineout-Overholt, 2005).
 Planning Data Collection Procedures
To plan the process of data collection, you must determine step by step how and in what sequence data
will be collected from a single subject. The timing of this process also must be established. For example,
how much time will be required to identify potential subjects, explain the study, and obtain consent? How
much time is needed for activities such as completing questionnaires or obtaining physiological
measures? Next, envision the overall activities that will be occurring during data collection. At what point
are subjects assigned to groups? When and how will you implement the study treatment? Will data be
collected from more than one subject at a time, or is it necessary to focus attention on one subject at a
time? How many subjects per day can be accessed for data given the study design and the setting? It
might be helpful to cowduct A​ txvA ruw at evew a. pilot study by collecting data from three to five subjects
to determine the strengths and weaknesses of the data collection plan. You will need a minimum of five
subjects if you plan to conduct a pilot study. You might develop a data collection tree or flow diagram to
illustrate the process for collecting data in your study. An example is shown in Figure 17-1.
 
Decision Points
Decision points that occur during data collection must be identified and all options considered. Decisions
might include whether potential subjects meet
The
The sampling criteria, whether a subject understands the infomation needed to give informed consent,
what group the subject will be assigned to; whether the subject comprehends instructions related to
providing data and whether the subject has provided all the data needed. your data collection tree should
indicate each point at which a decision is made.
Consistency
Consistency in data collection across subjects is critical, if more than one person is collecting the data,
consistency among data collectors (interrater reliability) is also necessary (see Chapter 15). Identify
situations in your study that might interfere with consistency, and develop a plan that will maximize
consistency. The specific days and hours of data collection may influence the consistency of the data
collected and thus must be carefully considered. For example, the energy level and state of mind of
subjects from whom data are gathered in the morning may differ from that of subjects from whom data
are gathered in the evening, visitors are more likely to be present at certain times of day and may
interfere with data collection or influence responses. Patient care routines vary with the time of day. In
some studies, the care recently received or the care currently being.provided may alter data you gather.
The subjects you approach on Saturday to participate in the study may differ from the subjects you
approach on weekday mornings. Subjects seeking care on Saturday may have a full-time job, whereas
those seeking. care on weekday mornings may be either unemployed or too ill to work,.
You and your research team also must decide who will collect the data. Will the researcher collect alkl
data or will data collectors be employed for this purpose? Can data collectors be nurses working in the
area? Researchers have experienced difficulties in studies in which they expected nurses providing
patient care to also be data collectors. Patient care takes priority over data collection, which may lead to
missing data ​or missed subjects.
If you decide to use data collectors, they must be informed about the research project, familiarized
with the instruments to be used, and provided equivalent training in the data collection process. In
addition to training data collectors need written guidelines or protocols that indicate which instruments to
use, the order in which to introduce the instruments, how to administer the instruments, and a time frame
for the data collection process (Gift, Creasia, & Parker, 1991). After training, data collectors must be
evaluated to determine their consistency in the data collection process Washington and Moss (1988)
suggested that minimum of 10 subjects must be rated with the
Chapter 17 ​Collecting and Managing Data 431

complete instrument before interrater reliability can be adequately assessed. The data collectors’
interrater reliability is usually assessed intermittently throughout data collection to ensure consistency.
Data collectors also must be encouraged to identify and record any problems or variations in the
environment that affect the data collection process.
Determine how you will reliably and competently deliver the study treatment. Often researchers
develop detailed protocols to guide them in delivering the treatment or intervention, and they train data
collectors in this process. Stein, Sargent, and Rafaels (2007) stressed the importance of achieving
intervention fidelity in a study, which involves training an individual called an interventionalist to deliver the
intervention protocol. To achieve intervention fidelity, the deliver}' of the intervention must include the core
components of adherence and competence. Adherence is the most basic and exists when the
interventionalist reliably or consistently implements the behaviors of the intervention protocol.
Competence is more complex and focuses on the interventionalist’s skill and expertise in delivering the
study intervention. For more details on intervention protocol development and implementation, refer to
Chapters 11 and 13.
 
