Psychosocial Variables in Adult Obese Women

Running Head: PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

Psychosocial Variables in Adult Obese Women:

Group 5: Chang, N., Donaldson, H., Elendu, S.,
Gardiner, A., & Hanlon, S.
The University of Texas at Arlington College of Nursing

In partial fulfillment of the requirements of

N3321 Nursing Research
Denise Cauble RN, BSN, PhD(c), CWOCN
April 25, 2014

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

Psychosocial Variables in Adult Obese Women

Smith, Theeke, Culp, Clark, & Pintos (2014) study entitled Psychosocial Variables and
Self-Rated Health in Young Adult Obese Women is an eye-opening article with regard to how
young obese women rate their health. It shows how these variables are not standalone but are
self-assessments affected by a range of variables like levels of stress, loneliness, sleep quality,
etc. (Smith et al., 2014, p.67).
This article evaluates how obesity affects the self-esteem of young obese women in
todays world. It takes into account various factors and their relationship with obesity. Some of
the variables mentioned in the article include stress and sleep quality. The article also categorizes
how obese young women rate their health as being good, fair or poor (Smith et al., 2014).
In the article, it is proposed that stress, sleep quality, loneliness, and self-esteem are
holistic indicators associated with self-rated health status for young adult women with a body
mass index of 30 and above, which indicates obese status.

Research Problem and Purpose

Smith et al. (2014) publish a study specific to obesity in young adult women and body
mass' effect on psychosocial issues including sleep, self-esteem, loneliness, and stress. Smith et
al. (2014) list the research problem statement as, [t]he psychosocial variables of perceived
stress, sleep quality, loneliness and self-esteem have not been studied as a cluster of variables in
a sample of young adult women with a BMI > 30 (p. 68). The purpose of this study was to
describe relationships among psychosocial variables and self-rated health status in a sample of

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

obese young adult women (Lewis et al., 2014, p. 68). Smith et al. (2014) address obesity in this
study because obesity is steadily increasing among adolescents and young adults. Smith et al.
(2014) cite a study performed by Ogden, Carroll, Kit, & Flegal in 2012 which presents
information that obese children and adolescents will become obese adults. Smith et al. (2014)
conduct a study that focuses on the effects of a BMI over 30 on self-esteem. Smith et al. (2014)
cite a previous study by Prosper, Moczulski, & Qureshi conducted in 2009 that determined obese
individuals have a reduced self-rated health status. Smith et al. (2014) determine women with
BMI >30 rate their health as poor and are at risk for psychosocial problems and negative health
outcomes (Smith et al., 2014). Smith et al. (2014) conduct a study relevant to nursing because it
is clinically important to recognize self-rated health among young obese women to begin early
discussion on the consequences of obesity and associated health problems. Smith et al. (2014)
mention that identifying women with lower self-rated health status can assist healthcare workers
in implementing relevant interventions to improve the overall health of women (Smith et al.,
2014). The Smith et al. (2014) study also shows the correlation between stress, sleep quality,
loneliness, self-esteem and obesity. Information about obesity and psychosocial factors are
important to nursing because nurses can implement stress reducing techniques to improve overall
health in obese young women (Smith et al., 2014). Self-reports indicate sleep is poor in the obese
participants regardless of self-rated health (Smith et al., 2014). Nurses can use this information to
implement interventions to improve sleep including weight reduction program (Smith et al.,
2014). Smith et al. (2014) conducted a feasible study. The study took place at a university student
health center in northern West Virginia University and the subjects were conveniently recruited
using a flier in the student health center (Smith et al., 2014). This study was conducted on a low
budget only requiring paper and pen for the survey and a movie ticket for the participants

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

completing the study. Funding for Smith et al. (2014) was provided by WVU School of Nursing
Research Fund and Dr. Theekes work was partially supported by the Robert Wood Johnson
Nurse Faculty Scholars Program. Smith et al. (2014) had this study ethically approved by West
Virginia University Review Board. Ethical considerations for Smith et al. (2014) study are at a
minimal risk. Minimal risk for a study means the probability of experienced discomfort during
this study is about the same amount of discomfort experienced in daily life or during physical or
psychological tests (Burns & Grove, 2011). Also, individuals voluntarily participated in the
study, further making this study ethically sound. The researchers in the Smith, et al (2014) study
are well qualified. The researchers include M. J. Smith, PhD, RN, L. Theeke, PhD, FNP-BC, S.
Culp, PhD, K. Clark, MD, and S. Pinto, MSN, RN (Smith, et al., 2014). M. J. Smith, L. Theeke,
S. Culp, and S. Pinto are associated with West Virginia University School of Nursing and K.
Clark is associated with School of Medicine, Health Sciences Center in West Virginia.
Literature Review
In the study by Smith et al. (2014) many previous studies for background knowledge are
identified and described. Many of the studies and surveys referred to appear to be both relevant
and current to within five years of this articles publication year of 2014. Out of the 14
documented citations, 9 of them fall inside the five year range. The referenced studies used by
Smith et al. (2014) include a study completed by Kestila, Marrelin, Rahkkonen, Harkamen and
Koskinen in 2009 that associates a correlation between obesity and reduced self-rated health
status. Another study used as a source by Smith et al. (2014) was performed by Bauldry,
Shanahan, Boardman, Miech and Macmillan in 2012. This study also shows a correlation
between obesity and self-rated health status and also indicates a correlation between obesity and
declining self-rated health status over an extended period of time (Smith et al., 2014). Smith et

