Hypothyroidism and Depression Associated with Obesity - Research Proposal Example

? Applying Self-Determination Theory to Patients with Diabetes Table of Contents Table of Contents 2 Introduction 2 problem Statement 2 Purpose of study 4 Research questions 4 Definition of terms: 4 Significance to nursing 5 Summary 5 2.Literature Review 5 Theoretical framework 6 Explanation of the theory 7 Literature Review 9 Summary 12 3.Methodology 12 Research Design 12 Research Setting 13 Sample 14 Measurement tools/instruments 15 Data collection measures 16 Procedures for protection of human rights 17 Proposed Data Analysis 18 4.References 19 1. Introduction problem Statement Given the high rates of sedentary lifestyles as noted by Abu-Omar, Rutten and Robine (2004), and the well established role of physical activity for successful and long-term weight control abilities, mechanisms to help maintain this in the fight against obesity have risen. Obesity has for two decades gained much prominence in the lives of many people in the United States. Children were in the past considered immune from this disease while adults produced the highest obesity rates. At least 20-25% of children in the US suffer this preventable ailment that has become a leading cause of death in the country (Haslam, 2007). Several studies reveal that the mortality risk is lowest for those with a body mass index (BMI) of 20-25 kg/m2 for nonsmokers and 24-27 kg/m2 for smokers. Those above a BMI of 32 are considered as having a double mortality rate, especially amongst women. It is estimated that at least 111,000 to 365,000 deaths are recorded annually as a result of obesity-related ailments in the US, with at least 1.1 million deaths being reported across Europe annually. Obesity is seen as reducing one’s life expectancy by at least seven years especially for those above the BMI of 35, and those with BMI’s greater than 40 reducing their expectancy by at least 10 years (Haslam, 2007). The main causes of obesity can be broken down to these eight reasons. One of them is age where one has increased chances of getting obese as they age due to slow metabolic rates. Another is gender, with women having a higher tendency to gain weight more than men. Genetics play a role with such trends running in the family. Environmental factors such as sedentary lifestyles or those that encourage such lifestyle changes put one at a higher risk (Haslam, 2007). Lack of physical activity also plays a great role in encouraging obesity tendencies since the excess sugars are not excreted from the body as required. Psychological factors influence eating habits and thus, obesity may result. Illnesses such as hypothyroidism and depression are also associated with obesity because of reported hormonal problems. The last one is medication, such as steroids and some antidepressants, which may lead to excessive weight gain (Haslam, 2007). Purpose of study The main purpose of this study is to assess the effectiveness of using the self-determination theory (SDT) in the treatment of obese patients Research questions i) How can the use of SDT be made effective in the treatment of obesity cases in the country? ii) Is there proof of its success in clinical or home settings? iii) Is there any proven correlation between SDT and obesity? Definition of terms: Obesity-a medical condition where the body accumulates excessive fat such that one has a BMI greater than 30 kg/m2 BMI-the body mass index is a heuristic representation for the amount of fat in the body, based on one’s height and weight. It is calculated by dividing one’s weight by one’s height. SDT-this is a theory that seeks to prove that an autonomy perspective context will generally foster the satisfaction of three basic psychological needs, namely the needs for competence, autonomy and relatedness. Motivation-an urge to achieve certain goals, can be intrinsic (of an individual’s inner self) or extrinsic (external forces acting on an individual). Significance to nursing Learning more about the causes of obesity and looking for ways of motivating individuals to take it upon them to ensure they remain safe is very important. With more than 300,000 deaths being reported daily, nurses need to understand how they can motivate their patients into taking the baby steps in their fitness program, and how they can assist them achieve better lifestyles through either counseling or weekly checkups to keep them motivated. Furthermore, given the almost zero ability for a total reverse for one who has obesity, and given the high rates of recidivism, helping patients to achieve and maintain a physical workout and an active lifestyle may be a more constructive and efficient method of handling the issue in the long-term. It is important for the nurse to understand how they can achieve this and get personally involved in self-regulation. Summary This study is very helpful especially in turning the home setting into a motivating setting for physical activities. The patients can be trained in dealing with few exercises every day and gradually improve on their rates to provide better chances of health regulation in the future. Once the nurse understands how to motivate the patient and arouse intrinsic motivation in the patient, the satisfaction of the three components of autonomy will keep them motivated for longer. 