Defining the problem and Research Methods

Introduction

According to Laureate Education (Producer). (2012), the term epidemiology refers to the

study of the distribution and the determinants of health-related states and events in a specified

population, and how it can be applied to curb health issues. Whereas, population health

implies to the incidence of diseases in different sets of people and in accordance to age,

gender or location (Healthy People 2020, 2011).

Section 1: The problem

Alcohol consumption is on the increase especially within my home locality, most youths

and the elderly are the victims, this has led to a rise in cases of gastric cancer, a healthy

problem associated with alcohol intake (Friis & Seller, 2021). In fact, most cancer patients I

normally encounter in Mother Francisco Nursing Home, where I happened to work, are often

diagnosed with gastric cancer (Rahal, et al., 2017). Gastric cancer is a health problem

associated with alcohol consumption (Nash, et al., 2021). This scenario has attracted my

attention, making me to develop a keen interest in researching and doing more studies on the

same, as well as trying to come up with viable interventions to curb the issue (Center for

Global Development, n.d.).

Critically looking at the home environment, where alcohol intake is often experienced,

it’s meaning cuts across the locality within the home environment (Center for Global

Development, n.d.). However, as claimed by Laureate Education (Producer). (2012), in the

normal setting, home entails the emotional warmth often received from the parents as they

mingle with their kids; provision of stimulating and learning experiences in the home; and

physical surroundings, such as safety of play areas and cleanliness (Healthy People 2020,

2011).

In regard to the health problem, I chose to do my study within the locality where I work,
DEFINING THE PROBLEM AND RESEARCH METHODS 2

since it is more of a home environment to me, and where incidences of gastric cancer have

been rampantly reported in the recent past (Rahal, et al., 2017). Early studies have revealed

that, gastric cancer acts as a main contributor to the global burden of cancer, in fact in less

than a century ago it was the most common cancer in the world (Friis & Sellers, 2014).

It is claimed that more than one million cases of gastric cancer are diagnosed every year

across the globe (Excite, 2014). It is asserted to be the 5th most and commonly diagnosed

cancer in the entire world, and the 7th most prevalent incidence with a high degree being

reported in male than in females (Nash, et al., 2021).

Notwithstanding, gastric cancers are often diagnosed in developed nations. The overall

incidence is pointed out to be 20 per 100,000 for males in developed nations, while in low

undeveloped nations it is ascertained that 6.6 per 100,000 males are diagnosed as pointed out

by Laureate Education (Producer). (2012).

Notably, gastric cancer has varied incidences depending on the genetic differences or the

kind of diet taken by an individual (Friis & Sellers, 2014). Studies have indicated that gastric

cancer revolves around the said characteristics of place, person and time as discussed below.

Person

Although age, sex, and race/ethnicity often plays a pivotal role in the health of a

person, other characteristics has been seen to be the main drivers of gastric cancer, these

includes diet, alcohol consumption, medication and religious practices (Laureate Education

(Producer), 2012).

An individual who often drink a lot of alcohol have a high tendency of acquiring gastric

cancer compared to non-alcoholic individuals, same case applies to smoking, rampant

smokers tend to be at risk of lung cancer (Nash, et al., 2021).

Additionally, religious practices play as significant role. Some religions have dietary

restrictions on drinking of alcohol and cigarette smoking. Such restriction help an individual
DEFINING THE PROBLEM AND RESEARCH METHODS 3

escape the risk of getting cancer (Friis & Sellers, 2021). Individual who often seek

medication are less affected by the disease, since early detection calls for early treatment.

Place

Variation by location where an individual life, works and travels can act as a platform

for gastric cancer exposure. It is worth noting that, the rates of gastric cancer also vary among

countries (Nash, et al., 2021). For instance, Japanese have a higher rate of gastric cancer

compared to Caucasians in California (Laureate Education (Producer), 2012).

Time

The incidence of gastric cancers keeps on reducing over time, this is basically due to

changes in behavior and improved diagnostic methods and treatment. A decrease in alcohol

consumption as well as adoption of modern methods of food preservation has also led to a

decrease in gastric cancer (Nash, et al., 2021).

In a nut shell, hypotheses about the determinants of disease arise from taking into

consideration the characteristics of person, place and time (Friis & Seller, 2021).

The main purpose of this study is to elucidate the true incidence of gastric cancer and its

risk factors among the general population, as drawn from Mother Francisco Nursing home.

The hypotheses, reiterated that, if alcohol is the cause of gastric cancer, then, the remedy is to

stop taking.

Section 2: Research Methods

The choice of study design selected to address the said research question was guided by

the nature of the health outcome under study, its presumed relation to habitual diets and

exposures as well as the feasibility constraints (Laureate Education (Producer), 2012).

