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Diabetes in Youth Type 2 diabetes was formerly known as adult-onset diabetes.

During the last few decades however, limited epidemiologic evidence and clinical
reports suggests that type 2 diabetes in youth is increasing in frequency (CDC
SEARCH; Fagot-Campagna et al, 2001; Neufeld et al, 1998; Rosenbloom et al, 1999).
Type 2 diabetes is rare among children less than 10 years of age. Among youth
aged 10 to 19, type 2 diabetes is still rare, however higher rates are seen in many
minority populations. From 2002 to 2005, 15,600 youth were newly diagnosed with
type 1 diabetes annually and 3,600 new cases of type 2 diabetes in youth were
diagnosed annually. Type 1 diabetes incidence was greater than the incidence of
type 2 diabetes in white youth aged 10-19. Newly diagnosed cases of type 2
diabetes outnumbered new cases of type 1 diabetes in Asian/ Pacific Islander and
Native American youth aged 10-19. In Black and Hispanic youth, aged 10-19,
incidence rates of type 1 and 2 diabetes were similar. Data from 2010 estimated
that 215,000 people younger than 20 in the US had type 1 or 2 diabetes. (CDC
Diabetes Fact Sheet, 2011). Complications of Diabetes Diabetes increases risk of
cardiovascular disease, stroke, blindness, kidney disease, neuropathy, and lower
limb amputations. If a person with diabetes can effectively manage their blood
glucose by keeping their hemoglobin A1c to near normal levels and manage their
blood pressure, many diabetes-related complications can be prevented of delayed.
Unfortunately though, diabetes was still the seventh leading cause of death based
on U.S. death certificates in 2007. Adults with diabetes have death rates due to
cardiovascular disease that are 2 to 4 times higher than adults without diabetes.
Diabetes is the leading cause of new cases of blindness among adults less than 75
years of age. Diabetes is also the leading cause of kidney failure among US adults
(CDC Diabetes Fact Sheet, 2011). Type 2 diabetes diagnosed in childhood or

adolescence places the individual at great risk of diabetes-related complications at

a young age, likely during the most economically productive years of life
(Bloomgarden, 2004; Botero and Wolfsdorf, 2005). Economic Burden of Diabetes
Diabetes places an economic burden on each diagnosed individual. Additionally, the
increasing prevalence of diabetes in the US is placing an enormous economic
burden on our nations healthcare system. Medical expenditures among people with
diabetes were 2.3 times higher than they would have been in the absence of
diabetes. In 2007, direct medical costs due to diabetes were estimated to be $116
billion. Indirect costs such as disability, work loss, and premature mortality were
estimated at $58 billion in the US (CDC Diabetes Fact Sheet, 2011) Prevention of
Type 2 Diabetes Type 2 diabetes can be prevented or at least delayed, therefore
reducing the risk of diabetes-related complications, in the majority of cases. The
Diabetes Prevention Program Research Group conducted a clinical trial that showed
the incidence of type 2 diabetes can be reduced, even among individuals with
prediabetes, by a reduction in body weight and increasing physical activity. Subjects
in the trial were not diagnosed with diabetes, however all had elevated fasting
blood glucose and impaired glucose tolerance. Subjects were assigned to one of
three groups: placebo, metformin, or lifestyle-modification group. Metformin is an
oral medication used in the treatment of type 2 diabetes. Subjects in the metformin
group were instructed to take metformin (850mg) twice daily and to follow
standard lifestyle recommendations. Lifestyle recommendations were given in
written materials and 20-30 minute annual education sessions. Subjects in this
group were encouraged to follow the Food Guide Pyramid, to reduce their weight,
and to increase their physical activity. Subjects in the lifestylemodification group
were given the goal of at least a 7% initial body weight reduction and maintenance