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

al. (2014) includes information for a study performed by Chen and Qian in 2012 that links higher
stress levels with obesity. Furthermore, Smith et al. (2014) provides another study performed by
Hasler et al. (2004) that links high Basic Metabolic Index percentages (BMI) to sleep duration of
less than six hours. Several other studies are referenced to present the previous research based on
the relationships between obesity and psychosocial variables including a study that links obesity
to loneliness and one that attributes obesity to low self-esteem (Smith et al., 2014). The sources
used by Smith et al. (2014) include data-based literature that has likely been peer reviewed for
accuracy (Burns & Grove, 2011). The study published by Smith et al. (2014) only contains one
theoretical citation. This citation is provided by Jylha (2009) and it discusses that health rating is
very important and relevant to every day as cited in Smith et al. (2014). Jylhas theory describes
how a persons self-rating of health is a holistic indicator of health status as cited in Smith et al.
(2014). This study works from Jyhlhas theory (2009) and relates self-health rating progression
with obesity (Smith et al., 2014). Smith et al. (2014) uses current and relevant sources to
progress through the different psychosocial variables. The previous research is understandable
and presented in a logical manner that supports the need for further research. Smith et al. (2014)
states that the psychosocial factors of loneliness, stress, sleep quality and self-esteem have not
been studied as combined effects and indicates the need for further research which gives
meaning and purpose to this study. In addition, it is acknowledged that there is not enough data
related to young adult women with a BMI of greater than thirty which also indicates a gap in the
research thus far (Smith et al., 2014). The progression of the research includes various studies
that have taken place individually relating to the different psychosocial variables outlined for this
particular study. Each psychosocial variable discussed has a supporting reference to validate the
research and some topics even have two sources for supporting evidence. The organization

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

includes headings for each different topic of the study. These topics are organized in a logical
and progressive way that supports the study and its claims. The first topic is self-rated health.
This part of the study relates self-rated health as a measure of health that is related to obesity.
The presence of obesity has a direct effect on a persons self-health rating (Smith et al., 2014).
The study progresses to link obesity with psychosocial factors including stress, lack of sleep,
loneliness and self-esteem. In this portion of the study a relationship is defined between the
effects of the aforementioned psychosocial variables and obesity which is then linked to the
rating of self-health. The collection of data from prior studies, surveys, and theories includes
both empirical and theoretical knowledge. The empirical knowledge is taken from a variety of
reputable studies that support the need for further research and indicate a clinically significant
link between obesity and various psychosocial factors. The theoretical knowledge also supports
the basis for further research as the empirical data provided from the studies support the theories
that have been formed in previous studies. Though there is not a summary in the ROL of this
study, the organization of the study indicates the need for more research in the relationships
between psychosocial variables, obesity, and self-rated health. The need for more research based
on the lack of information regarding young adult women and studying the psychosocial factors
as a cluster rather than individually provides a sound basis for continuing this study. The results
of this research are important and may have sound influence on future practice.
Study Framework
In this article Psychosocial Variables and Self-Rated Health in Young Adult Obese
Women by Smith et al. (2014), there is no external framework in the methodology. The
conceptual framework must be extracted from the ROL; however, in Section 3, a survey is
generated by Smith et al. (2014). In Section 4.2, the standard for self-rated health is referenced

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

by the 5-point Likert scale and could be used as a framework for the writing of this study.
However, without going into how it would influence the results or why it was picked for the
research, beyond it being good and implying causal links without giving any clear indication
as to how or why causation has been shown. Additional, a bivariate method was used for
gathering quantitative data that at best shows a loose correlation. The concept of interest is selfrated health, perceived stress, loneliness, self-esteem, and sleep quality. These variables are
expressed and defined in isolation respectively in Section 1 and 4.2, Section 4.3, Section 4.4,
Section 4.5, and Section 4.6. The relationship between obesity and psychosocial variables are
clearly indicated in Section 2, Paragraph 1, 2, 3. Smith et al. (2014) suggest that obesity status is
related to the four psychosocial variables, perceived stress, loneliness, self-esteem, and sleep
quality, which may be a negative effect on self-related health status. The framework presents the
relationships among the concepts in Table 3, however, is no pictorial representation of the
framework but this would not be hard to create. A distinctive reference to a source theory that is
used to propose the causal link between the variables of the study is not found. There are no
propositions from the theory as the authors were not testing a theory in this study. Likewise,
there are no hypotheses as this is not an experimental study.
Research Objective and Question
The objectives and questions are clearly and concisely expressed in the Smith et al.
(2014) study. There are no hypotheses in this particular study by Smith et al. (2014). The
objective of the study by Smith et al. (2014) is to show how psychosocial variables of perceived
stress, sleep quality, loneliness, and self-esteem contributes to obesity in young adult women.
The questions Smith et al. (2014) pose are:

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

1. What are the relationships among the variables of perceived stress, sleep quality,
loneliness, and self-esteem among obese young adult women? 2. What are the differences in
perceived stress, sleep quality, loneliness, and self-esteem for obese young adults who rate health
as poor/fair and those who rate health as good/very good? (Smith et al., 2014, p. 68)
The objectives and questions are logically linked to the research purpose. Smith et al.
(2014) state the purpose of this study is to describe the relationship between psychosocial
variables and self-rated health among young obese women. The questions posed by Smith et al.
(2014) contain the same variables as the purpose. The objectives and questions in the Smith et al.
(2014) are linked to the concepts and relationships from the framework. The study shows the
relationship among the psychosocial variables of perceived stress, sleep quality, loneliness, and
self-esteem and self-rated health among obese young adult women as well as the differences in
perceived stress, sleep quality, loneliness, and self-esteem for obese young adults who rate health
as poor/fair and those who rate health as good/very good (Smith, et al., 2014).
Variables
The major research variables defined by Smith et al. (2014) are self-rated health and the
psychosocial behaviors of perceived stress, sleep quality, loneliness, and self-esteem. Smith et al.
(2014) conceptually define the major variable, self-rated health, as a measurement of health and
an indicator of personal health. The psychosocial variables are not clearly defined by a meaning
but Smith et al. (2014) describe how the variables are used for the study. Smith et al. (2014)
show that stress has the highest reported levels of obese women, those with less than six hours of
sleep are more likely to have a higher BMI, lonely individuals have a higher BMI, and there is an
inverse relationship found with self-esteem. Some of the major operational variables are defined
based on research. Smith et al. (2014) defined self-rated health by using the 5-point Likert scale

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

based on poor, fair, good, very good and excellent scores. Smith et al. (2014) measure stress
based on the perception scale and scores ranged from 0-44; the higher the score received the
higher the stress level. Smith et al. (2014) use the UCLA loneliness scale and scores ranged from
20-80 in young adult obese women; the higher the score received the lonelier the individual.
Smith et al. (2014) use The Pittsburgh Sleep Quality Index to assess sleep over a month interval.
Smith et al, (2014) measure self-esteem using the Rosenberg Self-Esteem Scale and scores range
from 0-30; higher scores indicate higher self-esteem. The only variable that is defined as both
conceptual and operational is self-rated health. From the operational definition, Smith et al.
(2014) conclude that splitting the measure of self-rated health into two groups offers a clearer
understanding of how the groups differ on positive and negative responses regarding health
status. This information shows that the data is measured and manipulated. The psychosocial
variables of self-esteem and stress are only conceptually defined by Smith et al. (2014). Selfesteem did not meet the scale sample age range defined by Smith et al. (2014) because the
Rosenberg scale sampled women in age range 47-67 years old, making self-esteem only have a
conceptual definition. The psychosocial variable of stress uses age ranges of 17-60 which is
within the defined range of young adult women by Smith et al. (2014), but the researchers only
provide a conceptual definition. According to Smith et al. (2014), sleep quality varies among the
defined groups but the data does not include age ranges to draw an appropriate conclusion. Smith
et al. (2014) state the psychosocial variables show relationships among them but fail to provide
both conceptual and operational definitions for all variables in the study except self-rated health.
Smith et al. (2014) fails to appropriately address the relations among the variables and the
differences among the variables posed in the second question guiding the study. Smith et al.
(2014) use young adult women between the ages of 18 and 34 and BMI as the demographic

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variables. BMI is a demographic variable in the Lewis et al. (2014) study and gives a clear
definition of obesity. BMI of 19-24 is normal, 25-29 is overweight, 30-39 is obese, and 40-54 is
extreme obesity.
Research Design
The study by Smith et al. (2014) follows a comparative correlational design type. It is
correlational because there are various associations being made regarding different variables and
it attempts to generalize results from a smaller sample and generalize it to a larger population.
One question guiding the Smith et al. (2014) creates a correlational design because it addresses
relationships between variables of perceived stress, sleep quality, loneliness, and self-esteem
among young obese women. This study is also comparative. The second question guiding the
Smith et al. (2014) study examines the naturally occurring relationship between the variables and
self-rated health in young obese women and compares the groups rating health as poor/fair or
good/very good. Following the completion of the study Smith et al. (2014) discuss the new
information regarding the relationship between stress, sleep quality, loneliness and self-esteem.
Both the correlational design type and the comparative design type are the best types of design
for this study because the purposes of the study are to describe relationships linking psychosocial
variables and their differences based on self-rated health status in a sample of younger adult
obese women (Smith et al. 2014). The correlational comparative design enables the results and
data to be interpreted as intended. The comparative correlational design provides a means to
examine the intended variables, relationships, and differences guiding the study. The
demographic characteristics relating to age and BMI or body mass index are gathered by Smith
et al. (2014) to ensure the participants meet the predetermined sample group. Next, Smith et al.
(2014) asks the participants to measure self-rated health based on the 5-point Likert scale which

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shows the participant's spontaneous assessment of their believed health and studies the
relationship differences in the variables according to good/very good health or fair/poor health
groups. The psychosocial variables of stress, loneliness, self-esteem and sleep quality are
surveyed using various scales where participants rated themselves (Smith et al. 2014). The study
is very thorough and results are gathered and interpreted regarding each variable that was
proposed to be related for the purpose of the study. The data is then compared for differences
regarding the self-health ratings and the relationships between the variables affecting both
good/very good ratings and fair/poor ratings. The study conducted by Smith et al. (2014) does
not include an intervention or treatment. Smith et al. (2014) does not identify any extraneous
variables in this study. The study by Smith et al. (2014) is conducted in an uncontrolled setting, a
public healthcare clinic. Uncontrollable environmental factors facilitate extraneous variables and
may change the outcome. There is no pilot study conducted by Smith et al. (2014). The
researchers Smith et al. (2014) do not mention a previous study that looked at perceived stress,
sleep quality, loneliness, and self-esteem as a group of variables in a sample of young women
with a BMI >30.
Sample
In Smith et al. (2014), inclusion sample criteria is clearly defined in section 3 as students
18 years or older. These students must have a BMI of 30 or higher, and agree to attend a
preventative health care visit at the Student Health Center (Smith et al., 2014). The exclusion
criteria is not clearly stated, but includes individuals with a BMI of less than 30 or age of less
than 18 years old. Smith et al. (2014) state the sample group is obtained through convenience
methods. The sample of 68 obese, young, adult women is recruited using notices placed in the
student health center. The Smith et al. (2014) research team is employed by the health care clinic

