Critical appraisal of article entitled: “Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion services” Marshall et al 2003(p1).
This assignment will be based on a critical appraisal of the before mentioned article. The appraisal will include discussion of the title, authors, and topic discussed. Also included will be comments on the structure of the article, the methodology used and the research findings, whilst discussing any ethical issues that need to be addressed. Finally, in conclusion I will summarize my findings.
The title in an article is very important as it is this that first draws someone to read it, as Cormack (1996) states “it is extremely important for a research publication to have meaningful and non ambiguous title”, (p382). He goes on to say “it is the title which clarifies the topic of the research being described and gives the potential reader an indication of the content”,(p382).
Although the title is long, it is felt that it needs to be in order to describe the research topic and the content of the article in brief. Therefore giving, as much information, at a glance as possible. The authors of the article are all in a position academically, clinically and professionally to research their chosen topic. Each author has a background qualification in learning disabilities and has experience in this field.
The authors all have professional qualifications for instance David Marshall has a BSc and a Masters degree, and Roy McCockney has a PhD and is a professor specializing in learning disabilities. As the authors are suitably qualified they are also in a position to be able to measure and interpret their findings.
The fact that there are a number of authors may be because specialist input was needed at start in order to enhance the validity of the research. The abstract of the article clearly defines the content of the report and why it was written. The style and comprehension of the abstract is clear and understandable, as it discusses the aim, the methods used and findings in turn. This therefore is an ideal abstract, as stated by Ogier (1998) this should be “a summary of why the study was done and the main results” (p81). “.
In the introduction the subject area is clearly defined. The article reports on the research in to the impact of health screenings and health promotion, aimed at weight loss in people with intellectual disabilities. The only controversy that may be thought, to be unethical by some, is the fact that formal ethical approval was not sought for the study. The article goes on to explain why this was and to describe an alternative way of making sure that ethical issues were addressed in the study, such as informed consent by use of a steering group, which consisted of senior medical, nursing and social work colleagues, which was used to vet the research procedures. The authors did put enough emphasise in to the ethical issues surrounding the specific client group, this is essential process as Carpenter et al (2003) state “ethical issues and standards must be critically considered in any research study” (p311).
The authors made it clear how informed consent was obtained by simplifying the consent form and explaining the procedures to the clients and that they may leave the study at any time and that the clients’ confidentiality would be protected at all times during the study. The literature is up to date and relevant to gaps in human knowledge. The literature reviewed is thorough and relevant as are the quotes and references used in the text.
The article clearly describes its aims as firstly, identifying the people who took part in the study as being overweight and obese. It then follows up their progress after referral to their general practitioner or after them having been given health promotion advice at the screening center to determine actions taken. Secondly to evaluate the impact on the clients weight loss following health promotion classes.
The aims of this study are relevant and important as obesity seems to be more common among people who have learning disabilities and research suggests that specialist weight reduction programmes are scarce. Clinically the aims of the study are extremely important as obesity is linked to many serious conditions such as high blood, heart disease, diabetes and respiratory conditions. (Hogston et al1999).
Also as Hogston et al (1999) states that, “obesity reduces a persons life expectancy”, (p129).Therefore the aim of the study is important as follow up services for these clients need to be examined, in order to reduce their weight and therefore their risk factors. Academically the aims of the study are important as the findings of the research will assist future researchers on this and similar topics and the findings will assist health care professionals that are involved in the care of clients that are overweight or obese and who also have intellectual disabilities.
It could be argued here that the hypothesis is to prove that the necessary follow up of these individuals will not be undertaken, as in the introduction of the report it states that “the physical health and well-being of people with intellectual disabilities has not been promoted to the same extent as with non disabled people” (Marshall et al 2003, p2). Although the report itself reads more, like it wants to investigate and alter any negligent practice towards the clients than necessarily prove a hypothesis. It is not essential to formulate a hypothesis. (Ogier, 1998). Therefore I feel this particular article doesn’t have a research hypothesis.
