Understanding nutrition communication between health professionals and consumers: development of a model for nutrition awareness based on qualitative consumer research

Self-Perceived Nutritional Competency of Primary Healthcare Physicians in Qassim, Saudi Arabia

INTRODUCTION

Overnutrition plays a vital role in the development of a spectrum of non-communicable diseases. Diet-related disorders have a huge impact on personal health as well as the country's economy for the management of such disorders. The study aims to assess the primary healthcare physicians' nutrition competency, which will be beneficial for evaluating the current situation and future strategies, training, nutrition care, and disease prevention.

METHODOLOGY

Among 147 primary healthcare physicians by simple random sampling from four cities and two rural areas of Qassim, Saudi Arabia, from December 2022 to December 2023 using a validated (NUTCOMP) tool. Data were entered, cleaned, and analyzed with SPSS software version 21.0 (IBM Corp., Armonk, NY). Informed consent was obtained from all study participants. Chi-square and ANOVA tests were applied to draw the significant differences.

RESULTS

A total of 147 participants enrolled in this study, and the mean age and standard deviation (SD) of the study population were 34.38 ± 6.57. More than half of the physicians (n = 76, 51.7%) continued education on nutrition. Significant mean differences were observed between some and focused nutrition content received physicians versus no nutrition content received physicians concerning nutrition skill, communication, and nutrition attitude consecutively (P < 0.0001, P < 0.0001, and P < 0.0001). The mean nutrition knowledge, skill, communication, attitude score, and SD of PHCC physicians were 26.91 ± 5.42 (maximum 35), 31.19 ± 6.18 (maximum 40), 36.73 ± 7.48 (maximum 45), and 34.74 ± 6.23 (maximum 40), respectively.

CONCLUSIONS

Our study results show primary healthcare physicians perceive themselves to have good nutritional competency.

"Expert persuasion" can decrease willingness to pay for sugar-containing food

Recent studies have revealed types of eating nudges that can steer consumers toward choosing healthier options. However, most of the previously studied interventions target individual decisions and are not directed to changing consumers’ underlying perception of unhealthy food. Here, we investigate how a healthy eating call—first-person narrative by a health expert—affects individuals’ willingness to pay (WTP) for sugar-free and sugar-containing food products. Participants performed two blocks of a bidding task, in which they had to bid on sweets labeled either as “sugar- free” or as “sugar-containing.” In-between the two blocks, half of the participants listened to a narrative by a dietary specialist emphasizing the health risks of sugar consumption, whereas the remaining participants listened to a control narrative irrelevant to food choices. We demonstrate that the health expert’s narrative decreased individuals’ WTP for sugar-containing food, but did not modulate their WTP for sugar- free food. Overall, our findings confirm that consumers may conform to healthy eating calls by rather devaluating unhealthy food products than by increasing the value of healthy ones. This paves the way for an avenue of innovative marketing strategies to support individuals in their food choices.

Formative evaluation of a portion control and calorie reduction campaign: Insights from focus groups with target audience

Healthy eating campaigns can increase awareness of healthful foods and eating patterns and prompt behavior change. Portion control can be a useful strategy in weight management efforts, and new, innovative campaigns can help invigorate messages related to portion control and weight management. This qualitative study presents results of formative testing of portion control and calorie reduction messages and infographics for a proposed campaign. We conducted 17 focus groups with 113 adults ages 18-65 years in 3 US cities. We conducted separate focus groups by weight status (overweight/healthy weight) and gender (male/female) and analyzed coded data and categorized emerging themes. Participants, especially those with healthy weights, gravitated toward specific, and achievable messages to encourage portion control and calorie reduction. Men with overweight and women with healthy weights preferred messages that had a positive, supportive tone. Participants favored messages that addressed overeating and allowed for autonomy. In particular, women and those with healthy weights preferred messages that encouraged calorie budgeting. Many participants, in particular men, provided positive feedback on messages encouraging a "fresh start" on Mondays. Additionally, participants preferred messages that were colorful, informative, realistic, attractive, and relatable. With regard to message dissemination, participants suggested that messages and infographics be positioned in high-traffic areas and men generally suggested places where food decisions are made. Moreover, participants suggested message dissemination through trusted health professionals and credible research organizations. Health organizations planning a portion control or calorie reduction campaign should consider these factors early in the development process to help ensure acceptance and success.