2. Literature Review This section provides a very detailed research component for the use of SDT in the treatment of obesity and whether there are any successes that have been recorded so far. Various researchers have embarked on this journey as a way of filling the general void that characterized past researches on Obesity. It was also as a result of the failure of traditional approaches to fully assist obesity patients in recovering that researchers were necessitated to look for newer, and more advanced methods of ensuring primary care was delivered adequately. It will also provide theoretical insights on the reasons why people ought to maintain and adopt healthy behaviors that are more helpful and easily maintained, for better recovery and increased health benefits. It will also seek to present a rationale on the importance of SDT in the facilitation of behavioral change during obesity treatment and, the importance of maintaining an active physical regime. Theoretical framework Motivation is a very important concept in research. An individual without any motivation will achieve less over their entire lifetime. However, given the platform to perform something that allows them to engage with the society even more, allows them to find their niche and seek to maintain it. The ability to see results and to positively interact with the results allows one to engage fully in the activity. In treatment, researchers have recently become interested in the role that motivation can play in the maintenance of health (Sheldon, Williams and Joiner, 2003). It is reported that people have at hand the ability to change their lives and conditions only if they are willing to act. The ability to engage the psychological energies and propel an individual towards a specific goal can be quite helpful in health matters. As Deci and Ryan (2000) stipulate, there is a very big difference between intrinsic motivation, extrinsic motivation and Amotivation (the lack of any intention to get involved in any behavior). This is where SDT comes to play. The application of this theorem allows an individual to distinguish between self-determined or autonomous types of behavioral engagements and non-self-determined types. Learning how to capture the intrinsic motivation concept and apply it to a patient will lead to creativity, productivity and spontaneity, as well as inborn perseverance. It allows the individual to regulate themselves and determine what is of great importance in their lives (Landry and Solomon, 2004). But given the human nature of expecting an external force to push them before they can engage in any activity, whether for their own benefit or for the society, the need for extrinsic motivation cannot be excluded from SDT. This will involve external regulation where the individual is expected to do something as a way of avoiding punishment; identified regulation where an individual acts based on the outcomes; introjected regulation where an individual acts as a way of avoiding internal feelings of obligations and/or guilt and, integrated behaviorism where an individual has identified values and schemas in life that are coherent with the activity in question (Roth, Assor, Kanat-Maymon and Kaplan, 2007). In obesity, the internalization of the processes will be of greater importance since they ensure the patient’s vitality, development and motivation are internally motivated hence; they make greater progress accompanied by an internal perceived locus of casualty and a sense of true preference. It is thus true that a person needs to not only feel that they can maintain the same pace when carrying out an activity (confidence, efficacy, competence) but also need to feel fully responsible for the initiation and the maintenance of the behavior (autonomy, self-determination, responsibility) (Williams et al., 2004). Going by these same tenets, it is right to postulate that successful maintenance of a weight reduction program will occur if people choose eating and exercising behaviors as a result of personal motivation based on the perceived health benefits and the value of weight loss management. Explanation of the theory The SDT is a human motivational theory that seeks to hold considerable promise in the elucidation of social psychological processes that influence psychological attributes within an individual supportive context. It seeks to encourage people to find an inner strength and drive through which they can achieve their goals and visions by tapping that inner strength and using it as a way of managing their skills and their lives. It explains individual growth based on the inherent need to satisfy psychological needs. It encourages as many people as possible to make choices by depending on their innate will to successfully meet their needs rather than wait for any external influence to push them towards their goals (Roth, Assor, Kanat-Maymon and Kaplan, 2007). It seeks to encourage individuals to integrate that which they deem as necessary in their life for their survival in their daily livelihood. It deals with two types of motivation: intrinsic and extrinsic motivation. Intrinsic motivation is the self-drive towards achieving goals that help satisfy one’s needs without depending on any external interference. This need is further exacerbated by the extrinsic materials which act as external influences towards the continued persistence to the achievement of the expected goals (Deci and Ryan, 2000). By using this model in a clinical setting, the researchers seek to tap into the innate values to help push the patients to create a regime that satisfies their goals and psychologically helps them achieve that which they desire. As part of this desire lay three basic needs that are universally considered part of every being. They include; autonomy, competence and psychological relatedness. By using these three platforms, the theory allows a researcher to manipulate the setting to artificially create the needs and transfer them to the patients (Roth, Assor, Kanat-Maymon and Kaplan, 2007). When people are given deadlines they seek to finish the job within the set time period. However, this reduces their ability to tap into their innate resources and accomplish the same goals within a set period of time. It does not offer the patient the required timeframe to internalize and integrate the expected results into the system and make them yearn to achieve them. Autonomy allows the patient to feel responsible for their actions and thus take it upon themselves to fulfill their end of the bargain without any external coercion or reward (Deci and Ryan, 2000). Competence develops by choosing to give feedback when it is least expected but when it would make the biggest impact on the lives of these workers. Feedback is a way of showing people how competent they are in performing their duties or how incapable they are in achieving it. By using positive feedback in regulated notions; one can easily increase their intrinsic motivation and thus the ability perform tasks without looking at the external rewards, but the internal satisfaction of performing according to the laid out procedures. Relatedness has been found to have minimal effects on the way the individual is intrinsically motivated. Literature Review Silva et al. embarked on a research that sought to identify the rationale behind the use of SDT intervention in the treatment of obesity in a randomized control trial (Silva et al., 2008). They ought to find out an effective strategy through which obesity could be counteracted despite its high recidivism rates after people have begun losing weight. They randomly recruited over-weight and moderately obese women aged 25-50 through media advertisement from the community. A total of 290 were recruited but only 258 completed the initial assessments and continued with the study. They were to undergo 30 2-hour sessions, and met bi-weekly with a multi-disciplinary intervention team. They drew a set of motivational interviewing guidelines used to create topics that would be used in the program. After the program, the participants would be followed up for two years. The results got from this were positive though the authors noted that only 20% of them were able to integrate the activity behaviors successfully into their lifestyles and achieve long-lasting weight control. According to Baumann, Sallis, Dzewaltowski and Owen, the way an intervention is implemented determines its efficacy (2002). This is because the outcomes may not be well induced to affect the mediators proposed, thus, outcomes may not be as largely expected. They came to this conclusion in the article that sought to distinguish amongst different variables and determine those that have a correlation with physical activity in patients. In yet another study carried by Silva et al., the team of researchers was able to influence physical activity levels amongst premenopausal overweight and obese women using SDT (Silva et al., 2010). The method used in this was to create cross-sectional multiple-level mediation model that would comprise of experimentally-manipulated contextual need for support, perceived need satisfaction, and motivational regulations for two distinct physical activities. A total of 239 participants were recruited into the trial. The setting was in the community with the participants expected to sign up into intervention groups and follow through the program to the end. The results showed that vigorous exercise was largely and positively influenced by intrinsic motivation. Behavioral regulations were affected and influenced greatly by the perceived autonomy and competence as provided within the treatment climate. This is in agreement with what Edmunds, Ntoumanis and Duda (2007) reported in a similar study that was aimed at measuring the importance of adhering to an exercise prescription based on SDT. They reported that the multilevel regression analyses were in favor of more self-efficacy and autonomy for those who followed the regime to completion, and increased need satisfaction over time. This was in a study that involved 49 participants of whom 84% were women. They ranged from 16-73 years and were of different ethnicities. This was done at an Exercise on Prescription scheme in west Midlands, UK. From the four researches, it is important to understand that whatever outcome one gets after such an intervention will largely depend on their ability to correlate the variables in the expected manner. Each variable has a mediator, and a moderator. This means that the researcher must at all times distinguish amongst these and establish a way of ensuring they are met during the regime as a way of managing the exercise prescription to completion. Human beings will always get back to behaviors that they have been warned against. Creating