Wednesday, May 1, 2013

Introduction, Research Questions, and 8-entry Annotated Bibliography

The goal of this paper is to create an APA formatted reference list of eight articles from the knowledge base, a one paragraph summary of each article, and a brief rationale for the selection of each article. An introduction and purpose statement for the proposed study is included as are the research question and a justification of its viability.

Brief Article Summaries
Goodwin, P.J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H., Drysdale, E.,
Hundleby, M., Chochinov, H. M., Navarro, M., Speca, M., & Hunter, J. (2001).

The primary objective of Goodwin et al., (2001) was to discover whether adding support group participation to the treatment of metastatic breast cancer affected survival. The study also addressed psychological functioning, perceptions of pain, and life quality. (These were the greatest benefit to breast cancer patients. This longitudinal study recruited 237 metastatic breast cancer patients (women) over a five year period. Survival for the intervention group was 17.9 months and 17.6 months in the control group.

Rationale for Selection

There is a paucity of research on the survival benefit of support group participation. This study is valuable to my research even though the findings did not provide evidence that support group participation affects survival. It did, however, provide suggestions for future research, and variations that might be provocative toward generating similar data for online support groups as an addition to cancer treatment. Further, there was significant evidence of psychosocial benefits for this group of women. Although I am not planning to focus on this research question in my dissertation, at some point, it seems important to determine whether online support group participation provides the same benefit to both genders and individuals from diverse populations, or if online support benefits one population more than another. Goodwin et al., (2001) makes several beneficial suggestions for future research.

Huber, J., Ihrig, A., Peters, T., Huber, C., Kessler, A., Hadaschik, B., & ... Hohenfellner, M. (2011). Decision-making in localized prostate cancer: lessons learned from an online support group. British Journal of Urology International, 107(10), 1570-1575. doi:10.1111/j.1464- 410X.2010.09859.x
Huber et al. (2011) sought to add to the understanding of the dynamics and the content of peer-to-peer influences on decision making derived from online support. To accomplish this, the authors explored communication between prostate cancer patients and how this peer-to-peer counseling affected decision-making. The authors investigated 501 threads in the online community related to information seeking as it pertained to decision making. Huber et al. found patients in the online forum openly engaged in and benefitted from information exchange and advice, and benefitted from social and emotional support as well. Additionally, Huber et al. found online peer-to-peer interaction can provide the same support as traditional face-to-face support groups, and the online forums provided an ease of use in that direct personal contact was circumvented. Finally, these authors suggest the scientific evaluation of online support groups contributes to health care providers' understanding of their patients needs.

Rationale for Selection

This article is pertinent to my study because it identifies the inherent value in virtual peer-to-peer counseling in online support groups that cater to patients with a specific cancer type. This information exchange is not only beneficial to the patients, but healthcare providers as well. One of my research questions asks whether this benefit is significant for cancer patients that utilize virtual support groups specific to their disease. Huber et al. (2011) found virtual support for prostate cancer patients was as beneficial in providing emotional support as face-to-face support groups. Although the sample was comprised solely of men, the findings likely apply to samples independent of gender.

Juneau, J. M., & Remolino, L. (2000). Online support groups: Nuts and bolts, benefits, limitations and future directions. (pp. 1-6, Rep. No. ED446330). Greensboro, NC: ERIC Clearinghouse on Counseling and Student Services. (ERIC Document Reproduction Service No. EDO-CG-00-7).

Because online support groups have become a viable alternative to traditional face-to-face groups, Juneau and Remolino (2000) discussed the rudimentary facets of virtual support groups and identify benefits, limitations, and how these groups may become beneficial in the future. This ERIC report is important to my research as it provides foundational descriptions and established benefits and shortcomings of virtual support groups in general. There are no key results for this information analysis, however, the fundamental issues of online support groups need to be clarified in my study and this document will support that effort.

Owen, Boxley, Goldstein, Lee, Breen, & Rowland (2010)

The purpose of this study was to identify the increasing number of participants in online support group and to determine which characteristics incline individuals to utilize online support groups and face-to-face support groups. The authors polled 6,795 people with chronic conditions and found a limited number of individuals using online support groups, although suggested that internet based information sources have the potential to reach a greater number of individuals than do face-to-face groups. These authors discussed empirical evidence that supports face-to-face support, calling attention to the paucity of research on the effectiveness and experiences of participants in online support groups.

