Views of Treating Childhood Obesity in Saudi Arabia - Essay Example

MSC Public Health and Health Promotion Foundations in Research SHGM 38 Aled Jones Proposal on A Qualitative Study of primary care practitioners views of treating childhood obesity in Saudi Arabia Student No: 628587 Word Count: 3229 Submission Date: 15-8-2011 Background & Literature Review: In 2001, National Audit Office stated obesity as one of the most intricate health issue and a key threat to the health of children in Britain. According to statistics, being overweight and obesity itself, ranks as the fifth major cause of deaths globally leading to more than 2.8 million deaths annually amongst adults (WHO, 2011). Moreover, obesity is responsible for more than 23% of the ischaemic heart disease burden, 44% of the diabetes burden and amidst 7% to 41% of certain cancer burdens (WHO, 2011). Additionally, the lack of awareness amongst those who are just a little overweight leads to a consistent increase in obesity amongst them causing them to gain weight excessively overtime thus leading towards prolonged suffering for themselves as well as their families (WHO, 2006). Further to this is the fact that the overall costs for health care systems has risen alarmingly high causing even more strain for governments to meet these needs (WHO, 2006). More than 43 million children worldwide, below the age of five were diagnosed as overweight in 2010 (World Health Organization, 2011) Obesity which was once merely limited to the high income countries is now on the rise even in the middle class as well as the low income countries, particularly in urban settings (WHO, 2011). Today, more than 35 million children belonging to the developing countries are overweight and approximately 8 million children in developed countries belong to the group of obesity. Moreover, forty three million children under the age of five are overrweight (WHO, 2011). Obesity amongst infants and youth is related to a concurrent boost in rises associated with chronic diseases (Abalkhail, 2002). This glut of weight is also one of the key contributors of paediatric hypertension. Children who are obese are at a much more elevated risk for developing enduring chronic conditions including type 2 onset diabetes mellitus, orthopaedic disorders, coronary heart ailments and respiratory diseases (Abalkhail, 2002). Additionally childhood obesity can also lead to an increase in consequent morbidity regardless of the fact if obesity persists in adulthood or not (Abalkhail, 2002). Obesity and overweight have both become quite dominant in Saudi Arabia over the past few years. This is not only common amongst the adults but is equally widespread amongst the children as well. Based on recent statistics, approximately 6% of the people in Saudi Arabia are obese, with 50% of these being children and adolescents (King Saud University Obesity Chair, 2011).What’s even more alarming is the fact that today’s culture in Saudi Arabia promotes eating habits that directly contributes towards increasing obesity. People prefer eating larger amounts of readily available food instead of choosing foods that are most nutritious. Additionally, in a country like Saudi Arabia, food is often used in terms of reward, especially for children who are awarded sweets for completing their chores. The whole idea of eating only when hungry seems to have become completely obsolete (King Saud University Obesity Chair, 2011). In such crucial times, where obesity poses a threat to both adults and children alike, the King Saud University (KSU) Hospitals has been consistently active in supporting various public policies that are beneficial for both children and families. The KSU Advocacy and Public Policy Program believe not only in revolutionizing but also promoting it so that families can maintain a healthy lifestyle (King Saud University Obesity Chair, 2011). The Paediatric Advocacy Program is an alliance between the King Saud University School of Medicine and the local communities to develop the fitness and health of infants and youth. The various community medical residents along with practicing nurses work hand in hand with each other to address this problem through means of education, service and research. A major part of these projects emphasize upon the prevention of obesity among children (King Saud University Obesity Chair, 2011). Obesity, a frequently stumbled upon problem with massive public health implications is indicated by Al-Rukban (2003) as far one of the most annoying and wearisome disorders to manage. Hence, there is a need for an immediate and an effective course of action to deal with the problem (Musaiger, 2004). Based on current research evidence on intervention systems for preventing obesity amongst infants, there is an availability of high quality data but limited data on the prevention program’s effectiveness (Etelson et al, 2003). In King Saudi University’s College of Medicine, there’s a special branch called The University’s Center for Obesity Research, which was developed to study disorders related to obesity and related disorders in order to gain a insight to obesity in Saudi Arabia (Attree & Milton, 2006). It has been found by the practice nurses and doctors, also the university