Understanding Vietnamese Urban Consumers' Nutrition Label Use, Health Concerns, and Consumption of Food and Beverages with Added Sugars

Vietnam is experiencing a diet and nutrition transition. Increasing consumption of food and beverages with added sugars is a significant public health concern. Policies and interventions, such as mandatory nutrition labelling, are being considered to improve consumers’ awareness and understanding of diet and health implications of added sugars in food and beverages. The effectiveness of various policy approaches relies on an improved understanding of the interrelationships between urban Vietnamese consumers’ health concerns, nutrition label use, and intake of sugars. We empirically disentangle these relationships for urban Vietnamese households using novel intra-household data covering 4047 adults and 737 adolescents from 1590 households in Hanoi and Ho Chi Minh City. The data are from comprehensive household surveys and 24-hour food diaries. Simultaneous equation regression models are estimated using three-stage least squares (3SLS) to account for possible endogeneity. Nutrition label use is significantly associated with a lower share of calories from foods and beverages with added sugars. These findings suggest that nutrition labelling programs may be an effective policy mechanism to reduce the negative health implications of increasing availability and consumption of food and beverages with added sugars in urban Vietnam.

Factors affecting maternal nutrition and health: A qualitative study in a matrilineal community in Indonesia

The Minangkabau people of West Sumatra in Indonesia are renowned for their matrilineal culture with property and land passing down from mother to daughter. Despite there being a fairly balanced social status for women in the community, the impact of health inequalities is uneven. This study was therefore carried out to explore the relationship between the social, cultural and economic contexts in such a distinctive community with maternal nutrition and pregnancy-related health outcomes, from the perspectives of the mothers, fathers and care providers. Qualitative methods were used to undertake this study in collaboration with partners from the University of Andalas in a suburban area of Padang district. The data collection method was qualitative, semi-structured interviews (n = 19) with women, men, midwives and community health workers. The data were recorded with informed consent, transcribed in the local language and then translated into English prior to being thematically analysed. The major themes which emerged from the data included ‘Minangkabau matrilineality and role of women’; ‘culture and supportive attitude towards pregnant women’; ‘dietary patterns, attitude and access to food’; and ‘limited access to information about food and nutrition’. The findings showed healthy dietary patterns such as regular consumption of vegetables and fruit among the participants. However, the issues of poverty, access to food, dietary taboos and inadequate nutritional information remained major challenges for the mothers and the families who participated in the study. The evidence from this study suggests that the matrilineal culture of the Minangkabau promotes the empowerment of women and offers an encouraging environment for enhancing reproductive health. This lends itself to co-developing locally sensitive and sustainable complex interventions incorporating professional support and building on family and community back-up, enhancing knowledge and demystifying dietary misinformation to improve maternal health and nutrition.

A Public Health Messaging Campaign to Reduce Caloric Intake: Feedback From Expert Stakeholders

OBJECTIVE

To obtain expert feedback on a public health messaging campaign to reduce caloric intake in US adults.

DESIGN AND SETTING

In 2018, researchers conducted semistructured telephone interviews with US-based experts in obesity prevention, mental health, and health communications.

PARTICIPANTS

The research team invited 100 experts to participate using purposive and snowball sampling techniques. Of those invited, 60 completed interviews, among which 37 (62%) were obesity prevention experts, 12 (20%) were mental health experts, and 11 (18%) were health communications experts.

MAIN OUTCOME MEASURE

Expert feedback regarding a public health messaging campaign to reduce caloric intake.

ANALYSIS

Two researchers reviewed and coded all transcripts. The team identified major themes and summarized findings.

RESULTS

Most experts identified barriers to effective calorie reduction including social and environmental factors, lack of actionable strategies, and confusion regarding healthy eating messages. Expert suggestions for effective messaging included addressing eating patterns, emphasizing nutrient density, and dissemination through multiple channels and trusted sources. In general, mental health experts more frequently voiced concerns regarding eating disorders, and communications experts raised issues regarding the dissemination of campaigns.

CONCLUSIONS AND IMPLICATIONS

Professionals should identify and address barriers to delivering a calorie reduction campaign before implementation, using strategies that enhance delivery to ensure an effective campaign.

Consumer Distrust about E-numbers: A Qualitative Study among Food Experts

Food additives (E-numbers) are allowed in foods, but many consumers have a negative perception of them. The objective was to study the opinion of food experts about the causes and ways to reduce consumer distrust about E-numbers. Thirteen food experts from universities, research institutes, the government, food industry organisations, media, a nutrition information organisation, a consumer association and two other non-governmental organisations (NGOs) were interviewed with a semi-structured topic list, based on a model of risk perception. Interviews were transcribed, coded by an open-coding approach and analysed. Results indicated that, according to food experts, consumer distrust of E-numbers arose from negative communication by traditional media, social media and books. Food experts suggested that the information sources and the reliability of E-number information are important for consumers. Food experts also suggested reducing consumer distrust by avoiding negative label claims and making collective agreements with all parties about honest and transparent communication. According to interviewed food experts, food companies need to explain clearly and honestly why they use E-numbers in food. A nutrition information organisation and the government were often mentioned as appropriate parties to undertake action. The interviews suggested that consumers had no confidence in the food industry.

