Running Head: Quantitative Research Critique

“Beliefs, Knowledge, and Self Efficacy of Nursing Students Regarding Tobacco

Cessation”

Abstract
The purpose of this descriptive study was to develop three different sample populations

and analyze their beliefs, knowledge and self-efficacy regarding tobacco cessation. The

aim was to determine if the participants own lifestyle choices had an effect on the

different variables of the study. This critique focuses on the research problem and

purpose, it provides a brief literature review, addresses the framework, objectives,

variables, design and sample population. It also critiques the measurement tools as well

as the collection process and analysis of the data. The findings gathered from this

research study are beneficial to undergraduate nursing educators to develop better

teaching strategies including not only knowledge and information, but rather addressing

one’s belief system and attitudes.

 “Beliefs, Knowledge, and Self Efficacy of Nursing Students Regarding Tobacco

Cessation”

The title of the research article summarizes what the article entails. It addresses

the topic and population of concern being tobacco cessation and nursing students. There

is no abstract for this article. However there is an introduction which includes a

background, the research sample, why registered nurses are in pivotal positions to address

smoking cessation and some barriers they may face.

Research Problem and Purpose

A research problem is an area of concern where there is a gap of knowledge base

needed for nursing practice (Burns & Grove, 2008). This research problem for this article

is not clearly stated. After reading the introduction, the reader might still question the

problem of the study. However the concern of the clinical situation focuses on nursing

students and barriers such as, the amount of knowledge about tobacco use, dependence

and treatments, their own beliefs regarding tobacco cessation treatment and their self-

efficacy in providing effective interventions. The significance of the problem, which

indicates the importance of the problem to nursing and to the health of individuals, is,

“ensuring that registered nurses are knowledgeable and have the self-efficacy to provide

such clinical interventions.” The background or what we know about the problem area is

registered nurses constitute the largest group of healthcare professionals…employed in a

variety of settings…spend more direct time with patients.”

 The purpose of this research was “to examine nursing students’ beliefs about

smoking, knowledge about tobacco use and tobacco dependence interventions, self-

efficacy to intervene with their patients who use tobacco, and perceived barriers and

benefits to delivering tobacco-cessation interventions.” The purpose clarifies the aim of

the study, but does not narrow the population of nursing students or identify the setting.

The study did not appear to require a large amount of money in order to be

conducted. The subjects were readily available; all located in the Minnesota area and

recruitment was done via e-mail and a follow-up phone call. The researchers knowledge

of the topic was difficult to determine.

Literature Review

The author provides empirical literature by briefly discussing previously

conducted studies. The author relies heavily on previously conducted studies and

questionnaires in order to conduct her own research. The previous studies were relevant

in identifying the barriers for the current study. The previous studies are not described in

detail or critiqued by the author nevertheless the outcomes are clearly identified. For

example the on page 494 the author states, “..These findings were similar to a study of

Kansas nursing programs, and a related study that reported that students who smoked

provided less frequent counseling…”. In this example, the author is linking her findings

to previous studies, however does not provide the reader with any detail of the study.

The author also provides theoretical literature, which provides a background of

concepts and relates them together. For example, the author discusses nurses and the

amount of time they spend on direct patient care, therefore linking the importance of

effective knowledge base in order to intervene tobacco abuse with their patients. The
theoretical literature is appropriate and although not in-depth, it is enough information for

the reader to relate to the purpose of the current research study.

The review of literature appears valid and the references up to date. The reference

list consists of only nineteen references. There are 5 references that are less that 5 years

old, 11 references are 6-10 years old and 3 references that are greater than 10 years old.

The review of literature summarizes the pivotal position nurses are in to

effectively intervene and provide smoking cessation information and treatment. The

majority of the literature focuses on the perceived barriers and how it affects nursing

students that currently smoke and nursing students that do not smoke. The literature

provided is organized and the results from previous research studies are appropriately

used within the study to show progressive development of ideas needed to develop the

current research. The literature conveys a small amount of previous known knowledge

from previous studies. The author should have explained the health belief model that is

used as the framework for the study in order to help the reader understand and link the

model to the study.

