Critical Appraisal of Pereira Da Silva; SS Obesity Meanings - Essay Example

Critical Appraisal of Pereira Da Silva; SS Obesity Meanings Introduction The research done by Pereira da Silva provides an account on the various ways of tackling obesity which has become a world wide menace. This is attributed to the fact that there have been efforts to offer treatment to obesity. However, the study was about evaluating the meanings of experiences associated with obesity patients awaiting bariatric surgery (Pereira da Silva, 2012:1715). It started by tackling the background information and utilized a qualitative approach to understand how the morbid obese conceptualizes and deals with obesity and obesity treatment. Therefore, study explored the expectations and the beliefs regarding the exigencies and the impacts of bariatric surgery (Bowling, 2009:56-58). The methods included a study population comprised of 30 morbid obese patients. The results were based on three core themes namely: eating behaviour, treatment, and obesity. Critical appraisal is an integral process in the evidenced based practise. The aim of critical appraisal is aimed at identifying the methodological flaws in the literature besides, providing the consumers of research evidence with the opportunity to make informed decisions regarding the quality of the research evidence (Trinder & Reynolds, 2000:69-72). The critical appraisal for both the quantitative and qualitative research is appropriate. Developing a critical appraisal framework for healthcare services allows for the need to have competent healthcare treatment for obesity. Therefore, health professionals are required to be intelligent consumers of research, and this entails the ability to publish research something which Pereira da Silva has accomplished. According to Benton and Cormack (2000) argue that there have been tendencies to evaluate qualitative research against the appropriate criteria against the quantitative research. This has led to attempts by various individuals to analyse the qualitative research within a quantitative framework thus raising the questions of credibility, reliability, dependability, and transferability. Hamers and Colison (2005) state that “there have been various frameworks that have been reviewed and the common features that are related to quantitative and qualitative research established” Generally, the guidelines tend to reflect upon the respective approaches, whereby the guidelines for quantitative research tend to be in the form of check lists, the guidelines for qualitative research tend to be more discursive. Sajiwandani is of the view that there must be a check list that covers all the points appropriate for covering the points appropriate in treating obesity. They must include to the hypothesis, operational definitions, reliability, and validity of any questionnaires (Sajiwandani, 1996). According to Sackett et al. (2002) assert that evidenced based research, is the “integration of the best research based evidence with clinical expertise and patient’s value.” The evidence-based practise as described in the work of Pereira da Silva gives an equal emphasis on: the situation of the patient, the best available research evidence, the patient’s values, wishes, and goals, and the clinical expertise of the practitioner in this case those dealing with obesity cases. The Literature Review The researcher uses contemporary material about the topic being discussed; and the meanings of experiences associated with awaiting bariatric surgery. The research on obesity uses a lot of high quality material of the obesity topic being researched on (Fried, Hainer, & Basdevant, 2007:267). This led to the development of the research question thus allowing the hypothesis testing and identification of the appropriate method of data collection. Data collection involved the use cognitive interviews, questionnaires, open ended questions, and the focus groups. The interviews were audio-taped, transcribed, and the coded according to the ground analysis methodology. However, through quantitative research the literature appraised the research question which was that, “are there meanings of experiences associated with awaiting bariatric surgery” in relation bariatric surgery as the treatment for obesity. The themes emanating from the study are clearly elaborated but the researcher does not substantiate the link between the literature review and the wider knowledge regarding treatment of obesity through bariatric surgery. The researcher however, does not link the topic to the question about the theory regarding obesity. This creates an information gap with regard to the reporting of data. This when it has been stated that until now there have been no known qualitative or quantitative study that has explored to establish how the morbidly obese view their own in terms of the maintenance and costs. Consequently, it affects the validity of the result (Heatherton, Baumeister, & Binge, 1991:102-4). Conversely, the absence of some studies on the causes or the origin of obesity in terms of its maintenance and causes, the recent literature review has shown that obesity, for most of the obese is a source of distress that is related to the contemporary culture that mostly stigmatizes the obese. The research showed that it increased their probability of internalizing negative information about themselves. There is also a clear link between the literature and the formulation of the research question(s). The formulation of the research questions to some extent shows clear link between the literature review and the research question. This is attributed to the fact that although bariatric surgery is perceived by the patient to be the ultimate miracle of treating obesity, the research shows that the health practitioners are of the contrary opinion (Wadden & Stunkard, 2006:45-47). The research question is clearly stated because it contains the goals, the actual purposes and the actual overall direction that the study is taking. It strives to explain why bariatric surgery is the preferred mode of treatment for obesity by many obese patients. The Methods Section The utilization of rigorous qualitative research methods has been on the rise in the health services and health’s policy research. Qualitative research must have a problem statement. The problem statement should never be set in such a way that is very general or extremely specific. It should be set in such a way that it should be subject to change as the value of the variables (or data) change. Methodological rigor is evidenced when he research design was clearly described in the research paper. The research methods were typically appropriate for the topic being investigated (Bowers, 2008:18). There is a clear statement about who participated in the research which included the 30 obese patients at the obesity treatment center awaiting bariatric surgery. Moreover, there is also a clear statement about how the participants were selected which was through randomization. Furthermore, the number of people taking part in the research which was 30 patients; 20 men and10 women was clearly stated. Conversely, this mode of selection of participants was appropriate to the design that was chosen. The sampling strategy that was used showed reliability; validity has been evidenced in the paper. The sample size included thirty patients (20 women and 10 men) from a multidisciplinary treatment center for obesity in the northern Portugal were interviewed before the bariatric surgery. All the patients had several failure attempts to lose weight and were integrated (Pereira da Silva, 2012:1718). Furthermore, recommendation for improving sampling was to increase the samples to be a little larger that increases an accuracy of results. Data Collection and Analysis Data from the qualitative research are typically suggestive and rarely conclusive. Therefore it is not appropriate to treat qualitative data in a quantitative manner. The process of analysis of the data should have been highly systematic and deliberate (Ogden, Clementi, & Aylwin, 2005:268-272). This qualitative work by Pereira da Silva was to generate impressions basing on tapes that conducted interviews and the written summaries that blurred distinction between what was actually read or overheard and the patterns and the themes that the researcher discerned. Crabtree and Miller (1999:112) suggest that the interviewed data was “analyzed utilizing the original steps of the grounded analysis method of qualitative research”. This gives clear description of how the data was collected. The qualitative methods most familiar in the field of healthcare quality are focus groups and cognitive interviews, which are both increasingly being used as a precursor to the development of survey’s instruments including those intended to measuring quality. On the other hand, the data may not collected by the correct people because the methods of data collection have had many loopholes for data distortion like the people disseminating information were not in sober mental state, no variability in samples, and research biasness. The data collection and analysis were interwoven in a process referred to as theoretical sampling. The subsequent questions were revised to check and reflect on the emergent categories. Interviews were conducted and later transcribed verbatim and consequently analyzed with NVivo 8.0 software in accordance to constant comparative method (Pereira da Silva, 2012:1716). Pereira da Silva validated the data that was collected using theoretical sampling, though it required to be validated by a larger sample and other qualitative data. After its analysis, it was seen that the reliability and validity of the data collection methods were not up to the task, therefore, affecting the internal validity of the data. This is attributed to instances where the researcher did not give an account of the mental state of their respondents and also the missing links in the literature review regarding the appropriate obesity treatment. As a result, there is no referential adequacy thus giving results on a negative case analysis. However, to ensure validity during the coding process of the research data analysis, a second researcher was consulted as an auditor throughout the entire data analysis process to aid the primary researcher by the challenging ideas and assisting in the construction of categories (Crookes and Davies, 2004:72). This added some reliability to the data presented. The approach to data analysis was therefore not appropriate to the type of data collected. This is due to the persistent observation of the aforementioned discrepancies. Also, the steps of analysis were not sequential; rather moved forward and the backward, constantly re-examining the data, categories, codes, and the whole model thus depicting how untrustworthy the results may be. Quantitative There is an explanation of sample size used that was thirty (30) obese patients, (10 men and 30 women) from a multidisciplinary center for treating obesity awaiting bariatric surgery. The level of significance of the tests used implied to be the customary 5%. The Pearson correlation coefficients have not been calculated, thus there is no evidence of a check for a linear relationship. Consequently, since it is a qualitative research, the t-tests or analysis of variance (ANOVA) were not to preformed, thereby no evidence of check(s) to demonstrate that the data follows a normal distribution, or of assumptions that are made hence, no clear statement describing how valid and reliable the measurements are ( Harrism & Taylor, 2008:88-91). Whilst the quantitative paradigm has several potentialities in different dimensions, they typically fall short in the accounting for and unfolding the patients’ perceptions about different process called obesity. This affects the trustworthiness of the results being presented with regard to experiences before bariatric surgery as obesity treatment. Qualitative There is a clear reflexive statement about the researcher's role in the analysis which was to ensure the data was appropriately analyzed, and therefore, went ahead to involve an independent auditor. Furthermore, the approach taken to data analysis was absolutely clear. There is the utilization of any electronic analysis package discussed which was NVivo 8.0 software used for data collection. There is a clear statement about how the researcher validated interpretations of the results. The research however does not present evidence of the data collected. Additionally, the data is not presented as part of a theme support the analysis suggested (Halloway, 1997). This is because the data suggested that the meaning of eating, effect of obesity, and treatment expectations are very complex as it has been captured by the existing standardized measures. Ethics Gerrish, et al. (2007: 329) states that “the research exhibits ethical rigor because of the descriptions on confidentiality and voluntary nature of the participations” The study took a descriptive approach to the data gathered, applied the traditional ethical principles of autonomy, beneficence, and justice to the study process. The research showed that the participants gave informed consent to the inclusion in the study and audiotaping the interviews. This was approved by the Clinical Research Ethics Committee of the Braga hospital. The interviews were taken at the hospital before surgery. Ultimately, all the interviews were transcribed verbatim and audiotaped. This gives a clear description about gaining consent and maintaining confidentiality. Moreover, there is a clear statement regarding the approval of the ethics committee of the