Best practices in nutrition science to earn and keep the public's trust

Public trust in nutrition science is the foundation on which nutrition and health progress is based, including sound public health. An ASN-commissioned, independent Advisory Committee comprehensively reviewed the literature and available public surveys about the public's trust in nutrition science and the factors that influence it and conducted stakeholder outreach regarding publicly available information. The Committee selected 7 overlapping domains projected to significantly influence public trust: 1) conflict of interest and objectivity; 2) public benefit; 3) standards of scientific rigor and reproducibility; 4) transparency; 5) equity; 6) information dissemination (education, communication, and marketing); and 7) accountability. The literature review comprehensively explored current practices and threats to public trust in nutrition science, including gaps that erode trust. Unfortunately, there is a paucity of peer-reviewed material specifically focused on nutrition science. Available material was examined, and its analysis informed the development of priority best practices. The Committee proposed best practices to support public trust, appropriate to ASN and other food and nutrition organizations motivated by the conviction that public trust remains key to the realization of the benefits of past, present, and future scientific advances. The adoption of the best practices by food and nutrition organizations, such as ASN, other stakeholder organizations, researchers, food and nutrition professionals, companies, government officials, and individuals working in the food and nutrition space would strengthen and help ensure earning and keeping the public's continued trust in nutrition science.

Are Nutrition-Related Knowledge and Attitudes Reflected in Lifestyle and Health Among Elderly People? A Study Across Five European Countries

Background: Nutrition-related knowledge (NRK) and nutrition-related attitudes (NRAs) are necessary for dietary changes toward healthier dietary patterns. In turn, healthier dietary patterns can be beneficial in maintaining health of older adults. Therefore, the aim of this cross-sectional study was to investigate whether NRK and NRAs were associated with lifestyle and health features among older adults (65+ years) from five European countries (France, Italy, Poland, the Netherlands and United Kingdom).

Methods: Within the European project NU-AGE, 1,144 healthy elderly volunteers (65–79 years) were randomly assigned to two groups: intervention (NU-AGE diet) or control. After 1-year of follow-up, both NRK and NRAs were assessed during exit interviews, in combination with a number of lifestyle and health variables (e.g., physical activity, smoking, alcohol use, BMI, self-assessed health status). Multivariable linear regression models were used in data analysis.

Results: In the NU-AGE study sample, good NRK was associated with lower BMI and higher physical activity. More positive NRAs were related to lower BMI and self-reported very good or good appetite. Moreover, both NRK and NRAs were associated with some socio-economic determinants, like financial situation, age, education, living area (for NRK), and country (for NRAs). Participants in the intervention group showed a better NRK (β = 0.367 [95% CI: 0.117; 0.617], p = 0.004) and more positive NRAs (β = 0.838 [95% CI: 0.318; 1.358], p = 0.002) than those in the control group. Higher self-evaluated knowledge was also significantly related to more positive NRAs (p < 0.001). The most popular sources of nutrition information were food labels, books and magazines on health, the dietitian and the doctor's office, although their importance varied significantly among countries, and, to a lesser extent, between women and men and between intervention and control group.

Conclusion: Higher NRK and NRA scores were associated with lower BMI and higher physical activity level. Therefore, a good nutrition-related knowledge and positive nutrition-related attitudes can strongly and positively influence the health status and quality of life among the older population. These results offer a great opportunity for policy makers to implement educational programs in order to counteract the epidemic of obesity and to improve the health span of European population.

Self-tests for influenza: an empirical ethics investigation

BACKGROUND

In this article we aim to assess the ethical desirability of self-test diagnostic kits for influenza, focusing in particular on the potential benefits and challenges posed by a new, mobile phone-based tool currently being developed by i-sense, an interdisciplinary research collaboration based (primarily) at University College London and funded by the Engineering and Physical Sciences Research Council.

METHODS

Our study adopts an empirical ethics approach, supplementing an initial review into the ethical considerations posed by such technologies with qualitative data from three focus groups.

RESULTS

Overall, we map a range of possible considerations both for and against the use of such technologies, synthesizing evidence from a range of secondary literature, as well as identifying several new considerations previously overlooked.

CONCLUSIONS

We argue that no single consideration marks these technologies as either entirely permissible or impermissible but rather tools which have the potential to incur certain costs and benefits, and that context is important in determining these. In the latter stages of the article, we explain how developers of such technologies might seek to mitigate such costs and reflect on the possible limitations of the empirical ethics method brought out during the study.

TRIAL REGISTRATION

Not applicable.

