- Email: [email protected]
Methodological Challenges During 20 Years of Adolescent Research
Methodological Challenges During 20 Years of Adolescent Research Adela Yarcheski, PhD, FAAN Noreen E. Mahon, PhD, FAAN
The purpose of the present article was to highlight the methodological challenges we have experienced in conducting adolescent research for the past 20 years or more. In this article, we describe the methodological issues we have encountered with nonexperimental research designs, sampling, instrumentation, data collection procedures, statistical analyses, and ethical concerns of adolescent research, particularly the process of informed consent. Sharing our experiences with adolescent research can shed light on methodological issues (specifically in this age group) that are not addressed in research textbooks and can provide guidance for other researchers who are interested in developing knowledge relevant to adolescent populations. n 2007 Elsevier Inc. All rights reserved.
CCORDING TO ELLIOT AND FELDMAN (1990), adolescence is a period of transition from childhood to adulthood—a developmental process characterized by dramatic physical, psychological, and psychosocial changes. The period of adolescence extends over so many years that it can be conceptualized into the early, middle, and late phases of development. The literature reflects on the study of adolescence as either one lengthy period or a period of three developmental phases. For the past 20 years or more, as principal investigators, we have focused on developing our program of research by studying a wide range of variables that are relevant to adolescents who were accessed, for the most part, in school systems. For selected studies, adolescents were accessed in hospital clinics. The purpose of the present work is to highlight the methodological challenges we have experienced in conducting adolescent research. Describing how we met these challenges, by using our published research as examples, could provide direction to other researchers who are interested in studying adolescents and phenomena relevant to this population.
A
SELECTING A RESEARCH PROBLEM The first task for a researcher is to define a research problem (Polit & Hungler, 1999). The problem should be relevant to the population studied (which for us is adolescents) and the
Journal of Pediatric Nursing, Vol 22, No 3 (June), 2007
discipline from which the research emerges (which for us is nursing). To ensure that our research was relevant to adolescents, we often selected variables from the literature that had developmental implications during adolescence, such as future time perspective, introspectiveness, and loneliness. In the hope of contributing to the body of knowledge for nursing practice, we also selected variables that were phenomena of concern to the discipline of nursing, as well as to adolescents, such as positive health practices, perceived health status, and wellbeing. To add to discipline-specific knowledge, we conducted several studies (Yarcheski & Mahon, 1991, 1995; Yarcheski, Mahon, & Yarcheski, 2002a, 2004) examining correlates in the Rogerian nursing framework (Rogers, 1970) adapted for adolescents, such as perceived field motion. Using the aforementioned variables, we, along with others, crafted a program of research that was primarily focused on the testing of theory for adolescents. The testing of this theory guided the development of research design, which varied
From the College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ. Address correspondence and reprint requests to Adela Yarcheski, PhD, FAAN, 30 Coolidge Avenue, Carteret, NJ 07008. E–mails: [email protected], [email protected] 0882-5963/$ - see front matter n 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.pedn.2006.08.001
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across studies. The methodological issues that arose (e.g., sampling, instrumentation, and data collection procedures) with the methods used to execute research design with adolescents are discussed below. RESEARCH DESIGNS Any scientific investigation must begin with some structure or plan called research design (Spector, 1981). We have used a variety of nonexperimental quantitative designs in our research program with adolescents, some of which presented methodological challenges. To meet the challenge of strengthening causal implications in several studies testing alternate theories of loneliness (Mahon & Yarcheski, 1988b, 1992) and a causal model of health consequences of loneliness (Mahon, Yarcheski, & Yarcheski, 1993), we used a design recommended by Spector (1981) whereby data were collected at several intervals a week apart. Variables predicted to be causes were measured first, followed in time by variables expected to be the effects. To meet the challenge of maintaining participant anonymity (thus minimizing response set bias) in this staggered design, we used a subjectgenerated identification code (SGIC) developed by Damrosch (1986) to match data from participants across intervals. In the first study (Mahon & Yarcheski, 1988b), despite concerns as to how this would work with early adolescents, we reported success with the use of the SGIC. Researchers can be assured that the SGIC works well with adolescents as young as 12 years (Mahon & Yarcheski, 1988b), as well as with older adolescents (Mahon & Yarcheski, 1992; Mahon et al., 1993). When Spector’s (1981) staggered design could not be used to test causal models that we formulated (Yarcheski & Mahon, 1989; Yarcheski, Mahon, & Yarcheski, 1997), we deliberately ordered the instruments in a manner that approximated the staging of variables in causal models. We recommend that instruments be ordered according to the causal sequence of variables in the model when data cannot be collected at various points in time due to school or clinic constraints. Researchers are seldom able to meet the assumptions of comparative design spelled out by Wood and Brink (1998), such as controlling for extraneous variables that influence the dependent variable through sampling methods. To meet this assumption in the sampling process, we used data sets from studies to create groups of adolescents who differed
