PERIOPERATIVE NURSING (2018), VOLUME 7, ISSUE 3

REVIEW ARTICLE

LIMITATIONS AND DELIMITATIONS IN THE RESEARCH PROCESS

Dimitrios Theofanidis1, Antigoni Fountouki2
1. PhD, MSc, Assistant Professor, Nursing department, Clinical Professor, Alexandreio Educational Institute of Thes-
saloniki, Greece
2. PhD(c), MSc, Clinical Lecturer, Nursing department, Clinical Professor, Alexandreio Educational Institute of Thes-
saloniki, Greece

DOI: 10.5281/zenodo.2552022
Cite as: Theofanidis, Dimitrios, & Fountouki, Antigoni. (2019). Limitations And Delimitations In The Research Process. Periopera-
tive nursing (GORNA), E-ISSN:2241-3634, 7(3), 155–162. http://doi.org/10.5281/zenodo.2552022

Abstract

Introduction: Many authors tempt to balance the recognition of shortcomings and study limitations with the risk of
having their paper rejected. Yet, before any attempt to run a study, a researcher needs to recognise the meaning and
operational definitions of the terms ‘limitations’ and ‘delimitations’ in biomedical research. Aim: to define, review and
elaborate how limitations and delimitations are currently acknowledged in the nursing and biomedical literature and
their implications in health care studies. Methods: A critical literature review was undertaken, focusing on papers
debating the core essence of research limitations and associated concepts. Initial searches yielded >300 papers of
which only 25 were appropriate for this paper’s needs. Results: It is evident that any research attempt inevitably car-
ries limitations and delimitations regarding its underlying theories, study design, replication potential, shortcomings
in data collection and questionnaire design, insufficient subgroups or data for robust statistical analysis, narrow time
span for data collection, lack of consideration for seasonal differences and missing data, causal relationships, meas-
urement errors, study setting, population or sample, ethical parameters, data collection/analysis, result interpreta-
tions and corresponding conclusions. Delimitations require challenging the assumptions of the researchers and openly
exposing shortcomings that might have been better tackled. Some authors cite study limitations solely because it is
required by journal policy. Under these circumstances, the weakest limitation may be put forward in an attempt to
‘safeguard’ the study’s chance of being published. Researchers need to be aware of the wide range of limitations and
delimitations and address them early in the research process Conclusions: Constructive rethinking and restructuring
of the global nursing and biomedical research agenda is necessary to upgrade the profession and reassure the public.
Thus, authors should openly and extensively report their research limitations, delimitations and assumptions in order
to improve the quality of their findings and the interpretation of the evidence presented. On the contrary, when any
of these key elements are neglected, overlooked or hushed, the study kudos is jeopardised.

Keywords: Study Limitations, Methodology, Nursing Research

Corresponding Author: Theofanidis Dimitrios, Ierosolimon 21, Kalamaria, 55134, Thessaloniki, e-mail: [email protected], Mo-
bile:6945227796

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Introduction area which would not provide an overall scope of

responses.2
In today's highly competitive culture of interna- Thus, in quantitative studies, that sample would
tional publishing, many authors are rather tempted not have been representative and when doing
to balance the recognition of shortcomings and qualitative research, data saturation would not
study limitations with the risk of having their paper have been achieved. With regards to measure-
rejected.1 In this respect, this critical discussion pa- ments and testing, the research tool itself may be
per was developed through analysis and self-reflec- a limiting factor by providing ‘narrow results’. For
tion by the author, a researcher in the health care example, a set of good reliable scales would be per-
sector, who has also experience as editor and re- fect for weight measurements but would provide
viewer of national and international nursing publi- only one of two essential parameters for estimat-
cations. ing body mass index. Time is another factor that
Before any attempt to run a study, one needs to may limit a study by distorting results. For example,
grasp the fundamental principles which make a pa- a study on dietary habits may limit the extent of the
per suitable or not for publication and acceptable conclusions drawn, depending on the time of year
to a wider readership base. Thus, as a first step, a data were gathered. In addition, greater societal
researcher needs to recognise the meaning and op- circumstances and financial trends that may coin-
erational definitions of the terms ‘limitations’ and cide with the study period should be acknowledged
‘delimitations’ in biomedical research which in- as such.3
clude the following: Data analysis methodology is another area of po-
Limitations of any particular study concern poten- tential limitation. For example, most qualitative
tial weaknesses that are usually out of the re- methodologies cannot be truly replicated (as in
searcher’s control, and are closely associated with controlled experimental conditions) and therefore
the chosen research design, statistical model con- are unable to be verified per se. With regards to
straints, funding constraints, or other factors. In quantitative statistical analysis, most models can
this respect, a limitation is an ‘imposed’ restriction easily determine correlation between two or more
which is therefore essentially out of the re- variables, but again, not causation per se. Thus, all
searcher’s control. Still, it may affect the study de- of the above limitations must be clearly stated so
sign, results and ultimately, conclusions and should that results are not distorted and misinterpreted
therefore be acknowledged clearly in the paper by the wider readership. Unfortunately, when re-
when submitted. For example, when exploring par- porting results, ‘author excitement’ may easily
ticipants’ responses to a survey, the researcher overlook this important aspect of conducting and
may be limited to access only a small geographical reporting research.4