Undernutrition: who cares? Perspectives of dietitians and older adults on undernutrition

Background

Many older adults are at risk of undernutrition. Dietitians play a key role in the management and treatment of undernutrition, but older adults have difficulties to comply with dietetic recommendations. This qualitative study investigated which barriers older adults experience in adhering to treatment for undernutrition. Current dietetic practices and older adults’ experiences were studied, and the potential to use protein-enriched regular products in undernutrition treatment was investigated.

Methods

We interviewed 18 older adults who were under treatment for undernutrition, and 13 dietitians. Semi-structured interview guides were used, and all interviews were audiotaped and transcribed verbatim. The interviews were coded with qualitative analysis software NVivo9, followed by content analysis to formulate main themes.

Results

The interviews resulted in seven themes, which related to three main topics: barriers for treating undernutrition in older adults, current dietetic treatment, and new strategies to complement current treatment. Low awareness and a lack of knowledge regarding undernutrition, physical limitations, and loss of appetite were found to be major barriers for treating undernutrition in older adults. Dietitians said to focus mostly on increasing energy and protein intake by recommending the use of regular food products that fit the needs and habits of the patient, before prescribing oral nutritional supplements. Dietitians considered enriched regular products to be useful if they fit with the habits of older adults, the portion sizes were kept small, if products were easy to open and prepare, had good palatability, and were offered in a variety of taste and textures.

Conclusions

Results from the interviews suggest that undernutrition awareness is low among older adults and they lack knowledge on how to manage undernutrition despite efforts taken by dietitians. Enriched regular products could enable older adults to better adhere to undernutrition treatment, provided that these products meet the needs and eating habits of older adults. If protein-enriched food products can replace regular, low-protein variants, older adults do not need to consume more, but can adhere to their usual pattern while consuming more protein.

Employees' Expectations of Internet-Based, Workplace Interventions Promoting the Mediterranean Diet: A Qualitative Study

OBJECTIVE

Explore employees' perceptions of ability to follow the Mediterranean diet (MedDiet), preferences for setting goals if asked to follow the MedDiet, and expectations of an Internet-based, workplace MedDiet intervention.

DESIGN

Seven focus groups to guide intervention development.

SETTING

Four workplaces (business/professional services, government branches) in Southwest England.

PARTICIPANTS

Employees (n = 29, 51.7% women), ages 24-58 years.

PHENOMENON OF INTEREST

Ability to follow the MedDiet; preferences for goal-setting if asked to follow the MedDiet; intervention content.

ANALYSIS

Data were analyzed with the use of thematic analysis.

RESULTS

Participants perceived that adhering to some MedDiet recommendations would be challenging and highlighted cost, taste, and cooking skills as adherence barriers. Behavior change preferences included a tailored approach to goal-setting, reviewing goal progress via a website/smartphone app, and receiving expert feedback via an app/website/text/face-to-face session. Desirable features of an Internet-based MedDiet application included recipes, interactivity, nutritional information, shopping tips, cost-saving information, and a companion smartphone app. Engaging in social support was deemed important to facilitate adherence.

CONCLUSIONS AND IMPLICATIONS

An Internet-based, workplace MedDiet intervention should address adherence barriers, utilize a tailored approach to setting and reviewing goals, and activate social support to facilitate adherence. These findings provide insights to planning to promote the MedDiet in non-Mediterranean regions.

Australian general practitioners' views regarding providing nutrition care: results of a national survey

BACKGROUND

The prevalence of chronic disease is considerable, and dietary behaviours influence the progression of many chronic diseases. Practice guidelines recommend that general practitioners (GPs) promote healthy dietary behaviours in relevant consultations with patients in order to improve health outcomes at a population level.

OBJECTIVE

To describe GPs' perceived interest, confidence and barriers to support patients to have a healthy diet.

METHOD

A 24-item online and written survey was distributed in a national weekly newsletter to GPs in Australia. Results were descriptively analysed and investigated for associations with GPs' demographic characteristics.

RESULTS

A total of 322 GPs responded to the survey. Nearly all (n = 295, 91.6%) were interested in supporting patients to eat well, and most (n = 231, 71.7%) reported moderately high confidence for providing nutrition care with clear public health messages for conditions, such as cardiovascular disease. Many GPs (n = 170, 52.8%) cited lack of time as the biggest barrier to providing nutrition care, and the overwhelming majority (n = 289, 89.8%) were interested in receiving additional education and training to enhance their nutrition knowledge and skills.

DISCUSSION

Many GPs are interested in nutrition and would benefit from educational programmes that improve their competence to provide nutrition care. Professional development opportunities should focus on the identification of nutritional risk and the promotion of healthy dietary behaviours within the time constraints of a standard consultation.

