Critical Appraisal of Research Evidence: University Assignment

This report provides a critical appraisal of a qualitative research study by da Silva and da Costa Maia (2012) that examines obesity and treatment meanings in bariatric surgery candidates. The report utilizes the CASP tool to evaluate the study's methodology, including the research design, sampling techniques, and data collection methods. The analysis assesses the appropriateness of the qualitative approach, the selection of participants, and the data analysis procedures, including the use of semi-structured interviews and grounded analysis. The report also critiques the ethical considerations, reflexivity, and the interpretation of results, highlighting the study's strengths and limitations. The key findings of the research study had been the fact that the study provided a rich and in-depth understanding of the perceptions of the obese individuals regarding their obesity and bariatric surgery, the study has a small sample size, and the lack of detailed ethical considerations. The conclusion summarizes the value of the research and its implications for healthcare practice.

Running head: CRITICAL APPRAISAL OF RESEARCH EVIDENCE
Critical appraisal of research evidence
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction:....................................................................................................................................2
Background and rationale:...............................................................................................................2
Methodology:...................................................................................................................................4
Data collection.................................................................................................................................5
Data analysis:...................................................................................................................................6
Ethics and reflexivity:......................................................................................................................7
Result interpretation and findings:...................................................................................................7
Value of the research and interpretation:.........................................................................................9
Conclusion:....................................................................................................................................11
References:....................................................................................................................................12

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da Silva, S.S.P., and da Costa Maia, Â., 2012. Obesity and treatment meanings in bariatric
surgery candidates: a qualitative study. Obesity surgery, 22(11), pp.1714-1722.
Introduction:
Evidence-based practice has become one of the greatest needs for the practice of health
care professionals. In order to be able to competently utilize the benefits of evidence-based
practice, it is crucial for the healthcare professionals to be able to understand the literature value
of an article and critically analyse it (Zeng et al. 2015). This study will attempt to take the aid of
the CASP or Critical appraisal skills program tool in order to critically appraise the study by the
da Silva and da Costa Maia. The selection of the CASP tools is based on the applicative benefits
associated with it. CASP tool allows the researchers with a standardized template format
encompassing a systematic, strategic and methodological steps to analyse a research evidence
before utilizing it in the practice. Along with that a CASP tool has differentiated checklist for
different research designs or methods which allows to critically analyze with minimal bias.
Additionally, impartial set of factors and elements allows the biased opinion of the researchers to
be eliminated as well (Buccheri and Sharifi 2017).
Background and rationale:
One of the greatest health concerns all over the globe is the prevalence of obesity and the
ever-increasing incidence rate of the obesity among the target groups (Ejima, Aihara and
Nishiura 2013). It has to be mentioned in this context that for most of the first world countries,
obesity is an alarming public health priorities and it has become very difficult to control the ever-
rising prevalence of this disease. The prevalence of obesity has enhanced at a frightening rate
since the last couple of years all over the world. The alarming statistical data suggests the fact
that within the time period of 1998 to 2008, the mean body mass index of men has enhanced by

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0.8 kg/m2 and the same has increased by a 1 kg/m2 on a worldwide basis (da Silva and da Costa
Maia 2012). According to Wolfe, Kvach and Eckel (2016), obesity is by far the health adversity
which is considered to be the second leading cause of death as it is associated with a variety of
different co-morbid health disorders such as diabetes, cardiovascular diseases, cerebrovascular
diseases, and renal disorders. Hence, obesity can be broadly considered as the precedent of a
number of serious health concerns and hence, better management of obesity before it can
facilitate a severe comorbid disorder is crucial.
Among various other options for obesity management, the bariatric surgery is one of the
most effective therapeutic measures for the patients who have clinically significant morbid
obesity (Chang et al. 2014). The study under focus for this critical appraisal paper identifies the
dilemma in the available literature regarding the use of bariatric surgery as the therapeutic
measure for the better management of obesity and its effect on the outcome. As described by the
Jakobsen et al. (2018), the available literature on obesity management with bariatric surgery only
focuses on quantitative data, which does not take into consideration the perceptions,
expectancies, and beliefs of the patients regarding the bariatric surgery and obesity management
outcomes. Hence, the aim and objectives of this study focus on the perceptions of the people
regarding obesity, its management with bariatric surgery, and the outlook of the patient
population regarding the outcomes achieved by the bariatric surgeries.
Hence, it can be considered that the aims and objectives of the research study have been
very clearly identified by the authors and is also relevant to the present public health priority
issues. It has to be understood in this context that a clear and relevant justification provided by
the researchers is critically important for the authenticity and validity of the study is to be
established. In this case, as well, the justification for the conduction of this study is provided by