faculty, that transition in food habits in the young people of Saudi Arabia, especially children has led to this current obesity issue. The new type of staple food is fast food like carbonated drinks and fried foods, which is high in sugar, salt and fat content. Along with this, there is a drastic decrease in physical activity of children, which augments the obesity problem. Additionally, a logistic regression was used to demonstrate how the age, region, education, and economic background can help predict obesity among children in Saudi Arabia. Moreover, among children, the findings of this study (King Saud University Obesity Chair, 2011) found the prevalence of obesity was more common in female children than males; also obesity was more prevalent in children from urban areas than from rural areas. This proposed research study attempts to investigate the views of the general practitioners’ and practice nurses’ in relation to their position in managing childhood obesity in the city of Jeddah in Saudi Arabia. From a review of the literature there is a gap in knowledge regarding the obesity issue of children in Saudi Arabia, and in particular to its effective management. Research Question: In order to conduct a research study effectively, the right set of questions must also be put forward. The main guiding principle of a research study is usually presented in the form of a statement which in turn prompts a number of questions (Parahoo, 2006). Generally, the aim of this study is to assess the views of doctors and nursing staff with regards to pre-emptive measures and standard precautions against obesity in children - in a large tertiary teaching hospital in Saudi Arabia. Hence, the key objectives of the study are: Views on different intervention effectiveness. Identify any differences in views. Approach & Design: There are a number of differences between quantitative methods and qualitative research methods. Qualitative methods integrate in depth interviews, reviews, questionnaires and focus groups, whereas in quantitative research methods, surveys are used (Attree & Milton, 2006). Quantitative methods also incorporate deductive processes of research such as constructs, pre specified concepts and hypothesis. Qualitative method is subjective, closely associating the deductions with the experiences of observers, whereas quantitative is more objective in nature, establishing the inferences on observed effects. Additionally, qualitative research is text based whereas quantitative method is number based. Furthermore, in qualitative research, the number of cases is low but the research conducted is more in depth, while for quantitative, the expanse of research is more on a limited number of cases, comparatively (Ritchie & Spencer, 1993). The use of a qualitative descriptive design is the key focus of this study which further elaborates into the usage of individual interviews. Moreover, the main rationale of qualitative research is to comprehend and explain the partaker meaning (Morrow & Smith, 2000). The researcher has attempted to use a qualitative approach throughout the course of study. This is not only the most appropriate means of conducting this research study question - it is also more aligned to the topic. The advancements made within the field of qualitative research is an excellent way to obtain answers from the desired research questions where in-depth data is required (Walker et.al, 2007). Additionally, it corroborates with the desired research settings allowing the researcher to collect and compare finding to previous research which has used this approach and design, for example Walker et.al, (2007) who undertook a qualitative study focusing on GP’s and practice nurses in Britain in relation to this perspective . Thus, by incorporating a qualitative approach to the research, the research will be more effective (Black, 1998). The use qualitative methods within research studies is quite prominent due to its relentless necessity in social policy fields along with developing an understanding for complex behaviours, needs, systems and cultures (Ritchie & Spencer, 1993). There are a few important qualitative design options; one of them includes ethnographic studies. In an ethnographic study, a cultural and social analysis of the study unit is carried out (Attree & Milton, 2006). In phenomenology, the subjective experiences are emphasized more. Hence in a phenomenological study, the objective is understanding the true meaning of a individual experience (Booth & Sutton, 2007). Grounded Theory is one of the most important aspects of a qualitative research, since it is a proposed theory after the research and hence is valuable (Bryman & Burgess, 1993). A substantive theory is developed in this approach, which contains elements such as properties, hypotheses and a number of other categories (Attree & Milton, 2006). The Grounded Theory design is defined by the properties and the categories while links between the properties and the categories are defined by the hypothesis. On the other hand, case study is another crucial qualitative design option which is deployed for getting added understanding of the situation which is being studied in the research (Holloway, 1996) Although methods like ethnographic