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and identified potential study candidates. The individuals who met the inclusion criteria were
approached by the Smith et al. (2014) team and were offered a chance to participate using a
standardized verbal script. The methodology of sampling clearly indicates that non-random
convenience sampling is used in the Smith et al. (2014) study because the individual sample is
not chosen at random. The inherent bias in convenience sampling means that the sample is
unlikely to be representative of the population of interest. This undermines the ability to make
generalizations from the sample to the population of interest.
Bias
Biases are found within convenience sampling. Selection bias occurs because the
participants volunteer for the Smith et al. (2014) study. The Smith et al. (2014) study sample is
recruited using notices posted at a healthcare clinic. The Smith et al. (2014) study includes
narrowly defined criteria to obtain a sample of 68 women, 18 years or older with a BMI of 30 or
higher. A less remarkable bias is seen in self-health rating; 48 participants rate their health as
good or very good while only 20 participants rate as their health as poor or fair (Smith et al.,
2014). The distribution of participants is uneven and this could result in biased conclusions. The
study would be less biased if the number of participants self-health ratings were closer to 50%
rating their health as good or very good and 50% rating their health as poor or fair health.
Size
A sample of 68 obese women with BMI 30 or higher, with a mean of 35, is recruited
using posted notices at a health center. The women recruited for the Smith et al. (2014) study
were aged 18-34 years old with a mean of 22 years. Survey data is gathered and analyzed using
descriptive and bivariate procedures to assess relationships and group differences (Smith et al.,
2014). A power analysis is a statistical method allowing researchers to calculate the number of

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subjects needed to conduct a study, based on the variables of the study (D. Cauble, personal
communication, April 2, 2014). A power analysis is not conducted to determine if the sample
size is adequate for the Smith et al. (2014) study.
Attrition
Smith et al. (2014) do not report any potential subjects who refused to participate in the
study. According to Smith et al. (2014) all the potential subjects for the study: 68 women,
participated in the study; no one refused to participate. Table 2 lists the total group sample of 68
participants, including 20 individuals rating their health as "poor/fair" and 48 individuals rating
health as "good/very good" (Smith et al., 2014, p. 69). Smith et al. (2014) identifies 68
participants over a 15 month period at the university student health center in northern West
Virginia. Smith et al. (2014) does not mention any subjects dropped from the study making the
attrition rate 0%. The interpretation of this attrition percentage means that all 68 participants
recruited successfully complete the study. Smith et al. (2014) includes the sample of 68 young
adult women with a BMI of 30 and above and divides these subjects into two noticeably unequal
groups. Table 2 concludes that 48 individuals or 70% rated health as good/very good and 30% or
20 participants rated health as poor/fair (Smith et al., 2014, p.69). According to Smith et al.
(2014) the study does meet the IRB expectation. Smith et al. (2014) state that young adult
women are recruited using notices placed in the student health center. The research team,
employed by the clinic, identified potential participants using the inclusion criteria set by Smith
et al. (2014).
Protection of Subjects
The study by Smith et al. (2014) meets the privacy regulations set by HIPPA based on the
fact that those performing the study get informed consent and they do not identify any participant

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throughout the study or in the results. As mentioned by Smith et al. (2014), the participant gives
a packet containing the surveys to a member of the research team who records the participant's
BMI. From this we can draw the conclusion that only those directly involved in the study are
aware of the females condition.
Setting
The study by Smith et al. (2014) took place on a university student health care clinic in
northern West Virginia. The setting is appropriate because this study involves health issues in a
population of college students. Although appropriate, the setting creates a potential for bias.
Smith et al. (2014) use participants that are actively being treated for preventative health, and the
study is open to individuals presently at the college during the study time. The study by Smith et
al. (2014) does not include individuals who may have a preexisting condition or those seeking
preventative health screenings, potentially impacting the number of obese participants. For the
age demographic a university setting is perfect because the participants can easily fall between
the ages of 18 and 34. There is also a bias with the people selecting the participants. The research
team for Smith et al. (2014) is comprised of employees of the student health clinic. These
employees have the potential to be familiar with the study participants and their health history
because they are actively visiting the health center.
Measurement Methods
The tools and instruments used in the method of measurement are described in the article.
In Section 3, data is gathered in a setting where the participants completed pen and paper
surveys. There are no physiological measurements in the study by Smith et al. (2014). Smith et
al. (2014) conducts a survey that takes place in a university student health center in northern
West Virginia. Young adult women over 18 years old are recruited using notices placed in the