Hospital of Braga (Oliver, 2003). The research paper thereby, gives a scientific value to the research by paying attention to all these variables used in data collection and analysis. This leads to the conclusion that the relayed results are trustworthy considering the ethical framework that was used (Mays & Pope, 2000:67). The Results/ Findings The research is related to the literature review in that the results found out that study accomplished its objective of establishing the experiences that the obesity patients go through while awaiting bariatric surgery. A total number thirty obese patients responded to Portuguese version of the Childhood History questionnaire, and a self report of measure that assessed the brief symptom report and adverse childhood experiences. The results found out that the participants recognized that their personal eating behavior exacerbates this obesity condition, thus difficult to change and control as it was a hereditary trait. The results were in tandem with literature review as bariatric surgery emerges to be the only treatment for obesity, and many participants highlighted this moment as the commencement of a new role. The bariatric surgery candidates saw their eating behavior as being out of control and dedicating to its demands was typically a huge sacrifice. Moreover, the literature was related to the results whereby the core processes emerged as: treatment, obesity, and eating behavior. According to the literature obesity is an internal immunitable problem impacting all life dimensions. Eating behavior seems to play a crucial role in obesity maintenance, and it is always controlling the life of the patient. Similarly, it is viewed as coping strategy to deal with negative feelings. The obesity treatment, especially the surgery, seems to be perceived as a miracle moment that will solve all the life’s problem (Pereira da Silva, 2012:1720). According to Gray (2001) asserts that the weaknesses in the research design were actually not acknowledged, casting a doubt on the reliability and dependability of the data that was being relayed by the researcher. Interpretation of results There is a link between the literature review and the research findings. This is because according to the results, patients were aware that bariatric surgery is not the only option in obesity treatment. As a consequence, it is fundamental to develop a more reasonable and realistic expectations that highlight the central and active role of the individual and the changes in lifestyle required for the success of obesity intervention. Conversely, the data can be perceived as untrustworthy because there is need to establish the characteristics of the candidates for bariatric surgery and to comprehend their challenges, difficulties, and expectancies something that is conspicuously missing in the existing literature (Proctor & Renfrew, 2000:43-44). Moreover, the data was not appropriately validated in the study because it required a larger sample with other qualitative data The results were reliable to the extent that the core domains before bariatric surgery that arose from the researcher’s data has brought us a step closer to the actual experience that is lived by the morbid obesity patients. The Conclusions The problem statement should lack biasness based on the assumptions of the researcher as well as the findings that are desired. In writing, it should include “how” and “how” in its expression so that the focus on the description of the phenomenon is kept (Watson, Atkinson, & Egerton, 2006). The central phenomenon was to be included in the problem statement. Besides, it should also include the participants as well as the site of conduction of the research something the research achieved. According to Polgar and Thomas (2008:67) found out that the research needs longitudinal studies required to evaluate the relationship that exists between weight loss and the quality of life’s expectations, and the subsequent potential for disappointment could exert in the long term. Furthermore, there are limitations that exist in the study is that all the participants came from the same hospital thus no variability in the sample. Therefore, the results implied are a reflection of only one particular environment and medical tradition. The use of cognitive interviews are considered by many to be a crucial element of testing the validity and reliability of the survey instruments in particular to establish if the items and response options are comprehended and consistently interpreted by potential respondents as intended by the investigator. To sum up, the study found out that it is vital to refer to the fact that all the participants; healthy eating behavior is typically conceptualized and it is a big sacrifice where bariatric surgery is the only surgery that will solve all the problems. However, it is not the medical treatment that was under evaluation but the meanings of experiences associated with awaiting bariatric surgery. Recommendations Parahook (2006:46) argue that “there is need for further research on the promotion of a new awareness on the process of weight loss and empowering patients before and after bariatric surgery.” The literature on the effects of maltreatment has shown that several methodological problems of the retrospective studies like the stability and validity of the retrospective reports may have been influenced by a number of factors like the mental health status of someone at the time of gathering the information, financial constraints, and the unwillingness of some of the respondents to fill up the questionnaires. The data reported by Pereira da Silva as suggested in other literature is that, bariatric patients have he greater vulnerability to external factors as well large propensity for idealizing surgery because it is like a miracle to them that will solve their life problems. The researcher is obliged to discuss how the field’s engagement and observations need to build trust and ensure validity of the data collected. According to Boswell and Cannon (2010:349) argue that because data collection and analysis occur in tandem in the qualitative research, the code utilized as categories and the process used to establish data saturation must be explicitly discussed in the report. Reference List Benton, D., & Cormack, D. (2000) The Research Process in Nursing. Oxford: Blackwell Sciences Ltd. Boswell, C., & Cannon, S. (2010) Introduction to Nursing Research:Incorporating Evidence Based Practice. London: Jones & Bartlett Learning. Bowers, D. (2008) Medical Statistics from Scratch. Chichester: John Wiley and Sons. Bowling, A. (2009) Research Methods in Health Investigating Health and Health Service. Buckingham: O U Press. Crabtree, B. F., & Miller, W. L. (1999) Doing Qualitative Research . London: Sage. 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