The article being critiqued is titled “Hmong Healing Practices used for Common Childhood Illnesses.” The authors, Patricia Nuttall and Filomena C. Flores are qualified to research since both have attained Ph.D. level education, not mentioning that they are registered nurses and at the time of conducting this particular study, the two researchers were fully-fledged professors at California State University (Nuttall & Flores, 1997). It is, therefore, safe to conclude that the two researchers have a wealth of experience in nursing research.
Phenomenon of Interest
The research is indeed focused on human experience within a natural setting. Specifically, the research focuses on the health experiences of Southeast Asian Hmong immigrants who for the past 20 years have been living in central California and have been assimilated into mainstream American society.
The critiqued study is triggered by a gap in knowledge about multi-ethnic understanding and culturally sensitive healthcare interventions, thus knowledge regarding the health care practices of the Hmong immigrant group particularly in early care becomes the phenomenon of interest (Nuttall & Flores, 2007).
Research Structure
As is the case in many other qualitative studies, this particular research does use a research question to answer fundamental study objectives. However, the descriptive qualitative research uses a well-grounded process, including describing the Hmong group’s indigenous healing methods, their purposes of the healthcare practices used, their beliefs and attitudes regarding western medical care, and, lastly, their viewpoints regarding western pediatric healthcare, to come up with objective data that is later used to describe the knowledge regarding the health care practices among the Hmong immigrant group, particularly in early care.
Although the study does not make use of an explicit research question, it can be safely argued that the descriptive process used applies to the selected qualitative method because it can provide answers to the key research objectives in addition to bringing out issues of germane importance as concerns Hmogs healthcare practices.
The biases of the investigators, if any, have not been reported in this particular study. From the study, it is evident that the researchers provide an objective account of the Hmog’s immigrants’ perceptions of their traditional healthcare practices and beliefs about western medical care based on a critical review of related literature.
The interview schedule (Hmong Parenting Interview) was developed based on the knowledge that was already in the public domain and administered by 2 Hmong nursing students. The above factors prevent any form of biases appearing on the part of the investigators (Nuttall & Flores, 2007).
The literature review for the critiqued study has been done through secondary means, that is, the researchers relied on other previous works from numerous authors to lay the groundwork for the study, especially about the Hmong’s group traditional healthcare practices and perceptions about western health care.
By relying on previous studies conducted by other researchers, the facts that inform Hmong’s beliefs, attitudes, and perceptions, including limited exposure to western medical care, economic and communication barriers, overreliance on herbal remedies, unique cultural practices, and lack of trust in western health care professionals, among others, are brought into the fore (Nuttall & Flores, 2007). It is imperative to note that the literature review has been integrated into the study as background information intended to validate or disapprove the study findings.
In sample selection, the study under critique utilizes subjects who are inarguably living the phenomenon of interest. Although the study is primarily focused on traditional healthcare interventions among Hmong’s children, it is the parents who administer these interventions and it is the parents who make decisions not to take their sick children to conventional medical facilities.
As such, it can be argued that the tradition, values, attitudes, and beliefs about traditional health care and western health care interventions are firmly embedded in parents, who later transfer the values to children and relatives through socialization. In consequence, it can be safely argued that the sample, composed of Hmong parents, has been living the phenomenon of interest (Nuttall & Flores, 1997). These observations further reveal that the informants’ context within the phenomenon of interest has been identified.
It can be argued that the sample, selected through the convenience sampling method, is sufficient to tap all viewpoints relating to the phenomenon of interest since it is representative of the whole population of Hmong immigrants residing in central California. According to the 1990 U.S. census data, the population of Hmong immigrants residing in central California was 20,000, implying that the sample of 21 participants is sufficient to offer objective data on the phenomenon of interest (Nuttall & Flores, 1997).
The researchers “…informed parents of their rights as participants in this study, and assured them confidentiality” (Nuttall & Flores, 1997, p. 249). In addition, the investigators only included in the study the participants who were willing, of their own volition, to take part. As such, it can be argued that informed consent was obtained. However, the investigators did not seek IRB approval, which is mostly needed when the research entails studying human subjects (Holloway & Wheeler, 2002).
From the study methods and procedures, however, there are no apparent violations of human rights, especially when this is considered against the backdrop of the fact that the interviews were conducted by Hmong nursing students and were done in a language that could be well understood by the subjects.
Data Collection
Data sources for the critiqued article are the parents of Hmong children, and their demographic characteristics, including age, sex, marital status, religious affiliation, education, number of years lived in the U.S., and number of children, are well described (Nuttall & Flores, 2007). The review of literature is also well described.
The parents form the primary data source, while the review of related literature forms the secondary data source. It is indeed true that the informant’s consent to take part in this study is an integral part of the data collection process. The investigators not only made sure that participants were informed of their rights during the study, but were also categorical that the data collection process was to be limited to participants who were willing to take part.
Data Analysis
Qualitative data arising from the interviews were transcribed by the interviewers and content analysis was then used as the primary method of data analysis. Content analysis entails reading the interviews over and over again for content agreement and then constructing the summary records and recording the responses based on a valid conceptual framework (Holloway & Wheeler, 2002).
Here, it is important to note that the investigators borrowed largely from Neuman’s Systems Model to classify data aimed at describing the participants’ parenting practices. As implied in Neuman’s Model, prevention is the most important nursing intervention, and it revolves around curtailing the detrimental outcomes that may be initiated by various forms of stressors and the stress response (Nursing Theories, 2011).