and to participate in 150 minutes or more of moderate physical activity per week.
Subjects in this group received a 16-lesson curriculum covering a healthful diet and
physical activity to help them achieve these goals. Fifty percent of the lifestyle
group were able to obtain a 7% reduction in body weight, 38% were able to
maintain that weight loss. The goal of 150 min of weekly physical activity was
obtained by 74% of the lifestyle group, 58% of the group was able to maintain this
level of activity throughout the study period. At the end of the study the lifestylemodification intervention reduced the incidence of type 2 diabetes by 58%, and the
metformin intervention decreased the incidence by 31% relative to the placebo
group (DPP, 2002). What are the behavioral and environmental factors contributing
to the increasing rates of obesity and type 2 diabetes in the US? More specifically,
what are the behavioral and environmental factors that are contributing to the high
rates of obesity and increasing cases of type 2 diabetes in youth? Increasing portion
sizes, the availability and intake of energy-dense foods and sugary drinks, the easy
access and convenience of fast-food restaurants, limited access to healthy
affordable foods in some communities, and advertising of less healthy foods
targeted at youth have all been identified as contributors to increasing energy
intake. Lack of safe places to play and exercise in some communities, decreased
levels of active forms of transportation, lack of daily physical activity in all schools,
and increasing use of television and media have been identified as factors
contributing to decreases in energy expenditure among youth (CDC Childhood
Obesity; Dehghan, Akhtar-Danesh, and Merchant, 2005).


This chapter presents the research methodology which has been preformed to carry out
this study. The research design that has been used for conducting this study is presented followed
by demonstration of the rationalization for choosing this specific design. A discussion is also
presented for conducting a qualitative study and using the method of secondary data collection.
The inclusion and exclusion criteria have also been presented in this section along with the
method of data analysis that has resulted in the emergence of various themes.

Research Design
The research design that has been selected for performing this study is a secondary
qualitative research design. The rationale for the selection of this research design is based on its
relevance with the aims and objectives of this study. The secondary qualitative research has been
performed through a systematic review of the studies which have been performed previously by
several researchers on the topics that are related to this study. This methodology is appropriate
for the search strategy of this study as the aim of the researcher is to evaluate the effects of
prophylactic antibiotics on the rate of survival of the dental implants. The appropriateness of this
method resides in its ability to allow the collection of the outcomes of numerous studies. It also
provides a way to the researcher through which interpretation of the outcomes of these studies
could be performed to develop a more succinct outline of the topic (Barbour, 2010, p. 156). This
research design also enables to perform a an analysis of the present literature as it enabled the
researcher to gather important information on the topic of study (Jolley, 2010, p. 78). This has
enabled the generation of numerous themes of the topic under study which included the
associated information essential for conducting the systematic review. The secondary research

design has included a systematic review of the studies that have been done for the evaluation of
the effects of prophylactic antibiotics on the rate of survival of the dental implants.

Strategy used for the Search

A search of the recent literature has been performed by the researcher for the collecting
the data which is relevant to this study. This has been performed by the researcher by conducting
a search of the from the manual sources and electronic databases so that the collection of the
previous studies which had been performed related to the survival rates of dental implants
following prophylaxis treatment with antibiotics. It has been supposed that access to an
enormous amount of data is possible through search of the databases, including both manual and
electronic databases. Taking this fact into consideration, the search of the literature performed in
this study has incorporated the relevant databases into the search process so that vast information
on the topic under study can be collected. A search of the peer-reviewed journal articles has been
performed to include the studies which are eligible for inclusion in the review of literature. A
search of several databases had been performed for fulfilment of this purpose. The databases that
have been searched for this purpose included Science Direct, MEDLINE, Pub Med, and
CINHAL plus electronic databases. Restriction of the year of publication of the articles has also
been performed to retrieve the studies that provide current insight into the topic under review.
The year of the studies for review had been restricted from the year1993-2013. The rationale for
this limitation is dependent on the aims of this review as it was an essential requirement to
retrieve all the present literature of the studies which are relevant to this review and had been
performed for determining the survival rate of dental implants in cases where antibiotics are
administered prophylactically and in those cases where prophylaxis is not performed. Certain

restrictions of language had also been considered while conducting the search of studies so that it
becomes possible to eliminate the studies that are in languages other than English language.

A significant role is played by the keywords during the retrieval of relevant studies. This
formed the basis for utilisation of several keywords for performing the search of literature. The
selection of keyword had been based on their relevance with the study topic. This had allowed
retrieving the relevant studies that demonstrates the impact of the prophylactic antibiotics on the
rate of survival of the dental implants. The keywords that were used for search of the relevant
studies included Antibiotic, Dental Implant, Prophylactic, Prevent, Postoperative,
Therapy, Surgery, Infection, Disease, Antimicrobial and Agents. The studies retrieved
from the initial search had been than further analysed for inclusion or exclusion from the study
based on the inclusion and exclusion criteria set for selection of the relevant studies.

