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Running head: IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
1
The Impact of Lifestyle on the Prevalence of High Blood Pressure amongst the Middle-Aged
Walden University
NURS 6052
Essentials of Evidence Based Practice
December 7, 2017
Antwan Cooke
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
2
Impact of High Blood Pressure on Middle-Aged Lifestyle
Cardiovascular diseases have become a common issue in the present times. However,
one of the most prevalent cardiovascular diseases is high blood pressure. As blood is pumped
from the heart through the arteries to other body organs, it is necessary to maintain a
particular level of pressure that should sustain the flow while at the same time aligning to the
capacity of the blood vessels. When this pressure exceeds the pressure that the blood vessels
can support, this could be devastating to both the blood vessels and the organs that receive
this blood. In return, this affects the distribution of vital body requirements such as oxygen
and nutrients. There are various studies that focus on this problem and more so due to its
relevance in the healthcare sector. While many of these focus on particular at-risk groups,
very few studies explore the overall issues pertaining the problem including causes, risk
factors, interventions, prevention, and secondary illnesses. At the same time, the prevalence
and risk factors of the disease may vary from time to time, which calls for a continuous
update of the studies in order to identify the positioning of the problem at every one time.
This impacts clear roles of nursing practice that have been established many years ago that
center around patient education of hypertension management. “The role of nurses has been
recognized for nearly 50 years in public and professional education to improve hypertension
control promoted by the US National High Blood Pressure Education Program’s Joint
National Committee reports and other publications” (Himmelfarb, Mensah, & Hill 2016, para.
4). In an attempt to develop a clear understanding of the problem, this paper will develop a
plan that will help in exploring various recent studies discussing various specific aspects of
high blood pressure and consolidate the discussions into a single comprehensive document.
Significance of the problem
High blood pressure has become a common problem especially for the young and
middle-aged. In this case, high blood pressure is responsible for at least 12% of the total
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
3
annual mortalities around the world (Bromfield & Muntner, 2013). However, the prevalence
of the disease may vary from place to place as well as from one population to another.
According to Joffres, Falaschetti, Gillespie, Robitaille … Campbell (2013), more than 75
million Americans, which represents 29% of the total US population, suffers from high blood
pressure. While this may be a major problem amongst the general population, races such as
the non-Hispanic whites are at relatively higher risks of getting high blood pressure
(Lackland, 2014). Unfortunately, some of these studies take a long time before their results
are availed to the public. At the same time, the causes and risk factors may keep on changing
from time to time. As reported by Lindsay, Connor, Joffres, Birtwhistle … Cloutier (2013),
the lifestyle of that people lead at the present age has changed drastically from the lifestyles
that they led a decade or two ago. Coincidentally, high blood pressure is one of the most
common lifestyle diseases (Diaz & Shimbo, 2013). As a result, it is necessary to constantly
update the prevalence, causes, risk factors, and the interventions available for the disease.
This will then help the public to understand how to address the problem.
There is a need to develop comprehensive results detailing every aspect of high blood
pressure. It is evident that researchers have accorded high blood pressure the attention that it
deserves. In this case, a simple search on various catalogs avails a large number of articles
and books discussing various issues regarding the disease. Unfortunately, a simple analysis of
the results indicates that most of these studies focus on a particular area rather than the whole
problem. This leaves a lot of gaps in the results. While it may be important to generate the
specific results as a way of creating a more meaningful understanding of that particular area,
it is equally necessary to consolidate all the aspects of the disease. For instance, it is necessary
to avail information regarding both the risk factors and the prevention at the same time in
order to create the best impact. If this study is accomplished, it will thus be of high
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
4
significance to the healthy population, patients with high blood pressure, health practitioners
and caregivers, and the wider health sector.
Research questions
A number of research questions have been developed in order to help in exploring the
problem. However, some of the most significant questions and a description of their
feasibility will be discussed in this section.
1. What are the risk factors for high blood pressure?
This is an important research question for this paper. In this case, it helps in
identifying the things that make people susceptible to high blood pressure. As discussed by
Tespaye, Byass & Wall (2009), for example, being middle-aged puts one at a higher risk of
getting high blood pressure than it is the case for the elderly. At the same time, a group such
as the non-Hispanic Whites in the US is at a relatively higher risk than the African Americans
(Lackland, 2014). There is a lot of data regarding the risk factors, which means that this will
be important while studying the problem.
2. What are the causes of high blood pressure?
There are various causes of high blood pressure. While many studies have developed a
set of causes regarding the disease, it is difficult to identify one that explores all the possible
causes. As such, this area may need more focus as a way of developing a better
understanding.
3. How prevalent is high blood pressure and how does it vary?
High blood pressure is highly prevalent. As discussed earlier, however, this prevalence
may vary from place to place as well as from one group to another. As such, exploring the
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
5
prevalence from various regions may be important in order to generate results that best
represent the general population.
4. What interventions are available for high blood pressure and which are the most
appropriate?
Various interventions exist regarding the disease. However, they may work differently
for different groups. While most of these interventions are often generalized, it may be
important to illustrate how well each of them works and to which group.
5. How does one know when they have high blood pressure?
It is important to discuss the diagnosis of the disease. Similar to other diseases, high
blood pressure has a number of signs and symptoms that one can evaluate to determine its
existence as well as other laboratory tests that could be done to generate a better conclusion.
Pico question
This study will focus on the middle-aged as the population of the study. At the same
time, the paper will also focus on a change of lifestyle as the intervention of the disease. The
expected outcome revolves around a decline or rise in the risk factors of high blood pressure.
In this paper, this will be represented by the chances of the disease. The following PICO
question will thus guide this study.
Does a change of lifestyle determine the chances of high blood pressure amongst the
middle-aged population?
Keywords
It is important to develop a set of keywords that will guide the process of research. In
order to generate good results, the following keywords have been developed after narrowing
down the PICO question.