studies, phenomenology and case study are effective research methods, due to time constraints for this research, none of these research methods are considered suitable for this study. Qualitative research is essentially a type of methodology which is based on descriptive narratives such as questionnaires, interviews, video and audio tapes (Holloway & Wheeler, 1996). For an effective descriptive qualitative design open ended questions which are semi structured is generally used, particularly for getting the information from nurses and doctors about child obesity (Dixon-Woods et al, 2007). A descriptive qualitative design allows the thoughts and feelings of the participants to be explored more thoroughly. Additionally, a descriptive qualitative design allows the researchers to gain an in depth knowledge about the issues in a small group. Hence for medical research, particularly for a deeper insight to child obesity in Saudi Arabia, it is important that the descriptive qualitative design approach is utilized as it facilitates the respondents to share their feelings and views as well as their constructed reality (Miles & Huberman, 1994). Sample: The primary purpose of sampling is for drawing conclusions about the populations. Generally, inference to draw conclusions about population and statistics are used for determining the characteristics of the population (Attree & Milton, 2006). Also, in sampling, a small portion of the population is observed in order to understand the population’s characteristics. Sampling is a cost effective method since it’s much cheaper to observe a small segment, rather than observing the whole population. There are a number of sampling procedure types, while some are better; none of them can claim to be perfectly accurate all the time, since there are some errors and inabilities which sometimes crop up in samples (Dixon-Woods et al, 2007).The sample must be quite similar to that mentioned in the study of Walker et.al (2007), however, due to a lack of personnel and resources in Jeddah, only those who are available will be incorporated. The target sample population comprised of medical staff in hospital located in the eastern provinces of Saudi Arabia. The total sample population included 10 general doctors and 10 practice nurses out of which 3 general doctors and 3 practice nurses will be chosen as a representation from the total population. During the course of study a non-probability sample had to be used for the study. This was furthermore elaborated into convenience sampling method as a result of which the target population comprised of medical staff who had been working to prevent childhood obesity in all hospitals in Jeddah. In qualitative research, transferability means that the results of the research can be seamlessly transferred to different settings and contexts (Morse, 1996). From the standpoint of qualitative research, the one who has undertaken generalizing should have the onus of transferability. Transferability can be enhanced by describing the context of research clearly as well as clarifying the research assumptions (Morse, 1996). Ethical Approval: To approach the medical team, the permission had to be granted from the gate keepers, the General Hospital human resources director of these hospitals; this involved explaining the nature and the purpose of the research in order to obtain a formal approval from the staff to invite them to participate in the research (Bryman & Burgess, 1993). All participants shall be informed regarding the nature of the study to gain their consent. However, the participants will have the liberty to stop the interview at any time they feel like (Morse & Field, 1996). I will also ensure that the data collection methods are approved by the human ethical committee, since the data collection methods involve human subjects. The data gathered shall be concealed and at the end of the award of MSc, all of this data shall be destroyed. Moreover, I shall make sure that the information is carefully collected and the findings will be accounted accurately without any falsification. To explain the nature and the purpose of the study, an information sheet (see appendix one) was also created along with a consent form (see appendix two) shall also be affixed and will be given to the potential participants. Moreover, the participation of the desired candidates is purely voluntary and they possess the right to decline from participating any time (Parahoo 2006). Data Collection: There are primarily three methods for data collection in qualitative research. They are namely participant observation, unstructured/ semi structured questionnaire, or in depth interview, either individually or by focus group (Dixon-Woods et al, 2007). A focus group is essentially a group discussion which lasts about two hours, and it is on a particular topic. The group usually consists of about six to ten people who are homogeneous. A moderator is the person who conducts the interview and asks the participants about their opinions. The discussion is recorded and then analysed (Holloway, 1996).In-depth interview on the other hand is a detailed discussion between the interviewer and the individual respondent (Dixon-Woods,et al 2007). In either case the discussion