Boolean Operators
Boolean operators are used for performing a logical search of the terms which are
relevant to the study and enable the researcher to exclude several items that are irrelevant to the
search. Boolean operators are used for joining, exclusion, or expansion of the keywords when
conducting a search. This method involves a combination of different key words along with the
utilisation of capitalised AND for restricting the search and OR for expanding the search
upon combination. Subject heading with map terms were used to identify terms from the
database thesaurus, in order to refine the search. Boolean operators were used in the search that
allowed the researcher to perform the search in accordance with the study topic and narrowing

the search. It also saved the time so that search of the useful research materials could be
performed and enabled to exclude the irrelevant items.

Inclusion and Exclusion Criteria for the Selection of Studies

The inclusion criteria for the selection of the studies include initially the inclusion of
those studies that are relevant to the topic under study. Finally, all the retrieved studies were
thoroughly screened to include only those studies for the literature review that were based on
effectiveness of antibiotics in dental implants. Only Human studies were included that were
published between the years 1993-2013 and in English language. The inclusion criteria included
those studies which evaluate at least 5 patients with a follow up of > 1 year. This resulted in the
exclusion of those studies that were performed on animals. In vitro studies were also excluded
along with those studies which were published in other language than English and based on case
reports. Multiple publications on the same patient cohorts were also excluded from the review.

Studies Included in the Systematic Review of the Literature

The studies retrieved from the initial search had been than further analysed for inclusion
or exclusion from the study based on the inclusion and exclusion criteria set for selection of the
relevant studies. The initial search had resulted in retrieval of 100 studies that were considered to
be relevant for the literature review initially. However, some of the studies were excluded as they
did not meet the inclusion criteria. As a consequence, 50 studies were excluded from this study
that resulted in a total of 50 studies that were left. After the screening of the retrieved studies,
those studies that have considerable amount of the relevant information about effectiveness of

antibiotics in dental implants were included. This has resulted in the inclusion of only six studies
which were included in the systematic literature review.

Methodology used for the Quality Appraisal of the Selected Studies

It is vital to perform the quality appraisal of the studies which have been selected for the
review. Quality appraisal allows the evaluation of the quality of the evidence that has been
presented in the studies. The method which has been chosen for performing the quality appraisal
of the selected studies is the method of critical appraisal. It is a process which is structured on
order to perform the assessment of a fraction of research so that an evaluation of the limitations
and strengths of these studies could be made. CASP (2002) tool has been used for performing the
critique of the selected qualitative studies, which has been followed by a quality appraisal. It
enabled the researcher to perform a review of the studies which provide more refined and
reliable evidences. The validity of these studies is also justified through the quality appraisal and
critique process. Couglan et al (2007) has been used to direct during the procedure of the quality
appraisal of the quantitative studies. A frame work has been provided by Couglan et al (2007)
which mentions the quantitative research. Use of these tools has allowed the ease of
consideration of the objective, analytical and distinct viewpoint of the studies that have been
selected for the review. These tools also enabled to recognise the weaknesses and strengths of the
studies which have been selected. Suggestion of the implication of the findings of these studies
into practice has also been possible through these tools. The attainment of the clear and reliable
concepts of the studies was also made through the use of these tools.

Method for Thematic Analysis of the Selected Studies

The data for this study was provided by the review of the literature which has included all
the studies that were relevant to the topic under consideration. The data that has been collected
was in the form of information that was derived from the systematic review of the literature. The
outcomes of the systematic review of the literature were interpreted by the analysis of the
information that was collected during the review of the selected studies. Synthesis of the
collected ideas was than performed than for making associations between the different parts of
the information that were identified during the process of analysis. Synthesis of the themes also
provides the method in which the presentation of the conclusion of the material gathered for the
review of the literature has formed the basis of the literature in relation to the research question.
It is essential to perform the process of synthesis in a sequential and gradual manner so that it
becomes possible to develop the collected data into manageable form (Aveyard, 2010, p. 234).
Review of the selected studies has been possible in a wide manner by the generation of themes.
After the synthesis of the data, various themes have emerged that were related to the topic of this
study. Further identification of the emergent themes has been performed for finding their
relevance to the survival of dental implants following prophylactic antibiotic treatment. As a
consequence of the identification of themes the emergent themes had provided the framework for
conducting the systematic review of the literature. The systematic literature review has been then
performed based on the themes that have been identified for providing the information that is
related to the topic under study.