Time Factors
Researchers often underestimate the time required to collect data for a study, which sometimes takes two
to three times longer than anticipated. It is helpful to write out a time plan for the data collection period.
Conduct a pilot study to refine the data collection process, and determine the time required to collect data
from a subject.
Events during the data collection period sometimes are not under the researcher’s control. For
example, a sudden heavy staff workload may make data collection temporarily difficult or impossible, or
the number of potential subjects might be reduced for a period. In some situations, researchers must
obtain permission from each subject’s physician before they are permitted to collect data on that subject.
Activities required to meet this stipulation—such as contacting physicians, explaining the study, and
obtaining permission— require extensive time. In some cases, potential subjects are lost before the
researcher can obtain the mandatory permission, thus extending the time required to obtain the
necessary number of subjects.
 
Cost Factors
Cost is another consideration when planning a study. Measurement tools—such as Holter monitors,
spirometers, infrared thermometers, pulse oximeters, or Glucometers—used in physiological studies may
need
432 Unit T​ WO ​The Research Process
to be rented, purchased, or obtained from the company manufacturing .the equipment. You may need to
pay a fee for questionnaires or scales and for analyzing the data. Data collection forms must be typed and
duplicated. In some cases, printing costs for materials that are to be distributed during data collection
must be factored in, such as teaching materials, questionnaires, or scales. In some studies, postage is an
additional expense. There may be costs involved in coding the data for entry into the computer and for
conducting data analyses. Consultation with a statistician early in the development of a research project
and during data analysis must also be budgeted. You may need to hire a secretary to type the final report,
research presentations, or a manuscript for publication.
In addition to these direct costs, there are also indirect costs. The researcher’s time is a cost and costs
for travel to and from the study site and for meals eaten out while working on the study must be taken into
account. You also must estimate the expense of presenting the research project at conferences, and
include that cost in the budget. To prevent unexpected expenses from delaying the study, examine all
costs in an organized manner during the planning phase of the study. A budget is best developed early in
the planning process and'revised as plans are modified (see Chapter 28 for a sample budget). Seeking
funding for at least part of the study costs can facilitate the conduct of a study (see Chapter 29 on funding
for research).
Neophyte researchers have difficulty making reasonable estimates of time and costs related to a
study. We advise validating the time and cost estimates with an experienced researcher. If the cost and
time factors are prohibitive, simplify your study so that fewer variables are measured, fewer instruments
are used. Make the design less complex, and use fewer data collectors. These are serious modifications,
however, so you and your team should thoroughly examine the consequences before making such
revisions. If time or cost estimates go beyond expectations, you can revise the time schedules and budget
with a new projection for completing the study.
 