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student health center. Data is collected from 68 subjects over a 15 month period. Each
participant in the Smith et al. (2014) study completes a pen and paper survey and has their BMI
recorded; the participants are provided movie tickets as incentives. The study by Smith et al.
(2014) is approved by the West Virginia University Institutional Review Board. Self-rated health
and psychosocial variables such as perceived stress, loneliness, and self-esteem are measured
using self-reported scales. Self-rated health is evaluated using the 5-point Likert scale of poor,
fair, good, very good, and excellent (Smith et al., 2014). Stress is measured using the perceived
stress scale. Loneliness is measured using the Revised UCLA loneliness scale. Self-esteem is
measured using the Rosenberg Self-esteem Scale. Sleep quality is determined using the
Pittsburgh Sleep Quality Index (Smith et al., 2014). A higher score on the scale indicates a
higher level of perceived stress, loneliness, and self-esteem. For the variable of sleep quality
using the Pittsburgh Sleep Quality Index, higher scores indicate poorer sleep quality. The
measurements for variables are cited and addressed adequately with reliability and validity as
described in the article. In Section 4.1, obesity is determined by BMI, a global accepted index for
body mass. In Section 4.2, Smith et al. (2014) conclude splitting the measure of self-rated health
into two groups offers a clearer understanding of how the groups differ in positive and negative
responses regarding self-rated health status. This approach is consistent with the work of
Goodwin et al. (2006). In Section 4.3, the scale of perceived stress is determined to be reliable
based on Cronbach's alpha coefcients of 0.89 in a sample of U.S. college students. The
convergent validity is supported with a correlation of 0.87 between the perceived stress scale and
a measure of anxiety based on work of Roberti et al. (2006). In Section 4.4, scale of loneliness is
described to have high internal consistency ( = 0.890.94) and adequate testretest reliability (r
= .73). This statement is confirmed with concurrent validity and with significant correlations

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between the Beck Depression Inventory (r = 0.62) and the Costello-Comrey Anxiety (r = 0.32)
from the work of Russell et al. (1980). In Section 4.5, the scale of self-esteem is described with
adequate reliability and validity of a global measure from work of Rosenberg (1979).
Correlations of 0.85 and 0.88 demonstrate very good reliability. Construct validity is claimed by
relating the scale to peer group reputation among high school seniors. In Section 4.6, sleep
quality is determined using Pittsburgh Sleep Quality Index, the global score has an overall
Cronbach's alpha of 0.83 indicating a high degree of reliability (Smith et. al., 2014). Smith et al.
(2014) used the work of Buysse, Reynolds, Monk, Berman, & Kupfer (1989) to validate the
methodology cited in the article. No instrument is developed for this study, Smith et al. carries
out the study using the quantitative survey. Smith et al. (2014) ensures the reliability and validity
of this study by using instruments of measuring that have been previously developed and
acknowledged.
Data Collection
In Smith et al. (2014) the data collection process is clearly described. The convenience
sample of 68 young obese women are recruited for the Smith et al. (2014) study using notices
placed in a student health center. Smith et al. (2014) then describes the inclusion criteria for
those subjects identified by the members of the research team allowed to participate based on the
inclusion criteria. The members of the research team use a verbal script to invite the students to
participate in the study (Smith et al., 2014). Smith et al. (2014) states that for the study, data is
gathered by pen and paper surveys that the subjects complete. After a member of the research
team records the students BMI or body mass index, the student receives a movie ticket for their
participation. There is no indication that these steps are not consistently implemented with all 68
participants of the study. Both the setting and the length of time for data collection are described.

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Smith et al. (2014) state the location of the study as a health science center at a university in
northern West Virginia and discuss the time frame of data being collected as over 15 months.
Smith et al. (2014) states that the verbal script provided is prescribed which means that each
member of the research team has the same words to read to each prospective student that is
identified. The verbal script and inclusion criteria indicate the method of data collection is
consistent. Smith et al. (2014) do not adequately describe the training of the data collectors.
Smith et al. (2014) state that members of the research team are employed by the clinic but do not
discuss any training or variances in the identification of potential subjects. Smith et al. (2014) do
not provide an inter-rater reliability rating for this study. An inter-rater reliability rating is not
indicated in this study because survey instruments are used for the study. The data collection
methods in the study by Smith et al. (2014) directly address one of the research questions. The
data collection takes place in a student health clinic at a college. This setting is a good place to
recruit participants for the study because most of the students should meet the age criteria. The
first research question poses relationships among variables of sleep quality, perceived stress,
loneliness and self-esteem in relation to obese young women (Smith et al., 2014). The data
collection methods include having selected participants fill out a pen and paper survey
employing various tools that relate to the relationships between the variables in question. The
collection of data includes responses from young obese women which are specifically identified
as the target of study for the first research question (Smith et al., 2014). The second research
question is only somewhat addressed. The question relates to the differences in relationships
between psychosocial variables in people with varying self-health ratings. While the data
collection employs useful tools and uses a survey method to gather information, the specific
target of this question is obese young adults and not only obese young adult women. Smith et al.

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(2014) fails to collect data relating to young obese adult men which is a group that should be
included within young obese adults. The study conducted by Smith et al. (2014) correlates with
the research questions but does not address them in their entirety. A survey or questionnaire is an
appropriate means for collecting quantitative data in the Smith et al. (2014) study.
Data Analysis
Smith et al. (2014) analyzes each variable mentioned in the research questions. The
measures section of the study incorporates the level of significance for each psychosocial
variable studied. Smith et al. (2014) uses the Cronbachs alpha coefficient value of 0.80 to 0.90
to indicate that the data collected is reliable enough to use in the study. For the Smith et al.
(2014) study, the level of significance used is Alpha = 0.01. This information is found under table
4 of the article and is not listed in the text portion. For perceived stress, loneliness, and selfesteem the alpha coefficients are 0.9 or above as indicated in Table 1. These values indicate that
the data collected with the tools used to measure these variables is reliable to use for the study.
The tool used for sleep quality only scored 0.70 on the coefficient rating. Because of this low
value, Smith et al. (2014) states that the data collected for this variable is only minimally
accepted. Data analysis for the study by Smith et al (2014) uses t tests and r values to address
both research questions. The data analysis addresses the first research question by measuring the
results for each tool and variable for possible relationships based on the demographics being
studied. Smith et al. (2014) reports that correlation coefficients are completed to determine the
relationships that exist between the variables in question. For the self-rated health score, Smith et
al. (2014) determines that splitting the self-health ratings into two groups provides for clearer
understanding of the positive versus negative responses for both groups. The groups are split into
good/very good rating or fair/poor rating (Smith et al., 2014). The analysis of the data collected