Data Analysis Technique

Qualitative data used in the studies is chiefly examined in two distinct ways. One of the
ways of investigating this kind of information is application of thematic analysis method
(Johnson et al., 2007). The other way of examining such information incorporates the standard
way of discussion of the results. This discussion of the results is chiefly founded on the gathering
of a numerous researches and studies which indicate certain facets of the aims of the research.
Numbers of varied studies utilize a range of diverse techniques of investigating the information
(Hancock et al., 2009). This study though, appropriately made use of thematic analysis
techniques for analyzing the data gathered.

Critical Analysis
The critical analysis is a crucial procedure of any research study. It entails significant
thoughts which apply rational and logical thought procedure while dissecting the textual
information and data (Green & Thorogood, 2013). As it is complex in nature, it prompts an
intellectual action which entails analysis and evaluation on the material accumulated. Browne
and Keeley (2001) explained the critical thinking as a form of knowledge that interconnects with
the research questionnaire which is supposed to be seriously analyzed.
It gives an ability to reply and raise the critical question at the correct time and needs to
make use of the critical questions effectively ((Bryman & Bell, 2011). With no methodology,
critical evaluation and systemic literature, any study cannot be put into to a practice or in any
way put in the consumption of knowledge (Hart, 2005). Critical evaluation of the information
also proposes a structure for the assessment of the inferences on varied researches and their

The process of conducting a review of literature is presented including its various aspects.
Search of the literature, critical appraisal, thematic analysis and synthesis of the literature to
provide answer to research question. Research paradigm which can be appropriate for achieving
the aforementioned purpose has also been presented. Aptness of literature review for this study
and the significance of being methodical during search of literature are discussed. Importance of
adequate inclusion/exclusion criteria, selection of relevant search terms, and databases is argued.
Various methods of critiquing and analysing the literature are presented. Ethical implications of
the literature review are also considered.

3.1 Literature Review as Research Methodology

Qualitative and quantitative research designs are the two basic types of methods that are
adopted for executing a research. Mixed method is another design employed for this purpose and
is a blend of the two aforementioned methods. It can also be applied in a study depending on the
purpose of research and its aim and objectives. The representation of a quantitative design is in
numerical form and is based on statistical methods. Its measurements are numerically performed
while its findings are used for testing the causal hypothesis. Experimental design and careful
sampling strategies are main characteristics of quantitative research in order to simplify the
outcomes. This research design is used when the aim of the researcher is to perform a large scale
study that involves a baseline survey or an assessment of the needs of the individuals. It does not
require participation of the researcher and is autonomous, based on the fact that it can be
replicated by any person and the results would be the same as that of the primary research
(Friedho et al, 2013). There are several advantages of quantitative research design that includes
the fact that it can be utilised for the collection of large quantities of data. The results of this
design are typically quantifiable due to which they are considered objective. Thus, the data is
believed to be quantifiable and it can be generalised to a population that is larger. It enables the
observation of changes over a long period and aid in the development of quantitative indicators
(Creswell, 2014). It facilitates the provision of distinct, quantitative measure that can be utilized
for proposals and grants.
Likewise, there are numerous disadvantages of a quantitative research design that
includes the calculation of its results through software used for data analysis (such as SPSS),
Access, or Excel; the accessibility of which might not be possible in numerous countries. This
research design is time consuming since the process is lengthy that involves the entrance,
cleaning, and analysis of the data by the researcher. The duration of this process extends with the
larger sample size because large sample size includes more data that requires longer duration for
its analysis and interpretation of the results. Furthermore, large sample size also requires more

