Calcium Supplementation and Pregnancy-Induced Problems - Research Proposal Example

 Calcium Supplementation and Pregnancy-Induced Problems Introduction This is the research proposal pertaining to calcium supplementation that has been widely recognised as effective mechanism to reduce the risks of pre-natal and post-natal health related problems, especially hypertension, in pregnant women. Hofmeyer and Arallah et al. (2007) described that the most common causes of serious morbidity and death are pre-eclampsia and eclampsia and Calcium supplementation can have positive effects on the health of both mother and child against such risks. In this paper, the researcher proposes to carry out research on the nutrient intake of pregnant women in poverty stricken regions of UK to assess the level of risks of hypertension and other disorders including premature deliveries. The study proposed is mix of qualitative and quantitative in nature with mean and variance analysis using statistical techniques. Motivation from past researches It is a well known fact that the growth and development of foetus in pregnant mothers is highly dependent upon the nutrients intake by the mother through food and drinks. The quantity of the nutrients has high impact on the health of both the mother and the child during the pre-natal and post-natal period. There have been number of researches on this aspect in post world war II period that encouraged implementation of supplementary food programmes. The mother undergoes a number of metabolic changes during pregnancy that results in increased protection of the foetus provided the micro-nutrients status of mother is maintained at desired levels. Deficiency in micro-nutrients can cause serious impacts on the mother and child health leading to maternal morbidity and mortality. (Kolsteren and De Souza. 2001). Culleton (2008) presented the following chart for essential intake of micronutrients of pregnant women as compared with non-pregnant women (Table 1). While intake requirements of other micronutrients do differ in pregnant and non-pregnant women, the Calcium intake is recommended as the same in both. Table 1: Diet Chart for pregnant and non-pregnant women (Source: Culleton. 2008) Calcium supplementation is highly recommended in women (both pregnant and non-pregnant) to help risks of pregnancy induced hypertension whenever the women gets pregnant. Vainio (2003) and Sibai (2002) described “pregnancy induced hypertension” or “gestational hypertension” as the systolic level of blood pressure in excess of 140 mmHg or diastolic level of blood pressure in excess of 90 mmHg that occurs after 20 weeks of gestation. Such conditions may lead to pre-eclampsia that is associated with other signs like headache, epigastria pain or visual disturbances and possesses laboratory abnormalities like low platelet counts, elevated lever enzymes or hemolysis. It can be detected by measuring protein content in urine (proteinuria) that may be 0.3g or more in 24 hour urine specimen. The cause of pre-eclampsia is still largely unknown but the symptoms are seen as largely related to foetal growth restriction that may be due to increased degree of trophoblastic invasion which causes remodelling of spiral arteries into maximally dilated low-resistance vascular channels. The phenomenon of reduced platelet counts (also called HELPP syndrome) may be causing the hypertension which is said to be a genetic disorder. Pre-eclampsia due to genetic disorder may occur in second pregnancy if not the first as suggested by many researchers in the past. (Vainio. 2003; Sibai. 2002) Hofmeyer and Atallah et al. (2007) conducted a research on Calcium supplementation during pregnancy on a large number of pregnant women. They discovered that the risk of high blood pressure was reduced in 14946 women due to calcium supplementation, risk of pre-eclampsia was reduced in 15206 women (among which, 587 were undergoing high risk pregnancy) due to calcium supplementation. The composite outcome was reduction in maternal death or morbidity although they couldn’t get evidence of reduction in risk of preterm birth because the women without calcium supplementation didn’t gave birth to premature child although they did suffer with pregnancy induced hypertension. Murray and Marc et al. (2000) also found similar results although their research had relatively smaller number of samples. They however added that risk of pre-eclampsia was higher in those pregnant women that had low calcium intake during early weeks of pregnancy. They also found that supplementation with magnesium, zinc and selenium were also factors in reducing risk of pre-eclampsia although they recommended further research before the results can be used for clinical practice. Sibai (2002) presented the process of detecting high risk hypertension during pregnancy as presented in the figure below (figure 1): Figure 1: Evaluation of Women with Pregnancy Induced Hypertension to detect the risks of Pre-eclampsia (2002) This evaluation process is developed for clinical verification of risk of pre-eclampsia during pregnancy in women by analysing primary and secondary chronic hypertension in pregnant women. The researcher is motivated by these researches because they still are not definite and leave room for further investigation given that issues