The study deployed case control study methodology. A decision arrived after a keen

consideration of other observational study designs and the required timeline and nature of

scope of the study respondents (Healthy People 2020. (2011). Additionally, the choice of the
DEFINING THE PROBLEM AND RESEARCH METHODS 4

study design was also due to the fact that the design is cost efficient and not time consuming.

Hence, suitable for a rare disease with long latency periods like gastric cancer (Center for

Global Development, n.d.). Moreover, case control studies are very essential in conducting

studies that are triggered by individual’s way of living, as depicted by gastric cancer, which is

associated to high intake of alcohol (Center for Global Development, n.d.).

The assessment strategy which was to be incorporated in the study design was to ensure

that the participants who were to be included in the study, should be based on the outcome,

that is, gastric cancer (Friis & Sellers, 2021). Therefore, participants with gastric cancer,

referred as the cases were to be included (Excite, 2014).

Additionally, some participants who were to act as controls, were drawn from patients in

the same locality who have not been diagnosed with gastric cancer. The exposure of the

participants was then assessed in both groups (Healthy People 2020. (2011). By design, in

any case-control study, the outcome has to occur in some of the participants that have been

included in the study (Nash, et al., 2021).

The selection criteria deployed was randomized sampling technique. This was to ensure

that there were equal chances of patient to be included in the study, as well as to ensure that

the selection was not bias (Center for Global Development, n.d.). Data was later collected and

captured through, self-administered questionnaires and telephone interviews alongside mails

(Rahal, et al., 2017). I managed to assess the participants who were rampant drinkers of

alcohol, noting how often they drink, how many years they have been in the same habit and

the resultant outcome (Excite, 2004).

Moreover, I also collected information on other variables such as gender, age and

occupation. The association between alcohol consumption and gastric cancer was later

critically analyzed (Nash, et al., 2021).

For clear and coherent data, as claimed by Laureate Education (Producer). (2012), I
DEFINING THE PROBLEM AND RESEARCH METHODS 5

chose to work with a small sample size of 100 cases of individuals with gastric cancer,

selected within Mother Francisco Nursing home, and 105 participants who acted as controls,

and were also selected randomly from the same nursing home. They were later matched from

an age range of plus or minus five years and sex (Friis & Seller, 2014).

Notably, sampling enabled me to deal with a small collection of participants from a

much larger population, hence accuracy was highly ascertained and attained for a true

generalization of the entire population (Excite, 2014). It also gave me an ample time to

collect viable data which was later analyzed, interpreted and recommendations made in

support of the intended inferences. It is assumed that, sampling techniques often yield

significant research result, if well administered (Laureate Education (Producer), 2012).

A structured questionnaire was administered during the process of data collection. Each

participant was assured of the confidentiality of data to be captured and that whatever

responses they gave, will only be used for the purpose of research (Friis & Sellers, 2014). I

managed to administer the questionnaires to the study participants, although some were out of

the facility at that time, and could not be reached (Excite, 2014).

Luckily, those participants who were in the list of the respondents and could not be

physically met were conducted through a phone call, and the essential data captured

electronically (Friis & Sellers, 2014). Additionally, those who were unreachable were

emailed, and after they responded, the data were captured. Finally, the collected data was

cleaned and coded for the purposes of analysis (Nash, et al., 2021).

Section 3: The Intervention

According to Friis and Sellers (2021), there has been a growing call for the

application of robust systems approaches to intervention planning, service delivery and

evaluation in order to assist in the understanding of intervention implementation and impacts

in real life situation. A case of gastric cancer, a risk factor associated to rampant alcohol
DEFINING THE PROBLEM AND RESEARCH METHODS 6

consumption, although other factors play a pivotal role in increasing and causing the disease.

For instance, poor dietary habits, low income and education background (Excite, 2004). To

tackle this health issue, one has to first understand the methodologies and systems to

incorporate as intervention approach (Nash, et al., 2021).

Precisely, systems infer to the combinations of elements that interact and produce

viable and valid health results. Hence, a sure intervention to gastric cancer, calls for adoption

of technological advancement in the health sector. Moreover, training of all the care fraternity

on its significance and applications, should follow in curbing the health problems (Healthy

People 2020. (2011). I therefore suggest that, for quality health care to be realized, the key

interventions approach is to amass the public on risk factors as well as reduce educational

barriers. This will act as a sure mode of reducing the burden of gastric cancer worldwide

(Laureate Education (Producer), 2012).

