HLSC122 Inquiry in Health Care- Abdominal Obesity

Scenario

Leah is a 21 year old health science’s student at an Australian university. She has travelled from her home country (United States [US]) to study a semester in Australia. While living with three other international students she has reported gaining weight particularly around her abdomen, from not eating healthy meals, and not exercising regularly. Leah is enjoying living away fromhome, socializing and going out to parties and experimenting with different mixed alcoholic drinks and Australian take-away foods. At home in the US she enjoyed going to the gym regularly, at least four times a week. However, whilst in Australia Leah has decided not to participate in a gym, but rather spend her money elsewhere on social activities, such as going out and partying. In her spare time Leah has casual employment to supplement her lifestyle in Australia. She likes travelling and is not homesick. She would like to make changes to her lifestyle which will have a long term positive impact on her weight and eating patterns. Leah visits the university student health clinic and asks you (as a student undertaking placement there) to provide guidance with respect to her health concerns. After your initial meeting with Leah you locate two relevant research studies that you would like to critically evaluate for quality.

The following PICO question is used for a systematic search

Part A

Identify the strengths and weaknesses by critically evaluating the two research studies that Leah found during her CINAHL search (Rogerson, Soltani & Copeland., 2016; Share et al., 2015).

1. Authorship
a. Make a judgement regarding the authors’ expertise, qualifications and affiliations.
b. Are there grounds for conflict of interest related to the authors of the paper and the study findings?

2. Research Aims
a. What were the research question, aims or hypothesis (if stated)?
b. Explain how the authors justified the need for the study?

3. Design
a. Examine the research methodology and methods used in the study?
b. Justify why the methodology and methods were appropriate to meet the aims of the study?
c. Who were the participants in the research study?

4. Findings
a. Discuss how the findings/results/conclusion answers the stated research question, aim or hypothesis?

Part B

1. Discuss how Leah's personal circumstances may create a barrier for the application of evidence.
2. Discuss how closely the research aligns with the PICO question.

Answers

Part A.

1. Authorship:

a. The two research articles mentioned is written by two authors namely David Rogerson and Bianca Share. David Rogerson is a faculty of Health and well being and Sheffield Hallam University in Sheffield. His major qualifications are B.Sc, M.Sc, and a Doctorate degree in professional studies. He is a registered Nutritionist and has fellowship (FHEA).He has seventeen citations and 6 research publications and 937 publications that are read. He is an expert nutritionist as he is specialized in public health nutrition. He did full justification to his research paper on weight loss as he has the knowledge that weight loss is a complex process and a lot of factors are directly related itRogerson, Soltani, Copeland, 2016).

Bianca Share is a faculty of physiology public health in Australian Catholic University. Her major qualifications are Bachelor in Exercise Science (Honors) and also has completed her Post Doctorate (PhD ).She has a graduate certificate in higher education and a graduate diploma in education. She has 18 citations, 443 publications that are read and 12 published research papers. She is an experienced Exercise Science professional and did full justification to her research work. She is a knowledgeable and can manage various changes in the lifestyle on patients and check for the outcome(Share al., 2015).

b. The two research publications involve body weight and its loss but there are also a few differences in them. The research publication by the author Bianca Share is based on the fact that in young women suffering from obesity, various changes in lifestyle can reduce the risks of cardio metabolic risks. Cardio metabolic refers to the condition that involves the occurrence of diabetes , cardiovascular diseases and atherosclerosis together. It occurs because of the presence of atherogenic dyslipidemia and resistance to insulin which in turn occurs due to the presence of high level of triglycerides and low density lipoprotein cholesterol. This type of condition occurs in women with cholesterol content in their lipids above 50 mg/dl and having waist circumference more than 88 cm. A large group of females were taken into consideration for the study and it involved lifestyle changes in the population and the results were recorded on the basis of the outcome. Results were obtained from linear mixed model that is completely different from the other research publication( Richardson-Tench et al., 2016 )

The research paper published by Rogerson deals with the exploration of weight loss experience. He deals with the maintenance of weight and its loss. He focuses on various factors which inhibit the loss of the weight and the factors that help to gain weight. His study is done by the use of semi structured interview. The facts were based on the interview that was recorded and the data was used for the analysis. Lastly, verification of the data was done.

