Social Determinants of Health: A Critical Appraisal of Selected Pieces of Health Research
Introduction to the health issue
Social determinants of health are the social and the economic conditions under which an individual is born, work, live or age. According to Braveman & Gottlieb (2014) these conditions influences the difference in health status observed between individuals or groups of persons. The social determinants of health are also referred to as the living and working condition of an individual that have significant influence on the risk for a disease of vulnerability to an injury. Boutayeb et al (2016) have reported that the circumstances of the conditions of living are shaped by the power distribution, distribution of resources and wealth at the local, national and global levels. Individuals or any group of people within a society are likely to be exposed to different working and living conditions, hence the difference in their level of risk to different diseases.
Social determinants of health are responsible for the quality of health of an individual. The different social determinants of health that an individual is exposed to influences their health status. In the process of analyzing the relationship between the social determinants of health and an individual’s quality health, critical appraisal of 3 research papers related to social determinants of health are carried out to evaluate the research evidence needed to facilitate evidence-based practice. Critical appraisal of the documents is also vital in assisting the researcher decides on the best available evidence from the large body of research.
Statement of the research question
To determine the relationship between social determinants of health and health quality of an individual
What is the relationship between the social determinants of health and an individual’s health quality?
Critical Appraisal
Critical appraisal refers to the process of systematically and carefully examining a particular study to judge its value, relevance
Brief description of the selected papers
The first paper by Azam, Bakouei, Mohammadi, Montazeri, Hosseni (2015) is entitled “the social determinants of health in association with women’s health status of the reproductive age: a population-based study”. This study aimed at determining the association observed between the social determinants of health and the women’s health of reproductive age.
The second paper by Palipudi, Gupta, Sinha, Andes, Asma & McAfee (2012) is entitled “Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey”. This study focussed on determining the influence of the social determinants of health on tobacco usage.
The third paper by Rueden, Gosch, Rajmil, Bisegger & Sieberer (2006) is entitled “Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study”. The authors sought to determine the effects of the socioeconomic status on the quality of health of a child and adolescents.
Critique of first paper
The first paper by Azam et al (2015) focussed on determining the association between the social determinants of health and the women’s health. The study was limited to the women of the reproductive age and so the women included in the study were of the age of 15-49 years. The study information on the effects of the social determinants on their health was determined using interview and questionnaires that were done at their respective homes.
Strengths
The method of data collection adopted in the study is effective in obtaining information from a large number of people. According to Fowler (2013) survey is the appropriate method that can be adopted in collecting information from a wide range of people who can be easily accessed. The use of two methods of data collections is also appropriate in ensuring that the information that is not captured in the interviews is obtained through the use of the questionnaires. The authors also carried out a pilot test and involved an expert in the formulation of the interview questions. As Bowling (2014) indicates, this approach is effective in ensuring that the interview questions presented actually answers the research questions that are formulated.
The inclusion of a large number of study participants is effective in any quantitative study. Creswell (2013) has indicated that unlike the qualitative data that focuses on the quality of the information presented by the study participants and therefore does not necessarily require a large number of study participants, the quantitative research approach requires that a large range of data is collected for the accuracy desired to be attained. The inclusion of the information provided by about 770 women in the study is a sure way of getting a wide range of information on the effects that the social determinants of health have on the health conditions of the women in their reproductive age.
The quality and present ability of data is enhanced through a rigorous data analysis process. The authors of this paper have adopted the SPSS statistical software to analyze the data that was collected from the study participants. This software is effective in analyzing the relationship between the independent and the dependent variables in a study (Zikmund, Babin, Carr & Griffin, 2012). In this case, the dependent variable was the health status of the women, while the independent variable as the social health determinants. In this case, the SPSS software was the most appropriate tool in analyzing the relationship observed between the study variables identified. The fact that the system is computerized is a surety of obtaining a higher level of accuracy. The use of this approach by the authors therefore guaranteed the attainment of quality findings in regards to the relationship between the social determinants of health and the women health status.
The descriptive analysis conducted by the authors provided mean values for the variables that were included in the study. This statistical method was also used to categorize the women involved in the study based on their marital status, ethnicity and education levels. This was important in identification of the social determinants of health. The relationship observed between the social determinants of health and the health status of the women was analysed through one-way analysis of variance (ANOVA). The authors then conducted the linear regression of the variables to further determine the relationship between the dependent and the independent variables without the effect of the confounding factors. The use of these statistical methods is effective in ensuring that relationships observed between the study variables are accurate and reflect the view of the study participants.