on the independent variable (e.g., they were from intact or divorced families). We matched the groups on extraneous variables, such as age, gender, and race. Making the groups relatively comparable on such variables allowed us to examine differences in future time perspective and loneliness in adolescents from single-parent and two-parent families (Yarcheski & Mahon, 1986a); differences in anger, anxiety, and depression in adolescents from divorced and intact families (Mahon, Yarcheski, & Yarcheski, 2003); and differences in loneliness, future time perspective, and perceived maternal expressiveness in adolescents who were healthy and those who had cystic fibrosis (Yarcheski, Mahon, Kraynyak-Luise, & Dillon-Baker, 1987). These studies must be planned a priori to data collection, and data on relevant extraneous variables must be collected. Controlling for extraneous variables through matching procedures lends a clearer picture of differences that exist in dependent variables (Wood & Brink, 1998). SAMPLING Elliott and Feldman (1990) assert that b. . . the study of adolescence cannot be taken completely out of the social setting in which it occurs . . .Q (pp. 7–8), which, in large part, is the school that adolescents attend. Knowing that we required large sample sizes for quantitative studies, we gained access to bhealthyQ adolescents in school systems in our geographical area. Although we often considered probability sampling, realistically, we knew that obtaining samples of convenience would be least disruptive to the school. As our program of research expanded, we were fortunate to have personal and professional networks of teachers and principals who could facilitate our access to school systems. For those researchers who do not have such a network, they need to create one by providing professional services (such as in-service education or classes about health) to teachers and students. During our meetings with school authorities, study instruments were available for review, data collection procedures were outlined, and we assured authorities that we would be the data collectors to minimize disruptions in school routines and data collection procedures. If research assistants were to collect data, we recommend that the investigators also be present to supervise data collection procedures. In our experience, school authorities wanted us to be present in all data collection procedures. Without samples, research
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cannot be conducted. Therefore, we recommend that adolescent researchers develop networks to gain entry into school systems, refine their negotiation skills, and be ready to provide services to schools to procure access to adolescents. Even under the best of circumstances, researchers should know that access might be denied. Several of our studies (Scoloveno, Yarcheski, & Mahon, 1990; Yarcheski, 1988; Yarcheski et al., 1987) took place in hospital clinics, and, again, professional networks with nursing directors or physicians facilitated access to adolescent populations. Gaining entry into hospitals and clinics has become increasingly difficult, and researchers in the academe need to be prepared to obtain approval from both the university’s and the hospital’s institutional review boards before research can commence. This dual-approval process needs to be factored into the timeline specified for research projects. In clinic settings, it is important to schedule data collection from adolescents before or after their appointments. We have found that most adolescents, usually accompanied by a parent, prefer to participate in studies after their appointment with the health care provider. One final point needs to be made relative to the sampling of adolescents. If the theory being tested suggests differences in phenomenon across early, middle, and late adolescents, it is important that the researcher has groups of adolescents whose chronological ages closely appropriate the three stages of adolescents, or else, the theory will not be adequately tested. Elliott and Feldman (1990) suggested that ages 10–14 years represent early adolescents, ages 15–17 years represent middle adolescents, and ages 18 years to mid-20s represent late adolescents. Because their work was recognized nationally, we have used their definition of adolescence as a general guideline in our research in the 1990s and thereafter, but other researchers may choose to use other prominent adolescent theorists. INSTRUMENTS Kerlinger (1986) asserted that theory-testing research requires impeccable measurement. We have encountered numerous challenges with instrumentation in terms of using age-appropriate measures for adolescents, gathering evidence on the reliability and validity of instruments for the age group studied, and determining the reading levels of instruments.
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When possible, we used instruments that were developed for adolescents, such as the Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Introspectiveness Scale (Hansell & Mechanic, 1985), the Adolescent Life Change Events Questionnaire (Mendez, Yeaworth, York, & Goodwin, 1980), and the Hinds (1988) Hopefulness Scale for Adolescents. Using instruments created for adolescents is an ideal situation in that psychometrics have been established for this age group. The psychometrics of many instruments that measure psychological variables, such as loneliness (Russell, Peplau, & Cutrona, 1980) and future time perspective (Heimberg, 1963), have been ascertained on college students and adults. We have used these and other instruments in our research with adolescents after following several procedures. First, we have teachers review all the instruments to be administered to ensure that the items are worded at the reading level of the adolescents to be tested, and we highly recommend that adolescent researchers carry out this procedure routinely. Second, in some instances, we have nurses working with adolescents review the instruments for content validity. Based on feedback from the teachers, nurses, or both, we make slight modifications in the wording of items to make them suitable for adolescents. Third, we assess the reading level of the instruments via computer programs. Fourth, we conduct pilot studies, when necessary, to establish test–retest (Yarcheski & Mahon, 1986b, 1991) or internal consistency reliability (Yarcheski, 1984; Yarcheski & Mahon, 1991) for the adolescents being studied. When the researcher is in doubt about the reliability of an instrument with a particular age group of adolescents, we recommend that a pilot study be performed. Whether or not an instrument has been created for adolescents, we strongly recommend that researchers report reliability coefficients obtained on instruments for their adolescent samples, as we have performed in our studies. This not only satisfies a scientific principle of repeatability (Nunnally & Bernstein, 1994) but also provides information about the quality of the instrument for use with adolescents. A major challenge with instrumentation is when early, middle, and late adolescents are part of the same study that compares the groups. For comparative purposes, every effort should be made to use the same instruments across all three groups. These instruments need to be suitable for all three groups,
