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Evaluating a Quantitative Research Study

In this assessment, you will evaluate the study according to research design methods, procedures and study results, for example, see Evaluating a Quantitative Study LoBiondo-Wood,& Haber (2018).

Additional Instructions:

4 to 6-page paper. Include title and reference pages.

All      submissions should have a title page and reference page.

Utilize      a minimum of two scholarly resources.

Adhere      to grammar, spelling and punctuation criteria.

Adhere      to APA 7th edition compliance guideline

Suggested Reading

Chapter 7 & 8 LoBiondo-Wood, G., & Haber, J. (2018).

Nursing research: Methods and critical appraisal for evidence-based practice

.(9th ed) St. Louis, MO: Elsevier.

Astroth, K. S., & Chung, S. Y. (2018). Focusing on the fundamentals: Reading quantitative research with a critical eye. Nephrology Nursing Journal, 45(3), 283-287. Retrieved from

http://americansentinel.idm.oclc.org/login?url=https://search-proquest-com.americansentinel.idm.oclc.org/docview/2063390700?accountid=169658

Harris et al. BMC Public Health 2013, 13:375
http://www.biomedcentral.com/1471-2458/13/375
RESEARCH ARTICLE
Open Access
The impact of a brief lifestyle intervention
delivered by generalist community nurses
(CN SNAP trial)
Mark F Harris*, Bibiana C Chan, Rachel A Laws, Anna M Williams, Gawaine Powell Davies, Upali W Jayasinghe,
Mahnaz Fanaian, Neil Orr, Andrew Milat and on behalf of the CN SNAP Project Team
Abstract
Background: The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical
inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive
interventions. Community nurses are an important component of PHC in Australia. However there has been little
research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study
aimed to address this gap in our knowledge.
Methods: The study was a quasi-experimental trial involving four generalist community nursing (CN) services in
New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late
intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors
and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the
first 6 months and then received training. Clients aged 30–80 years who were referred to the services between
September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported
data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral
received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis
compared changes using univariate and multilevel regression techniques.
Results: 804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled
receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention
group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for
dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in
the late intervention group. There a shift towards greater readiness to change in those who were physically inactive
in the early but not the comparison group. Clients in both groups reported being more physically active and eating
more fruit and vegetables but there were no significant differences between groups at 6 months.
Conclusion: The study demonstrated that although the intervention was associated with increases in advice and
referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant
changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term
interventions for clients with risk factors identified by primary health care nurses.
Trial registration: ACTRN12609001081202
Keywords: Primary health care, Lifestyle behaviours, Smoking, Nutrition, Alcohol, Physical activity, Community
nursing
* Correspondence: m.f.harris@unsw.edu.au
Centre for Primary Health Care and Equity, School of Public Health and
Community Medicine, University of New South Wales, Sydney, NSW 2052,
Australia
© 2013 Harris et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Harris et al. BMC Public Health 2013, 13:375
http://www.biomedcentral.com/1471-2458/13/375
Background
In Australia, chronic diseases such as heart disease and
diabetes are the leading causes of death and disability [1].
The risk factors for these conditions include risk behaviours
(in smoking, nutrition, alcohol and physical activity)
and overweight (SNAPW). These are prevalent in the
community, with over 90% of adults not consuming the
recommended five serves of vegetables per day, over
half not consuming adequate amounts of fruit, 62%
overweight or obese, one third, physically inactive, one
in five smoke and 21% drink alcohol at levels which
pose a risk to their health [2].
Primary health care (PHC) is an important setting for
addressing lifestyle risk factors because of its accessibility,
continuity, and comprehensiveness of the care provided [3].
There is evidence that clients expect to receive lifestyle
intervention from PHC clinicians [4]. Lifestyle interventions
delivered in PHC are effective in helping clients to stop
smoking [5], reduce ‘at-risk alcohol’ consumption [6],
improve weight, diet and physical activity levels [7-12]. The
5As (assess, advise (including motivational interviewing)
and agree on goals, assist (including referral), and arrange
(follow up) have been developed as a framework for
addressing these risk factors in clinical practice [13,14].
In NSW, generalist community nurses frequently see
clients in their own home, providing care for patients
recently discharged from hospital, the aged and those with
chronic diseases. Although the traditional community nursing model of practice includes health promotion activities,
community nursing services have increasingly tended to
provide shorter term more clinically focused services to
individual clients [15,16]. Our previous research has shown
that community health nurses consider the provision
of lifestyle intervention appropriate to their role and it
is well accepted by clients [17]. However, few studies
have evaluated the effectiveness of lifestyle interventions
provided by community nurses in routine practice
[18-21]. The aim of this study was to evaluate the impact
of a brief lifestyle intervention delivered by community
health nurses as part of their routine practice on changes
in clients’ SNAPW risk factors.
Page 2 of 11
consultations. The protocol for the study has been
previously described [22].
Intervention
The intervention was designed and implemented on two
levels: (a) service level and (b) client level.
Service-level intervention
The service-level intervention was delivered by University
staff and consisted of four components:
A 1-day training program in the assessment and
management of the SNAPW risk factors
(including motivational interviewing) for participating
community nurses delivered by the research team in
conjunction with local providers. The training
included the use of role-plays with simulated clients
(actors), group discussions and activities;
Integration of standardised screening tools and
prompts for SNAPW risk factors into the
service-specific assessment processes used by the
nurses in the management of clients;
Development and distribution of a local service referral
directory to each community nursing team to promote
referral of clients for ongoing specialist management
or more / ongoing intensive lifestyle intervention; and
Provision of client resources to all participating nurses.
The resources included a written guide for nurses,
written action plans for use with clients on each
SNAPW risk factor, tape measures for measuring waist
circumference and pedometers for loan to clients to
encourage self-monitoring of physical activity.
A nurse from each of the EI sites was seconded to
work with the research team to develop the intervention
and to support its implementation at the local level.
Client-level intervention
The client-level intervention was provided by the participating nurses. The goals of the clinical intervention
were to achieve and maintain lifestyle changes consistent
with current Australian recommendations [23]:
Methods
Study design and setting
Moderate physical activity for at least 30 minutes/
This study was conducted in four general community
nursing services in New South Wales, Australia.
Services were recruited via an expression of interest
mailed to all Area Health Services (AHS) in NSW
(n = 8). The design was quasi-experimental, with the
services randomly allocated to an ‘early intervention’
(EI) group or ‘late intervention’ (LI) (comparison)
group. EI services were provided with training and
support for nurses in identifying clients with high
risk and offering brief SNAPW intervention during routine
day, including walking, jogging, swimming, aerobic
activity, ball games, skiing, with circuit-type
resistance training if possible, twice a week;
A diet low in saturated fats, sucrose and salt with
increased portions of vegetables and fruit per day
(up to seven portions) in order to achieve a diet
where the percentage of energy from
carbohydrates = 50%, saturated fats =5 serves of vegetables per day
Self report
Progression in stages of change
On five point intentions scales [28]
At risk clients offered evidence-based advice to modify their risk factors
Recall over previous 3 months
At risk clients offered evidence-based referral to modify their risk factors
Recall over previous 3 months
Collected by client telephone survey at baseline, 3 and 6 months.
change in mean risk scores of self-reported measures
of lifestyle risk factors. This was sufficient based on
a standard deviation from previous research [29], design
effect of 1.8 and loss to follow up of 20% to detect the
following changes in mean risk scores: 1 portion of fruit and vegetables per day
