Research for Evidence Based Practice

Quantitative Study

Quantitative Study

Tina Cherry

Walden University

Research for Evidence Based Practice: NURS-8201C

Dr. Revell

January 17, 2024

Quantitative Study

Quantitative Study

Transition of mental health service delivery to telepsychiatry in response to COVID-19: A

literature review by Li et al. (2022) ought to investigate the changes in face-to-face or, in other

words, in-person mental health service delivery to telepsychiatry in response to the coronavirus

Pandemic. During the first few weeks of March 2020, WHO declared the coronavirus a global

pandemic and put in place several measures, including social distancing, quarantine, or stay-at-

home measures disrupting the convectional traditional health service delivery. Li et al. conducted

a study to assess this transition by examining the perspective of both healthcare experts and

patients, offering valuable insight into the efficacy and the challenges of implementation of

telepsychiatry amid the COVID-19 Pandemic.

The study employs a comprehensive search strategy across three databases, PubMed,

PsycINFO, and Web of Science, to help identify pertinent literature that explores the transition to

telepsychiatry amid the Pandemic. The study included both quantitative and qualitative studies

focusing on the transition from healthcare to telepsychiatry. The study narrowed down to patients

aged 18 years and above with pre-existing mental illnesses published between 2020 and January

2021. Studies that examine the experiences or perspectives of healthcare experts and patients were

eliminated. Also, non-peer-reviewed articles were eliminated from the study. The study

encompasses a diverse range of participants from a broad demographic, offering a comprehensive

perspective. Seven thousand six hundred fifty-five7,655 pertinent items were selected for this and

comprised healthcare providers, patients, and patient proxies. Synthesis of results from these

studies offered a comprehensive understanding of the merits, hurdles, and overall satisfaction of

transitioning from convection mental healthcare delivery to telepsychiatry amid the Pandemic.

Strengths and Weakness of the Study

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The strength of the study includes various study designs with more focus on quantitative

design. The systematic search conducted across the major database and the inclusion/ exclusion

criteria bolsters the reliability of the study's findings. By employing this methodology, the study

warrants a diverse range of viewpoints, contributing to a better understanding of the transition to

telepsychiatry amid the Pandemic. The study's inclusion of a diverse demography of participants

where different age categories, genders, ethnicities, and locations are taken into account while

selecting the sample enhances the study's applicability and generalizability, enabling the

identification of possible variations in preferences and diverse experiences based on demographic

factors (Berndt, 2020).

The statistical analysis used in the study allows for an effective comparison of diverse

groups in the study. For instance, the use of Chi-square tests for categorical variables in the study,

like conversion rates, warrants a robust examination of differences seen between patients with

severe and non-severe mental illnesses. The Chi-square test yielded a non-significant result (χ2

(1) = 0.471, p = 0.492), indicating a thorough examination of the groups' transition to teletherapy

during COVID-19. The study also leveraged independent samples t-test to analyze mean

teletherapy sessions among the study sample, revealing a statistically significant difference as

shown in utilization rates between SMI and non-SMI patients where the mean was found to be

1.04, while the standard deviation was 1.42). This approach to statistical analysis allows for

accurate and quantifiable comprehension of the disparities in teletherapy usage amid the Pandemic.

The study's results and discussion reinforce findings from extant literature on

telepsychiatry pre-pandemic. In this study, the participants, and healthcare providers, expressed

satisfaction with the use of telepsychiatry, which corroborates findings from previous literature.

The consistency seen in these findings enhances the robustness and reliability of this study's

Quantitative Study

results. Therefore, showing that telepsychiatry is indeed a feasible and satisfactory mode of mental

health service delivery in today's healthcare landscape. Additionally, this study also offers insight

into the potential implementation of a hybrid model that combines convection in-person-person

and telepsychiatry, catering to patients limited by geographical barriers or morbidity issues.

Weaknesses of this study include the use of a smaller sample, as evidenced by a few

selected articles for review. Although the researchers employ rigorous inclusion and exclusion

criteria, fewer studies impact the generalization of the study findings and overlook diverse contexts

in which they have been successfully implemented. The study has a quantitative focus and lacks

qualitative depth. Although the study employs qualitative studies, the majority of the studies are

quantitative. Focus on the quantitative approach alone limits the depth of insight into the lived

experiences and perspective of the patient, especially in understanding the emotional responses

and those factors affecting the participant.

Another area for improvement is that the study lacks more representation from

interdisciplinary teams. Given the collaborative nature of mental health care, the lack of fair

representation from multidisciplinary teams limits the study's applicability to a broader healthcare

context; integrating perspectives from diverse healthcare professionals can bolster the study's

relevance and applicability.

Although the study employs chi-square tests to examine differences between the treatment

group and the control group, it is important to note that Chi-square presents numerous limitations.

One of the Chi-square limitations lies in its sensitive sample size, affecting the significance of the

study results (Shen et al., 2022). In this study, it is evident that the non-significant chi-square result

(χ2 (1) = 0.471, p = 0.492) is influenced by the small sample. Using a larger sample can enhance

the statistical significance seen between the two groups.