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keeping in mind that there is a wide age range across adolescence. On one occasion (Mahon & Yarcheski, 1992), we decided that the SelfDisclosure Inventory for Adolescents (West & Zingle, 1969) was more appropriate for early and middle adolescents than for late adolescents. Thus, we used the Jourard Self-Disclosure Inventory (Jourard, 1971) for late adolescents, which was content-valid for this age group. The use of this different instrument for late adolescents did not present a problem in statistical analyses. Again, however, uniformity in the use of instruments across all three age groups is recommended. It is incumbent upon adolescent researchers, at times, to develop instruments that are specific for adolescents. For example, when embarking upon studying correlates in Rogers’ (1970) science of unitary human beings, we had to develop instruments to measure human field motion (Perceived Field Motion Scale) and human field rhythms (Human Field Rhythms Visual Analogue Scale) (Yarcheski & Mahon, 1991) for adolescents. These instruments have been used in other studies (Yarcheski & Mahon, 1995; Yarcheski et al., 2002a, 2004), as have been the two instruments developed (Yarcheski, 1984) to measure perceived maternal expressiveness, perceived paternal expressiveness, or both (Mahon & Yarcheski, 1988b, 1992; Yarcheski et al., 1987). We recommend that researchers learn the skills to develop instruments in their educational process because these skills will be needed in a research program that extends over a professional career. Lastly, researchers who consistently use the same instruments in their research program that have not been validated on adolescents have a responsibility to provide psychometric evidence through methodological studies. To meet the methodological challenge of conducting these studies, we recommend that researchers learn about factor analysis procedures used routinely in methodological research. Because loneliness was a major variable in our research program, we have performed several studies providing psychometric evidence of the reliability and validity of the Revised UCLA Loneliness Scale (Mahon & Yarcheski, 1990; Mahon, Yarcheski, & Yarcheski, 1995) for adolescents. Several instruments developed by nurse scientists also have played a large role in our research program. We have provided extensive psychometric evidence for adolescents for Weinert’s (1987) Personal Resource Questionnaire 85—Part II (Yarcheski, Mahon, & Yarcheski,
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1992), for Muhlenkamp and Brown’s (1993) Personal Lifestyle Questionnaire (Mahon, Yarcheski, & Yarcheski, 2002), and for the Laffrey (1986) Health Conception Scale (Yarcheski, Mahon, & Yarcheski, 2005). Because the Personal Lifestyle Questionnaire had items that were not appropriate for young adolescents, we modified the instrum (with permission) and presented extensive psychometric evidence for this instrument as revised for early adolescents (Mahon, Yarcheski, & Yarcheski, 2003). These studies contribute to the literature and provide reliable and valid instruments for others to use in their adolescent studies. DATA COLLECTION PROCEDURES bResearch data, particularly in quantitative studies, are often collected according to a structured plan that indicates what information is to be gathered and how to gather itQ (Polit & Hungler, 1999, p. 310). Most self-administered instruments are highly structured, and all of our data on adolescents have been collected using self-reports. We have worked closely with teachers to ascertain that all adolescents in our studies comprehend the English language on these self-reports, especially because culturally diverse populations are increasing in this country. A methodological challenge in data collection is ensuring that adolescents will be able to complete the instrument packet in a class period, which is generally the time allotted for us to collect data in schools. Pretesting with a small group of adolescents to assess completion time will quell concerns in this area. Gaining the cooperation of teachers or clinic staff when planning procedures for data collection is critical for success; in some instances, this may require several meetings. We have collected data in classrooms, auditoriums, and gymnasiums of school systems, and in waiting rooms and examining rooms of clinics. Experience has taught us that constancy of research conditions has been maintained better with some procedures for data collection than with others. In schools, classrooms best facilitate the constancy of research conditions because the number of students in each class is limited, there is seating for all participants, noise levels are controlled by closing doors, lighting and temperature are adequate for testing purposes, and researchers can answer all questions and review all instrument packets for completeness of responses. In clinics, we have found that an empty examining
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room is best suited for participants to complete instruments and that the room needs to be reserved in advance; this room provides privacy and few distractions. Current trends suggest a movement toward the use of computer-assisted interviewing and audio computer-assisted self-interviewing methods to collect data, which we have not used yet in our research program. A researcher who has used this method of data collection with young children and adolescents (C. DiIorio, personal communication, October 2, 2005) suggests that there are advantages and disadvantages with the use of computers to collect data. Data obtained via computer programs have been shown to be reliable and valid, data entry is efficient, and children and adolescents like responding to questionnaires on computers. In contrast, computer programs developed to collect data are costly and time-consuming, and require staff supervision during administration. Researchers need resources and expertise to use this sophisticated technology, which is a new challenge on the horizon. STATISTICAL ANALYSIS The use of advanced statistical methods and innovative research methodologies help us understand the complexities of adolescent development (Feldman & Elliott, 1990). As research programs evolve, studies usually become