Nutrition Information In Community Newspapers: Goal Framing, Story Origins, and Topics

Obesity rates are high in the rural United States. Because small communities often have few health care practitioners, nutrition news in community newspapers may be a useful source of information. This content analysis of a random sample of 164 nutrition stories from 10 community newspapers in the rural West North Central Midwest was guided by concepts from goal-framing theory. Locally generated stories comprised nearly half of the sample, suggesting that nutrition is a salient topic in many rural communities. Hedonic frames related to food enjoyment were twice as frequent as health improvement frames. Results suggest food promotion was the most common topic of nutrition stories, with guidelines for a healthy diet appearing about half as often. Stories about a healthy diet and food promotion were most often written locally. Findings are discussed with recommendations for improvement of community news coverage of nutrition.

The influence of a physician and patient intervention program on dietary intake

BACKGROUND

Efficient dietary interventions for patients with hypertension in clinical settings are needed.

OBJECTIVE

To assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension.

DESIGN

A nested 2×2 design, randomized controlled trial conducted over 18 months.

PARTICIPANTS

A total of 32 physicians and 574 outpatients with hypertension.

INTERVENTION

MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake.

MAIN OUTCOME MEASURES

Dietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score.

STATISTICAL ANALYSES

The main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance.

RESULTS

After 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score.

CONCLUSIONS

Both MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes.

Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets

Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older people's awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older people's nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.

Nurses and dietitians differ in food safety information provided to highly susceptible clients

OBJECTIVE

To determine content, education channels, and motivational factors that influence what health professionals teach about safe food handling to populations who are highly susceptible for foodborne illnesses. To assess the differences in information provided by health professionals to highly susceptible populations.

DESIGN

Descriptive, cross-sectional, Web-based survey.

SETTING

National convenience sample from across the United States.

PARTICIPANTS

Registered nurses (RNs; n = 232) and registered dietitians (RDs; n = 267).

MAIN OUTCOME MEASURE(S)

Content, motivation, and education channels used to educate highly susceptible populations.

ANALYSIS

Various nonparametric tests were applied to measure differences. Significance was declared at P < .05.

RESULTS

Although both RDs and RNs were providing some food safety information to their high-risk clients, RDs had more training than RNs in safe food handling and were more likely to provide comprehensive food safety messages to their highly susceptible clients; however, neither professional type provided consistent food safety information to patients at high risk for foodborne illness.

CONCLUSIONS AND IMPLICATIONS

There is a need for more information about what motivates the health professional to teach safe food handling and a need for a universally adopted, evidence-based practice for teaching safe food handling to patients at high risk for foodborne illness.

Health promotion services for patients having non-comminicable diseases: feedback from patients and health care providers in Cape Town, South Africa

BACKGROUND

Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken.

METHODS

A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach.

RESULTS

Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance.

CONCLUSION

The majority of patients attending PHC facilities want to receive lifestyle modification education. There is not however, one specific method that can be regarded as the gold standard. Patients' preferences regarding health education methods differ, and they are more likely to be susceptible to methods that do not involve much reading. Health education materials such as posters, pamphlets and booklets should be used to supplement information received during counselling or support group sessions.

Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review

Strong evidence linking poor diet and lack of physical activity to risk of obesity and related chronic disease has supported the development and promotion of guidelines to improve population health. Still, obesity continues to escalate as a major health concern, and so the impact of weight-related guidelines on behaviour is unclear. The aim of this review was to examine consumer response to weight-related guidelines. A systematic literature search was performed using Medline, PsycInfo, ProQuest Central and additional searches using Google and reference lists. Of the 1,765 articles identified, 46 relevant titles were included. Most studies examined attitudes towards content, source, tailoring and comprehension of dietary guidelines. Many respondents reported that guidelines were confusing, and that simple, clear, specific, realistic, and in some cases, tailored guidelines are required. Recognition of guidelines did not signify understanding nor did perceived credibility of a source guarantee utilization of guidelines. There was a lack of studies assessing: the impact of guidelines on behaviour; responses to physical activity guidelines; responses among males and studies undertaken in developing countries. Further research is needed, in particular regarding responses to physical activity guidelines and guidelines in different populations. Communication professionals should assist health professionals in the development of accurate and effective weight-related guidelines.

What a man wants: understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men

Little attention has been paid to the physical activity (PA) and nutrition behaviors of middle-aged men; thus, the aim of this study was to gather information and gain insight into the PA and nutrition behaviors of these men. Six focus group sessions were undertaken with middle-aged men (N = 30) from regional Australia to explore the challenges and motivations to PA participation and healthy eating. Men had a good understanding of PA and nutrition; however, this was sometimes confounded by inconsistent media messages. Work commitments and family responsibilities were barriers to PA, while poor cooking skills and abilities were barriers to healthy eating. Disease prevention, weight management, and being a good role model were motivators for PA and healthy eating. By understanding what a man wants, PA and nutrition interventions can be designed and delivered to meet the needs of this hard-to-reach population.