causative effects that affect the mediators and influence holistic changes will help achieve autonomy and self-determination that will eventually be essential in meeting the desired and expected goals of SDT (Edmunds, Ntoumanis and Duda, 2007). Wilson and Rodger (2004) are of the opinion that the competence need satisfaction is a great mediator in the relationship between autonomy support and self-determined regulation. In their article, they involved 232 females in a team-based intramural event where they sought to measure the perceived autonomy support in exercise regulation. They concluded that human beings associated regular exercises with favorable intrinsic, and identified regulations with support from friends being a key influence in the intentions to exercise in the long-run. There is also agreement on the fact that competence need satisfaction and self-determined regulations have a positive influence on behavioral changes, cognitive abilities, and affective aspects of exercise experience (Edmunds, Ntoumanis and Duda, 2006, 2005; Wilson and Rodgers, 2004. It is therefore evident that the best way of creating better mindsets is by trying to influence the behavioral persistence amongst patients suffering from obesity (Baumann, Sallis, Dzewaltowski and Owen, 2002). This will positively allow them to incorporate the exercise regimes as part of their daily routine and lifestyle. This means that each individual has the ability to engage in an active lifestyle if only they can get the recommended and expected level of motivation to drive them towards integrating the experiences for their personal good, and thus internalize features of the health regime as a part of their lifestyle. These researchers agree that creating motivational guidelines allows the patient to visualize what it would be like if they followed certain regimes, and this will intrinsically push them to achieve it (Edmunds, Ntoumanis and Duda, 2006, 2005; Wilson and Rodgers, 2004). Summary This section sought to detail the main points that relate SDT to obesity and how people can be intrinsically motivated to deal with issues as they arise. People are mostly influenced by that which they believe to be in their best interests, and thus the need for positive feedback. Negative feedback may increase recidivism as each individual banks on satisfying some form of need to ably continue with their everyday activities. If the variables emphasized by the clinician or physician are influential enough to cause change, the probability of gaining long-term integration of exercise programs into personal lifestyles is probable. 3. Methodology This section will dwell on the design components of the research and how the patients will be recruited and handled. It will look at the different tools to be used in data collection, the data collection measures, the research setting and the proposed data analysis. Research Design The need for a motivational program that allows patients to use their innate desires to achieve positive results is important. Coming up with a way of meeting this need is also imperative, given that it can be shared with other care centers and allow for better interaction and assistance with patients with obesity. Patients will be encouraged to participate in the whole process by manipulating some of the variables as a way of encouraging them to come up with goals that they can achieve or that they can reckon with during the whole process. The SDT strategies to be tested will be included in the study with each participant expected to go through the program within a period of four months, with constant intervention from professionals chosen for this particular study. They will be expected to participate in the program with questionnaires being the main form of data collection. They will be given both the start and the end of the regimen as a way of measuring any changes that may have taken place during the program. The independent variables in this design will be the chosen exercise behaviors, with the feelings being the dependent variables. There will be a control group and an experimental group to see whether feelings of autonomy change in regard to the exercise chosen or the support accorded from the rest of the participants. The questionnaire at the end of the regimen will be used to explain this effect. Qualitative and quantitative data will be sought as a means of ensuring that nothing is left to chance or assumed during the course of the study and even after. Research Setting The use of a community center known to cater for people with obesity will be used as the research facility for the rest of the program. The facility is a focal point given the existence of different persons with different levels of obesity. They are also from different backgrounds with a majority being from well-to-do families. This will also create a good place to dispel some of the notions that are associated with obesity and create a knowledgeable conclusion based on facts as well as tested facts. Factual information will be sought from the physicians on the ground with the intervention group working hand in hand with them to come up with the best sample, and with relevant guidelines that would allow them to get the intended response from the participants. The community center is also an ideal place due to the availability of support groups and also direct