Quantitative Study

Furthermore, the t-test that has been used to compare mean teletherapy sessions also has

its drawbacks, especially in assuming homogeneity of variances as well as the normality of data

distribution. Considering that mental health data usually exhibit variability, relying on such

parametric assumptions may introduce significant bias. The non-parametric tests can be helpful in

providing a more precise representation of the distribution in this context. Another weakness

evident in this study is its use of cross-sectional design, which limits its ability to establish

causation relationships (Shen et al., 2022). To mitigate this weakness, it is recommended to use a

longitudinal design to provide researchers with a detailed understanding of changes over time,

reinforcing the study's internal cogency. Lastly the study focus on transition rather than

psychotherapy limits its scope.

Proposed Changes to Improve the Quality of the Study

The quality of the study can be enhanced by improving the sampling strategy to ensure that

there are more representative and diverse participants by considering other factors like socio-

economic status, ethnicity, culture, geographic location, as well as patient and healthcare expert

technological accessibility. This can be achieved, for instance, by implementing a stratified

sampling approach to aid in capturing diverse demographic aspects and participant’s varying levels

of technological access and proficiency. By introducing these changes, it is possible to enhance

the generalizability of study findings and be able to account for the potential impact of these

variables on user telepsychiatry experiences (Singh & Masuku, 2014).

The scope of the study should be expanded to include the psychotherapeutic facet of mental

health services. For instance, the study should focus on psychotherapeutic aspects of

telepsychiatry. This can entail assessing the efficacy of psychotherapy delivered via telepsychiatry

Quantitative Study

and gaining insights into patient experiences, as well as identifying potential challenges that are

unique to this kind of treatment model.

The study should be adjusted to explore the viability and merits of implementing a hybrid

model that combines the convectional face-to-face psychiatric healthcare delivery and

contemporary telepsychiatry services based on users of participant preferences, needs, and

conveniences. This can be achieved, for instance, by conducting focus groups or interviews to

understand participants' needs and preferences regarding the integration of traditional mental

healthcare delivery and telepsychiatry services. Specifically, I would recommend that the study

introduces a pilot study to assess the efficacy of the hybrid model on patient satisfaction and

treatment outcomes.

Implication of the Study for Nursing Practice

The findings of this study support the integration of telepsychiatry into nursing practice by

emphasizing the efficacy of this emerging form of mental healthcare delivery. Nurse practitioners,

particularly those in telehealth roles, can use the evidence presented in this study to champion the

implementation of telehealth services in healthcare delivery models. As we continue to witness

tremendous growth in technology and people become more inclined to tech-savvy services, this

study calls for nursing professionals to embrace technology. Furthermore, amid the proliferation

of emerging state-of-the-art technology, it provides accessible and efficient service delivery to

individuals with mental health issues.

Professional Development

As telepsychiatry increasingly becomes part of the healthcare delivery model, this study's

findings suggest the need for training and equipping nurses to deliver mental health services to this

program. Training programs should be tailored to equip nurses with the crucial skills and expertise

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needed to navigate the complexities of this technology and make them more confident in delivering

care via traditional and virtual models.

Advocacy for Policy Changes

The study finding provides a platform for advocating for policy change in the healthcare

sector. The nursing profession can use the findings of this study to influence policy changes. This

means that Nure can use this evidence to support the formulation of laws and regulations that allow

for telehealth innovations like remote patient monitoring and store-and-forward technology. With

advancements in technology and possible occurrences of a pandemic similar to the Covid-19

pandemic, Telehealth services should be made mandatory in the healthcare industry to enable

patients who want to access mental healthcare services. Existing laws do not allow this, and certain

laws in the US do not allow healthcare providers to help patients (Cowan et al., 2019). This study's

findings show that telepsychiatry, especially amid crisis times, can help enhance healthcare

delivery at a low cost. Using this evidence, nurses can advocate for policy changes to increase the

adoption of telepsychiatry in the healthcare context. Additionally, the findings can help support

the move to permanently end geographic and site restrictions to expand the definition of

telepsychiatry telemedicine and include audio and video services.

Quantitative Study

References

Berndt, A. E. (2020). Sampling methods. Journal of Human Lactation, 36(2), 224-226.

Cowan, K. E., McKean, A. J., Gentry, M. T., & Hilty, D. M. (2019, December). Barriers to use of

telepsychiatry: clinicians as gatekeepers. In Mayo Clinic Proceedings (Vol. 94, No. 12, pp.

2510-2523). Elsevier.

Li, H., Glecia, A., Kent-Wilkinson, A., Leidl, D., Kleib, M., & Risling, T. (2022). Transition of

mental health service delivery to telepsychiatry in response to COVID-19: A literature

review. Psychiatric quarterly, 93(1), 181-197.

Shen, C., Panda, S., & Vogelstein, J. T. (2022). The chi-square test of distance correlation. Journal

of Computational and Graphical Statistics, 31(1), 254-262.

Singh, A. S., & Masuku, M. B. (2014). Sampling techniques & determination of sample size in

applied statistics research: An overview. International Journal of economics, commerce

and management, 2(11), 1-22.