Consequently, the investigators used Neuman’s model to classify arising data based on the following:
- primary prevention – practices that can be naturally prevented by the virtue of the fact that they strengthen the individual’s capacity to deal with various forms of stressors. Such practices include better nutrition, immunizations, health promotion, and maintenance of wellness;
- secondary prevention – practices aimed at treating common acute healthcare conditions to prevent damage to the central core. The practices, according to Nursing Theories (2011), operate by reinforcing internal lines of resistance in an individual or by removing the stress response; and
- tertiary prevention – healthcare practices aimed at availing assistance for chronic care and other innate complications. According to Nursing Theories (2011), tertiary prevention provides support to the patient and endeavors to add/reduce the energy required by the system to facilitate reconstitution.
Using Neuman’s Systems Model, the investigators can paint a clear picture of the reality and meaning expressed by the participants. Using the person variables included in the model, it is evident that the psychological, sociocultural, spiritual and developmental variables can be applied to describe the reality and meaning expressed by participants.
For instance, it can be observed that the open system (Hmong group) utilizes the psychological variable to extend their anti-trust for western healthcare practices, while the socio-cultural variable is used to bind the immigrants together in the use of traditional healthcare practices for the treatment of common childhood diseases rather than depending on western health care practices.
The spiritual variable has been used to describe the reality and meaning expressed by the subjects especially when evaluated against the background of the role of shamans, prayers, rituals, and other religious ceremonies to the broader aim of traditional health care delivery. In the literature review, the Hogs are described as a group that do not subscribe to conventional theories of individual development or phases of development, and that a child of 6 years is expected to behave as an adult.
In this perspective, the developmental variable in Neuman’s Systems Model is also well represented and to a large extent contributes to the understanding of the reality and meaning expressed by participants (Nursing Theories, 2011; Nuttall & Flores, 1997).
The critiqued study has done a good job in eliciting knowledge about multi-ethnic understanding and culturally-sensitive health care interventions in populations that to a large extent subscribe to traditional beliefs and traditional systems of health care delivery such as the Hmong. As such, the study is conclusive in as far as describing how the immigrants use traditional knowledge and beliefs to treat various forms of childhood illnesses, and how they perceive western healthcare practices.
Consequently, the sample is indeed the right one because the findings of the study have been able to offer conclusive answers to the basic research objectives, that is, describing Hmog’s traditional healing techniques, describing the main objectives of the healthcare practices used by the group, describing the group’s beliefs and attitudes regarding western medical care, and describing the group’s standpoint regarding western pediatric care (Nuttall & Flores, 1997).
It is indeed true that the relationships among all the concepts discussed in this study are either supported by primary data (interviews) or Secondary data (literature review). The parents explicitly discuss how they manage various childhood illnesses during the interviews, and their responses are largely supported by a comprehensive literature review done by the investigators. As such, it is safe to argue that all the concepts included in the study are supported by data.
It is also safe to suggest that it is untenable to know if the relationships make sense or the possibility of other relationships since the study largely involves describing traditional beliefs, values, and attitudes that are central to a particular group in terms of making health care decisions. Indeed, Holloway & Wheeler (2002) observe that it is hard to undertake studies aimed at evaluating some traditional beliefs and attitudes since such beliefs may not necessarily be united by reason or hard evidence.
The informants involved in the study have effectively validated the interpretations by the virtue of the fact that the interviews provide them with an opportunity to comprehensively describe their units of meaning and central themes needed to answer the key research objectives (Holloway & Wheeler, 2002). In equal measure, similar trends of how the Hmogs deal with their health issues have been effectively captured by other researchers in the literature review section, implying that other professionals have indeed confirmed the researchers’ interpretations.
Description of Findings
Examples of participants’ responses have been well provided to link the raw data to the investigator’s synthesis. In one particular example, a respondent reveals why they distrust western health care practices by giving an example that most western health professionals end up doing what they have not been asked to, and fail to do what they have been asked to do, hence causing more harm to children.
In consequence, the investigators synthesize lack of trust as one of the leading concerns as to why immigrant communities continue to disregard or ignore the more conventional healthcare practices (Nuttall & Flores, 1997).
The findings of this particular study are linked to existing theory and current literature. Indeed, the findings of this study have been categorized according to Neuman’s Systems Model on primary prevention, secondary prevention, and tertiary prevention (Nursing Ethics, 2011), and they also resonate well with the basic elements espoused in each of the model’s 3 categories. In primary prevention, for instance, the findings reveal that 13 of the 21 sampled participants favored immunizations as a way to prevent childhood illnesses.
This is in line with Neuman’s model, which postulates that primary prevention should aim to offer the system (individuals or groups) a better way of dealing with stressors. In the discussion section, the findings are linked to a wide range of studies that have been previously done by other researchers and incorporated in this particular study as a source of secondary data.
Reference List
Holloway, I., & Wheeler, S. (2002). Qualitative research in nursing. Hoboken, NJ: Wiley-Blackwell.
Nursing Theories. (2011). Application of Betty Neuman’s System Model. Web.
Nuttall, P., & Flores, F.C. (1997). Hmong healing practices used for common childhood illnesses. Pediatric Nursing, 23(3), 247-251.