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Statistics multiple Read Joanne Hardy’s Guidelines on
choice questionnaire practice profile on how to write a
pre-operative assessment practice profile

Understanding quantitative
research: part 1
NS673 Hoe J, Hoare Z (2012) Understanding quantitative research: part 1.
Nursing Standard. 27, 15-17, 52-57. Date of acceptance: March 2 2012.

Aims and intended learning outcomes

Abstract
This article, which is the first in a two-part series, provides an introduction
to understanding quantitative research, basic statistics and terminology
used in research articles. Critical appraisal of research articles is essential
to ensure that nurses remain up to date with evidence-based practice
to provide consistent and high-quality nursing care. This article focuses
on developing critical appraisal skills and understanding the use and
implications of different quantitative approaches to research. Part two
of this article will focus on explaining common statistical terms and the
presentation of statistical data in quantitative research.
Authors
Juanita Hoe
Senior clinical research associate, Research Department of Mental Health
Sciences, University College London, London.
Zoë Hoare
Clinical trials statistician, Bangor University, Bangor.
Correspondence to: j.hoe@ucl.ac.uk
Keywords
Evidence-based practice, quantitative research, statistics, study design
Review
All articles are subject to external double-blind peer review and checked
for plagiarism using automated software.
Online
Guidelines on writing for publication are available at
www.nursing-standard.co.uk. For related articles visit the archive and
search using the keywords above.
This article aims to provide information to nurses
who are attempting to appraise and review
quantitative research articles critically. The
broad nature of research means it is not possible
to cover all aspects of research methodology in
detail, however the article can help nurses gain a
better understanding of quantitative research and
the principles that underpin it. After reading this
article and completing the time out activities you
should be able to:
Acknowledge
 the importance of identifying,
appraising and understanding quantitative
research evidence.
Identify
 key questions for appraising research
evidence critically.
Recognise
 and identify the common
quantitative research methods used within
different studies.
Appraise
 and evaluate the limitations of
quantitative research evidence from a range
of sources.
Develop
 evidence-based knowledge relevant
to your area of practice.
Introduction
At a time of considerable advances in medical
and nursing practice, it is important that
healthcare professionals stay abreast of the
changes (Department of Health (DH) 1997,
2008). The Code (Nursing and Midwifery
Council (NMC) 2008) states that nurses need
to provide a high standard of care at all times.
Nurses also need to ensure that their skills
and knowledge reflect evidence-based practice
(NMC 2008). The ability of nurses to use or
undertake research is therefore essential, not

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 only in promoting best practice, but also in
establishing nurses as competent, autonomous,
highly skilled and knowledgeable professionals
(Salvage 1998, Godshall 2009). The impetus
for nurses to use research skills to implement
evidence-based practice is not new and the
ability to ‘think, apply, analyse, synthesise and
evaluate’ are fundamental skills that nurses
should possess (Elliot 1995).
It has been argued that evidence-based nursing
offers a prescriptive approach to nursing practice,
whereas in reality it allows nurses to decide how
relevant the evidence is to practice and to patients
(DiCenso et al 1998, Godshall 2009). Clinical
decision making should be underpinned by an
understanding of the evidence; it should not,
however, replace clinical judgement – what is
right for the patient – and may need to be adapted
to accommodate patient choices and preferences.
Rycroft-Malone et al (2004) recommended
that evidence-based practice should be based on
research, clinical experience, patient and carer
knowledge, and the environment in which care
is applied. Moreover, patients now have greater
access to information and research evidence
(DH 2008), particularly through the media and
internet. Nurses are in a prime position to help
explain and interpret what the evidence means,
whether it is valid and relevant, and how it can
be integrated into care. Evidence-based practice
is viewed as the ‘integration of best research
evidence with clinical expertise and patient
values’ (Sackett et al 2000).
Improvements in clinical judgement can
only be achieved by developing abilities in
deliberate reasoning (logical and reflective
thinking) and analytical skill (Paniagua 1995,
Benner et al 2009). Advances in medical and
nursing research and technology, as well as the
need to stay abreast of current evidence and
best practice, may be daunting for some, but
are vital to ensure best practice. It is important
that nurses do not feel discouraged from
developing and using critical appraisal skills.
Only by using and practising such skills will
nurses become more familiar with quantitative
research methodology and outcomes, and
develop the skills necessary to assess the
quality of published evidence and its relevance
to nursing practice.
Critical appraisal
Nurses may not be in a position to be
involved in research studies or undertake
research themselves. They do, however,
have the capacity to make sense of published
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evidence through appraisal of the literature.
