Examine the means and standard deviations for Systolic BP at pretest, 3 months (completion of the treatment), and 6 months. What do these results indicate? Are these results clinically important? Provide a rationale for your answer.
TEST FOR DEPENDENT
GROUPS
EXERCISE
31 t-TEST FOR DEPENDENT
GROUPS
STATISTICAL TECHNIQUE IN REVIEW
The t-test for dependent groups is a parametric analysis technique used to determine statistical
differences between two related samples or groups. Groups are dependent or related because they
were matched as part of the design to ensure similarities between the two groups and thus reduce
the effect of extraneous variables. For example, two groups might be matched on gender so an
equal number of males and females are in each group, thus reducing the extraneous effect of gender on the study results. The researcher’s decision to match groups is determined by the study being conducted and is detailed in the study design. In previous research, groups have most commonly been matched for age, gender, ethnicity, diagnoses, and status of illness. Matching the groups strengthens the study design by reducing the effect of extraneous variables controlled by matching. Groups are also dependent when scores used in the analysis are obtained from the same subjects under different conditions, such as pretest and posttest study design. In this type of design, a single group of subjects is exposed to pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest that is then compared with the posttest scores following the treatment. This is a weak quasi-experimental design since it is difficult to determine the effects of a treatment without comparison to a separate control group. The assumptions for the t-test for dependent groups are:
1.
The distribution of scores is normal or approximately normally distributed.
2. The dependent variable(s) is (are) measured at interval or ratio levels.
3.
The groups examined for differences are dependent based on matching or subjects serving as
their own control.
4. The differences between the paired scores are independent (Burns & Grove, 2005).
RESEARCH ARTICLE
Source: Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascular
risk factors, health behaviors, and life satisfaction in institutionalized elderly women. International
Journal of Nursing Studies, 40(4), 375–81.
Introduction
Kim, Junes, and Song (2003) conducted a quasi-experimental study with a one group pretest-posttest
design. “A convenient sample of 21 elderly women was recruited from a home for elderly people.” (Kim et al., 2000, p. 376). The purpose of the study was to determine the health benefits of a 3-month health-promotion program for institutionalized elderly women on cardiovascular risk factors,
health behaviors, and life satisfaction. These researchers found the following positive effects from the
program: reductions in total risk score, improved health behaviors, and improved life satisfaction.
However, Kim et al. (2003) noted a decrease in these positive effects 3 months after the completion
of the health-promotion program.
Relevant Study Results
A total of 25 women were enrolled in the health-promotion program and 21 subjects completed the
program with three sets of outcome assessments at pretest, 3 months, and 6 months. The mean age
of the subjects was 77 years, and 90% of them had been diagnosed with one or more chronic
diseases. The significance level of the study was set at a= 0.05. The results from the study are
presented in the two tables that follow. Table 2 describes the health-promotion program’s effects
on cardiovascular risk factors, and Table 3 describes the effects on health behaviors. The third
dependent variable of this study was life satisfaction, which was significantly improved from
pretest to the end of the health-promotion program at 3 months and at 6 months follow-up.
TABLE 2 ¦ Program Effects on Cardiovascular Risk Factors
PRETEST 3 MONTHS 6 MONTHS
Variable M (SD) M (SD) Paired t a M (SD) Paired t b
Total risk score 20.1 (4.5) 16.8 (3.2) 4.14* 18.1 (4.0) 2.56*
Cholesterol 200.2 (29.1) 189.6 (25.3) 2.03* 192.7 (22.1) 1.73
Triglyceride 164.2 (42.0) 150.4 (44.1) 2.58* 142.9 (53.5) 2.20*
BMI 22.7 (3.0) 22.1 (3.0) 3.44* 22.9 (3.0) -0.80
Systolic BP 121.7 (14.6) 117.2 (12.3) 1.57 115.6 (13.4) 1.66
BMI (body mass index), BP (blood pressure)
*p < 0.05.
a Paired t-test results between the pretest and 3-month measures.
b Paired t-test results between the pretest and 6-month measures.
Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in
institutionalized elderly women. International Journal of Nursing Studies, 40(4), p. 378.
TABLE 3 ¦ Program Effects on Health Behavior
PRETEST 3 MONTHS 6 MONTHS
Variable M (SD) M (SD) Paired t a M (SD) Paired t b
Total health behavior 66.3 (8.1) 69.7 (5.0) -3.02* 68.1 (5.1) -1.34
Health responsibility 2.19 (0.5) 2.13 (0.3) 1.03 2.29 (0.3) -1.39
Exercise 1.88 (0.3) 2.58 (0.3) -7.75* 2.29 (0.4) -3.93*
Diet behavior 3.41 (0.3) 3.47 (0.2) -0.93 3.26 (0.3) 2.00
Stress management 2.39 (0.4) 2.44 (0.3) -0.65 2.45 (0.3) -0.70
Smoking behavior 2.85 (0.8) 2.92 (0.8) -1.45 3.01 (0.7) -0.96
*p < 0.05.
a Paired t-test results between the pretest and 3-month measures.
b Paired t-test results between the pretest and 6-month measures.
Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in
institutionalized elderly women. International Journal of Nursing Studies, 40(4), p. 379.
