Christensen et al., (1983) in their article ‘Quantitative Assessment of Dietary Adherence in Patients with Insulin-Dependent Diabetes Mellitus’ provide important information on an alternative method to measure dietary adherence. This paper seeks to critique the article by focusing on the methodology used, data management and analysis, interpretations of the findings, and its implications for future research and practice.
Protection of Human Participants
The article does not indicate the methods used to safeguard the participants. Also, the researchers fail to indicate the method used to collect data. It is not possible to determine whether the tool used was unobstructive, although the researchers tried to ensure participation was voluntary. Parents were also present during the collection of data from the minors; presence of parents is recommended to ensure that the minors are safeguarded and the parent can make informed decisions on the participation of their child (Burns & Groove, 2011).
The article does not indicate whether there was an external reviewer to ensure that the participants were protected, although the data was derived from visits by the patients to their care provider, that is, the Model Demonstration Unit of the Diabetes Research and Training Center. Also, there is no indication how the participants were recruited or whether permission to carry out the research from an institutional review board was obtained.
97 subjects were selected through convenience sampling for the research. The researchers did not indicate the variables, although they provide an in-depth analysis of some of the factors that were considered during the study. Identification of variables is not concise.
The data presented by the researchers is obtained by assessing the relationship between metabolic control and measures of adherence. The researchers compared patient diet plan and their actual eating habits. Data was obtained by observing the participants during a 24hour recall at each visit to the clinic and calculating feeding deviation as the number of meals added, deleted or eaten after one hour from the proper time. The article does not indicate the rationale for using the method, although it indicates that a pilot study had been done to assess the reliability of the method.
The process of measuring adherence involved recalling patients for twenty fours in the clinic and then observing their adherence to the dietary plan. Also, the dieticians encouraged the patients to recommend changes to the plan to try and increase adherence to the diet plan.
Data Management and Analysis
There is minimal information on the data analysis method or the software used to analyze the data. Despite this limitation, it is evident that the process used by the researcher is appropriate. The researchers clearly discuss how the data were analyzed. The data analysis involved calculating and obtaining deviations between diet plan and actual feeding habits. The method of analysis is simple which reduces the chances of different interpretation of the data thus reducing bias (Cohn, Jia & Larson, 2009).
The article does not indicate how the researchers minimized bias, although the pilot study was carried out to assess the reliability of the approach. In the pilot study, a group of dieticians observed videos of patients’ 24 hours recall and determined the deviations between actual dietary behavior and the dietary plan. The researchers utilized a t-test to examine the validity of deviation measures. Data was presented in tables, while measures of central tendency were used to analyze the data.
Interpretation of Findings: Implications for Practice and Future Research
The study was geared towards identifying a quantitative and reliable method of assessing dietary adherence in patients suffering from IDDM. The assessment involved assessing the closeness between consumption and dietary plan. Some of the findings are that, there is a significant relationship between diet deviation scores and metabolic control. Also, the researchers found that diet deviation can determine metabolic control. Lastly, the researchers found an insignificant relationship between metabolic control and caloric intake.
There were various limitations identified by the researchers. First, the patients can provide false information, although the reports had a high level of accuracy. In addition, the researchers indicate that the sample selected may not representative of the whole population.
The application of the study in the nursing field is in managing diabetes in patients and assessing their adherence to the dietary plan. However, its applicability is limited as it deals with dietetics. However, nurses may utilize the information whenever they are managing patients with IDDM. Gaps for further research include the studies on the applicability of educational programs in increasing the level of dietary adherence.
A critique of the article can shed light on how the development and execution of any research study is to be done. The article provides important information that can be used in the assessment of dietary adherence and presentation of such data. Despite the minimal limitations associated with the study, the authors have explicitly discussed the methods used to obtain and analyze data. Information derived from such assessments allows healthcare providers to develop programs that can be used to increase the level of adherence.
Burns, N., & Groove, S. (2011). Understanding Nursing Research (5th ed.). Elsevier.
Christensen, N. K., Terry, R. D., Wyatt, S., Pichert, J. W., & Lorenz, R. A. (1983). Quantitative assessment of dietary adherence in patients with insulin-dependent diabetes mellitus. Diabetes Care, 6(3), 245-250.
Cohn, E. G., Jia, H., & Larson, E. (2009). Evaluation of Statistical Approaches in Quantitative Nursing Research. Clinical Nursing Research, 18(3), 223-241.