Critical Appraisal of 'Parent-Focused Intervention' Obesity Study

This report provides a critical appraisal of the study "A parent-focused intervention to reduce infant obesity risk behaviours: A randomized trial." The study, published in the National Library of Medicine and the National Center for Biotechnology Information, investigated the effectiveness of parent-focused interventions in mitigating obesity risk behaviors in early childhood. The appraisal includes an overview of the study's background, methodology, and key findings, emphasizing the randomized controlled trial design and the interventions' focus on eating and playing habits. The report critiques the research methods, highlighting strengths such as the study design and the use of gold standards for measuring dietary and physical activity, while also acknowledging potential weaknesses like the overrepresentation of women from higher socioeconomic backgrounds and the dropouts from lower socioeconomic backgrounds. The appraisal concludes with an analysis of the study's usefulness to nursing practice, including generalizability and implications for public health, and suggests improvements such as more stringent follow-ups for women from lower socioeconomic groups.

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Critical Appraisal
Student's Name:
Instructor's Name:
Date:
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Critical appraisal of the study “A parent-focused intervention to reduce infant obesity risk
behaviours: A randomized trial”
Abbreviation is using in this essay including:
NLM _ the national library of medicine
NCBI _ the national center for biotechnology information
LGA _ local government areas
RCT _ randomized controlled trial
BMI _ body mass index
Introduction
According the study “A parent-focused intervention to reduce infant obesity risk behaviours: a
randomized trial” published on April 2013 issue of the national library of medicine ( NLM) and
the national center for biotechnology information ( NCBI), Campbell and colleagues highlight
the effectiveness of parents- focused intervention to reduce the risks of obesity behaviour in
very early childhood (result....). This assignment will discuss and critique the study following
three main sections. The first section will discuss the background of the study, including
summarizes the key results of the study, methodology and evaluating the level of evidence in the
study. The second section will critique the research, including analysing the strengths and
weaknesses of the research methods by citing relevant literature to support appraisals. The last
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section will analyse the usefulness of the article to nursing practice, including generalizability
and implication of the research, and suggested improvement.
Background of research:
Recent research has established that from early life, adipose deposition and activities such as
excessive eating, sedentary lifestyle, and lack of physical activity are factors that promote
obesity in early life (Campbell et al., 2013). Several high-end research studies have illustrated
the interventions necessary to curb obesity-promoting behaviour in early childhood. The current
adds to the information available from existing research to highlight the reception of parents,
especially the first-timers, towards the interventions of such kind Campbell et al., 2013). This
study aims to create awareness of obesity-promoting behaviour and enhance the receptivity of
parents of children towards these interventions during very early years of childhood of their
children (Campbell et al., 2013). The interventions suggested in this study are those that focus on
the eating and playing habits of their new infant Campbell et al., 2013). The study additionally
puts forth evidence regarding the effectiveness of certain behaviours that promote obesity in
early childhood (Campbell et al., 2013).
The study observes that obesity is a global issue and is often left unaddressed (Campbell et al.,
2013). In early childhood, the prevalence of obesity is notably high in most countries worldwide
(Campbell et al., 2013). Most often, in extreme situations, medical interventions and
pharmacological treatments are resorted to along with utilizing surgery as a common means of
combating obesity (Campbell et al., 2013). Since obesity is primarily a result of unhealthy
lifestyle, the current study focuses on interventions that address lifestyle issues and aim to curb
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risky behaviours that lead to obesity in children Campbell et al., 2013). In most cases,
interventions of awareness focusing on parents and increasing the receptivity of parents of
infants towards such interventions are often important means of increasing awareness and
promoting the anti-obesity drive Campbell et al., 2013). The current study observes that recent
studies have established the effect of the body weight of individuals in early childhood has a
direct implication on the prevalence of adiposity in later life Campbell et al., 2013). Additionally,
it rightly reports that the body weight of infants as much as five or six months old has an impact
on the occurrence of adiposity in their later lives Campbell et al., 2013).
This study rightly identifies a background for its research by making an analysis of collective
research data from previous studies of relevant backgrounds (Campbell et al., 2013). It displays
the collection of information from previous, reliable studies to provide evidence for the impact of
obesity in early childhood on the occurrence of adiposity in later life Campbell et al., 2013). The
primary aim of the current study is to make and assessment of the effectiveness of interventions
that are focused on parents of new-borns and infants to reduce the risk of obesity and risky
behaviours in children and curb unhealthy increase in BMI values Campbell et al., 2013). The
current study is, in fact, a randomized trial that focuses on understanding the extent of
effectiveness of different interventions focused on parents of infants Campbell et al., 2013). It
possesses a control group and a random sample group and statistically determines the response
and effectiveness of the interventions focusing on educating new parents about risky behaviours
leading to excessively high values of BMI and thus obesity in early childhood (Campbell et al.,
2013). The current study successfully establishes an initial hypothesis that parent-focused
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interventions on risky obesity-promoting behaviours may indeed be a promising approach in this
direction (Campbell et al., 2013).