includes one or a number of open ended questions (Dixon-Woods,et al 2007). Participant observation incorporates trained people for deeply observing a series of events related to the topic, for instance observing the encounters between patients and health providers. Participant observation is used for understanding the behavioural patterns of the study group (Miles & Huberman, 1994). The fourth method which is commonly used in qualitative research is structured questionnaire. A list of open ended questions is prepared and is distributed among the respondents. The questions can ether emphasise on factual materials or on the experiences of the respondents (Miles & Huberman, 1994). Individual interviews is the preferred option for this study because it is more in depth and individual opinions can analyse answers related to specific issues in child obesity, which focus groups might not be able to. A qualitative interview tends to be less intrusive since it encourages a two way communication. Moreover the information gathered from these semi-structured interviews not only provides answers, but the reasons for the answers as well. During the interview process, the participants may also conveniently discuss sensitive issues (Miles & Huberman, 1994). Various techniques that are used in the data collection during a semi-structured interview are known as an interview schedule (Parahoo, 2006). During the course of this study, the data assortment process shall be by semi-structured interview following the interview schedule devised by Epstein and Ogden (2005), and modified by walker et al (2007) tailored to recount to childhood rather than adult obesity (See appendix three). The questions asked to the respondents are appropriate, since they are the health practitioners who work closely with child health issues and hence, they are the best respondents to accurately answer the questions. Generally, interviews must not last more than an hour (Field & Morse 1985). Thus, as a part of the research plan, the researcher would pre-plan the interview. This shall include a suggested estimated time so that participants can plan their time accordingly (Holloway, 1996). The interviews shall be conducted face to face, in an informal setting or venue, where the respondents will be more relaxed and unstressed (Epstein and Ogden, 2005). The recorded data shall be analysed using the Framework method used by Ritchie and Spencer (1993). Data Analysis & Rigour: During the analysis phase, all interviews shall be properly recorded and then examined with the help of using the Framework method (Ritchie & Spencer, 1993). As advised by Holloway & Wheeler (1996), the data will be transcribed by the student thus involving them in the overall process of data collection and analysis as well as sensitizing them to the issues at hand. To meet a variety of different objectives of the research, it was important to apply qualitative methods of gaining results. The questions involved shall be addressed will diverge from study to study but broadly they can be separated into four categories: contextual, diagnostic, evaluative and strategic (Ritchie & Spencer, 1993). Many researches endeavour to address more than one of these categories of questions (Ritchie & Spencer, 1993). The various stages adopted during this phase included familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation (Ritchie & Spencer, 1993). The process of the data analysis begins with familiarisation with the relevant data, ideas and themes that has taken place. This can further be developed into an iterative manner during ensuing readings of the transcripts. Next, the data can be indexed and annotated followed by mapping and interpreting the data. In qualitative research, rigour is a key aspect, and rigor is established on the thoroughness and discipline in data collection methods, the openness of the data collection method and research, the strict adherence to the philosophy of the research methodology and careful scrutiny of all the data which is collected (Dixon-Woods et al 2007). The rigour of qualitative research is evaluated on the basis of emerging theory. Moreover, for rigour, the four important steps to consider include transparency, credibility, reflexivity and theory integration. Regarding credibility, it can be integrated through external experts and group members who check off the data. On the other hand, transparency can be brought about by having clarity in the audit trail (Ritchie & Spencer, 1993). For successful theory integration, the researcher must ensure that the theoretical concepts are linked properly with the literature. Finally, reflexivity means that the research is properly reflecting the work of the nurses on the patients and their relationship with the patients (Ritchie & Spencer, 1993). Strengths and Limitations This study shall help in understanding the health education programs, thus assisting to make improvements in the obesity prevention programs within the country. Moreover, the findings of the research will give room for further variations and reformulate ideas as the analytical process progresses. This research has been primarily carried out to give valuable insight into the future decision making regarding obesity