Application of Epidemiology in Community Health Nursing

Georgela Rasadu

Jun 15, 2023

 Application of Epidemiology in Community Health Nursing

Community health nurses provide an essential linkage between epidemiological data and

clinical understanding of health and play an active role in monitoring health status indicators, to

determine problems that jeopardize the public’s health. This paper aims to provide an in-depth

critique of a selected research article, for inclusion of its research outcomes in real life

community nurse practice. A thorough appraisal will be used to identify the article’s strengths

and limitations, including the study’s significance to the current and future development of

health promotion within community nursing practices.

Summary of the Research Article

The research article selected for this paper is “The relationship between dietary exposure

to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations

in Canada” authored by Marushka et al. (2021). The study is published in the Canadian Journal

of Public Health, a reputable peer-reviewed journal publisher, thus, it is likely to be of adequate

quality to warrant a full critique. The aim of the research article is to determine the association

between dietary persistent organic pollutants (POP) intake and the prevalence of type 2 diabetes

(T2D) among Canada’s First Nations adults living on-reserve First Nations south of the 60th

parallel (Marushka et al., 2021). For this purpose, the researchers extracted data collected by the

First Nations Food, Nutrition and Environment Study (FNFNES), a 10-year cross-sectional

participatory study (Marushka et al., 2021). The study included 6085 participants aged 19 years

and over from a total of 84 First Nations communities across 10 Canadian ecozones, to represent

the diversity of diets of First Nations. After First Nations communities identified the most

consumed fish species, 551 samples from 96 fish species were collected and analyzed for the
presence of POP (Marushka et al., 2021). The findings revealed positive associations between

dietary POP exposure and the prevalence of type 2 diabetes (T2D) in the overall population and

“is more prominent in females than in males” (Marushka et al., 2021, p. S179). Although these

results do not prove cause and effect, they are consistent with the findings of other studies. The

authors concluded that the prevalence of T2D is impacted by geographical differences in POP

concentrations in fish species and the amount of fish intake, thus fish consumption advisories

should be designed according to regional and ecozone differences.

Critique of the Research Article

The title clearly identifies the purpose of the study and suggests the key phenomenon and

the population under study. The abstract permits readers to decipher if the article is of interest to

them. It provides a clear overview of the study, including information about the purpose of the

study, methodology, sample size, the main findings, and conclusions. Keywords such as First

Nations, T2D and fish consumption allow the reader to know what the study consists of.

Statistics are used in the introduction and earlier studies are cited to show the correlation

between exposure to POP and T2D and how First Nations are disproportionally affected by T2D

compared with non-Indigenous population. The research question is implied by its aim and

objective and is placed at the end of the introduction.

The study used a quantitative approach and a descriptive, cross-sectional, and non-

experimental correlational design (Woo, 2019). Correlational design is used when researchers

study effects of a potential cause that cannot be manipulated to examine relationships between

variables (Polit & Beck, 2021). Thus, the use of a cross-sectional approach is appropriate for this

study. Participants were selected via a stratified random sampling approach, which “proceeded in

three stages: the regions, the communities and the households” (Marushka et al., 2021, p. S170).
Data collection was completed through household interviews, and participants were asked to fill

in a questionnaire, which collected sociodemographic information. The final sample included a

random sampling of 6085 First Nations individuals aged 19 and over from a total of 84 First

Nations communities across 10 Canadian ecozones (Marushka et al., 2021).

The researchers used logistic regression and chi-squared tests to analyze statistical data,

which is only used in quantitative studies (Woo, 2019, p. 252). Descriptive analysis methods

(percentage values) were used in analyzing the data collected and inferential statistical tests

(ANCOVA) were used to identify whether relationships between variables were statistically

significant. The data collected were synthesized in five tables, an efficient means of summarizing

and presenting substantial amounts of data (Woo, 2019).

Limitations and Strengths

The article was published in 2021 and the literature review contains citations to several

global articles, ranging in years from 1999 to 2021; thus, not all the research is current (Woo,

2019). The sources used in the articles are completely cited in references section in alphabetical

order. The strength of the literature reviewed and provided in the introduction is that it has all

been cited. However, the researchers did not discuss the strengths and limitations of the methods

used in previous studies. One major issue with the research article is the validity of the research

findings and to what extent they could be applied to other contexts (Taherdoost, 2016). The

instrument for collecting data was a survey questionnaire and the researchers did not witness the

participant’s fill out the questionnaires (Chan et al., 2021). Thus, confirming the authenticity of

the results is difficult (Woo, 2019). According to the researchers, “there may be errors associated

with [their] classification of T2D [thus,] the prevalence of T2D could have been underreported”

(Marushka et al., 2021, p. S179), which can affect the validity of the study. The internal validity
of the study has been enhanced through the statistical control of confounding variables, using the

univariate analysis of variance to examine the associations between fish consumption and dietary

POP intake categories with T2D (Marushka et al., 2021). P-values expressing the significance of

statistical relationships were also calculated and the statistical information was described in

tables. This study used a cross-sectional approach, therefore, a causal relationship between

dietary POP intake and T2D cannot be established because “potential reverse causality is also

possible” (Marushka et al., 2021, p. S179).