The article is a mix between qualitative research, that is as identified by Ogier (1998) “research which paints a picture in words and aims to identify concepts and common themes” (p84) and quantitative research which is described by Ogier as “research in which the data is numerical and seeks to test hypothesis by statistical analysis of the data”(p84).
The type of research study used within the study is descriptive research which Ogier describes as “the researcher tries to describe accurately the findings derived from careful, systematic collection and recording of information or data” (p39) she goes on to say “the different ways data are gathered are numerous and often referred to as research tools; these include questionnaires, interviews and observations”(p39) or in this case, examinations.
The article is made up of two studies, study one was a medical examination to establish the clients weight and any condition that obesity had caused or contra-indications i.e. hypertension and high cholesterol. The second study was a follow up to see how many clients responded to the health promotion advice given to them by the nurses at the clinic where the studies took place and how many attended health promotion sessions arranged by the nurses. Also the second study discusses how many clients lost weight as a result of the health promotion programme.
The sample group utilised by the studies were people aged between 10 years and over who attended either a special school or a day centre in any given area, which in this case was Northern Ireland. There were 503 people invited to take part in the study, out of those 464 people took part in the study.
A criticism of age range is that it was very broad, the study may have benefited from a narrower age range, as obesity in children as young as 10 years old should be dealt with in a different way to those who are older and have different implications on the clients health (Waugh et al 2001). A strength of the study here is the amount of clients taking part. The larger the amounts of people taking part the better, as this will have a beneficial impact on the validity of the results.
The other aspect that needs considering is that the examinations were extremely thorough, maybe unnecessarily so. For instance the report says that blood was checked if appropriate. We cannot be sure what was meant by this, maybe blood tests were taken if the patient complied? If the patient was not willing to participate then the blood test was not performed. However I feel it was inappropriate to contemplate taking blood, an unpleasant procedure for most, but least of all those who may not understand the reasons for it and are caused unnecessary stress by even the mention of it.
The ethical issues in this study are apparent through most of it, although it is believed that every effort was made to gain informed consent from the client, it cannot be known how much someone understands, one must use their professional judgment. It would have been useful to have had a copy of the consent form in the study so that the reader could see how simplified it was to meet the client’s needs.
The data collected was presented in written format as well as in a table format. This was easily readable and it was easy to see the results and make comparisons between them. Each study had a table to represent the findings, which I found to be a useful and easy method of displaying and interpreting the findings of the study.
The discussion of the article carefully discusses the findings in a detailed manner. The presentation of the tables was a helpful way of disseminating the findings and the conclusion is well structured and thoroughly evaluates the findings, whilst confirming that people with intellectual disabilities who are overweight or obese need more specialist services to promote health. The study more or less proved that if these types of services are offered to this particular client group they are accessed on a regular basis.
The results mostly agree with other reports on this particular topic, although this study found that “unlike past studies, no significant differences were found among males and females in levels of obesity” (Marshall, 2003, p8).
The conclusion extends beyond the results and discusses ways in which nurse led health promotion activities can help reduce weight in the clients. The professional implications, for people involved in the care of people, with intellectual disabilities are that health promotion and education needs to be more widespread among these individuals and more readily available. The report suggests that future research could target overweight adolescents with intellectual disabilities so that it can be understood what influences their developing lifestyles and eating habits.
The references used, suggest a vast amount of research was carried out on this topic whilst conducting this study. They also allow the possibility of further studying on this topic. The referencing is accurately documented, only a few minor grammatical mistakes are noticed throughout the article. The references used are mostly up to date but some references were as old as 1988, which maybe call into question their validity for this type of research, although this didn’t affect the study itself or the findings.
In conclusion the article was found to be informative and beneficial to the reader. The presentation was good and the contents were grammatically correct and easily understandable. The reader found the article easy to read and the results easy to interpret. The task of appraising this article critically was both informative and interesting.
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