Limitations and Delimitations. Due to the ongoing COVID-19 pandemic, we were not able to recruit, nor perform interviews in person. Additionally, during the pandemic it was difficult to get respondents during the study recruitment period. Due to the limitations on recruiting in person and low response rate through emailing organizations, social media was the primary recruitment method. A meta-analysis on the use of social media for recruiting participants into studies found evidence that it can be the best recruitment method for observational studies and for individuals within specific groups and with specific conditions (Xxxxxxxxx-Xxxxxx & Xxxxxxxxx, 2016). We also found using Facebook and Instagram ads was an effective recruitment strategy for our specific population and age group (Xxxxxxxxx-Xxxxxx & Natarajan, 2016). There may be limitations to the results since the population sampled from mainly consisted of users of Facebook and Instagram. The people selected were known to have internet use, since they were using some form of social media, there may be skewed telehealth connectivity results. Due to the retrospective nature of the data gather, there may be potential recall bias. There is always a possibility that participants willing to participate are different than the general population, but this is hard for researchers to mitigate. The risk level of COVID-19 may differ among patients, however, from what was gathered from the respondents, they all had the same basic COVID-19 safety protocols implemented within their care locations. We were limited to using Zoom for our interviews because of the pandemic, which may have altered the interactions between interviewer and interviewee, but also may have made the interviews more accessible for participants. We did not accurately access ethnicity since we paired it with race and respondents mainly chose their race without choosing the ethnicity, so only race can be compared but not ethnicities within the results and conclusion. The study did not have the ability or resources to create the online consent, screener, or interviews in languages other than English, so this non-English speaking population is omitted from the study and language proficiency is not a consideration for this study in the satisfaction of perinatal telehealth services. The study aimed to have equal number of rural and urban in-depth interview participants, but by using the Atlanta Regional Commission definition of what classifies a county as urban and rural, our inte...
Limitations and Delimitations. Due to time and human resource constraints, there were several limitations to this program assessment. First, the curriculum was not delivered on the intended bi-monthly schedule, and instead was condensed into a three-week workshop. This may have contributed to participant fatigue that may have influenced participant engagement in some sessions. Again, due to limited time, we were unable to pilot the final session of the curriculum and as such no data was collected for the acceptability or improvement of this session. The first curriculum session was piloted among mothers from Cohort 2 only. Because of this variation in population and methodology, assessment data from this session was excluded from this analysis. Under ideal circumstances, each session would have had a designated facilitator from SWEAT staff so that they could familiarize themselves with the preparation and delivery of the curriculum materials, in addition to an external observer to record detailed notes on the timing of activities, challenges and topics generating the most interest. However, because members of the Mothers for the Future team had to complete their regularly scheduled responsibilities in addition to attending the workshop, this was not possible. As a solution to these constraints, I functioned as the primary facilitator, interviewer, focus group moderator, and survey administrator. My dual roles in workshop facilitation and data collection may have influenced participants to respond to questions more favorably. My position as an outsider to the community may have further influenced participants’ behaviors throughout the workshop or responses elicited through data collection. Because the Mothers for the Future team thought it would be beneficial for mothers from both the “core group” and Cohort 2 to participate in the assessment, the group size was also larger than had been anticipated when the sessions were developed. This may have, at times, impacted the ability of all participants to fully engage during all sessions and therefore effectiveness of the activities. Additionally, the larger group may have created unanticipated challenges to completing certain activities that may not have occurred under ideal circumstances. CHAPTER 4: RESULTS Program participants provided feedback on the curriculum across various data sources (focus group discussions, open-ended survey responses, and as described through facilitator field notes). Findings are presented below in two sections t...
Limitations and Delimitations. To begin with, while the interview guide was deemed adequate by the research team and was revised after the initial interviews, the data collected, while rich in parts, is considerably thin. This is perhaps due to cultural nuances at play, the use of an interpreter, the dynamics of having an outsider interviewer, and the probing skills (or lack thereof) of the interviewer. The goal of the study was to interview three to four mothers from each of the five postnatal periods, resulting in 15 to 20 interviews, an amount recommended to reach saturation, but only 13 interviews were garnered thus limiting the potential of the data. However, after data analysis, it was determined that saturation was in fact reached despite the low number of interviews conducted. Also, the distribution among the comparison groups varies. While the goal of at least three interviews were met for some postnatal periods, as mentioned previously, only two interviews from the three month- and one interview from the nine month postnatal period were obtained. This affects the outcome of the comparison groups, especially with but one representative from the nine month group. Also, originally, it was planned to interview puerperal women within one to two weeks of having delivered but due to certain constraints such as transportation, the availability of a trained interpreter, and the sheer lack of babies within that age group, the inclusion criteria was expanded to include one month old infants. Another limitation to the study was the setting. While 11 interviews took place in a health clinic or health post, two of the interviews took place in the participants‘ homes. On both occasions, other family members, including the husbands, were present, which may have influenced the responses given by the participants. In addition, the use of interpreters greatly affected the quality of the data. Despite having acted as interpreters for previous studies and having been given a refresher course on the roles of interpreters, some richness of the data remained lost. Other hindrances included the weather, as rain and mud kept people away, and the lack of transportation limited the interviews, and therefore participants, to Calhuitz and one other village. Also, the Catholic church‘s holidays, such as the Feast of the Assumption of the Blessed Xxxxxx Xxxx, commanded people‘s time and therefore they did not show up to scheduled interviews.