Rationale for Selection

This study is important because it identified the potential of online support groups. It is a seminal exploration into the utilization of online support, which is an important facet of determining the benefits of this type of group support. Further, Owen et al.'s (2010) findings on user demographics may be an important comparison to my research. Owen et al. found that 54% of online support group users never participated in face-to-face groups, and they are younger, educated and more likely to utilize complementary and alternative medicine. Furthermore, most users are White or Asian-American.

Seckin, G. (2009).

Seckin (2009) explored whether and how strongly cancer patients believed their participation in an online cancer support group affected their ability to cope with their disease, especially when the disease is life threatening, and to what extent the benefits of online support groups are associated with how often and how long individuals participate. Seckin posted announcements on 31 internet support groups from which 375 questionnaires were received from cancer patients . Although Seckin found participants were helped by the supportive communication, it did not provide sufficient information on alternative treatments. Seckin's participants appraised their participation as helpful, instilled optimism and a sense of control, increased knowledge about their disease, and finding meaning in coping.

Rationale for Selection

This study was included because it found cancer patients perceive their involvement in online support groups as a benefit to their outcomes, at least as they apply with ability to cope. My research focuses on the perceived benefits of disease specific online support groups, so this research supports my assumption that, in general, online support groups are helpful, and the specificity of disease specific groups has implications for additional benefit. Although Seckin (2009) found online support groups deficient in the sharing of treatment variations, I anticipate findings may be different for disease-specific groups.

Sen, N. (2008).

Sen (2008) explored online support group participation and the degree to which participation was influenced by disease severity, perceptions of support networks, and the participants degree of extroversion. Sen enlisted 178 cancer patients and had them respond to a few questions and implemented a scale for extroversion, and one to determine perceived support networks. Sen found that cancer patients who participate in online support groups believe it fills a significant resource for emotional support as well as an information resource.

Rationale for Selection

Sen (2008) supports my contention that online support groups are a significant source of emotional support as well as disease-related information. Furthermore, this study found that across a variety of support networks and personality traits, cancer patients find significant support in online groups. Sen made a final recommendation that oncologists recommend online support groups to their patients, which is one of the goals of my research. Only eight out of Sen's 178 participants said their oncologists recommended the online support group. I hope to influence that number.

Shim, M., Cappella, J. N., & Han, J. (2011).

Shim et al., (2011) examined the effects of women (breast cancer patients) sharing insights and emotions through communicating in online support groups. These authors found that one benefit of support groups is the shared experience of communication and processing, which helps patients adapt and adjust to the trauma of a cancer diagnosis and subsequently provides patients with potential health benefits, such as improving patients' well-being (Shim et al., 2011). Further, these authors found that sharing insights online promoted self-efficacy, emotional well-being. Sharing negative emotions, however had no significant effect on health outcomes. This study explored the effects of support in 231 women.

Rationale for Selection
Shim et al.(2011) supports the idea that communication in online support groups has significant benefits, specifically in the process of the written communication necessary in this type of support network. These findings are supportive in my research because they describe an effect of group support (written communication) exclusive to online participation.

Tehrani, Farajzadegan, Rajabi, & Zamani, 2011

This study evaluated the effects of peer support and educational programs on quality of life in women with breast cancer. This study included 68 breast cancer patients. Findings suggest support groups are successful in providing cancer patients and caregivers with information, psychological support, a sense of camaraderie, and insight from others with similar experiences (Tehrani et al., 2011). Furthermore, the support groups enhanced quality of life for the cancer patients.

Rationale for Selection

This study provides fundamental support and justification for inquiry into online support groups as a means of social support for cancer patients. Further, this study suggests that social support enhances quality of life. It justifies asking whether online support would provide the same sense of social support and the subsequent benefits of face-to-face support groups.

Introduction to Study

Online communication and social networking have a prominent place in daily life for many individuals. As a result of this prominence, online support groups have established themselves as viable means of positively affecting mood, palliating pain, and increasing the quality of life for cancer patients (Goodwin et al., 2001; Juneau & Remolino, 2000). Online groups, like face-to-face support groups, provide cancer patients with psychological support, a sense of camaraderie and control over disease, and insight gained from others in similar circumstances (Tehrani et al., 2011). There is, however, a paucity of research that explores the perceived benefits of cancer patients' participation in disease-specific online support groups for patients with rare cancer types, and little is known on the effectiveness of online support groups in general (Owen et al., 2010). Although the benefits of online support have been documented for cancer patients, individuals with rare cancer types have challenges exclusive to their disease. For example, specialists for rare cancers such as multiple myeloma may not be available locally, and exchanging information with patients who have access to specialists may be an effective means of educating oneself about the disease and treatment options (Huber et al., 2011). When exploring information exchange in general online support groups, Seckin (2009) found participants were helped by the supportive communication, although it did not provide sufficient information on alternative treatments. Considering the ideosyncratic information communicated in disease-specific support groups, these findings may prove inaccurate.