Review of literature:
Obesity in early childhood is a prominent problem worldwide (Campbell et al., 2013). Over the
years, the prevalence of childhood obesity has increased (Campbell et al., 2013). Research has
evaluated the obesity-risk behaviours in children and has assessed the effectiveness of
intervention for parents in controlling the risk behaviour (Campbell et al., 2013). The risk factors
of childhood obesity is well-documented and understood (Farhat et al, 2009). However, not
much is known about the risk behaviours in children that lead to obesity (Farhat et al, 2009). The
present study primarily highlights the importance of parent-based interventions and their
receptivity levels toward obesity-risk behaviours (Campbell et al., 2013). Previous research has
focused on the eating habits, sedentary lifestyle, and lack of physical activity amongst other risk
factors in increased adiposity in children (Campbell et al., 2013). A few high-end studies have
focused on evaluated interventions in order to influence the development of such behaviours in
childhood (Campbell et al., 2013). The present study lays emphasis on parent-based
interventions that focus on the eating habits and physical activities of their new-born (Campbell
et al., 2013).
The study is a randomized controlled trial, which means that the sample was selected randomly
from fourteen LGAs out of a total of 28 LGAs (Campbell et al., 2013). In a recent study by
Farhad et al in 2010, key risk factors such as smoking, substance abuse, and alcohol were studied
in School pupils between the age 11 and 17 (Farhad et al, 2010). Albeit, most studies in this field
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of research have focused primarily on the risk factors in adolescents and children. The current
study emphasises a novel perspective on parent-based interventions for obesity-risk behaviour in
infants (Campbell et al., 2013).
Methodology
The current study is aimed at assessing the effectiveness of a parent-focused manipulation
intervention to control obesity-risk behaviours and body mass index in early childhood
(Campbell et al., 2013). The study is a randomized control trial that utilises a balanced cluster
group consisting of 542 English-speaking, first-time parents (Campbell et al., 2013). The subject
group attended focus groups led by nurses in Melbourne, Australia (Campbell et al., 2013). The
sample was selected from fourteen local government areas (LGAs) in the Melbourne (major
metropolis). Interventions were carried out in the focus groups of the study sample along with
some basic nurse-led lifestyle advice provided to the control group (Campbell et al., 2013). The
criterion for the focus groups was a minimum of eight participants i.e. eight or more sets of
parents in each group (Campbell et al., 2013). However, the groups of parents belonging to the
lower socio-economic strata were put into groups containing at least six participants (Campbell
et al., 2013). The reason for this gradient was primarily that there is an observed greater
prevalence of juvenile obesity in the lower socio-economic regions in the country along with
having lower levels of participation of parents in those areas (Campbell et al., 2013). The study
hypothesises that a smaller size of sampling in these areas would impact by reducing the
sampling bias (Schuna., Lauersdorf., Behrens., Liguori& Liebert, 2013). The current study
utilizes inferential statistics to analyze the data obtained within the study groups. However,
generalizations and assumptions may be flawed due to the limited ability of inferential statistics
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in testing the entire population within the baseline characteristics (Lund & Lund, 2013). In order
to provide equal opportunities of participation for each individual, a probability method of
sampling was used (Campbell et al., 2013).
Evaluating the level of evidence in the study
The study uses a standardised method of study and eliminates the risk of bias to a considerable
extent due to the randomized inclusion criteria for subjects (Campbell et al., 2013). It uses a
control group in order to ensure the validity of receptivity to interventions as observed in the
control group (Campbell et al., 2013). According to the NHMRC levels of evidence, randomized
subject and control groups is essential at the base of a study (Campbell et al., 2013). The current
study has procured considerable background data and information on the existing evidence from
valid studies (Campbell et al., 2013). The design of study is based on the standard protocol that
has been successfully tested in previous studies (Stocks et al, 2011; Taveras et al, 2011). Due to
the method of study, sample size that included the mean and standard deviation of children of 18
months old, the study is reliable and does not pose notable risk of bias (Campbell et al., 2013).
