Critical evaluation of methodology in “Experiences of insomnia among older people living in nursing homes a qualitative study”

TL;DR

This paper reviews a study on insomnia in nursing home residents, pointing out strengths and weaknesses in its research methods.

Contribution

The paper provides a critical evaluation of a qualitative insomnia study's methodology, highlighting biases and suggesting improvements.

Findings

The study used purposive sampling and inductive content analysis but lacked intercoder reliability checks.

Environmental factors like noise were self-reported without objective validation.

Gender imbalance and exclusion of dementia patients limited the study's generalizability.

Abstract

This letter critically evaluates the methodology of Eva Hjort Telhede’s qualitative study exploring insomnia experiences among nursing homes. While the study contributes valuable insights into subjective sleep challenges, its methodological rigour warrants scrutiny to inform future research.

The study employed a qualitative descriptive design with semi-structured interviews (n = 19 participants) and inductive content analysis. Data collection occurred in nine Swedish nursing homes, with purposive sampling based on insomnia criteria (ICD-10) and cognitive competence (S-MMSE ≥20). Analysis followed Graneheim and Lundman’s qualitative content analysis framework.

Key methodological strengths included purposive sampling, data saturation, and reflexive practices. Limitations identified were single-researcher bias, lack of intercoder reliability checks, gender imbalance (4 men, 15 women), and exclusion of variables such as cognitive diagnoses and medication use. Environmental factors (e.g. noise and lighting) were self-reported without objective validation, and contextual transferability was constrained by limited demographic diversity.

The reliance on a single coder and absence of triangulation may compromise the depth of thematic analysis. Recommendations include: (1) multi-researcher collaboration to enhance credibility; (2) inclusive sampling of residents with dementia; (3) mixed-methods designs integrating objective sleep measures; and (4) staff training in sleep hygiene to address institutional barriers. Strengthening methodological transparency and addressing contextual factors could improve future interventions for insomnia in nursing homes.