| Course | RES 4353 Evidence-based Health Education and Literacy |
|---|---|
| Module | Module 1 |
| Paper type | Research design comparison |
| Length | 1,180 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | B.S. in Healthcare Administration |
| Updated | September 2026 |
Free sample paper for RES 4353 Module 1
Five Studies, Five Designs, One Question About a Plastic Cup: What Each Research Design Can Show About Parents' Liquid Medicine Dosing Errors
Student Name
American College of Education
RES4353: Evidence-based Health Education and Literacy
Module 1 Assignment
Instructor Name
October 5, 2026
The Question
The pharmacy manager at a composite community health center with a busy pediatric clinic has proposed three changes to how liquid medicines are dispensed to families: printing doses in milliliters only, handing out an oral syringe with every liquid prescription instead of a dosing cup, and counseling parents with a picture-based instruction sheet. Most of the center's families have limited incomes, a third speak Spanish at home, and many have limited health literacy. The manager asked whether the evidence supports the changes.
The question matters because limited health literacy has consequences. Berkman et al. (2011) updated a systematic review of what limited health literacy does to people, and the pattern was steady: more hospital stays, more emergency visits, and more trouble both reading labels and showing how a medicine should be taken. Liquid medicines for young children combine all of those risks. The evidence on dosing comes from studies of several different designs, and each design answers a different kind of question. This paper examines five of them.
Designs and the Evidence Hierarchy
Research designs are often ranked in a hierarchy, with systematic reviews and randomized controlled trials at the top, followed by cohort, case-control and cross-sectional studies, and expert opinion at the bottom. The order reflects one thing only: how well a design guards against misleading results when someone asks whether an intervention causes an outcome. It is a useful guide but a blunt one. A design sits high in the hierarchy only for the questions it is built to answer; a well-done cross-sectional study can describe how common a problem is better than a trial can, and a policy statement can tell a pharmacy what standard it will be judged against. The five studies below show those differences.
A Randomized Controlled Trial
Yin et al. (2008) randomly assigned 245 caregivers of young children, seen in an urban public hospital's pediatric emergency department, to receive either standard medication counseling or counseling with plain-language, pictogram-based instruction sheets. At follow-up, caregivers were observed measuring doses. Among those given daily-dose medicines, 5.4% of the pictogram group made a dosing error of more than 20% compared with 47.8% of the control group, and nonadherence was also lower.
Randomization is the design's strength. Because chance decided who received the sheets, differences in literacy, language or income should be spread evenly between groups, so the difference in errors can reasonably be attributed to the intervention. The design cannot show which part of the intervention worked, since the sheets and the plain-language counseling came together, and a single emergency department in one city may not represent a community clinic in another state.
A Randomized Experiment in a Controlled Task
Yin et al. (2016) used a different randomized design. In three urban pediatric clinics, 2,110 English- or Spanish-speaking parents were randomly assigned to study arms with different combinations of label units and dosing tools, and each parent measured nine doses of medicine using a cup and two kinds of syringes. More than four in five parents, 84.4%, got at least one of the nine doses wrong, and mistakes were far more likely with cups than with syringes, with an adjusted odds ratio of 4.6, especially for small doses.
This design tests one thing precisely: how the tool and label affect measuring, with other conditions held constant. It answers the manager's syringe question more directly than the trial does. Its limitation is that measuring a dose in a clinic while being observed is not the same as dosing a feverish child at home at 2 a.m., so it shows what tools make possible rather than what families actually do.
A Cross-Sectional Study
Yin et al. (2014) enrolled 287 English- or Spanish-speaking parents whose children had been prescribed liquid medicines in two emergency departments and examined, at a single point in time, whether the unit on their instructions was associated with errors. Parents who used teaspoon or tablespoon units had about twice the odds of measuring the intended dose incorrectly compared with those who used milliliters only, after adjustment for health literacy, language, education and other factors, and use of kitchen spoons partly explained the difference.
A cross-sectional design can show that two things occur together and how common each is, and it can adjust for measured confounders. It cannot show that the unit caused the errors, because parents were not assigned to units; something unmeasured about the prescribers or families who used teaspoons might explain both. It is strong evidence that a problem exists and where to look, and weaker evidence about what to change.
A Policy Statement
In a 2015 policy statement, the American Academy of Pediatrics recommended that liquid medicines given by mouth be dosed in milliliters rather than teaspoons or tablespoons, and that families have suitable metric dosing devices (Committee on Drugs et al., 2015). A policy statement sits low in the hierarchy because it is expert judgment rather than new data. Yet it synthesizes studies like those above, and it defines the professional standard to which a pharmacy will be held. For the manager, it answers a question no trial could: what the profession now expects.
Designs Not Represented
Two common observational designs are missing from this set, and their absence is informative. A cohort study would follow a group of families forward from the day a liquid medicine is dispensed, recording which tool and label they received and whether the child later had an unplanned visit or a poison center call. That design could link tools to real harm rather than to a measured dose in a clinic, but it would need thousands of families, because serious dosing harm is uncommon. A case-control study would work backward instead, starting with children seen for a dosing-related problem and comparing the tools and labels their families used with those of similar children who had no problem. It is efficient for rare outcomes but depends on parents remembering accurately which spoon or cup they used, which is exactly the kind of detail people misremember. For the manager, the gap means the evidence shows fewer measuring errors with better tools and instructions, but it does not directly show fewer injuries.