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
•
High blood pressure
•
Prevalence of high blood pressure
•
Risk factors of high blood pressure
•
High blood pressure amongst the middle-aged
•
Impact of age on prevalence of high blood pressure
•
Interventions of high blood pressure
•
Causes of high blood pressure
•
How to prevent high blood pressure
•
Impact of lifestyle on high blood pressure
•
Lifestyles that contribute to high blood pressure
6
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
References
Bromfield, S., & Muntner, P. (2013). High Blood Pressure: The Leading Global Burden of
Disease Risk Factor and the Need for Worldwide Prevention Programs. Current
Hypertension Reports, 15(3), 134–136. http://doi.org/10.1007/s11906-013-0340-9
Diaz, K. M., & Shimbo, D. (2013). Physical Activity and the Prevention of
Hypertension. Current Hypertension Reports, 15(6), 659–668.
http://doi.org/10.1007/s11906-013-0386-8
Himmelfarb, C., Mensh, Y., & Hill, M. (2016). Expanding the Role of Nurses to Improve
Hypertension Care and Control Globally. Obtained from
http://www.sciencedirect.com/science/article/pii/S221499961600028X
Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., …
Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in
national surveys from England, the USA and Canada, and correlation with stroke and
ischaemic heart disease mortality: a cross-sectional study. BMJ Open, 3(8), e003423.
http://doi.org/10.1136/bmjopen-2013-003423
Lackland, D. T. (2014). Racial Differences in Hypertension: Implications for High Blood
Pressure Management. The American Journal of the Medical Sciences, 348(2), 135–
138. http://doi.org/10.1097/MAJ.0000000000000308
Lindsay, P., Connor Gorber, S., Joffres, M., Birtwhistle, R., McKay, D., & Cloutier, L.
(2013). Recommendations on screening for high blood pressure in Canadian
adults. Canadian Family Physician, 59(9), 927–933.
7
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
8
Tesfaye, F., Byass, P., & Wall, S. (2009). Population based prevalence of high blood pressure
among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovascular
Disorders, 9, 39. http://doi.org/10.1186/1471-2261-9-39
Literature Review Summary Table
NURS 6052
Name: Antwan Cooke
Citation
Type of Study
Setting
Key
Concepts/Variables
Findings
Hierarchy of
Evidence Level
Concepts:
Prevalence of
diseases across the
world has been
changing, and with
hypertension ranking
amongst the leading
causes of death for
the past few
decades.
Hypertension has been the
leading single cause of death for
the past few decades. Contrary to
the initial misconception that
developing nations are the only
ones at risk of an increase in the
mortality rate due to hypertension,
developed nations are equally
affected. This means that the
economic impacts such as
lifestyle differences, foods
consumed, and awareness levels
determine the prevalence of
hypertension.
Although intervention programs
should be established in both
developing and developed
countries, more emphasis should
be placed on developing
countries. Their risks are more
pronounced as a result of the
poor lifestyles that people lead.
Less significant.
Important for
creating a
foundation and a
global overview of
hypertension and a
comparison against
other GBDs.
Design Type
Framework/Theory
Bromfield, S., &
Muntner, P. (2013).
High Blood Pressure:
The Leading Global
Burden of Disease
Risk Factor and the
Need for Worldwide
Prevention Programs.
Current Hypertension
Reports, 15(3), 134–
136.
http://doi.org/10.1007/s
11906-013-0340-9
Global
Type of Study:
Secondary
Design Type:
Report
Framework/Theory:
Hypertension is, and
has over time been,
the leading cause of
death around the
world. However, its
prevalence could be
caused by economic
gaps and other risk
factors such as age.
Independent
Variable:
Global burden of
disease (GBD).
Dependent Variable:
Mortality rate
Controlled Variable:
Economic factors,
age.
Although differences are
identified in the prevalence of
hypertension amongst both
developing and developed
nations, it may be necessary to
conduct studies that will lead to
customized prevention, treatment,
and control based on the
economy of a region.
1
Literature Review Summary Table
NURS 6052
Lackland, D. T. (2014).
Racial Differences in
Hypertension:
Implications for High
Blood Pressure
Management. The
American Journal of
the Medical Sciences,
348(2), 135–138.
http://doi.org/10.1097/
MAJ.000000000000030
8
Type of Study:
Secondary
Design Type:
Integrative review
Framework/Theory:
Racial disparities
are common in both
the prevalence of
diseases and
mortalities. In
hypertension, there
are various factors
associated with
racial disparities,
and that may put
some of the races at
a higher risk than
others.
The United
States.
Concepts:
Blood pressure
amongst African
Americans has been
high than in
Caucasians.
Lifestyle differs
across races in the
US.
Independent
Variable:
Prevalence of
hypertension
Dependent Variable:
Race
Controlled Variable:
Age, comorbidities.
Clinical guidelines have shown a
high prevalence of hypertension
amongst the African Americans.
Other races such as the
Caucasians face relatively lower
risks of the same, which is
evident in both mortalities, ratio of
diagnosis, and associated
comorbidities. The lifestyles and
factors associated with
hypertension also differ from one
race to another to another.
The lifestyles of different cultures
and groups needs to be
considered when developing
intervention and management
programs that should help in
addressing the hypertension due
their high influence on its
prevalence.
There is insufficient evidence in
studies to justify the differences in
factors associated with racial
disparities as well as the
differences in prevalence. This
calls for focused research based
on these gaps.
Strong evidence.
Analyzes tens of
primary studies.
Literature Review Summary Table
NURS 6052
Citation
Study
Design Type
Framework/Theory
Diaz, K. M., & Shimbo,
D. (2013). Physical
Activity and the
Prevention of
Hypertension. Current
Hypertension Reports,
15(6), 659–668.
http://doi.org/10.1007/s
11906-013-0386-8
Type of Study:
Secondary research
Setting
Global
Design Type:
Integrative review
Framework/Theory:
Prevalence has
been on the
increase and
prevention is
becoming
increasingly
significant.
Key
Concepts/Variables
Findings
Hierarchy of
Evidence Level
Concepts:
Lifestyle could be key
to achieving a
success in improving
prevention of
hypertension.
Many studies also indicate that
different people may respond
differently to various physical
activities based on their body
processes. However, all existing
literature and studies strongly
support a positive relationship
between physical activity and the
prevalence of hypertension.
Some physical activities may be
more successful than others in
the prevention and management
of hypertension.
Physical activity thus needs to be
well developed alongside other
lifestyles such as food
consumption and social lives.
Very strong
evidence. The
study explores
tens of primary
studies and
analyzes their
findings to derive
a more reliable
conclusion.
Independent
Variable:
Prevalence of
hypertension.
Dependent Variable:
Physical activity.
Controlled Variable:
Gender, age, other
risk factors.
Yang, M. H., Kang, S.
Y., Lee, J. A., Kim, Y.
S., Sung, E. J., Lee, K.Y., … Lee, S. Y. (2017).
The Effect of Lifestyle
Changes on Blood
Pressure Control
among Hypertensive
Patients. Korean
Journal of Family
Medicine, 38(4), 173–
180.
http://doi.org/10.4082/k
Type of Study:
Primary research
Design Type:
Survey
Framework/Theory:
Hypertension is
common for patients
that occasionally
seek primary care.
However, lifestyle
behaviors could be
Korea
Concepts:
Hypertension is a
lifestyle disease.
Lifestyle
modifications may be
necessary during the
period of intervention.
Independent
Variable:
Hypertension control
Dependent Variable:
Gaps thus appear on the
prescription of physical activities
on at-risk individuals and
hypertension patients, which call
for further studies.
Poor physical activity led to
weight gain. Consuming high
amounts of salt, weight gain, and
inadequate physical activity
created more risks of getting
hypertension and led to increased
period of recovery. Proper
lifestyle balance reduced the
need for medication amongst
many patients. Physicians should
thus modify the lifestyles of
patients so as to achieve better
results.
The evidence is
highly reliable.
This study will
form a critical
part of the
research.
Literature Review Summary Table
NURS 6052
jfm.2017.38.4.173
Patients’ lifestyles
(increased salt intake
and physical activity)
integrated into their
care so as to help
them achieve better
results.
Controlled Variable:
Age, sex
Babaee Beigi, M. A.,
Zibaeenezhad, M. J.,
Aghasadeghi, K.,
Jokar, A.,
Shekarforoush, S., &
Khazraei, H. (2014).
The Effect of
Educational Programs
on Hypertension
Management.
International
Cardiovascular
Research Journal, 8(3),
94–98.
Type of Study:
Primary
Design Type:
Quasi-experimental
study
Framework/Theory:
Hypertension
creates the greatest
risk for other chronic
illnesses such as
CDVs and stroke.
Education programs
could be an
important part in
creating awareness
and creating lifestyle
change, which will
then improve
response to these
diseases.
Iran
Concepts:
Hypertension creates
the greatest risk for
other chronic
illnesses such as
CDVs and stroke.
Effectiveness of
educational programs
would thus indirectly
influence prevalence
of the chronic
illnesses.
Independent
Variable:
Short-term
educational
programs.
Dependent Variable:
Lifestyle changes,
knowledge levels,
and blood pressure.
Controlled Variable:
Healthcare providers should
make it a priority for them to
evaluate their patients’ needs and
develop lifestyles that should be
adopted alongside medications
for their primary care.
The study identifies multiple other
lifestyles that had been
mentioned by the existing
literature as having a potential
impact. This study may thus need
to be expanded so as to create
more reliable results.
Educational programs raised
controlled hypertension response
through lifestyle by close to five
times and awareness and
treatment at relatively the same
rate. This could then be important
in improving self-management
and enhancing the control of
detrimental lifestyles, which then
help in managing hypertension
and its comorbidities.
Patients and the general society
should be taught to manage
themselves through adoption of a
healthy lifestyle rather than just
relying on the decisions of their
cater givers.
The study covered limited
lifestyles. In fact, the authors
insisted that their lack of covering
issues such as smoking cessation
could have an impact on their
study. There is thus a need for a
more comprehensive study that is
also not limited geographically.
The evidence is
limited due to the
low sample size.
However, the
study can be
important in
developing a set
of probable
lifestyle changes
and factors.
Literature Review Summary Table
NURS 6052
Running head: QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
High Blood Pressure: Qualitative Vs. Quantitative Research Designs
Walden University
NURS 6052
Antwan Cooke
January 13, 2018
1
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Information Gained from the Two Resources
There are many questions that arise in relation to the differences between qualitative
and quantitative approaches when it comes to medical research. In this paper, two papers –
each featuring each approach – will be critiqued and the differences between the two
approaches will be discussed so as to develop a better comparison. At the same time, the issue
of whether or not qualitative research is scientific research will also be explored so as to
create a clear picture.
Application, Advantages, and Disadvantages
A lot of information has been gained from the two resources. Notably, it has been
determined that both qualitative and quantitative designs are important in research and can
help in the collection of vital information. However, there are areas that each of the two
approaches is more appropriate than the other. In the case of the first paper, for example, Lee
et al. (2016) sought to link multiple stressors to the prevalence of high blood pressure
amongst the African Americans. As such, this sought to attribute many factors to one attribute
and, by so doing, a lot of information that is easily quantifiable was required. In return, this
called for a quantitative research approach. On the other hand, the study by Shima, Farizah &
Majid (2014) focused on collecting comprehensive data involving a higher level of opinion.
It could not be possible to quantify these data especially since the collected data was
unstructured and could differ significantly from one participant to the other. This means that it
could not be easily standardized despite being of value, which then called for a qualitative
research rather than a quantitative approach.
Quantitative research facilitates standardization of data collection and analysis. In this
case, it has been identified that data to be collected can be easily coded and thus quantified as
was the case with the surveys in the study by Lee et al. (2016). This made it easy to collect
2
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
data and within a short period as all the participants filled a replicated survey. Unfortunately,
the same could not be possible in qualitative research. As identified in the paper, there were
difficulties in the standardization of the interview responses, which prompted multiple
processes such as discussions and involvement of multiple professionals to code the data. In
fact, the time taken to collect data was too long, which was between 45 and 90 minutes for
each patient. Further, this process could only support dealing with one participant at a time.
Qualitative research supports the coverage of a larger sample size. In this case, this is
facilitated by the ease of data collection due to the standardization of processes and data sets
as well as the ability to collect the data of multiple participants at once. In the study by Lee et
al. (2016), for example, 127 participants took part in the study. On the other hand, qualitative
research is quite demanding in terms of time and resources. In return, this limits the coverage
and sample size, which explains the reasons that Shima, Farizah and Majid (2014) were able
to cover just 25 participants against 127 in the quantitative study.
Quantitative research significantly eliminates bias. In this case, Lee et. Al. (2016)
standardized the questions and thus each participant was subjected to the same survey. This
means that the participants were subjected to similar conditions. Further, the patients worked
on their own without the influence of the researchers. Unfortunately, the study Shima, Farizah
and Majid (2014) required that the researchers work hand in hand with the participants over a
long period while at the same time posing probing and guiding questions that sought to guide
the direction of the study. Since the probing questions were not standardized, there are
chances that the results could have been biased. This is worsened by the fact that there is no
standard time for each interview.
3
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Qualitative Research is not Real Science
Qualitative research is science. Notably, scientific studies are known for their high
reliability and use of standardized measures so as to create a better representation of the
population from the sample. Despite raising unending questions on the basis of its scientific
accuracy as compared to quantitative research, qualitative research is well known for its high
relevance. As reported by Johansson, Risberg and Hamberg (2003), the high relevance of
scientific research with regard to its purpose makes it scientific. Moreover, a research is
scientifically justified if it is of significance to its initial purpose and its ability to represent the
population. On the same note, Shuval et al. (2011) acknowledge that there has been an
increase in the number of qualitative research papers in the health sector in the recent past as a
result of the realization of their significance and relevance to the industry, especially in social
studies and other fields requiring interaction with the subject. As a result, these are equally
important scientifically to quantitative research.
Despite being acknowledged, qualitative studies have a number of setbacks such as
high possibilities of bias and the presence of too much opinion. In order to improve these
studies and their scientific soundness, Shuval et al. (2011) recommend that qualitative
researchers develop a better mastery of scientific research methodologies and more
standardized approaches be developed to ensure that the studies are better representative of
the population.
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QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
References
Johansson, E. E., Risberg, G., & Hamberg, K. (January 01, 2003). Is qualitative research
scientific, or merely relevant? Research-interested primary care and hospital
physicians’ appraisal of abstracts. Scandinavian Journal of Primary Health
Care, 21(1), 10-4.
Lee, A. K., Corneille, M. A., Hall, N. M., Yancu, C. N., & Myers, M. (2016). The stressors of
being young and Black: Cardiovascular health and Black young adults. Psychology &
Health, 31(5), 578–591. http://doi.org/10.1080/08870446.2015.1127373
Shima, R., Farizah, M. H., & Majid, H. A. (2014). A qualitative study on hypertensive care
behavior in primary health care settings in Malaysia. Patient Preference and
Adherence, 8, 1597–1609. http://doi.org/10.2147/PPA.S69680
Shuval, K., Harker, K., Roudsari, B., Groce, N. E., Mills, B., Siddiqi, Z., & Shachak, A.
(January 01, 2011). Is qualitative research second class science? A quantitative
longitudinal examination of qualitative research in medical journals. Plos One, 6(2),
e16937. https://doi.org/10.1371/journal.pone.0016937
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QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Critique Template for a Quantitative Study
NURS 6052
Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies
January 13, 2018
Antwan Cooke
Article Reference:
Lee, A. K., Corneille, M. A., Hall, N. M., Yancu, C. N., & Myers, M. (2016). The stressors of
being young and Black: Cardiovascular health and Black young adults. Psychology &
Health, 31(5), 578–591. http://doi.org/10.1080/08870446.2015.1127373
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975165/
1. Research Problem and Purpose
In this study, Lee, Corneille, Hall, Yancu & Myers (2016) sought to evaluate the
impact of various stressors on cardiovascular diseases. While evaluating the problem guiding
their study, the authors acknowledge that humans are often subjected to various biological and
social factors, and that may have an impact on their health. In this case, however, the authors
specify that some groups are more vulnerable and, with reference to the African American
youths, they tend to be predisposed to some factors such as racism and marginalization.
Consequently, these could have ramifications for their health outcomes. It is for this reason
that the authors seek to identify the impact of stressors such as occupational, racial, financial,
and psychological distresses pose on this group based on its vulnerability.
2. Hypotheses and Research Questions
The authors list hypotheses that are fetched from their objectives and the identified
problem. These are:
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QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
a. It has been determined that racial stress and psychological distress are directly
associated with body mass index (BMI) – an indicator of cardiovascular health risk.
b. It has been determined that racial stress and psychological distress are directly
associated with waist to hip ratio (WHR).
c. Racial stress and psychological distress would be positively associated with systolic
and diastolic blood pressure (BP).
3. Literature Review
The authors create a comprehensive literature review section that provides a lengthy
integrated analysis of many past studies relevant to the problem statement. The materials are
highly relevant and the authors critically review various studies and their findings against
each other. Rather than giving a summary, however, the authors conclude the review with a
statement of the hypotheses, and that reflect upon what has already been analyzed in the
section. Intriguingly, the authors chose not to use just the latest papers in their review. Rather,
they explore papers as old as two decades and progressively develop their points in a way that
leads to the establishment of the hypotheses.
4. Theoretical or Conceptual Framework
The authors theorize that, with the existing white supremacy and poor resources
distribution, the young African Americans definitely face multiple challenges associated with
racial disparities. Added to restricted access to resources and services, this structural racism
puts them at a relatively higher risk of getting a high blood pressure.
5. Population
The population is fetched from the African Americans race. In this case, the number is
divided into 28 males against 96 females. While sampling, the authors only consider those
aged between 18 and 27 years. In order to arrive at this group, the study focused on university
students, and with all other races being excluded from the study. This was done through flyers
7
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
and classroom announcements in Southeastern US.
6. Protection of Human Research Participants
All the patients were required to fill an informed consent form. To protect human
research subjects, the research was conducted in private cubicles so as to protect the
participants identify.
7. Research Design
In this quantitative study surveys were used to collect data from the students. There
was no pilot study. The research developed a demographic questionnaire specifically for their
study while they borrowed other designs from previous work so as to collect comprehensive
data. In this case, depression anxiety stress scales were borrowed from Lovibond and
Lovibond (1995), the Nadanolitization Scale from Taylor & Grundy (1996), Index of RaceRelated Stress-Brief version (IRRS-B) from Utsey (1999), Anthropometric Measures from
Cochrane recommendation, and the collection of blood pressure was collected using Omron
automatic blood pressure monitor.
Instruments and Strategies for Measurement
The study utilized surveys in collecting data. These surveys consisted of various
questions that helped the authors to measure the youths’ stress levels. Additionally, blood
pressure was collected using Omron automatic blood pressure monitor.
8. Data Collection
After signing the informed consent form, the participants filled the various questions
contained in the questionnaire. Afterwards, anthropometric indicators and blood pressure
were collected in private cubicles. The participants were also informed of a follow-up study
and informed of the dates.
9. Data Analysis
Statistical Package for Social Sciences was used to analyze the data statistically and
8
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
generate bivariate associations, and that were later assessed through the Pearson correlations.
These methods were highly relevant owing to the multiple data items collected in this study.
10. Interpretation of Results
The authors also used hierarchical multiple regressions to establish various
associations. These associations were then analyzed against the hypotheses. Correlation
analysis and analysis of covariance further furnished the results.
11. Discussion of Findings
The study found internalized racism to be associated with BMI, individual racism with
BP, and depression with cardiovascular diseases risk. These coincided with the hypotheses.
Various resources were used to discuss these findings, and that showed a significant
relationship with the framework.
12. Limitations
The authors clearly identified the limitations. These included the small sample size
and the lack of accounting for the many confounding variables.
13. Implications
The conclusions and implications have been directly associated with the study
findings. In fact, this is briefly discussed by the authors.
14. Recommendations
The authors offer legitimate recommendations in that they suggest that future studies
concentrate on the limitations of their study such as specific mechanisms to analyze the
impact of psychological distress and psychosocial stress. The authors also insist on the need to
account for more variables such as culture so as to improve results. Based on the
1
The Impact of Lifestyle on the Prevalence of High Blood Pressure amongst the Middle-Aged
Walden University
NURS 6052
Essentials of Evidence Based Practice
December 7, 2017
Antwan Cooke
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
2
Impact of High Blood Pressure on Middle-Aged Lifestyle
Cardiovascular diseases have become a common issue in the present times. However,
one of the most prevalent cardiovascular diseases is high blood pressure. As blood is pumped
from the heart through the arteries to other body organs, it is necessary to maintain a
particular level of pressure that should sustain the flow while at the same time aligning to the
capacity of the blood vessels. When this pressure exceeds the pressure that the blood vessels
can support, this could be devastating to both the blood vessels and the organs that receive
this blood. In return, this affects the distribution of vital body requirements such as oxygen
and nutrients. There are various studies that focus on this problem and more so due to its
relevance in the healthcare sector. While many of these focus on particular at-risk groups,
very few studies explore the overall issues pertaining the problem including causes, risk
factors, interventions, prevention, and secondary illnesses. At the same time, the prevalence
and risk factors of the disease may vary from time to time, which calls for a continuous
update of the studies in order to identify the positioning of the problem at every one time.
This impacts clear roles of nursing practice that have been established many years ago that
center around patient education of hypertension management. “The role of nurses has been
recognized for nearly 50 years in public and professional education to improve hypertension
control promoted by the US National High Blood Pressure Education Program’s Joint
National Committee reports and other publications” (Himmelfarb, Mensah, & Hill 2016, para.
4). In an attempt to develop a clear understanding of the problem, this paper will develop a
plan that will help in exploring various recent studies discussing various specific aspects of
high blood pressure and consolidate the discussions into a single comprehensive document.
Significance of the problem
High blood pressure has become a common problem especially for the young and
middle-aged. In this case, high blood pressure is responsible for at least 12% of the total
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
3
annual mortalities around the world (Bromfield & Muntner, 2013). However, the prevalence
of the disease may vary from place to place as well as from one population to another.
According to Joffres, Falaschetti, Gillespie, Robitaille … Campbell (2013), more than 75
million Americans, which represents 29% of the total US population, suffers from high blood
pressure. While this may be a major problem amongst the general population, races such as
the non-Hispanic whites are at relatively higher risks of getting high blood pressure
(Lackland, 2014). Unfortunately, some of these studies take a long time before their results
are availed to the public. At the same time, the causes and risk factors may keep on changing
from time to time. As reported by Lindsay, Connor, Joffres, Birtwhistle … Cloutier (2013),
the lifestyle of that people lead at the present age has changed drastically from the lifestyles
that they led a decade or two ago. Coincidentally, high blood pressure is one of the most
common lifestyle diseases (Diaz & Shimbo, 2013). As a result, it is necessary to constantly
update the prevalence, causes, risk factors, and the interventions available for the disease.
This will then help the public to understand how to address the problem.
There is a need to develop comprehensive results detailing every aspect of high blood
pressure. It is evident that researchers have accorded high blood pressure the attention that it
deserves. In this case, a simple search on various catalogs avails a large number of articles
and books discussing various issues regarding the disease. Unfortunately, a simple analysis of
the results indicates that most of these studies focus on a particular area rather than the whole
problem. This leaves a lot of gaps in the results. While it may be important to generate the
specific results as a way of creating a more meaningful understanding of that particular area,
it is equally necessary to consolidate all the aspects of the disease. For instance, it is necessary
to avail information regarding both the risk factors and the prevention at the same time in
order to create the best impact. If this study is accomplished, it will thus be of high
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
4
significance to the healthy population, patients with high blood pressure, health practitioners
and caregivers, and the wider health sector.
Research questions
A number of research questions have been developed in order to help in exploring the
problem. However, some of the most significant questions and a description of their
feasibility will be discussed in this section.
1. What are the risk factors for high blood pressure?
This is an important research question for this paper. In this case, it helps in
identifying the things that make people susceptible to high blood pressure. As discussed by
Tespaye, Byass & Wall (2009), for example, being middle-aged puts one at a higher risk of
getting high blood pressure than it is the case for the elderly. At the same time, a group such
as the non-Hispanic Whites in the US is at a relatively higher risk than the African Americans
(Lackland, 2014). There is a lot of data regarding the risk factors, which means that this will
be important while studying the problem.
2. What are the causes of high blood pressure?
There are various causes of high blood pressure. While many studies have developed a
set of causes regarding the disease, it is difficult to identify one that explores all the possible
causes. As such, this area may need more focus as a way of developing a better
understanding.
3. How prevalent is high blood pressure and how does it vary?
High blood pressure is highly prevalent. As discussed earlier, however, this prevalence
may vary from place to place as well as from one group to another. As such, exploring the
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
5
prevalence from various regions may be important in order to generate results that best
represent the general population.
4. What interventions are available for high blood pressure and which are the most
appropriate?
Various interventions exist regarding the disease. However, they may work differently
for different groups. While most of these interventions are often generalized, it may be
important to illustrate how well each of them works and to which group.
5. How does one know when they have high blood pressure?
It is important to discuss the diagnosis of the disease. Similar to other diseases, high
blood pressure has a number of signs and symptoms that one can evaluate to determine its
existence as well as other laboratory tests that could be done to generate a better conclusion.
Pico question
This study will focus on the middle-aged as the population of the study. At the same
time, the paper will also focus on a change of lifestyle as the intervention of the disease. The
expected outcome revolves around a decline or rise in the risk factors of high blood pressure.
In this paper, this will be represented by the chances of the disease. The following PICO
question will thus guide this study.
Does a change of lifestyle determine the chances of high blood pressure amongst the
middle-aged population?
Keywords
It is important to develop a set of keywords that will guide the process of research. In
order to generate good results, the following keywords have been developed after narrowing
down the PICO question.
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
•
High blood pressure
•
Prevalence of high blood pressure
•
Risk factors of high blood pressure
•
High blood pressure amongst the middle-aged
•
Impact of age on prevalence of high blood pressure
•
Interventions of high blood pressure
•
Causes of high blood pressure
•
How to prevent high blood pressure
•
Impact of lifestyle on high blood pressure
•
Lifestyles that contribute to high blood pressure
6
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
References
Bromfield, S., & Muntner, P. (2013). High Blood Pressure: The Leading Global Burden of
Disease Risk Factor and the Need for Worldwide Prevention Programs. Current
Hypertension Reports, 15(3), 134–136. http://doi.org/10.1007/s11906-013-0340-9
Diaz, K. M., & Shimbo, D. (2013). Physical Activity and the Prevention of
Hypertension. Current Hypertension Reports, 15(6), 659–668.
http://doi.org/10.1007/s11906-013-0386-8
Himmelfarb, C., Mensh, Y., & Hill, M. (2016). Expanding the Role of Nurses to Improve
Hypertension Care and Control Globally. Obtained from
http://www.sciencedirect.com/science/article/pii/S221499961600028X
Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., …
Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in
national surveys from England, the USA and Canada, and correlation with stroke and
ischaemic heart disease mortality: a cross-sectional study. BMJ Open, 3(8), e003423.
http://doi.org/10.1136/bmjopen-2013-003423
Lackland, D. T. (2014). Racial Differences in Hypertension: Implications for High Blood
Pressure Management. The American Journal of the Medical Sciences, 348(2), 135–
138. http://doi.org/10.1097/MAJ.0000000000000308
Lindsay, P., Connor Gorber, S., Joffres, M., Birtwhistle, R., McKay, D., & Cloutier, L.