sophisticated, requiring the use of advanced statistical methods to test complex theories, as we have experienced with our adolescent research. The methodological challenge here is acquiring the knowledge to apply these advanced statistical procedures, such as structural equation modeling. We have met this challenge over the years by reading relevant literature and statistical books, and by obtaining statistical consultation when needed. For example, we have used hierarchical analyses of sets to test alternate theories of loneliness (Mahon & Yarcheski, 1988b, 1992), anger (Yarcheski, Mahon, & Yarcheski, 1999), and happiness (Mahon & Yarcheski, 2002), and we have used LISREL in our adolescent studies to test causal models (Mahon et al., 1993; Yarcheski & Mahon, 1989, 2000; Yarcheski et al., 1997) and outcome models (Mahon & Yarcheski, 2001; Mahon, Yarcheski, & Yarcheski, 2000), and to conduct multisample analyses (Yarcheski & Mahon, 1991; Yarcheski et al., 2002b). Because some scientific journals enlist a statistician in the manuscript review process,
we recommend that researchers obtain statistical advice prior to data collection and during data analysis to ensure that appropriate statistical procedures are used and correctly carried out. If the body of knowledge on adolescent health and wellbeing is to advance, research programs need to become increasingly sophisticated. ETHICAL CONCERNS In an earlier publication, the authors (Mahon & Yarcheski, 1988a) addressed ethical concerns in research with adolescents. Most of these concerns have not changed, such as being available at the end of data collection procedures to debrief participants and considering the cognitive level of development of the participants in the study during the informed consent process, be they early, middle, or late adolescents. The methodological challenges associated with the informed consent process deserve mention here. For adolescents 18 years and younger, consent is needed from one parent, as well as from the adolescent, for the youngster to participate in research. This has not changed in our state over the years. For adolescents studied in school, it is important for researchers to clearly spell out the purpose and procedure of the research in letters sent home to parents, along with duplicate informed consent forms and information about how the researcher can be contacted to answer questions. The researchers should enclose all of this information in an envelope and distribute it to the adolescents, who will then take it home to their parents at least 1 week prior to data collection procedures. The researchers should also enlist the aid of teachers to collect signed parental consent forms prior to the scheduled testing date. There are probably many ways to accomplish the parent consent procedure, but what we have described worked best for us over the years. Because parents accompany adolescents to clinics for appointment, they are available to sign parental consents during the adolescent’s clinic visit. Sharing our experiences with adolescent research sheds light on methodological issues concerning adolescents that have not been specifically addressed in research textbooks. Many adolescents have participated in our research over the years, and we are grateful for their willingness to do so. They have been a wonderful age group to work with, far more cooperative than one might expect, and they have made our research come alive over and over again.
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REFERENCES Damrosch, S. P. (1986). Insuring anonymity by the use of subject-generated identification codes. Research in Nursing & Health, 9, 61 – 63. Elliott, G. R., & Feldman, S. S. (1990). Capturing the adolescent experience. In S. S. Feldman & G. R. Elliott (Eds.) At the threshold: The developing adolescent (pp. 1 – 13). Cambridge, MA: Harvard University Press. Feldman, S. S., & Elliott, G. R. (1990). Progress and promise of research on adolescence. In S. S. Feldman & G. R. Elliott (Eds.) At the threshold: The developing adolescent (pp. 479 – 505). Cambridge, MA: Harvard University Press. Hansell, S., & Mechanic, D. (1985). Introspectiveness in adolescent symptom reporting. Journal of Human Stress, 2, 165 – 176. Heimberg, L. K. (1963). The measurement of future time perspective (Doctoral dissertation, Vanderbilt University, 1963). Dissertation Abstracts, 24, 1686–1687. (University Microfilms No. 63-7346). Hinds, P. S. (1988). The relationship of nurses’ caring behaviors with hopefulness and health care outcomes. Archives of Psychiatric Nursing, 2, 21 – 29. Jourard, S. M. (1971). Self-disclosure: An experimental analysis of the transparent self. New York: Wiley Interscience. Kerlinger, F.N. (1986). Foundations of behavioral research, (3rd ed). New York: Holt, Rinehart and Winston. Laffrey, S. C. (1986). Development of a Health Conception Scale. Research in Nursing & Health, 9, 107 – 113. Mahon, N. E., & Yarcheski, A. (1988a). Ethical concerns in research with adolescents. Journal of Pediatric Nursing, 3, 341 – 344. Mahon, N. E., & Yarcheski, A. (1988b). Loneliness in early adolescents: An empirical test of alternate explanations. Nursing Research, 37, 330 – 335. Mahon, N. E., & Yarcheski, A. (1990). The dimensionality of the UCLA Loneliness Scale in early adolescents. Research in Nursing & Health, 13, 45 – 52. Mahon, N. E., & Yarcheski, A. (1992). Alternate explanations of loneliness in adolescents: A replication and extension study. Nursing Research, 41, 151 – 156. Mahon, N. E., & Yarcheski, A. (2001). Outcomes of depression in early adolescents. Western Journal of Nursing Research, 23, 360 – 375. Mahon, N. E., & Yarcheski, A. (2002). Alternative theories of happiness in early adolescents. Clinical Nursing Research, 11, 306 – 323. Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (1993). Health consequences of loneliness in adolescents. Research in Nursing & Health, 16, 23 – 31. Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (2000). Positive and negative outcomes of anger in early adolescents. Research in Nursing & Health, 23, 17 – 24. Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (2002). Psychometric evaluation of the Personal Lifestyle Questionnaire in adolescents. Research in Nursing and Health, 25, 68 – 75. Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (2003). Anger, anxiety, and depression in early adolescents from intact and divorced families. Journal of Pediatric Nursing, 18, 267 – 273. Mahon, N. E., Yarcheski, T. J., & Yarcheski, A. (1995). Validation of the Revised UCLA Loneliness Scale for adolescents. Research in Nursing & Health, 18, 163 – 170.
