The effect of nursing interventions applied at home to improve rational use of
medicines and awareness of elderly individuals: A randomized controlled
study:
Summary:
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Post positivist paradigm
Quantitative
Deductive
Level II
Primary Data - interviews and questionnaires
No explicit theory
1. Purpose of the Study
To determine whether home-based nursing interventions (education, counselling,
brochures, pill boxes) can improve:
● Rational Use of Medicines (RUM)
● Awareness of rational drug use
among elderly individuals (≥65 years) living in a rural area.
2. Study Design
● Type: Prospective randomized controlled trial (RCT) - Experimental
● Groups: Intervention (n = 37) vs Control (n = 37)
● Timeline: Pretest → 7-week intervention → Post-test
● Randomization: Simple randomization using randomizer.org
● Setting: Rural district in Central Anatolia, Türkiye
● Population: Elderly individuals using at least 1 medication regularly
3. Intervention
The intervention group received:
1. Two home-visit education sessions
○ First session: 30 minutes
○ Second session (4 weeks later): 20-minute reinforcement
2. Counselling
3. Brochures (RUM guide)
4. 7-compartment pill box
5. Family members involved when present
Control group: No intervention during the study.
(They were educated after post-test for ethical reasons.)
4. Measurement Tools
All collected through face-to-face interviews:
Primary Outcome
Rational Use of Medicines Scale
● 21 items, 0–42 score
● Higher score = better RUM
● Reliability α = 0.78
Secondary Outcome
Rational Drug Use Awareness Scale (RDUA)
● 15 items, score 15–75
● Higher score = higher awareness
● Reliability α = 0.83
5. Data Analysis
● Normality checked with Kolmogorov–Smirnov → Not normally distributed
● Non-parametric tests used:
○ Mann-Whitney U (between groups)
○ Wilcoxon signed rank (within groups)
● Significance level p < 0.05
6. Key Findings
Primary Outcome: Rational Use of Medicines
Intervention group:
● Pretest mean: 23.32 ± 4.82
● Post-test mean: 31.46 ± 3.15
● Significant improvement (p < 0.001)
Control group:
No significant change.
Between groups post-test:
Intervention group scored significantly higher than control (p < 0.001).
Secondary Owutcome: Awareness of RUM
Intervention group:
● Pretest mean: 44.76 ± 1.53
● Post-test mean: 56.86 ± 4.62
● Significant improvement (p < 0.001)
Control group:
No significant change.
Between groups post-test:
Intervention group scored significantly higher (p < 0.001).
7. Interpretation
The intervention worked extremely well.
Home-based nursing interventions:
● improved correct medication use,
● increased awareness of safe medication practices,
● and achieved large, statistically significant effects on both outcomes.
8. Strengths
● Strong RCT design
● Randomization ensured comparable groups
● Validated, reliable scales
● Practical, real-world intervention (home visits, pill boxes)
9. Limitations
● Conducted in one rural district → limits generalizability
● Short follow-up (7 weeks)
● Potential Hawthorne effect (elderly may behave better because they know
they are observed)
10. Conclusion
Home-based nursing care—including patient teaching, counselling, and pill
box use—significantly improves rational medication use and awareness
among elderly adults.
The study recommends:
● Ongoing education
● Regular home visits by nurses
● Integrating RUM training into community health practices
✅ 1. THREATS TO INTERNAL VALIDITY
Internal validity = whether the study really shows cause-and-effect between the
intervention and the outcome.
Common Threats
Threat
What It Means
Did this Article Address It?
Selection bias Groups differ before
intervention
Controlled using randomization
(“simple randomization” using
randomizer.org) — good.
History
Outside events
influence outcomes
Short study period (7 weeks) reduces
risk.
Maturation
Natural changes over
time affect outcomes
Elderly may naturally change
medication habits; however, the
control group accounts for this.
Testing effect
Taking pretests
changes posttest
scores
Both groups did pretests, so effects
cancel out.
Instrumentati
on
Changes in
measurement tools
Same validated scales used at both
times.
Attrition
Dropouts differ between Minimal attrition — both groups ended
groups
with 37.
✅ 2. THREATS TO EXTERNAL VALIDITY
External validity = how well results generalize to other populations/settings.
Threat
What It Means
For This Study
Selection
Effects
Can results be applied
to other people?
Sample was rural elderly Turkish
adults → may not generalize to
urban elderly, other countries, or
non-elderly.
Reactive/
Hawthorne
effect
Participants change
because they’re being
observed
Possible—home visits may increase
motivation.
Measurement
Pretests influence
behavior
Possible—but occurs in both groups.
✅ 3. DATA COLLECTION (Type of Data Used)
The study collected quantitative, primary, self-reported data.
Types of Data in the Article
Type
Example from Article
Level of
Measurement
Demographic
data
Age, gender, education, living situation
Mostly
nominal/ordinal
Scale scores
Rational Use of Medicines Scale (0–42) Interval-like
Awareness
scores
Rational Drug Use Awareness Scale
(15–75)
Interval-like
Mental status
test
Standardized Mini Mental Test
Interval
These are quantitative, structured, and collected via face-to-face interviews.
✅ 4. DATA ANALYSIS: PARAMETRIC VS. NON-PARAMETRIC
Parametric Tests
Use when:
● Data are interval/ratio
● Normally distributed
● Variances equal
Examples: t-test, ANOVA.
Non-Parametric Tests
Use when:
● Data not normally distributed
● Ordinal data or skewed data
● Small sample sizes
Examples: Mann-Whitney U, Wilcoxon test, Kruskal-Wallis.
What This Article Used (and Why)
✔ Normality was tested using Kolmogorov–Smirnov
✔ Data did NOT follow normal distribution → so they used:
Test
Purpose
Why Appropriate?
Mann–Whitney
U
Compare intervention vs
control posttest scores
Non-parametric alternative to
independent t-test
Wilcoxon
signed-rank
Compare pre vs post within
each group
Non-parametric paired t-test
So they analyzed the difference in scores without assuming normality.
✅ 5. RELIABILITY & VALIDITY OF MEASURES
Reliability = Consistency of the tool
Measured using Cronbach’s alpha.
Scale
Cronbach’s Alpha
(article)
Interpretation
Rational Use of Medicines
Scale
0.78
Acceptable
reliability
Drug Use Awareness Scale
0.83
Good reliability
Anything ≥0.70 is considered acceptable for research.
Validity = Accuracy of the tool (does it measure what it claims?)
Types relevant here:
Type of
Validity
Explanation
In Article
Content
validity
Items cover all relevant
aspects
Established by original
developers
Construct
validity
Measures underlying concept
(e.g., awareness)
Previously validated scales
Face validity
Appears appropriate
High because items directly
relate to medication use
Internal
validity
Cause-effect between
intervention & outcome
Randomization helps
External
validity
Generalizability
Limited to rural elderly
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