like premature birth of foetus are not yet definitely linked with calcium supplementation. Also, study of impact of varying amount of calcium intake shall give inputs on the threshold of deficiency after which the risk suddenly ramps up. Research Design A paper by Educational Researcher (2003) emphasised the value of design based research in the modern academic world given that it ensures more systematic approach of research by master and doctorate students. Design based research requires that past empirical theories already established by past researchers should be carefully blended with the defined research problem in such a way that the outcomes are supported by them. This approach has resulted in easier and innovative techniques of research conducted by students and reduction in gaps between deliveries of academia world and industry expectations. The research design is an objective methodology with all the aspects considered that can affect the successful completion of the research. Figure 2: Designing a Research (Source: Varkevisser and Pathmanathan et al. 2003) As presented by Varkevisser and Pathmanathan et al. (2003) the design should take into account selection analysis and statement of the research problem, review of literature, formation of objectives of the research, defining the research methodology, developing a work plan, setting aside the budget, and planning the administrative aspects of the project. Copper and Schindler (2003) explained that research design is step by step definition of the approach that the researcher intends to follow. As per the details by Copper and Schindler (2003) and Saunders and Lewis et al. (2007), the design of this research is proposed to comprise of the following steps: (a) Development of research aims and objectives (b) Development of research questions or hypotheses (c) Finding out relevant literature and documentation that can possibly address the research questions (d) Literature and Documentation review and formation of theoretical foundation (e) Development of research methodology (f) Conducting primary research (g) Organisation and presentation of primary data (h) Analysis of primary data and comparison with the secondary data (literature review) (i) Critical discussions (j) Conclusions, Generalisations and Recommendations for future research The research design chosen by the author is explained below: (a) Research Problem: The researcher shall investigate the effect of lack calcium supplementation leading to hypertension and premature birth from the perspective of the women in the unprivileged poverty stricken population of the UK. This problem has been investigated in the past as well but the causes of primary and secondary chronic hypertension in pregnant women and causes of premature birth is not definitely explained by the past researches. There is lot of room for further investigations and hence the author expects to value add over and above the existing findings. (b) Literature Review: The researcher shall review at least 50 sources of information related to past efforts in this area and develop a theoretical foundation that shall help in formulation of the questionnaire for the surveys. The number 50 is not quantitatively established but is an intrinsic interpretation of the researcher keeping in view the validity requirements of the outcome. The sources shall be (but not limited to) – medical journals, medical books, research reports, press releases, news, articles, expert viewpoints, etc. (c) Research Approach: The research shall be conducted by the researcher with the help of a female participants by taking down details of pregnant women from the hospitals and community centres after taking permission from the relevant authorities and approach the women after taking permission of their husbands or their guardian and the women. The authorities shall be presented with a copy of research proposal such that consent can be taken from them on the format prescribed by the university. (d) Research Objectives: The proposed objectives of the research are: a. To study the causes of primary and secondary chronic hypertension and premature birth due to deficient calcium supplementation as has been established by past researchers and scholars. b. To establish a theoretical foundation based on the literature study conducted in the above objective which shall answer the research questions partially. c. To conduct a survey among the unprivileged poverty stricken women population in the UK and capture the finer points that may lead to the conclusions – like their food intake, medical prescriptions given to them, life style, living environment during or before pregnancy, etc. d. To present the conclusions which are expected to value add over and above the past empirical generalisations. (e) Research Questions: Following are the research questions pertaining to this study: a. What are the known empirical theories about the causes of primary and secondary chronic hypertension and premature birth due to deficient calcium supplementation? – will be answered by literature review. b. What are the factors in the life of women belonging to poor societies in the UK that cause deficiency in Calcium supplementation? – will be answered by primary research (survey) c. How can such factors be controlled such that the