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the literature cited by the authors in the article. Exploring the details further, the recent literature
data cited by the authors in the study states that along with the physical impact of the obesity in
the form of comorbid disorders, the obese target people are also subjected to extreme
psychological stress induced by bullying, negative body image and lack of self-worth due to the
obesity (Ejima, Aiharz and Nishiura 2013). Furthermore, though bariatric surgery is extremely
beneficial for weight loss which shows drastic improvements instantaneously, there is very little
focus on how the obese people perceive the concept of the bariatric surgeries and its effect on the
weight-loss. As this study focuses on the perception of the obese people regarding their obesity
and bariatric surgery, the justification provided by the authors is apt (Cohen, Manion and
Morrison 2013).
Methodology:
The research methodology of a study succeeds to achieve the set outcome or goals in case
the methodology selected is critically aligned with each of the exact factors associated with the
study and the goals set by the researchers to be achieved (Gloy et al. 2013). The research design
that has been selected for this assignment is a qualitative research design, now it has to be
mentioned that the qualitative research design allows the researcher to observe and document
non-numerical data (Inge et al. 2014). Along with that, the qualitative research methodologies
are mainly concerned with exploring and comprehending the perception, attitude, beliefs, and
outlook of different individuals with the lack of any statistical data interpretation. As the primary
aim and objective of this research study had been associated with interpreting the perception,
expectations, and outlook of the obese people regarding the bariatric surgeries for weight-loss,
the use of qualitative research design can be easily considered apt. In justification of the research
design chosen, the authors have stated that this research design chosen is to deliver richness of

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details on the concept of the obese regarding the surgical intervention and obesity management
outcome, which had been missing in the previous literature published (Nakamura et al. 2014).
Regarding the sampling technique that has been considered in the research study, 30
participants have been selected for the study involving 10 men and 20 women from a
multidisciplinary treatment centre for obesity located in northern Portugal. Thus, the participants
were selected within the mean age group of 31.17 years that had a mean BMI of 42.5 (da Silva
and da Costa Maia 2012). Now, it has to be mentioned that sampling of the research study is a
very important aspect as it has a direct impact on the research validity and hence the sampling
technique of any research study is supposed to be executed very critically. According to the
CASP tool, the sampling procedure of the research study is considered as complete in case the
researcher has explained how and why the participants were selected, and whether the researcher
has included any additional discussions regarding recruitment provided. In this case, the
researcher has incorporated how the participants were selected (Buccheri and Sharifi 2017); the
only information regarding why the participants were selected includes the participants that are
about to undergo a bariatric surgery; which can be considered insufficient and to be a drawback
of the study. Lastly, the authors have not incorporated any additional details regarding the
sampling and exclusion of certain participants either in order to further analyze the sampling, the
sample size for the study had been very small which can aid in maintaining the homogeneity of
the data collection and its subsequent analysis (da Silva and da Costa Maia 2012).
Data collection
According to the CASP tool, a data collection process of a research study is supposed to
be complete if the researchers have justified the setting of the data collection, how the data was
collected, methods chose for data collection, clear description of the form of the data, and