Mahon, N. E., Yarcheski, T. J., & Yarcheski, A. (2003). The Revised Personal Lifestyle Questionnaire for early adolescents. Western Journal of Nursing Research, 25, 533 – 547. Mendez, L. K., Yeaworth, R.C., York, J. A., & Goodwin, T. (1980). Factors influencing adolescents’ perceptions of life change events. Nursing Research, 29, 384 – 388. Muhlenkamp, A. F., & Brown, N. J. (1983, September). The development of an instrument to measure health practices. Paper presented at the American Nurses Association Council of Nurse Researchers Conference, Minneapolis, MN. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory, (3rd ed). New York: McGraw-Hill. Polit, D. F., & Hungler, B. P. (1999). Nursing Research: Principles and methods, (6th ed). Philadelphia: Lippincott. Rogers, M. E. (1970). An introduction to the theoretical basis of nursing. Philadelphia: F. A. Davis. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The Revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472 – 480. Scoloveno, M. A., Yarcheski, A., & Mahon, N. E. (1990). Scoliosis treatment effects on selected variables in adolescents. Western Journal of Nursing Research, 12, 601 – 615. Spector, P. E. (1981). Research designs. Beverly Hills, CA: Sage. Weinert, C. (1987). A social support measure: PRQ85. Nursing Research, 36, 273 – 277. West, L. W., & Zingle, H. W. (1969). A Self-Disclosure Inventory for Adolescents. Psychological Reports, 24, 439 – 445. Wood, M. J., & Brink, P. J. (1998). Comparative designs. In P. J. Brink & M. J. Wood (Eds.) Advanced design in Nursing Research, (2nd ed., pp. 143 – 159). Thousand Oaks, CA: Sage. Yarcheski, A. (1984). The relationship of perceived parental instrumentality and expressiveness to future time perspective of tenth-grade adolescents. Public Health Nursing, 1, 107 – 120. Yarcheski, A. (1988). Uncertainty in illness and the future. Western Journal of Nursing Research, 10, 401 – 413. Yarcheski, A., & Mahon, N. E. (1986a). Future time perspective and loneliness: A comparison between adolescents from father-absent and two-parent families. Journal of Pediatric Nursing, 1, 102 – 110. Yarcheski, A., & Mahon, N. E. (1986b). Perceived stress and symptom patterns in early adolescents: The role of mediating variables. Research in Nursing & Health, 9, 289 – 297. Yarcheski, A., & Mahon, N. E. (1989). A causal model of positive health practices: The relationship between approach and replication. Nursing Research, 38, 88 – 93. Yarcheski, A., & Mahon, N. E. (1991). An empirical test of Rogers’ original and revised theory of correlates in adolescents. Research in Nursing & Health, 14, 447 – 455. Yarcheski, A., & Mahon, N. E. (1995). Rogers’ pattern manifestations and health in adolescents. Western Journal of Nursing Research, 17, 383 – 397. Yarcheski, A., & Mahon, N. E. (2000). A causal model of depression in early adolescents. Western Journal of Nursing Research, 8, 879 – 894. Yarcheski, A., Mahon, N. E., Kraynyak-Luise, B., & DillonBaker, C. (1987). Testing the validity of categories in a theoretical perspective on chronic illness. International Journal of Nursing Studies, 24, 249 – 260.
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Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (1992). Validation of the PRQ85 Social Support Measure for adolescents. Nursing Research, 41, 332 – 337. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (1997). Alternate models of positive health practices in adolescents. Nursing Research, 46, 85 – 92. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (1999). An empirical test of alternate theories of anger in early adolescents. Nursing Research, 48, 317 – 323. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2002a). Humor and health in early adolescents: Perceived field
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motion as a mediating variable. Nursing Science Quarterly, 15, 150 – 155. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2002b). Anger in early adolescent boys and girls with health manifestations. Nursing Research, 51, 229 – 236. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2004). Health and well-being in early adolescents using Rogers’ science of unitary human beings. Nursing Science Quarterly, 17, 72 – 77. Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2005). Psychometrics for the Laffrey Health Conception Scale for adolescents. Journal of Nursing Measurement, 13, 65–76.
The purpose of the present article was to highlight the methodological challenges we have experienced in conducting adolescent research for the past 20 years or more. In this article, we describe the methodological issues we have encountered with nonexperimental research designs, sampling, instrumentation, data collection procedures, statistical analyses, and ethical concerns of adolescent research, particularly the process of informed consent. Sharing our experiences with adolescent research can shed light on methodological issues (specifically in this age group) that are not addressed in research textbooks and can provide guidance for other researchers who are interested in developing knowledge relevant to adolescent populations. n 2007 Elsevier Inc. All rights reserved.
CCORDING TO ELLIOT AND FELDMAN (1990), adolescence is a period of transition from childhood to adulthood—a developmental process characterized by dramatic physical, psychological, and psychosocial changes. The period of adolescence extends over so many years that it can be conceptualized into the early, middle, and late phases of development. The literature reflects on the study of adolescence as either one lengthy period or a period of three developmental phases. For the past 20 years or more, as principal investigators, we have focused on developing our program of research by studying a wide range of variables that are relevant to adolescents who were accessed, for the most part, in school systems. For selected studies, adolescents were accessed in hospital clinics. The purpose of the present work is to highlight the methodological challenges we have experienced in conducting adolescent research. Describing how we met these challenges, by using our published research as examples, could provide direction to other researchers who are interested in studying adolescents and phenomena relevant to this population.