risks of primary and secondary chronic hypertension and premature birth of foetus can be reduced? – will be answered by critical analysis on the survey findings using qualitative methods and quantitative methods (details in next chapter) d. What unique information has been captured by this research which can enhance the already established empirical theories pertaining to the research problem? – will be answered by the concluding discussions. (f) Primary Research: The method and plan of primary research is presented in the next two chapters. Methodological Paradigms and Tools As explained by Bryman (2004), any research can be carried out using two methodologies – qualitative methodology and quantitative methodology. Many modern researches use both methodologies in such a way that surveys and interviews are carried out using qualitative techniques and analytics are carried out using quantitative techniques. The researcher presents a brief of both techniques herewith: As described by Thompson and Walker (1998), qualitative research can be carried out in the form of phenomenology, grounded theory, ethnography or historical study. The research is carried out with interpretive frame of mind whereby the researcher builds the theories as the findings come to the surface. Phenomenology is the most common form of qualitative study which involves study of social phenomena by involving a large number of participants and conducting surveys or structured/unstructured interviews. Grounded theory involves study of already established empirical theories from books, journals or other forms of published literatures. Ethnography is more popular for cultural studies that involves self experience by the researcher by getting deeply involved in the community under study. Historical study involves study of historical events pertaining to the subject matter which is found from historical evidences like manuscripts, stone carvings, ancient literatures, etc. Bryman (2004) described that the quantitative methodology of research involves positivist mode by the researcher in which she/he is required to develop hypotheses and prove or disprove them with the help of findings. Hence, the research essentially involves more scientific methods of data analysis rather than just interpretations – like mathematical modelling, statistical analysis, simulation, etc. Some of the popular statistical methods are t-modelling, mean-variance analysis, chi-square analytics, probability distribution analytics, etc. As described by Saunders et al. (2007), the qualitative research tools can comprise of questionnaire designed for structured and unstructured interviews, cause-effect charts, voice/video recordings and observation notes. The quantitative research tool comprises of experimental setups in laboratories, simulation tools (like Arena), statistical tools (like SPSS), mathematical modellers (like Lindo or Lingo), etc. Quantitative research requires more scientific skills whereas qualitative research requires more critical thinking skills. The research problem can be addressed using qualitative techniques only if survey is chosen as the research tool. But this is a very serious medical issue whereby the target participants of the survey may have little or no knowledge of the subject matter. Hence, a qualitative method with one or more of the techniques (like phenomenology and ethnography) may not lead to accurate results. The author feels that quantitative data would be required to compare the outcome of this research with the outcomes of past researches scientifically using proven statistical and mathematical modelling methods. Hence, the author has proposed that this research may be the mix of qualitative and quantitative methods. In qualitative research, the researcher shall use phenomenology and grounded theory approach. Phenomenology shall be used to carry out the surveys and grounded theory shall be used to carry out the literature review. The researcher plans to use pre-designed questionnaire with multiple-choice answers. The number of votes to the specific answers shall be used as quantitative data that shall be analysed using mean – variance statistical methodology using SPSS tool. The type and nature of data collected as independent and dependent variables The questionnaire shall be designed in such a way that the women of non-privileged poverty stricken population in the UK can easily understand and respond to them. The researcher shall employ structured questionnaire with multiple choice answers. The responses shall be organised in tables under the criteria based on extent of Calcium intake by the pregnant women – group taking high calcium, group taking medium calcium, group taking milk only, and group taking negligible calcium. The data shall be collected through structured interviews having questionnaire having about ten questions with multiple choice answers. The researcher doesn’t propose use of more than 10 questions because the research requires study on very large number of samples (may go in thousands). Hence, the time taken per respondent should not be more than a minute or two. The researcher proposes the following primary variables: (a) Type of food intake – grams, fruits, pulse, meat, etc. (b) Quantity of food intake – approximate value in grams shall be captured (c) Frequency of food intake – once, twice, thrice, four times, etc. (d) Samples of blood and urine shall be collected to ascertain the calcium content in the individual women. The outcome of the information on primary variables shall be the amount of calcium intake by the women selected in the population. The researcher shall map the outcome of these primary variables with the following secondary variables: (a) Amount of Calcium intake by the individual women (b) Symptoms of primary and secondary hypertension in the individual women (c) Cases of premature child birth in the individual women The mapping between the primary and secondary variables will lead to following useful information: (a) The threshold of Calcium intake at which the cases of hypertension occurred (b) The threshold of Calcium intake at which the cases of premature birth occurred (c) Are the thresholds of calcium intake leading to primary hypertension, secondary hypertension and premature child birth different? The researcher shall use the Diet Chart for pregnant women by Culleton (2008) published for California Department of Health Services to assess if the calcium intake by a particular respondent is negligible, low, medium or high. Selection and manipulation of participants, procedure(s) and/or protocol(s) Cooper and Schindler (2003), Burton, D. (2000) and Denzin, N. & Lincoln (1994) described three methods of sampling of respondents – quota sampling, purposive sampling and convenience sampling. These methods are typically used in qualitative research where the sampling criteria is more important than the size. Quota sampling refers to different sampling groups under different classifications, purposive sampling refers to selection of respondents based on the purpose of the research and convenience sampling refers to selection of respondents based on ease at which they are accessible and can be made to agree for participation. Quantitative research techniques however employs statistical methods to assess the size of samples that depends upon the variance allowed (targeted) by the researcher. Lee (1993), Maynard and June (1994), and Doucet (1996) presented that research on sensitive topics require careful approach to select the respondents and hence the researcher should be very much particular about the willingness of the respondent to participate in the research. Looking into the fact that the proposed subject is very sensitive in nature, the researcher proposes to adopt convenience sampling although classification of respondents shall be carried out using quota sampling technique. Special care shall be taken to ensure that the number of respondents under every classification shall remain equal although the classification itself shall be understood after the responses have been recorded. The researcher shall take the consent of the husband or any other guardian of the lady before questions are asked. For this purpose, the researcher shall explain the context of the research to the husband/guardian very clearly and will ask questions to the pregnant woman in his/her presence. If they object to certain questions, the researcher will drop them for particular respondents and the questions facing too much resistance shall be taken off from the research questionnaire or else shall be rephrased differently. [Maynard and June. 1994; Doucet, Andre. 1996; Kelly and Liz et al. 1994] The procedure of employment of participants is proposed to be the following: (a) The researcher shall develop a criteria for selecting the women participants from poverty stricken families. The criteria shall be the monthly income of the family and the number of persons dependent upon the monthly income. (b) The researcher shall identify the areas where such participants can be located. (c) The researcher shall approach the head of families in such areas, explain the purpose of this research and seek permission to interview the women family members in the presence of male family leaders. (d) The participants selected shall be preferably between the age of 18 years to 35 years. (e) The participants should be able to understand and speak in English, Urdu or Arabic. (f) All responses shall be recorded on a piece of paper and shown to the head of the family such that he has no objections as such in the researcher using the data. (g) The head of the family and the women members shall be assured that their names shall be kept confidential. (h) The author plans to interview and take samples from at least 300 participants. This number is an intrinsic interpretation of the author perceiving to be sufficient to achieve valid outcomes. Data analysis – Appropriate types and tests to be used In research, the data analytics comprise of inductive and deductive approach that is chosen based on subjectivity or objectivity of the analysis. Such a relationship is developed by Goetz and LeCompte (1981) as presented in figure 3. The inductive approach begins with research questions whereby outcomes at every stage of the research are interpreted to form theoretical foundation that can support the conclusions and generalisations. Hence, inductive approach of data analysis is primarily followed by interpreters. The deductive research begins with hypotheses whereby the outcomes are mapped with the hypotheses points to finally arrive at the level of match the researcher has achieved with the hypothetical points. Hence, deductive approach of data analysis is primarily followed by positivists. Figure 3: Interpretative analysis of qualitative research outcomes (Source: Goetz and LeCompte. 