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addresses the second research question as it evaluates the existence of relationships between each
psychosocial variable in relation to the participants self-health rating of good/very good or
fair/poor (Smith et al., 2014).
Data analysis for the Smith et al. (2014) study uses SPSS version 21.0. Correlation
coefficients are completed to determine the significance of relationships between the variables
(Smith et al., 2014). Smith et al. (2014) uses correlation coefficients to analyze the data regarding
relationships between psychosocial factors and obesity in young adult women. This analysis is
appropriate for a correlational study and is effective in showing the statistical variance between
the psychosocial variables being studied. T-tests are also used to analyze the data collected. The
t-tests are used in this study to identify differences in the responses of both the good/very good
self-health rating group and the fair/poor self- health rating group relating to stress, self-esteem,
loneliness and sleep quality. The t-test analysis is an appropriate method for analyzing the results
of a comparative study such as this one. In the results section of the study, Smith et al. uses the
reliability coefficients to show the reliability of the tools used. This statistical number helps to
add to the reliability of the study and data collected. The next statistical measure included in the
study by Smith et al. (2014) includes the mean age and BMI for the sample. This statistic is
useful in showing the data is collected from the target sample for the study. Next, Smith et al.
(2014) includes the values for the correlation coefficients showing the strength of the
relationships between each of the variables studied. Smith et al. (2014) finds a strong inverse
relationship between stress and self-esteem, and a positive correlation between higher stress
levels and both sleep quality and self-esteem. The study also finds a negative relationship
between self-esteem and loneliness as well as a negative relationship between sleep quality and
self-esteem (Smith et al., 2014). The correlation coefficients are appropriate as they define the

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

20

strength of the relationships between variables as weak, moderate, and strong. Finally, the t-test
results are analyzed between the two self-health ratings. Here standard deviation is defined for
the mean BMI values of both self-health rating groups (Smith et al., 2014). These deviations are
evaluated for statistically significant differences. Smith et al. (2014) does not find statistically
significant differences regarding the mean age or mean BMI of the two different health rating
groups. Smith et al. (2014) is able to point out a significant difference in the mean responses for
perceived stress, loneliness, and self-esteem between the two groups but does not find a
difference in the mean value for sleep quality between the two groups. These descriptive
statistics are appropriate for the data collected and address the relationships between the
variables and the two groups for self-health ratings. The methods of analyzing the data collected
are appropriate and help to explain the significance of the results.
The results in Smith et al. (2014) are presented in an understandable way. The use of
correlation coefficients, mean, standard deviation, and statistical significance are given values
that are easy to understand. Smith et al. (2014) uses four different tables to help explain the
results and their relationship to the research questions. Table 1 examines the reliability of the
various tools used to collect the data from the study participants and lists the study instruments
with the possible scores and the gathered scores relative to the Smith et al. (2014) study. Table 1
supplies the Cronbachs alpha value for each study instrument used in the Smith et al. (2014)
study. Table 2 describes the characteristics of the sample including the standard deviation of the
mean for age and BMI of the participants. It also divides this information based on the selfhealth ratings of good/very good and fair/poor. Table 3 defines the correlation coefficients and
the relationships found between the major variables of the study. Table 4 describes the t-test
results for the two health groups, the variables, and discusses the statistical significance of the

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

21

differences found between the standard deviation for each variable and for each health group
(Smith et al., 2014). The tables are organized and positioned within the study where they are easy
to find and their explanation is found on the same page. The tables used for this study are
appropriate and easy to figure out. The variables used in each table are explained in the text
which gives meaning and clarity to the figures used. The tables also emphasize the results of the
study in an easily comparable format.
Interpretation
The researchers interpret the findings in the Smith et al. (2014) study to be important in
understanding how stress, sleep, loneliness and self-esteem relate to self-rated health in obese
young women. The researchers report significant relationships between self-rated health in
young obese women and the psychosocial variables of loneliness, self-esteem, and perceived
stress in the Smith et al. (2014) study and also find there is no significant relationship in sleep
quality. Smith et al. (2014) states that young obese women who report high levels of stress may
also experience poor sleep quality and greater loneliness. Smith et al. (2014) also report an
inverse correlation between perceived stress and self-esteem in young obese women. Smith et al.
(2014) discuss a high correlation between loneliness and stress in young obese women and
significant differences between stress, loneliness, and self-esteem in young obese women who
rate health as poor/fair and good/very good. Individuals that report health as poor/fair may have
greater loneliness, higher stress, and lower self-esteem. Smith et al. (2014) indicate young obese
women who report their health as good/very good experience stress, loneliness, and poor selfesteem and suggest that obesity is a contributing factor. All young obese women, regardless of
self-health, report poor sleep quality according to Smith et al. (2014). The results of the Smith et
al. (2014) relate to the conceptual framework and use previous research to suggest a relationship