(2013). Recommendations on screening for high blood pressure in Canadian
adults. Canadian Family Physician, 59(9), 927–933.
7
IMPACT OF LIFESTYLE ON HBP AMONGST THE MIDDLE-AGED
8
Tesfaye, F., Byass, P., & Wall, S. (2009). Population based prevalence of high blood pressure
among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovascular
Disorders, 9, 39. http://doi.org/10.1186/1471-2261-9-39
Literature Review Summary Table
NURS 6052
Name: Antwan Cooke
Citation
Type of Study
Setting
Key
Concepts/Variables
Findings
Hierarchy of
Evidence Level
Concepts:
Prevalence of
diseases across the
world has been
changing, and with
hypertension ranking
amongst the leading
causes of death for
the past few
decades.
Hypertension has been the
leading single cause of death for
the past few decades. Contrary to
the initial misconception that
developing nations are the only
ones at risk of an increase in the
mortality rate due to hypertension,
developed nations are equally
affected. This means that the
economic impacts such as
lifestyle differences, foods
consumed, and awareness levels
determine the prevalence of
hypertension.
Although intervention programs
should be established in both
developing and developed
countries, more emphasis should
be placed on developing
countries. Their risks are more
pronounced as a result of the
poor lifestyles that people lead.
Less significant.
Important for
creating a
foundation and a
global overview of
hypertension and a
comparison against
other GBDs.
Design Type
Framework/Theory
Bromfield, S., &
Muntner, P. (2013).
High Blood Pressure:
The Leading Global
Burden of Disease
Risk Factor and the
Need for Worldwide
Prevention Programs.
Current Hypertension
Reports, 15(3), 134–
136.
http://doi.org/10.1007/s
11906-013-0340-9
Global
Type of Study:
Secondary
Design Type:
Report
Framework/Theory:
Hypertension is, and
has over time been,
the leading cause of
death around the
world. However, its
prevalence could be
caused by economic
gaps and other risk
factors such as age.
Independent
Variable:
Global burden of
disease (GBD).
Dependent Variable:
Mortality rate
Controlled Variable:
Economic factors,
age.
Although differences are
identified in the prevalence of
hypertension amongst both
developing and developed
nations, it may be necessary to
conduct studies that will lead to
customized prevention, treatment,
and control based on the
economy of a region.
1
Literature Review Summary Table
NURS 6052
Lackland, D. T. (2014).
Racial Differences in
Hypertension:
Implications for High
Blood Pressure
Management. The
American Journal of
the Medical Sciences,
348(2), 135–138.
http://doi.org/10.1097/
MAJ.000000000000030
8
Type of Study:
Secondary
Design Type:
Integrative review
Framework/Theory:
Racial disparities
are common in both
the prevalence of
diseases and
mortalities. In
hypertension, there
are various factors
associated with
racial disparities,
and that may put
some of the races at
a higher risk than
others.
The United
States.
Concepts:
Blood pressure
amongst African
Americans has been
high than in
Caucasians.
Lifestyle differs
across races in the
US.
Independent
Variable:
Prevalence of
hypertension
Dependent Variable:
Race
Controlled Variable:
Age, comorbidities.
Clinical guidelines have shown a
high prevalence of hypertension
amongst the African Americans.
Other races such as the
Caucasians face relatively lower
risks of the same, which is
evident in both mortalities, ratio of
diagnosis, and associated
comorbidities. The lifestyles and
factors associated with
hypertension also differ from one
race to another to another.
The lifestyles of different cultures
and groups needs to be
considered when developing
intervention and management
programs that should help in
addressing the hypertension due
their high influence on its
prevalence.
There is insufficient evidence in
studies to justify the differences in
factors associated with racial
disparities as well as the
differences in prevalence. This
calls for focused research based
on these gaps.
Strong evidence.
Analyzes tens of
primary studies.
Literature Review Summary Table
NURS 6052
Citation
Study
Design Type
Framework/Theory
Diaz, K. M., & Shimbo,
D. (2013). Physical
Activity and the
Prevention of
Hypertension. Current
Hypertension Reports,
15(6), 659–668.
http://doi.org/10.1007/s
11906-013-0386-8
Type of Study:
Secondary research
Setting
Global
Design Type:
Integrative review
Framework/Theory:
Prevalence has
been on the
increase and
prevention is
becoming
increasingly
significant.
Key
Concepts/Variables
Findings
Hierarchy of
Evidence Level
Concepts:
Lifestyle could be key
to achieving a
success in improving
prevention of
hypertension.
Many studies also indicate that
different people may respond
differently to various physical
activities based on their body
processes. However, all existing
literature and studies strongly
support a positive relationship
between physical activity and the
prevalence of hypertension.
Some physical activities may be
more successful than others in
the prevention and management
of hypertension.
Physical activity thus needs to be
well developed alongside other
lifestyles such as food
consumption and social lives.
Very strong
evidence. The
study explores
tens of primary
studies and
analyzes their
findings to derive
a more reliable
conclusion.
Independent
Variable:
Prevalence of
hypertension.
Dependent Variable:
Physical activity.
Controlled Variable:
Gender, age, other
risk factors.
Yang, M. H., Kang, S.
Y., Lee, J. A., Kim, Y.
S., Sung, E. J., Lee, K.Y., … Lee, S. Y. (2017).
The Effect of Lifestyle
Changes on Blood
Pressure Control
among Hypertensive
Patients. Korean
Journal of Family
Medicine, 38(4), 173–
180.
http://doi.org/10.4082/k
Type of Study:
Primary research
Design Type:
Survey
Framework/Theory:
Hypertension is
common for patients
that occasionally
seek primary care.
However, lifestyle
behaviors could be
Korea
Concepts:
Hypertension is a
lifestyle disease.
Lifestyle
modifications may be
necessary during the
period of intervention.
