This paper critically appraises a qualitative study by Oates et al. (2004) titled Postnatal Depression across Countries and Cultures: A Qualitative Study. This research evaluates its introduction and literature review, purpose statement, methods, results, and discussion. The appraisal reveals that the researchers affirmed the significance of their study and identified a gap in the literature their study sought to fill. In addition, the literature review was detailed and comprehensive; nevertheless, the researchers did not clearly define all important concepts related to the research. They also used the specific qualitative research design, the ground theory design, which is consistent with the purpose of their study. A weakness of their methodology is the potential of biases, especially in the selection of countries to include in the research. The researchers specified that they had utilized a non-probabilistic sampling. Nevertheless, the sample offered a good representation of a representative sample. The researchers collected data using interviews and focus groups. In analyzing their information, they used thematic content analysis, provided the implications of their findings. However, they failed to identify some future research directions.
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A Qualitative Study
Postnatal recognition has been internationally recognized as a major concern as regards public health owing to the following fact. It is one of the primary causes of suicide and maternal morbidity. In line with this, a number of studies have been performed exploring the issue of postnatal depression. To this end, this essay performs a critical appraisal of one such studies by Oates et al. (2004) titled Post Natal Depression across Countries and Cultures: A Qualitative Study published in The British Journal of Psychiatry.
Evaluation of Introduction and Literature Review
Oates et al. (2004) has provided the adequate rationale for conducting the study. The authors acknowledge that a vast research on post-natal depression has been performed in Western developed nations. A little consideration has been accorded with the diverse psychological experiences likely to be witnessed during childbirth. Oates et al. (2004) also acknowledge that all these studies make use of Western notions of depression and standardized measurement instruments, especially the Edinburgh Postnatal Depression Scale (EPDS). Nevertheless, no study has been undertaken across diverse cultures at the time to compare the consequences, psychosocial origins, and incidence rates of postnatal depression. Oates et al. (2004) have used these limitations as a rationale for their study to come up to a qualitative method to investigate whether or not postnatal depression has universal descriptions and attributes. They have also tried to explore the perceptions of people regarding the services and remedies that can be used to address the morbid unhappiness locally.
The study has been significant owing to the fact that it aimed at developing a reliable technique. It could be utilized and analyzed locally but offer meaningful cross cultural comparisons about some aspects of postnatal depression. It is a gap in the literature that the study sought to address owing to the fact that there was no research instrument for the assessment of postnatal depression. It accounted for the cultural differences. Essentially, the study sought to develop, translate and modify research instruments that could be utilized in future studies of post natal depression in different cultures and countries (Oates et al., 2004, p. s11).
Oates et al. (2004) have performed a thorough and comprehensive review of literature. In trying to justify their research, the authors acknowledge the limitations and gaps in the existing literature. Specifically, their literature review is geared towards illustrating that those postnatal depression concepts and measures are centered on Western contexts. A little attempt has been made to explore postnatal depression in cross-cultural settings. In addition, the literature review is not biased owing to the fact that Oates et al. (2004) have included the literature relating to both Western and non-Western societies. They have attempted to provide a link between Western and non-Western notions of post-natal depression. For instance, Oates et al. (2004) have indicated that a lack of post-partum rituals (a common practice in non-Western societies) is a likely factor causing postnatal depression in Western societies. Therefore, it can be argued that the authors have conducted a comprehensive and thorough review of literature being devoid of biases.
A weakness of the article is that the authors failed to clearly define all important concepts associated with the study. For instance, in the introduction and literature review section, the authors emphasize on postnatal depression. However, there is no conceptual definition regarding postnatal depression. Another issue that has been vastly mentioned but has not been defined is morbid unhappiness. The researchers have clearly described previous methods being relevant to understanding the purpose for conducting the research. As a matter of fact, the purpose of the study is underpinned by limitations in some previous research instruments used in assessing postnatal depression. In this regard, the authors have stated that their research has a main objective of developing, translating, and validating research instruments that the future studies examining postnatal depression could use. In addition, the researchers have framed the purpose of their study as a means of avoiding the cross-cultural assumptions associated with quantitative instruments. It has resulted in the development of qualitative research that sought to explore postnatal depression in cross-cultural settings.
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Evaluation of the Purpose Statement
Oates et al. (2004) have clearly stated their purpose statement. In this regard, the primary objective of the qualitative study was to clarify whether or not postnatal depression is a universal experience with common expression and attributions across cultures and nations, or whether postnatal depression is a concept confined to the West (Oates et al., 2004, p. s11). In addition, the authors have sought to come up with a qualitative technique that could be used in investigating whether postnatal depression has universal descriptions and attributes or not. Also, some perceptions of people regarding the services and remedies that can be used in addressing morbid unhappiness locally could be explored.