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Delimitations are in essence the limitations con- delimitations are currently acknowledged in the
sciously set by the authors themselves. They are nursing and biomedical literature and their implica-
concerned with the definitions that the researchers tions in health care studies. A further objective is to
decide to set as the boundaries or limits of their examine briefly the implications of limitations in bi-
work so that the study’s aims and objectives do not omedical studies and patient care per se.
become impossible to achieve. In this respect, it
can be argued that delimitations are in the re- Methods
searcher’s control. Thus, delimitations are mainly A critical literature review was undertaken, focus-
concerned with the study’s theoretical back- ing on recognised scholarly papers debating the
ground, objectives, research questions, variables core essence of research limitations and associated
under study and study sample. The alternatives to concepts. Key words used included research limita-
these and reasons for rejecting them, e.g. the par- tions, delimitations, assumptions and biases within
ticular sampling technique chosen out of many a 20 year time span in Medline and Google Scholar
available, should be clearly presented so that the databases. Initial searches yielded more than 300
reader is fully informed .5,6 papers which were concerned with particular (of-
In a way, delimitations are not as much as “why ten clinical) limitations within specific research
I did this” but rather “why I did not do it like this”. fields such as the limitations in cancer studies or
Reasons for rejecting a certain course of action dur- animal models and not the research process itself.
ing the research process and the options available Close scrutiny of abstracts concluded that only 25
should also be cited. Then, a brief rationale should articles could be used for this paper’s needs. As this
be provided. Usual reasons for choosing a particu- is a discussion and position paper, findings are in-
lar sampling technique for example are related to corporated in the discussion.
available resources, local circumstances (practical
access), ethical and permit considerations or time Discussion
constraints. In this light, delimitations are not pos- In any given study, potential study limitations may
itive or negative but rather a detailed account of include assumptions regarding underlying theories,
reasoning which enlightens the scope of the causal relationships, measurement errors, study
study’s core interest as it relates to the research setting, population or sample, data collection/anal-
design and underpinning philosophical frame- ysis, result interpretations and corresponding con-
work.7 clusions. Furthermore, failure to measure im-
portant aspects and potential confounding varia-
Aim bles are also common study limitations while the
The goal of this critical discussion paper was to re- remaining refer to aspects of applicability of the re-
view and elaborate how limitations and sults to clinical practice, i.e. external validity. All of

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these may contain potential factors that could in- cases costly and sometimes lengthy.13 In this case,
duce uncertainty in a study overall. Some uncer- observational research can be used instead. How-
tainty in biomedical research is inevitable but open ever, an awareness of the benefits and limitations
communication about it can inform readers on the of observational research needs to be exercised as
validity and applicability of a study’s findings. It is there is a potential for bias. As clinical decisions of-
therefore important to recognize the uncertainties ten involve a degree of uncertainty it could be ar-
within research findings which should be explicitly gued that such research needs to be at a level of
expressed in research papers.8 certainty sufficient to influence diagnostic and/or
A fundamental form of limitation is when scien- treatment decisions albeit less certain than RCTs.14
tists are restricted in their research scope due to In this light, Rubin & van der Laan15 suggested
ethical concerns.9 One of the pillars for establishing that a means of minimising study limitations is per-
limitations to research is the Harm Principle estab- sonalised medicine by the use of replication. They
lished by John Stuart Mills (based on the Hippo- argued that working towards more tailored thera-
cratic Oath) whereby an inquiry is limited if the out- pies, could provide additional evidence of safety
comes of the research might cause harm especially and efficacy before pharmaceutical drugs can be
to vulnerable groups or individuals.10 marketed. However, their model of patient simula-
Thus, as much as researchers may carefully plan tions based on two active RCTs of antibacterial
and design their study, it is inevitable they will face drugs for the treatment of skin and skin structure
some limitations which are not always identified at infections gave poor results and the authors con-
the beginning, before conducting the research. For cluded that statistical approaches to personalized
example, in most health care research, it would be medicine will often face difficult challenges. Yang
ideal to conduct a qualitative study before design- and Rannala,16 used a Bayesian modeling approach
ing a quantitative one as this would inform and im- to generate posterior probabilities, i.e. when rele-
prove the methodology of the latter.11 Yet, in most vant background is taken into account. The statisti-
instances, this may not be possible due to limited cal performance of their method incorporated sim-
time and other resources. ulations but again, limitations in their proposed
According to Morris et al.,12 when credible clini- statistical approach remain evident.
cal evidence is lacking, then the consequences on With regards to data collection, when an on-line
patient’s care and outcomes may be dramatic. tool is to be used, an inherit shortcoming is that the
Thus, limitations in biomedical studies may carry a questionnaire needs to be shorter than a ‘paper
further effect on clinical decisions and desired and pencil’ one.17 A long self-administered ques-
health outcomes. According to Boyko, although tionnaire risks ‘participant fatigue’ and consequent
randomized controlled trials (RCTs) are the gold higher drop-out rate. This limits the study as some
standard for treatment efficacy; they are in most of the potential (polarised) participants’ views

