Nursing

In the Health Sciences, you will need to critically appraise articles.

Critical appraisal is the process of careful & systematic examination of research to judge its trustworthiness, validity, reliability, value, & relevance to a particular context.

The Evidence Pyramid depicts the hierarchy of literature related to the strength of the evidence.

Text alternative to Evidence Pyramid graphic

When finding sources to answer/support your PICO question, you will want the best evidence available for your topic. However, your assignment's directions can overrule this, use the sources that follow your assignment's directions.

There are many different types of study designs. To determine the design of the study in an article, you need to find specific information about the study in the article. Look for this information in two places.

• First, look at the title of the article. Often the authors will include the study design in the title or subtitle of the article.
• Next, look at the methods section of the article. The first sentences of the initial paragraph in the methods section usually describe the study design. 
• If there is no methods section to the paper, it is not a study.
• If the methods section describes searching for published literature, it is a review study. 

Now that you have located the methods section with the information you need to determine the study's design, the first step is to determine if the study is analytic or non-analytic/descriptive.

• Analytic studies attempt to quantify relationships between two factors. 
• Non-analytic or descriptive studies attempt to describe what is happening in a population. Descriptive studies include case reports, case series, qualitative studies, and surveys (cross-sectional) studies.

Follow these questions about the study to determine the study design subgroup. 

1.       Did the investigator assign exposures/interventions?

a.       Yes: Experimental Study, go to 2

b.       No: Observational Study, go to 3

2.       Experimental Study – Is there a random allocation of the exposure/intervention?

a.       Yes: the study is a randomized control trial

b.       No: the study is a non-randomized control trial

3.       Observational Study –  Is a comparison group included?

a.       Yes: Analytical Study, go to 4

b.       No: the study is a descriptive study

4.       Analytical Study – Which direction?

a.       Exposure to outcome: the study is a cohort study (also called a prospective study)

b.       Outcome to exposure: the study is a case-control study

c.       Exposure and outcome at the same time: the study is a cross-sectional study or survey

The Study Designs link below leads to more information about each study type and a decision tree chart for determining the design of the study. 

References

Centre for Evidence-Based Medicine (n.d.) Study designs. https://www.cebm.ox.ac.uk/resources/ebm-tools/study-designs

Howick, J. (2013). Introduction to study design. Centre for Evidence-Based Medicine.https://www.cebm.ox.ac.uk/files/testing/cebm-study-design-april-20131.pdf )

If you want to use information from a website, use the SIFT process to evaluate if the information is reliable.

Stop = Pause and ask yourself if you know about the reputation of the site or author before reading it (or sharing it). Also, stopping periodically throughout the process will help you reflect and reevaluate your strategy.

Investigate the source = know about what you are reading before your read it. Take one minute to investigate the author (do they have the expertise or credentials to be an authority on this topic?) and the publisher (are they reputable? what is their agenda?).

• To learn about the author, do a quick Google search. Many researchers will have a webpage about them on their institution's website.

• You can often find information about the publisher in the "About" section of the website. Or you can do a quick Google search to read about what others have written about them.

Find better coverage = if you want to know if a claim is true or false, look to other resources that are authorities on the topic. Look to groups, organizations, agencies, and government departments that would be an authority on this topic. 

Trace claims = go back to the original source and see if the claim is accurately presented. By reading the claim in the original context you can decide if the information was taken out of context or not in the source.

Mike Caufield's Web Literacy for Student Fact-Checkers...and Other People Who Care About Facts is the publication that introduced SIFT also called the "Four Moves and a Habit" process. The ebook can be accessed with the link below.

If you are finding health information on websites, make sure you are evaluating it to make sure you are using good information. Follow the steps outlined in "Find Good Health Information" linked below.

Evidence Pyramid

The Evidence Pyramid is an illustration of a pyramid, separated into layers representing different levels of evidence. An arrow pointing upwards towards the point from the base is labelled "quality of evidence."

The green bottom level of the pyramid is labelled "Background Information/Expert Opinion."

The orange level second from bottom is labelled "Case Controlled Studies Case Series/Reports."

The pink level third from bottom is labelled "Cohort Studies."

The light blue level fourth from bottom is labelled "Randomized Controlled Trials (RCTs)."

Case Controlled Studies, Cohort Studies, and Randomized Controlled Trails are all labelled together as "Unfiltered Information."

The aqua level third from the top is labelled "Critically Appraised Individual Articles [Article Synopses]."

The yellow level second from the top is labelled "Critically Appraised Topics [Evidence Syntheses]."

The top light pink level is labelled "Systematic Reviews."

Critically Appraised Individual Articles, Critically Appraised topics, and Systematic Reviews are all labelled together as "Filtered Information."

All layers except the lowermost Background Information/Expert Opinion have the label "TRIP database searches for these simultaneously."