A review of consumer awareness, understanding and use of food-based dietary guidelines

Food-based dietary guidelines (FBDG) have primarily been designed for the consumer to encourage healthy, habitual food choices, decrease chronic disease risk and improve public health. However, minimal research has been conducted to evaluate whether FBDG are utilised by the public. The present review used a framework of three concepts, awareness, understanding and use, to summarise consumer evidence related to national FBDG and food guides. Searches of nine electronic databases, reference lists and Internet grey literature elicited 939 articles. Predetermined exclusion criteria selected twenty-eight studies for review. These consisted of qualitative, quantitative and mixed study designs, non-clinical participants, related to official FBDG for the general public, and involved measures of consumer awareness, understanding or use of FBDG. The three concepts of awareness, understanding and use were often discussed interchangeably. Nevertheless, a greater amount of evidence for consumer awareness and understanding was reported than consumer use of FBDG. The twenty-eight studies varied in terms of aim, design and method. Study quality also varied with raw qualitative data, and quantitative method details were often omitted. Thus, the reliability and validity of these review findings may be limited. Further research is required to evaluate the efficacy of FBDG as a public health promotion tool. If the purpose of FBDG is to evoke consumer behaviour change, then the framework of consumer awareness, understanding and use of FBDG may be useful to categorise consumer behaviour studies and complement the dietary survey and health outcome data in the process of FBDG evaluation and revision.

Nutritional training in gastroenterology

Despite the clear importance of nutritional knowledge for health professionals, such education has long been notoriously patchy at both undergraduate and postgraduate levels. Gastroenterologists in particular have a special responsibility to provide advice and expertise, not only in general nutrition but also in artificial nutrition support in the setting of extreme risk of malnutrition and intestinal failure. Recently, with the restructuring of undergraduate medical teaching and the advent of modernising medical careers, curricula have been examined in detail and training programmes have become competency based. These changes, together with increasing public expectations regarding both the importance of nutrition and ability of doctors to provide advice and guidance, have provided an opportunity to reassess nutritional training at all levels of medical education. In this review, the authors consider the factors which may have hindered the progression of nutritional education for doctors, and gastroenterologists in particular, as well as the steps which have been taken in recent years to address these issues and move such training forward. There is now a real opportunity to improve the quality of nutrition training in gastroenterology. If this can be achieved, all gastroenterologists of the future, instead of shrinking from difficult nutritional issues, should be able to manage them with confidence and enthusiasm no matter what their subspecialty; indeed, an increasing proportion may become nutrition subspecialists in their own right.

They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals

OBJECTIVE

The present study aimed to evaluate the knowledge and practices of public-sector primary-care health professionals and final-year students regarding the role of nutrition, physical activity and smoking cessation (lifestyle modification) in the management of chronic diseases of lifestyle within the public health-care sector.

DESIGN

A comparative cross-sectional descriptive quantitative study was conducted in thirty primary health-care facilities and four tertiary institutions offering medical and/or nursing programmes in Cape Town in the Western Cape Metropole. Stratified random sampling, based on geographical location, was used to select the health facilities while convenience sampling was used to select students at the tertiary institutions. A validated self-administered knowledge test was used to obtain data from the health professionals.

RESULTS

Differential lifestyle modification knowledge exists among both health professionals and students, with less than 10 % achieving the desired scores of 80 % or higher. The majority of health professionals seem to be promoting the theoretical concepts of lifestyle modification but experience difficulty in providing practical advice to patients. Of the health professionals evaluated, doctors appeared to have the best knowledge of lifestyle modification. Lack of time, lack of patient adherence and language barriers were given as the main barriers to providing lifestyle counselling.

CONCLUSIONS

The undergraduate curricula of medical and nursing students should include sufficient training on lifestyle modification, particularly practical advice on diet, physical activity and smoking cessation. Health professionals working at primary health-care facilities should be updated by providing lifestyle modification education as part of continuing medical education.

A comparison of Dutch family doctors' and patients' perspectives on nutrition communication

BACKGROUND

In recent years, we have investigated both patients' and family doctors' communicative characteristics towards nutrition communication in general practice with several qualitative and quantitative studies. A sound comparison of the survey results between both conversation partners has not been made before.

OBJECTIVE

The aim of the present study was to put together data obtained by earlier studies for the first time in order to make comparisons of patients' and family doctors' communicative characteristics regarding nutrition communication.

METHODS

In The Netherlands, 603 patients completed a face-to-face interview-assisted questionnaire (65% response rate) and 267 family doctors completed a questionnaire (45% response rate).

