Benchmark -Evidence-Based Practice Project: Literature Review
The purpose of this assignment is to write a review of the research articles you evaluated in your Topic 5 “Evidence-Based Practice Project: Evaluation of Literature” assignment. If you have been directed by your instructor to select different articles in order to meet the requirements for a literature review or to better support your evidence-based practice project proposal, complete this step prior to writing your review.
A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT. You will use the literature review in this assignment in NUR-590, during which you will write a final paper detailing your evidence-based practice project proposal.
In a paper of 1,250-1,500, select eight of the ten articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:
- Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.
- Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.
- Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT.
- Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).
- Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
- Conclusion – Provide a summary statement of what you found in the literature.
- Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.
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Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
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Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing
3.2: Analyze appropriate research from databases and other information sources to improve health care practices and processes.
SAMPLE STUDENT ANSWER
Benchmark -Evidence-Based Practice Project: Literature Review
Recently, there have been concerted efforts to reduce the cost of care in the United States, which is among the highest within the OECD countries (Tikkanen & Abrams, 2020). One of the contributing factors to the high cost of care is the increasing cases of chronic diseases, including cancer, cardiovascular diseases, diabetes, to list a few. One of the major causes for the increase in chronic conditions is obesity. Obesity is a major risk factor for cardiovascular diseases, type-2 diabetes, and certain types of cancer.
According to statistics by the Centers for Disease Control and Prevention (CDC), it is estimated that 42% of adults suffer from obesity with 10% having severe obesity (CDC, 2019). Similarly, the same data indicates that African American adults are at a significantly higher risk compared to other racial groups with a prevalence of almost 50% of the total adult population. This makes the African American population be at a higher risk of getting chronic diseases and attached high mortality rates compared to other population groups.
In a paper by Chooi et al. (2019), it was suggested that obesity may be far more common and serious than detailed in the studies conducted thus far, calling for more urgent attention. Based on the underlined factors, this proposal seeks to identify some of the evidence-based interventions that could assist in dealing with obesity with a specific interest in the African American population. To achieve this objective, the following PICOT question was formed;
PICOT: In adult African American patients with obesity (P), does a physical exercise program held for 30-40 minutes, thrice a week (I) compared to no exercise (status quo) (C) help to reduce BMI (O) within three months (T)?
Search Methods
Having an elaborate search strategy is vital in getting evidence-based information that can be used to guide a population-specific quality improvement intervention. The search strategy used in this proposal documents applied the concept of keywords and Boolean operators to identify articles that are relevant and specific to answering the PICOT question.
The keywords used in the search included “obesity,” “African American,” “physical activity,” and “walking.” The search was limited to articles written between 2017 to date. Similarly, only peer-reviewed articles were selected during the search, this included both systematic reviews, meta-analysis, experimental, and observational research. Booleans were used to make the search more specific, reducing the number of search results at the same time increasing the efficiency of getting relevant articles. Some of the databases that were considered during the search include CINAHL Plus with Full Text, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PUBMED, MEDLINE with Full Text to list a few.
Synthesis of Literature
The first article selected is an article by OʼNeal et al. (2018). The study wanted to determine “the relationship between meeting the minimum recommendation for moderate physical activity and multi-level, including policy, systems, and environmental (PSE) strategies thought to influence health behaviors.” The research participant included 256 low-income and predominantly African Americans in three southeastern cities in the United States. The research was a multi-level obesity prevention study, which measured the impact of the intervention on the population.
The researchers conducted face-to-face interviews to collect the data for the study and were given a $15 gift card after. The data was converted to descriptive data then analyzed using descriptive statistics. From the findings, it was established that individual, environmental and social factors determine whether participants meet the recommended guidelines for physical activity. This study underscores the importance of the listed factors in creating a workable intervention that could be used among the low-income African American population.
The second study is a study by Lincoln (2019). The study wanted to determine “the role of stress in the association among physical activity, obesity, and depression among women.” The participants in this study included African American, Caribbean Black, and White women. The research obtained data from the National Survey of American Life with the analysis being done using multivariable regression analyses.
The primary findings from the research relevant to the PICOT identified that physical activity had a moderating effect on depressive symptoms and BMI among African American women who had a higher prevalence of chronic stress compared to the two other racial groups. The results of this study point out the impact of physical activity on positive outcomes among African American women with obesity, thus supporting the intervention selected in the PICOT.