communication with family members of those in the experimental group to make them aware of what is expected of them during the whole study period. This is because the study group will be privy to positive feedback and support from the family whereas those in the control group will be in the usual interactive modes with the family members with no particular emphasis on feedback or support. Sample The 136 participants (aged 20-48) will be recruited by an analysis of the records in the facility with the help of the physician on the ground. The main aim of choosing this age group is the fact that they are at a higher risk of getting obese in today’s world compared to the rest. The sedentary lifestyles they lead, given that they are just out of college and into the working class are more likely to affect them. Furthermore, they are at a stage where they can ably discern their emotions and make decisions depending on what they perceive as valuable to them. The intervention group will choose from the list and come up with suitable candidates with the help of the drawn guidelines. The main target is for the chosen group to at least have a mean BMI of 34.73.9kg/m2. Those in the intervention/experimental group (n=70) will not be expected to differ from those in the control group (n=66) in terms of BMI. Measurement tools/instruments The social environment quality will be assessed and certified by the use of the health care climate questionnaire (HCCQ) as drawn by Markland and Tobin (2004). Response to the 15 items in the questionnaire will be rated from a scale of 1 to 7 with 1=strongly disagrees and 7=strongly agree. There is also the psychological need satisfaction that will be measured using a scale of nine items that was developed by Tobin (2003). It will help expound on the feelings of the participants. The answers will mainly be aimed at tapping into their autonomy on issues such as whether it was introjected or identified regulation, relatedness on whether the individual felt the expected support and competence where the answers will be analyzed to see whether they portray a sense of confidence in their abilities. Motivational regulations for the exercises will be measured using a behavioral regulation in exercise questionnaire (BREQ) that has a total of 19 items to be tested on a scale of 0-4 (0=not true for me, 4=true for me) (Markland and Tobin, 2004). The items will also test on amotivation (a lack of will), external, introjected, and identified regulations. They will also touch on intrinsic motivation to verify whether the exercises were having any impact on their inner desires. Self-efficacy when faced with certain barriers will be measured using a barriers-efficacy scale which has 12 items to assess individual’s perception of barriers and the amount of willpower they possess to get past these barriers (Edmunds, Ntoumanis and Duda, 2007). Satisfaction with life will also be measured as a sure way of identifying whether any progress was being made and whether the participant felt this progress. This will be measured on a scale with five items which is termed as the life scale and the results analyzed to determine the progress (Edmunds, Ntoumanis and Duda, 2007). Data collection measures Before conducting the research, certain issues will have to be taken care. First and foremost, the participants have to voluntarily commit through writing on their consent to participate in the study. They will also be informed of everything that will be taking place and the expected results to ensure that they are fully aware of what is going on during the study. Those who will be taking care of them and interacting with them during this period will be introduced to them and each given a consent form to abide by the federal rules on human research. They will also be assured of total confidentiality in case they feel a need to withhold their information before or after the trial, but with express consent for the research team to use their details at their own discretion. The exercise regimes will take place during the day for a given period of time and the patients will be allowed to continue with their normal duties. This is to avoid disrupting their normal routines and also to observe them in their natural setting for comparison later. The intervention team will always be keen to engage the participants both in the control and experimental group during the course of the program. They may conduct interviews that will be used during the final write-up of the report as a way of ensuring that any changes being witnessed are recorded and taken into consideration in the long run. They will have a daily occurrence book from which they will record any conspicuous happenings as a way of keeping in touch with the program and the participants. Discussions about these findings may be refined to help in setting objectives for further research in case the findings do not conform to the current study. A separate chart will be kept to help map out the participants’ journey throughout the program as a way of ensuring that they do not miss anything. The amount of weight lost and the vigor of the participant, whether induced or inherent, will be mapped as well to check on the frequency of these attitudes. In case changes are noted, the researcher may talk to the individual to capture the feelings at the moment and also create a database on what to