University Health Practice Module: Research Article Critical Appraisal

This report presents a critical appraisal of two research articles using the Critical Appraisal Skills Programme (CASP) tool. The first article, "It is just not part of the culture here": Young adults' photo-narratives about smoking, quitting, and healthy lifestyles in Vancouver, Canada, examines the impact of lifestyle on smoking cessation among young adults using a qualitative approach involving participant-driven photography. The second article, "Factors that influence physical activity for pregnant and postpartum women and implications for primary care," employs a quantitative approach to identify factors influencing physical activity in pregnant and postpartum women, linking physical inactivity to gestational diabetes. The report assesses the methodologies, findings, and ethical considerations of both articles, highlighting their relevance to health practice and identifying strengths and weaknesses in the research designs and data analysis. The report concludes with a discussion of the implications of the findings for health promotion and the importance of considering socio-spatial factors and perspectives of target groups.

Running head: RESEARCH LITERACY FOR HEALTH PRACTICE
Critical appraisal of 2 research articles
Name of the Student
Name of the University
Author Note
Word Count

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Executive summary
Health and lifestyle modifications play an essential role in the overall wellbeing of an individual.
The presence of complete mental, social and physical wellbeing not only depends on the diseased
state of an individual, but is directly influenced by several environmental and social factors. This
report aims to critically appraise 2 research articles that focus on the prevalence of smoking in
youth and gestational diabetes among women.

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Table of Contents
Introduction..........................................................................................................................................3
Discussion.............................................................................................................................................3
i. Tool selection................................................................................................................................3
ii. Critical appraisal..........................................................................................................................4
iii. Ethical issues...............................................................................................................................8
Summary...............................................................................................................................................9
References..........................................................................................................................................10
Appendix............................................................................................................................................12

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Introduction
Critical appraisal refers to the process of systematically and carefully examining research
articles for judging their value, trustworthiness, and relevance in the context of medicine and
healthcare. It focuses on asking answerable questions that helps in establishing the strength and
weakness of the analysed articles (Singh 2013, p.76). This helps in evaluating the practice. The
report will focus on critical appraisal of 2 research articles that are based on adopting habits and
activities that promote a healthy lifestyle. Critically analyzing the articles are imperative for gaining
a sound understanding of lifestyle modifications and physical activity, which can be implemented
for improving the overall health, wellbeing and quality of life (LoBiondo-Wood & Haber 2017,
p.23).
Discussion
i. Tool selection
The research appraisal tools formulated by the Critical Appraisal Skills Programme (CASP)
will be used for analyzing the 2 research articles on factors influencing physical activity and
narratives on smoking, quitting and adoption of healthy lifestyles respectively. The CASP tool will
be considered for appraising the articles owing to the fact that it helps to ascertain the rigour,
credibility and relevance of the research findings (O’Brien et al. 2014, p.1247). CASP is therefore
used for researchers and students who focus on using research evidences in the context of
professional practice, which thereby helps in decision making, and development of guidelines and
policy (Appendix).
The CASP tool that will be used for the aforementioned articles contain three sections that
help in assessing the internal validity of the study, the results or key findings, and the relevance of
these findings in real-time settings or medicine and health practice. Thus, the primary objective of
the CASP tool lies in assisting to develop an evidence-based approach in health and social care
practice, while working with local, national or international organizations (Claydon 2015, p.8820).
Its importance lies in the fact that it facilitates development of skills that are imperative for making
a sense of the available research evidence in relation to a particular health scenario, thereby
assisting implementation of the collected evidence in practice.