Huber et al. (2011) found online peer-to-peer interaction provides the same social support as face-to-face support groups, and the online forums eliminated the constraints of being held at a particular time and location. Seckin (2009) found when cancer patients strongly believed in the value of their participation in an online cancer support group, it helped them to cope with their diagnoses, especially when the disease was classified as a terminal illness. Seckin's participants believed their participation in online support groups helped them remain optimistic, maintain a sense of control, and increased their knowledge about their disease. Additionally, the shared experience of communication and processing disease-related stress helps cancer patients adapt and adjust to their disease (Seckin, 2009). Sharing insights and emotions through online communication improves psychological well-being (Shim et al., 2011). Sen (2008) found online support group participants believe it is a significant resource for emotional support and information. Juneau and Remolino (2000) described the benefits and limitations of online support groups, although these highly generalized characterizations may not necessarily apply to online disease-specific support groups.

Huber et al., (2011) suggested the scientific evaluation of online support groups is essential because it contributes to increasing health care providers' understanding of their patients' needs. By exploring the perceived benefits of cancer patients and their experiences of disease-specific online cancer support group participation, the psychological sciences gain an increased understanding of the effects of online support during illness and disease. Furthermore, it may encourage oncologists to recommend participation in disease-specific online support groups to their patients. If cancer patients benefit from such participation, oncologists have gained a new capacity to increase positive outcomes for their patients.

Purpose Statement

The purpose of this study is to explore the perceived benefits of disease specific online support groups for patients with rare cancer types. To address the paucity of research on this type of online social support, this study surveys the experiences of 150 cancer patients diagnosed with one of three rare cancers. The 150 participants in this study are members of an Association of Cancer Online Resources online support group specific to their disease. In this study, the subjective experiences and opinions of support group participants are examined. Through an extensive survey, the goal of this study is to increase the understanding of patients' experiences in their online support group. Although social support during illness and disease is well-established in its ability to palliate pain and suffering and support positive outcomes, there is a deficiency of empirically derived research on disease specific online support groups for rare cancer types. The goal is to clarify benefits perceived by cancer patients that are exclusive to disease-specific online support groups. This qualitative study was designed to explore patient experiences in the online environment and their perception of the benefits of their online support communities.

Research Question

The research question for this proposed qualitative study is ‘what do participants of disease-specific online support groups perceive as the benefits of their participation in their online community?’ Exploring these benefits may be of value to cancer patients, especially those with rare cancer types. In addition, understanding patients' needs places oncologists in a position to provide direction toward effective emotional support and the opportunity to increase disease-related knowledge.


Goodwin, P.J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H., Drysdale, E.,

Hundleby, M., Chochinov, H. M., Navarro, M., Speca, M., & Hunter, J. (2001). The

effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345 , 1719–26

Huber, J., Ihrig, A., Peters, T., Huber, C., Kessler, A., Hadaschik, B., & ... Hohenfellner, M. (2011). Decision-making in localized prostate cancer: lessons learned from an online support group. British Journal of Urology International, 107(10), 1570-1575. doi:10.1111/j.1464- 410X.2010.09859.x

Juneau, J. M., & Remolino, L. (2000). Online support groups: Nuts and bolts, benefits, limitations and future directions. (pp. 1-6, Rep. No. ED446330). Greensboro, NC: ERIC Clearinghouse on Counseling and Student Services. (ERIC Document Reproduction Service No. EDO-CG-00-7).

Owen, J., Boxley, L., Goldstein, M., Lee, J., Breen, N., & Rowland, J. (2010). Use of Health- Related Online Support Groups: Population Data from the California Health Interview Survey Complementary and Alternative Medicine Study. Journal Of Computer-Mediated Communication, 15(3), 427-446. Doi: 10.1111/j.1083-6101.2010.01501

Seckin, G. (2009). Medical Conversations in Technology Enabled Communities: Perceived Benefits of Participation in Online Patient Communities. Conference Papers -- American Sociological Association, 1.

