Critical Appraisal 1

Critical Appraisal of a Descriptive Study

Jill Radtke
University of Pittsburgh
Critical Appraisal 2

Worksheet for Critical Appraisal of Descriptive (Correlation, Comparative) Design Study
Citation:
Palmeira, A!, "ei#eira, PJ, $ranco, "!, %artins, SS, %inderico, CS, $arata, J", et al
&'((), April '(* Predicting short+term ,eight loss using four leading health behavior
change theories International Journal of Behavioral Nutrition and Physical Activity, 4,
Article -. Retrieved June -/, '((), from http011,,,i2bnpaorg1content1.1-1-.
What type of article is this (e.g., research data!"ased, clinical paper, revie#, editorial$)
Research1data+based
%f this is a research articledata!"ase article, #hat makes it this type of article$ %dentify &!
' characteristics of the article.
- End Product: "he article presents original findings based on the conception of a study
design and its implementation
' Methodology: "he article1study seeks to obtain data in a systematic fashion &eg, the
introduction3s literature search, the attempt to measure variables consistently and
accurately in the methods section, the summation of findings in the results sections,
etc*
4 Style: "he article3s findings and design are presented in an o"(ective and frank manner
&also discussing the limitations* in order that the reader may 2udge, implement, 5uestion,
and1or disregard the evidence
State the research )uestion posed "y the authors:
6o, do key e#ercise and ,eight management psychosocial variables, derived from four health
behavior change theories, predict ,eight change during a short+term behavioral obesity
intervention7
What is my clinical )uestion$
Can the same e#ercise and ,eight management psychosocial variables found in this study to
predict short+term ,eight loss in ,omen predict ,eight loss in ,omen si# ,eeks postpartum7
*sing +%C,, identify the follo#ing if applica"le:
+ (- population): Premenopausal ,omen from a community ,ho are greater than '. years of
age, not pregnant, free from ma2or disease, and have a $%8 greater than '.9 kg1m
'
% (-intervention): -/ ,eekly ,eight management meetings of -'( minutes each ,here the
groups of 4'+4/ participants met ,ith a mi# of PhD and %aster3s level e#ercise physiologists, as
,ell as dieticians and psychologists ,ho administered to the participants e#ercise, behavioral,
and nutrition content "he content included didactic material &eg, information on caloric
content of food*, motivational tools &eg, giving pedometers*, self+a,areness instruments &eg,
food log, e#ercise log*, and goal+setting &eg, dietary and physical activity* "he intervention
Critical Appraisal 3

,as based on Social Cognitive "heory &SC"*, but designed to include constructs from three
other behavior change theories0 Self+Determination "heory &SD"*, "ranstheoretical %odel
&""%*, and the "heory of Planned $ehavior &"P$*
C (- comparison group): :1A
, (-outcome): ;eight change &and the specific behavioral change theories and psychosocial
constructs yielding the most predictive po,er for ,eight change*
A++.A%SA/ 0*%D1 C,22134S
%. Are the methods validtrust#orthy$
- ;as the research 5uestion
clear7 ;as the need for the study
ade5uately substantiated7
<#plain
"he research 5uestion ,as stated clearly both in the
abstract and the =background> section of the research
report &not under a separate =purpose> section*, =?the
purpose of this study ,as to investigate the predictive
value of changes in e#ercise and ,eight management
related variables on ,eight change, in a sample of
over,eight and moderately obese ,omen participating in a
University+based ,eight management program,>
&=background> section* 6o,ever, it ,as less clearly
delineated ho, the content of the intervention parlayed into
improvement of the psychosocial variables and ,eight
loss Although some e#amples ,ere given &eg, =?the
intervention had the underlying goals of improving
autonomy?"hese are highly motivational factors that
should have an effect on SD" constructs?>*, it seems that
the study did not include, or at least did not mention, ho,
constructs from each behavioral change theory ,ould be
incorporated into the intervention "hus, the reader
remains unsure as to ,hat type of ,eight loss intervention
program &ie, ,hich variables1constructs should be
incorporated and ho,* ,ould yield the same predictive
po,er of certain behavioral change theories, as ,ell as
improvements in psychosocial variables and ,eight loss as
found by the study team
"he need for the study ,as ade5uately substantiated in
several instances in the =background> section "he authors
comment that obesity has become an epidemic in
industriali@ed countries, yet there has been a great void in
the integration of biological, psychosocial, and
environmental solutions in ,eight management programs
"he authors hold that several psychosocial variables that
they incorporate into the present study &and the basis of
the four behavioral change theories in the study* are ,idely
believed to e#plain ,eight management in this integration
conte#t, yet are underserved in ,eight management
literature Aor e#ample, in the background section,
=Buestions remain about ,hich model or set of variables
could better e#plain the outcomes of choice, ,hich
constructs may overlap, or if a set of variables from
different theories could delineate the ,ay to a ne,
Critical Appraisal 4

paradigm Rothmam highlights this last aspect as a likely
cause of some of the disappointing results for most studies
of behavior change interventions conducted to date>
' ;hat ,as the design of the
study7 6o, ,ere the data
collected &one time &cross+
sectional* or repeated over time
&longitudinal*7 ;hat ,ere the
limitations of the data collection
methods7
"he design of this study ,as descriptive correlational, and
the data ,ere collected in a prospective manner at t,o
different time points, baseline and four months &the study is
not longitudinal, per se, as it only collected at t,o time
points during a short span of time*
"here ,ere several limitations to data collection Cne such
limitation may be the ,eighing procedure "he article
states that a =standardi@ed procedure> ,as utili@ed in the
,eighing process and cites a specific scale used Aurther
elaboration is not provided 6o,ever, ,e are unsure ho,
much clothing participants ,ore during ,eighing, ,hat time
of day they ,ere ,eighed &eg, morning versus later in the
day*, after ,hat activities they ,ere ,eighed &eg, after
,orking out, after eating, etc*, ho, the scale ,as
calibrated, if participants ,eighed themselves on the scale
,ithout the study team &ie, self+reportDthis is not
specified in the article*, etc %oreover, ,e are unsure
,hether the conditions for ,eighing ,ere similar for all
participants
Another limitation in data collection ,as the self+report
used in the psychosocial variable 5uestionnaires &as stated
in the article* Although the instruments ,ere validated,
there is al,ays a sub2ective limitation in self+report Aor
e#ample, a participant may mark feeling competent and
autonomous on an instrument at the follo,+up because
they feel that this is ,hat the researchers ,ould like to see,
,hether the researchers are communicating this
subconsciously &e#perimenter effect* or not &6a,thorne
effect*
Another limitation in the data collection &but could be
considered a design limitation*, as stated in the article, ,as
only measuring the participants t,ice0 at baseline and at
follo,+up at four months Perhaps there ,as more
fluctuation bet,een the baseline and follo,+up Perhaps,
as the authors suggest is likely, the predictive po,er of the
,eight management and e#ercise variables in ,eight loss
,ould be reversed if the data ,ere collected more long+
term &ie, at -E months*
Cther limitations in this study are discussed under =sources
of bias> in this paper, as they seemed to be more of design
limitations than data collection limitations, per se
4 Describe the sample 6o, ,as
the sample selected &eligibility
At the beginning of the program, the sample consisted of
-.' ,omen ,ith $%83s 4(' F 4) kg1m
'
&over,eight and
Critical Appraisal 5

criteria*7 6o, is the sample
representative of the population7
obese* and ages 4G4 F /G years &the sample had -44
completers at the end of the program* "he ,omen ,ere
free of ma2or disease, premenopausal, not pregnant, and
recruited from a particular community "he sample ,as a
purposive sample &due to the very specific eligibility criteria
used for selection*, recruited using advertisements in the
community0 ne,spaper ads, a ,ebsite, email messages on
listservs, and announcement flyers "hese recruitment
methods ,ere presumed by the reader &myself* to list
eligibility criteria, though this is not e#plicitly stated
&perhaps directly stated on the poster or the interested
party is directed to call a number for eligibility criteria* "he
eligibility criteria given by the authors is0 premenopausal
,omen greater than '. years of age, not pregnant, free
from ma2or disease, and have a $%8 greater than '.9
kg1m
'
8t is unclear ,hether the participants self+selected
&ie, if they called and met criteria they ,ere in the study*
or ,ere specifically chosen among all applicants ,ho met
eligibility criteria, although the article seems to assume
self+selection
"his sample is some,hat representative of the population,
in that it satisfies all the eligibility criteria 6o,ever, the
age range is relatively tight bet,een about -( years of
young to middle adulthood "here are no individuals
greater than ./, nor any younger than 4', despite the
population re5uirement only specifying greater than '.
years old "hus, the age of the sample is not very
representative of the population Additionally, the $%83s of
the sample constituted over,eight individuals to obese
individuals "here ,ere no participants ,ho ,ere severely
or morbidly obese "hus, $%8 is not completely
representative of the population &population re5uirement0
$%8 great than '.9 kg1m
'
* Also, ,e are not given
demographics of the sample "herefore, ,e cannot be
sure that the sample can be generali@ed or applied to
different communities &populations* that differed from the
sample significantly on these variables
. Describe the variables of
interest 8f a comparison study, on
,hat variable&s* are the groups
being compared7 6o, ,ere the
groups similar7 6o, ,ere the
groups different7 8f it is a
correlation study, on ,hat
variables are associations being
e#amined7 ;ere there any
confounding variables7
"here ,ere multiple variables of interest in this study Cne
variable ,as ,eight &at baseline and at . monthsH the
average taken of t,o readings each time and rounded to
the nearest (- kg* "here ,ere also ,eight management
psychosocial variables from each behavioral change
theory &e#cept SD"* measured as scores on instruments
administered to the participants, including self+efficacy and
outcome e#pectancy from SC"H self+efficacy, stages of
change &SCC*, and processes of change &PCC*, including
both behavioral processes and cognitive processes, from
""%H and intentions, attitudes, sub2ective norms, and
perceived behavioral control &P$C* from "P$ "here ,ere
e#ercise psychosocial variables also from each behavioral
change theory measured as scores on instruments
Critical Appraisal 6

administered to the participants, including self+efficacy,
perceived barriers, and social support from SC"H self+
efficacy, SCC, and PCC, including both behavioral and
cognitive processes from ""%H intentions, attitudes,
sub2ective norms, and P$C from "P$H and
interest1en2oyment, perceived competence,
importance1effort, pressure1tension, and intrinsic motivation
from SD" "ypically, the higher the score on the
instruments for the e#ercise and ,eight management
psychosocial variables indicated greater embodiment of
that variable by the participant Additionally, the four
behavioral change theories &SC", SD", ""%, and "P$*
served as variables of interest in the study "ime ,as also
a variable of interest &from baseline measures to four
months* Ienerally, ,eight, psychosocial variables, and
the behavior change theories acted as dependent
variables, ,hile time served as the independent variable
"his ,as a correlation study, and several associations
among these variables ,ere e#amined Airst, ,eight ,as
e#amined for its association ,ith time &ie, ,eight change
from baseline to four months* "he e#ercise and ,eight
management psychosocial variables ,ere also each
individually studied for their association ,ith time &change
from baseline to four months* "hen ,eight change ,as
correlated ,ith baseline e#ercise and ,eight management
psychosocial variables in order to determine any possible
moderator variables ;eight change ,as also correlated
,ith four+month change in e#ercise and ,eight
management psychosocial variables Ainally, the
correlation bet,een ,eight change and the four different
behavioral change theories &SC", SD", ""%, and "P$*
,as e#amined by entering the psychosocial variable
scores present in each theory into separate regression
models for each theory
"he study did not note any confounding variables
/ ;as the sample si@e large
enough to detect a statistically
significant association or
difference7 ;as a po,er analysis
performed7
Jes, the sample si@e ,as large enough to detect
statistically significant associations ,ith -.' sub2ects to
start and -44 completers 8t ,as not mentioned that a
po,er analysis had been performed
E ;ere there any potential
sources of bias7 &Differences
bet,een groups not accounted for
in the analysis, drop+outs,
discounting outcomes, funding
agency, etc*
"here ,ere many potential sources of bias in this study
Cne such bias involves the method of recruitment0 through
advertisements in the ne,spaper, on a ,ebsite,
announcement flyers, and email messages on listservs in
one community "his is a sampling bias, in that study
participants appear to self+select for a purposive sample
"hese study participants, due to their presence in one
particular community and ,illingness to volunteer for the
study &ie, they likely desire to lose ,eight*, may differ
from the population in several fundamental aspects "his
limits the generali@ability of the study findings
Critical Appraisal 7