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saturation of data (Zeng et al. 2015). This research study had been a qualitative research study
which focused on interviewing the study participants before their bariatric surgery. The data
collection method selected for the research study is also qualitative, however, as mentioned by
the authors, the data collection and analysis for this study had been deliberately interweaved to
the process of theoretical sampling which allows the researcher to revise and reflect on the
subsequent questions and check the emergent categories (Lewis 2015). Regarding the data
saturation, the authors have mentioned that theoretical saturation method has been used in order
composes the sampling data. The method of data collection and its documentation had been
through audio taping the interviews, turning into transcripts and then coding it through grounded
analysis, which eases the process of understanding and interpreting the qualitative data. It has to
be mentioned in this context that the interview process and the collection of the data had been
discussed very critically in the research study, which is undoubtedly commendable (Silverman
2016).
Data analysis:
The data collection method that has been implemented in this assignment is semi-
structured interviews which are associated with asking the study participants open-ended
questions. The primary aim of the research study had been to explore or understand the
perception and outlook of the obese regarding obesity and use of bariatric surgery. The open-
ended questions allow the data to be very versatile and inclusive or the exact opinion and
perception of the research participants which further helped the researcher achieve the aims and
objectives of the research study (Creswell and Creswell 2017). Furthermore, the parameters that
were included in the semi-structured interviews include age, weight, BMI, eating habits of the
person. Moreover, questions were also asked questions pertaining to their eating habits, which

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further enrich the collected data. Exploring the data analysis further the process of grounded
analysis had been taken which is a highly systematic method of deducing final themes. The
software used for the coding and further analysis of the data had been NVivo 8.0 with the use of
the constant comparative method which eased the process of open coding. Furthermore, in order
to ensure the validity of the data coding based analysis method, a second researcher has also
been employed as the auditor to challenge he present ideas and assist in the constructing the
coding categories. Hence, it can be stated that the data analysis process had been much
consolidated, robust and with as minimal bias as possible (Green and Thorogood 2018).
Ethics and reflexivity:
Considering the reflexivity of the research, the relationship between the researcher and
participants, very limited information has been provided. However, the data collection, sample
recruitment and choice of the location have been discussed in details as well, although no
information is available in the article regarding the response of the researchers regarding the
events during the study or any changes in the study design. Regarding the ethical considerations
being employed in the research, the authors have mentioned that informed consent has been
taken from the participants for audiotaping the interviews that have been approved by the
Clinical Research Ethics Committee of the Hospital of Braga. However, no other ethical
considerations have been incorporated or declared in the study design, especially ensuring that
no participants are forced to participate in the interview. This can be considered a significant
drawback of the study (Taylor, Bogdan and DeVault 2015).
Result interpretation and findings:
In order for a research study to be valid and authentic, the data findings need to be
explained critically in relation with the research questions asked and goals with respect to a

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balanced discussion of the topic from the perspectives of all participant groups. The key findings
of the research study had been the fact that the bariatric patients entertain many false beliefs
regarding the outcomes of the surgical intervention. One of the primary requirements of the
research study had been to establish a link between the obese patients and their outlook before
and after the commencement of the surgery, and the data findings discussed in the paper had
been successful in establishing the link between the perceptions. Considering the data findings,
they can be considered adequately explicit meeting the quality benchmarks of the study
(Sjöström et al. 2014). Exploring further, three core processes have been represented in the
research study, obesity eating behavior and the surgical treatment. The findings indicate that the
bariatric surgery as per the outlook of the patients is associated with bariatric surgery is of a
miraculous result without any amendments to eating behavior. As per the data findings of the
research the perception of the research participants is associated with the idealizing the surgery
expecting bariatric surgery to be the only miracle that has the potential to magically solve all the
problems without changing the eating behaviors from the patient’s ends which on the other hand
is considered to be a huge sacrifice in the perception of the students.
The research study had been capable of incorporating for supportive and argumentative
takes from literature evidence while discussing the research findings of the research study,
although the argumentative take to the research is limited lacking more explicit details from
relevant and authentic literature. The data findings of this research study have been discussed
with accurate details and have been correlated with the original research questions of the study as
well. Along with the above mentioned strengths of the research study, there are certain
limitations of the study as well. Exploring more, it has to be mentioned that sample size of the
research study had been extremely small and the data had been collected from only collected