Sen, N. (2008). Online Social Support for Cancer Patients: Effects of Stress, Shyness, and Family Support. Conference Papers -- National Communication Association, 1.

Shim, M., Cappella, J. N., & Han, J. (2011). How does insightful and emotional disclosure bring potential health benefits? Study based on online support groups for women with breast cancer. Journal Of Communication, 61(3), 432-454. doi:10.1111/j.1460- 2466.2011.01555.x

Tehrani, A., Farajzadegan, Z., Rajabi, F., & Zamani, A. (2011). Belonging to a peer support group enhances the quality of life and adherence rate in patients affected by breast cancer: a non-randomized controlled clinical trial. Journal Of Research In Medical Sciences, 16(5), 658-665.

Program Proposal

Program Proposal

Obesity predisposes individuals to an increased risk for morbidity, disabilities, mortality and a tremendous healthcare burden (Brown, Gotshalk, Katzmarzyk, & Allen, 2011). In the Native Hawaiian population, the rapid increase in rates of obesity suggest rather than biological or genetic changes, this increase can be attributed to changes in health behaviors (Hill & Peters, 1998). Health behaviors are changeable, although the complexity of overweight and obesity should not be understated. Obesity and obesity-related diseases and conditions are prevalent in the Native Hawaiian population, partly because of behavioral components, but also because of a genetic predisposition to overweight and obesity (Brown et al., 2011). Although Hawaii as a whole, does not have higher rates of overweight and obesity and related disorders than the American population, Native Hawaiians (who make up only 10-11% of the Hawaiian population) are at a higher risk of chronic and other conditions related to obesity (Brown et al., 2011). The goal of this proposal is to create a culturally sensitive weight management program for Native Hawaiian women that considers their biological, psychological, and social aspects of being overweight or obese. The Transtheoretical Model (TTM) is utilized as a parameter for this program. Further, the anticipated challenges to the program are discussed.

Target Population

The target population for this program is Native Hawaiian women. Although the problem with overweight and obesity in Native Hawaiians is not exclusive to women or adults, this program is designed specifically for adult Native Hawaiian women. More than 62% of Native Hawaiian women are overweight, 34% of whom are severely overweight (Aluli, 1991; Mau et al., 1997). Hawaiian women have experienced an increase in insulin resistance (Mau, Grandinetti, Arakaki, & Chang, 1997), an increase in kidney disease (Mau, West, Shara, Efird, Alimineti, Saito, & ... Ng, 2007), and a significant increase in overweight and obesity (Brown et al., 2011). Further, this population has seen an escalation in many chronic diseases as well as a risk for breast cancer (Maskarinec, Zhang, Takata, Pagano, Shumay, Goodman, ... and Kolonel, 2006). Overweight, obesity, alcohol consumption, and nulliparity have risen alongside this increase in breast cancer (Maskarinec et al., 2006). Although all of these factors represent changeable health behaviors that deserve attention, this proposal focuses on overweight and obesity in Native Hawaiian women.

Addressing a Need

Obesity continues to increase in the Native Hawaiian population. Hawaiians are at a greater risk of dying earlier than White Americans because of chronic conditions such as diabetes and obesity. Mental illness and substance abuse in youth contribute to their early demise as well (Park, 2010). Native Hawaiians are almost twice as likely as Whites to die from heart disease, and three times more likely to receive a diagnosis of chronic heart disease (U.S. Department of Health and Human Services (USDHHS), 2010). Further, the frequency of high blood pressure is 70 percent higher in Native Hawaiians than in Whites (State of Hawaii, 2010; USDHHS, 2010). At this time, no culturally sensitive weight management programs designed for Native Hawaiian women exist in the Hawaiian archipelagos.

In exploring the cognitive and behavioral components of overweight and obesity in this population, research suggests stressors (specifically, discrimination) for this indigenous population may contribute to negative health behaviors that provoke weight gain (Agosto, 2011; McCubbin & Antonio, 2012). Of all ethnicities living in Hawaii, Hawaiians have the lowest incomes, the least education, and the highest level of social problems and health issues (Mokuau & Matsuoka, 1995). Although a paucity of research exists regarding these issues, McCubbin and Antonio (2010) found a connection between overt discrimination and body mass index scores for a sample of Native Hawaiians. This research suggests that an effective weight management program for Native Hawaiian women must also include teaching coping mechanisms to relieve the psychosocial stress of discrimination and cognitive strategies to increase self-esteem and reduce other psychological aspects of overweight and obesity (Agosto, 2011).

