Quantitative Research Critique and Ethical Considerations

The current paper centers on a critique of two quantitative research articles: “Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children with Obesity or Normal Body Mass” by Tan et al (2016), and “Effectiveness of a Childhood Obesity Prevention Programme Delivered through Schools, Targeting 6 and 7 Year Olds: Cluster Randomised Controlled Trial (WAVES study)” by Adab et al (2018). In the paper, the background, method of study, results, and study outcomes are compared. The paper also looks at how each article’s information supports the nurse practice issue chosen. In this case, childhood obesity is the issue.

Background

According to Tan et al (2016), childhood obesity is a global public health issue of concern. It affects body fitness, and interferes with muscle flexibility and cardiovascular function. Understanding the role that exercise plays in promoting physical fitness and preventing obesity is important for nursing practice. The purpose of Tan et al (2016)’s study was to look at the importance of exercise on obese children and those who are lean. Its objective was to investigate the effect of exercise training on the physical fitness, cardiovascular function, and body composition of children aged 5 years.  Although the researchers did not directly state their research questions, it is obvious that they wanted to answer a question on whether exercise improves the condition of both obese children and those whose body mass in normal.

Adab et al (2018) agree with Tan et al (2016) that childhood obesity or overweight is indeed a global problem. Over 41 million children around the world below the age of five live with the condition. Childhood obesity is associated with various psychological and physical health consequences, and adverse economic effects. Since the condition is largely preventable, understanding the function of healthy lifestyle habits in addressing it is crucial in nursing practice. The purpose of Adab et al (2018)’s study was to investigate the role of healthy lifestyle programs in prevention of childhood obesity. The objective was to compare the efficiency of school and home based healthy lifestyle program (WAVES) and usual practice in addressing childhood obesity. Just like Tan et al (2016), Adab et al (2018) did not specify their research questions. However, it is clear that they sought to answer the question on whether school based healthy lifestyle interventions help to promote childhood obesity prevention.

Support to Nurse Practice Issue

The PICOT question that was adopted is as follows:

  • Among obese children and adolescents (P) is physical activity more effective than (I) health education (C) in promoting weight loss (O) within a period of six months (T)?

The two articles that are being critiqued give important information that can be used to answer this PICOT question. Tan et al (2016) article contains information on how exercise training can help to promote health and prevent obesity in a population comprising 5 year-old children. The intervention that the study participants were subjected to was in form of physical activity that entailed exercise training for a period of 10 weeks.There was a control group for comparison with the exercise group.

On its part, the article of Adab et al (2018) has information on how school based programs that promote healthy lifestyles can be used to prevent obesity among children aged between 6 and 7 years. The respondents were given a 12 months intervention that involved physical activity, and healthy eating. The intervention group had a control group for the purpose of comparison.

Method of Study

Tan et al (2016)’s study is based on a randomized controlled trial (RCT) study design. This method involves testing a given treatment’s effectiveness by way of randomly assigning subjects to either two or more study groups whereby they are treated differently in order to determine their outcomes. One of the advantages of RCT is that this method is that it minimizes selection and allocation bias. Its major weakness lies within the fact that it is associated with ethical limitations. For example, it is unethical for patients to be randomized unless the treatments given provide equal support within a given clinical setting.

In their study, Adab et al (2018) adopted a cluster randomized trials design. This kind of research design involves randomization of groups of subjects rather than individual subjects. The process enabled the researchers to randomly select groups of schools and pupils for the study. The main benefit of the cluster randomized trials is that they are useful for interventions that target the whole community rather than individual persons (Edison, 2011). On the other hand, this research design is disadvantageous in the sense that its accuracy is questionable (Maltby et al., 2014). Individually randomized trials tend to be more efficient compared to this design.

Results of Study

From the results of the study of Tan et al (2016), it was established that exercise training helped to reduce the body mass index (BMI), circumference of waist, and body fat among trained lean and obese children. It slowed down the speed of growth of their body mass. Exercise as well decreased trained obese children’s systolic blood pressure. This in turn helped to reducetheir heart rates. Moreover, exercise training enabled the trained obese children to improve in running, long jump, and beam walk balance. On their part, the trained lean children were able to improve in more physical fitness activities.

The findings of Tan et al (2016) have important implications in nursing practice. They demonstrate that prevention of obesity should start early in life. This will help to reduce chances of the onset of adulthood obesity (Miller et al., 2004). These results also help to enhance nurses’ knowledge of the relationship between childhood obesity and high blood pressure, and the relationship between motor skills ability and childhood obesity (Rosner et al., 2013; Liang et al., 2014). This understanding will enable them to effectively manage childhood obesity and the complications associated with it.

Adab et al (2018)’s study also generated important results. It was found that after 15 months, the mean BMI score of the intervention group was non-significantly lower than in the control group. Even after 30 months, there was no major evidence for improvement in BMI reduction. It is also important to note that there was no significant different between the intervention and control groups for other physical activity, dietary, psychological, and anthropometric measurements.

The results and findings of Adab et al (2018)’s study as well have vital implications for nursing practice. They show that experiential focused interventions rarely play a role in the reduction of BMI, and prevention of childhood obesity. There is need to put in place feasible programs that can help to address the issue of obesity among children (Pallan, et al., 2013). The results also imply that school based programs and other interventions are less likely to have a positive impact in addressing obesity without the support of other environments and sectors. The influences of the family, community, food industry, and media need to be considered (Clarke et al., 2013).