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 PERIOPERATIVE NURSING (2018), VOLUME 7, ISSUE 3

would not be represented in the results. An inherit can result in a non representative population, thus
limitation on a self-administered survey, is that the the results cannot be generalised to the rest of the
researcher cannot control the course of the inves- student population.20
tigation and clarify any questions from respond- Some studies within the nursing paradigm
ents. Another built-in limitation of a self-adminis- gather data through self-reporting questionnaires
tered questionnaire is missing data due to respond- in order to identify relationships between varia-
ent withdraws or failure to fill in the whole survey, bles. By using these, the researcher relies on the
but since this is nowadays usually done as postal or honesty of the participants and the problem starts
more likely an online survey, the researcher cannot at the point where the respondent is willing to dis-
prevent this from happening.18,19 close the truth or not.21 It is a common problem in
The specific period when a survey is distributed behavioural research that the questionnaire in-
is in itself a limiting factor, for example when a volves personal and sometimes indiscreet ques-
study on university students is conducted during tions; however, most studies try to avoid seeking
summer and particularly during August. During this invasive personal data and the survey question-
time most of the students are not in the university naires are usually anonymous. Still, there may be
or tend to spend a limited amount of time on the some participants that do not want to report their
university websites so they may not easily come actual, true responses and therefore this can con-
across and answer a survey. Also, the time span of stitute another limitation to a study. The semi-
a survey may have an impact on the sample size. structured, open-ended interview is a gold stand-
Again, when looking at the previous example with ard alternative for questionnaires in qualitative
the study population of university students, it is un- health research. Yet, despite its methodological
likely that a big sample size is to be achieved during merits, a long interview is unsuitable when partici-
summer months. As a consequence of a limited pants find content sensitive to discuss, or when
sample size, outcomes may be unevenly distrib- they have restricted communication skills. Thus, re-
uted regarding participants’ parameters. There- searchers who explore emotionally sensitive topics
fore, some socio-demographic characteristics may should look for alternative data collection methods
need to be grouped in order to form bigger sub- and careful wording that lead to uninhibited emo-
groups such as the ethnicity of the students. Thus, tional expression.22
instead of many ethnic groups, ethnicity may be Last but not least, the use of Likert scale on the
limited to only Black, White or Other. Furthermore, questionnaire can be a limiting factor when asking
when the research design incorporates a non-prob- attitudes or behavioural questions. Many partici-
ability or convenience sampling, this may also lead pants may avoid selecting the extreme measures
to sampling biases and corresponding limitations. ‘Strongly Disagree’ and ‘Strongly Agree’ and prefer
When a sample has not been chosen randomly, this choosing middle measures like ‘Agree’ and