The Program

The program is a culture-oriented weight awareness and management program, sensitive to the needs of Native Hawaiian women. Utilizing the parameter of the transtheoretical model of health behavior change, this program aims to create an awareness of cultural tendencies for food consumption and its effects on the Hawaiian population. Additionally, the program will address and treat the effects of overt discrimination on weight gain in this population, and teach effective coping strategies to manage this stressor unique to the indigenous Hawaiian population (McCubbin & Antonio, 2010). Furthermore, it will incorporate strategies that aim to change self-esteem, body image, and attitudes toward food that have been previously successful in establishing weight loss in Native Hawaiian women (Agosto, 2012).

Neel (1962) suggested that Native Hawaiians developed a culturally specific, highly efficient metabolism because of their geographically isolated location that may have predisposed them to limited resources and the need for biological efficiency. This theory was partly based on research that determined an association between an increased tendency toward obesity and a higher percentage of Hawaiian ancestry (Grandinetti, Chang, Chen, Fujimoto, Rodriguez, & Curb, 1999; Neil, 1962). The program described herein will utilize research guidelines that suggested when Hawaiians returned to their pre-Western contact diet, they lost weight and were healthier, with lower serum cholesterol and blood pressure (Shintani, Hughes, Beckam & O'Connor, 1991). The proposed weight management program is holistic because it addresses biological, psychological, and social aspects of weight loss in Native Hawaiian women, and culturally sensitive because it increases awareness of factors exclusive to weight gain in this diverse population. It combines a culture-appropriate diet and seeks to resolve culture-specific psychological issues.

The Transtheoretical Model
The Transtheoretical Model (TTM) of behavior change provides a parameter for understanding the process of change that will occur over the course of the biopsychosocial weight management program for Native Hawaiian women. The TTM emphasizes the behavioral processes aligned with attitude and awareness change and readiness to change (Glanz, Rimer, & Viswanath, 2008). Central to the TTM is the belief that emotional attitudes and beliefs change with increased awareness and understanding, and this process is the antecedent to change. Further, it explains that individuals cannot make durable behavior changes, until they are cognitively ready to change (Glanz et al., 2008; Rossi, 2004). An important consideration in utilizing the TTM in relation to the biopsychosocial weight management program for Native Hawaiian women is the exclusively cultural factors associated with weight gain in this population. Without embracing all of these factors, and creating awareness in each individual, weight management may not be effective or successful for these women. The TTM accounts for individual variation of cultural embeddedness as well as other contextual circumstances such as an increased awareness of discrimination, and stress related to cultural issues as explained above. Brug (2004) found tailored interventions, such as those accommodated by the TTM, are more effective and promote a higher rate of durable change. The TTM takes into account individuals' readiness to understand, prior to engaging in their education. It theorizes that individuals cannot take action until they are cognitively ready to understand what is involved in making change (Glanz et al., 2008).

Anticipating Challenges

Although this program is designed to affect the various and complex issues of weight management effectively, challenges should be anticipated. One of the primary issues is the sizeable task of increasing self-esteem. Because this issue is inherent in obese and overweight Native Hawaiian women, it must be addressed and at least, partly mitigated, with the hope of continuing to resolve this issue longitudinally. Self-esteem issues do not develop in a vacuum, and it is understandable and expected that resolving such powerful and wholly pervasive psychological issues are far more difficult to resolve in an environment in which personal variables cannot be controlled.

In the action stage of the TTM, the women would have decided to take action against their food consumption habits and their self-perceptions. However, although individuals may be vigilant, they may revert to past behaviors, attitudes, and beliefs (Glanz et al., 2008). Similarly, in the maintenance stage, the women must continue to maintain vigilance against cultural and contextual tendencies, although at this stage their resolve has been strengthened and new and healthier patterns continue to be implemented (Glanz et al., 2008). Psychological cues, such as overt discrimination and the Hawaiian cultural tendency to use food as a social communication, will continue to plague these women, and they should be advised that their changes in health behaviors, beliefs, and attitudes are an ongoing journey.