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ii. Critical appraisal
Article 1- Haines-Saah, R.J., Oliffe, J.L., White, C.F. and Bottorff, J.L., 2013. “It is just not
part of the culture here”: Young adults' photo-narratives about smoking, quitting, and healthy
lifestyles in Vancouver, Canada. Health & place, 22, pp.19-28.
The article presented a clear statement about its aims and objectives that focused on
evaluating the effects of healthy lifestyle on smoking cessation and increased rates of livability. The
objective is important owing to the fact that the youth form a major percentage of smokers
according to national survey of Canada and little photo-based research has been conducted for
health promotion. Implementation of the intervention in early adult years is more likely to establish
good habits (Freedman, Nelson & Feldman 2012, p.13).
The qualitative approach is an appropriate for addressing the research objective due to the
fact that young adults most often carry negative perceptions regarding lifestyle interventions that
aim to prevent or reduce smoking rates. The approach based on principles of participant-driven
photography was the best method for correlating between narrative and visual representations.
Thus, it is relevant to the goal as it would help in directly correlating the effect of lifestyle habits on
participant perspectives.
The research design was appropriate as it focused on soliciting imagery and insights from
19-26 years aged participants who had quit smoking. The research design can be described accurate
since the researchers elaborated on the use of participant-driven photography during 3 visits to the
hospital for determining the views of the participants on their photographs. Thus, the design is
accurate as it provided a nuanced description of the representations of smoking and its cessation on
young adults in Vancouver.
The study was accurate in recruiting 6 men and women of the age 19-26 years as more than
20% and 24% of females and male, respectively, account for the number of current smokers in
Canada. The study used the fact that the youth are often underserved by cessation programs and
show resistance to formal support for quitting smoking. Moreover, the authors also explained the
reason for considering participant who quitted smoking within the past year.
The data collection setting was justified by the statement that an eligibility screening was
conducted before providing the disposable cameras and background survey. It was further accurate

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in that the researchers briefed about the ethical responsibilities and considerations for conducting
the participant-driven photography research. Owing to the fact that a qualitative researcher should
focus on feelings and thoughts of the participants, the use of survey as the data collection tool was
an accurate step for addressing the question (Weigold, Weigold & Russell 2013, p.53).
The researchers did not examine presence of any potential bias except the probability of
fluid nature of cessation and relapse among participants who quitted smoking within 1 month.
However, the choice of location was justified as 5 out of the 12 respondents were born and raised at
Vancouver. The city was selected owing to its ranking as one of the most liveable cities and the
increased access to sports, natural environment and outdoor activities.
Prior ethical approval was taken from the University and the participants were given a brief,
before taking the necessary photographs. The researchers also demonstrated a good practice in
considering the stigmas that are associated with objectifying smokers as dying or deceased in such
cessation programs (Graham 2012, p.87). Although the implications of the research were explained
to the respondents, they did not provide information on maintaining participant confidentiality.
The researchers provided a detailed description of the data analysis portion that included
transcription of the interviews conducted on the focus group. Detailed description suggested that
captions, photographs and field notes were fed into the qualitative analysis program for
categorization of the data. Sufficient data were provided, which were related to influence of the
health culture and the presence of outdoor spaces on smoking cessation rates. Thus, the data
analysis was a rigorous one.
The findings are explicit and an adequate discussion is provided by the researchers.
However, they failed to discuss the reliability and credibility of their research findings (Leung 2015,
p.325). The findings did not represent the experiences of the participants living in contexts where
less restrictive tobacco measures exist. The findings therefore correlated health and the socio-spatial
context and reinforced considerations of complex interactions.
The value of the research lies in adding information to the already existing body of
knowledge on the association between health and socio-spatial factors that stress on the importance
of considering the importance of health practices. The study contributed to the understanding that
lifestyle modifications are imperative to the local health culture at Vancouver and smoking

