Critical Appraisal Related to Internal Validity
The study presented in the article used smokers who were not ready to quit as the patient population. The intervention involved the use of three treatments for comparison purposes, including motivational interviewing, health education, or Brief advice. The researcher compared the efficacy of the three interventions as a source of motivation to quit smoking. The results revealed Motivational Interviewing as being effective compared to brief advice, but health education was the most efficacious.
First, the participants were randomly placed in different treatment groups, Motivational Interviewing, health education, or brief advice. The researcher used the ratio of 2:2:1 in allocating the participants. Randomization affected bias in this study. Randomized trials are less prone to bias. However, other factors affect biasness, including if the participants were not blinded to their participation in the study. However, in the study, while it was not possible to blind the counselors, participants were not given any information about their assignment to the different treatment groups. Therefore, the randomization of the participants together with blinding allowed the researchers to prevent biasness.
Worth noting is that the groups were similar but not equivalent at the beginning of the study. The participants, all smokers, were recruited from November 2010 to November 2011. The selection criteria included those who smoked at least one cigarette per day, not using any cessation medication, and cessation plans in the next seven days. However, they were placed in the three treatment groups at a ratio of 2:2:1. The researchers made the groups similar by using the same criteria for the participants in the three groups. The consideration was critical in preventing any form of bias in the study. Therefore, the researchers would avoid the effect on the internal validity by ensuring that the participants in the three treatment groups were similar in characteristics.
Besides the allocated treatment, the groups were treated equally. For instance, the participants were not given any information regarding their allocation to the different groups. In addition, the allocation was done using a predetermined computer-generated randomization sequence. Hence, besides the differences in the interventions, the participants received similar treatment. Therefore, the similar treatment of the groups is another important factor in preventing bias. The researcher was not biased in the allocation of the participants and their treatment during the research process, an approach that ensures objectivity.
During the actual participation, the researcher enrolled 255 participants at the beginning of the study. They were allocated to the different groups in the ratio of 2:2:1. These participants were accounted in the sample and the data analysis (Motivational Interviewing (n=102), health education (n=102), and brief advice (n=51). The participants were analyzed in the groups where they were initially randomized. The researchers wanted to compare the efficacy of the three treatment interventions. Thus, it was critical to analyze them depending on the treatment they received. The presence of a suitable analysis in the respective groups allows the researcher to avoid any form of bias. The researcher gets objective results by ensuring that the participants remain in the group they were originally assigned.
On the other hand, the researcher used blinding for the participants, but it was not possible to achieve the same with the counselors. In this approach, the participants did not have any prior information on the treatment procedures used in the study. However, the counselors were informed on the same, including the approach and the procedure of the treatment. It is important to note that blinding plays an important role in preventing bias. At the level of the participants, the researcher avoided any form of bias, while the counselors could be biased because of the having prior knowledge about the procedures. However, to a large extent, the researcher maintained objectivity.
The researchers used self-report to collect information from the participants, especially their smoking history and cessation motivation. Such instruments do not guarantee the reliability and validity due to issues associated with internal consistency, precision in analysis, content validity of self-report measures, and empirical validity. The self-report is not always the actual representation of the status of the participants. The statistical data analysis was appropriate for the findings for an RCT. The researcher used the ANOVA in analyzing continuous variables and chi-square tests for categorical variables. RCTs are aimed at testing treatments without bias by collecting and analyzing data from two groups, control and experimental. The data for the current study was collected and analyzed using valid research methods to avoid bias. As a result, the statistical methods present strong findings of the randomized controlled trial.
The study made a rigorous comparison between three interventions to support smoking cessation among individuals with low motivation to quit. The sample was adequate to provide reliable findings from the analysis. The findings are consistent with previous studies that evaluated the efficacy of motivational interviewing in promoting the motivation to quit smoking or other negative behaviors. The study also used intensive treatment for a suitable period to gain positive results. However, the findings countered the assumption that motivational interviewing is the most effective method of supporting quitting intentions.
The findings apply to practice in supporting behavior change such as intentions to quit smoking. However, motivational interviewing should not be used as the default intervention since the study revealed health education to be more effective. The results indicate the potential for blending the effective interventions for the best possible outcome in supporting smoking cessation. Hence, more research is critical to inform the need for changes in the Clinical Treatment Guideline recommendation to use MI to induce quit attempts.
Furthermore, the results of the study are generalizable to the patients and other similar settings where behavior change such as smoking cessation is required. Therefore, the interventions can be used in treating patients who have low motivation to quit smoking. My patients are not much different from the study participants. They are completely hooked up to tobacco smoking and show no intentions to stop. The treatment is feasible in my setting since it includes interventions in helping such people to see the positive implications of quitting the negative behavior to protect their health.
As it is evident from the critical appraisal related to internal validity, the findings reveal the most effective intervention or a combination of treatments to achieve the best results. Therefore, the potential benefits are more than the negative effects of treating the patients. Smoking has many negative health consequences that can be prevented through the smoking cessation process. On the contrary, quitting is not easy since it creates temporary psychological challenges before one becomes accustomed to the acquired behavior. However, the health benefits outweigh the short-term side effects.