The third study selected was a study by Towner et al. (2019). The study evaluated the impact of physical activity on the systolic blood pressure changes among obese African American adolescents. The study involved African American adolescents aged between 12 and 16 years with a BMI equal or greater than the 95th percentile. Descriptive statistics were used to analyze the data. The findings indicated that more than half the participants had a clinically significant change in systolic blood pressure at 7- and 9-month timelines after the start of the intervention. This study also supports the positive effects of physical activity on cardiovascular function in persons with obesity.
The fourth study was done by Dieli-Conwright et al. (2018). In this study, the participants were one hundred overweight and obese breast cancer survivors. The research was a randomized controlled trial. The exercise intervention involved a moderate to vigorous aerobic and resistance exercise conducted thrice a week lasting for 16 weeks. The findings indicated positive outcomes in the intervention group which include increased muscular strength, reduced fatigue, and depression. From this, it can be seen that moderate to vigorous aerobic and resistance exercise can be effective for persons with obesity, including breast cancer survivors which validates the intervention selected in the PICOT.
In a study by Castro et al. (2017), 89 overweight and obese adults were selected to participate, where they were randomized into four intervention groups (strength, endurance, combined strength and endurance, and physical activity recommendations) with a 25–30% caloric restriction of total daily energy expenditure. The intervention lasted for 22 weeks. The findings realized indicated a significant correlation between light-intensity physical activities and the body weight of the participants. While the study did not strictly focus on African American adults, it provides some evidence that supports implementing physical activity in mitigating the effects of obesity.
The sixth study selected was a study by Hernández-Reyes et al. (2019). The aim of the study was “to investigate the effect of a hypocaloric diet on the body composition of obese adult women throughout different degrees of physical activity during a weight loss program.” The research subjects involved 117 healthy female volunteers. The research was a randomized experimental study that involved various interventions including a low-level prescription of physical activity, a moderate physical activity involving 10.000 steps walking, and an intense physical activity group that trained three times a week.
The subjects were requested to adhere to a hypocaloric diet designed with a reduction of 500 kcal/day. The findings indicated that while a hypocaloric diet, without physical activity, is adequate to lose weight in the short term (12 weeks), physical activity remains vital to modify the body composition in women with obesity. Therefore, the findings support the PICOT intervention on engaging in physical activity as a way of reducing weight among persons with obesity.
The seventh study reviewed is a study by Villareal et al. (2017). In this study, the participants were 160 obese older adults. The participants were randomly assigned to a weight-management program plus one of three exercise programs, namely; aerobic training, resistance training, or combined aerobic and resistance training with the control group being placed under no weight-management or exercise program. The research findings indicate that a combination of weight loss plus aerobic and resistance exercise is effective in enhancing the functional status of obese older adults. This research has a similar structure to the proposal and highlights the efficacy of physical activity in mitigating the effects of obesity among older adults.
The last study was research by Flórez et al. (2018). The study involved 799 adult African Americans living in low-income neighborhoods in Pittsburgh, PA. The research measured numerous structural and functional aspects including social isolation, social network size, diversity, and perception of social support for physical activity. The findings from the research indicated that social isolation was significantly correlated with lower BMI among African American men, while for women it was associated with an increase in moderate-to-vigorous physical activity. The research points out an interesting correlation between social support and adherence to physical activity and may inform redefining of the intervention to capture it as an extraneous variable.
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Comparison of Articles
The identified articles shed some light on the application of different forms of physical activity and their impact in mitigating obesity. Starting with the population, the PICOT question targeted African American population. Out of the eight articles reviewed four were focused on African Americans as a standalone sample population or part of the larger sample. One of the articles (Towner et al., 2019) focused on adolescents, compared to the remaining articles and the PICOT which intends to focus on adults. Similarly, two articles were specific to women, while the remaining had mixed gender. The PICOT will focus on both genders.
In terms of methodology, the articles employed different methodologies with different aspects of physical activity. For example, Flórez et al. (2018). applied moderate-to-vigorous physical activity. Villareal et al. (2017) used aerobic training, resistance training, or combined aerobic and resistance training, Hernández-Reyes et al. (2019) used low-level prescription of physical activity, a moderate physical activity involving 10.000 steps walking, and intense physical activity, to list a few
One of the emerging themes was the link between physical activity and well-being. Physical activity was seen to not only help reduce BMI as noted by Towner et al. (2019), it was also indicated to help deal with symptoms of depression common among people with obesity as per Lincoln (2019). Hernández-Reyes et al. (2019) noted the link between physical activity and body composition in obese women, which merges with this theme. With aspects such as bone density being improved as a result of physical activity.