Another challenge to this program is in its culturally sensitive delivery. Because Hawaiians continue to experience low socioeconomic status, far less education, and a higher level of social and psychological issues than other ethnicities in Hawaii, the experience of discrimination is common, and many harbor anger toward other ethnicities, but especially the White citizens of Hawaii. It will be important to engage Native Hawaiian women as facilitators, speakers, and teachers in the program. For program facilitators not of Hawaiian descent, cultural competency training will be critical to the facilitator's success as well as the success of the program (Kamaka, Paloma, & Maskarinec, (2011).

Although overweight and obesity is a complex issue for any population or individual, Native Hawaiian women face biological, psychological, and social factors idiosyncratic to their indigenous culture. The program described herein aims to guide Native Hawaiian women toward an appropriate weight management plan that accommodates the biological, psychological, and social implications of being a Native Hawaiian woman. The program relates to the stages of change described in the TTM and utilizes awareness as a key factor in implementing durable change in food consumption as well as other aspects of this program's weight management. The most significant aspects of this program is that it is culturally sensitive toward Hawaiian women and considers individuals' readiness for change.


Agosto, J. T. (2012). The psychological effects of obesity in Native Hawaiian women. Dissertation Abstracts International, 72,

Aluli, N. E. (1991). Prevalence of obesity in a Native Hawaiian population. The American Society for Clinical Nutrition, Inc. Retrieved from

Antonio, M. K., & Mccubbin, L. D. (2012). Relationship Between Discrimination and Obesity Among Native Hawaiians. Washington, District of Columbia, US: American Psychological Association (APA).

Brug, J. (2004). The Transtheoretical Model and stages of change: A critique: Observations by five Commentators on the paper by Adams, J. and White, M. (2004) Why don't stage- based activity promotion interventions work? Health Education Research, 20(2), 244- 258. doi: 10.1093/her/cyh005

Brown, D. E., Gotshalk, L. A., Katzmarzyk, P. T., & Allen, L. (2011). Measures of adiposity in two cohorts of Hawaiian school children. Annals Of Human Biology, 38(4), 492-499. doi:10.3109/03014460.2011.560894

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.

Grandinetti, A., Chang, H., Chen, R., Fujimoto, W., Rodriguez, B., & Curb, J. (1999). Prevalence of overweight and central adiposity is associated with percentage of indigenous ancestry among native Hawaiians. International Journal Of Obesity And Related Metabolic Disorders: Journal Of The International Association For The Study Of Obesity, 23(7), 733-737.

Hill, J. O., Peters, J. C. (1998). Environmental contributions to the obesity epidemic. Science 280, 1371– 1374.

Kamaka, M., Paloma, D., & Maskarinec, G. (2011). Recommendations for medical training: a Native Hawaiian patient perspective. Hawaii Medical Journal, 70(11 Suppl 2), 20-24.

Maskarinec, G., Zhang, Y., Takata, Y., Pagano, I., Shumay, D., Goodman, M., & ... Kolonel, L. (2006). Trends of breast cancer incidence and risk factor prevalence over 25 years. Breast Cancer Research And Treatment, 98(1), 45-55.

Mau, M. K., Grandinetti, A., Arakaki, R. F., & Chang, H. K. (1997). The insulin resistance syndrome in Native Hawaiians. Diabetes Care, 20(9), 1376-80. Retrieved from

Mau, M. K., West, M. R., Shara, N. M., Efird, J. T., Alimineti, K., Saito, E., & ... Ng, R. (2007). Epidemiologic and clinical factors associated with Chronic Kidney Disease among Asian Americans and Native Hawaiians. Ethnicity & Health, 12(2), 111-127. doi:10.1080/13557850601081720

McCubbin, L., & Antonio, M. (2012). Discrimination and obesity among Native Hawaiians. Hawai'i Journal Of Medicine & Public Health: A Journal Of Asia Pacific Medicine & Public Health, 71(12), 346-352.

Park, A. (2010). Lab Report. Time, 176(14), 20.

Rossi, J. (2004). Transtheoretical model of behavior change. In N. Anderson (Ed.), Encyclopedia of health and behavior. (pp. 719-722). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412952576.n211

Shintani, T., Hughes, C., Beckham, S., & O'Connor, H. (1991). Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet. The American

Journal Of Clinical Nutrition, 53(6 Suppl), 1647S-1651S.