Critical appraisal is the process of examining
systematically a research article to assess its
validity – whether the study measures what is
says it measures – results and relevance before
using the evidence to inform decision making
(Burls 2009). It is the process of assessing the
facts presented and the quality of the study to
determine best evidence (Fowkes and Fulton
1991, Burls 2009). Nurses should, however,
be aware that not all published studies are of
a good quality and that research may be poorly
reported, weak in design or flawed (Greenhalgh
1997, Churchill 1998, Godshall 2009).
Critical appraisal is therefore a fundamental
component of establishing evidence-based
practice. Sackett et al (1996) suggested that
critical appraisal of the best available and
clinically relevant information is essential
for designing and developing new research,
and integrating it with clinical expertise to
implement evidence-based practice. Nurses
should be able to use their critical appraisal
skills to decide whether the quality of the
research evidence is sufficient to underpin their
practice or whether the evidence is flawed.
Most published research articles go through
a peer-review process, where the credibility of
the article has been assessed by experts from
within the area in which the research was
carried out. The purpose of critiquing is to
analyse a research article, identifying flaws,
evidence of bias or other factors that might have
affected the results and how this, in turn, might
affect the findings or outcome (Godshall 2009).
Complete time out activity 1
Assessing quality
Greenhalgh (1997) identified three key
questions for assessing the methodological
quality of a research article:
Why
 was the study done and what clinical
question were the authors addressing?
What
 type of study was undertaken?
Was
 the study design appropriate for
1 Think about an area
of practice that you
the research?
know is evidence-based.
Nurses need to determine the relevance of
Can you identify where
the evidence to their patient population by
that evidence came
considering whether the results of the study
from? Was the evidence
are valid – whether the authors of the study
established from a
measured what they were supposed to measure
– and how the results can be applied to their
single piece of research
or from several studies?
clinical area (Jaeschke et al 1994). To help
Has any additional or
assess the validity of the research, nurses may
recent evidence been
find it useful to use a checklist that asks key
published in that area?
questions, such as:
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 Learning zone statistics
Is the study of interest?
Who
 are the subjects and how were they
recruited?
How
 accurate is the data collected?
 the measures used valid and reliable?
Are
 the statistical methods used appropriate
Are
and performed properly?
What
 did the study find?
What
 are the implications of the study?
There are several online resources available
to help develop skills in critical appraisal and
literature searching, and several journal articles
offer frameworks of questions for assessing
the quality of research studies (Jaeschke et al
1994, Greenhalgh 1997, Greenhalgh and
Taylor 1997, Churchill 1998, Morton and
Morton 2003, Solutions for Public Health
2012). Nurses are also encouraged to attend
workshops on how to conduct database
searches to ensure access to the most recently
published literature.
Complete time out activity 2
Structure of a research article
Published research articles generally consist
of a standardised layout. This includes
(Greenhalgh 1997):
Abstract
 – the abstract summarises the main
points of the study design, its aim, how the
research was undertaken and key findings
from the research.
Introduction
 – the introduction provides
a comprehensive overview of research
previously undertaken in the area of interest
and specifies why this particular piece of
research is needed. It should be noted that
the background information may be brief at
times, particularly where authors are limited
by word count.
Method
 – the method section should begin
with a description of the aims and objectives
of the study and the hypothesis (research
question) that the study intends to answer.
This is followed by a description of the study
design and the sample population, such as
how many participants were needed and
how they were recruited to the study, and
if applicable the randomisation procedures
followed. Where relevant, a description of
the planned intervention should be given,
and any procedures that were followed for
the recruitment of participants, applying
measures, providing interventions and
collecting data should be outlined. This
is necessary to ensure that the study can
be replicated elsewhere. The primary
54 december 12 :: vol 27 no 15-17 :: 2012
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and secondary outcomes that are being
measured should be identified as well as
the tools (assessments or scales) used to
determine this, with brief reference to their
acceptability, validity and reliability. Scales
are known to measure what they should
measure and this can be done consistently
and without any adverse effects, such as
causing increased burden or distress to
participants. Any ethical issues and details of
who gave permission for the research to be
undertaken should be detailed.
Analysis
 – the analysis should describe the
steps taken to analyse the data collected and
justification for the statistical tests applied.
Results
 – the results should include details
of the number of people completing the
study, with an explanation for those that
did not complete the study. Demographic
information, such as age, gender, ethnicity,
living area, education and income should
be provided for the sample population. This
helps to determine whether the results are
generalisable to the wider population or
limited in their application. Descriptive and
comparative data may be presented alongside
figures or tables that help to illustrate any
significant results.