2. Research Aims

a. The main objective of the researcher Share was to keep a check whether the effect of 12 weeks multidisciplinary changes of lifestyle is there on the cardio metabolic diseases in the case of young obese female women.The research was based on therapy behavior, diet and the changes in physical activity on the group of females other than the control group. The main objective of the scientist Rogerson was to study the weight loss in a group of participants using the interview method and not involving clinical changes. The participants were selected who undergone the weight loss program.

b. In the research study of Share, to fulfill her objectives she selected young females of the age group from 18-30 suffering from abdominal obesity and they were included in the changes program of 12 weeks, that was done by the means of a method .The results obtained were recorded in a proper manner. The changes occurred were observed carefully and the results showed that the risks related to the cardio metabolic diseases was reduced because of the various changes in the lifestyle behavior implemented on the female participants. The results obtained met the needs of the aim of the researcher.

In the case of Rogerson, his main aim was to keep a check on the factors associated with weight loss that inhibit or help in the gain of the weight loss. He did not involve the use of clinical interventions that are considered more accurate. He did a systematic interview of the participants with the use of any clinical changes and found various factors such as dichotomous thinking and social and peer pressure which lead to hindrance in weight loss and social support and self monitoring were the factors that helped in losing weight. The results obtained justified his aim of study (Hoffman, Bennet Del Mar, 2013).

3. Design

a. The participants finalized were subjected to pre control testing/pre changes and were divided into two groups namely the wait listed group and the intervention group. The researcher wanted to have a correct model and hence the wait list design was used. This model is ethical and it provides all the participants with changes in the lifestyle(Sabouret al., 2015). The wait list group was better than the control group. For each of the testing period (0, 12, 24), the participants were asked to visit the lab in two steps. Initially, the participants were told to come in the fasting state and the duration of the test continues for 75 minutes and then they will be advised to avoid coffee and alcohol before the commencement of the lab test.

For the intervention group , the test were performed at (pre ) 0 week, (post) 12 weeks and (sustainability phase) and 24 weeks. The control group also had the testing at pre and post control time period (12 weeks).All the tests were performed by the same researcher at the same time interval. The measures of testing were Anthropometric assessment (total body measurement was taken including BMI circumference and metabolic syndrome markers and other parameters were also checked) and evaluation of health (heart rate was checked against the work rate) and Survey data (complete lifestyle data of the participants was collected). The lifestyle changes included behavior therapy (participants were given counseling and psychosocial support provided), nutrition education (healthy diet habit and its maintenance was given by qualified dietician) and physical activity (exercise supervised by exercise scientist)( Share et al., 2015).

In the case of research by the scientist Rogerson, the methods used for exploring the loss in weight included theoretical underpinning ( to get exploration of participants experience and it was granted ethical by ethics committee of Sheffield Hallam University), sampling ( participant were selected based on the purposive sampling and data saturation) ,Data collection(interview data was collected by face to face and using interview guide and were recorded in digital recording device) , Data analysis(using proper framework analysis) , Verification( codes themes and theoretical framework was verified) (Rogerson, Soltani Copeland, 2016).

b. All the methods and the methodologies used in both the research papers were requires and seemed perfect to meet the aim of the researcher. In the case of Share, two groups were taken including the participants which had one as the control group. There were fixed timings and the condition matched to achieve the desired outcomes without fail. The changes in the interventions applied were documented in a proper manner in order to check the outcome.

In the case of Rogerson, he used an interview technique and recorded it as an evidence and purposive sampling was used for sampling. Interview guide was used for the data collection and finally the verification process was done( Greenhalgh et al., 2016 ).

c. A total of 62 participants showed interest for the research program of Author Share who were at the risk of CVD. Out of these 39 finally progressed for further investigation.

In the case of Rogerson the participant number was low and only 6 were enough to get his research outcome.

4. Findings:

a. The research study of Share revealed the results and the analysis of groups gave positive outcomes. The changes in the lifestyle like nutrition education, physical activity therapy for behavior successfully reduced the risk factor of CVD after the completion of research. But there were unexpected and positive changes were observed in the control group and these changes may overpower the changes in intervention group. These results were challenging for the prospective study designs with obese young women.

In the case of research study by Rogerson, he found that the weight loss is a complex process which involves various factors that inhibit and facilitate the process of weight loss. The sample of this research provided data saturation and the study helped in providing all the information of experiences in weight loss. The study involved the lack of diversity in the sample as the information related to all social and ethnic groups was not covered here.

PICO question:-

In female university students, does healthy eating compared to exercise lead to weight loss?

P (patient/population):- Female University Students

I (intervention/indicator):- Healthy Eating

C (control):- Exercise

O (outcome):- Leading to weight loss

Part B:-

1. According to the case scenario of Leah the PICO question was framed. Leah personal circumstances, which create a barrier, are the peer or social pressure (three international students) that made her to have a healthy diet. She was suffering from abdominal obesity and stopped going to gym, which she used to do at home. She wished to spend money for partying and socializing and have alcohol and Australian take away food. She also started doing part time job so that she can carry out the Australian lifestyle. She thought that, even if she wanted to stop her friends would not leave her to do so.

2. The research of Share follows the PICO pattern. P (participants):- 62 female students were initially selected but only 39 female students were available for research to carry out. The participants were selected based on students at risk of CVD with abdominal obesity. Leah is also having abdominal obesity and can have a risk of CVD. The participants can be university students according to Pico question. I (Intervention):- This included 12 week lifestyle changes. It included nutrition education, physical activity, and behavior therapy. These changes will be helpful for Leah to reduce the weight and the risk of CVD. C (Control):- Along with the intervention group, a control group was taken to compare the research aim. O (Outcome):- The result showed that sufficient changes occurred in the weight in the intervention group, due to the changes in the lifestyle. If these changes are applied to Leah then there is a possibility of weight loss for her.

Research study of Rogerson includes the weight loss experience and its maintenance. This research can be applied on Leah after the changes applied in the research of Share. This study included no clinical changes. People who underwent weight loss diet were selected for this research. Interview and data collection methods were used and analyzed and finally verification was done. Here the outcome was the factors which inhibit and facilitate the weight loss. The weight loss which is a difficult situation to achieve because of many factors and it's hard even to maintain it. Similar to the PICO question, Leah is university student who is facing problem in maintaining healthy lifestyle because she is having friends who are affecting her lifestyle. She started eating Australian take away foods and alcohol leading to obesity. She stopped going to the gym because she wants to enjoy her life away from home and spend the money in party and socializing Dichotomous thinking and social and peer effect is affecting Leah to lose weight (Zulkosky,2014). In this study, these factors are obtained only as a result of the interview methods used on certain participants.

References:-

Coelho, R. C. L. A. (2016). If Obese Patients Overeat sometimes, their Adherence will Last Longer: The Controlled Overeat. Journal of Obesity Eating Disorders.

Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., Warland, J. (2016). Understanding Research Methods for Evidence-Based Practice in Health 1e.

Hoffmann, T., Bennett, S., Del Mar, C. (2013). Evidence-based practice across the health

Kritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., Nicklas, B. J. (2015). Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS One, 10(3), e0121993.

Leibel, R. L., Rosenbaum, M., Hirsch, J. (2015). Changes in energy expenditure resulting from altered body weight. New England Journal of Medicine, 332(10), 621-628.

professions. Elsevier Health Sciences.

Richardson-Tench, Marilyn Taylor, Beverley J. (Beverley Joan), 1951-, (author.) Kermode, Stephen, (author.) Roberts, Kathryn L. (Kathryn Louise), 1943-, (author.) (2016). Inquiry in health care (5th edition). South Melbourne, Victoria Cengage Learning Australia

Rogerson, D., Soltani, H., Copeland, R. (2016). The weight-loss experience: a qualitative exploration. BMC public health, 16(1), 371.

Rogerson, D., Soltani, H., Copeland, R. (2016). Undergraduate UK nutrition education might not adequately address weight management. Public health nutrition, 19(02), 371-381.

Sabour, H., Javidan, A. N., Soltani, Z., Pakpour, A. H., Yekaninejad, M. S., Mousavifar, S. A. (2016). The effect of behavioral intervention and nutrition education program on serum lipid profile, body weight and blood pressure in Iranian individuals with spinal cord injury: A randomized clinical trial. The Journal of Spinal Cord Medicine, 1-8.

Share, B. L., Naughton, G. A., Obert, P., Peat, J. K., Aumand, E. A., Kemp, J. G. (2015). Effects of a Multi-Disciplinary Lifestyle Intervention on Cardio metabolic Risk Factors in Young Women with Abdominal Obesity: A Randomised Controlled Trial. PloS one, 10(6), e0130270.

Zulkosky, K. (2014, April). Self?efficacy: a concept analysis. In Nursing Forum (Vol. 44, No. 2, pp. 93-102). Blackwell Publishing Inc.

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