All i need is for you to rewrite into different words anything that is nota direct quotes. The direct quotes have the names of authors in parenthesis. Turnitin came up too high in this paper!

In many ways, qualitative research contributes significantly, if not more so than quantitative research, to the field of primary care at various levels. Qualitative studies are chosen to illustrate how various methodologies of qualitative research helped in advancing primary health care. According to monitoring of chronic obstructive pulmonary disease (COPD) through mobile-health technology, informed the decision for colorectal cancer screening, triaging out-of-hours GP services, and evaluating care pathways for community psychiatry and finally prioritization of healthcare initiatives for legislation purposes at national levels. With the recent advances in information technology and mobile connecting device, self-monitoring and management of chronic diseases via telehealth technology may seem beneficial to both the patient and healthcare provider. Given the diverse genera and forms of qualitative research, there is no consensus for assessing any piece of qualitative research work.

In qualitative research, validity is used to imply improvising the necessary tools and data. The choice of methodology is essential when answering most of the research question. The design used in qualitative research is used during methods, sampling and analysis of data.  In assessing the validity of qualitative research, the challenge can start from the ontology and epistemology of the issue being studied, and an example can be the concept of the individual is seen differently between humanistic and positive psychologists due to different philosophical perspectives. Where humanistic psychologists believe the individual is a product of existential awareness and social interaction, positive psychologists think the individual exists side-by-side with the formation of any human being. Set off in different pathways, qualitative research regarding the individual’s wellbeing will be concluded with varying validity. Choice of methodology must enable detection of findings/phenomena in the appropriate context for it to be valid, with due regard to culturally and contextually variable. For sampling, procedures and methods must be appropriate for the research paradigm and be distinctive between systematic, purposeful or theoretical sampling where the systematic sampling has no a priori theory, purposeful sampling often has a particular aim or framework, and theoretical sampling is molded by the ongoing process of data collection and theory in evolution.

In quantitative research, reliability refers to the exact reliability of the processes and the results. In qualitative research with diverse paradigms, such definition of reliability is challenging and epistemologically counter-intuitive. Hence, the essence of reliability for qualitative research lies in consistency. A margin of variability for results is tolerated in qualitative research provided the methodology and epistemological logistics consistently yield data that are ontologically similar but may differ in richness and ambience within similar dimensions.  As data were extracted from the sources, researchers must verify their accuracy regarding form and context with the constant comparison, either alone or with peers.

Most qualitative research studies, if not all, are meant to study a specific issue or phenomenon in a particular population or ethnic group, of a focused locality in a particular context, hence generalizability of qualitative research findings is usually not an expected attribute. However, with rising trend of knowledge synthesis from qualitative research via meta-synthesis, meta-narrative or meta-ethnography, evaluation of generalizability becomes pertinent. A pragmatic approach to assessing generalizability for qualitative studies is to adopt same criteria for validity: That is, use of systematic sampling, triangulation and constant comparison, proper audit and documentation, and multi-dimensional theory. However, some researchers espouse the approach of analytical generalization where one judges the extent to which the findings in one study can be generalized to another under similar theoretical, and the proximal similarity model, where generalizability of one study to another is judged by similarities between the time, place, people and other social contexts. Thus said, questioned the suitability of meta-synthesis given the basic tenets of grounded theory, phenomenology and ethnography. He concluded that any valid meta-synthesis must retain the other two goals of theory development and higher-level abstraction while in search of generalizability and must be executed as a third level interpretation using Gadamer’s concepts of the hermeneutic circle, dialogic process and fusion of horizons.

Cognitive and Cognitive-Behavioral Marital Therapy although been recognized, behavior, cognition, and emotion are important factors in marital functioning, the applications of Behavioral Marital Therapy discussed earlier place a primary emphasis on altering behavior as the primary strategy for improving marital functioning. Behavioral Marital Therapy follows from the premise that, because all three domains are interrelated, behavioral changes should result in different ways of thinking about the partner and the marriage, along with concomitant shifts in feelings about the marriage. Concurrent with an increasing emphasis on cognitive factors in psychological functioning, marital investigators recently have begun to explore the role of cognitions in marital functioning.

The most basic question to ask regarding marital therapy is whether the interventions are efficacious in treating the marital problems reported by distressed couples. Whereas this might at first appear to be a straightforward question, in actuality it is more complex. There are at least two ways to alter marital distress (Brown, Barros-Gomes, Smith-Marek, Cafferky, & Stith, 2017). First is helping the couple become more satisfied with their current relationship and second is assisting the couple in terminating a relationship that is not healthy or rewarding for the persons involved. Behavioral Marital Therapy is the most widely evaluated marital treatment that has served as a focus of more than two dozen well controlled (Kaplan & A, 2004).