Independent
Variable:
Hypertension control
Dependent Variable:
Gaps thus appear on the
prescription of physical activities
on at-risk individuals and
hypertension patients, which call
for further studies.
Poor physical activity led to
weight gain. Consuming high
amounts of salt, weight gain, and
inadequate physical activity
created more risks of getting
hypertension and led to increased
period of recovery. Proper
lifestyle balance reduced the
need for medication amongst
many patients. Physicians should
thus modify the lifestyles of
patients so as to achieve better
results.
The evidence is
highly reliable.
This study will
form a critical
part of the
research.
Literature Review Summary Table
NURS 6052
jfm.2017.38.4.173
Patients’ lifestyles
(increased salt intake
and physical activity)
integrated into their
care so as to help
them achieve better
results.
Controlled Variable:
Age, sex
Babaee Beigi, M. A.,
Zibaeenezhad, M. J.,
Aghasadeghi, K.,
Jokar, A.,
Shekarforoush, S., &
Khazraei, H. (2014).
The Effect of
Educational Programs
on Hypertension
Management.
International
Cardiovascular
Research Journal, 8(3),
94–98.
Type of Study:
Primary
Design Type:
Quasi-experimental
study
Framework/Theory:
Hypertension
creates the greatest
risk for other chronic
illnesses such as
CDVs and stroke.
Education programs
could be an
important part in
creating awareness
and creating lifestyle
change, which will
then improve
response to these
diseases.
Iran
Concepts:
Hypertension creates
the greatest risk for
other chronic
illnesses such as
CDVs and stroke.
Effectiveness of
educational programs
would thus indirectly
influence prevalence
of the chronic
illnesses.
Independent
Variable:
Short-term
educational
programs.
Dependent Variable:
Lifestyle changes,
knowledge levels,
and blood pressure.
Controlled Variable:
Healthcare providers should
make it a priority for them to
evaluate their patients’ needs and
develop lifestyles that should be
adopted alongside medications
for their primary care.
The study identifies multiple other
lifestyles that had been
mentioned by the existing
literature as having a potential
impact. This study may thus need
to be expanded so as to create
more reliable results.
Educational programs raised
controlled hypertension response
through lifestyle by close to five
times and awareness and
treatment at relatively the same
rate. This could then be important
in improving self-management
and enhancing the control of
detrimental lifestyles, which then
help in managing hypertension
and its comorbidities.
Patients and the general society
should be taught to manage
themselves through adoption of a
healthy lifestyle rather than just
relying on the decisions of their
cater givers.
The study covered limited
lifestyles. In fact, the authors
insisted that their lack of covering
issues such as smoking cessation
could have an impact on their
study. There is thus a need for a
more comprehensive study that is
also not limited geographically.
The evidence is
limited due to the
low sample size.
However, the
study can be
important in
developing a set
of probable
lifestyle changes
and factors.
Literature Review Summary Table
NURS 6052
Running head: QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
High Blood Pressure: Qualitative Vs. Quantitative Research Designs
Walden University
NURS 6052
Antwan Cooke
January 13, 2018
1
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Information Gained from the Two Resources
There are many questions that arise in relation to the differences between qualitative
and quantitative approaches when it comes to medical research. In this paper, two papers –
each featuring each approach – will be critiqued and the differences between the two
approaches will be discussed so as to develop a better comparison. At the same time, the issue
of whether or not qualitative research is scientific research will also be explored so as to
create a clear picture.
Application, Advantages, and Disadvantages
A lot of information has been gained from the two resources. Notably, it has been
determined that both qualitative and quantitative designs are important in research and can
help in the collection of vital information. However, there are areas that each of the two
approaches is more appropriate than the other. In the case of the first paper, for example, Lee
et al. (2016) sought to link multiple stressors to the prevalence of high blood pressure
amongst the African Americans. As such, this sought to attribute many factors to one attribute
and, by so doing, a lot of information that is easily quantifiable was required. In return, this
called for a quantitative research approach. On the other hand, the study by Shima, Farizah &
Majid (2014) focused on collecting comprehensive data involving a higher level of opinion.
It could not be possible to quantify these data especially since the collected data was
unstructured and could differ significantly from one participant to the other. This means that it
could not be easily standardized despite being of value, which then called for a qualitative
research rather than a quantitative approach.
Quantitative research facilitates standardization of data collection and analysis. In this
case, it has been identified that data to be collected can be easily coded and thus quantified as
was the case with the surveys in the study by Lee et al. (2016). This made it easy to collect
2
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
data and within a short period as all the participants filled a replicated survey. Unfortunately,
the same could not be possible in qualitative research. As identified in the paper, there were
difficulties in the standardization of the interview responses, which prompted multiple
processes such as discussions and involvement of multiple professionals to code the data. In
fact, the time taken to collect data was too long, which was between 45 and 90 minutes for
each patient. Further, this process could only support dealing with one participant at a time.
Qualitative research supports the coverage of a larger sample size. In this case, this is
facilitated by the ease of data collection due to the standardization of processes and data sets
as well as the ability to collect the data of multiple participants at once. In the study by Lee et
al. (2016), for example, 127 participants took part in the study. On the other hand, qualitative
research is quite demanding in terms of time and resources. In return, this limits the coverage
and sample size, which explains the reasons that Shima, Farizah and Majid (2014) were able
to cover just 25 participants against 127 in the quantitative study.
Quantitative research significantly eliminates bias. In this case, Lee et. Al. (2016)
standardized the questions and thus each participant was subjected to the same survey. This
means that the participants were subjected to similar conditions. Further, the patients worked
on their own without the influence of the researchers. Unfortunately, the study Shima, Farizah
and Majid (2014) required that the researchers work hand in hand with the participants over a
long period while at the same time posing probing and guiding questions that sought to guide
the direction of the study. Since the probing questions were not standardized, there are
chances that the results could have been biased. This is worsened by the fact that there is no
standard time for each interview.
3
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Qualitative Research is not Real Science
Qualitative research is science. Notably, scientific studies are known for their high
reliability and use of standardized measures so as to create a better representation of the
population from the sample. Despite raising unending questions on the basis of its scientific
accuracy as compared to quantitative research, qualitative research is well known for its high
relevance. As reported by Johansson, Risberg and Hamberg (2003), the high relevance of
scientific research with regard to its purpose makes it scientific. Moreover, a research is
scientifically justified if it is of significance to its initial purpose and its ability to represent the
population. On the same note, Shuval et al. (2011) acknowledge that there has been an
increase in the number of qualitative research papers in the health sector in the recent past as a
result of the realization of their significance and relevance to the industry, especially in social
studies and other fields requiring interaction with the subject. As a result, these are equally
important scientifically to quantitative research.