The studies had some limitations, including low levels of generalizability with the populations being specific to either one gender, for example in the article by Lincoln (2019), which focused on women alone, or age for example in the article by (Towner et al., 2019) that focused on adolescents. Another limitation is that a majority of the articles failed to mention the type of physical activity. Leaving it vague may lead to disparities in results as noted in the study by Hernández-Reyes et al. (2019). There were also surprisingly few articles focused specifically on African American population, which led to the broadening of the search to encompass studies done on other racial groups. This could affect the validity of the intervention.
Suggestion for Future Research
Based on the established limitations, future research needs to be focused on African American population, specifically studies that explore the link between different forms of physical activity on outcomes of obese African Americans. More studies should also be conducted with a more inclusive and wider population base to enhance the generalizability of the application of the interventions. Future studies also need to focus on specific physical activities and how they impact different aspects of persons with obesity.
Conclusion
From the literature, it can be identified that physical activity, from light to intense can be effective in mitigating the effects of obesity among African Americans, especially those from disadvantaged socioeconomic backgrounds. The literature therefore supports the PICOT intervention and could be a promising aspect in reducing the overall burden of obesity in the health care system, both in terms of cost and population health outcomes. However, more studies need to be conducted on specific interventions that increase the level of physical activity among obese patients to provide better evidence-based guidelines that could support practice and behavioral change.
References
Castro, E. A., Júdice, P. B., Silva, A. M., Teixeira, P. J., & Benito, P. J. (2017). Sedentary behavior and compensatory mechanisms in response to different doses of exercise-a randomized controlled trial in overweight and obese adults. European journal of clinical nutrition, 71(12), 1393–1398. https://doi.org/10.1038/ejcn.2017.84
Centers for Disease Control and Prevention. (2019). Adult obesity facts: Obesity is a common, serious, and costly disease. https://www.cdc.gov/obesity/data/adult.html
Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism, 92, 6-10. https://doi.org/10.1016/j.metabol.2018.09.005
Dieli-Conwright, C. M., Courneya, K. S., Demark-Wahnefried, W., Sami, N., Lee, K., Sweeney, F. C., Stewart, C., Buchanan, T. A., Spicer, D., Tripathy, D., Bernstein, L., & Mortimer, J. E. (2018). Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Research: BCR, 20(1), 124. https://doi.org/10.1186/s13058-018-1051-6
Flórez, K. R., Richardson, A. S., Ghosh-Dastidar, M. B., Troxel, W., DeSantis, A., Colabianchi, N., & Dubowitz, T. (2018). The power of social networks and social support in promotion of physical activity and body mass index among African American adults. SSM – Population Health, 4, 327–333. https://doi.org/10.1016/j.ssmph.2018.03.004
Hernández-Reyes, A., Cámara-Martos, F., Molina-Luque, R., Romero-Saldaña, M., Molina-Recio, G., & Moreno-Rojas, R. (2019). Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial. BMC Women’s Health, 19(1), 167. https://doi.org/10.1186/s12905-019-0864-5
Lincoln K. D. (2019). Social stress, obesity, and depression among women: clarifying the role of physical activity. Ethnicity & Health, 24(6), 662–678. https://doi.org/10.1080/13557858.2017.1346190
OʼNeal, L. J., Bateman, L. B., Smith, T., Li, Y., Dai, C., Wynn, T. A., & Fouad, M. N. (2018). An Exploration of Multilevel Physical Activity Correlates Among Low-Income African Americans in Alabama and Mississippi. Family & community health, 41(4), 197–204. https://doi.org/10.1097/FCH.0000000000000203
Tikkanen, R., & Abrams, M. (2020). U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?. Commonwealth Fund Issue Briefs. doi: 10.26099/7avy-fc29.
Towner, E. K., Kapur, G., Carcone, A. I., Janisse, J., Ellis, D. A., Catherine Jen, K. L., & Naar, S. (2019). Physical Activity as a Predictor of Changes in Systolic Blood Pressure for African-American Adolescents Seeking Treatment for Obesity. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 65(3), 430–432. https://doi.org/10.1016/j.jadohealth.2019.04.001
Appendix: APA Writing Checklist
Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.
☒ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.
☒ The title page is present. APA format is applied correctly. There are no errors.
☒ The introduction is present. APA format is applied correctly. There are no errors.
☒ Topic is well defined.
☒ Strong thesis statement is included in the introduction of the paper.
☒ The thesis statement is consistently threaded throughout the paper and included in the conclusion.
☒ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.
☒ All sources are cited. APA style and format are correctly applied and are free from error.
☒ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.
Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.
Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.
Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.
Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.
☒ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.
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