The present study claims to the first attempt in first-time parent group interventions (Campbell et
al., 2013). The current study has consistency of results due to the intention-to-treat basis
followed during the statistical analysis (Campbell et al., 2013). The results indicate no
noteworthy differences between mid-intervention and post-intervention groups along with no
noticeable discrepancies in results for those parents excluded for post-intervention (Campbell et
al., 2013). The mid-intervention results indicate a clear improvement in noncore-drink, reduced
sweet intake, lower television viewing periods, increased physical activity and overall lifestyle
habits with a considerable reduction in obesity-risk behaviour amongst intervention groups as
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compared to control group (Campbell et al., 2013). The current study is a ‘low-dose, low-cost’
intervention and has immense applicability in the public health realm (Campbell et al., 2013).
Thus, it likely has much relevance and clinical impact due to the promising levels of interest
acknowledged by the participating parent groups (Campbell et al., 2013).
The Generalisability and applicability: The study is largely generalisable as it is a simple,
randomized trial designed with low-cost intervention methods. Due to the randomized selection
method of the study may be regarded promising as the study design is easily translatable into
larger, general populations and also the existing health care system in Australia (Campbell et al.,
2013). The parents’ receptivity and desire to attain knowledge of child obesity-risk behaviours is
an essential indicator of the high degree of generalisability of the study (Campbell et al., 2013).
In the intervention undertaken, the study demonstrates great improvements in the dietary
patterns, attitudes towards physical activity and lifestyles of children and those of the participant
mothers (Campbell et al., 2013). Thus, it can be said to have a “ripple effect” as described by the
authors impacting the lifestyle of the members of the families (Campbell et al., 2013).
Analysing the strengths and weaknesses of the research methods
The strengths of the current study mainly include the study design which is a randomized control
trial, and the monitoring of dietary and physical activities measured using gold standards
(Campbell et al., 2013). However, the participant groups are likely to have provided idealistic or
socially “desirable” responses about the eating habits and general lifestyle habits such as
television viewing during the groups (Campbell et al., 2013). Although the recruitment of
women from all social and economic strata was ensured, there is a distinct overrepresentation of
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women from higher socio-economic backgrounds (Campbell et al., 2013). Most of the dropouts
after the mid-intervention and into the post-intervention zones were women from lower socio-
economic strata (Campbell et al., 2013).
Suggested improvement: The follow-ups of women from lower socio-economic groups have to
be made more stringent to avoid dropouts during mid-intervention to avoid negative implications
and inconsistency of results (Campbell et al., 2013). The infants studied as a sample in this study
mainly consume breast milk and thus, the study design to analyse their eating habits and physical
activity is invalid (Campbell et al., 2013). Due to these reasons, the study lacks applicability at
baseline and thus future studies could focus on sample selection and baseline study methods
(Campbell et al., 2013).
References:
1. Campbell, K.J., Lioret, S., McNaughton, S.A., Crawford, D.A., Salmon, J., Ball, K.,
McCallum, Z., Gerner, B.E., Spence, A.C., Cameron, A.J., Hnatiuk, J.A., Ukoumunne, O.C.,
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Gold, L., Abbott, G., Hesketh, K.D. (2013). A parent-focused intervention to reduce infant
obesity risk behaviours: a randomized trial. Pediatrics, 131(4), 652-660
2. Farhad, T., Iannotti, R.J., & Morton, B.S. (2010). Overweight, obesity, youth, and health-risk
behaviours. Am J Prev Med., 38(3), 258-267
3. Stocks, T., Renders, C.M., Bulk-Bunschoten, A.M.W., Hirasing, R.A., van Buuren, S., Seidell,
J.C. (2011). Body size and growth in 0- to 4-year-old children and the relation to body size in
primary school age. Obes Rev., 12(8), 637–652
4. Taveras, E.M., Rifas-Shiman, S.L., Sherry, B., et al. (2011). Crossing growth percentiles in
in-fancy and risk of obesity in childhood. Arch Pediatr Adolesc Med., 165(11), 993–998
5. Waters, E., de Silva-Sanigorski, A., Hall, B., et al. (2011). Interventions for preventing
obesity in children. Cochrane Database Syst Rev, (12):CD001871
6. Campbell, K., Hesketh, K., Crawford, D., Salmon, J., Ball, K., McCallum, Z. (2008). The
Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood
obesity: cluster-randomised controlled trial. BMC Public Health, 8(1), 103
7. Goldfeld, S.R., Wright, M., Oberklaid, F. (2003). Parents, infants and health care: utilization
of health services in the first 12 months of life. J Paediatr Child Health, 39(4), 249–253
8. Scott, D., Brady, S., Glynn, P. (2001). New mother groups as a social network intervention:
consumer and maternal and child health nurse perspectives. Aust J Adv Nurs, 18(4), 23-29
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