Weaknesses
The main aim of the paper is to determine the relationship between the social determinants of health and the health of women in their reproductive age. As much as the authors have presented the major focus of the study, they have failed to clearly outline the study objectives or the research questions that will be attained in the study. According to Corbin & Strauss (2014) a clear statement of the research objectives is important in ensuring that the research findings answer the research questions as stated. In addition, the statement are appropriate in ascertain whether the study has accomplished its aim or not.
The sampling strategy adopted by the authors in this paper is also not appropriate for a quantitative study. According to Jackson (2015) the use of the multi-stage sampling procedure does not a guarantee a 100% representation of the entire population. In addition, the sampling technique is characterized with a high level of subjectivity hence bias in the representation of the population. As much as the approach is cost effective and simplified, the use of a random sampling approach is more appropriate in ensuring that a clear and more accurate representation of the study population are observed. Moreover, the issues of bias in the selection of the individuals to involve in the study are largely minimized in the cases where a random sampling method has been adopted (Zikmund, Babin, Carr & Griffin, 2012). The authors therefore need to have considered the use of the random sampling method other than the multi-stage sampling process.
The findings obtained by the researcher are likely to be accurate following the effective data collection and analysis process that was adopted. However, the authors have failed in the proper presentation of the findings achieved. It is observed that there is significant relationship between some of the social determinant of health factors and the health status of the women. There are equally some variables that have not shown any form of significant relationship. The authors needed to clearly outline which of the social determinants of health have significant relationship with the different health status variables in a way that they do not cause any form of confusion on the readers.
Critique of second paper
The second paper
The second paper by Palipudi, et al., (2012) looked at the influence that the social determinants of health had on tobacco smoking in different countries. The major focus was on the effects observed in low and medium income nations. A total number of 13 nations were included in the study as a representation of the low and medium income nations. Survey method of data collection was adopted to obtain information from more than 200000 respondents of 15 years of age and above, on the current use of tobacco across various socio-demographic factors such as place of residence, age, level of education, wealth index, knowledge on harmful effects of tobacco smoking and gender. The study findings indicated that there was a decrease in use of tobacco with increase in the education level in 5 of the countries. The study findings also indicated that there was a decrease in the use of tobacco with the increase in wealth in some of the nations. The prevalence of smoking also decreased with the increase in knowledge in the harmful effects of tobacco in most parts of the nations that were engaged in the study.
Strengths
Quantitative research design is appropriate in a study whose research questions can be determined objectively. Moreover, the approach is appropriate in a research that seeks to establish the relationship between a dependent variable and several other independent variables (Allen & Allen, 2015). The use of this approach in the study is therefore effective since it involves the determination of the relationship between the social determinants of health variables and the rate of smoking variable. The fact that quantitative research approach is effective in providing accurate formation further justifies its suitability in this study where a higher level of objectivity is needed.
The sample size adopted by the authors is appropriate in carrying out a quantitative research across different nations. The fact that there was a higher number of study participants means that the authors are likely to obtain a wide range of information needed to determine the influence of the social determinants of health on the smoking rates. The authors also adopted random sampling strategy that is important in ensuring that the target population is well represented. According to Jackson (2015) this approach is also less prone to subjectivity hence ensuring thus enhancing the quality of the research process. The use of the random sampling strategy is therefore appropriate in ensuring that the large population of all the 13 nations are well represented.
The use of survey is also appropriate in ensuring that the higher number of the study participants are accessed. Since this study involved individuals from different nations, survey was the most appropriate method since it is convenient in terms of costs and time involved. The use of the online survey method further enhanced the convenience of the method, since the researcher had to reach the respondents from a single location.
Weaknesses
The use of SPSS software in data analysis is appropriate in cases where a large number of objective data are to be analyzed. This software is effective in filtering data and providing automatic analysis since it is computerized. However, the use of a single regression analysis process is not appropriate in determining the relationship between dependent and independent variables (Jackson, 2015). The authors needs to have considered conducted ANOVA analysis before moving to the multiple regression to ensure that only suitable variables are included in the regression model. This will also ensure that confounding factors are not included in the analysis process.
The process involved the inclusion of human study participants hence there were issues of ethical considerations that needed to have been taken into consideration. The authors should have sought for informed consent from the study participants prior to engaging them in the study. This is a way of ensuring that they participate willingly in the study (Boutayeb, et al., 2016). Ethics also needs to have been considered in dealing with people from different countries since they are likely to have varying values, attitudes and perceptions on the study being conducted.