services. Some of the key limitations which might be encountered are incorporating subject matters from various other hospitals instead of single settings to obtain more accurate results, the lack of authentication of cause and effect relationship in descriptive studies, the time limitation and finally, the geographically bound sample size. Conclusion This research therefore inspects the overall perception of the primary care practitioners regarding obesity in children and their being overweight. The paper also poses a concern and attempts to understand their views of the principle factors that cause obesity amongst children along with their views of appropriate actions and precautions that they take to curb the problem at hand. The qualitative method of research is deployed for the study and through the qualitative research methodology, the paper attempts to document the behavioural efforts of the primary care practitioners (General Doctors and Practice Nurses) on how they resolve the problem of obesity amongst children. For better comprehension of the current state of obesity in children of Saudi Arabia, the findings should also be distributed in a number of important journals for publication. References Abalkhail, B. (2002) ‘Overweight and obesity among Saudi Arabian children and adolescents between 1994 and 2000’ Eastern Mediterranean Health Journal, Vol. 8, 4-5. Al-Rukban, M.O. (2003) ‘Obesity among Saudi male adolescents in Riyadh, Saudi Arabia’, Saudi Med, 24 (1), pp. 27-33. Attree, P & Milton, B (2006) Critically appraising qualitative research for systematic reviews: defusing the methodological cluster bombs. Evidence & Policy: A Journal of Research, Debate and Practice, 2 (1): 109-126. Black, N. (1998). Health services research methods: A guide to best practice. London: BMJ Books. Bowling, A. (2002). Research methods in health: Investigating health and health services (2nd edition.). Buckingham: Open University Press. Bryman A, Burgess R (Eds) (1993) Analysing Qualitative Data. London, Routledge Cormack, D. F. S. (2000). The research process in nursing (4th ed.). Oxford: Blackwell Science. Dixon-Woods M, Booth A. & Sutton AJ (2007) Synthesizing qualitative research: a review of published reports Qualitative Research, Vol. 7, No. 3, 375-422 Epstein. L, Ogden. J. (2005) ‘A Qualitative Study of GPs’ views of treating obesity’British Journal of General Practice, Vol. 55, pp. 750-754. Etelson. D, Brand. D.A, Patrick. P.A, Shirali. A. (2003) ‘Childhood Obesity: Do Parents Recognize This Health Risk?’ Obesity Res, 11(11):1362-1368. Field, P.A., & Morse, J.M. (1985). Nursing Research: The Application of Qualitative Approaches. Croom Helm, London. Holloway, I., & Wheeler, S. (1996). Qualitative research for nurses. Oxford: Blackwell Science. King Saud University Obesity Chair (2011) About Obesity. Available at: http://obesitychair.ksu.edu.sa/about.php?lang=english (Accessed: 3 June 2011). King Saud University Obesity Chair (2011) What causes obesity?. Available at: http://obesitychair.ksu.edu.sa/what_causes_obesity.php (Accessed: 3 June 2011). King Saud University Obesity Chair (2011) Advocating for Public Policy Change to Promote Healthy Weight. Available at: http://obesitychair.ksu.edu.sa/prog5.php (Accessed: 3 June 2011). Mays N, Pope C (Eds) (1996) Qualitative Research in Health Care, London, BMJ Publishing Group. Miles M, Huberman A (1994) Qualitative Data Analysis. Thousand Oaks, Sage. Morrow and Smith. )2000) Qualitative research for counseling psychology. New York. John Wiley. Morse, J. M., & Field, P. (1996). Nursing research: The application of qualitative approaches (2nd ed.). London: Chapman & Hall. Morse, J. M. (1996). Qualitative and quantitative methods: issues in sampling, in Nursing Research Methodology, Aspen: Rockville Musaiger, A.O. (2004) ‘Overweight and obesity in the Eastern Mediterranean Region: can we control it?’, Eastern Mediterranean Health Journal, Vol. 10, No. 6 (789 - 790). National Audit Office, (2001). Tackling Obesity in England. Report by the Comptroller and Auditor general. National Audit Office. London, Stationery Office. Parahoo, K. (2006). Nursing research: Principles, process and issues (2nd ed.). Basingstoke: Palgrave Macmillan. Ritchie. J, Spencer. L. (1993) ‘Qualitative data analysis for applied policy research. In Analysing qualitative data’. London: Routledge Walker et.al (2007) ‘A qualitative study of primary care clinicians views of treating childhood obesity’ BioMed Central, Vol. 8, No. 50. World Health Organization (2011) Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/index.html (Accessed: 3 June 2011). World Health Organization (2006) What are the health consequences of being overweight?. Available at: http://www.who.int/features/qa/49/en/index.html (Accessed: 3 June 2011). GANNT CHART Appendix 1 Participant Information Sheet Date: 28/06/2011 Title of Project: A Qualitative Study of primary care practitioners views of treating childhood obesity in Saudi Arabia Study overview: This research not only inspects the overall perception of the primary care practitioners regarding obesity in children and their being overweight, but also poses a concern and attempts to understand their views of the principle factors that cause obesity amongst