RESULTS

When comparing communicative characteristics, patients stronger believed that nutrition was an influence on health than family doctors. They also attributed a greater role to personal hygiene, stress and heredity, while family doctors were more convinced of the role of alcohol use and smoking on health. Patients more often rated their own nutrition knowledge as good than family doctors. In contrast, family doctors showed higher interest in nutrition and nutrition information than patients. As a result, a collinear model for family doctors and nutrition communication towards patients was provided.

CONCLUSIONS

Significant differences between patients and family doctors were found for several communicative characteristics towards nutrition communication. It is important that family doctors become convinced that patients perceive them as a reliable and expert source of nutrition information. It is recommended that family doctors raise nutrition awareness among patients. Finally, we advise family doctors to pay attention to nutrition communication styles.

Diet and nutrition advice from the Cochrane Library: is it useful for the consumers and family physicians?

BACKGROUND

The role of nutrition in public health is well established. This raises the need for reliable and up to date evidence and its ready accessibility for health professionals and consumers.

OBJECTIVES

The principal objectives are to evaluate whether nutrition-related Cochrane Systematic Reviews contain clear guidance on nutritional aspects that may be applicable to individual patient care.

METHODS

We screened and searched the Cochrane reviews of Issue 3, 2007 of the Cochrane Library. The abstracts were assessed to identify nutrition-relevant reviews which are applicable in the consulting room. All irrelevant studies were excluded and a questionnaire was filled in for each review by the consumers and a Nutrition specialist.

RESULTS

The screening and search of the Cochrane Library Issue 3, 2007 retrieved overall 270 reviews. After excluding the irrelevant results, from the remaining reviews, 17 reviews were about the nutrition and feeding of infants, 44 of the reviews were on diet and nutrition and 78 on nutritional supplementations. From the 38 reviews on nutrition, seven did not have clear translation for the consulting room.

CONCLUSIONS

Our study provided an overview of the number of Cochrane reviews on diet and nutrition in Issue 3, 2003 of the Cochrane Library and highlighted the need for more clear and understandable evidence-based information in the field of nutrition.

Follow-up of a web-based tailored intervention promoting the Mediterranean diet in Scotland

OBJECTIVE

To assess the impact of a 3-month follow-up of a 6-month quasi-experimental study conducted to evaluate a web-based, tailored-feedback intervention promoting four key components of the Mediterranean diet.

METHODS

Fifty-three (intervention) and nineteen (control) healthy females, 25-55 years, employed at two Universities in Glasgow, Scotland, between 2003 and 2004 participated. Participants received tailored dietary and psychosocial feedback and Internet education, or minimal dietary feedback and general healthy-eating brochures, respectively. Dietary intake using 7d-estimated food diaries and blood lipids were assessed at baseline, 6 (post-test) and 9 months (follow-up).

RESULTS

Intention-to-treat analyses for between-group comparisons over time showed that the intervention group had increased their vegetable intake over 9 months and had more favourable levels of HDL-cholesterol and ratio of total:HDL-cholesterol over the 9-month assessment, compared with the control group. Within-group comparisons showed that, except for fruit consumption, the intervention group sustained their dietary improvement at 9 months, compared with baseline.

CONCLUSION

This intervention proved successful at sustaining most of the favourable dietary and blood lipid profile changes achieved over the 6-month intervention at the 3-month follow-up.

PRACTICE IMPLICATIONS

This intervention can be effective in promoting a Mediterranean-style diet in work settings.

Motivational factors for consuming omega-3 PUFAs: an exploratory study with Danish consumers

Growing consumer awareness of functional foods and understanding of their positive nutritional effects have led to the need of specific studies and have captured more attention than ever before. In Europe, Danish consumers have been found to be relatively negative towards the concept of functional foods. This paper presents the results of a qualitative pilot study that aimed to explore Danish consumers' motives for choosing omega-3/fish oil enriched products. The Health Action Process Approach (HAPA) was applied as a theoretical framework to understand the process by which people choose healthy foods. By conducting qualitative in-depth interviews the study mostly focused on the role of behavioural intention predictors such as risk perception, outcome expectations and self-efficacy. The results of the study suggest that consumers' understanding of healthy eating as such does not relate to the choice of omega-3/fish oil, whereas perception of omega-3 as an ingredient in selected foods does indeed influence consumers' choice of carrier-ingredient combinations.

Exploration of possible correlates of nutrition awareness and the relationship with nutrition-related behaviours: results of a consumer study

Objectives

To unravel the concept of nutrition awareness, as it relates to risky personal nutrition-related behaviours, and to assess the sociodemographic and psychosocial correlates of nutrition awareness.