Another source of bias may be that the SD" ,as not
accounted for in the ,eight management psychosocial
variables "he authors state that this is due to the fact that
a valid Portuguese instrument had not been validated for
the constructs in this theory ,ith ,eight management
6o,ever, it is plausible that psychosocial variables in this
theory still affect ,eight change &even though they are not
tested*
A source of bias also possibly e#isted in 5uestionable
construct validity 8n fact, the article states that some
variables ,ere measured ,ith less than ideal instruments,
such as outcomes e#pectancies "he article does not tell
us the reliability and validity of the instruments used to
measure the psychosocial variables, and ,e are left to look
up the instruments on our o,n or 2ust accept the authors3
2udgment
Also it is mentioned that there ,as a E4K attrition rate
from baseline to four months, ,ith -.' ,omen starting the
study and -44 completing it "his is not an especially high
attrition rate, but if the sub2ects dropping out differed in
some fundamental ,ay from those staying in the study,
then ,e ,ould have attrition bias &ie, our results ,ould
not reflect the population of interest, but those individuals
that had had certain characteristics that allo,ed or
motivated them to complete the study* $ecause the
characteristics of those dropping out &or those staying in*
,ere not elucidated, and the point in the study ,hen the
drop+out occurred ,as not discussed, the reader is unable
to make an informed decision as to ,hether attrition bias
e#isted $ias could also e#ist in the relatively small sample
si@e in the study, ,hich affects e#ternal validity
Another potential source of bias is testing effects "he
same instruments &5uestionnaires* ,ere apparently given
at baseline and at four months 8t is entirely feasible that
the sub2ects became sensiti@ed to the material on the
instruments at baseline, and then ans,ered the same
5uestions differently at four months due to the pre+test
rather than an actual intervention effect
$ias could also result from maturation effects "he
sub2ects could have changed from baseline to four months,
regardless of the intervention Aor e#ample, as ,omen
move into middle age, their metabolism slo,s and ,eight
gain occurs more easily "his ,eight gain &or lack of
,eight loss* ,ould have little to do ,ith the intervention
Lalidity may have been affected in the study by the
6a,thorne effect &ie, the sub2ect ans,ered the
instruments in a certain ,ay or lost more ,eight because
Critical Appraisal 8

