Conceptual-Theoretical-Empirical Structure (CTE) Evaluation
Evaluating Conceptual-Theoretical-Empirical Linkages for testing or generation of a theory involves five steps. Critical thinking and judgment making is required to determine the extent to which information about a certain Conceptual-Theoretical-Empirical component meets selected criteria. The five steps include evaluating 1) C-T-E linkages, 2) selected theory, 3) empirical indicators, 4) research findings, and 5) utility and soundness of the practice theory. While information adequacy is evident on empirical indicators, and research findings, information adequacy in C-T-E linkages, selected theory, and utility and soundness of the practice theory is not clearly evident.
Evaluation of the Conceptual-Theoretical-Empirical Linkages
There exists a complex Conceptual-Theoretical-Empirical Linkage useful in guiding the application to nursing practice. Nursing research cannot be conducted without the guidance of conceptual models. Also, theories cannot be derived without the guidance of conceptual theories (Butts & Rich, 2017). This paper focuses on evaluating this linkage. In this evaluation, two things are clear. First, there is evidence of specification adequacy. This means there is information provided about the conceptual model.
The report presents a Health Belief Model. This is a theoretical model useful in guiding health promotion as well as in programs of disease prevention. The model is used in explaining and predicting changes in health behaviors (Butts & Rich, 2017). It is one of the most common models used in understanding health behaviors. The report has identified the conceptual model that guided the research as the ‘Health Belief Model HBM’ (Tharek et al., 2018). However, there is no much information that has been given about the conceptual model. There is no clear overview of the content of the identified model. It, however, shows the connection between the model and the research topic. For example, the report states that the integration of the HBM and self-efficacy theory suggests that self-efficacy increases self-care behavior that leads to improved glycaemic control (Tharek et al., 2018). Specialization adequacy is not clearly evident.
Second, in the evaluation of the Conceptual-Theoretical-Empirical Linkages, evidence of linkage adequacy is evaluated. This refers to the amount of information given in the study report about the connections between the middle-range theory and the conceptual model. The connections should be stated clearly (Butts & Rich, 2017). There is limited information on this connection. The report shows self-efficacy theory derived from the Health Belief Model improving self-care behavior eventually leading to enhance glycaemic control. For example, the report states, “The integration of self-efficacy theory and the HBM suggests that self-efficacy improves self-care behavior which ultimately leads to better glycaemic control” (Tharek et al., 2018). Linkage adequacy is not clearly evident.
Evaluation of the selected theory- Self-efficacy theory
First, self-efficacy theory is significant. This means that it is socially and theoretically significant. It is socially significant because it addresses a topic that is practically important to society (Butts & Rich, 2017). For example, the report states that “Type 2 Diabetes Mellitus (T2DM) has become a major burden not just to individuals but also to the health care systems both nationally and internationally. Globally, 387 million people have T2DM in 2014 and this is expected to rise to 592 million by 2035 …T2DM poses a significant healthcare burden accounting for 16% of the Malaysian healthcare budget (2.4 billion Malaysian Ringgits),” (Tharek et al., 2018). The theory is theoretically significant because it offers some new insights about the topic. For instance, the report states that the study showed that higher self-efficacy enhanced self-care behavior improving glycaemic control. (Tharek et al., 2018).
Second, we evaluate if the theory is internally significant or how comprehensible the theory is (Butts & Rich, 2017). Several middle-range theory concepts were identified with no clear definition including self-efficacy, glycemic control, and self-care behaviors. The report used similar terms for theory concepts throughout the paper. Therefore, the information on internal significance is inadequate. Third, we evaluate the parsimony of the selected theory. This refers to the extent to which content about the theory is briefly stated. The theory should be explained in a few propositions and concepts to ensure that it conveys the intended meaning (Butts & Rich, 2017). This information is not clearly stated. Fourth, we evaluate if the theory is testable. Each concept should be measured and assertions testable (Butts & Rich, 2017). To measure self-efficacy levels, DMSES was used. SDSCA was used in measuring self-care behaviors. HbA1c was used in measuring glycaemic control (Tharek et al., 2018). So, the theory is testable.
Evaluation of the empirical indicators.
In this step, we evaluate the information given in the study of empirical indicators. An empirical indicator us an actual and precise real-world representation for a concept of the selected middle-range theory (Butts & Rich, 2017). It can be an experimental condition, a procedure, or a real instrument used in measuring or observing a concept of middle-range theory. Empirical indicators provide means through which theories are tested or generated. Assessment instruments are among the empirical indicators (Butts & Rich, 2017). They yield data that can be sorted into scores of categories. Studies can also have intervention protocols as empirical indicators.
Operation adequacy is evident. First, the study report provides sufficient information about empirical indicators, assessment tools (Butts & Rich, 2017). It states, “The tools for this study consisted of two sets of questionnaires which have been previously translated and validated: the Diabetes Management Self-Efficacy Scale (DMSES) Malay version  and the Summary of Diabetes Self-Care Activities Scale (SDSCA) Malay version… The DMSES Malay version  was chosen to measure the self-efficacy levels in this study population because of its reliability (Cronbach’s α of 0.951) and comprehensiveness in covering the domains in diabetes management… The SDSCA Malay version  was chosen because of its reliability (Cronbach’s α of 0.740), brevity and ease of scoring.” (Tharek et al., 2018).
Second, the methods used in conducting the research are clearly described and appropriate (Butts & Rich, 2017). For example, a cross-sectional study was used which was appropriate. The study population was patients with T2DM. The single proportion formula with 5% precision and a 95% confidence interval, was used in calculating the sample size (Tharek et al., 2018). Findings from a similar study were used in estimating the proportion (P). The Statistical Package for the Social Sciences (SPSS) was used in data analysis (Tharek et al., 2018).
Evaluation of research findings.
In this step, the focus is on evaluating the amount of information given on the empirical adequacy of the selected middle-range theory. Empirical adequacy, in this case, refers to the extent to which findings agree with the theory (Butts & Rich, 2017). Empirical adequacy is evident. For example, the report states, “This was the first study evaluating the relationship between self-efficacy, self-care behavior and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting…A positive correlation between self-efficacy and self-care behavior was demonstrated in patients with T2DM in this study,… A review of the role of self-efficacy in diabetes care showed that self-efficacy provides a suitable framework for understanding and predicting commitment towards self-care behaviors and the effectiveness of self-management in diabetes treatment … this study has demonstrated that higher self-efficacy was correlated with better self-care behavior and glycaemic control.” (Tharek et al., 2018).
Evaluation of the utility and soundness of the practice theory.
In evaluating the utility and soundness of the practice theory, we determine if information about pragmatic adequacy of the theory is provided. Pragmatic adequacy, in this case, refers to the extent to which theory should be used as the basis for practical undertakings (Butts & Rich, 2017). A theory can be used as a basis for practical undertakings if it is meaningful to society, if it is suitable for use in a certain practice situation, if it is feasible in a certain practice setting, if its use is consistent with expectations from the public, and if practitioners have legal control over its use in practice (Butts & Rich, 2017).
The study report provides limited information on the pragmatic adequacy of the self-efficacy theory. It states, “Despite its limitations, this study is the only study that explored such relationships among T2DM patients in the Malaysian primary care setting. The findings of this study highlight the importance to measure self-efficacy in order to develop individual self-management intervention programs for patients with T2DM in primary care, with the aim of improving glycaemic control and reducing major complications.” (Tharek et al., 2018).
Butts, J. & Rich, K. (2017). Philosophies and Theories for Advanced Nursing Practice. Jones & Bartlett Learning.
Tharek, Z., Ramli, A., Whitford, D., Ismail, Z., Zulkifli, M., Sharoni, S., Shafie, A. & Jayaraman, T. (2018). Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting. BMC Family Practice, 19(39).