Additionally, early detection of both changeable and unchangeable gastric cancer risk

factors, can also acts as an essential and viable intervention in the primary prevention

approaches of the health problem (Center for Global Development, n.d.). Where changeable

risk factors associated to gastric cancer revolves around the patient, namely, maintenance of a

balanced diet, moderating alcohol consumption rate, giving up smoking and trying as much

as possible to keep and maintain a normal body weight (Nash, et al., 2021). Whereas, the

unchangeable risk factors associated to gastric cancer includes, but are not limited to

occupational exposures and family history based on the disease (Friis & Sellers, 2014).

Notably, another better and sure intervention for curbing or reducing gastric cancer

rate and mortality is through the institution of robust screening programmes in almost all the

health facilities (Healthy People 2020. (2011). It is ascertained that most high-income Asian

countries, particularly Japan and South Korea, possess a robust and well developed screening

policies (Excite, 2004). This has made the fatalities of gastric cancer rates to reduce
DEFINING THE PROBLEM AND RESEARCH METHODS 7

significantly, compared to the rate of incidence (Laureate Education (Producer), 2012).

Although, the value of some more expensive and elaborate endoscopic screening

programmes in most parts with less cases of gastric cancer, has not yet been validated (Friis

& Sellers, 2014). However, in the recent past, there have been several novel developments in

non-invasive screening tools which could be adopted as an intervention strategy to curb the

issue, in future, avoid the need for invasive endoscopic assessment (Excite, 2014).

Interestingly, for instance, in cases of esophageal cancer, a non-endoscopic sampling

device has been developed, called the Cytosponge, which can be swallowed and retrieved

from the esophagus and stomach to obtain the cells (Center for Global Development, n.d.). It

has proved viable and highly sensitive in the detection of another form of cancer called

esophageal cancer (Laureate Education (Producer), 2012). Additionally, the same technology

can be effectively used in the detection of other ailments, especially in patients who possess

higher tendency of acquiring gastric cancer (Nash, et al., 2021).

Another sure intervention approach, actually is to encourage for a change of lifestyle,

as they always say, change is inevitable, so is to health, change in lifestyle means a change

and an improved health (Rahal, et al., 2017). Moreover, strict regulations regarding alcohol

consumption and sell should be enacted as an intervention approach to curb the act of alcohol

consumption, since by doing that, we can be able to avert a number of human deaths globally,

and reduce the incidences of gastric cancer in particularly (Papathanasiou & Zintzaras, 2010).

Concurrently, as pointed out by Friis and Sellers (2021), alcohol consumption and

smoking during a course of therapy is detrimental, and patients should be advised to shun

away from such acts, especially those undergoing or yet to undergo surgery.

In a nut shell, as reiterated by Excite (2004), it is still eminent also that, better and

advanced social conditions in accessing medical care can act as an intervention measure, and

will help to substantially reduce the mortality and morbidity associated with gastric cancer,
DEFINING THE PROBLEM AND RESEARCH METHODS 8

although globally, there is still an increased incidence of almost one million deaths reported

yearly, implying that there is still more work to be done.

Section 4: The Impact

Health outcomes infers to how healthy a county is presently (Healthy People 2020,

2011). This article seeks to bring positive impacts in the society, through boosting on the

physical and mental well-being of residents within a community, spanning from the length of

life and quality (Center for Global Development, n.d.). Notably, health outcomes are highly

affected by varied aspects which always influence health, ranging from the quality of medical

care being administered to the availability of good jobs, clean water as well as affordable

housing facilities (Von Elm, et al., 2007).

Most of the health aspects are initiated by programs and viable policies put in place at

the local, state, and federal levels, such as the adoption of a just culture, which advocates for

quality of care and a healthy nation (Laureate Education (Producer), 2012). In fact, there exist

some noticeable variation in health outcomes, depending on our living environment, the

money we often make each day, our ethnicity as well as other varied characteristics (Rahal, et

al., 2017). Critically analyzing the data of health outcomes, we can vividly unravel the

variation as witnessed in health outcomes across a nation and how a variety of health factors

combine to influence these outcomes, and how our policies and programs are supporting or

restricting opportunities for health for all (Papathanasiou & Zintzaras, 2010).

Notwithstanding, if the intervention approaches are fully implemented and followed,

there is a high tendency of a reduction in the incidences of gastric cancer (Excite, 2004). This

can be ascertained by the case witnessed during the 1980s, where a significant improvement

was recorded after intervention measures were incorporated, an observation derived from a

nationwide study based in Sweden (Nash, et al., 2021). It became clear from the study that,

early detection of the disease followed by subsequent complete resection could increase
DEFINING THE PROBLEM AND RESEARCH METHODS 9

survival period in young patients with gastric cancer (Friis & Sellers, 2014). When we work

together to improve education, employment, income, and family lives and social supports, the

essential and vital social and economic factors that influence our communities, then we can

be able to improve the health of all who dwell within any locality (Von Elm, et al., 2007).