time for the collection of data. Ignorance of the human element is also an important aspect of this
According to Aveyard (2013), a literature review is a thorough analysis and interpretation
of existing literature on a particular research topic. Meanwhile, Machi and MacEvoy (2009)
define literature review as a written document that puts forth a logically argued case based on a
thorough understanding of the existing state of current knowledge about a particular topic. A
convincing thesis is established by this case that answers the question being sought by the
research study to be answered. Conducting a literature review is a systematic process started with
the identification of a research interest or issues by the researcher that he or she would like to
explore further. The issue or area of interest is generally read by the researcher to ascertain what
is known or unknown about that topic. Based on this phenomenon, development of research
question takes place. As the researcher proceeds, it is imperative to narrow down and clarify the
research question and come up with a research topic to help frame the literature review. The
outcome of the comprehensive literature review is the formulation of an argument which tends to
answer the research question initially posed by the researcher. Machi and MacEvoy (2009) have
presented a six step guide to conduct a literature review according to which the first step is
selection of a specific topic. It is followed by a search of literature that involves previewing,
selecting, and organising data for the study. The next step is development of an argument through
organisation of the relevant literature into a body of evidence explaining pre-existing knowledge
about the topic. A survey of the literature including assembling of the key findings, their
synthesis, and analyses in order to form the argument about information related to the area being
consider for the study is next step in this process. Later, critique of the literature and analyses is
performed by the researcher regarding the parameters that answered by the research question.
Finally, a review is written by the researcher where he or she composes and refines the work to
ensure its understanding by the target audience.
The current literature has not delivered adequate information pertaining to the topic being
considered for research which is in accord by majority of the researchers (Sharp & Hamilton,
2001). However, it has been researched in great depth by various authors at different points of
time each of them presenting different findings. Therefore, considering the gaps in the literature
about this topic, there is a need for an additional study to comprehensively reassess the
knowledge and provide its synopsis to develop a better and clearer understanding of the issue.
Thus, for the purpose of this study, a literature review was adopted as research methodology
because it was felt by the researcher that there was a need to synthesise the different findings,
and reanalyse the results to come up with new inferences. It also aimed at impending novel ideas
that could contribute towards better understanding of the different factors leading to patient nonattendance, and subsequently minimise the adverse effects of those factors on the hospital
management. The fact that there is no dearth of literature on this research topic encouraged the
researcher to use literature review as a research methodology, instead of conducting primary
research. Moreover, the fact that there was a difference of opinion among the different authors

encouraged the researcher to synthesise and reanalyse the findings of the different authors to
come up with new and unique inferences. The author would have instead opted for a primary
research method if there had been a scarcity of literature on this topic or a consensus of opinion.
The methods for identifying the latent relevant studies include search of several
bibliographic databases and scanning the reference list of the eligible studies and reviews that
already exist. Scanning the conference proceedings and hand-searching the major journals and
important databases at the internet is also a significant step in the process of searching. The third
step is the evaluation of collected data. In this step, the studies that have been studied are
subjected to quality assessment through critical appraisal guidelines and quality checklists that
are based on designs. The next step is summarisation of the evidence that include development of
the review in a systematic manner (Hagen-Zanker & Mallett, 2013). The final step is the
interpretation of findings that involves a comprehensive description of the findings of the review
along with a conclusion and recommendations for further research on the topic being studied
(Uman, 2011).

3.2 Inclusion and Exclusion Criteria

The research question and topic often determine which research studies should be
included in the literature review, and which should not. The inclusion criteria specifies which
studies are to be included in the literature review, while the specification of the elimination of
studies along with its justification is provided in great depth by the exclusion criteria (Fink,
2014). Hence, the inclusion and exclusion criteria define the parameters of the selection criteria
used to select studies for the literature review (Aveyard, 2013). This phenomenon is somewhat
similar to the criteria used in primary research for the selection of sample of participants of the
research study.
The inclusion and exclusion criteria of this study set off to demarcate the studies which
were not related to the topic being considered. Certain considerations regarding the year of
publication of research articles were also practiced. The literature published during the year 2000
till 2013 was included in the research study to ensure that the findings of those studies are based
on the recent information. Recent research studies were given more preference because it is
believed that the findings of the older studies might not hold true anymore due to consistent
variations in the healthcare system (Ham, Dixon, & Brooke, 2012). The research studies
conducted in the United Kingdom were included in the literature review while, similar studies
conducted in other regions of the world were excluded because it is believed that the healthcare
provision systems, the quality of healthcare service provided by the healthcare providers, and the
way the patients perceive them differs from one country to another. Hence, it was assumed that
what might hold true for the healthcare service provider in one country might not hold true for