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22

between the psychosocial variables of perceived stress, sleep, loneliness, and self-esteem in
young obese women. The framework addresses obesity status related to four psychosocial
variables that may have a negative effect on self-rated health. Smith et al. (2014) relates the
results to the questions, problem, and purpose, and the framework is consistently presented
throughout the study. Smith et al. (2014) do not state hypotheses predicting the expected
relationship because this is not an experimental study. However, Smith et al. (2014) question the
relationships between stress, sleep quality, loneliness, and self-esteem and whether these
psychosocial variables are indicators associated with self-rated health status for young adult
obese women. Smith et al. (2014) report significant relationships between stress, loneliness, and
self-esteem in young obese women that are consistent with the expected findings. Smith et al.
(2014) also propose possible differences in the four psychosocial variables for young obese adult
women who rate their health as poor/fair and those who rate their health as good/very good.
Perceived stress, loneliness, and self-esteem all have significant differences between groups that
rated health as poor/fair and good/very good according to Smith et al. (2014). The serendipitous
finding in the study by Smith et al. (2014) is the unsubstantial relationship of sleep in young
obese women who rated their health as poor/fair and good/very good.
Significance of Findings
The significant and non-significant findings are discussed in depth in the results section
of the article. Smith et al. (2014) provides evidence about relationships among the psychosocial
variables of stress, sleep, loneliness, and self-esteem from self-rated health in young obese
women. Loneliness is negatively related to self-esteem and sleep quality. Another significant
relationship is between self-esteem and stress. The samples are divided into two groups based on
self-related health status; subjects who rated health poor/fair and those who rated health

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

23

good/very good. The groups does not differ on mean age (t = 0.78, p = 0.45). There are
statistically significant mean differences in the independent t-tests between the two groups on
perceived stress (p = 0.003), self-esteem (p < 0.001), and loneliness (p < 0.001). Although the
groups have different mean BMI values: the good/very good group has a BMI of 34.9 and the
poor/fair group has a mean BMI of 37.3, this difference is not statistically significant (t = 1.80, p
= 0.075). Also, studies found that there are no statistically significant differences between the
two groups and sleep quality (Smith et al., 2014). The findings are examined, and the
relationship between high levels of stress and poor sleep quality are statistically significant. This
finding highlights the value of assessing for stress in this age group when they indicate poor
sleep quality. The strong inverse correlation between self-esteem and stress could serve as a call
for intervention development. The high correlation between loneliness and perceived stress leads
to the implication that these psychosocial variables should be assessed concurrently in obese
young adult women (Smith et al., 2014).
Limitations
Smith et al. (2014) do not mention any specific limitations in this study. However, one
limitation could be that no subject rated her health as excellent; this only provides the Smith et
al. (2014) study with information on individuals rating their health as poor/fair and good/very
good. Another limitation could be that Smith et al. (2014) report different BMI averages of
individuals rating their health as poor/fair and good/very good.
Implications for Practice
The researcher generalizes the findings by stating that the study reports knowledge about
the relationships between psychosocial variables with obese young adult women. The researchers
also state that there is an emphasis on shedding light on the value of understanding how

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

24

loneliness, sleep and self-esteem could interact with self-rated health status in the population of
obese young adult females. They further summarize their findings through showing that there are
positive correlations among sleep quality, loneliness and stress and that there is a high inverse
correlation between loneliness and self-esteem. The obese young women who rank health as
poor differ from those who ranked themselves as good/very good in the areas of stress, loneliness
and self-esteem. In conclusion; the researchers determine that assessing and addressing sleep
quality could lead to improved health outcomes in these obese young women (Smith et al.,
2014). Smith et al. (2014) state the first implication for nursing practice is that the psychosocial
variables of perceived stress, sleep quality, self-esteem and loneliness are related and can be
addressed in practice interventions with the goal of improving health outcomes. Also, Smith et
al. (2014) report the possibility that interventions targeting stress can impact sleep quality, selfesteem, and loneliness which impact the overall experience of obesity. The second implication to
practice is the importance of knowing the relationship of self-related health in persons with
obesity because poor self-related health is linked to problems in the four psychosocial variables
from the Smith et al. (2014) study. The third implication to nursing is aimed at addressing and
assessing sleep patterns of obese young women because Smith et al. (2014) report poor sleep
quality regardless of self-rated health.
Future Research
Smith et al. (2014) give several suggestions for further studies; the first is to replicate the
study in a sample of young adult obese men which would determine if there are gender
differences within the four psychosocial variables. Secondly, Smith et al. (2014) suggest a
qualitative study that describes and identifies the causes of health ratings in young obese women.
Lastly, Smith et al. (2014) suggest a randomized intervention trial that targets self-related health,

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

25

perceived stress, sleep quality, loneliness and self-esteem as outcome variables for young obese
adults.
Evaluation
The study results of the Smith et al. (2014) are consistent with the previous research with
the exception of sleep quality. Smith et al. (2014) cite a study done in 2012 by Chen & Qian
reporting high stress levels are expressed in obese persons. Smith et al. (2014) reference a 2010
study by Whisman that determined loneliness has been linked to obesity in other age samples.
Smith et al. (2014) cite a study conducted in 2011 by Singleton, Bienemy, Hutchinson Dellinger,
& Rami which reports poor self-esteem in obese persons. Smith et al. (2014) reference a study in
2012 by Bauldry, Shanahan, Boardman, Miech and Macmillan that reports a correlation between
obesity and self-rated health status and indicates a correlation between obesity and declining
self-rated health status over an extended period of time. Smith et al. (2014) cite previous research
by Hart, Larose, Fava, James, & Wing in 2013 reporting poor sleep quality in young obese
adults. Smith et al. (2014) does not have a significant correlation between sleep quality and selfrated health in young adult obese women. According to Smith et al. (2014) this is the first time
the psychosocial variables of perceived stress, sleep quality, loneliness and self-esteem have been
studied as a group of variables in a sample of young adult obese women. The correlational study
by Smith et al. (2014) reports a statistically significant p-value of less than .001 in variables of
loneliness and self-esteem from self-reported health in young adult obese women. The variable
of perceived stress has a p-value of .003, a statistically significant finding. The sample size of 68
young obese women were collected using non-random methods which makes this study difficult
to generalize and decreases confidence in the discoveries. Before researchers can be confident in
the study's findings, studies that implement interventions should be conducted to show the