Concurrently, we should team up and strive to work together as a community in order

to empower victims of alcohol addiction, as well as assist and train them on the healthy and

safe way of living, by enacting viable healthy plans to be followed by the victims so as to

enable them shape and change on their dietary habits, hence enabling them to reduce on

alcohol intake (Healthy People 2020. (2011).

Section 5: Evaluation

The evaluations of both simple and complex public health interventions always

focuses on measuring the impacts public health interventions on a single or rather a small

number of a specified health and health-related outcomes, in this case, gastric cancer (Friis &

Sellers, 2014). However, looking at the impact evaluations alone, one is subjected to a small

chance of exploring the mechanisms behind an intervention’s success or failure, especially

when the impacts are unevenly distributed among different population groups (Healthy

People 2020, 2011).

For the purposes of this research, I chose to deploy other forms of evaluation in trying

to tackle and look for valid ways to counter the health problem. I settled on process

evaluation technique (Excite, 2004). Process evaluation is a kind of evaluation plan that has

been developed and utilized in order to understand the intervention, implementation and the

mechanisms by which the mentioned interventions can be utilized in order to yield viable and

captivating impacts across a population, while at the same time cutting short alcohol

consumption and minimizing incidences of gastric cancer (Center for Global Development,

n.d.). However, there is no known sole and sure definition of a process evaluation, but
DEFINING THE PROBLEM AND RESEARCH METHODS 10

according to the Medical Research Council’s, the term can be used to imply to the act of

assessing and examining the fidelity and the quality of the implementation process, clarifying

the causal mechanisms of gastric cancer, as well as identifying and unraveling the contextual

factors associated with the variation in outcomes across various patients within the facility

(Healthy People 2020, 2011).

A process evaluation should be carried out alongside the outcome or impact

evaluation, this will ensure that it quantify the impact of an intervention on varied outcomes,

as well as the known and anticipated outcome of gastric cancer associated to alcohol intake

(Excite, 2004). Moreover, the act of evaluating public health interventions deployed in

countering health issues, can be of great significance. Health care sectors should adopt the

approach and the use of robust and complex systems in their day to day activities, for a

healthy nation to be realized (Friis & Sellers, 2014).

Indeed, the application of systems thinking and insights from the complexity

epidemiology sciences can provide a channel in which alcohol consumption can be evaluated

against its associated risk (Excite, 2004). Thinking systemically also means making sense of

the boundaries of a system and making decisions about what constitutes the system, and what

might be considered within or outside of the system (Framingham Heart Study, 2018).

Although system maps are not a necessary element of systems thinking, they can be helpful

for making sense of and depicting system boundaries, as articulated by both those acting

within the system (Healthy People 2020. (2011). It can also assist in unraveling the

uniqueness upon which the interventions may bring varied impacts within a system (Friis &

Sellers, 2014). This may include impacts termed to be of value during evaluation, as intended

as well as emerging impacts during evaluation process.

Notably, by incorporating epidemiological and an explicitly relational focus to the

evaluation design and placing the wider context in the foreground of the analysis, coaxed
DEFINING THE PROBLEM AND RESEARCH METHODS 11

with a a complex system approach to evaluation may assist in making sensible intervention

strategies that are viable and applicable in curbing the issue of gastric cancer globally (Excite,

2004). In addition, an explicit epidemiological complex systems approach can assist public

health evaluators in coming up with a scheme, that will oversee the success of a set system

(Healthy People 2020, 2011). This could include considering how the intervention acts as an

event that prompts a series of changes in the way a complex system behaves (Excite, 2004).

Furthermore, it could include consideration of how the intervention itself changes, as

system elements and the system as a whole adapt and respond to it (Healthy People 2020.

(2011). Additionally, complexity science enabled me in my study to inculcate varied extra

aspects that were valuable in my study (Center for Global Development, n.d.). Especially in

my quest to unravel and gain insights worthy of curbing the health issue, as well as seek to

evaluate the mechanisms by which public health interventions have impacted in the real-

world environments (Excite, 2004).

Concurrently, these concepts can as well be applied in describing, analyzing, measuring

and estimating the essential attributes needed for change (Healthy People 2020, 2011). In

fact, the change will have to happen first within and across the elements incorporated in the

system, indeed, these collective changes will eventually yield or result in the emergent

system change (Framingham Heart Study, 2018). I therefore, suggest that to ascertain this,

evaluations should be designed with a complex systems perspective, which requires being

agile and adaptable in order to capture the system change the evaluators intend to assess

(Friis & Sellers, 2014).

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& Bartlett.

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