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Critical Appraisal Related to Internal Validity

1. There are definite questions asked in the article. Instead, the article begins with a brief introduction of the research issue of obesity providing background information. This includes its dangers and the need to develop some form of control on the chronic condition as well as prevent its occurrence. A summarized purpose of the study is thus provided as a final sentence that provides the reader with an idea of what the study is about in the absence of questions.

It is quite clear in the study what is the cause and what is the effect. Accordingly, the cause is obesity and its impact on the quality of life of the affected. The effect is development of an intensive behavioral treatment weight loss program within an adult primary care practice which is meant to ease management of the condition and improve quality of life.

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2. The study carried out as per the article did not have a control group. In this case, the participants of the study were not included in any comparisons with a similar group. A comparison group would have been beneficial for the study because it would have contributed greatly to the elimination of bias and other external influences likely to impact the study. By impact, this refers to cause any alteration to the results of the study and the implemented program that is serving as the experiment of the study. In this case, the control group would have fulfilled the role of ensuring that focus is placed on the variable that is under study of weight loss and its impact on obesity. This thus goes on to reduce reaching any erroneous conclusions in a study.

3. Randomization would have impacted bias in the study by bringing it to the fore. While randomization is generally perceived as a fundamental experimental method in medical studies it does not lack errors. Thus, it is inevitable that degree of bias will come about as a result of use of this research method. One of the key reasons for this emanates from the possibility of some share of the recruited participants choosing to withdraw from the study. This is a decision that will result in sample bias. In addition, it is possible for some participants to take treatment at varying degrees of time as well as dosage in the course of a study. This is an issue that can bring about measurement bias.  Further, in the course of randomization it is possible for there to be partial blinding or even a lack of blinding during the study. For this reason, the resultant impact of this is selection bias. All these levels of bias have an overall impact of undermining the validity of collected data and key conclusions reached in a study.

4. Application of blinding in the study would have had the impact of strengthening it. That is, the study would be strengthened as a result of reduction of bias. In this case, blinding reduces the occurrence of bias because of knowledge regarding the intervention or form of control that is being received by participants of a study. Thus, with application of blinding participants do not change their behavior. This change can take place because of possessing knowledge on their group assignment. For this reason, the participants will not have the opportunity to report subjective outcome measures in a manner that is different. Further, it can be said that the study is strengthened because of improvement of its internal validity. In this case, it is through blinding that the study participants will be treated in a way that is salient despite the groups that they have been assigned. Bias will be overcome by prevention of common research phenomenon that brings it about such as the halo effect, Hawthorne effect, and compensatory rivalry.

5. There is no clear indication of occurrence of any multiple measurements of outcome both pre and post the intervention. Particularly, the study lacks any clear information regarding measurement of outcome at pre intervention. There is only demonstration of the status of the patients upon enrollment in the program.  Some of the key factors that are captured in this case are such as: hypertension, diabetes diagnosis, cholesterol medication, multiple chronic disease status. As for post intervention there is presentation of results relating to measurement of hemoglobin and cholesterol after participation in the program. That is, the study shows the results of the hemoglobin and total cholesterol by assessing both low and high cholesterol.

6. All the subjects that were enrolled in the study were accounted for in considering the sample and data analysis. The study had initially selected a sample size of n=38 from a population of male and female adult patients that were referred by primary care providers to the program. Further, these were participants who had attended at least four sessions of the program. Following application of the inclusion and exclusion criteria, two participants were eliminated leading to a sample size of n=36. These were well accounted for in the data analysis stage as the results provided reflected for 36 participants as indicated in all the tables of results developed. The absence of such strategies that are meant to ensure that the research subjects enrolled are well accounted for will have an impact on bias on this study. In particular, this will bring about sample bias. The bias will be because the selected sample size will not reflect the true distribution of the population of interest.

7. The reliability and validity of the reporting instruments that was used in the study is as follows. The study utilized three main reporting instruments consisting of surveys, focus groups, and medical records. Reliability as it entails to surveys is the instrument remaining consistent from every participant, across settings and time. As for validity, this was present as shown by how the information collected remained relevant for the conclusion that was being drawn. Regarding, the focus groups they were reliable because of the questions developed enabling the collection of information that was specific. In relation to validity this was assured by ensuring that participants were talking about what was intended by the researchers. As for medical records, reliability and validity are not well highlighted in the study. 

The data analysis showed considerable amount of appropriateness in reporting the strength of the findings of the study. This is because, the process only focused on illustrating that which was learnt from the collected data and how it relates to the research problem under study. Further, this is because the data analysis process entailed assessing the data in relation to the research objectives of the study and thus enhancing findings. In addition, the process of data analysis encompassed assessing the research purpose which was thus captured in the findings of the study as well.

The patient survey and provider satisfaction and focus group significantly informed the findings of the study. This is because; the survey and focus group served as useful sources of data regarding the research issue under study. As a result, the collected data was in tandem with the research problem investigated and therefore adequately informed the findings.

Critical Appraisal Related to External Validity

1. The overall strength, quality, and consistency of the evidence provided by the findings of this study can be described as being satisfactory. One key reason demonstrated by this is the absence of any outstanding research limitation. To add, the fact that there was no any form of inconsistency in the presented results further went on to confirm strong, quality, and consistent evidence of the findings of the study. To add, the selected study design played a great role in ensuring strength, quality, and consistency of evidence as per the findings made. The degree of minimization of bias further goes on to demonstrate the degree to which the findings of the study emerged as strong, quality, and consistent as was demonstrated by the sampling method. Thus, there is a high level of confidence that the findings of this study are true and it is possible for these same findings to be detected by other studies. That is, these findings bear a closeness to the truth regarding obesity and its management.

2. The findings of the study are quite generalizable. In particular, the findings are generalizable to our patients because the patients used in the study share similar characteristics with our patients. Further, the treatment is thus feasible for our setting. For this reason, the results of the study can apply to our patients and such a program can be used to control and reduce the impact of obesity to our patients. In further understanding the degree of feasibility of the results of the study the potential benefits of the treatment program outweigh the potential harms to the treatment of our patients. That is, the harms can entail mere sours and aches as a result of exercise and discomfort because of change in diet. However, the benefits are more significant as they will entail weight loss which will enhance the quality of life and prevention of detrimental conditions such as diabetes and hypertension due to obesity.

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