Discussion
 – the discussion covers key
findings of the research, interpreting
their usefulness for clinical practice and
implications for future research. There should
also be a comparison of the findings to other
similar research studies, as this demonstrates
how the findings fit with existing research and
builds on the evidence. The authors should
also reflect critically on the limitations of the
study and any conclusions drawn should be
justifiable and relevant to the results given.
Conclusion
 – the conclusion restates the
aims of the research study and provides a
summary of the main points. This should
include a statement about the significance of
the research and how it can be applied or is
useful to practice.
Complete time out activity 3
Research study design
There are two main approaches to research:
qualitative and quantitative. Qualitative
techniques are used to explore new topics and
understanding of the human experience by
making sense of or interpreting phenomena
in terms of the meanings people bring to them
(Greenhalgh and Taylor 1997, Bowling 2002).
It is a rich source of data and examples of
© NURSING STANDARD / RCN PUBLISHING
10/12/2012 10:59
 such research include focus groups, in-depth
interviews and narrative inquiry (Polit and
Hungler 1995, Greenhalgh and Taylor 1997,
Bowling 2002). Qualitative data can be used
to generate ideas (theory) or hypotheses, which
may then be addressed using quantitative
methods (Polit and Hungler 1995).
Quantitative techniques are used to test
hypotheses, determine causation (relationships)
between variables (characteristics or values that
can be changed) and measure the frequency
(number) of observations (Fowkes and Fulton
1991, Greenhalgh 1997, Bowling 2002).
Quantitative data can be counted or measured
and examples of such methods include clinical
trials, surveys and cohort studies.
Quantitative methods have traditionally
been considered more rigorous than qualitative
methods, with randomised controlled trials
(RCTs) and systematic reviews being the ‘gold
standard’ for determining evidence (Sackett
et al 2000). There is an established ranking or
hierarchy of evidence for assessing the quality
and robustness of methodological approaches
(Evans 2003), but quantitative and qualitative
methods are both considered valid and
complementary when applied correctly, and
may also be integrated (Bowling 2002).
Research in nursing has focused largely
on qualitative approaches, although there is
now a move towards using mixed methods,
which combine qualitative and quantitative
approaches. As it is beyond the scope of this
article to describe the range of qualitative and
quantitative research methods, the article
focuses on common quantitative research
methods. Qualitative approaches to research
are dealt with elsewhere within the nursing
literature (Ploeg 1999, Holloway and Wheeler
2010, Streubert and Carpenter 2010).
Quantitative approaches
The hierarchy of evidence (weighting of the
strength of the evidence) for quantitative
approaches is generally recognised as set out
below. As previously indicated, systematic
reviews and RCTs are considered the gold
standard for determining evidence.
Systematic reviews
Systematic reviews provide an overview of the
evidence relating to a specific research question
by combining data from existing or primary
research, usually published RCTs. Where RCTs
are unavailable, observational studies such as
controlled before and after or interrupted time
© NURSING STANDARD / RCN PUBLISHING
p52-57w15-17.indd 55
series (where outcomes are measured at specific
points in the study) may be included, and the
evidence may also be informed by the findings
of qualitative studies.
The quality of the studies included in the
review is assessed systematically. Where
possible a meta-analysis is carried out in
which numerical data from two or more
clinical studies is pooled and a weighted
average calculated. Systematic reviews and
meta-analysis are used to determine the
effectiveness of healthcare interventions. An
example of a systematic review is Moore and
Cowman’s (2008) review of risk assessment
tools for the prevention of pressure ulcers.
Randomised controlled trials
RCTs are experimental studies that are used to
test the effectiveness of interventions between
two or more groups, usually an intervention
and a control (non-intervention or placebo)
group. Participants are randomly allocated
to a group and the intervention is delivered
under tightly controlled conditions to avoid
systematic errors (bias) and random errors
(chance). The study participants and/or
those undertaking the research assessments
may be blinded (single-blind where either
the participant or the researcher is unaware
to which group the participant has been
randomly allocated, or double-blind where
the participant and researcher are unaware of
the allocation), where information about who
is and who is not receiving the intervention
is concealed until the trial is complete. Data
are usually collected before and after the
intervention and differences in outcome
examined between the groups. An example
of an RCT is Kataoka et al’s (2010) study
comparing the use of self-administered
questionnaires versus interview as a screening
method for intimate partner violence in the
prenatal setting in Japan.
Cohort studies 2 Make a list of
Longitudinal or cohort studies are the main differences
observational studies of people with common between quantitative
characteristics or experiences and are used and qualitative research.
to determine the prognosis and progress
of disease over time, from its early to late 3 Read the article
stages. Data are collected at two or more by Kataoka et al
points over a particular period, usually of (2010) and answer the
several years duration. An example of a checklist questions in
cohort study is Mueller et al’s (2010) study of the ‘Assessing quality’
patient functioning as a predictor of nursing section to assess the
workload in acute hospital units providing validity of the research.
rehabilitation care.