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

26

relationship between the psychosocial variables and self-rated health in obese young women.
Experimental studies should be conducted to show a cause and effect relationship between the
variables in obese young women. The correlational study by Smith et al. (2014) adds knowledge
to the field of nursing. Smith et al. (2014) conducted the first study that looks at the
psychosocial variables of stress, sleep, loneliness, and self-esteem as a group in young obese
women using self-rated health. Smith et al. (2014) reports self-rated health is an indicator of a
person's personal health. Poor health can be predicted in young obese women by using a selfrated health tool and the four psychosocial variables which can begin early discussions about
problems associated with obesity according to Smith et al. (2014). The findings from the Smith
et al. (2014) study are not ready for practice because there has not been enough research
conducted to determine the relationship among the variables of perceived stress, sleep quality,
loneliness, and self-esteem among young obese women. This study by Smith et al. (2014) is the
first time the four psychosocial variables of stress, sleep, loneliness, and self-esteem have been
studied as a cluster in a population of obese young women. Smith et al. (2014) categorizes the
women by rating health as very good, good, fair or poor and this is the only variable that shows
consistency in the study. The researchers need to provide a firmer understanding among the other
psychosocial variables in order to draw a conclusion that obesity in young adult women is caused
by those variables identified by Smith et al. (2014).
Assessment of References
Smith et al. (2014) use 29 references in the study. The Smith et al. (2014) article contains
9 disciplines. The disciplines are Psychiatric/Psychology (10), Social Science and Medicine (3),
Research (4), Medicine (4), Nursing (3), Diet/Nutrition (2), Public Health (1), Womens Health
(1) and Humanities (1). Referencing many disciplines is appropriate because collaboration helps

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

27

the credibility of the Smith et al. (2014) study. Two referenced journals are specific to middle
aged adults and two are specific to adolescents. These journals, if used to gather data, may have
an effect on the outcome of the study because they do not meet the demographics of young adult
women 18-34 set by Smith et al. (2014) and. Ten of the references are older than ten years, and
all others are within ten years, including Smith et al. (2014). Smith et al. (2014) reference one
article providing data self-rated health, the only consistent variable in the study. Smith et al.
(2014) reference a classic study on loneliness and obesity published in 1985 by Schumacher,
Krejci & Small. Five of the ten references are actual tools that validate the systems used in the
study by Smith et al. (2014). Four references formulate the conduct for the Smith et al. (2014)
research. To get the best results in a study the data should be consistent, validate and reliable.
Credibility of the Authors
There is collaboration among the researchers and Smith et al. (2014) have disciplines
including medicine, nursing, and research. The researchers include M. J. Smith, PhD, RN, L.
Theeke, PhD, FNP-BC, S. Culp, PhD, K. Clark, MD, and S. Pinto, MSN, RN (Smith et al.,
2014). M.J. Smith and L. Theeke are registered nurses with post doctorates. L. Theeke is also a
Family Nurse Practitioner and can contribute information from clinical experience. Clark, K. is a
medical doctor contributing research insight into medicine. Additionally, S. Culp has a post
doctorate which indicates she has experience in research and S. Pinto, a masters level registered
nurse, which involves clinical experience. The level of education of the researchers Smith et al.
(2014), are medical doctors, doctorates, doctorate of nursing and master level nursing. The
researchers include M.J. Smith, PhD, RN, L. Theeke, PhD, FNP-BC, S. Culp, PhD, K. Clark,
MD, and S. Pinto, MSN, RN (Smith et al., 2014). The people employed by the research team
who worked at the health center and helped to identify participants did not have any education

PSYCHOSOCIAL VARIABLES IN ADULT OBESE WOMEN

28

level indicated by Smith et al. (2014). Smith et al. (2014) received funding from WVU School of
Nursing Research Fund and Dr. Theekes scholarly work is partially supported by Robert Wood
Johnson Nurse Faculty Scholar programs.
Conclusion

Obesity has been a serious problem for so many years and, thankfully, it is being
addressed now. Today, more actions are being taken to ensure that people live healthier lifestyles.
This is evident in the solutions proposed in the article. These solutions include eating healthier,
exercising more and being more proactive when it comes to monitoring their health. It was the
hope of the study to see that obesity rates in the United States reduced by a significant degree in
the next few years, and that people would start living healthier lifestyles.
The article contributes significant data on young obese women, especially how certain
factors influence their self-health ratings. Self-health ratings are important data for health
institutions for assessing psychological and physical health. As such, knowing which factors
influence self-health ratings for this particular group is a huge step forward that will hopefully
contribute to positive outcomes.

REFERENCE
Burns, N., & Grove, S. (2011). Understanding nursing research: Building an evidenced-based
practice. Maryland Heights, MO: Elsevier-Saunders.
Smith, M., Theeke, L., Culp, S., Clark, K., & Pinto, S. (2014). Psychosocial variables and selfrated health in young adult obese women. Applied Nursing Research: ANR, 27(1), 67-71.
doi.org/10.1016/j.apnr.2013.11.004