Understanding PICO format

1(A). Before starting the research question of the article by Hardcastle, et al. (2013) by applying the PICO format it is important to delve into what it means. Riva et al. (2012) write that clinicians use this format in most of their research. Each letter in this format has a meaning and therefore by breaking down what each letter stands for, a reader will be better placed to understand the research question. The letter (P) simply stands for the population that one recruits for the study. The research has participants for a study, and that is what letter (P) represents. The letter (I) stands for intervention. According to Riva et al. (2012) intervention is the treatment that is offered to the sample for the study. The subjects or the population used in the study is likely to be offered treatment and when coming up with a research question that should be incorporated. The letter (C) stands for comparison. It identifies the plan one uses as a reference to the group to compare with treatment intervention. In some instances the (C) is viewed as the control group. Finally, the letter (O) stands for the outcome, which represents the result one, will measure to examine the effectiveness of their intervention.

The research question based on the article is: Are people (P) who use motivational interviewing intervention on weight loss, BMI, physical activity, and CVD risk factor and counseling (I) compared with people who do not use motivational interviewing intervention (C) at a lower risk of cardiac disorders (O)?

(B) This research has three objectives which raise essential points that can help in addressing obesity and CVD risk factors. According to the research, Hardcastle, et al. (2013) state that their study’s first objective is to examine if any changes in body mass index, physical activity, and cardiovascular diseases risk factors were maintained for a year within the intervention group. In essence, this objective is essential in this research, because it assists in understanding the changes that could occur within the intervention group if they observed some of the procedures of the research.

Hardcastle et al. (2013) also state that their research aimed at exploring the effect of counseling session attendance on the maintenance outcomes. This is a post-intervention follow up, and counseling was involved in this research. It was, therefore, important to research to investigate the effect of counseling session on helping people to maintain the outcomes of interventions like physical activity.  Finally, the research assessed motivational interviewing impacts on the result for the sub-groups with CVD risk factors at baseline. Hardcastle et al. (2013) assert that they expected to see the intervention increases physical activity as well as reduce cholesterol, hypertension, BMI and weight significantly. Nevertheless, like any other research, this research had a hypothesis. According to the authors, they hypothesized that the participants attending several sessions were more likely to retain changes within one year later after interventions.

Objectives of the study

2 (A).Approval- This research was conducted procedurally and the researchers ensured that they had consent to do the research. Hardcastle et al. (2013) inform that their first step was to seek approval. The local NHS Research Ethics and Research Governance Committee approved this research, and this is to imply that the laws and ethical issues were addressed before the researchers got approval. Research is regulated, and to give it authority, permission must be granted to provide research credibility, before it is conducted.

Drawing Participants- After getting approval, the researchers went ahead to get participants. The subjects were acquired from a patient electronic database at one of a primary care health centre. Obtaining participants from the primary care health centre, confirms that the researchers did not just pick up participants, but they ensured that they had the right population to facilitate the research. Besides, the sourcing of participants in the study was through partnership in the sense that the researchers worked with a local health centre to assist with the participants.

Requirement- The participants were not just picked up, but they had to meet a requirement of age. For one to qualify to be a participant they had to fall the age bracket of 18-65 years.  The age range is extensive, and it must have enabled the researchers to have diverse participants based on age. It is possible for the researchers to get young adults, and also old people. Apart from age requirement, for one to be included in the trial, they had to have at least one of CVD risks factors like weight, blood pressure or hypercholesterolemia.

Contacting patients- After identifying the participants, they were reached by email inviting them to participate in the research. In the email, the researchers ensured that there was an information sheet to inform the potential participants what exactly the study was all about. 1439 patients were reached by email; however, the researchers only wanted to recruit nearly 350 patients.  Fortunately, out of the total number of people contacted, 28 per cent of them accepted to take part in the study. The 28 per cent was an equivalent of 358 participants.

Completing and returning a stamped envelope- For the patients who qualified to take part in the study, they were issued a form to fill in some details. The completed and stamped forms in an envelope were then returned to the researcher. The researchers had to establish the recruitment bias, which they calculated by comparing data. The data drawn from the electronic patient record that joined the trial was compared to the patients who passed up the invitation. Nevertheless, those who participated in the research received the standard, after accepting to enter the trial. The decision to ensure that the participants stamp the confirmation letters was to provide that those who declined the invitation never participated in it.

Procedures followed to obtain participants

(B)The participants of the study were randomized into the motivation intervention and control group. Based on the types of randomization, this researcher used allocation concealment. Kim, & Shin, (2014) defines allocation concealment as a technique that prevents selection bias, where the person assigning the participants conceals the allocation sequence from participants and researchers until the time of assignment. The researchers are likely to influence the way participants are placed to intervention groups, and allocation concealment was used to prevent that influence. Importantly, to randomize the participants into the motivational interviewing (MI) intervention, the researchers gave the statistician that role.

The patients that accepted the invitation to take part in this research entered the minimal intervention and MI through the randomization carried out by a statistician. The statistician did not have any contact with the patients who accepted the invitation; hence there was no any influence or bias on the randomization. The statistician using the ratio of the 7:5 randomized the participants into the minimal intervention and MI cohorts. Fortunately, the participant also used stratification by age and gender using the records of the patients. Besides, the statistician then used the block randomization where each stratum had 12 blocks. Using the 12 blocks, the statisticians randomly assigned the participants to MI intervention and minimal intervention cohort, through the use of a computer. The computer used the ratio of 7:5 to place participants to each of the MI and minimal intervention cohorts. From the ratio, the statistician ensured that the MI intervention cohort was higher than the motivational interviewing group.  

Nevertheless, at first, it appears that the researchers used allocation concealment because they used an external individual/statistician without contact with them to select participants. In this case, the researchers did not know how the statistician was going to allocate the participants to either group. However, the two relevant randomization methods used in this study were block randomization and stratified randomization. Kim, & Shin, (2014) note that block randomization is used to establish two possible sequences. Thus, the rationale for using block randomization was to develop sequences to ease randomization. After, putting the participants into stratum, where each had 12 blocks, the statistician must have found it easier to stratify the participants. Weber et al., (2015) indicated that stratified randomization makes it easier and possible to assign all variables equally. Considering that this research was stratified by gender and age, the rationale therefore for the use of this method was to establish a balance by gender and age in each group.

Allocation concealment and randomization methods

(C) There were significant findings that were made in this research about the biomedical and behavioral outcomes. For the behavioral outcomes, walking was observed to increase considerably between baseline and 6-months. It also increased between the baseline and 18-months. This finding showed in the MI intervention cohort that walking showed a considerable decrease in cholesterol. In the review of the research of Murtagh et al., (2015) the researchers confirm that walking is a significant activity that is decreasing the CVD risk factors. In this case, the risk factor is cholesterol, and if people walk, it means that the will reduce it, hence improving cardiovascular health. Besides, the biomedical outcome shows that clinically, there was only 0.5 mmol/l decrease, and giving a mean difference of −0.16 mmol/l in the MI intervention group and minimal intervention group at in the 18-months (Hardcastle, et al. 2013). Considering this difference, the researchers indicate that the difference was not clinically significant.

The research also found that behavior change is linked to both duration and number of MI sessions. That is to mean that physical activity, diet and BMI are influenced by behavior change. If a person changes their behavior positively to commit to one of the activities in the MI, they are likely to minimize their weight. For instance, this research indicates that in the minimal intervention group, BMI increased from baseline to 18-months, while in the MI intervention group, in entire follow-up there was change. However, the research notes that the change is insignificant, but what is imperative is the fact that there was a change. Hardcastle et al. (2013) indicate that any small change in the CVD risk factors is essential. Thus, the decrease in BMI observed in the MI intervention group is significant as far as the fight against CVD is concerned.