another. The studies that are in languages other than English language were excluded because it
might be difficult for the researcher to read and comprehend other languages.
3.3 Choosing Search Terms
According to Fink (2014), it is important for the researcher to select the search terms
carefully while searching in library catalogues or databases. Search engines and library databases
are not intelligent like humans and their response to search queries is generated by merely
matching up words that are entered in the search box. They do not consider the meanings of
different words. Therefore, during the utilisation of the search option in the library catalogues or
databases, it is imperative that careful selection of the key words or phrases describing the topic
as clearly and specifically as possible is considered (Fink, 2014). Selection of good keywords
make literature search very easy for the researcher. However, often the word describing the topic
of a research might have multiple meanings which make identification of appropriate key words
a difficult task. Hence, the researcher needs to be very careful about the selection of key words.
Despite the best efforts of the researcher there exist a possibility of missing some of the
journal articles or books as different key words might have been used by the authors of those
journal articles or books to describe their work (Ridley, 2008). Therefore, utilisation of a variety
of keywords that can be employed to describe the research topic is always helpful. Hence, as
Ridley (2008) suggests, the researcher can commence by using specific terms describing the
research topic, then move on to using similar and related terms, and later check whether any of
the words already used can be spelled differently. Majority of the words have different UK and
US spelling (e.g. organisation vs. organization). Some of the library catalogues or databases
cannot automatically call up journal articles or books that use US spelling if the researcher
entered the UK spelling during search. Therefore, both the UK and the US spellings should be
used by the researcher when entering the search terms to assure that any important journal
articles or books are not missed while searching for the pertinent literature. Additionally, the use
of both singular and plural forms of the key words should be tried by the researcher as the title of
the journal article or book may contain either of the two. There is a possibility that library
catalogue or database search engine might not retrieve the plural form in the search result if the
researcher entered the singular form, or vice versa. The search terms used for this research study
are discussed in the next chapter to provide a brief overview of the considerations by the
researcher during the search process of this dissertation.
Search strategy is an essential criterion of a systematic review that involves search of the
relevant databases. The first step in searching the databases is defining the question of research
and breaking into individual concepts. Use of synonyms of key terms for searching the relevant
information is crucial to the process of review. Filters and limits are also used for searching the
material that allows the retrieval of information pertaining to the topic being studied. The second
step of a systematic review is the collection of data. The criteria for the selection of studies have
to be specified prior to the commencement of review. It should present the criteria for

inclusion/exclusion. The process of search should be extensive that should involve search of
multiple databases.

3.4 Selecting and Justifying Databases

According to Aveyard (2013), the researcher can get access to various online academic
journals and e-books by using electronic databases that often require paid subscription. These
online academic journals and e-books are not accessible through the search engines on the
internet. Hence, by carefully entering appropriate key words in the search engines of these
databases, the researcher can get immediate access to a plethora of online journal articles and ebooks that would have been hard to access otherwise.
Bearing in mind the diversified approaches and tremendous amount of data which can be
retrieved from the databases, a search of the university database was performed by the researcher
of this dissertation. Electronic databases available through the Oxford Brookes University online
portal were accessed. These databases included PubMed, MEDLINE and CINAHL. Additionally,
Google Scholar was also used to conduct some of the research; however, it was ensured that the
literature chosen was either from journal articles published in reputed academic journals
pertaining to health and social care or it was from books published by reputed publishing houses.
It was ascertained that unpublished works, web articles or blog entries were not used for the
purpose of the literature review.
There is a vast variety of databases which can be accessed to retrieve the information
about the topic being studied. The most significant databases from the field of medical and
healthcare are CINAHL, PubMed, MEDLINE, ScienceDirect, and Google Scholar. CINAHL is
the world's most inclusive database of nursing & allied health research, offering full text for
approximately more than 770 indexing and journals for greater than 3000 journals from the fields
of nursing and allied health. It possesses coverage of publications from the National League for
Nursing and the American Nurse Association. PubMed central is a free database of full-text
scientific literature in biomedical and life science. MEDLINE provides the citations and abstracts
for journals that are related to biomedical literature from around the world. It contains 21 million
references to articles published in approximately 5,600 current biomedical journals. Science
Direct database contains around more than 25% of the worlds technology, science, and medicine
bibliographic and full text information. Google Scholar finds results from academic or scholarly
sources. This can assist in focusing on the search or can be helpful if peer-reviewed material is
being searched for a course work or dissertation. Results may include journal articles, books,
papers, abstracts, and theses etc.

Name of



CINAHL is the world's most inclusive database of nursing & allied health
research, offering full text for approximately more than 770 indexing and
journals from the fields of nursing and allied health. It possesses coverage of
publications from the National League for Nursing and the American Nurse


PubMed central is a free database of full-text scientific literature in biomedical

and life science.


