How to write an PH4004: Evidence-Based Practice in Public Health Nursing

Part 1: Evidence-Based Practice in Public Health Short Answer

Table of Contents

Why should evidence be used when designing interventions in public health nursing?

The increasing rate of diseases and the growing scientific basis for interventions demand the use of evidence-based strategies to address population health concerns. Evidence-based public health involves the integration of science-based interventions to improve population health outcomes. By using this approach, public health nurses can promote the quality, efficacy, and cost-effectiveness of interventions used to promote public health. The use of EBP leads to the generation of new knowledge that can be used to address chronic diseases and other emerging health conditions. An evidence-based approach to public health promotes a higher likelihood of successful prevention programs and policies while improving productivity and efficiency (Lhachimi et al., 2016). Additionally, the public health sector can make decisions using acquired knowledge to address issues like funding that form the core of public health.

How does evidence-based practice in public health nursing differ from evidence-based practice in acute care?

Public health decision-making can be a complicated process due to group approaches to health and the involvement of the community in these decisions. Additionally, the use of the evidence-based practice in this setting is different from clinical patient care. Unlike acute care where evidence is derived from randomized controlled trials and practice guidelines, public health EBP derives evidence from cross-sectional and quasi-experimental studies (Lhachimi et al., 2016). Study designs in public health EBP research sometimes lack comparison groups and the interpretation of study results may have to account for multiple caveats. Another key difference is that public health EBP is often a single intervention and often involves large-scale policy changes addressing the diverse needs of large populations.

Part 2: Evaluating and Selecting Appropriate Evidence

Source 1 (APA citation)

Danielli, S., Coffey, T., Ashrafian, H., & Darzi, A. (2021). Systematic review into city interventions to address obesity. EClinicalMedicine, 100710. https://doi.org/10.1016/j.eclinm.2020.100710

Summary

Obesity is among the chronic diseases that disproportionately affect lower-socioeconomic and ethnic minority groups in the US and the rest of the world. A systematic review was conducted to identify city-wide interventions to address obesity, from which recommendations for policymakers, health system leaders, and political leaders in cities could be made. The authors examined studies from Embase, Ovid Medline, Central, Scopus, Campbell Library, CINALH, and Health Business Elite along with policy white papers.

Strategies Used

The majority of the studies identified had interventions made in North America, particularly in the US and New York City. One of the interventions focused on marketing and nutritional information labeling to address challenges related to food intake. A number of studies were observed to focus on healthy food availability while other cities embarked on restricting fast foods in restaurants and food outlets. The use of physical infrastructure to promote exercise and educational programs targeting specific communities were among the key interventions.

Effectiveness of the Strategies

People living in cities have numerous constraints to maintaining a healthy diet. The research observed that approaches targeting food availability and intake only addressed about 10% of the problem. The use of physical activity programs like change in infrastructure and promotion of active travel in cities had a greater impact on obesity control. Overall, the researchers recommend multi-level and multi-component interventions at the individual, community, and city level to address the challenge of obesity among adults.

Application to Your Population and Health Problem

The use of these interventions can help to reduce the burden of obesity among adults in Portland City. For instance, restriction of fast foods in restaurants and food outlets can be among the best interventions in the city. Considering the population working in the city, interventions involving the promotion of physical activity and exercise can help address obesity among adults in Portland.

Source 2 (APA citation)

Flack, K. D., Hays, H. M., & Moreland, J. (2020). The consequences of exercise-induced weight loss on food reinforcement. A randomized controlled trial. PloS One, 15(6), e0234692. https://doi.org/10.1371/journal.pone.0234692

Summary

Exercise is among the long-standing remedies for nearly all obesity-related comorbidities and is recommended for weight loss and maintenance. The focus of this study was to determine the effectiveness of aerobic weight loss exercise in increasing food reinforcement among obese adults. The study used a randomized controlled trial (RCT) approach where 80 adult participants were recruited.

Strategies Used

The study involved a 12-week exercise intervention with men and women randomized separately. Upon completion of the exercise, food reinforcement and body composition were assessed 24 to 48 hours after the final exercise. The researchers also assessed liking of foods and hunger after exercise.

Effectiveness of the Strategies

Upon exercise and food reinforcement strategies, changes in fat-free mass were observed among the study population. The use of exercise was observed to increase energy expenditure among the study group compared to the control group. Exercise and food reinforcement can result in reward-driven eating that can help in weight management and control of obesity.

Application to Your Population and Health Problem

This research provides insight on why exercise programs are marginally the most effective approaches to weight loss. Adults in Portland can use exercise to change food reinforcement as a measure of reducing weight.

Source 3 (APA citation)

Pearce, C., Rychetnik, L., Wutzke, S., & Wilson, A. (2019). Obesity prevention and the role of hospital and community-based health services: A scoping review. BMC Health Services Research, 19(1), 1-16. https://doi.org/10.1186/s12913-019-4262-3

Summary

Control of obesity is important to address the burden of chronic diseases in communities. In the past, the management of obesity has focused on primary healthcare with little focus on other community-based interventions. This study examined the role of hospital and community-based health services in adult obesity prevention. The primary data collection method involved searching for articles from CINAHL, MEDLINE, Cochrane, and PubMed databases. 43 articles with relevant data were included in the final analysis.

Strategies Used

The first strategy identified to address the challenge of obesity was the use of the 5A framework (Ask, Assess, Advise/Agree, Assist, and Arrange). The 5A approach was mainly used in healthcare settings and outreach programs. The use of screening approaches in hospitals and community settings also turned to be effective in helping individuals realize the challenges of being obese.

Effectiveness of the Strategies

The study highlights that while a population health approach is important to address obesity, it is important to expand healthcare interventions beyond medical treatment. The use of the 5A screening approach was important in helping patients realize the cost of obesity and provided a framework for a timely referral.

Application to Your Population and Health Problem

Screening for obesity and providing timely referral is among the ways to address the burden of the disease in the community. This study indicates that the public health sector can collaborate with primary care providers to screen individuals and offer assistance to programs available to manage obesity.

Source 4 (APA citation)

Tseng, E., Zhang, A., Shogbesan, O., Gudzune, K. A., Wilson, R. F., Kharrazi, H., … & Bennett, W. L. (2018). Effectiveness of policies and programs to combat adult obesity: A systematic review. Journal of General Internal Medicine, 33(11), 1990-2001. https://doi.org/10.1007/s11606-018-4619-z

Summary

Policies are among the practical and feasible approaches to address chronic diseases like obesity. The focus of this study was to identify policies, programs, and built-in environmental changes that are useful in preventing obesity. Research studies from PubMed, CINAHL, PsycINFO, and EconLit were identified.

Strategies Used

The strategies identified by the researchers included the use of policies, programs, and built environment changes. Interventions studied included building light rail extensions in cities, policies on the physical activity like vigorous jogging, and food labeling interventions. Most reviewed policies involved interventions on change in calorie value and consumer knowledge.

Effectiveness of the Strategies

There were 158 natural experiments identified in the studies targeting obesity control. Physical activity/built environment approaches demonstrated reduced weight/BMI. The studies on policies targeting the food/beverage environment did not demonstrate significant weight management among obese individuals.

Application to Your Population and Health Problem

This research demonstrates that the use of policies and programs in the community can help to address obesity. Policies focusing on exercise and physical activity are more effective compared to those dealing with food selling and intake.

Source 5 (APA citation)

Barrow, D. R., Abbate, L. M., Paquette, M. R., Driban, J. B., Vincent, H. K., Newman, C., … & Shultz, S. P. (2019). Exercise prescription for weight management in obese adults at risk for osteoarthritis: synthesis from a systematic review. BMC musculoskeletal disorders, 20(1), 1-9. https://doi.org/10.1186/s12891-019-3004-3

Summary

Unlike primary strategies that focus on preventing the occurrence of a disease, secondary strategies deal with individuals that already have the disease. Obesity management mainly uses the secondary prevention approach through weight management using exercises. The focus of this paper was to identify principles of exercise interventions associated with improved physical function, weight management, or musculoskeletal pain relief among young and middle-aged adults with obesity. The systematic review identified articles that focused on exercise to reduce adult obesity from MEDLINE, PubMed, and SPORTDiscuss.

Strategies Used

Seven studies were identified to have relevant information about obesity control using exercise. The primary interventions of these studies involved 30 to 60 minutes of exercise done at least three times a week. The participants engaged in exercises like running on the treadmill, stationary bike riding, cross-trainer exercise, and aquatic exercises.

Effectiveness of the Strategies

The use of exercise interventions resulted in improved physical function compared to control groups. Three studies from the review reported significant weight loss and reductions in BMI after completing exercise interventions. In other studies, there was a significant reduction in visceral adiposities, total fat mass, and body fat percentage.

Application to Your Population and Health Problem

Exercise interventions are among the recommended approaches to weight management and obesity reduction in these studies. This intervention can be used in Portland to improve obesity management alongside other strategies. The public health sector can educate people on the importance of exercise to aid in obesity control.

Part 3: Synthesizing Evidence

Obesity is the next major epidemiological challenge facing today’s healthcare system and economy. The incidence of the disease in the US has increased rapidly and over 60% of the population in the country are either overweight or obese. The causes of the rapid increase are associated with consumption of fast foods, increasing portions of food, and reduced physical activity. Certain public health interventions have helped to reduce obesity including food regulations to remove TFAs from foods. In Portland, Oregon, obesity is a common challenge that has led to an increase in other chronic diseases like diabetes and heart disease. In this community, the major challenges leading to obesity development include increased intake of fast foods and decreased physical activity. Additionally, low-socioeconomic status among certain populations has affected access to safe foods leading to the observed challenge of obesity. There is a need for public health interventions in Portland to prevent adverse outcomes that may result from obesity.

Obesity threatens to undo the improvements in life expectancy made over the last few decades. During my literature search, the use of public health interventions rather than medical approaches can greatly help reduce obesity in communities. While most studies focus on one intervention like exercise or dietary restrictions, there is adequate evidence suggesting that multimodal approaches are most effective in reducing obesity (Danielli et al., 2021). These interventions should focus on healthy food availability, nutritional labeling of products, fast food restriction policies, and educational programs on exercise. The findings from this research are consistent with a study that analyzed hospital and community-based interventions. This study indicated that the use of screening approaches and timely referral in the community can aid in addressing obesity rather than relying on medical interventions (Pearce et al., 2019). In another study, it was observed that effective public health policies should be put to regulate food/beverages and exercise in communities (Tseng et al., 2018). These policies that focus on the environment, food supply regulation, and community awareness can serve as secondary preventive measures to obesity.

The slow progress in obesity management is reportedly due to the multiple complex causes of the disease that requires more than one single approach. So far, the use of exercise interventions has proven effective in managing weight and BMI that reduces obesity. Barrow et al. (2019) recommend the 30-60 minute daily exercise to improve weight management in individuals with comorbid diseases like diabetes and arthritis. Similarly, there is ample evidence that exercise can be an effective strategy in ensuring weight loss and food reinforcement (Flack et al., 2020). Overall, obesity management can be achieved using the right public health interventions that should include both food regulation policies and exercise alongside medical interventions.

In conclusion, obesity is a chronic disease that can be managed using the right public health interventions in the community. Interventions like the use of public health policies and programs, exercise, and multimodal strategies can help reduce obesity. Based on the available evidence, I recommend the use of multimodal approaches focusing on both policies to regulate food/beverages and exercise to address the challenge of obesity in Portland City.

Reference List

Barrow, D. R., Abbate, L. M., Paquette, M. R., Driban, J. B., Vincent, H. K., Newman, C., … & Shultz, S. P. (2019). Exercise prescription for weight management in obese adults at risk for osteoarthritis: Synthesis from a systematic review. BMC Musculoskeletal Disorders, 20(1), 1-9. https://doi.org/10.1186/s12891-019-3004-3

Danielli, S., Coffey, T., Ashrafian, H., & Darzi, A. (2021). Systematic review into city interventions to address obesity. EClinicalMedicine, 100710. https://doi.org/10.1016/j.eclinm.2020.100710

Lhachimi, S. K., Bala, M. M., & Vanagas, G. (2016). Evidence-based public health. BioMed Research International, 2016, 5681409. https://doi.org/10.1155/2016/5681409

How to write an PH4004: Evidence-Based Practice in Public Health Nursing

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