Concerning the second objective, there were no notable impacts for dose of MI on outcome measures from baseline to 18-months, except for triglycerides, where the more sessions attended. However, there was a higher development in triglycerides. Since any changes in the outcome variables were not related with the number of sessions attended, these impacts appear to be in response to an averagely low dose of MI. However, the biomedical outcomes show that second objective or aim, which is exploring the effect of counseling session attendance on the maintenance outcomes did not have a significant impact for a dose of MI on account measures from baseline to 18-months (Hardcastle et al. 2013).  However, there is an effect only on triglycerides. This shows that biomedical outcomes are not likely to help in reducing the CVD risk factors. Thus, the variables in the MI prove that behavior change can help reduce CVD risk factors, and also eliminating obesity.   

Significant biomedical and behavioral outcomes

Nonetheless, these findings can be generalized to the general patient population. In any research, the researchers always examine their research to discover knowledge that can be applied to the general population. These findings were not just meant to serve the participants, but they are supposed to help the general population. Persons who are obese or have CVD risk factors can use these findings to see how they can reduce their weight or increase physical activity to avoid cardiac disorders. If an individual changes their behavior and engages in physical activities like walking, they should be confident of reducing the level of cholesterol in their bodies. In essence, the point is that this research aimed at helping the general patient population, because research needs to discover knowledge to benefit all people.

3.Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig, J. T., Sorell, D. M., & Steele, R. G. (2011). Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. Journal of consulting and clinical psychology, 79(4), 433. This research used 5, 471 participants, as compared to the research of Hardcastle, et al. (2013) that merely used 334. The huge number used by Jensen et al (2011) research confirms that MI is effective and a research can easily randomize participants. Further, the use of a large representative sample gives the research more credibility and acceptability in the public unlike a research that uses a few participants

4.The MI intervention can still be used in the local context for example in Singapore. The personal research method in this case is quantitative research. The reason for quantitative research is that it will allow the research to experiment and analyze findings (Bryman, 2017). The research in this case, will have data which after research can be compared. By comparing data quantitatively the research is likely to be more credible than doing it qualitatively. Besides, the sampling should be stratified, because it would allow the researcher to have diverse participants in terms of age or gender. The research needs to be inclusive, because the issue of obesity or CVD does not just affect one gender, but it can affect a person of any sex or age. Thus, it would be essential to have a research with balanced variables.

 The recruitment method should be electronic, through a primary care health center. It is easy to use the health center to locate or reach participants, because the health center creates a perception of seriousness and evidence-based practice. Ideally, the purpose of using electronic is to ease access to the prospective participants. In essence, the target respondents will be patient population, especially people with CVD risk factors. The reason why people with CVD risk are used as respondents is because they will be motivated to participate in it, due to their health risks, which they will believe that the research will help. Nevertheless, the data collection procedures shall include use of questionnaires, and computer-assisted telephone interviews. Since it is hard to put all the participants at the same spot, it will be reasonable to send them questions to give details of their progress. Also, computer-assisted telephone interviews will help the researchers to keep touch with the participants to gather relevant data.

References

Bryman, A. (2017). Quantitative and qualitative research: further reflections on their integration. In Mixing methods: Qualitative and quantitative research (pp. 57-78). Routledge.

Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig, J. T., Sorell, D. M., & Steele, R. G. (2011).

Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. Journal of consulting and clinical psychology, 79(4), 433.

Hardcastle, S. J., Taylor, A. H., Bailey, M. P., Harley, R. A., & Hagger, M. S. (2013).

Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. International journal of behavioral nutrition and physical activity, 10(1), 40.

Kim, J., & Shin, W. (2014). How to do random allocation (randomization). Clinics in orthopedic

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Murtagh, E. M., Nichols, L., Mohammed, M. A., Holder, R., Nevill, A. M., & Murphy, M. H.

(2015). The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Preventive medicine, 72, 34-43.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your

research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.

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