State of Hawaii. (2010). The burden of cardiovascular disease in Hawaii 2007. State of Hawaii, 2007. Retrieved April 15, 2013, from

U.S. Department of Health and Human Services. (2010). Heart disease and Native Hawaiians/Pacific Islanders. The Office of Minority Health. Retrieved April 15, 2013, from

Weight Loss Program for Parents and Children

This program might be useful for children and parents because it involves parents and children together and has the potential to address issues and challenges within the parent/child relationship.

Bricker, Rajan, Zalewski, Anderson, Ramey and Peterson (2009) found parent-noncompliance had a strong negative influence on children's success. If parents become noncompliant, it is unlikely the children will maintain compliance. Perhaps ongoing parent support groups meeting once per month would help maintain inspiration that the parents will pass on to their children. Sharing parental experiences with the program may be beneficial to all. Since the parent-child relationship has a tremendous influence on children (Bricker, Rajan, Zalewski, Anderson, Ramey, & Peterson, 2009) this program may be valuable in teaching parents and children to work toward a goal together. This experience may have a positive effect on their ability to continue to work together to maintain compliance over the long-term.

Looking at the family context may be beneficial with weight loss programs. Identifying and understanding the family's narrative truth is central to addressing the complex issues of childhood obesity (Grønbæk, 2008). Because it is well-established that overweight and obesity is the result of unhealthy diet and insufficient exercise, these narratives are dubious and might benefit from being identified and modified (Grønbæk, 2008). The program was designed to include parents and children. This may help families correct their shared narrative of how overweight and obesity has become characteristic of one or more family members. Grønbæk (2008) explains when families believe they have control of making changes in family overweight and obesity, they are more likely to be successful in weight management over the long-term. It may be beneficial to guide families toward taking control and understanding their part in weight management.

Children need the full emotional support from parents (Grønbæk, 2008), and this program directly involves parents in becoming educated about overweight and obesity alongside their children. It would be important to address appropriate parent psychological support, and teach what works, and what does not, when trying to inspire children to maintain a weight loss program. The complexity of family relationships may be challenging, and it is important for parents to understand the ambiguity of messages they send to their children unknowingly, especially those messages that derive from established family narratives (Grønbæk, 2008).

Another challenge will be for children to maintain compliance over the long-term. According to the Theory of Triadic Influence, the influences of parents and friends on children are powerful (Bricker et al., 2009). After completing the program, the children will, at some point, be exposed to a social environment unfriendly to their goals. For example, when children visit a friend's home and the parent offers a sweet treat that does not comply with the child's eating plan, ordinarily, he or she will choose to eat the treat anyway, because the friend is eating it. Bricker et al., (2009) found teaching behavior regulating skills to adolescents at risk for noncompliance. To increase compliance with issues related to the negative influence of friends, children may benefit from learning skills that enable them to make decisions independent of their friend's choices (Bricker, Rajan, Zalewski, Anderson, Ramey, & Peterson, 2009).

For the children, it may be beneficial to add socialization programs that enable the children to build lasting supportive relationships that will provide a positive influence for decision-making related to food consumption choices, but it will also provide a peer support network. Peer influence weilds tremendous power on decision making, especially during adolescence, so emphasizing this type of relationship-building may help children succeed (Jaccard, Blanton, & Dodge, 2005; Thorlindsson & Bernburg, 2006).

In the management of chronic illness, more positive outcomes are likely when parents collaborate with children regarding decision making for their care, whether or not the children made the ultimate decision (Miller, 2009). Applying this concept to the weight loss program, children may be more likely to eventually make correct decisions about their exercise and food consumption habits if children become stakeholders and decision makers in matters relating to weight management. Considering this, the program could include educating the parents and children on collaborative decision making that includes practice scenarios in which they could become accustomed to sharing in this process. The process of shared decision making may combat rebelliousness that may at some point become a challenge to children's compliance.


Bricker, J. B., Rajan, K. B., Zalewski, M., Andersen, M. R., Ramey, M., & Peterson, A.V. (2009). Psychological and social risk factors in adolescent smoking transitions: A population-based longitudinal study. Health Psychology, 28(4), 439–447. doi:10.1037/a0014568

Grønbæk, H. N. (2008) "We’ve always eaten healthily": Family narratives about causes of their child’s obesity and the motivation for taking action. Nordic Psychology, 60(3), 183–208.

Jaccard, J., Blanton, H. & Dodge, T. (2005). Peer influences on risk behavior: An analysis of the effects of a close friend. Developmental Psychology, 41(1), 135–147.