STUDY QUESTIONS
1.
What clues do you have that this study had “dependent groups?”
2.
Which t ratio or value in Table 3 is the greatest for the 6-month follow-up? Which variable is being
examined for differences between the pretest and 6-month follow-up by this t ratio?
3.
Which t ratio or value listed in Table 2 is the smallest in determining the difference between the pretest and
6-month follow-up? This t ratio was calculated to determine the change in which variable from pretest to 6
months after the intervention?
4.
t = –0.93 is the result for what variable in this study? Is this t ratio significant? Provide a rationale for your
answer.
5.
Compare the pretest to 3 months and 6 months t ratios for BMI from Table 2. What is your conclusion
regarding the effects of the health-promotion intervention on the BMI long term?
6.
The t-test for dependent groups is conducted in research for what purpose?
7.
What is the smallest, significant t ratio listed in Table 3? Provide a rationale for your answer.
8. Why do you think that the smaller t ratios are not statistically significant?
9. How would you describe the result t = –1.45 in this study?
ANSWERS TO STUDY QUESTIONS
1.
This study was conducted using a one group pretest-posttest design in which the subjects serve as their own
control. The subjects’ outcomes at 3 and 6 months were compared with their pretest values. The single
sample pretest-posttest design indicates that the groups were dependent or related. In Tables 2 and 3 the
t-tests are identified as paired t-tests, which are conducted on dependent groups.
2. t = –3.93 (Exercise) is the largest t ratio at 6 months, as listed in Table 3.
3. t = –0.80 (BMI) represents the smallest t-ratio at 6 months, as listed in Table 2.
4.
t = –0.93 indicates the difference in Diet behavior from pretest to 3 months. This t-ratio does not have an
asterisk (*) next to it in Table 3; therefore, it is not statistically significant. The asterisk directs the reader to
the footnotes at the bottom of the table where the asterisk is said to represent p < 0.05, the least stringent
acceptable value for statistical significance.
5.
t = 3.44* (3 months) and t = –0.80 (6 months). At 3 months, the difference in BMI (body mass index) from
pretest was statistically significant with t = 3.44*, p < 0.05. At 6 months, the difference in BMI from pretest
was no longer statistically significant with t = –0.80. These results indicate that although initially the BMI
decreased significantly from the pretest (mean = 22.7) to 3 months (mean = 22.1), the BMI actually increased
at 6 months (mean = 22.9). Thus, the health-promotion intervention did not have a positive long-term
effect on the subject’s BMI, since the subjects demonstrated an increase in BMI versus a decrease.
6.
The t-test for dependent groups is conducted to determine statistical differences between two related or
dependent groups. The t-test can be used to determine differences between two dependent groups following
a treatment and also for comparing and contrasting two groups for a selected variable. Paired t-test is
another name for the t-test for dependent groups.
7.
t = –3.02*, p< 0.05 is the smallest significant t ratio listed in Table 3. The –3.02 is the smallest t ratio with
an *, indicating that Total health behavior was statistically significant from pretest to 3 months in this
study at p < 0.05.
8.
The small t ratios indicate small relative differences between the two groups that are usually not statistically
significantly different, especially in small sample studies. The larger the calculated t ratios, the smaller the
observed p values and the more likely one will reject the null hypothesis, since the groups are significantly
different.
9.
The result t = –1.45 indicates that there is no statistically significant difference in Smoking behavior
from pretest to 3 months in this sample. Thus, the null hypothesis would be accepted, which states the health-
promotion intervention did not have an effect on Smoking behavior.
EXERCISE 31 Questions to be Graded
Name: ___________________________________________________ Class: ______________________
Date: ______________________________________________________________________________
QUES 1.
What are the two groups whose results are reflected by the t ratios in Tables 2 and 3?
QUES 2.
Which t ratio in Table 2 represents the greatest relative or standardized difference between the pretest and 3 months outcomes?
Is this t ratio statistically significant? Provide a rationale for your answer.
QUES 3.
Which t ratio listed in Table 3 represents the smallest relative difference between the pretest and 3 months?
Is this t ratio statistically significant? What does this result mean?
QUES 4.
What are the assumptions for conducting a t-test for dependent groups in a study? Which of these assumptions
do you think were met by this study?
QUES 5.
Compare the 3 months and 6 months t ratios for the variable Exercise from Table 3. What is your
conclusion about the long-term effect of the health-promotion intervention on Exercise in this study?
QUES 6. What is the smallest, significant t ratio listed in Table 2? Provide a rationale for your answer.
QUES 7.
Why are the larger t ratios more likely to be statistically significant?
QUES 8.
Did the health-promotion program have a statistically significant effect on Systolic blood pressure (BP) in this study? Provide a rationale for your answer.
QUES 9.
Examine the means and standard deviations for Systolic BP at pretest, 3 months (completion of the
treatment), and 6 months. What do these results indicate? Are these results clinically important? Provide
a rationale for your answer.
QUES 10. Is this study design strong or weak? Provide a rationale for your answer.
BONUS QUESTION
Would you, as a health care provider, implement this intervention at your facility based on the
Total Risk Score results? Provide a rationale for your answer.
PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT