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from one hospital, which limits the variability of the data collected and enhances the possibility
of uncoverage bias and voluntary response bias. Hence, this limitation of the data findings need
to be interpreted with caution (Nakamura et al. 2014).
Value of the research and interpretation:
A very important element in the CASP tool for the research study requires the authors to
contribute new areas to the research which is considered to enhance the value and authenticity of
the research. For this research study, the authors have mentioned the fact that this research study
had been the first step of a longitudinal mixed method study that fundamentally aims to develop
a theory that typifies the psychosocial phenomenon linked with surgical management of obesity
with bariatric surgery. This study had been the first attempt at incorporating a qualitative intake
to researching the impact of bariatric surgery in obesity management. Considering the
contribution of this research study to the existing literature, it has to be mentioned that there has
been an acute lack of research studies focusing on the perception and outlook of the patients
regarding the outcome bariatric surgeries an achieve. On a more elaborative note, research
suggests that obesity management cannot be achieved only through surgical intervention.
Even though bariatric surgeries help the patients attain an immediate drastic weight-loss,
the bariatric surgery is by no means a miracle and without consistent lifestyle modifications with
extra emphasis on improving the eating behaviour to maintain the weight for the prolonged time
(Inge et al. 2014). It also needs to be mentioned that the previous literature has focused on only
quantitative data, lacking extensive details regarding the outlook of the patients regarding this
surgery. This qualitative design based longitudinal study had been successful in providing key
details regarding the perception of the patent regarding the surgery and revealed the idealizing
attitudes that the patients entertain regarding the surgery expecting miraculous consistent results

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from the surgery without changing the eating behaviour or any other related lifestyle
modifications. Hence, this study had been able to shed light on key issues associated with the
psyche of the patient before and after a bariatric surgery and its impact on their obesity
management progress after the surgery. The data findings indicate at the need for extensive
patient education for the patient before and after the surgery to help them understand the need for
additional behavioural and lifestyle modifications especially eating behaviour to ensure better
outcome achievement. Hence, this research study can be considered the first step to a better
understanding of health promotional educations the patient population needs to overcome the
false beliefs and idealization of a surgery.
Considering the generalizability and transferability of the study, it has to be mentioned
that the sample size for this research study had been very small focusing on only one hospital
setting which reducing the variability of the data incredibly and enhances the possibility of
several biases. Hence, this limitation of this study reduces the transferability and generalizability
of the study to a larger sample size and the data collected is completely subjected to the personal
perception of each of the participant and have not been standardized (Fellows and Liu 2015).
Furthermore, the Inge et al. (2014) have also mentioned in this discussion that in order to
validate the study there is a need for a larger sample population with the addition of quantitative
data employing a mixed methodology. Although, it has to be mentioned that the contribution of
the study to the area of study cannot be ignored, even after the drastic results achieved by a
bariatric surgery, a large percentage of obese patient population revert back to being obese due to
no modification in their eating behaviour or lifestyle.
Hence, this longitudinal study has been the first to reveal the idealizing attitude of the
patient regarding the surgery while eating behaviour change is seen as a huge sacrifice. This data

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is of tremendous use in clinical practice, and with further research to validate the authenticity of
the findings, patient education and promotional programs can be designed to change the
idealizing attitude of the patients and improve the long-term success rate of the surgical
intervention and changing the lifestyle and health status of the bariatric patients (Clarke and
Charmaz 2014).
Conclusion:
On a concluding note, critical appraisal exercise of a research study allows the
development of skills needed to explore the authenticity and reliability of an article before
utilizing it in the evidence-based practice. This had been an excellent opportunity for me to
understand the process evaluating the authenticity of literature evidence as per the standardized
format provided by the CASP checklist. This report has discussed in detail the different
methodological sections of the research study chosen, the data analysing and interpretation,
results and discussion and value of the research encompassing all key areas of a research study to
be authentic; and it can be hoped that this exercise will be of extreme help to me in my clinical
practice.