children along with their views of appropriate actions and precautions that they take to curb the problem at hand. Additionally this study also attempts to document the behaviour as well as the efforts of the primary care practitioners (General Doctors and Practice Nurses) on how they resolve the problem of obesity amongst children. What you will be asked to do: The participants in the study will be interviewed for maximum 30 minutes. During the interview the participants will be asked number of questions about the last time you were in a consultation with a child and you expressed concerns about their weight. These questions will try to assess your level of childhood obesity knowledge, attitude, and beliefs toward childhood obesity. Participation: Participation in the study is entirely voluntary, and will take approximately 30 minutes of your time. You may decline to answer any question presented during the study if you so wish and further, you may decide to withdraw from this study at any time without being affected in any way. Personal benefit of the study: The benefits of participation in this study include learning about childhood obesity in general and additional background information on the study in particular if contacted. There are no other personal benefits to participation. Risks to participation in the study: Participation in this study will not in any way pose any risk to you. Confidentially: All information that will be provided will be considered completely confidential; indeed, your name will not be included or in any other way associated, with the data collected in the study. The tap recorded in this study will be locked up in a secured place and it will be destroyed after the award of the degree. Questions: If after receiving this letter, you have any questions about this study, or would like additional information to assist you in reaching a decision about granting consent, please feel free to ask student investigator listed at the top of this sheet. Thank you for your interest in our research and for your anticipated contribution with this project. Appendix 2 Informed Consent Form Project Title: A Qualitative Study of primary care practitioners views of treating childhood obesity in Saudi Arabia The purpose of this research project is to explore general practitioners’ and practice nurses’ views in relation to their role in managing childhood obesity in Jeddah city in Saudi Arabia. .Interview will be conducted one time, and it will last approximately 30 mints. During the interview questions will be asked regarding the last time you were in a consultation with a child and you expressed concerns about their weight. These taps will not be shared with the ward staff, but the final report, containing anonymous questions, will be available to all at the end of the study. There may be no benefits to you as a participant of this study, but there may be changes in the primary care to childhood obesity following the completion of this study. This is to certify that I …………………. (Print name) hereby agree to participate as a volunteer in the above named project. I hereby give permission to be interviewed and for the interview to be tape recorded. I understand that, at the completion of the research, the tap will be erased. I understand that the information may be published, but my name will not be associated with the research. I understand that I am free to deny any answer to specific questions during the interviews. I also understand that I am free to withdraw my consent and terminate my participation at any time, without penalty. I have been given the opportunity to ask whatever questions I desire, and all such questions have been answered to my satisfaction. Participant: ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Investigator: ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Date: ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Appendix 3 Data collection: Data collection will be by semi-structured interview following the interview schedule used by Epstein and Ogden, adapted to relate to childhood rather than adult obesity: * Think about the last time you had a consultation with a parent/child who expressed concerns over their childs weight... OR * Think about the last time you were in a consultation with a child and you expressed concerns about their weight... Can you tell me about the consultation? How did you feel about managing this patient? What advice or information did you provide for the patient/their parent? What did you think the patient/their guardian expected from you? Did you feel that the consultation was successful? Do you think primary care has a role in dealing with childhood obesity? What management do you think primary care should employ in tackling obesity in children? How would/do you feel about managing children with obesity routinely? As a GP/practice nurse, whom would you contact for support and advice in relation to obesity? * How do you feel about the following: Counselling in primary care? Behavioural adjustment techniques? Education in obesity management for GPs and practice nurses? Extending the primary care team to include nutritionists and/or dieticians? Secondary and tertiary care in relation to obesity management? Read More