What the Designs Show Together
No single study settles the manager's question, but together they point the same way. The cross-sectional study shows that teaspoon units and kitchen spoons are linked with errors in real families. The experiment shows that syringes and milliliter labels reduce measuring errors when other factors are held constant. The trial shows that plain-language, picture-based counseling reduced errors among caregivers observed after a real visit. The review explains why these families are at risk, and the policy statement sets the standard. When studies built in different ways, each with its own weakness, arrive at the same answer, the answer is harder to dismiss than any one of them alone. The next module will search for further studies, particularly any tested in community clinics, to see whether the pattern holds.
References
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
Committee on Drugs, Neville, K., Galinkin, J. L., Green, T. P., Johnson, T. D., Paul, I. M., Sullivan, J., & Van Den Anker, J. N. (2015). Metric units and the preferred dosing of orally administered liquid medications. Pediatrics, 135(4), 784-787. https://doi.org/10.1542/peds.2015-0072
Yin, H. S., Dreyer, B. P., Ugboaja, D. C., Sanchez, D. C., Paul, I. M., Moreira, H. A., Rodriguez, L., & Mendelsohn, A. L. (2014). Unit of measurement used and parent medication dosing errors. Pediatrics, 134(2), e354-e361. https://doi.org/10.1542/peds.2014-0395
Yin, H. S., Dreyer, B. P., van Schaick, L., Foltin, G. L., Dinglas, C., & Mendelsohn, A. L. (2008). Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Archives of Pediatrics & Adolescent Medicine, 162(9), 814-822. https://doi.org/10.1001/archpedi.162.9.814
Yin, H. S., Parker, R. M., Sanders, L. M., Dreyer, B. P., Mendelsohn, A. L., Bailey, S., Patel, D. A., Jimenez, J. J., Kim, K.-Y. A., Jacobson, K., Hedlund, L., Smith, M. C. J., Maness Harris, L., McFadden, T., & Wolf, M. S. (2016). Liquid medication errors and dosing tools: A randomized controlled experiment. Pediatrics, 138(4), Article e20160357. https://doi.org/10.1542/peds.2016-0357
The RES 4353 Module 1 assignment instructions
RES 4353 Module 1 usually asks you to explain the main research designs used in health research and what each can and cannot tell a practitioner. Prompts commonly ask you to describe experimental, quasi-experimental and observational designs, systematic reviews and expert opinion, place them in an evidence hierarchy, and apply the comparison to a health question or a set of studies. Some versions supply articles; others ask you to find one example of each design. Graders expect you to go beyond definitions and to discuss bias, causation and generalizability in the context of real studies. Choose a question that has been studied in several ways, and check the Canvas prompt for how many designs you must compare and whether each needs its own heading.
Inside the RES 4353 Module 1 example
The sample opens with a pharmacy manager's practical question and uses a systematic review to explain why it matters for families with limited health literacy. It then sets out the evidence hierarchy and its limits before taking five sources one at a time. For each, it reports what the study found, with its numbers, and then explains what the design allows the reader to conclude. The trial supports a causal claim but cannot separate its components; the experiment isolates tools but not home behavior; the cross-sectional study shows association and adjustment but not cause; the policy statement defines the standard. A closing section shows how the designs combine and names a gap for the next module.
Reading the RES 4353 Module 1 rubric
Design comparison rubrics usually reward accurate description of each design, correct placement in the evidence hierarchy, and application to real studies. The accuracy criterion checks that terms such as randomization, confounding and generalizability are used correctly. Graders give more credit when designs are illustrated with actual studies and their findings than with hypothetical examples. A critical thinking criterion rewards explaining what each design can and cannot show, and recognizing that the hierarchy depends on the question. Synthesis across designs often earns the top marks. Use of peer-reviewed sources, clear organization and APA 7 formatting complete the rubric in most sections.
Common RES 4353 Module 1 mistakes, and how to avoid them
Design papers often read like a glossary, defining each design without showing it at work. Another common problem is treating the hierarchy as absolute, as if a trial were always better regardless of the question. Students also confuse association with causation when describing cross-sectional or cohort results. Report each study's key numbers, because they show you read it. Explain one strength and one limit for every design. End by saying what the designs show together. If your question concerns vaccination reminders, discharge teaching or nutrition labels instead, tell us the topic and share your prompt, and a Module 1 comparison can be written around it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More RES 4353 and B.S. in Healthcare Administration sample papers
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- RES 4353 Module 3: Critical Appraisal of a Study
- RES 4353 Module 4: Statistical Results Interpretation
- RES 4353 Module 5: Plain-Language Evidence Brief
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- HLTH 4363 Module 3: Positioning and Message Strategy
- HLTH 4383 Module 3: Program Budget and Justifications
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RES 4353 Module 1 questions, answered
What does RES4353 Module 1 usually ask for?
RES4353 typically opens by asking you to compare research designs, such as randomized trials, observational studies, systematic reviews and expert statements, and to explain what kind of question each can answer about a health topic. Your classroom's instructions decide the topic.
Why are randomized controlled trials considered strong evidence?
Random assignment spreads known and unknown differences between groups by chance, so a difference in outcomes can more reasonably be attributed to the intervention.
Can a cross-sectional study show cause and effect?
No. It shows that factors occur together at one point in time and can adjust for measured confounders, but it cannot rule out unmeasured explanations or show which came first.
Where can I find a free RES 4353 Module 1 sample paper?
This page carries the complete Module 1 comparison of five designs, from a randomized trial to a policy statement, all addressing parents' liquid medicine dosing errors, with margin notes on each design.
Where does a policy statement fit in the evidence hierarchy?
Near the bottom, because it is expert judgment rather than new data, but it often synthesizes the research and defines the professional standard for practice.