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 Learning zone statistics
Non-randomised trials
Uncontrolled or non-randomised trials are
used when randomisation is not possible or
is unethical. The results of non-randomised
or uncontrolled trials may be considered less
reliable as there is an increased risk for errors
affecting the outcome of the trial. An example
of a non-randomised trial is Lam et al’s (2010)
study of mental health first aid training for
the Chinese community in Australia, which
examined the effects of such training on
knowledge about and attitudes towards people
with mental illness
Case-control studies
Case-control studies focus on people with a
specific diagnosis or disease, who are matched
with people who do not have the disease (the
controls). Data are collected on the two groups
and compared to explore what differences
exist between the groups and identify any
characteristics that may be contributing to the
disease. An example of a case-control study is
Lazovich et al’s (2010) study of indoor tanning
and risk of melanoma.
Cross-sectional surveys
Cross-sectional surveys are used to determine
the frequency of disease or diagnosis (screening),
risk factors or other phenomenon, such as
events, behaviour and attitudes, at one point
in time. Although methodologically weak,
cross-sectional surveys can be used to explore
causal relationships (cause and effect) between
variables. An example of a cross-sectional
survey is Aung et al’s (2010) study of access to
and use of GP services among Burmese migrants
in London.
4 Identify a relevant Case studies
area in your clinical Case series and case studies are descriptive
practice that would be in nature and are used to determine factors
of interest to research. contributing to the development of an illness.
What would be your Case studies are considered the weakest level
research question? of evidence, but are useful in the early stages
What quantitative of research about a particular disease. An
example of a case study is Chaboyer et al’s
research methods do
you think you could (2010) study of bedside nursing handover.
use to investigate this Complete time out activity 4
area of practice? What
outcomes would you
Ethics
measure? What support
is available in your Consideration must be given to the ethical
clinical area to help you implications of the research being undertaken.
undertake a research Any health-related research project involving
study? humans, their tissue and/or data must be
reviewed and approved by a research ethics
56 december 12 :: vol 27 no 15-17 :: 2012
p52-57w15-17.indd 56
committee before it can start. The
research ethics committee will review
the research protocol and other project
documents to ensure that the dignity,
rights, safety and wellbeing of research
participants is protected. Of particular
concern are issues related to participants’
capacity to consent to take part in the
research study, maintaining confidentiality,
and data management and storage.
Stringent guidance is provided by the
Research Governance Framework for
Health and Social Care (DH 2005), which
supports undertaking good quality studies
and promotes good clinical practice within
research. The Mental Capacity Act 2007
also provides guidance on the inclusion of
vulnerable adults in research, such as people
with a learning disability or patients with
dementia, who may not have the capacity
to consent to their participation.
Results
The results are an important part of
a quantitative study as they provide
information on the amount of data collected
and the outcome of the statistical analyses
performed. The results reported can be
particularly difficult to follow and may
be open to misinterpretation if the data
are not reported accurately and clearly.
The credibility of the research undertaken
is based on the thoroughness of the data
reported, appropriateness of the statistical
tests performed and accurate interpretation
of the findings. Researchers conducting good
quality clinical studies will have sought advice
and assistance from a qualified statistician
in planning and undertaking the analysis,
and there should be justification given for the
analysis used. The statistical analysis used
should be relevant to the design of the research
proposed and the research question stated.
Conclusion
Staying abreast of developments in health
care, and using this knowledge to inform and
improve patient care, can be both challenging
and rewarding for nursing staff. Key to
this is having good critical appraisal skills
and an understanding of quantitative and
qualitative research design and methodological
approaches. While research terminology is not
always easy to comprehend, it does become
easier to understand with familiarity. The
© NURSING STANDARD / RCN PUBLISHING
10/12/2012 10:59
 broad scope of this subject means it is not nursing practice. Nurses have a leading role in
possible to incorporate all aspects of research establishing this evidence base, as well as being
design, but this article provides an overview central to the implementation of improvements
of the key factors relevant for assessing the in practice across care settings.
methodological quality of quantitative research Part two of this article will focus on
articles and interpreting their findings. explaining common statistical terms and
5 Now that you have
The evidence base for nursing care and the presentation of statistical data in
completed the article,
interventions is expanding and this is an quantitative research NS
you might like to write
exciting and challenging time for advancing Complete time out activity 5
a practice profile.
Guidelines to help you
are on page 60.

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