Literature review
Suzanne Millage
Lakeview College of Nursing
Nursing Research
April 8, 2011

Literature review
The purpose of this assignment is to develop a research question and be able to be able to review articles that support the question.  My research question is: Does a globally school-based developed nutrition program given for one year of obese children in participating schools impact the children’s weight? 
The first research article to be reviewed is entitled “Economic and Other Barriers to Adopting Recommendations to Prevent Childhood Obesity: Results of a Focus Group Study with Parents” by Sonneville, La Pelle, Taveras, Gillman, and Prosser (2009).  The purpose of the study was to address the issue that childhood obesity is a prominent public health concern that is associated with an increased risk of cardiovascular disease, diabetes, some cancers, depression, discrimination, weight-related bias, and other morbities.  This study was a qualitative study.  According to Burns and Grove (2009), the purpose of qualitative research is to “use a systematic, interactive, subjective approach used to describe life experiences and give them meaning and describe and promote our understanding of human experiences such as pain, caring, and comfort” (22).   The dependent variable used in the study by Sonneville, et al., (2009) was the amount of weight lost; the independent variable was factors that contributed to childhood obesity.  According to Burns and Grove (2009) the dependent variable represents the “response, behavior, or outcome that is predicted and measured in research; changes in the dependent variable are presumed to be caused by the independent variable” while the independent variable represents “the treatment, intervention, or experimental activity that is manipulated or varied by the researcher to create an effect on the dependent variable “(171).  The sample population in the study included 4 focus groups in Boston, MA during October and November 2009.  Two of these groups were English and two of these groups were Spanish.  To participate in the study, the children’s BMI had to be greater than the 85th percentile and rage from 5-17 years of age.  Focus group sizes ranged from 2-7 participants per group.  Additional demographic data was not collected.  The focus group time lasted 2 hours. The findings of the study by Sonneville, et al., (2009) were that parents were concerned with child resistance to changing behaviors in the home. The researchers noted the following limitations in their study: there were recruiting challenges in the size of the focus groups varied with the groups of Spanish speaking parents were smaller than English speaking families.  Also, the groups consisted of all ages and the original study called for a more focused age group.  The results in the sample show that they are not relevant or are able to represent the barriers/facilitators of all parents.  Also, detailed demographic information was not collected that could have useful in the study.  Examples of this include family size and family BMI.   Burns and Grove (2009) note that limitations in a research study are restrictions of problems in a study that may decrease the generalizability of the findings (Burns and Grove, 2009). The research concluded that this study supports that parents face a unique combination of barriers when adopting recommendations to reduce childhood obesity.  This study explains all of the barriers that affect a healthy weight such as decreased physical activity, total time of watching television, fast foods, and not eating healthy.  Also, the financial aspect of trying to be healthy and prevent childhood obesity plays a role as well.  To prevent obesity, parents would have to buy health food, which in turn is more expensive.  This affects the child’s weight immensely.  The information from this study that will be used to support the research proposal entitled “Does a globally school-based developed nutrition education program given for one year of obese children in participating schools impact the children’s weight? ” will be how a combination of barriers affect childhood obesity.  The information given will help when trying to figure out the main reasons child obesity if present in the world today. 
The second research article to be reviewed is entitled “How Children Eat May Contribute to Rising Levels of Obesity: Children Eating Behaviours: An Intergenerational Study of Family Influences” by Kime (2009).  The purpose of the study was to investigate the family environment and specifically, the food culture of different generations with families.  This study was a qualitative study using the grounded theory design.  This article represents a qualitative study as Burns and Grove noted in the previous article. Grounded theory research allows the discovery of what problems exist in a social setting and the process people use to handle them. It also “emphasizes observation and development of practice-based intuitive relationships among variables” (25).  The dependent variable used in the study by Kime (2009), were results from the participants from the same family; the independent variable were the results from the participants who were from different families. Dependent and independent variables are defined by Burns and Grove in the previous article.    The sample population in the study by Kime, (2009), was divided into 2 parts: Phase 1 and Phase 2. Phase 1 involved focused group discussions with separate generational groups and was conducted between March and July 2005.  One hundred and eighteen participants were involved and included grandparents, parents, and families from different families.  The children were between the ages of 11 and 12.  Phase 2 involved grandparents, parents, and children from the same family.  These families also included a child that was considered obese and a child of normal, appropriate weight.  This phase was conducted from May to August 2009.  It represented 9 families and 27 interviews: 3 interview per family.  The findings of the study by Kime (2009) show that families who eat together and eat healthier food overall are less likely to have obese adolescents. The researchers noted the following limitation in their study: research proving that eating healthy is effective when losing weight does not normally last long and  Burns and Grove (2009) note that limitations in a research study are restrictions of problems in a study that may decrease the generalizability of the findings (Burns & Grove, 2009). The research concluded that there is a correlation between what you eat how you eat it.  The information from this study that will be used to support the research proposal entitled “Does a globally school-based developed nutrition education program given for one year of obese children in participating schools impact the children’s weight?” will be the fact that it is not just what children eat in schools or at home, but more importantly how effective eating with family is in general.
The third research article to be reviewed is entitled “A 4-year, Cluster-Randomized, Controlled, Childhood Obesity Prevention Study: STOPP” by Marcus et al., (2009).  The purpose of the study was to assess the efficacy of a school-based intervention program to reduce the presence of childhood obesity in children 6-10 years of age.  This study was a qualitative study using a cluster-randomized controlled study.  This article represents a qualitative study as Burns and Grove noted in the previous article. The randomized type of design allows the researcher to examine the effects of various treatments in which the effects of a treatment are examined by comparing the treatment group with the no-treatment group (Burns and Grove, 2009). The dependent variable used in the study by Marcus et al., (2009) was the outcome and the changes implemented in the study and the independent variable was the schools that participated and the effect the school environment has on childhood obesity. Dependent and independent variables are defined by Burns and Grove in the previous article.  The sample population in the study by Marcus et al., (2009), included 10 schools in Stockholm County.  The study went for 4 school years between August 2001 and June 2005.  The children that participated were from the ages 6-10.  Children who participated were from middle and working class families.  The findings of the study by Marcus et al., (2009) revealed that implementing changes in the school environments decreased childhood obesity.  The researchers noted the following limitations in their study: most of the children did not participate for the full 4 years, thus possibly hindering the results of the study and they did not continue keeping records over the summer months, also hindering results.  Burns and Grove (2009) note that limitations in a research study are restrictions of problems in a study that may decrease the generalizability of the findings (Burns & Grove, 2009). The research concluded that interventions in the schools and having strict rules against unhealthy eating has a positive influence of eating habits in the home as well as decreasing childhood obesity.   The information from this study that will be used to support the research proposal listed in the previous article will be the effect of eliminating vending machines, increasing health food in the cafeteria, and increasing physical activity in school systems. 
The forth research article to be reviewed is entitled “Obesity Prevention Opinions of School Stakeholders: A Qualitative Study” by Della-Torre, Akre, and Suris, (2010).  The purpose of the study was to investigate the opinions of different school stakeholders on the willingness to change and the acceptance of current obesity prevention strategies that could be implemented.  This study was a qualitative study using the grounded theory.  This article represents a qualitative study as Burns and Grove noted in the previous article. Grounded theory research allows the discovery of what problems exist in a social setting and the process people use to handle them. It also “emphasizes observation and development of practice-based intuitive relationships among variables” (25). The dependent variable used in the study by Della-Torre (2010) was the open-ended questionnaire; the independent variable was the discussion between the stakeholders in steps 1 and 2 on changes that could be implemented to decrease the prevalence of childhood obesity.  Dependent and independent variables are defined by Burns and Grove in the previous article.  The sample population in the study was conducted in Switzerland and was organized using two steps.  The first step had 40 school representatives ranging from P.E. teachers, parents, adolescents, and school nurses.  Each focus group was made up of 4-10 participants. Step two included a participant from the previous step and was part of the focused group discussion.  The study took place between November 2007 and January 2008.  The discussions lasted 90 minutes. The findings of the study by Della-Torre (2010) indicated that most of the participants agreed that a change should be implemented and that vending machines should be eliminated, an increase in physical activities, and healthy food in the cafeteria. The researchers noted the following limitations in their study:  adolescents were not included in step 2 which was the discussion aspect of the study. It would have been beneficial to interview and allow participation of adolescents in the study. Another limitation was opinions were only collected from those that were part of step 1.  It would have been beneficial to allow interview to go on involving people outside of the school system.  Burns and Grove (2009) note that limitations in a research study are restrictions of problems in a study that may decrease the generalizability of the findings (Burns & Grove,2009). The research concluded that this study supports that parents face a unique combination of barriers when adopting recommendations to reduce childhood obesity.  This study explains all of the barriers that affect a healthy weight such as decreased physical activity, total time of watching television, fast foods, and not eating healthy.  Also, the financial aspect of trying to be healthy and prevent childhood obesity plays a role as well.  To prevent obesity, parents would have to buy health food, which in turn is more expensive.  This affects the child’s weight immensely.  The information from this study that will be used to support the research proposal entitled “Does a globally school-based developed nutrition education program given for one year of obese children in participating schools impact the children’s weight?” will be how people in the school system feel about childhood obesity and the changes they are willing to implement to help decrease the prevalence. 

References
Burns, N., & Grove, S. (2010). The practice of nursing research: Appraisal, synthesis, and 	generation of evidence (6th ed.). St. Louis, MO: Elsevier Saunders.    
Kime, N. (2009). How children eat may contribute to rising levels of obesity: children's eating behaviours: an intergenerational study of family influences. International Journal of Health Promotion & Education, 47(1), 4-11. Retrieved from EBSCOhost.
Marcus, C., Nyberg, G., Nordenfelt, A., Karpmyr, M., Kowalski, J., & Ekelund, U. (2009). A 4-
year, cluster-randomized, controlled childhood obesity prevention study: STOPP”. International journal of Obesity (2005), 33(4), 408-417.  Retrieved from EBSCOhost.
Sonneville, K., La Pelle, N., Taveras, E., Gillman, M., & Prosser, L. (2009). Economic and other 
barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents. BMC Pediatrics, 981. Retrieved from EBSCOhost.
Torre, S., Akré, C., & Suris, J. (2010). Obesity Prevention Opinions of School Stakeholders: A 
Qualitative study.  Journal of School Health, 80(5), 233-239. Doi:10.1111/j.1746-1561.2010.00495.x