they kne, they ,ere in a ,eight loss study* <#perimenter
effects could have also been present if the sub2ects
perceived, for e#ample, that the researchers ,anted them
to lose ,eight or ans,er the instruments indicating that
their self+efficacy ,as improving
Also, the study &as mentioned in =limitations>* did not
include a control group "his is a source of biasDif a
control group had been present and e#posed to the
possible 6a,thorne effect, e#perimenter effects, and had
differed as much as the intervention group on fundamental
aspects &such as race, income, etc*, ,e could say that the
intervention ,as likely the cause of the changes in ,eight
and psychosocial variables 6o,ever, one has to also
keep in mind that this is a correlation study and it did not
claim causation
Ainally, a source of bias could e#ist in the outcome that the
,eight management psychosocial variables better
e#plained ,eight change from baseline to four months as
opposed to the e#ercise psychosocial variables 8n fact,
the authors note that in a similar study that ,as carried to
-E months, e#ercise psychosocial variables ,ere better
correlates of ,eight loss 8f this study had been e#tended,
perhaps they ,ould have also found e#ercise psychosocial
variables as more po,erful predictors of ,eight change
$iases could also e#ist in the data collection methods &eg,
self+report* as described in this paper previously
) Describe the reliability and
validity of the measures
;ere the measures appropriate
for the population or the variable
being studied7 <#plain
"he first instrument used, the ;eight <fficacy !ifestyle
Buestionnaire has sho,n significant validity in a -99-
study using cross+validation ,ith t,o different samples of
sub2ects and ,ith a different instrument measuring self+
efficacy, the <ating Self+<fficacy Scale &convergence
construct validity* "he study also sho,ed the instrument
to have good reliability ,ith Cronbach alpha coefficients
ranging from )(+9( for internal consistency 6o,ever, the
article states its sub2ects ,ere ,omen, the great ma2ority
over .( years of age &Clark, Abrams, :iaura, M <aton*
"herefore, this instrument may not be appropriate for our
sub2ects in this study under .( Additionally, the instrument
is over -/ years old, and it is reasonable to e#pect that the
instrument3s constructs may be outdated
"he dream ,eight outcome e#pectancy score used in this
study, derived from a portion of the Ioals and Relative
;eights Buestionnaire, 8 feel is mostly appropriate for this
study population "he ,omen that the instrument ,as
tested on ,ere in the same general age range as our
sub2ects, ho,ever, the test sub2ects ,ere all obese ,omen
&Aoster, ;adden, Logt, M $re,er, -99)* 8n our study ,e
had over,eight to obese ,omen 6o,ever, data regarding
Critical Appraisal 9

reliability and validity of the instrument and construct of
=dream ,eight> ,as difficult to come by "he -99) study
mentioned above did state that there ,as 5uestionable
reliability of the =dream ,eight> for the same sub2ects
measured one ,eek apart "his seems to indicate that
=dream ,eight> can fluctuate based on changing
e#pectations as one goes along in life and in a study
"hus, by measuring the =dream ,eight> e#pectancy at the
beginning and end of this study, ,e see ho, e#pectations
change "his particular usage of =dream ,eight,> ho,ever,
has not been ade5uately validated or sho,n reliable
Aor the SCC measure, the article states that SCC ,as
measured by four 5uestions developed by Suris &Suris,
"rapp, DiClemente, M Cousins, -99G* 6o,ever, the
5uestions are not stated e#plicitly in the article cited Cne
has to assume that the 5uestions are part of the UR8CA
short form, ,hich does demonstrate considerable
reliability, measured by internal consistency &Suris, et al,
-99G* Aor the PCC, the Suris article states that the
original form of the ;eight Processes of Change Scale
&,hich ,as used in our article* has good reliability and
validity, although the shortened form &used by Suris, et al*
has 5uestionable reliability $ecause the SCC in our
article is measured by the four 5uestions developed by
Suris, et al, ,ho used a small sample of %e#ican+
American ,omen, ,e have to 5uestion the validity of the
measure, as ,e do not kno, the ethnic origin of our
sample
"he specific scales using -G and -) items to address the
constructs of intention, attitude, sub2ective norms, and P$C
in the "P$ for ,eight management and e#ercise,
respectively, could not be located 6o,ever, these
constructs are the basis of "P$, as stated in the article
"he constructs seem to have good reliability as measured
by internal consistency in this particular study, 2udging by
the alpha levels given in the article 6o,ever, because the
articles containing the specific scales used could not be
located, ,e are unable to measure the scale3s true validity
and reliability
Self+efficacy for <#ercise $ehaviors Scale &S<<$* ,as not
able to be located through the authors3 citation, nor through
an CL8D search, but the abstract to the article ,as given in
a different database &although one had to purchase the
article to receive full+te#t* "he abstract stated that the
scale demonstrates good reliability and validity for
measuring self+efficacy behaviors relating to e#ercise
"he <#ercise Perceived $arriers Scale &<P$* has sho,n
considerable reliability and validity in measuring e#ercise
perceived barriers in a -9G9 study 6o,ever, the study
Critical Appraisal 10

,as based on t,o large samples including undergraduates
from a college and a group of ,orkers from a company
classified as ,hite, upper+middle class &Steinhardt M
Dishman* "his sample differs considerably from the
middle+aged over,eight and obese ,omen in our sample
Additionally, the study ,as conducted -G years ago 8t
,ould be remiss to cite the same barriers today
"he <#ercise Social Support Scale3s &<SS* validity and
reliability could not be located using the author3s citation on
CL8D 6o,ever, our article and another &%ar5ue@ M
%cAuley, '((E* cite good internal consistency and, thus,
reliability in measuring social supports of e#ercise
behaviors in this scale
Again, for the e#ercise SCC and PCC, the e#act scales
could not be located using the authors3 citations "hus,
there is no ,ay to evaluate the validity and reliability of the
measures here Although, the <#ercise Processes of
Change &<PC* did have good internal consistency in the
cognitive and behavioral domains in our article, indicating
reliability for this study
"he study cited for the scale used for the 8ntrinsic
%otivation "heory ,as accessed in its abstract form "he
full article could not be 6o,ever, it ,as stated that the
scale had good validity &in that divergent models used to
test motivation did not improve the goodness+of+fit as
compared to the 8ntrinsic %otivation "heory model* 8t also
stated that the model had ade5uate reliability "he make+
up of the sample ,as not discussed in the abstract,
ho,ever the theory ,as tested on a sport team in -9G9
&%cAuley, Duncan, M "ammen, -9G9* 8t should be noted
that our population differs considerably from this type of
sample 6o,ever, the constructs ,ithin the model did
sho, good internal consistency, and thus, reliability in our
article
Ainally, ,eight at baseline and at four months ,as
measured and had several potential limitations discussed
under =data collection limitations> earlier 8 ,ould suspect
that the ,eighing procedure had good validity, in that the
sub2ect3s ,eight in kilograms &to the nearest (- kg* ,as
obtained at t,o set time periods during the study using an
electronic scale, ,hich is perceived to be an accurate and
appropriate means of measuring ,eight 6o,ever,
reliability could have been an issue ,ith the ,eighing,
although ,e are told that a =standardi@ed procedure> is
used 6o,ever, ,e do not kno, ,hether all sub2ects ,ere
,eighed ,ith clothes on or off, ,hat time of day they ,ere
measured, etc 8f these measurement conditions differed
for any sub2ects, ,eight could be affected and ,e ,ould
not have a reliable measure Ainally, the authors might
Critical Appraisal 11

have considered measures such as ,aist circumference or
skin fold caliper measurements obtained at baseline and
four months instead of, or in addition to, ,eight "hese
measures may offer added validity and reliability in
measuring true body mass1fat
G ;ere the analysis plans
&statistical methods* described in
detail7
6o, ,ere the data distributed
&eg, normal versus ske,ed*7
;ere the correlative and
comparative tests appropriate for
the type of data analy@ed and the
5uestions asked7 <#plain
"he statistical methods ,ere described in some detail in a
separate section called =Statistical analysis> %ore detail
,as divulged about the analysis in the results section ;e
,ere told ,hich statistical tests ,ere used for each result,
and in some cases, ,hy they ,ere used &for e#ample, in
the results section, ="he first set of correlation ,as done
bet,een baseline values in predictors and ,eight change,
to e#plore possible moderator effects>*
;e are not told if the data ,as distributed normally or not
6o,ever, in order to do the regressions and t+tests, one
,ould make the assumption that the psychosocial
variables and ,eight changes for the sub2ects ,ere
distributed normally
;e cannot be sure that the correlative tests ,ere
appropriate for our data, as ,e ,ere not made privy to
detail about the actual tests
%%. What are the resultsfindings$
- ;hat ,ere the findings7 "here ,as a significant decrease in ,eight overall from
baseline to four months among group members, though
there ,as ,ide individual variability %ost of the e#ercise
and ,eight management psychosocial variables improved
from baseline to four months, ,ith the most improvement
in the e#ercise variables 6o,ever, ,eight management
variables predicted ,eight change more strongly and
significantly than the e#ercise variables Self+efficacy ,as
the strongest statistically significant individual psychosocial
variable predictor of ,eight change ;eight change ,as
significantly predicted by each of the four behavior change
theories noted above
"he SC" ,as the strongest model, follo,ed by the ""%,
though the only psychosocial variable that added
statistically significant po,er to these theories ,as self+
efficacy
"he importance1effort psychosocial variable ,as a strong
independent predictor of ,eight change and ,as
statistically significant &accounting for .GK of ,eight
change variance*, although its theory, the SD", did not
significantly predict ,eight change
' ;as there clinical significance7
Statistical significance7
As stated under the =findings> section, there ,as statistical
significance found in this study 6o,ever, 8 ,ould be
Critical Appraisal 12

,eary of clinical significance %ost of the psychosocial
measures ,ere based on small scales, some only
measuring four or five items "herefore, because a large
number of people &by statistical standards* participated in
the study, a difference of less than one point1position on an
item could and did yield statistical significance &eg, the
attitude e#ercise psychosocial variable change over time in
the "P$* 8n reality, ,e ,ould probably not consider this a
significant difference and confidently predict that ,ith a
similar ,eight loss intervention an individual ,ould see a
significant improvement in attitude to,ard e#ercise
4 Did the authors put their
findings in the conte#t of the
broader literature on this topic7
<#plain
"he authors did put their findings in the conte#t of the
broader literature on ,eight loss and psychosocial
variables in the results and discussion sections "he
authors discussed ho, this study ,as different from similar
studies, in that it compared several psychosocial variables
from behavioral change theories in the same intervention
and study "hey also discussed ho, other theories have
used different change variables, eg, pre+post subtractions
versus this study3s residuals, but still found similar results
Additionally, the authors discuss ho, this study3s findings
may be limited, in that sub2ects ,ere only measured to four
months "hey state that in a similar study ,hich follo,ed
participants -E months, e#ercise psychosocial variables
,ere found to be more predictive of ,eight loss than
,eight management psychosocial variables at -E months,
though similar to our study, the trend ,as reversed in the
first four months "he authors suggest if this study ,ere
e#tended, they might find results comparable to the
comparison study
%%%. 5o# can % apply the resultsfindings$
- ;hat relevance do the findings
have to nursing practice7
As stated above, the results may not yield as much clinical
significance as statistical significance 6o,ever, the
findings are relevant to nursing practice, in that obesity is a
ma2or health concern that brings ,ith it a host of
comorbidities and issues that affect nursing care &eg,
being a,are of the risk for "ype 88 diabetes development,
the propensity of these individuals to,ard developing
bedsores and being mindful of turning the patient
fre5uently* "herefore, it is to the nurse3s advantage that
she be cogni@ant of emergent literature, like this study, that
strives to understand the associations behind motivation for
behavior change leading to ,eight loss Arom this study,
the nurse can internali@e the fact that increasing her
patient3s self+efficacy &ie, the feeling that he or she has
the po,er to affect change in his or her o,n life* increases
the patient3s ,eight loss likelihood
' Discuss ho, the findings can be
applied to practice
"hese findings may be applied in practice to create hospital
or community ,eight+loss programs that focus on
increasing the self+efficacy of participants to,ard ,eight
loss and e#ercise &eg, giving the participants tips to avoid
over+eating on holidays and pointers on ho, to read food
labels, providing pedometers to the participants to track
Critical Appraisal 13

e#ercise progress* Additionally, the programs could
include modules that focus on the intrinsic motivation of the
importance1effort of e#ercise &another strong psychosocial variable
predictor of ,eight loss* Aor e#ample, participants
might be asked to self+organi@e a ,eekly plan for e#ercise,
according to the types of e#ercises, times, and days that
they feel they can achieve the best results
Critical Appraisal 14

References
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Aoster, ID, ;adden "A, Logt, RA, M $re,er, I &-99)* ;hat is
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obesity treatment outcomes Journal of onsulting and linical
Psychology, #!&-*, )9+G/
%ar5ue@, DN, M %cAuley, < &'((E* Social cognitive correlates of leisure
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