A
SELECTING A RESEARCH PROBLEM The first task for a researcher is to define a research problem (Polit & Hungler, 1999). The problem should be relevant to the population studied (which for us is adolescents) and the
Journal of Pediatric Nursing, Vol 22, No 3 (June), 2007
discipline from which the research emerges (which for us is nursing). To ensure that our research was relevant to adolescents, we often selected variables from the literature that had developmental implications during adolescence, such as future time perspective, introspectiveness, and loneliness. In the hope of contributing to the body of knowledge for nursing practice, we also selected variables that were phenomena of concern to the discipline of nursing, as well as to adolescents, such as positive health practices, perceived health status, and wellbeing. To add to discipline-specific knowledge, we conducted several studies (Yarcheski & Mahon, 1991, 1995; Yarcheski, Mahon, & Yarcheski, 2002a, 2004) examining correlates in the Rogerian nursing framework (Rogers, 1970) adapted for adolescents, such as perceived field motion. Using the aforementioned variables, we, along with others, crafted a program of research that was primarily focused on the testing of theory for adolescents. The testing of this theory guided the development of research design, which varied
From the College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ. Address correspondence and reprint requests to Adela Yarcheski, PhD, FAAN, 30 Coolidge Avenue, Carteret, NJ 07008. E–mails: [email protected], [email protected] 0882-5963/$ - see front matter n 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.pedn.2006.08.001
169
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across studies. The methodological issues that arose (e.g., sampling, instrumentation, and data collection procedures) with the methods used to execute research design with adolescents are discussed below. RESEARCH DESIGNS Any scientific investigation must begin with some structure or plan called research design (Spector, 1981). We have used a variety of nonexperimental quantitative designs in our research program with adolescents, some of which presented methodological challenges. To meet the challenge of strengthening causal implications in several studies testing alternate theories of loneliness (Mahon & Yarcheski, 1988b, 1992) and a causal model of health consequences of loneliness (Mahon, Yarcheski, & Yarcheski, 1993), we used a design recommended by Spector (1981) whereby data were collected at several intervals a week apart. Variables predicted to be causes were measured first, followed in time by variables expected to be the effects. To meet the challenge of maintaining participant anonymity (thus minimizing response set bias) in this staggered design, we used a subjectgenerated identification code (SGIC) developed by Damrosch (1986) to match data from participants across intervals. In the first study (Mahon & Yarcheski, 1988b), despite concerns as to how this would work with early adolescents, we reported success with the use of the SGIC. Researchers can be assured that the SGIC works well with adolescents as young as 12 years (Mahon & Yarcheski, 1988b), as well as with older adolescents (Mahon & Yarcheski, 1992; Mahon et al., 1993). When Spector’s (1981) staggered design could not be used to test causal models that we formulated (Yarcheski & Mahon, 1989; Yarcheski, Mahon, & Yarcheski, 1997), we deliberately ordered the instruments in a manner that approximated the staging of variables in causal models. We recommend that instruments be ordered according to the causal sequence of variables in the model when data cannot be collected at various points in time due to school or clinic constraints. Researchers are seldom able to meet the assumptions of comparative design spelled out by Wood and Brink (1998), such as controlling for extraneous variables that influence the dependent variable through sampling methods. To meet this assumption in the sampling process, we used data sets from studies to create groups of adolescents who differed
on the independent variable (e.g., they were from intact or divorced families). We matched the groups on extraneous variables, such as age, gender, and race. Making the groups relatively comparable on such variables allowed us to examine differences in future time perspective and loneliness in adolescents from single-parent and two-parent families (Yarcheski & Mahon, 1986a); differences in anger, anxiety, and depression in adolescents from divorced and intact families (Mahon, Yarcheski, & Yarcheski, 2003); and differences in loneliness, future time perspective, and perceived maternal expressiveness in adolescents who were healthy and those who had cystic fibrosis (Yarcheski, Mahon, Kraynyak-Luise, & Dillon-Baker, 1987). These studies must be planned a priori to data collection, and data on relevant extraneous variables must be collected. Controlling for extraneous variables through matching procedures lends a clearer picture of differences that exist in dependent variables (Wood & Brink, 1998). SAMPLING Elliott and Feldman (1990) assert that b. . . the study of adolescence cannot be taken completely out of the social setting in which it occurs . . .Q (pp. 7–8), which, in large part, is the school that adolescents attend. Knowing that we required large sample sizes for quantitative studies, we gained access to bhealthyQ adolescents in school systems in our geographical area. Although we often considered probability sampling, realistically, we knew that obtaining samples of convenience would be least disruptive to the school. As our program of research expanded, we were fortunate to have personal and professional networks of teachers and principals who could facilitate our access to school systems. For those researchers who do not have such a network, they need to create one by providing professional services (such as in-service education or classes about health) to teachers and students. During our meetings with school authorities, study instruments were available for review, data collection procedures were outlined, and we assured authorities that we would be the data collectors to minimize disruptions in school routines and data collection procedures. If research assistants were to collect data, we recommend that the investigators also be present to supervise data collection procedures. In our experience, school authorities wanted us to be present in all data collection procedures. Without samples, research
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cannot be conducted. Therefore, we recommend that adolescent researchers develop networks to gain entry into school systems, refine their negotiation skills, and be ready to provide services to schools to procure access to adolescents. Even under the best of circumstances, researchers should know that access might be denied. Several of our studies (Scoloveno, Yarcheski, & Mahon, 1990; Yarcheski, 1988; Yarcheski et al., 1987) took place in hospital clinics, and, again, professional networks with nursing directors or physicians facilitated access to adolescent populations. Gaining entry into hospitals and clinics has become increasingly difficult, and researchers in the academe need to be prepared to obtain approval from both the university’s and the hospital’s institutional review boards before research can commence. This dual-approval process needs to be factored into the timeline specified for research projects. In clinic settings, it is important to schedule data collection from adolescents before or after their appointments. We have found that most adolescents, usually accompanied by a parent, prefer to participate in studies after their appointment with the health care provider. One final point needs to be made relative to the sampling of adolescents. If the theory being tested suggests differences in phenomenon across early, middle, and late adolescents, it is important that the researcher has groups of adolescents whose chronological ages closely appropriate the three stages of adolescents, or else, the theory will not be adequately tested. Elliott and Feldman (1990) suggested that ages 10–14 years represent early adolescents, ages 15–17 years represent middle adolescents, and ages 18 years to mid-20s represent late adolescents. Because their work was recognized nationally, we have used their definition of adolescence as a general guideline in our research in the 1990s and thereafter, but other researchers may choose to use other prominent adolescent theorists. INSTRUMENTS Kerlinger (1986) asserted that theory-testing research requires impeccable measurement. We have encountered numerous challenges with instrumentation in terms of using age-appropriate measures for adolescents, gathering evidence on the reliability and validity of instruments for the age group studied, and determining the reading levels of instruments.