Framework

In this study the theoretical framework was based on the health belief model,

which provides a framework to examine perceived barriers, perceived benefits, and self-

efficacy for exploring why some nurses take action and others fail to provide tobacco-

cessation intervention (Lenz, 2008). The four main constructs of the health belief model

(perceived threat, knowledge, perceived barriers and benefits, and self-efficacy) were

used to select specific variables. The model gives clarity to the framework and directly

links it to the variables in the study. The underlying concept of the original health belief
model is that health behavior is determined by personal beliefs and perceptions about a

disease and the strategies available to decrease its occurrence (Hochbaum, 1958). Lenz’s

study states the health belief model identifies knowledge about a disease or health

condition as an essential element of perceived susceptibility. In reference to this study,

the author used an appropriate model for the framework to generate and refine the

research problem and purpose and link it to knowledge in nursing.

Objectives, Questions, or Hypothesis

The first aim (question) of the study was to determine if baccalaureate-nursing

students in Minnesota believed that they received sufficient training in the clinical

treatment of tobacco dependence. The second aim (objective) was to identify the

perceived barriers that may limit their ability to intervene with their patients. The aims

were logically linked to the purpose statement. They are directly linked to the framework

based on the health belief model four main constructs: perceived threat, knowledge,

perceived barriers and benefits and self-efficacy (Lenz, 2008).

Variables

The author identifies demographic variables in the study being gender, ethnicity,

age, type of college, location of college, age of first tobacco use, do you consider yourself

a smoker and tobacco use within the last 30 days.

Operational definitions are derived to manipulate or to measure the existence or

degree of existence of the dependant variable (Burns & Grove, 2009). Multiple

operational variables were listed under the three main categories; 1. beliefs about tobacco

2. nurses knowledge of tobacco treatment, 3. self-efficacy and application of cessation

interventions. The study does not provide conceptual defintions.

 In this study three dependant variables are clearly identified. “Two items asked

about smoking: do you consider yourself a smoker, and during the past 30 days how

many days did you use. Responses to these two items became the dependant variables.”

The first dependant variable was individuals who smoke and smoked within the past 30

days. The second dependant variable is identified as occasional smokers and the third

variable being non-smokers.

Design

The research design is clearly addressed in the abstract of the study stating it is a

quantitative descriptive study. According to Burns & Grove, 2009 descriptive

characteristics are to gain more knowledge, identify problems, and make judegements.

The design was therefore appropriate for this study, however a correlational descriptive

design may have been better in order to compare the knowledge and beliefs between the

nonsmokers, occasional smokers and smokers. A pilot test was mentioned but not talked

about. There were no threats mentioned by the author in regards to design validity.

Sample, Population, Setting

The target population is clearly defined. The inclusions are described as

Minnesota BSN program students in their senior year spring semester 2007 including

seven private and four public institions. The exlusion was also stated, “excluded from the

sample were BSN programs…” (Lenz, 2008). The method used to obtain the sample was

recruitment via email and follow-up phone call. From the 10 participating institutions,

675 (87%) senior nursing students were recruited with 102 (13%) choosing not to take

part or absent (mortality). A total of 657 students actually took part in the study. (Lenz,

2008) The author does state that two questions were asked and responsesto the questions
divided participants into three groups. From the two questions the author explains the

respones and how the groups were divided based on fact and therefor little bias.

A big enough sample size was used to avoid type II error with a significant

difference between the groups being smokers, occasional smokers and non smokers. The

IRB approval was obtained from the principal investigator’s institution and additional

approval when required. It is not clearly stated whether the rights of human subjects were

protected and HIPAA regualtions followed. Informed consent was received from

participants and site visits were made to each instituion (being the setting), to administer

a paper survery in a classroom. The setting avoided internal validity, being in one

location and having the survey be the primary focus. Even so, the author does not address

internal validity threats and how to reduce possible threat.

Measurements and Instruments

The measurement strategies are described individually by the author. The

National College Health Risk Behavior Survey was used to measure tobacco-use history.

