Did the health-promotion program have a statistically significant

Did the health-promotion program have a statistically significant effect on Systolic blood pressure (BP) in this study? Provide a rationale for your answer.?t-TEST FOR DEPENDENTGROUPSEXERCISE31 t-TEST FOR DEPENDENTGROUPSSTATISTICAL TECHNIQUE IN REVIEWThe t-test for dependent groups is a parametric analysis technique used to determine statisticaldifferences between two related samples or groups. Groups are dependent or related because theywere matched as part of the design to ensure similarities between the two groups and thus reducethe effect of extraneous variables. For example, two groups might be matched on gender so anequal 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 astheir own control.4. The differences between the paired scores are independent (Burns & Grove, 2005).RESEARCH ARTICLESource: Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascularrisk factors, health behaviors, and life satisfaction in institutionalized elderly women. InternationalJournal of Nursing Studies, 40(4), 37581.IntroductionKim, Junes, and Song (2003) conducted a quasi-experimental study with a one group pretest-posttestdesign. 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 theprogram: 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 completionof the health-promotion program.Relevant Study ResultsA total of 25 women were enrolled in the health-promotion program and 21 subjects completed theprogram with three sets of outcome assessments at pretest, 3 months, and 6 months. The mean ageof the subjects was 77 years, and 90% of them had been diagnosed with one or more chronicdiseases. The significance level of the study was set at a= 0.05. The results from the study arepresented in the two tables that follow. Table 2 describes the health-promotion program’s effectson cardiovascular risk factors, and Table 3 describes the effects on health behaviors. The thirddependent variable of this study was life satisfaction, which was significantly improved frompretest to the end of the health-promotion program at 3 months and at 6 months follow-up.TABLE 2 ? Program Effects on Cardiovascular Risk FactorsPRETEST 3 MONTHS 6 MONTHSVariable M (SD) M (SD) Paired t a M (SD) Paired t bTotal 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) 1.73Triglyceride 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) -0.80Systolic BP 121.7 (14.6) 117.2 (12.3) 1.57 115.6 (13.4) 1.66BMI (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 ininstitutionalized elderly women. International Journal of Nursing Studies, 40(4), p. 378.TABLE 3 ? Program Effects on Health BehaviorPRETEST 3 MONTHS 6 MONTHSVariable M (SD) M (SD) Paired t a M (SD) Paired t bTotal health behavior 66.3 (8.1) 69.7 (5.0) -3.02* 68.1 (5.1) -1.34Health responsibility 2.19 (0.5) 2.13 (0.3) 1.03 2.29 (0.3) -1.39Exercise 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) 2.00Stress management 2.39 (0.4) 2.44 (0.3) -0.65 2.45 (0.3) -0.70Smoking 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 ininstitutionalized elderly women. International Journal of Nursing Studies, 40(4), p. 379.STUDY QUESTIONS1.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 beingexamined 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 and6-month follow-up? This t ratio was calculated to determine the change in which variable from pretest to 6months 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 youranswer.5.Compare the pretest to 3 months and 6 months t ratios for BMI from Table 2. What is your conclusionregarding 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 QUESTIONS1.This study was conducted using a one group pretest-posttest design in which the subjects serve as their owncontrol. The subjects' outcomes at 3 and 6 months were compared with their pretest values. The singlesample pretest-posttest design indicates that the groups were dependent or related. In Tables 2 and 3 thet-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 anasterisk (*) next to it in Table 3; therefore, it is not statistically significant. The asterisk directs the reader tothe footnotes at the bottom of the table where the asterisk is said to represent p < 0.05, the least stringentacceptable 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) frompretest was statistically significant with t = 3.44*, p < 0.05. At 6 months, the difference in BMI from pretestwas no longer statistically significant with t = 0.80. These results indicate that although initially the BMIdecreased significantly from the pretest (mean = 22.7) to 3 months (mean = 22.1), the BMI actually increasedat 6 months (mean = 22.9). Thus, the health-promotion intervention did not have a positive long-termeffect 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 ordependent groups. The t-test can be used to determine differences between two dependent groups followinga treatment and also for comparing and contrasting two groups for a selected variable. Paired t-test isanother 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 withan *, indicating that Total health behavior was statistically significant from pretest to 3 months in thisstudy at p < 0.05.8.The small t ratios indicate small relative differences between the two groups that are usually not statisticallysignificantly different, especially in small sample studies. The larger the calculated t ratios, the smaller theobserved p values and the more likely one will reject the null hypothesis, since the groups are significantlydifferent.9.The result t = 1.45 indicates that there is no statistically significant difference in Smoking behaviorfrom 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 GradedName: ___________________________________________________ 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 assumptionsdo 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 yourconclusion 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 thetreatment), and 6 months. What do these results indicate? Are these results clinically important? Providea rationale for your answer.QUES 10. Is this study design strong or weak? Provide a rationale for your answer.BONUS QUESTIONWould you, as a health care provider, implement this intervention at your facility based on theTotal Risk Score results? Provide a rationale for your answer.

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