Developing Data Collection Forms
Before data collection begins, you may need to develop or modify forms on which to record data. These
forms can be used to record demographic data, information from the patient record, observations, or
values from physiological measures. The demographic variables commonly collected in nursing studies
include age, gender, race, education, income or socioeconomic status, employment status, diagnosis,
and marital status. You also might need to collect other data that may be
either extraneous or confounding variables such as the subject’s physician, stage of illness, length of
illness or hospitalization, complications, date of data collection, time of day and day of week of data
collection, and any untoward events that occur during the data collection period. In some cases, the
length of time required of individual subjects for data collection may be a confounding variable and must
be recorded If it is necessary to contact the subject at a later time, you will need to obtain the subject’s
address and telephone number, but only with that person’s awareness, and permission. Names and
phone numbers of family members may also be useful if subjects are likely to move or be difficult to
contact. Consider the importance of each piece of datum and the amount of the subject’s time required
to collect it. If the data can be obtained from patient records or any other written sources, you do not
need to ask the subject to provide this information; just make sure that the institusional review board
(IRB) has authorized your team to collect these data in the study setting. You also need to protect the
participant’s private health information that is regulated by the Health Insurance Portability and
Accountability Act (HIPAA) (available online at ​www.hhs.gov/ocr/hipaa​).
Data collection forms must be designed so that the data are easily recorded and entered into the
computer. Decide whether data will be collected in raw form or coded at the time of collection. ​Coding is
the process of transforming data into numerical symbols that can be entered easily into the computer.
For example, variables such as gender, ethnicity, and diagnoses can be categorized and given
numerical labels. For gender, the male category could be identified by a 1 and the female category by a
2. For the ethnicity variable, the African-American category could be represented by the number 1,
Caucasian by a 2, Hispanic by a 3, and Other by a 4.
The coding categories developed for a study must be not only mutually exclusive but also exhaustive
which means that the value for a specific variable fits into only one category, and each observation must
fit into a category. For example, the income ranges would not be mutually exclusive or exhaustive if they
were categorized in the following way on a demographic questionnaire:
Income Range (Please check the range that most accu​ r​ ately reflects your income.)
(1) $30,000 to $35,000
(2) $35,000 to $39,000
(3) $40,000 to $45,000
(4) $45,000 to $50,000
(5) $50,000 and more
Chapter 17 ​Collecting and Managing Data 433
These categories are not exclusive because they over-lap and a subject with a $35,000 income could
mark category 1, or category 2, or both. The categories are not exhaustive because a subject may have
an income of either $25,000 or $39,500, yet the questionnaire does not contain categories that include
each of these incomes. For many items, a code for “Other” should be included for unexpected
classifications of variables such as marital status, ethnicity', or diagnosis, the following income ranges
are both exclusive and exhaustive and would be appropriate for collecting demographic data from
subjects:
Income range (Please check the range that most accurately reflects your income.)
Data collection forms offer a number of response styles. The person completing the form (subject or data
collector) might be asked to check a blank space before or after the words ​male or ​female, to circle the
word ​male or female, or to write a 1 or a 2 in a blank space before or after the word selected. If codes are
used the meaning of the codes should be indicated on the collection forms so that the individual
completing the form will understand them.
Placement of the data on the forms is important, because careful placement makes it easier for users to
complete the form and to locate responses for computer entry. Placement of blanks on the left side of the
page seems to be most efficient for data entry,but this layout may prove problematic when subjects are
completing the forms. The least effective arrangement is when the data are positioned irregularly on the
form, because the risk of data being missed during data entry is high. Subjects’ names should not be on
the data collection forms; only the subject’s identification number should appear. The researcher will
usually keep a master list of subjects and assosiated coding numbers, which is stored in a separate
location to ensure the subjects’ privacy, often this master list of subjects and codes is kept with the
subject consent forms. Figure 17-2 provides a sample data collection form. It includes four items that
could be problematic in terms of coding, data analysis, or both. The blank used to enter Surgical
Procedure Performed would lead to problems when it is time to enter the data into a computerized data
set. Because multiple surgical procedures could have been performed, developing
DATA COLLECTION FORM Demographics
Subject Identification Number
Age
Gender
1. Male
2. Female
Weight (in pounds)
Height (in inches)
Surgical Procedure Performed
/ /​ Surgery Date (Month/Day/Year)
/ /​ Surgery Time (Hour/Minute/AM or PM) Narcotics Ordered After Surgery
Narcotic Administration
Date Time Narcotic Dose
1​.
2​.
3.
4.
5.
Instruction on Use of Pain Scale
/ /​ Date (Month/Day/Year)
/ / T​ime (Hour/Minute/AM or PM)
Comments:

Treatment Group
1. TENS
2. Placebo-TENS
 3. No-Treatment Control
Treatment Implemented
/ /​ Date (Month/Day/Year)
/ /​ Time (Hour/Minute/AM or PM)
Comments:

Dressing Change
/ /​ Date (Month/Day/Year)
/ /​ Time (Hour/Minute/AM or PM)
Hours since surgery
Comments:

Measurement of Pain
Score on Visual Analogue Pain Scale
/ /​ Date Pain Measured (Month/Day/Year)
/ /​ Time Pain Measured
(Hour/Minute/AM or PM)
Hours since surgery
Comments:

Data Collector Code

Comments:
Figure 17-2 Example of a data collection form. 
434 Unit TWO r​​ i he Research Process
codes for the various surgical procedures would be difficult and time consuming. In addition, different
words might be used to record the same surgical procedure. It may be necessary to tally the surgical
procedures manually. Unless this degree of specification of procedures is important to the stud}', an
alternative would be to develop larger categories of procedures before data collection and place the
categories on the data collection form. A category of “Other” might be useful for less commonly performed
surgical procedures. This method would require the data collector to make a judgment regarding which
category was appropriate for a particular surgical procedure. Another option would be to write in the
category code number for a particular surgical procedure after the data collection form is completed but
before data entry. Similar problems occur with the items Narcotics Ordered after Surgery and Narcotic
Administration. Unless these data are to be used in statistical analyses, it might be better to manually
categorize this information for descriptive purposes. If these items are needed for planned statistical
procedures, use care to develop appropriate codes. In this study, the researcher might be interested in
determining differences in the amount of narcotics administered in a given period in relation to weight and
height. Recording the treatment groups on the data collection form may be problematic because the
information could influence the data recorded by the data collectors.
 
Using Electronic Devices for Data Collection
Electronic devices can be used to collect a variety of scale, questionnaire, or physiological data. However,
the use of these devices for research may require considerable preparation. You may need to purchase,
rent, or borrow the equipment. You also may need to make arrangements with the data collection site or
to place measurement scales on special forms.
 
Scantron Sheets
Scantron sheets are forms that allow subjects to respond to test questions or scale items by using a
pencil to bubble in responses. These responses can be entered directly into the computer by optic
scanner (Dennis, 1994) and stored into a database for analysis. This practice speeds up the process of
entering data and reduces errors related to data entry. However, subjects not familiar with Scantron
sheets may be reluctant to use them, and some inaccuracies in data may occur because of subject error.
These forms have been used commonly for administering multiple-choice tests to nursing students.
Scantrons are best used when subjects cannot be accessed by e-mail or there is
no computer for direct data entry and data must be collected using paper-and-pencil forms.