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‘Disagree’; this could lead to masking of the inten- hedging, authors can express an element of uncer-
sity of the real attitudes and behaviours of the par- tainty about their study’s validity in order to pre-
ticipants.23,24 vent readers from accepting strong or definitive
Although unbiased and frank discussion and de- statements without critical interpretation.
tailed presentation of a study’s limitations are the Although a conscientious author seeks to report
core part of scientific integrity, too few papers in his results by avoiding unfair assumptions, all too
the medical literature openly admit to how limita- often nursing literature is littered with crude exam-
tions could affect their findings and interpreta- ples of stereotyping or over-generalizations. A typ-
tions. Morris and Ioannidis explored some philo- ical example has just been provided in the proceed-
sophical and scientific underpinnings of clinical re- ing sentence where the assumption was made that
search and corresponding evidence within the pa- ‘most authors are male!’. Similarly, in many nursing
tient-clinician arena.12 They suggest that due to journals, the prevailing culturally associated as-
lack of credible evidence making correct clinical sumption is that nurses are female. Yet, research
choices is often a low-probability exercise. Thus, assumptions and biases are so commonplace and
when study limitations are not clearly expressed, inherit to the content of any study, Leedy and
the findings may wrongly guide clinical practice to Ormrod (2016) state that, “…without them, the re-
an extent where these may become the new ‘un- search problem itself could not exist”.6 Thus, as long
questionable’ therapeutic or interventional norm. as these are spelled out clearly in either the study
In every day rhetoric and daily interactions, as- limitations section or in the discussion, the author
sumptions cannot be avoided as every viewpoint is covering for potential pitfalls. Yet, even more im-
holds to some degree a concealed assumption. Re- portantly, an investigator needs to clarify and rec-
search assumptions are essentially issues, ideas, or ord all identified assumptions.
positions found anywhere from the beginning of Although not identical, often limitations and as-
the study design to the final report, that are taken sumptions are viewed interchangeably as of the
for granted and viewed as reasonable and widely same essence and hence, grouped together. There-
accepted. Regarding nursing studies, the re- fore, a researcher should not only cite them distinc-
searcher may assume for example that the re- tively (e.g. in the Methods and Discussion/Conclu-
spondents will show true responsiveness to a face- sions sections respectively), but also take adequate
to-face interview. Yet, in reality, some respondents steps that these are not contradicting each other
may intend to answer in terms of ‘what the re- both at a theoretical and practical level. For exam-
searcher wants to or would be pleased to hear’. Ac- ple, if a particular statistical test is used which has
cording to Hyland,25 authors should be presenting a inherited limitations concerning data distribution,
proposition as an opinion rather than a fact, i.e. when reporting results, generalizations should be
should “hedge” their statements. Thus, by using avoided. In this respect, it becomes apparent that

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 PERIOPERATIVE NURSING (2018), VOLUME 7, ISSUE 3

a study’s limitation is totally outside that re- assumptions should be put in the context of the en-
searcher’s control, while an assumption is some- tire paper. In this respect, authors will tend to pre-
what. Yet, both should be clearly addressed. sent a proposition as an opinion rather than a fact.
Thus, in order to optimise a study from contem- Thus, researchers will be exposing the possible un-
plation to completion, a valid self-reflective exer- certainties of the study and the readership will de-
cise during all research stages should be exercised. cide more easily if the findings are supporting weak
That is, the investigator should challenge his/her or definitive conclusions or if further studies are
own biases, judgments and assumptions, whether definitely needed before clinical practice can be in-
personal or in an assumed wider socio-cultural con- formed accordingly.
text. In this respect, self-reflection exercises may This paper itself has its limitations as it was de-
turn uninformed assumptions to informed opin- signed as a critical analysis rather than an extensive
ions. Unfortunately, some authors cite study limi- literature review whereby biomedical literature
tations solely because it is required by journal pol- would have been scrutinised for individual limita-
icy. Furthermore, under these circumstances, the tions. For example, a detailed assessment of all rel-
weakest limitation may be put forward in an at- evant papers (in the region of thousands) would
tempt to ‘safeguard’ the study’s chance of being have revealed all recorded limitations within the
published. selected papers referring for example to aspects of
internal validity which could distort the results. De-
Conclusions limitations of this paper include the lack of depth
Serious rethinking and restructuring of the when statistical techniques were discussed and
global nursing and biomedical research agenda is presented in the text. Assumptions of this paper in-
necessary to upgrade the profession and reassure clude that the basic premise that all aspects of the
the public. Authors should report their research notions of Limitations-Delimitations-Assumptions
limitations, delimitations and assumptions in order have been adequately covered and thoroughly dis-
to improve the quality of their findings and the in- cussed
terpretation of the evidence presented. On the
contrary, when any of these key elements are ne-
glected, overlooked or hushed, the study kudos is
jeopardised. However, when a solid study elabo-
rates on its limitations, delimitations and assump-
tions, it is more likely to be cited and may also act
as a benchmark for future nursing research en-
deavors.
Overall, study limitations, delimitations and

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