Provides the citations and abstracts for journals that are related to biomedical
literature from around the world. It contains 21 million references to articles
published in approximately 5,600 current biomedical journals.


Science Direct database contains around more than 25% of the worlds
technology, science, and medicine bibliographic and full text information.


Google Scholar finds results from academic or scholarly sources. This can
assist in focusing on the search or can be helpful if peer-reviewed material is
being searched for a course work or dissertation. Results may include journal
articles, books, papers, abstracts, and theses etc.

Table 1: Description of databases used to access relevant literature

3.5 Critique of the Literature

The next step after deciding what literature is going to be used for the purpose of
literature review by the researcher is to ascertain the manner in which the researcher is going to
critically analyse that literature (Aveyard, 2013). This method is ordered to achieve the
assessment of a section of research for allowing the investigation of both the reliability and
validity of selected studies. Appraisal of the quality of studies is conducted through the
employment of critical appraisal tools. This process enables ease of addressing the reliability and
validity of the studies. It also allows critically evaluating the results of the research articles.
Critique of the studies can be performed through several tools used for critical appraisal of the

articles. It is a planned procedure that accomplishes the evaluation of a fragment of research to

facilitate the investigation of strength and weaknesses of the studies. Several tools are used for
appraising the quality of evidences provided by the studies that ensure that they are of
appropriate quality to be included in the review. While, there is a range of standard critical
appraisal tools to evaluate the quality of published research studies, a consensus has not been
developed among the researchers in the field of health and social care about the ideal critical
appraisal tool (Katrak et al., 2004).
Different critical appraisal tools are available and their suitability to a particular research
study depends on the research design being adopted by the researcher. Since, this research study
is a literature review, various critical appraisal tools were analysed which are best suited to this
type of research design. Following a comprehensive assessment of all the tools developed for
critically appraising studies in a review, the researcher deemed the Critical Appraisal Skills
Programme (CASP) for Systematic Review to be well suited to the needs of the research study. It
was considered apt because it facilitated the researcher in assessing the validity of the literature
review, the results of the literature review, and whether the results were such that they would
help the researcher locally. Use of these tools has allowed the ease of consideration of intent,
critical and obvious viewpoint of the studies that were selected for the review. It also facilitated
the recognition of strengths and weaknesses of selected studies along with implication of the
findings to practice. Apparent and consistent concepts of the studies were also obtained through
the employment of this critique tool.

3.7 Ethical Implications of Literature Review

Most of the researchers have suggested that secondary studies do not require observation
of ethics (Bryman, 2012). Despite this perception, there are certain ethical considerations that
must be considered in secondary studies. These ethics pertain to the observation of the fact by the
researcher that all the information provided by the literature is not to misinterpreted. It also
necessitates possibility of plagiarism has been entirely eliminated which is a common
phenomenon that occurs during a review (Burns and Grove, 2011). An ethical approval is not
required for this research because the proposed methodology of this study is a literature review.
This is primarily due to the fact that literature reviews are based mainly on critical analysis of the
research carried out by other researchers, and primary research is not conducted by the
researcher. Hence, there is no direct interaction between the researcher and the participants of the
study (Aveyard, 2013). However, this does not mean that there are no ethical issues involved in
conducting a literature review. As Kelder (2005) suggests, ethics of research limit the nature and
extent of information that can be acquired and used by the researcher. Since information is being
used to make arguments while conducting literature review, it is expected that the researcher
abide by the ethics of research. Moreover, Punch (2006) points out that several ethical issues are
involved in adopting literature review as a research methodology. Firstly, it has to be ensured that

the work of others is properly cited, and their research findings are not portrayed as own. Hence,
the researcher has to adhere to the principles of academic honesty and integrity, and give credit
to the researcher by whom the primary research was actually conducted. Secondly, the researcher
needs to ensure that the information collected by another researcher was gathered in an ethical
manner, and the researcher who conducted the primary research observed the ethical principles
of research. The researcher has prevented the presentation of any counterfeit information. It is
essential to avoid use of information without acknowledging the researchers. Any such activity is
considered as plagiarism due to which researcher has provided appropriate citation and
referencing of every article that has been utilised in the research. Misinterpretation of the results
of the literature has also been prevented by the researcher in the entire process of research to
eliminate the possibility of violation of ethics (Wager and Wiffen, 2011). The ethical
considerations of this research have been discussed in greater detail in the subsequent chapter.