Despite being acknowledged, qualitative studies have a number of setbacks such as
high possibilities of bias and the presence of too much opinion. In order to improve these
studies and their scientific soundness, Shuval et al. (2011) recommend that qualitative
researchers develop a better mastery of scientific research methodologies and more
standardized approaches be developed to ensure that the studies are better representative of
the population.
4
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
References
Johansson, E. E., Risberg, G., & Hamberg, K. (January 01, 2003). Is qualitative research
scientific, or merely relevant? Research-interested primary care and hospital
physicians’ appraisal of abstracts. Scandinavian Journal of Primary Health
Care, 21(1), 10-4.
Lee, A. K., Corneille, M. A., Hall, N. M., Yancu, C. N., & Myers, M. (2016). The stressors of
being young and Black: Cardiovascular health and Black young adults. Psychology &
Health, 31(5), 578–591. http://doi.org/10.1080/08870446.2015.1127373
Shima, R., Farizah, M. H., & Majid, H. A. (2014). A qualitative study on hypertensive care
behavior in primary health care settings in Malaysia. Patient Preference and
Adherence, 8, 1597–1609. http://doi.org/10.2147/PPA.S69680
Shuval, K., Harker, K., Roudsari, B., Groce, N. E., Mills, B., Siddiqi, Z., & Shachak, A.
(January 01, 2011). Is qualitative research second class science? A quantitative
longitudinal examination of qualitative research in medical journals. Plos One, 6(2),
e16937. https://doi.org/10.1371/journal.pone.0016937
5
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
Critique Template for a Quantitative Study
NURS 6052
Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies
January 13, 2018
Antwan Cooke
Article Reference:
Lee, A. K., Corneille, M. A., Hall, N. M., Yancu, C. N., & Myers, M. (2016). The stressors of
being young and Black: Cardiovascular health and Black young adults. Psychology &
Health, 31(5), 578–591. http://doi.org/10.1080/08870446.2015.1127373
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975165/
1. Research Problem and Purpose
In this study, Lee, Corneille, Hall, Yancu & Myers (2016) sought to evaluate the
impact of various stressors on cardiovascular diseases. While evaluating the problem guiding
their study, the authors acknowledge that humans are often subjected to various biological and
social factors, and that may have an impact on their health. In this case, however, the authors
specify that some groups are more vulnerable and, with reference to the African American
youths, they tend to be predisposed to some factors such as racism and marginalization.
Consequently, these could have ramifications for their health outcomes. It is for this reason
that the authors seek to identify the impact of stressors such as occupational, racial, financial,
and psychological distresses pose on this group based on its vulnerability.
2. Hypotheses and Research Questions
The authors list hypotheses that are fetched from their objectives and the identified
problem. These are:
6
QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
a. It has been determined that racial stress and psychological distress are directly
associated with body mass index (BMI) – an indicator of cardiovascular health risk.
b. It has been determined that racial stress and psychological distress are directly
associated with waist to hip ratio (WHR).
c. Racial stress and psychological distress would be positively associated with systolic
and diastolic blood pressure (BP).
3. Literature Review
The authors create a comprehensive literature review section that provides a lengthy
integrated analysis of many past studies relevant to the problem statement. The materials are
highly relevant and the authors critically review various studies and their findings against
each other. Rather than giving a summary, however, the authors conclude the review with a
statement of the hypotheses, and that reflect upon what has already been analyzed in the
section. Intriguingly, the authors chose not to use just the latest papers in their review. Rather,
they explore papers as old as two decades and progressively develop their points in a way that
leads to the establishment of the hypotheses.
4. Theoretical or Conceptual Framework
The authors theorize that, with the existing white supremacy and poor resources
distribution, the young African Americans definitely face multiple challenges associated with
racial disparities. Added to restricted access to resources and services, this structural racism
puts them at a relatively higher risk of getting a high blood pressure.
5. Population
The population is fetched from the African Americans race. In this case, the number is
divided into 28 males against 96 females. While sampling, the authors only consider those
aged between 18 and 27 years. In order to arrive at this group, the study focused on university
students, and with all other races being excluded from the study. This was done through flyers
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QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
and classroom announcements in Southeastern US.
6. Protection of Human Research Participants
All the patients were required to fill an informed consent form. To protect human
research subjects, the research was conducted in private cubicles so as to protect the
participants identify.
7. Research Design
In this quantitative study surveys were used to collect data from the students. There
was no pilot study. The research developed a demographic questionnaire specifically for their
study while they borrowed other designs from previous work so as to collect comprehensive
data. In this case, depression anxiety stress scales were borrowed from Lovibond and
Lovibond (1995), the Nadanolitization Scale from Taylor & Grundy (1996), Index of RaceRelated Stress-Brief version (IRRS-B) from Utsey (1999), Anthropometric Measures from
Cochrane recommendation, and the collection of blood pressure was collected using Omron
automatic blood pressure monitor.
Instruments and Strategies for Measurement
The study utilized surveys in collecting data. These surveys consisted of various
questions that helped the authors to measure the youths’ stress levels. Additionally, blood
pressure was collected using Omron automatic blood pressure monitor.
8. Data Collection
After signing the informed consent form, the participants filled the various questions
contained in the questionnaire. Afterwards, anthropometric indicators and blood pressure
were collected in private cubicles. The participants were also informed of a follow-up study
and informed of the dates.
9. Data Analysis
Statistical Package for Social Sciences was used to analyze the data statistically and
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QUALITATIVE VS. QUANTITATIVE RESEARCH DESIGNS
generate bivariate associations, and that were later assessed through the Pearson correlations.
These methods were highly relevant owing to the multiple data items collected in this study.
10. Interpretation of Results
The authors also used hierarchical multiple regressions to establish various
associations. These associations were then analyzed against the hypotheses. Correlation
analysis and analysis of covariance further furnished the results.
11. Discussion of Findings
The study found internalized racism to be associated with BMI, individual racism with
BP, and depression with cardiovascular diseases risk. These coincided with the hypotheses.
Various resources were used to discuss these findings, and that showed a significant
relationship with the framework.
12. Limitations
The authors clearly identified the limitations. These included the small sample size
and the lack of accounting for the many confounding variables.
13. Implications
The conclusions and implications have been directly associated with the study
findings. In fact, this is briefly discussed by the authors.
14. Recommendations
The authors offer legitimate recommendations in that they suggest that future studies
concentrate on the limitations of their study such as specific mechanisms to analyze the
impact of psychological distress and psychosocial stress. The authors also insist on the need to
account for more variables such as culture so as to improve results. Based on the
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