Behavioral Marital Therapy has been presented as a skills-oriented approach emphasizing that couples need basic skills and understanding of relationship interactions to improve their marriages. The treatment focuses primarily on the current marital relationship, teaching couples how to communicate with each other and solve problems more effectively. In addition, the therapist assists the couple in planning behavioral changes to increase the frequency of pleasing interactions while minimizing destructive, negative interactions (Gardner, 2014). This can include caring or loving acts toward the partner as well as increases in coupling activities such as taking walks, attending the theatre, and so forth. As noted earlier, Behavioral Marital Therapy is not a single intervention strategy. Rather, it is an approach to treatment based on social learning principles. Some interventions have been developed that focus primarily on behavior exchange strategies, such as teaching couples how to contract for reciprocal behavior changes or suggesting increases in joint couple recreational activities (Agius, 2017), and communication and problem-solving skills. Although there are differences among these interventions, almost all focus on the present. Also, it deals with behaviors and interaction patterns that are in the couple’s awareness, involve specific behavioral changes (Oliveira, Schwartz, & Stahl, 2013) to promote more adaptive functioning and incorporate homework or the application of behavioral principles outside of the session.

Our review of the couple- and family-level treatments that have been submitted to controlled investigation indicated that most could be classified into one of three broad types. First, some interventions can be viewed as partner-assisted or family-assisted interventions (PFAIs). In these interventions, the partner or family (Slonim, 2014) is used as a surrogate therapist or coach in assisting the identified patient. PFAIs typically are developed from a cognitive-behavioral framework in which the patient has specific assignments outside of the treatment session. The preceding criteria for establishing efficacy are based on comparisons of group means; thus, a treatment is deemed to be efficacious if it is superior to no treatment or nonspecific treatments in the bulk of the investigations conducted (Sobanski, et al., 2010).

The efficacy criteria do not consider whether the magnitude of change produced by the treatment is in some manner clinically significant or worth noting regarding a couple’s day-to-day functioning. Some additional issues regarding the clinical utility and efficient implementation of Behavioral Marital Therapy have been evaluated. Although the majority of Behavioral Marital Therapy investigations do not report data on consumers’ satisfaction with Behavioral Marital Therapy (Slonim, 2014), the findings of a small number of studies suggest that couples rate the treatment positively and continue with the intervention. Whereas couples who receive Behavioral Marital Therapy appear to be pleased with the intervention and persist through treatment, it is also important to know who seeks intervention and in what settings.

In addition to reviewing the marital therapy literature, we also identified couple- and family-based treatments for a number of individual adult mental disorders. The results indicate that some the couple- and family-based treatments appear to be beneficial for marital distress and individual disorders.

Regarding the first of these issues, we decided to determine efficacy status by focusing on changes from pretreatment to post-treatment, recognizing that the long-term effects of treatment are of extreme importance. Our decision was based primarily on methodological difficulties with follow-up data. First, the follow-up time periods used by different investigators vary widely, often ranging from a few months to several years. Drawing a single conclusion about a treatment’s efficacy status using such discrepant time periods is difficult and increases the subjective nature of the decision of how to classify a treatment. Second, often there is significant dropout during the follow-up period, further complicating initial low power and the possibility of differential dropout between conditions, which can significantly affect the findings. Third, although most investigators seem to disallow additional intervention outside of the treatment protocol while treatment is occurring, clients typically are free to seek additional treatment during the follow-up period, which makes it difficult to evaluate the long-term effects of the stated treatment.

In evaluating the efficacy status of couple and family interventions, the report has incorporated different domains that include clinical psychology, cognitive and perceptual psychology, clinical neuropsychology, and psychopharmacology. In summary, all four domains described involved rather small sample sizes, but the magnitude of change produced for various dependent measures appears to be consistent with what has been found in some Behavioral Marital Therapy investigations. Thus, to date, the findings suggest that supplementing Behavioral Marital Therapy with cognitive restructuring is as efficacious as Behavioral Marital Therapy alone but does not produce enhanced treatment outcomes. The combination of Behavioral Marital Therapy and cognitive reorganization has been found to be more effective than a waiting list condition by only one research team and, therefore, is most appropriately classified as possibly efficacious. Taken together, the preceding studies suggest that involving a partner or family member in the exposure treatment of OCD is at least as effective as treating the patient without such assistance. The fact that treatment can be successfully implemented in this way may be especially important in cases in which the patient requires the reinforcement of a significant other in the home environment to follow through with the treatment protocol. Alcohol treatment studies are limited in their design options. Heavy drinkers’ reluctance to change and the immediate dangers involved in excessive drinking rule out assigning them to no-treatment or waiting list control groups. Virtually all alcohol treatments are compared with another active intervention, at least at the treatment-as-usual level.

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