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When possible, we used instruments that were developed for adolescents, such as the Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Introspectiveness Scale (Hansell & Mechanic, 1985), the Adolescent Life Change Events Questionnaire (Mendez, Yeaworth, York, & Goodwin, 1980), and the Hinds (1988) Hopefulness Scale for Adolescents. Using instruments created for adolescents is an ideal situation in that psychometrics have been established for this age group. The psychometrics of many instruments that measure psychological variables, such as loneliness (Russell, Peplau, & Cutrona, 1980) and future time perspective (Heimberg, 1963), have been ascertained on college students and adults. We have used these and other instruments in our research with adolescents after following several procedures. First, we have teachers review all the instruments to be administered to ensure that the items are worded at the reading level of the adolescents to be tested, and we highly recommend that adolescent researchers carry out this procedure routinely. Second, in some instances, we have nurses working with adolescents review the instruments for content validity. Based on feedback from the teachers, nurses, or both, we make slight modifications in the wording of items to make them suitable for adolescents. Third, we assess the reading level of the instruments via computer programs. Fourth, we conduct pilot studies, when necessary, to establish test–retest (Yarcheski & Mahon, 1986b, 1991) or internal consistency reliability (Yarcheski, 1984; Yarcheski & Mahon, 1991) for the adolescents being studied. When the researcher is in doubt about the reliability of an instrument with a particular age group of adolescents, we recommend that a pilot study be performed. Whether or not an instrument has been created for adolescents, we strongly recommend that researchers report reliability coefficients obtained on instruments for their adolescent samples, as we have performed in our studies. This not only satisfies a scientific principle of repeatability (Nunnally & Bernstein, 1994) but also provides information about the quality of the instrument for use with adolescents. A major challenge with instrumentation is when early, middle, and late adolescents are part of the same study that compares the groups. For comparative purposes, every effort should be made to use the same instruments across all three groups. These instruments need to be suitable for all three groups,
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keeping in mind that there is a wide age range across adolescence. On one occasion (Mahon & Yarcheski, 1992), we decided that the SelfDisclosure Inventory for Adolescents (West & Zingle, 1969) was more appropriate for early and middle adolescents than for late adolescents. Thus, we used the Jourard Self-Disclosure Inventory (Jourard, 1971) for late adolescents, which was content-valid for this age group. The use of this different instrument for late adolescents did not present a problem in statistical analyses. Again, however, uniformity in the use of instruments across all three age groups is recommended. It is incumbent upon adolescent researchers, at times, to develop instruments that are specific for adolescents. For example, when embarking upon studying correlates in Rogers’ (1970) science of unitary human beings, we had to develop instruments to measure human field motion (Perceived Field Motion Scale) and human field rhythms (Human Field Rhythms Visual Analogue Scale) (Yarcheski & Mahon, 1991) for adolescents. These instruments have been used in other studies (Yarcheski & Mahon, 1995; Yarcheski et al., 2002a, 2004), as have been the two instruments developed (Yarcheski, 1984) to measure perceived maternal expressiveness, perceived paternal expressiveness, or both (Mahon & Yarcheski, 1988b, 1992; Yarcheski et al., 1987). We recommend that researchers learn the skills to develop instruments in their educational process because these skills will be needed in a research program that extends over a professional career. Lastly, researchers who consistently use the same instruments in their research program that have not been validated on adolescents have a responsibility to provide psychometric evidence through methodological studies. To meet the methodological challenge of conducting these studies, we recommend that researchers learn about factor analysis procedures used routinely in methodological research. Because loneliness was a major variable in our research program, we have performed several studies providing psychometric evidence of the reliability and validity of the Revised UCLA Loneliness Scale (Mahon & Yarcheski, 1990; Mahon, Yarcheski, & Yarcheski, 1995) for adolescents. Several instruments developed by nurse scientists also have played a large role in our research program. We have provided extensive psychometric evidence for adolescents for Weinert’s (1987) Personal Resource Questionnaire 85—Part II (Yarcheski, Mahon, & Yarcheski,
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1992), for Muhlenkamp and Brown’s (1993) Personal Lifestyle Questionnaire (Mahon, Yarcheski, & Yarcheski, 2002), and for the Laffrey (1986) Health Conception Scale (Yarcheski, Mahon, & Yarcheski, 2005). Because the Personal Lifestyle Questionnaire had items that were not appropriate for young adolescents, we modified the instrum (with permission) and presented extensive psychometric evidence for this instrument as revised for early adolescents (Mahon, Yarcheski, & Yarcheski, 2003). These studies contribute to the literature and provide reliable and valid instruments for others to use in their adolescent studies. DATA COLLECTION PROCEDURES bResearch data, particularly in quantitative studies, are often collected according to a structured plan that indicates what information is to be gathered and how to gather itQ (Polit & Hungler, 1999, p. 310). Most self-administered instruments are highly structured, and all of our data on adolescents have been collected using self-reports. We have worked closely with teachers to ascertain that all adolescents in our studies comprehend the