Tobacco use history was measured using an Attitudes Towards Smoking Scale. Items

were measured using a 5-point Likert scale to measure positive and negative beliefs. The

knowledge of tobacco treatment was measured using a seven item tool developed and

implemented by Freid et al. Items too were measured using a 5-point Likert scale. Self-

efficacy and application of cessation interventions was measured using the Modified

5A’s Training Program Survey and measured using the Likert Scale. Lastly a 4-point

Likert scale (ranging from strongly agree to strongly disagree) was used to ask about the

nurse’s role in tobacco cessation (Lenz, 2008). The author does state that content was

validated by a panel of experts prior to pilot testing and administering the tool.
Questionnaires

The survey consisted of a 46-item questionnaire on knowledge about tobacco

treatment, tobacco-use history, beliefs about smoking, self-efficacy and behavioral

application of cessation interventions and demographic items. The author states

measurement validity could be a limitation as only eight of the 18 items were used

from the ATS-18 validated instrument. There was only one psychmetric

measurement tool used, which does not allow for validation of responses.

Data Collection

The data collection process was conducted in a consistent way. They are displayed in

tables within the research study. The mean scores and standard deviations among the

smokers, occasional smokers and nonsmokers were displayed in each category for

each variable. The table also displays the ANOVA variable and the post-hoc

analysis. The questions (variables) asked under “Beliefs About Tobacco”,

“Knowledge About Tobacco” and “Self-Efficacy Tobacco” address the objectives

stated in the beginning of the study. The author does not state a time frame in regards

to the collection process.

Data Analysis

Statistical analysis was completed with SPSS (Lenz, 2008). According to Burns

and Grove, 2009 ANOVA is the statisical technique used to examine differences between

two or more groups by comparing the variability. Three way ANOVAs were completed

on responses to tobacco related knowledge, attitudes, beliefs and self-efficacy variables.

The ANOVAs between and within subgroups were followed by pot-hoc test using the

Levine’s test to determine the appropriate test. Games-Howell test was completed where
equal variances could not be justified and the Tukey honestly significant differences

when variances were assumed to be equal when indicated. Results were considered

statistically significant when p<0.05. (Lenz, 2008).

Interpretation and Findings

The researchers interpretation of findings is that there is a need for future research

regarding effective methods for teaching students about tobacco cessation. In regards to

smoking beliefs there was significant difference between the smokers and nonsmokers

beliefs. However it is stated that more research regarding students’ smoking beliefs is

needed for comparison of results. In addition the study demonstrates that smoking

behavior affected students beliefs about smoking and their view about the professional

role in helping smokers quit.

Regarding the health belief model which identifies knowledge about a disease, the

study found regardless of their own smoking behavior, students reported similar

knowledge preparation. Also in regard to the health belief model, nonsmokers

demonstrated consistent viewpoints between their professional role and personal beliefs

about smoking whereas the smokers beliefs supported their personal smoking behaviors.

The author did not state expected findings prior to conducting the research study.

Therefore no comparison can be made between the expected and actual findings.

Limitations were addressed in the end of the study; including the potential for respondant

bias. The findings were generalized in tables which depicts the mean and standard

deviation of the variables for the smokers, nonsmokers and occasional smokers.

The findings have implications for undergraduate nursing education. “Teaching

strategies cannot be based solely on impairing knowledge or information, one’s belief

system or attitude needs to be addressed…Professional and state board of nursing need to

develop minimal competencies and standards”(Lenz, 2008).

Conclusion

The overall quality of this study is poor. The study does not generate a lot of new

knowledge nor does it provide theories or change for existing knowledge. The study

mainly identifies possible barriers nursing students might face when the opportunity to

intervene in tobacco cessation is needed with a patient. Parts of the research done in this

study may be used in order to develop a stronger study regarding tobacco cessation and

interventions needed to assist patients in quitting. This article focused on nursing

students, when the focus should have been on nurses currently practicing, helping to

recognize obstacles and develop interventions.

 References

Burns, N. & Grove, S. (2009). The practice of nursing research: Conduct, critique and

utilization, (5th Ed.). St. Louis: Elsevier Saunders.

Hochbaum, G.M. (1958). Public Participation in Medical Screening Programs:A Socio-

Psychological Study (Public Health Service Publication No. 572). Washington,

DC: Government Printing Office.

Lenz, B. (2008). Beliefs, Knowledge, and Self-Efficacy of Nursing Students Regarding

Tobacco Cessation. American Journal of Preventive Medicine, 35(6S)

S494-S500