Teleform
Teleform is a computer software package developed by Cardiff (see ​www.cardiff.com​) that enables
researchers to design a form specific to a scale or questionnaire to be used for data collection. Cardiff
software has unique features that allow users to develop point-and-click automated forms that can be
distributed electronically. Additional features i​ nclude data accuracy verification, selective data; extraction
and analysis, digital record signature support, auditing and tracking, print merge applications, and flexible
export interfaces (​www.cardiff.com/products/teleform/index.html​).
Training is available a at the Cardiff website or in person at location around the United States. Figure 17-3
shows a Teleform version of the Bums Cancer Belief Scale, which allows data to be scanned and stored
in a database. Or this form could be developed and sent to subjects_ electronically, and the data are
collected online and automatically entered into a database. Universities and schools of nursing are
purchasing this software as, are some researchers who can purchase it with grant monies. The costs of
acquiring the hardware and software are considerably less than the costs of entering data manually.
Im et al. (2007) conducted a multiethnic survey in the United States of the gender and ethnic
difference in the cancer pain experience. These researchers administered their questionnaire over the
Internet and through a paper-and-pencil format based on the desires of the subjects. The following
excerpt describes the data collection procedure for this study.
To administer the Internet questionnaire, a web site conforming to the Health Insurance Portability
and Accountability Act standards, the System Administration, Networking, and Security Institute
Federal bureaus of Investigation recommendations, and the institutional Review Board policy of the
institution where the. researchers were affiliated was developed and published on an independent,
dedicated Web site server. When potential participants visited the project Web site, informed
consent was obtained by asking them to click a button labeled
​ iagnoses, cancer therapies, and medications
I agree to participate. After this, questions on specific d
were asked, and the appropriateness of answers was checked automatically through a server-side
program; participants were connected automatically to the Internet survey web page if the answers
were appropriate.
Upon request, pen-and-pencil questionnaires were provided by mail to the community consultants, who
distributed the questionnaires in person only to those who were identified as cancer patients. These
questionnaires accompanied hard copies of the same informed consent form included in the Internet
format of the questionare, and the pen-and-pencil questionnaire included a sentence Filling out this
questionnaire means that you are aged over 18 years old and giving your consent to participate in this
survey.” After the self-administered questionnares were completed, community consultants retrieved all
except five (these were mailed directly to the research team by the participants) in person at the
community settings and mailed them to the research team. Supplementing pen-and-pencil
questionnaires was essential to recruit the target number of ethnic minority cancer patients across the
nation who did not have access to the internet but were interested in participating in the study among the
276 participants who were recruited through community settings, 246 (49 Hispanics, 6 N-H [non-Hispanic]
Whites, 99 N-H African Americans, and 92 N-H Asians) used the pen-and-pencil questionnaires, with an
α level of 0.05, there were no statistically significant differences in psychometric properties between
format and the pen-and-pencil format of the questionnaire. More detailed findings on psychometric
properties of the Internet and pen-and-pencil format of the questionnaire can be found in the larger study
(Im .et al. 2006) It took an average of 30-40 minutes for the participants to complete either the Internet
format or the pen-and-pencil format of the questionnaire. (Im et al.,2007 pp .299-300)
Im et al. 2007) maximized their sample size and ​obtained a ​more representative sample by giving
participants an option to complete their questionnaire on the internet or via the pen-and-pencil format. The
researchers then took steps to ensure that the data collected two formats were comparable by testing for
significant differences and finding none. The time to complete the Internet and pen-and-pencil
questionnaires did not vary. Im et al. (2007) also ensured that the rights of the subjects were protected
and an ethical study was inducted.
computerized Data Collection
with the advent of microcomputers, data collectors can code data directly into a microcomputer at the
data collection site. If a computer is used for data collection a program must ​be ​written for entering,
cleaning and storing data. A microcomputer enables users to collect large amounts of data with few
errors, which can be readily analyzed with a variety of statistical software p​ ackaues.
Chapter 17 ​Collecting and Managing Data 435 ​Personal Digital Assistants

Personal digital assistants (PDAs) are small handheld computers that allow the researcher to enter data
directly into the computer from observations as they occur or to download data from a larger computer for
easy access. Bernhardt et al. (2001) used PDAs to collect survey data and found that participants
preferred the PDA to paper-and-pencil surveys. Health care providers are loading programs on their
PDAs that facilitate accurate assessment, diagnosis, and pharmacological and nonpharmacological
management of patients with a variety of health needs. In addition, PDAs are being used to store patient
data from office computers in a form that is easily transportable. Thus, they have easy access to
information about patients who call during off hours. These small computers can also be used for
research purposes. PDA software is currently available that may help nurse practitioners in busy offices to
collect data for research. Multiple nurse practitioners involved in a research project could forward data
electronically from PDAs to a central research site for analysis. Care would need to be taken to protect
the confidentiality of the data during transmission. Also, PDAs can be misplaced or stolen, thus
threatening confidentiality. Researchers need to protect the information on their PDAf with a security code
to ensure that no one but themselves can access their PDAs.

 
Bioinstruments
Advancements in technology have made it possible to interface bioinstruments with computers for data
collection. The advantages of using computers for the acquisition and storage of physiological data from
bioinstruments are numerous. Harrison (1989) summarized them as follows:

1. Increased accuracy and reliability are achieved by reducing errors that may occur when manually
​ 1​- other clinical instruments.
recording or transcribing physiologic data from patient monitors 0
2. Linking microcomputers with biomedical instruments (e.g., cardiac, respiratory, blood pressure, or
oxygen saturation monitors) permits more frequent acquisition and storage of larger amounts of data
 (e.g., once or more per second) than is practical with manual recording procedures.
3. Once established, computerized data acquisition systems save researcher time during both the data
collection and analysis phases of research.
With