Limitations and Delimitations. The study took place at Concordia University, Irvine. A small private, not-for-profit, Christian, liberal arts, four-year University in Southern California. First-time first-year college students participated in the study. Findings and recommendations based on the survey results are specific to this institution, limiting the generalizability and implications of the results. Data collected for this study took place during the summer/fall 2016 and fall 2019 semester. The study will only report findings and conclusions on students attending these semesters and participating in the study. The Financial Education Proficiency developed for the study included questions adapted directly from Xxxxxxx'x (2008) Jump$tart college student survey. The Financial Self- Efficacy Scale questions (Xxxx, 2011) allow for evaluating a respondent's awareness of their behavior and the consequences of making specific financial decisions. Although these instruments are validated with other samples, they were not created for college students, which may affect the data's reliability and validity. For each instrument, choice of wording and order was maintained and only slightly altered for a college student audience. In some instances, readability, word choice, and flow may have affected survey responses. Regardless of these limitations, the study sheds light on the much-needed topic, the importance of the relationship between college student financial literacy, behavior, and self-efficacy.
Limitations and Delimitations. The study used the ICD-9 code for diabetes mellitus in selecting patients for recruitment and therefore enabled a selection of participants with an accurate diagnosis of diabetes mellitus. This provided an advantage over previous studies that relied on a self-reported diagnosis of diabetes. Although an initial plan involved the recruitment of 8-12 participants per focus group, ultimately the number of participants in each session was small enough to encourage involvement while still enabling a diversity of opinions. Our study had several limitations including the small sample size of participants receiving care at a single Healthcare system. Selection bias could be introduced and the study findings may not be generalizable to all patients with diabetes mellitus in Forsyth County. Given that Wake Forest Baptist Health, and specifically the Downtown Health Plaza, provides the majority of the primary care services in this area, it was selected as the source from which to recruit study participants. In addition, our study was subject to nonresponse bias which also has the potential to significantly impact the generalizability of results. Only a small proportion of patients contacted, actually participated in the study. Although reasons for this included unavailability on interview dates, there was no way to determine if respondents differed in meaningful ways from non- respondents. Another limitation of this research was the absence of an analysis of demographic data. Data on age, gender, ethnicity/race (except in the case of the Spanish speaking focus group), education and household income were not collected or analyzed. In previous studies, age and ethnicity had been shown to impact vaccination rates and therefore likely also influence perception. A lack of demographic heterogeneity results in under representation of the views of some groups. Finally, although the same team member conducted all the English focus group interviews, the Spanish group required a Spanish speaking group leader. To facilitate consistency, a standard set of questions was used to guide the focus group interview. However, the structure, phrasing and tenor of questions during an interview process have the propensity to influence respondents and could have introduced interviewer bias in our study.
Limitations and Delimitations. 82 Conclusions ............................................................................................................... 83 REFERENCES ...................................................................................................................... 84 APPENDICES ....................................................................................................................... 93 Appendix A: Teacher and Curriculum Coach -Part Survey ...................................... 93 Appendix B: School Leader Part Survey................................................................... 95 Appendix C: School Leader Questionnaire ............................................................... 97 Appendix D: Teacher Questionnaire ......................................................................... 98 Appendix E: National Institute of Health-Dr. Xxxxxxx Xxxxxxx ................................ 99 Appendix F: National Institute of Health-Xxxx Xxxxx 101 LIST OF TABLES Table 1. 1. Demographics of Participants........................................................................ 45 Table 2. 1. Evolving Themes ........................................................................................... 45 Table 3. 1. My Relationships with the School Leaders are Positive ............................... 46
Limitations and Delimitations. The study took place during the Fall and early Winter of 2021-2022 amid a global pandemic. Social distancing was required for safety measures. The pandemic has also added a significant extra workload to school leaders' and teachers' responsibilities. Thus, the researcher did not receive as many participants as initially desired. Additionally, the researcher was prohibited from recording any interviews because the corporate leadership was fearful of legal liabilities and time constructions. Therefore, the study included online surveys distributed via Google forms and open-ended questionnaires. The researcher also works for an educational organization that operates the school sites of the case study, which may inhibit the validity of the participants' responses because some participants may not feel secure providing honest feedback (Xxxxxxxx, 2014). Conversely, delimitations of this study included specific boundary locations, age groups, and pandemic considerations; however, the researcher believes that the data collected was a cross-section of valid data in which to format a conclusion.