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cessation. Thus, the findings were relevant in suggesting that there is a need to consider
perspectives of the youth and highlighted the importance of the implemented strategies.
Article 2- Doran, F. and Davis, K., 2011. Factors that influence physical activity for
pregnant and postpartum women and implications for primary care. Australian journal of primary
health, 17(1), pp.79-85.
The research aims were clearly stated as the authors mentioned about the lack of physical
activity and prevalence of sedentary lifestyle among pregnant women and those of child-bearing
age. The increase in physical inactivity often contributes to gestational diabetes and obesity (Hallal
et al. 2012, p.249). Therefore, the aim was clear and succinct in identifying the factors that create an
impact on physical activity, thereby improving or decreasing the health status in the focus group. It
is therefore relevant in the context of enhancing the overall health and wellbeing of pregnant and
post-partum women.
Owing to the fact that the research identified the probable factors that might directly
influence health of pregnant women and the onset of gestational diabetes, it was necessary to adopt
a quantitative approach in the research methodology, for obtaining an accurate statistical data (Pope
& Stanistreet 2017, p. 125). The quantitative method is appropriate since most women do not
adhere to lifestyle modifications and the recommended time for moderate physical activity during
their pregnancy. Thus, this methodology was imperative for gaining a numerical understanding of
the rates and percentage related to thoughts and feelings of the women on the probable factors.
The researchers justified the research design for collecting information on the factors that
might exert an influence on participation in physical activity during pregnancy. They stated that
previous research studies have identified these factors, which formed the foundation of their
research to explore differences between the negative and positive factors (Nascimento, Surita &
Cecatti 2012, p.392). Owing to the association of lack of physical activity with type 2 diabetes,
there researchers were correct in conducting a survey to identify the variables that might play a role
in lack of adherence to exercise.
The researchers identified the method of recruiting participants accurately and enlisted
women for the study that were pregnant or experienced GDM in the past 18 months. It focused on
the fact that pregnant and post-partum women fail to follow the national guidelines that emphasise

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on the importance of 30 minutes of moderate physical activities. Lack of sufficient activity among
the women influenced recruitment of the participants.
Data collection was based on completion of a survey that contained close-ended questions
on the 12 potential factors that were probably involved in influencing engagement in physical
activity among women. Use of surveys, followed by statistical analysis was a good research method
as it assists in accessing the thoughts and feelings of the research participants, with respect to
percentages and averages that might help in formulation interventions for future research (Weigold,
Weigold & Russell 2013, p.53). The method of data collection was also clearly represented.
The sample recruitment and data collection methods have been accurately represented.
However, the authors did not examine the influence of potential bias in the sample that might lead
to misleading results. Selection of 2 community health centres for the research was justified as well.
Thus, it can be said that the researchers did not critically consider their own role during the data
collection procedure.
The researchers took prior ethical approval from the Southern Cross University and the
North Coast Area Health Service Ethics Committees for conducting the survey. Conditional ethical
approval was based on the researchers and not on the women who were approached at the antenatal
clinic. There was no mention of explanation of the proposed research to the respondents.
Furthermore, the researchers did not present any information on maintaining confidentiality of the
collected participant data.
The researchers provided succinct information on the data collection process. The use of
posters for providing relevant information along with utilization of SPSS statistical software
packages for the research was described. They presented sufficient data to support the findings. A
total of 72 out of 112 surveys were completed by the participants, which were analysed for the
factors that influenced physical activity. Thus, the use of the statistical software for analysis of the
data made the analysis procedure rigorous (DiMaggio 2013, p.3).
The research findings were explicit and clearly explained by the authors. The percentage
scored for each of the factors during and after pregnancy was represented in the form of graphs. The
findings were adequately explained and helped in highlighting the positive and negative role of