(based on sd 2.02)
1 unit of physical activity score (based on sd 2.13)
5 kg of self-reported weight loss (based on sd 14.95)
Ethics
The project was approved by the Hunter New England
Human Research Ethics Committee (Ref No 08/10/15/4.03),
and ratified by the University of New South Wales Human
Research Ethics Committee (HREC) and the Human
Research Ethics Committees in each of the participating Area Health Services. The study was conducted
in compliance with this Committees regulations and
the Helsinki declaration. All participants provided full
informed written consent for publication of findings
from this research.
Analysis
Univariate comparisons were made within group between
baseline and 3 months and between groups for receipt of
advice and referral. Change in readiness to change was
categorised at 6 months and compared between groups.
Statistical tests included t test for continuous variables
and chi square test for categorical variables.
Change in clients’ lifestyle risk factors between the EI
and LI (comparison) groups were evaluated using multilevel
models which included a number of patient level covariates
thought to possibly influence the outcomes [30]. Three
repeated measures of SNAPW were compared within
clients [31]. Multilevel linear regression analysis was
conducted on physical activity score, diet score and
weight. In the first model three levels were fitted which
included: service (level 3), client (level 2) and time
(level 1). The variance between services was found not to
be significant. For each risk factor at 6 months, a two level
regression model was fitted. This included the time and
client as levels adjusting for baseline risk, intervention,
linear time (0 = baseline; 1 = 3 months; 2 = 6 months),
gender, age, employment status, reason for referral, mental
health and physical health status, number of risk factors
and physical limitation. The multilevel statistical models
were fitted using MLwiN version 2.25 [32].
Results
Baseline characteristics
A total of 804 clients were recruited from 2361 potentially
eligible clients (34.1%), 425 in the EI group and 379 in the
LI group (Figure 2). Just under half (49.3%) were female,
67.1% were 60 years of age or over and 53.1% were retired
from paid work. Few participants spoke a language other
than English or were of Aboriginal or Torres Strait Islander
descent (Table 3). There were no significant differences in
age and gender between those who accepted and those
who declined to participate or between those in the EI and
LI groups (Table 3).
The majority (61.6%) of clients rated their own health
as ‘good, very good or excellent’ and 12.7% reported that
during the past month they had felt ‘downhearted or
blue’ most or all of the time. Almost all clients (97.6%)
had at least one lifestyle risk factor and 101 (12.5%) had
at least four (Table 3). At baseline 17.2% of participants
reported being smokers, 78.5% had insufficient fruit and
vegetable dietary intake, 74.0% were overweight or obese,
36.9% had at risk drinking levels. Of those who were
able to engage in physical activity, 50.5% had inadequate
levels. There were no significant differences between
those in the EI and LI groups (Table 3).
Harris et al. BMC Public Health 2013, 13:375
http://www.biomedcentral.com/1471-2458/13/375
Page 6 of 11
Table 3 Characteristics of CN SNAPW trial clients at baseline
Characteristics
Early interv (n = 425)
Late interv (379)
N
Total (n = 804)
%
N
%
N
%
Female
396
49.3
214
50.4
182
48.0
Aboriginal/ Torres Strait Islander
4
0.5
2
0.5
2
0.5
Language other than English
35
4.4
18
4.2
17
4.5
Employed
215
26.7
115
27.1
100
26.4
Unable to work (long-term sickness/ disability)
109
13.6
50
11.8
59
15.6
Retired from paid work
419
53.1
229
53.9
190
50.1
Age (yrs)
30-39 yrs
44
5.5
22
5.2
22
5.8
40-49
78
9.7
44
10.4
34
9.0
50-59
142
17.7
76
18.0
66
17.4
60-69
256
31.9
136
32.2
120
31.7
≥ 70
280
35.2
143
34.3
137
36.1
Self-rated health status Poor or Fair
308
38.3
158
37.2
150
39.6
102
12.7
49
11.5
53
14.0
Hypertension
395
49.1
225
52.9
170
44.9
Arthritis
277
34.5
155
36.5
122
32.2
High cholesterol
239
29.7
132
31.1
107
28.2
Cancer
213
26.5
123
28.9
90
23.7
Diabetes
185
23.0
102
24.0
83
21.9
Depression
132
16.4
66
15.5
66
17.4
Heart disease
132
16.4
55
15.9
55
17.1
Self-rated mental health status: Downhearted or blue
Most to all of the time
Health conditions
no risk factors
18 (2.2%)
11 (2.6%)
7 (1.8%)
1 risk only
147 (18.3%)
76 (17.9%
71 (18.7%)
2 risks
328 (40.2%)
164 (38.6%)
159 (42.0%)
3 risks
215 (26.7%)
120 (28.2
95 (25.1%)
4 risks
92 (11.4%)
50 (11.8%)
42 (11.1%)
5 risks
9 (1.1%)
4 (0.9)
5 (1.3)
< 2 serves of fruit (n = 801) 336 (41.9%) 174 (40.9%) 162 (42.7%) Purchase answer to see full attachment

  
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