The study’s framework was not explicitly described but it can be inferred that this study

has taken on a theoretical framework to describe the theory that POP exposure leads to T2D

prevalence among First Nations people living on-reserves (Marushka et al., 2021). The

percentage of the sample used in the study was 78%, enough to avoid a response bias - at least

50% according to Polit & Beck (2006). The sample is large enough, which is the study’s

strength. The discussion in the article seems thorough and correlates the findings with preceding

epidemiological research, which is also a strength.

Ethics approval from the University of Northern British Columbia, the University of

Ottawa and the Université de Montréal and the Assembly of First Nations (AFN) Chiefs-in-

Assembly was obtained; also, written consent was obtained from the participants, both of which

reflect strong ethical consideration. Nevertheless, the privacy and confidentiality concerns are

not explicitly stated in the article.

Observed Relationships

Marushka et al. (2021) aligned their findings with previous research correlating that the

positive association between dietary POP exposure and the prevalence of T2D in First Nations is

a known phenomenon. For example, Wu et al. (2013) prospectively examined plasma POP
concentrations in relation to incident T2D and concluded that dietary POP intake through fish,

meat and dairy food products consumption increases the prevalence of T2D in general

population. Likewise, Rebouillat et al.’s (2022) study echoed the findings in Maryshka et al.’s

(2021) study, suggesting a role of dietary POP exposure in T2D risk.

Integration into Practice

This study’s findings will be shared with my colleagues and incorporated into my

community nursing practice, because its demographics make up the population that I would like

to focus on. The findings emphasize the need for monitoring contaminant levels in fish and fish

consumers, through appropriate fish consumption guidelines, monitoring exposures, and tracking

health impacts in the population. I would reach the population that I am attempting to encourage

health-promotion activities through public health clinics designed especially for those individuals

whose main dietary source is fish consumption. Designing and implementing screening programs

and teaching individuals the signs and symptoms of T2D could maximize early detection of T2D

and decrease the prevalence of T2D-related complications. The study’s findings suggest that the

prevalence of T2D in First Nations adults related to dietary POP intake is more pronounced in

females (Marushka et al., 2021). I would use these findings for emphasizing on comprehensive

diagnosis on my female clients due to their higher vulnerability to T2D (Marushka et al., 2021).

Further Research Considerations

The findings showing that the prevalence of T2D in First Nations adults due to dietary

POP intake is more pronounced in females than in males emphasizes the need for sex-stratified

data in the next epidemiological studies. Also, an interesting subsequent research project would

be to explore the relationship between dietary POP intake and the prevalence of T2D among
Canada’s First Nations living north of the 60th parallel, as well as the Métis and Inuit located in

Canada's three territories.

Conclusion

This article was interesting, and despite its few shortcomings, the study provided a good

illustration of quantitative descriptive research. Its results were insightful and concise. Also, the

study pulled out valuable information about the prevalence of T2D related to dietary POP intake

among Fist Nations and suggested potential solutions with which to address this problem.
 References

Chan, H.M., Fediuk, K., Batal, M., Sadik, T., Tikhonov, C., Ing, A., & Barwin, L. (2021). The

First Nations food, nutrition and environment study (2008-2018)-rationale, design,

methods and lessons learned. Canadian Journal of Public Health = Revue Canadienne de

Sante Publique, 112(Suppl 1), 8–19. https://doi.org/10.17269/s41997-021-00480-0

Marushka, L., Hu, X., Batal, M., Tikhonov, C., Sadik, T., Schwartz, H., Ing, A., Fediuk, K., &

Chan, H.M. (2021). The relationship between dietary exposure to persistent organic

pollutants from fish consumption and type 2 diabetes among First Nations in Canada.

Canadian Journal of Public Health = Revue Canadienne de Sante Publique, 112(Suppl

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dietary pesticide exposure profiles and type 2 diabetes risk in the NutriNet-Santé cohort.

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https://doi.org/10.1289/ehp.1205248