In addition, the purpose statement in the article is based on the argument developed in the literature review. As mentioned earlier, the literature review by Oates et al. (2004) is geared towards illustrating that those postnatal depression concepts and measures are centered on Western contexts. A little attempt has been made to explore postnatal depression in cross-cultural settings. Therefore, the authors have framed the purpose of their study to address the gaps in the literature.
Evaluation of Methods Section
Although not stated in the methods section, a specific qualitative research design was used in the study. The authors indicate that they used a grounded theory. They defined it as a theory development method that draws upon data being collected and analyzed systematically. Oates et al. (2004) have also provided a rationale for using the grounded theory in their research. It has included offering well-grounded and comprehensive portrayals of processes used in local contexts from the viewpoint of people being investigated. In addition, when using the grounded theory, researchers are not limited to their initial conceptions. As a result, they able to create and review conceptual frameworks as the research progresses on (Adouard, Glangeaud-Freudenthal, & Golse, 2005; Leigh & Milgrom, 2008).
The research design is also consistent with the purpose stated in the introduction. The authors have intended to generate theories related to how postnatal depression can be dealt with in a cross-cultural context. As a result, the grounded theory research design was ideal for their research purpose.
There are a number of potential biases in the procedures used by researchers. The only likely bias in the procedures is related to the selection of countries. Oates et al. (2004) did not outline any criteria for the selection of the countries to conduct the study. It leaves some room for potential bias when choosing countries to be included in the research. A second potential bias in the procedures is in the sampling method, whereby the researchers used a non-probabilistic sampling approach, which is inherently biased (Milgrom, Negri, Gemmill, McNeil, & Martin, 2005; Ramchandani, Stein, Evans, & O’Connor, 2005).
The researchers have used a non-probabilistic purposive sampling method having the predefined criteria. Purposive sampling involves researchers selecting the sample based on who they perceive to be appropriate to participate in the research. This sampling method is applicable for the study owing to the fact that it is qualitative. It does pose stringent requirements on the need to make use probabilistic sampling approaches such as random sampling.
The researchers did not provide relevant demographic characteristics of the sample. In addition, the sample size for the study was not clearly identified. The only description provided relating the sample included the size of focus groups (4-6 women with the babies aged 5-7 months), interviews conducted with three grandmothers, three grandmothers, interviews with three health administrators/planners, and three clinicians.
The sample selection methods used by researchers provide a good representative sample based on the population. It is because researchers have targeted diverse categories of participants including new mothers, their relatives (fathers and grandmothers), and health professionals. The sampling method, which is non-probabilistic in nature, presents inherent biases (Leigh & Milgrom, 2008). It is because researchers had the discretion to determine who they deemed appropriate to participate in the research. Such a sample selection process is inherently biased and likely to lock out potential participants in such an event that the views of the researcher are biased (Ramchandani et al., 2005). It is difficult to ascertain whether the sample size is large enough for the research owing to the fact that the researchers did not specify the sample size they had used in the study.
Data collection methods used in the study included focus groups and interviews. In addition, the authors provided an adequate description of the interview protocol applied with the way how the focus groups and interviews were conducted. The only limitations during the data collection process comprise of those being inherent with using focus groups and interviews. It included influencing the generated responses and reliance on assisted discussions (Leigh & Milgrom, 2008).
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Evaluation of the Results Section
The researchers have provided a clear description of the analysis method they used. It involved the use of a textual analysis of transcripts, concept coding, and the extraction of themes. Although not explicitly stated, it is evident that the authors used thematic content-coding and analysis. In addition, the results are described in a manner clearly linked to the identified themes. In this regard, the researchers organized their results around emergent and common themes involving those ones from health practitioners, postnatal depression, and contributors to unhappiness and happiness.
Evaluation of the Discussion Section
The researchers reinstated the aim of the study. Moreover, they clearly discussed the implications of their findings. They included the improved support from families and partners being largely perceived as the best therapy for postnatal depression. For those ones preferring professional help, talking therapies are considered as the best option. New mothers acknowledge that postnatal depression is a prevalent phenomenon after childbirth although not necessarily perceived to be an illness.
The limitations of the research are also identified including a relatively small sample in each center. The inability to generalize results from a qualitative study and comparing themes from various countries is likely to be perceived as controversial. Lastly, the authors did not identify directions for future research.
It is evident that the article under consideration provided an adequate rationale for performing the study. The authors also affirmed the significance of their research and identified the gap in the literature that their work sought to address. The literature review was thorough and comprehensive. However, the researchers did not clearly define all important concepts related to the research. They also used a specific qualitative research design, i.e. the ground theory design. It is being consistent with the purpose of their study. A weakness of their methodology is the potential of biases, especially in the selection of countries to include in the research. The researchers specified that they had utilized a non-probabilistic sampling. Nevertheless, the sample offered a good representation of the representative sample. They collected the data using interviews and focus groups. In analyzing their information, the researchers used thematic content analysis, provided the implications of their findings, but failed to identify the future research directions.