Critical Appraisal of a Study on Brief Lifestyle Intervention by Community Nurses

This critical appraisal examines a study on the effect of brief lifestyle intervention delivered by community nurses. It analyzes the study design, instruments and measurement procedures, statistical tests, findings, and clinical practice implications. The study provides insights into the role of community nurses in promoting healthy lifestyles and highlights the need for further training in addressing lifestyle issues.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student
Name of the university
Author’s note

1CRITICAL APPRAISAL
Critical appraisal
Rationale for the research
The paper by Harris et al., (2013) aims to evaluate the effect of brief life style
intervention delivered by the community nurses. The title of the paper gives a clear idea of the
topic and the research question. The back ground of the paper is string and has provided a string
rationale of choosing this topic. It has rightfully pointed out the responsibilities and the
accountabilities of nurses in primary health care services and management of chronic diseases.
The background of a study should be written in such a way such that it provides the context of
the study based on which the thesis can be supported or refuted. The background of the study
should also contain the research question and the aims and objectives.
Study design chosen
The research design chosen for this study is quasi- experimental, where the services were
randomly allocated to an early intervention groups and a late intervention group. True
experimental designs might not be feasible as the research can only be carried out in a natural
setting. Since, the variables are tightly controlled and might fail to create a realistic situation, the
external validity of such studies is increased (Watson, 2015). These kinds of studies can be
useful in understanding the general trends (Harris et al., 2016). Nurses has long been found to be
an integral part of primary care services and specific life style interventions like managing
weight, changing the eating patterns, steps to prevent early heart diseases can be given by the
nurses (Sargent, Forrest & Parker, 2012). Hence, quasi- experimental research design could be
used to understand the general trends of the nurses to participate in minor community care
interventions.

2CRITICAL APPRAISAL
Instruments and the measurement procedures
The services were randomly allocated to an early interventions and late interventions
group. A random allocation ensures that the participants can be place in any group, which helps
to ensure that any distinction between the groups are not systematic at the outset of the trial. The
main principle behind random allocation is the avoidance of any kinds of bias in the way in
which the trial is carried out and it limits the effect of the variables (Arcos, del Mar Rueda &
Singh, 2015). There was no control group used in this study. A control group involves elements
that presents the same characteristics as the experimental group (Pithon, 2013). It should be
mentioned, that control is an essential part of the experiment as it allows the elimination of the
variables. The sample was not blinded, hence there remains a chance of observational bias
(Claydon, 2015). The reliability of the interventions have not been supported by any statistical
data.
The article contain information about how trainings will be provided to the early
intervention group as well as the late intervention group. Information about the client level and
service level intervention has been mentioned property in the paper (Stern, Jordan & McArthur,
2014). Inclusion and exclusion criteria helps in the ruling in or out the target population of a
study (Stern, Jordan & McArthur, 2014). Proper inclusion and exclusion criteria helps in
optimizing the internal and the external validity of the study. High risk clients has been chosen
for the intervention.
The paper has utilised 5As model of brief life style interventions. The continuous
outcome measures were diet, alcohol, physical activity and weight. Diet score was obtained to
measure the total number of food served per day. The physical activity score was used to assess

3CRITICAL APPRAISAL
the physical assessment of the condition. The mediator variables were chosen to be changes in
the readiness of the clients to life style behaviour.
The data collection was done by using a 15 minutes telephone administered survey
conducted with each of the clients at the baseline. Baseline data are useful to tally the future
changes in the life style. The sample size of each of the group was selected to be 400. The
sample size influences confidence interval and the margin of errors. With an increased sample
size, the confidence of the estimates increases and the uncertainty of the data decrease and a
greater amount of precision can be obtained (Cleary, Horsfall & Hayter, 2014). Greater sample
size can give a greater power for detecting the differences. The sample size selected for the study
is moderate (Cleary, Horsfall & Hayter, 2014).
The paper had provided the entire client recruitment process and the baseline data
collection in a tabular form such that a comprehensive view of the entire methodology can be
obtained at a glance without going through the entire paper.
Statistical tests
The statistical analysis of the data involve the univariate comparisons within the groups
between the baseline and three months. Chatfield, (2018), have stated that univariate analysis is
the simplest form of data analysis.
The characteristics of the CN SNAPW trial has been provided in a tabular form. The
result contained a detailed account of the baseline characteristics followed by the data extracted
after the interventions has been made. A multilevel regression analysis was also done. The
benefits of a multilevel regression analysis is that a wider generalised population can be
considered. A regression analysis helps in the identification of statistical relationship between the

4CRITICAL APPRAISAL
two or more variables of interest. It would help to examine the influence of one or more
independent variables on a dependant variable. Few para meters are required and the information
can be shared within the groups (Watson, 2015). However, the paper has not provided any
information about the validity of the interventions. Reliability of the interventions has been given
in a tabular form. Tables and graphs has been used properly. Since, there were two groups there
were no chances of multiple comparisons. Inferential analysis has not been used in this paper.
Much information has not been provided how the research can be generalised to the
entire population. Some of the findings of the papers are in contract with the other researches
that has been conducted to find out the effectiveness of the brief life style interventions.
Description of the findings
The article has provide a clear description of the discussions as per the findings. The usefulness
of the statistical analysis lies in the fact that, it helps to make conclusion based on the statistical
data. It helps in providing critical guidance in the product of a trustworthy analysis and
predictions.
The interventions groups were not blinded thus the chance bias remains.
Ethical consideration
Consent has been taken from the participants before the application of the interventions.
The project has further obtained the ethical approval from the Hunter New England Human
Research Ethics Committee. The usefulness of the ethical approval lies in the minimization of
risk of harm. The main aim of the ethical approval is to protect the participants.

5CRITICAL APPRAISAL
Clinical practice implications
The paper has mentioned some of the clinic al implication of the research. The study has
shown that the interventions for providing the community nurse training can be useful for the
client with SNAPW risk factors. This life style interventions has motivated the clients to do
physical activities for managing weight and maintaining a healthy body. The research indicates
towards the fact, that in most of the cases the community nurses might not have knowledge about
how they can introduce life style intervention. These kinds of researches can provide a guidance
towards the nurses as of how they can contribute to a healthier community. However, it should
be understood that nurse require more training in order to develop skills for spontaneously
addressing the lifestyle issues of the people at risk.

6CRITICAL APPRAISAL
References
Arcos, A., del Mar Rueda, M., & Singh, S. (2015). A generalized approach to randomised
response for quantitative variables. Quality & Quantity, 49(3), 1239-1256.
https://doi.org/10.1007/s11135-014-0046-3
Chatfield, C. (2018). Introduction to multivariate analysis. Routledge.
Claydon, L. S. (2015). Rigour in quantitative research. Nursing Standard (2014+), 29(47), 43.
Cleary, M., Horsfall, J., & Hayter, M. (2014). Data collection and sampling in qualitative
research: does size matter?. Journal of advanced nursing, 70(3), 473-475. DOI:
10.1111/jan.12163
Harris, M. F., Chan, B. C., Laws, R. A., Williams, A. M., Davies, G. P., Jayasinghe, U. W., …
Milat, A. (2013). The impact of a brief lifestyle intervention delivered by generalist
community nurses (CN SNAP trial). BMC Public Health, 13(1). doi:10.1186/1471-2458-
13-375
Sargent, G. M., Forrest, L. E., & Parker, R. M. (2012). Nurse delivered lifestyle interventions in
primary health care to treat chronic disease risk factors associated with obesity: a
systematic review. Obesity reviews : an official journal of the International Association
for the Study of Obesity, 13(12), 1148–1171. doi:10.1111/j.1467-789X.2012.01029.x

7CRITICAL APPRAISAL
Stern, C., Jordan, Z., & McArthur, A. (2014). Developing the review question and inclusion
criteria. AJN The American Journal of Nursing, 114(4), 53-56. doi:
10.1097/01.NAJ.0000445689.67800.86
Watson, R. (2015). Quantitative research. Nursing Standard (2014+), 29(31), 44.