Critique of the third paper
The third paper by Rueden, Gosch, Rajmil, Bisegger & Sieberer (2006) sought to determine the effects of social economic status on the quality of health of children and adolescence. The study adopted the survey as a method of data collection where questionnaires were used to determine the influence that the social economic status of the study participants had on their lives. The study findings indicated that a higher parental educational status amongst the adolescents and the children had significant effects on the physical, emotional and psychological wellbeing. In addition, family wealth also plays a significant role in the quality of health of the children and the adolescents.
Strengths
The study took a quantitative research approach where the study findings were determined objectively. This was effective in ensuring that a higher level of accuracy is attained. The authors also engaged a higher number of study participants of about 1900 children and adolescents that is appropriate in any quantitative research.
The use of survey method is also effective in ensuring that all the study participants are engaged in the study. The authors designed questionnaires that were distributed to the children and the adolescents and their respective parents. According to Corbin & Strauss (2014) questionnaires are important data collection tool that are appropriate in collection of comprehensive information from learned study participants. This tool provided room for the participants to give information on the questions indicated without any form of interference from the researcher. The fact that the no names are indicated in the questionnaires further provides an opportunity for the study participants to give information without fear.
The use of the statistical analysis methods (correlation and regression analysis) to analyze the raw data collected was effective in ensuring that the quality findings are reported. This procedure is also appropriate in determining the relationship between the study variables in this case, the health condition of the children and the adolescents and their social economic status. The proper selection of an appropriate method of data collection followed with the effective analysis of the data collected is a guaranteed that the authors obtained accurate and reliable information.
Weaknesses
The authors have failed to clearly state the study objectives that are to be accomplished in the study. As Corbin & Strauss (2014) indicates, it is vital that the research objectives and questions are clearly highlighted so as to allow for free navigation by the readers as well as ensure that the findings being reported re in line with the stated objectives. In the event that they are absent, one is unlikely to know the direction of the study as well as the desired aims that it sought to accomplish.
Since the study also involved, human participants, their informed consents should have been sought prior to being engaged in the study. To adhere to the ethics of this kind of study, the researcher needs to have informed the study participants on what is expected from them so that they participate willingly in the study.
Summary and comparison / contrast of the methods used in the research papers
From the analysis of the three papers, it is observed that there are weaknesses and strengths of every article. The research approaches adopted by the authors of the 3 papers is effective depending on the nature of the study that they conducted. Quantitative research approaches are appropriate in studies that involve a wider range of participants and whose research questions can be determined objectively. The sampling technique adopted by some of the authors are however not appropriate in ensuring that there is a clear representation of the target population and that there is no form of bias in the study. Azam et al (2015) and Rueden, Gosch, Rajmil, Bisegger & Sieberer (2006) did not use appropriate sampling technique hence the generalization of their findings to reflect the general view of the entire population may be inappropriate.
All the authors of the 3 papers have adopted survey as their method of data collection. Azam et al (2015) have adopted a mixture of interview and questionnaires while Palipudi, et al., (2012) and Rueden, Gosch, Rajmil, Bisegger & Sieberer (2006) used questionnaire only. This research method is appropriate in reaching a large number of study participants. Interviews can equally be adopted where the participants can be easily accessed, however, it is suitable to rely on the use of questionnaires as a research tool in the cases where study participants are highly scattered. The questionnaires and the interview usage as methods of data collection have ensured that a larger number of participants are accessed by the researchers thereby ensuring that they obtain comprehensive information to respond to the research questions.
The use of SPSS in the analysis of large quantitative data is appropriate. As observed in the 3 studies, this data analysis is vital in cases where relationship between a dependent and independent variables is to be determined. ANOVA, multiple regression and correlations analysis are the processes that have been adopted by the researchers to analyze their data thus enhancing their quality.
None of the researchers have indicated how the ethical issues will be taken into consideration. Since their studies have mainly dealt with human study participants, it was vital that they include how they will obtain informed consent from the study participants and protect the information provided by every individual. This step is critical in ensuring that the study is in compliant with the ethical requirements.
Conclusion
The findings of the three articles are likely to be accurate based on the effectiveness of the research methods and data analysis adopted. However, only the research by Palipudi, et al., (2012) is likely to be generalized as a representation of the entire target population owing to the kind of sampling strategy that the authors adopted. The inclusion of a relatively higher number of study participants in the 3 studies ensured that comprehensive information is obtained to solve the research problem. As much as there may be weaknesses of the papers such as lack of clearly stated objectives, the findings of the studies are likely to be reliable due to the rigorous nature through which the data are collected and analyzed. The authors however, need to consider taking into consideration the ethical requirements of performing such studies to ensure they adhere to the ethical standards required when dealing within human subjects as study participants.
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