Limitations and Delimitations. This research suffered from limitations related to the data collection method. These include self-administered questionnaires in some instances, resulting in the potential for bias in the information collection process. Another limitation is the low response rates from ministries, research institutes, NGOs and private clinics. Missing data and limited data collection time points limit both the accuracy and generalizability of our analysis. These limitations also make it more challenging to observe a consistent trend in health financing and expenditures over time, making it impractical to create predictive or inferential models. Another important limitation of the analysis concerns the assumptions that went into calculating estimates of population level health coverage. These estimates, presented in comparison to the MOH estimates, were calculated using annual population percentages: % of working age population, % of working age population employed, % of working age population employed in public/private sectors, % of population above 60 years, % of population who report access to health coverage. We assume similar data sources were used to calculate the MOH projected estimates. It is also important to note the scope of the data. The analysis concerns not only the resources allocated to health in the relevant time period, but also all of the health-related expenses made at health facilities by citizens and foreign nationals. These health-related expenses refer to utilized health care services that were billed by providers but not necessarily paid for.
Limitations and Delimitations. A noticeable limitation in this project is the lack of a “true” dataset. A “true” dataset is the complete dataset without any missing observations. This is impossible to acquire since missing data may be due to systematic issues, lack of response, miscoding, errors in imputation and a variety of other factors. Consequently, the mechanism of missing data needs to be investigated. Complete-case analysis assumes that the data is either MCAR or MAR. This assumption is robust to small amounts of missing data (<5%); however, large proportions of missing data are unlikely to be MCAR. This project assumes that the missing data mechanism was MAR. It is also possible that the missing data mechanism was NMAR. An assumption of Case study 1 is that MPR accurately reflects patient adherence to their statin therapy. There are limitations with this assumption. MPR does not directly measure patient consumption of their statin therapy; instead, it provides an indirect estimate of adherence based on pharmacy refill data.76 Other forms of adherence measurements are available which were not used in Case study 1. For example, Proportion of Days Covered (PDC) reflects the percentage of days the medication was available to the patient.64 PDC is calculated as the total days the complete medication regimen was available divided by the total number of days evaluated capped at 1.0.64 MPR can also be truncated or allowed to exceed a cap of 1.0. In Case study 1, MPR was truncated at 1.0. It is unclear whether using the PDC would impact whether a patient was adherent or not. Xxxx, et al. reported that differences between MPR and PDC were negligible and provided similar answers in terms of categorizing patients as adherent or non- adherent.64 Another limitation of this project is the small sample size of the liraglutide group relative to the exenatide group in Case study 2.18 The small sample is potentially sensitive to missing data which can result in inaccurate parameter estimates due to large uncertainties or variances. A larger sample size would mitigate this issue; however, there was not possible with the current design. In observational studies, unmeasured variables can be potential confounders despite controlling for all measurable variables. Propensity score matching may be considered in this situation, however it is highly sensitive to unmeasured confounders.77 It is not an absolute answer in the absence of a randomized controlled trial. Future investigation using propensity sco...
Limitations and Delimitations. Potential weaknesses identified in this project’s design include lack of generalizability of findings, opportunities for missing data, inability to address all barriers to care, and uncertain long term impact of the intervention. This project was carried out in Georgia’s WCHD among HIV+ women enrolled in the RWP overdue for cervical cancer screening. Since the intervention’s benefit will be to this particular group, generalizable knowledge will not be developed. Chart review and CAREWare were the sources of outcome data and may not contain a complete record of the Pap tests performed. Pap reports from outside providers may not have been requested, or if requested, may not have been received. In addition, all available Pap results may not have been entered into CAREWare. Not all of the perceived barriers to this population’s care could be addressed, thus some women still had obstacles to completing the screening test. Finally, it is uncertain whether the intervention will have a lasting effect on the patient’s completion of future Pap screenings. Several factors narrowed the scope of the project. These factors relate to the selected group of participants and the timeframe for the intervention. The target population was comprised of HIV+ women enrolled in Georgia’s WCHD RWP overdue for cervical cancer screening. The inclusion and exclusion criteria used were as stated in the HAB performance measure. All women ≥ 18 years old or who reported a history of sexual activity and had had a medical visit with a provider with prescribing privileges at least once in the measurement year were included in the project. Women were excluded if they were < 18 years old and denied a history of sexual activity or if a hysterectomy had been performed for non- dysplasia/nonmalignant indications. The project was conducted from September 1, 2012 through December 31, 2012.