Miller, V. A. (2009). Parent-child collaborative decision making for the management of chronic illness: A qualitative analysis. Families, Systems, & Health, 27(3), 249–266. doi: doi:10.1037/a0017308

Thorlindsson, T., & Bernburg, J. G. (2006). Peer groups and substance use: Examining the direct and interactive effect of leisure activity. Adolescence, 41(162), 321–339.

Wilson, D. K., Van Horn, M., Kitzman-Ulrich, H., Saunders, R., Pate, R., Lawman, H. G., ... Brown, P. V. (2011). Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Health Psychology, 30(4), 463–471.

Survey Designs et al.


Surveys gather opinions or attitudes that can be analyzed to gain a general consensus, whereas experiments manipulate variables to produce an outcome, outcomes, or no outcome (Creswell, 2009). Both survey and experimental strategies of inquiry indentify characteristics of a sample and generalize to a wider populations, although the goal of the experimental design is to test how a treatment or intervention affects outcomes in a controlled setting, although not necessarily within a laboratory. The goal of experimental designs is usually to establish how variables are related. This can be accomplished by applying different variables to one group and not to a control group (Creswell, 2009). In a survey, researchers would not manipulate variables as they would in an experimental design .

For example, If I were attempting to identify attitudes of Japanese women recently integrated into the majority American culture, I would utilize a survey method. If I sought to determine the effects of American culture on newly integrated Japanese women who participated in an orientation class specifically designed for Japanese women, I would utilize an experimental design. In the experimental design, I would have an experimental group (the group that took the class) and a control group (the group that did not take the class). Experimental designs have the potential to answering cause and effect questions, however, a survey does not have that potential (Creswell, 2009).

Populations, Samples, and Participants

In a survey design, a population of interest is chosen by the researcher, and its characteristics described (size, gender, and other descriptive information). Similar information is needed for participants in an experimental design. Both can use randomly chosen individuals, however an experimental design considers statistical significance as well as the effect size when determining the size of a group studied.

Instrumentation, Variables, Data Analysis and Interpretation, and Experimental Procedures

In an experimental design, one or more groups of participants receive the independent variable or variables, and the control group does not. Variables in a survey design may be related to specific questions on the survey or questionnaire. In survey designs, the researcher reports the number of responders and non-responders. Further this type of research design must discuss response bias and provide information on the descriptive analysis utilized for the variables.

Both designs utilize a variety of statistical analyses to interpret and make inferences about the population characteristics or relationships between treatment and control groups. Both rely on inferential and descriptive statistics whereas . In the survey design, the primary instrument or means of collecting data is the survey or questionnaire, whereas in the experimental design, data is collected by observing the treatment group(s) as compared to the control group, and taking measurements at specified times during the experiment, (e.g., pre-test and/or post-test). Different from the survey design that utilizes the survey or questionnaire as its process of inquiry, experimental designs require the identification and description of procedures utilized as well as the rationale for the choice of procedures.

Reliability and Validity

In a survey design, it is important to prevent bias and confusion by using carefully chosen wording. Shortcomings in survey design include the challenge of obtaining the depth of information needed from a survey. Further, the survey relies on self-report, which has inherent shortcomings as well. Bowling (2005) found individuals provide answers to questions according to their immediate environment and transient emotional states. Although experiments are best evidence of causality, they have shortcomings as well. For example, some experiments are not possible and in many circumstances, individuals cannot be assigned to one group or another. In experimental designs, external and internal issues may threaten the validity of the experiment. These issues can occur as a result of participant characteristics or flaws in other aspect of the study (methods, measurements, inaccurate inferences and others). These threats must be identified, explained, and mitigated, when possible. Reliability and validity are cornerstones of scientific investigation. In empirical research, they provide a level of usability and practical application (Whiston, 2009). Without reliability and validity, research is of no consequence.


Experiments measure relationships and use words such as causation, control, and variability, confounding variables, placebo, participants, pre-test, post-test, and procedures, whereas survey designs use the words and concepts of population, response bias, samples, questionnaire, survey, target populations, samples, scales, choice, open and closed-ended questions (Creswell, 2009; Whiston, 2009). Health psychology seems to utilize quantitative methods as well as qualitative methods.


Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27(3), 281-291. doi: 10.1093/pubmed/fdi031

Creswell, J. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.

Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning.