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HLSC122 Inquiry in Health Care and Social Activities

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?
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.

Answer:

Introduction

The paper deals with the case scenario of Leah, a 21-year-old Australian university student. The student has gained weight recently particularly around her abdomen due to lack of regular exercise and eating healthy meals. In her hometown, US Leah engaged herself in gym four times a week. However, in Australia she has adopted sedentary lifestyle. She mostly engages in Partying, travelling and other social activities. In addition, she is consuming take away foods and trying mixed alcohol drinks in Australia.. She has joined a part-time work casually to supplement her lifestyle in Australia. I have been assigned this case as a student undertaking placement in the University health clinic to provide her guidance regarding health concerns. Two relevant research studies were chosen for critical evaluation of its quality after the meeting with Leah. The PICO question used for conducting the systematic search is given below:

“Does healthy eating as compared to physical exercise leads to weight loss among the female students in the Australian University?”

Part A

Research article 1

In the study executed by Rogerson et al. (2015) the authorship is not well presented. The article did not present the qualifications or credentials of the researchers who have worked in this study. This can be considered as imitation of the study. This is the first point of interest to any reader according to Barker and Kane (2016) because it indicates high


reliability and validity of the paper. It may lead to the conflict of interest as the working status and the educational status of the authors are not clearly labelled which was necessary to grab the attention of the readers according Hall and Roussel (2016). The research findings and the authorship of the paper is thus a ground for conflict of interest.

Rogerson et al. (2015) in this study has clearly presented the aim of the paper as qualitative explorations of weight loss experiences both in abstract and in background. This is the strength of the study as it helps a reader to gain brief understanding of the study right from the abstract, which helps in commencement of further interest. The need of the study is well justified by the author using the findings of other relevant studies which adds to the strength if the research paper. The background of the study is well referenced and have indicated that the literature gap in this area which are the necessary aspects of research article as mentioned by Simons et al., (2014).  

According to Letts et al. (2007) research methodology demonstrates represents the plan for data collection and analysis. It is evident from the title itself that it is a qualitative exploration. Since it is a qualitative study, the interview method of data collection is justified. Interview is an effective instrument that assists in gaining broad perspective of the problem area (LoBiondo-Wood et al., 2013). The use of purposive sampling is also justified as the participants recruited must be a dieter with weight loss experience and it emphasise reliability. The verification and reflectivity used in the methodology increases the validity and reliability of the study as it helps to eliminate any potential errors in the study (Simons, Yates & Cullis, 2014). The participants in the research study are 18 volunteers of both genders and of 40 ± 10 years and all of them are British, White citizens. These participants ha.ve either taken weight loss education programme, consulted nutritionist, and were members of commercial slimming group. This participant’s selection is justified, as they will be able to narrate their weight loss experiences, which is the goal for this study. This is the strength of the study as Letts et al. (2007) stated that the participants in the exploration study should be chosen in a manner who have experience, knowledge and views related to the study.

The results and the findings of the study are well documented under respective sections providing the established themes as highlighted by the Fineout-Overholt et al. (2010). It concluded that weight loss was a difficult task. The efforts are assisted and inhibited by physical, behavioural, social and environmental elements. It has clearly highlighted that the strengths and the weakness of the study which informs the readers about the generalisability of the study. The findings presented in the understandable format have addressed the research aim and have highlighted the major challenges that guides readers if they are interested in future research in this area Gray et al. (2015). The conclusion expresses the findings and the meaning of the research.

Research article 2

In the article Shar et al., (2015) has well presented the authorship of the paper. The credential and the educational status of the authors ensure the reliability and the validity of the study as mentioned by (Gray et al., 2015). It eliminates the ground for conflict of interest about the authors and the study findings in addition to the qualification the details of the workplace of the authors and affiliation is also given assuring that the authors are credible to conduct the research.

The research aim is clear from the title of the study itself as well as in abstract, which is “to assess the impact of multi-disciplinary lifestyle for 12 weeks on the cardio metabolic risk factors in young women (premenopausal) with abdominal obesity”. The research is based on thorough literature review conducted in this area, which is presented in the introductory section. The author has identified the gaps in the literature while citing and criticising the work of other relevant researchers from different background in this area as mentioned by Melnyk & Fineout-Overholt, 2011). It identified that cardiovascular disease is the major health threat of women worldwide. It is the strength of study and justified the significance of the research.  

The author has approached the area of interest with a thoroughly researched methodological design. A randomised control trial was conducted were women were subjected to lifestyle interventions of 12 weeks including physical activity, cognitive behavioural therapy and nutrition education. The control and intervention group both completed the anthropometric, biochemical, fitness and nutrition testing before and after intervention. Considering the research aim, this quantitative paradigm is justified as the goal is to assess the health impact of intervention which is not possible without collecting and comparing the biological and physiological data between the control and intervention group (Fineout-Overholt et al., 2010). The contamination is prevented by adequate measures such as prevention of disclosure by the intervention group.  However, avoiding blinding to the group allocation can be considered a limitation of the study (Hoffman et al., 2013). The statistical analysis was appropriate for handling complicated numeric data as it was used by previous studies (Fineout-Overholt et al., 2010). There seems to be an appropriate sample size of 43 although a larger size could have been more indicative of the results (Greenhalgh et al., 2017). By supporting with references, the author has increased the validity and reliability of research. The selection of participants that is postmenopausal is justified with abdominal obesity is justified as they are at high risk of cardiovascular diseases (Rogerson et al., 2016).

The results and findings have been well depicted in form of tabular charts. There was no group differences in the intervention group apart from increased physical activity maintained at 24 weeks post. There were within group improvements in control participants, which conclude that the lifestyle intervention decreased the Cardiometabolic risk factors. Therefore, the research aim is fulfilled and the discussion adds further supporting evidence to the results obtained adding to strength of the study. The discussion and conclusion aligns with the study aims and acknowledgement of limitations is the strength of the study as it guides readers in future research (LoBiondo-Wood et al., 2013).

Part B

1. As per evidence obtained from first article weight loss is an enduring challenge. It increases difficulty physically, mentally, and emotionally. Weight loss attempt creates social pressure which impacts the behaviours such as being highly conscious while eating outside. Further, people experiences demotivation if weight loss is not experienced. Dichotomous thinking due to loss of restraint is another major barrier (Rogerson et al., 2016). This can be considered as barriers for Leah in application of evidence due to high level of socialising behaviour in her and habit of eating any food irrespective of health benefits. It will be difficult for Leah to adhere to weight loss regimen as she is not homesick and loves travelling which increases her chance of losing restrain. She may continue to engage in sedentary lifestyle owing to peer pressure. Leah’s alcohol consumption is another barrier to weight loss attempts (Richardson-Tench et al. 2016). Exercise reinforces dietary behaviours particularly when it is hard to control eating. However, Leah spends most time in partying and in spare time she remains busy with her job. These adds barrier to weight loss maintenance as she is a university student.  As evident form second research article multidisciplinary lifestyle interventions helps reduce cardiometabolic risk factors (Share et al., 2015). However, in case of Leah the barriers are that she does not invest time in physical activity. However, she is interested in lifestyle management therefore cognitive behavioural therapy may increase her self-determination, which will in turn eliminate these barriers.  Further, being a university student it may be difficult for her to invest time and money on interventions such as dietary education, nutritional counselling and physical activity. However, she can reduce time in partying to engage in physical activity and exercise programme.

2. By evaluating the both the research articles it was found that weight loss is possible only by multiple factors such as dietary education, exercise, self determination, counselling and strictly adhering to healthy eating. According to Rogerson et al., (2016) exercises helped increase dietary behaviours and according to Share et al., (2015) both exercise and nutrition education were found to be effective in decreasing cardio metabolic risks. The first author highlighted that weight loss is not solely associated with healthy eating or exercise and instead depends on social support, knowledge about the intervention, readiness to change. Unlike the first research article the second research article, emphasise more on reducing the risk of cardio metabolic factors rather than weight loss.  Further, the data in the first article is collected from both female and male participants. However, in second article the data is collected only from female participants. In conclusion, the research does not closely align with PICO question. It can be concluded that in the Australian university, female students by adopting both healthy eating and exercise will lead to loss of weight. However Johns et al. (2014) argue healthy eating plays a significant role in weight loss and exercise is small and vital component. Physical activity alone is less effective and diet alone together with behavioural weight management program ensures same weight loss in short term and long term. Alternately both diet and physical activity increases weight loss in long run. Therefore, most effective method of weight loss is unclear.

References

Barker, J., & Kane, R. (2016). What is Critical Appraisal?. Evidence-based Practice for Nurses and Healthcare Professionals, 83.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice step by step: Critical appraisal of the evidence: part I. AJN The American Journal of Nursing, 110(7), 47-52.

Gray, M., Joy, E., Plath, D., & Webb, S. A. (2015). What supports and impedes evidence-based practice implementation? A survey of Australian social workers. British Journal of social work, 45(2), 667-684.

Greenhalgh, T.M., Bidewell, J., Crisp, E., Ambros, A., & Warland, J. (2017). Understanding research methods for evidence-based practice in health care. Milton, Australia: Wiley.

Hall, H. R., & Roussel, L. A. (2016). Critical Appraisal of Research-Based Evidence. Evidence-Based Practice, 125.

Hoffman, T., Bennett, S., Del Mar, C. (2013). Evidence-based practice across the health professions (2nd Ed.). Sydney, Australia: Churchill Livingstone/Elsevier.

Johns, D. J., Hartmann-Boyce, J., Jebb, S. A., Aveyard, P., & Group, B. W. M. R. (2014). Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics, 114(10), 1557-1568.

Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M. (2007). Guidelines for critical review form: Qualitative studies (Version 2.0). McMaster University Occupational Therapy Evidence-Based Practice Research Group.

LoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-based Practice. Elsevier Health Sciences.

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2016). Inquiry in health care. South Melbourne, Australia: Cengage Learning.

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

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 Cardiometabolic Risk Factors in Young Women with Abdominal Obesity: A Randomised Controlled Trial. PloS one, 10(6), e0130270.

Simons, M., Yates, C., & Cullis, J. (2014). LibGuides. Evidence-Based Practice. Critically Appraise the Evidence.

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