look for in others. Given the individual differences, the charts will be a good discerning point on some of the abilities that each individual holds and how well they can keep up the pressure. Those that drop out of the program will also be analyzed to check on their attitudes before dropping and possible conclusions and possible hypothesis for future research will be drawn. Procedures for protection of human rights This being a proposal in line with the university regulations, the first step would be acquiring the acceptance from the Institutional Review Board and the university’s Department of nursing to go ahead with the proposed program. The health care facility at the community center will be also be asked for permission as a way of ensuring that they approve of the use of their facility as a venue for the program. The team that will be used during the program period will also be sought and asked for their consent as a way of ensuring transparency and accountability. With that done, the integrity of the patients and study subjects will be established. This will help in informing the subjects of the intended study and get their approval on whether they would like to participate. Written consent will be signed as a commitment to the rules and regulations that will be drafted. They will be given time to internalize the rules and given a chance to ask questions. They will also be allowed to withdraw at any time during the program provided they inform the intervention before their departure for consistency. In case they want to remain anonymous during the whole study, that wish will be granted and will be asked to state so before or during the program. Proposed Data Analysis Data acquired from the study will be analyzed in terms of relevance. The different scales that are mentioned herein will serve as the points of departure. Each item will be classified under the relevant topics and analysis carried out in relation to the hypothesis being tested. Different theoretical literatures will be used to ensure the work is authentic, and this implies the inherent need for prior knowledge on the issue to avoid biases. Results will also be discussed amongst members of the intervention team as a way of ensuring that what was recorded was what a majority of the members can identify with. Questionnaires will be used as a way of ensuring that each participant gives an honest or relatively honest review of their period at the facility, and whether or not the program was helpful. Validity will be checked to ensure preciseness of the results given in comparison to past researches on the same. 4. References Abu-Omar, K., Rutten, A., & Robine, J. M. (2004). Self-rated health and physical activity in the European Union. Preventive Medicine, 49(4): 235-242. Bauman, A. E., Sallis, J. F., Dzewaltowski, D. A., & Owen, N. (2002). Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 23: 5–14. Deci, E. L., & Ryan, R. M. (2000). The ‘what’ and ‘why’ of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11: 227–268. Edmunds, J. K., Duda, J. L., & Ntoumanis, N. (2005). Psychological needs theories as predictors of exercise-related cognitions and affect among an ethnically diverse cohort of female exercise group participants. Unpublished doctoral dissertation: The University of Birmingham, UK. Edmunds, J. K., Ntoumanis, N., & Duda, J. L. (2006). A test of self-determination theory in the exercise domain. Journal of Applied Social Psychology. Edmunds, J. K., Ntoumanis, N., & Duda, J. L. (2007). adherence and well-being in overweight and obese patients referred to an exercise on prescription scheme; a self-determination theory perspective. Psychology of Sport and Exercise 8: 722-740 Haslam, D. (March 2007). "Obesity: a medical history". Obes Rev 8 (Suppl 1): 31–6. Markland, D., & Tobin, V. (2004). A modification of the behavioral regulation in exercise questionnaire to include an assessment of Amotivation. Journal of Sport and Exercise Psychology, 26: 191–196. Roth, G., Assor, A., Kanat-Maymon, Y., & Kaplan, H. (2007). Autonomous motivation for teaching: How self-determined teaching may lead to self-determined learning. Journal of Educational Psychology, 99: 761–774. Sheldon, G., Williams, G., & Joiner, T. (2003). Self-determination theory in the clinic: Motivating physical and mental health. New Haven, Yale University Press. Silva, M. N., Markland, D., Minderico, C. S., Vieira, P. N., Castro, M. M., Coutinho, S. R., et al. (2008). A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description. BMC Public Health, 8: 234-41. Silva, M. N., Markland, D., Minderico, C. S., Vieira, P. N., Castro, M. M., Coutinho, S. R., et al. (2010). Helping overweight women become more active: Need support and motivational regulations for different forms of physical activity. Psychology of Sport and Exercise 30: 1-11. Tobin, V. J. (2003). Facilitating exercise behavior change: A self-determination theory and motivational interviewing perspective. Unpublished doctoral dissertation: University of Wales, Bangor. Williams, G. C., McGregor, H. A., Zeldman, A., Freedman, Z. R., & Deci, E. L. (2004). Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 23:58–66. Wilson, P. M., & Rodgers, W. M. (2004). The relationship between perceived autonomy support, exercise regulations and behavioural intentions in women. Psychology of Sport and Exercise, 5: 229–242. Read More