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extrinsic and intrinsic factors such as, financial instability, lack of family support and time,
management of weight and scared of developing diabetes on the perceptions of the participants.
The research is valuable in the context of illustrating the probable role that the selected
factors play in adherence to moderate physical activity among pregnant and post-partum women. It
helped in exerting the importance of lifestyle modifications for achieving good health outcomes.
However, the major drawback of the article was associated with not approaching the women for
approval and selection of educated candidates at a rate much higher than the national average.
iii. Ethical issues
Owing to the fact that qualitative research focuses on direct interaction between the
respondents and the researchers, several ethical challenges are bound to arise for the latter. The
major ethical issues are related to confidentiality, anonymity, informed consent, and the potential
impact of the researchers on the participants or vice versa. Informed consent is regarded as the
process of protecting the patient's right to autonomy. On the other hand, the issue of anonymity and
confidentiality should also have been maintained as they are found to exist in close association with
respect for dignity and beneficence rights of the participants (Recker 2012, p.145). The practice of
anonymity suggests protection of the respondent’s identity and prevents its link with personal
responses. Additionally, confidentiality should be maintained while carrying out a research on
human subjects as it restricts reveal or disclosure of personal information, except in certain
situations. In the study conducted by Haines-Saah et al. (2013) although ethical approval was taken
from the concerned organizations prior to the data collection process, and the researchers briefed
about the ethical responsibities, they did not mention about maintaining confidentiality of the 12
participants while conducting the participant-driven photography test.
Confidentiality maintenance was essential as the photographs could be used by people with
wrong intentions (Sanjari et al. 2014, p.5). Similarly, the study by Doran and Davis (2011) failed to
demonstrate presence of adequate confidentiality standards or informed consent from the pregnant
women. The participants should have been informed about the purpose of the research to obtain
their permission for publishing the responses of the surveys. The researchers should also have
considered the potential impact they might have created on the responses of the participants, owing
to the fact that personal relationship development becomes inevitable during data collection. Thus,
there was a need to explain the role of the researchers as visitors, strangers, initiators or experts.

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Summary
According to the research conducted by Haines-Saah et al. (2013), the findings directed the
researchers away from considering nicotine dependence as the primary reason for smoking
cessation among people. The results focused on several approaches that emphasized the influence of
socio-spatial context on smoking cessation. The findings reinforced the need of planning tobacco
reduction efforts. It also elaborated on the role of Vancouver’s health culture as a positive
facilitator, which directly created an impact on smoking cessation among young adults. Thus, the
research was able to illustrate the importance of developing interventions for addressing needs of
young, adult smokers, feeling disconnected or resistant towards adoption of a collective lifestyle for
a healthy and active living. The representations and perceptions of the participants on smoking and
its quitting also helped in providing support for development of tobacco prevention programs,
which mobilize the perspectives of smokers. Furthermore, the study considered the need for
addressing the pleasure sensations that the youth feel, while smoking. This factor was also
identified as a major influence on tobacco control and mainstream health promotion strategies.
According to Doran and Davis (2011), there is a need to emphasise on the role of lifestyle
interventions, which focus on physical activity for promoting health and wellness among pregnant
women (specifically those experiencing gestational diabetes). This research was successful in
recognizing the role of primary health care centres (PHC) in improving the health status of the
target population, outside the traditional domain. The findings identified physical limitations, lack
of spaces for exercise, unsupportive family, lack of enjoyment in physical activities and external
barriers such as, family and personal responsibilities with inadequate time as some of the major
factors that created difficulties for post-partum and pregnant women to engage in moderate physical
activity. On the other hand, deriving benefit from physical activity, having exercise buddies,
adequate child care facilities and support from the family facilitated participation in physical
activity. Thus, this research was able to successfully establish the idea that a primary healthcare
approach and individual lifestyle modifications are necessary for encouraging women to engage in
moderate physical activity, which in turn will reduce the susceptibility of developing gestational
diabetes.
To conclude, it can be said that both the research articles that have been critically appraised
in the above report stressed on the importance of lifestyle modifications and some social and
environmental factors that can improve the health and wellbeing of individuals.

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References
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Doran, F. & Davis, K., 2011. Factors that influence physical activity for pregnant and postpartum
women and implications for primary care. Australian journal of primary health, 17(1), pp.79-85,
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Freedman, K.S., Nelson, N.M. & Feldman, L.L., 2012. Smoking initiation among young adults in
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Appendix

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