Outcomes

The anticipated outcome of the above PICOT question is that unlike education, physical activity is able to promote weight loss among obese adolescents and children within six months. Tan et al (2016)’s study reveals that intensity exercise training that lasts for 10 weeks is effective in the treatment of obese children who are 5 years old. The training helps to reduce BMI of the children. Thus, the outcome of this study compares favorably with the expected outcome in the PICOT question.On its part, Adab et al (2018)’s study shows that school based healthy lifestyle programs put in place for up to 30 months cannot alone help to prevent obesity among children. The prevention effort requires other programs based in families, communities, and other settings. This collaborative approach can help to effectively address the condition.

Rationale

Tan et al (2016) and Adab et al (2018)’s studies are based on the understanding that although obesity is a serious global health problem, it is preventable. The condition can be prevented through adoption of healthy lifestyle habits. Examples include involvement in physical activities, and embracing good nutritional habits. The two studies derive from the role of physical activity in the prevention of obesity. Physical activities such as running, jogging, walking, swimming, cycling, and weight training help to burn extra calories in the body (Pallan et al., 2013). This helps to enhance weight loss.

In Tan et al (2016)’s study, the researchers were interested in investigating how exercise helps to prevent obesity among fat and lean children. They found that it helps to reduce BMI, body fat, and waist circumference. On their part, Adab et al (2018) sought to investigate how healthy lifestyle programs helped to prevent childhood obesity. It was established that school based programs such as physical activity have a non-significant impact on reducing obesity among children.   

Ethical Considerations

Ethical considerations are important in any scientific research. They help to promote values necessary for collaborative work, including fairness and mutual respect. In studies that involve human subjects, research ethics help to ensure that participants are protected against potential harm (Maltby et al., 2014). One of the most important ethical considerations in research is getting the consent of the research participants. Tan et al (2016)’s study adhered to this requirement. Since the study involved minor participants, parents were asked to sign written informed consents on behalf of their children. In the same way, Adab et al (2018) sought parental informed consent as their study also included minor respondents. The researchers went as far as seeking verbal assent from all the child participants before measurements were undertaken.

Another vital ethical consideration in research is obtaining permission to carry out a study. The permission has to be sought from relevant authorities. The two studies observed this obligation. Before conducting their study, Tan et al (2016) ensured that their work was approved by Tianjin University of Sport’s Ethics Committee. On their part, Adab et al (2018) sought approval from the National Health Service Research Ethics Service Committee West Midlands, the Black Country (NHS REC No10/H1202/69).     

References:

Adab, P., Pallan, M. J., Lancashire, E. ., Hemming, K., Frew, e., Barret, T., Bhopal, R., Cade, J. E., Canaway, A., Clarke, J. L., Daley, A., Deeks, J. J., Duda, J. L., Ekelund, U., Gill, P., Griffin, T., McGee, E., Hurleey, K., Marin, J., Parry, J., Passmore, S. & Cheng, K. K. (2018). Effectiveness of a Childhood Obesity Prevention Programme Delivered through Schools, Targeting 6 and 7 Year Olds: Cluster Randomised Controlled Trial (WAVES study). BMJ, 360: K211.  10.1136/bmj.k211 

Clarke, J., Fletcher, B., Lancashire, E., Pallan, M. & Adab, P. (2013). The Views of Stakeholders on the Role of the Primary School in Preventing Childhood Obesity: A Qualitative Systematic Review. Obes Rev, 14: 975-88. doi:doi:10.1111/obr.12058.pmid:23848939

Edison, J. S. (2011). Research Methodology in Nursing. New Delhi: Jaypee Brothers Pvt. Ltd.

Liang, J., Matheson, B. E., Kaye, W. H., Boutelle, K. N. (2014). Neurocognitive  Correlates  of  Obesity  and Obesity-Related  Behaviors  in  Children  and Adolescents. Int  JObes., 38 (4): 494–506. doi:10.1038/ijo.2013.142

Maltby, J., Williams, G., McGarry, J. & Day, L. (2014).Research Methods for Nursing and Healthcare. London: Routledge. 

Miller, J., Rosenbloom, A. & Silverstein J.(2004). Childhood Obesity. J  ClinEndocrinolMetab., 89 (9): 4211–4218. doi:10.1210/jc.2004-0284

Pallan, M., Parry, J., Cheng, K. K. & Adab, P. (2013). Development of a Childhood Obesity Prevention Programme with a Focus on UK South Asian Communities.Prev Med, 57: 948-54. doi:doi:10.1016/j.ypmed.2013.08.025pmid:24012821

Rosner, B., Cook, N. R.,  Daniels, S. &  Falkner, B. (2013). Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure:  The NHANES Experience  1988-2008. Hypertension, 62 (2): 247–254. doi:10.1161/HYPERTENSIONAHA.111.00831

Tan, S., Chen, C., Sui, M. &Xue, L. (2016). Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children with Obesity or Normal Body Mass.Pediatric Exercise Science, 29 (2): 245-253. https://doi.org/10.1123/pes.2016-0107

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