1981) In this research, the interpretive method of research has been selected in the methodology chapter and hence the data analytics method selected is inductive. The qualitative methods will be used till the stage all the collected data has been successfully classified into one of the four targeted criterion – negligible calcium intake, low calcium intake, medium calcium intake and high calcium intake. The analysis after the classification shall be based on mean and variance statistical method that shall be conducted with the help of SPSS tool. The level of hypertension will be assessed based on the responses from the participants matched with the intake of calcium to verify if high variance of calcium intake at the lower side results in high hypertension and that at higher side result in low hypertension. The researcher shall try to model the results mathematically to find out the threshold of calcium deficiency after which the chances of hypertension increases considerably. Research Ethics Given that this is highly sensitive subject matter and the questions shall comprise of food intake and behaviour of the respondents and the clinical measurement records (like blood pressure, protein content in urine, etc.), confidentiality of data is the most significant prerequisite of this research. The researcher will take utmost care to protect the information collected from the respondents and will not declare their names or identities in the research report. The information collected shall be strictly based on permission from the authorities, from the husband/guardian of the pregnant women and the women themselves. All questions shall be asked in presence of the husband/guardian. To make the respondents comfortable, the questions shall be asked preferably by a female member of research team only. The researcher shall take utmost care to ensure that the report shall not represent any bias towards the gender, class, religion, community, country of origin, beliefs, etc. The researcher shall document an information letter explaining the entire research, its purpose and its benefits that will be presented to the head of the family. The researcher shall design some consent forms in predefined templates which will be populated and submitted to the head of the family. The head of the family, in turn, would be requested to verify all the content of the form, including purpose of research, method of collecting information, anonymity of the family details (including names), no-bias commitment towards class, religion, community, country of origin, beliefs, etc. The interviews shall be taken only after the head of family gives his consent on the form in writing after verifying all details. Intended Outcomes The reduction of risk of hypertension and other disorders due to calcium intake has already been presented in multiple past researches. The researcher wishes to ensure that this research presents results that are in-line with the findings of the past researches. In addition, the researcher also targets to find out the threshold value of calcium deficiency after which the risk increases dangerously. The past researches have already resulted in multiple empirical results pertaining to this problem. In this research the author plans to achieve the following: (a) The threshold of Calcium intake at which the cases of hypertension occurred in the population selected (b) The threshold of Calcium intake at which the cases of premature birth occurred in the population selected (c) Determine if the thresholds of calcium intake leading to primary hypertension, secondary hypertension and premature child birth different. If they are different, what is the mean and variance of the thresholds? (d) How does these outcomes matches the outcomes of previous research? What is the mean and variance when these results are compared with the previous ones? (e) What are the probable reasons for the variances? This outcome needs analysis with the help of the theoretical foundation formed as a result of the literature review. Conclusion In this paper, the author has presented the research design pertaining to assess whether calcium supplementation (and varying amounts of) is linked to a decrease in occurrence of pregnancy-induced hypertension primarily, and other related problems. The past researches have already proved that calcium intake reduces the risk of hypertension and associated disorders in pregnant women. This research intends to analyse the threshold value of calcium deficiency beyond which the risk becomes dangerous for the pregnant women. The author has selected phenomenology and grounded theory of qualitative research with interpretive approach and the analytics shall be inductive supported by statistical technique of mean and variance using SPSS tool. The sampling method chosen is a mix of quota sampling and convenience sampling. References Acker, Joan, Kate Barry and Johanna Esseveld. (1991), “Objectivity and Truth. Problems in Doing Feminist Research,” in Beyond Methodology. 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