English language on these self-reports, especially because culturally diverse populations are increasing in this country. A methodological challenge in data collection is ensuring that adolescents will be able to complete the instrument packet in a class period, which is generally the time allotted for us to collect data in schools. Pretesting with a small group of adolescents to assess completion time will quell concerns in this area. Gaining the cooperation of teachers or clinic staff when planning procedures for data collection is critical for success; in some instances, this may require several meetings. We have collected data in classrooms, auditoriums, and gymnasiums of school systems, and in waiting rooms and examining rooms of clinics. Experience has taught us that constancy of research conditions has been maintained better with some procedures for data collection than with others. In schools, classrooms best facilitate the constancy of research conditions because the number of students in each class is limited, there is seating for all participants, noise levels are controlled by closing doors, lighting and temperature are adequate for testing purposes, and researchers can answer all questions and review all instrument packets for completeness of responses. In clinics, we have found that an empty examining
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room is best suited for participants to complete instruments and that the room needs to be reserved in advance; this room provides privacy and few distractions. Current trends suggest a movement toward the use of computer-assisted interviewing and audio computer-assisted self-interviewing methods to collect data, which we have not used yet in our research program. A researcher who has used this method of data collection with young children and adolescents (C. DiIorio, personal communication, October 2, 2005) suggests that there are advantages and disadvantages with the use of computers to collect data. Data obtained via computer programs have been shown to be reliable and valid, data entry is efficient, and children and adolescents like responding to questionnaires on computers. In contrast, computer programs developed to collect data are costly and time-consuming, and require staff supervision during administration. Researchers need resources and expertise to use this sophisticated technology, which is a new challenge on the horizon. STATISTICAL ANALYSIS The use of advanced statistical methods and innovative research methodologies help us understand the complexities of adolescent development (Feldman & Elliott, 1990). As research programs evolve, studies usually become sophisticated, requiring the use of advanced statistical methods to test complex theories, as we have experienced with our adolescent research. The methodological challenge here is acquiring the knowledge to apply these advanced statistical procedures, such as structural equation modeling. We have met this challenge over the years by reading relevant literature and statistical books, and by obtaining statistical consultation when needed. For example, we have used hierarchical analyses of sets to test alternate theories of loneliness (Mahon & Yarcheski, 1988b, 1992), anger (Yarcheski, Mahon, & Yarcheski, 1999), and happiness (Mahon & Yarcheski, 2002), and we have used LISREL in our adolescent studies to test causal models (Mahon et al., 1993; Yarcheski & Mahon, 1989, 2000; Yarcheski et al., 1997) and outcome models (Mahon & Yarcheski, 2001; Mahon, Yarcheski, & Yarcheski, 2000), and to conduct multisample analyses (Yarcheski & Mahon, 1991; Yarcheski et al., 2002b). Because some scientific journals enlist a statistician in the manuscript review process,
we recommend that researchers obtain statistical advice prior to data collection and during data analysis to ensure that appropriate statistical procedures are used and correctly carried out. If the body of knowledge on adolescent health and wellbeing is to advance, research programs need to become increasingly sophisticated. ETHICAL CONCERNS In an earlier publication, the authors (Mahon & Yarcheski, 1988a) addressed ethical concerns in research with adolescents. Most of these concerns have not changed, such as being available at the end of data collection procedures to debrief participants and considering the cognitive level of development of the participants in the study during the informed consent process, be they early, middle, or late adolescents. The methodological challenges associated with the informed consent process deserve mention here. For adolescents 18 years and younger, consent is needed from one parent, as well as from the adolescent, for the youngster to participate in research. This has not changed in our state over the years. For adolescents studied in school, it is important for researchers to clearly spell out the purpose and procedure of the research in letters sent home to parents, along with duplicate informed consent forms and information about how the researcher can be contacted to answer questions. The researchers should enclose all of this information in an envelope and distribute it to the adolescents, who will then take it home to their parents at least 1 week prior to data collection procedures. The researchers should also enlist the aid of teachers to collect signed parental consent forms prior to the scheduled testing date. There are probably many ways to accomplish the parent consent procedure, but what we have described worked best for us over the years. Because parents accompany adolescents to clinics for appointment, they are available to sign parental consents during the adolescent’s clinic visit. Sharing our experiences with adolescent research sheds light on methodological issues concerning adolescents that have not been specifically addressed in research textbooks. Many adolescents have participated in our research over the years, and we are grateful for their willingness to do so. They have been a wonderful age group to work with, far more cooperative than one might expect, and they have made our research come alive over and over again.
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