What was the importance/purpose of the study? Describe the inclusion criteria for participant selection in this study.
The study recognizes that the numbers of persons that are infected with HIV are increasing and yet remain to be undiagnosed. Early detection and intervention is necessary for the effective management and care of HIV, but at present there is a relatively low success rate for community clinics and hospitals to reach out to HIV patients and to encourage them to seek counseling and testing. The purpose of this study is to bring HIV referral and screening to the inner-city emergency departments where most patients at risk for HIV come for treatment by the offering of a financial incentive to referred patients and to measure if the said program was effective in increasing the number of patients who submitted to HIV counseling and testing (Haukoos et. al., 2005).
The participants in the study were identified using convenience sampling, wherein the ED staff was asked to refer patients who they thought were either at low, medium, or high risk of HIV infection. The inclusion criteria for the participants were not specific in the sense that the ED wherein prospective patients came to for treatment assessed the patients in terms of the Centers for Disease Control and Prevention guidelines on the risk of HIV infection. Gender, age, socioeconomic status, occupation, religion, and other participant characteristics were not controlled for, although ethnicity was largely considered in the discussion.
Discuss the financial incentive offered to participants in the study.
The financial incentive was given to participants of the study at the second 6-month trial in order to determine if the possibility of getting a modest financial incentive would increase the number of at-risk patients to seek HIV counseling and testing. The study employed a three 6-month period wherein the first and last study period was designed as controls for the financial incentive period. The financial incentive was however awarded only after the completion of HIV testing and counseling.
What study design was employed in this study? Would this study be considered an experiment? Explain your answer. What were the results and conclusions of the study?
The researchers stated that the study followed a quasi-experimental design wherein the effect of financial incentive to the rate of HIV patient testing and counseling was measured. The study is quasi-experimental because there is less control of the participants’ characteristics and the external variables that may affect the behavior of the participants. The study in some sense can be called an experiment because it made use of a control and experimental treatment although with differing groups of participants (Polit & Beck, 2008). The results of the study showed that financial incentives increased the likelihood of completing HIV counseling and testing however, the researchers concluded that it is unclear whether the financial incentive would be cost-effective in increasing participant diagnosis.
In evaluating the research study, what were the weaknesses and strengths of the study?
The strengths of the study include the use of an extensive study period wherein the variable of financial incentives was manipulated, the study also made use of multiple variable regression models to analyze the data which increased the statistical power of the data. The study was also straightforward and the researchers did not make any claims as to the limitations of the study. The weaknesses of this study include the lack of randomization of participants which would have made the study more experimental in nature; the study also did not have a clear set of inclusion criteria for the participants which had resulted to the referral bias in the study.
Was the study susceptible to bias? If so, state, define and explain how the study was susceptible to the bias(es).
Yes, the study was susceptible to bias because there were no clear guidelines for the identification of the participants, the participants were just referred by the ED to HIV counseling and testing depending on whether they met some of the guidelines set by the CDCP. It is therefore the discretion of the ED staff to refer their patients or not, and without clear parameters, referral bias is easy to set in (Rubin, 2008). Even the researchers were cognizant that referral bias was present since there was a clear over representation of one ethnic group from another based on ED referrals.
Explain the concept of randomization. Was this a randomized study?
Randomization is one of the most important aspects of true-experimental designs; this means that the participants were gathered from a population sample that closely resembles the true population, thus the results of the study would be reliable and valid in the sense that it is not influenced by threats such as bias, environmental factors and others (Salkind, 2006). The study is not randomized because the participants were selected through convenience sampling and was influenced by referral bias. Moreover, the study periods although extensive did was still not randomized, the researchers could have used randomly assigned the participants from the three study periods to effect randomness but this was not done.
Haukoos et. al. (2005). The Effect of financial incentives on adherence with outpatient Human
Immunodeficiency Virus testing referrals from the Emergency Department. Academic Emergency Medicine 12 (7); 617. Retrieved May 27, 2008 from Proquest.
Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for
nursing practice. 8th ed. New York: Lippincott, Williams & Wilkins.
Rubin, A. (2008). Practitioner’s guide to using research for evidence-based research. New
Jersey: John Wiley ; Sons.
Salkind, N. (2006). Exploring Research, 6th ed. Upper Saddle River, NJ: Prentice Hall.