Design

Data were collected in a cross-sectional study with the aid of a face-to-face interview-assisted questionnaire that was based on the Precaution Adoption Process Model and Stages of Change Model.

Setting

Dutch consumer homes.

Subjects

Six hundred and three Dutch adults aged 18 to 80 years, selected from a panel.

Results

Our model explains nutrition awareness well (explained variance 53.7%). Psychosocial correlates were involvement with nutrition, health awareness, association with healthy food, perceived relevance of eating less fat, association with necessity, perceived relevance of vitamins, and perceived attributes of independent organisations. Sociodemographic correlates were gender and age. The relationship between nutrition awareness and nutrition-related behaviours proved to be very complicated.

Conclusions

The value of our study is that it unravels the concept of nutrition awareness. Understanding the correlates of nutrition awareness can contribute to a more effective application of behavioural change models. Our results support increasing involvement with nutrition through personalising and tailoring to the motivational stage.

Development of a decision tree to determine appropriateness of NVivo in analyzing qualitative data sets

A decision tree was developed to determine when NVivo is an appropriate tool for qualitative analysis. NVivo, a qualitative analysis software package, was used to analyze interviews of 204 Asian, Hispanic, and white parents in 12 states. The experience provided insight into issues that should be considered when deciding to use the software. NVivo can enhance the qualitative research process, quickly process queries, and expand analytical avenues. Before using, however, the following must be considered: training time, establishing inter-coder reliability, number and length of documents, coding time, coding structure, use of automated coding, and possible need for separate databases or additional supporting software.

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs

OBJECTIVE

The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables.

METHODS

Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST.

RESULTS

Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses.

CONCLUSION

The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted.

PRACTICE IMPLICATIONS

We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Nutrition Information Sources Vary with Education Level in a Population of Older Adults

Education level, more than any other socioeconomic factor, can predict disease risk, health behavior patterns, and diet quality. It has been suggested that one reason higher education promotes more healthful diets is that better-educated people may get better nutrition information. We present data from a survey examining specific sources of nutrition information among an older adult population (age >50 years, n=176), and compare the difference in sources associated with extent of education. Reliance on doctors, television, and neighbors was significantly higher among those with less education (P<0.05). Our results also show that less-educated older adults rely more upon different specific sources for their nutrition information than those who have attained a higher level of education. Strategies to improve and/or ensure the quality of the specific nutrition information sources this vulnerable group relies on may be needed.

The internet and nutrition education: challenges and opportunities

OBJECTIVE

To review the possibilities of using the Internet and especially the World Wide Web (WWW) in nutrition education.

RESULTS

A healthy existence is partly dependent on dietary behaviours. One way to promote health-promoting dietary habits is nutrition education. In the last decades several potentially important new channels for health communication and nutrition education have emerged, with the Internet and its WWW as the most striking example. The introduction and growth of the WWW has enabled swift and inexpensive distribution of nutrition education expertise and materials. Furthermore, the WWW has also been used for tailoring nutrition education to the personal characteristics of the user. Only few studies have investigated the effects of generic web-based nutrition education, while web-based computer-tailored nutrition education has been studied in randomised controlled trials, with promising but mixed results. Two important challenges for web-based nutrition education interventions are to realise sufficient exposure and to ensure sufficient source reliability and credibility.

CONCLUSIONS

Next to the great opportunities, there are many challenges for web-based nutrition education. Some evidence for effects of web-based computer-tailored nutrition education has been reported, but more research is needed to obtain evidence for the effectiveness in real-life situations.

Empowering general practitioners in nutrition communication: individual-based nutrition communication strategies in Croatia

BACKGROUND

There are a number of factors influencing individual food habits and the prerequisite for effective national strategy development is reorganization of factors aggravating or facilitating this dynamic process.

AIMS

The aims of this paper are to present a Croatian contextual framework influencing individual-based nutrition communication strategies and to identify important factors by general practitioners (GPs) and population.

METHODS

Two Croatian surveys are presented. The first one was carried out among GPs (random 425 GPs, all with office on lease) and the second on an adult population in Croatia (random 9060 respondents) answering the question: 'In the past year, has anyone advised you to change your behaviour?'

RESULTS

The Croatian case studies showed that GPs considered smoking and alcohol as more important public health issues than unbalanced nutrition and physical activity. GPs also recognized their role in individual work with patients in secondary and tertiary prevention, less in primary prevention or work with groups and the community. Among the obstacles in individual-based communication in daily work, they reported lack of time, lack of incentives, lack of knowledge and lack of family approach in nutrition consultation. They were more likely to advise the elderly, those with lower education, unemployed, overweight, those who lived alone and those who visited GP's office regularly. Differences in respondents' answers are determined by education and workplace.

The Mediterranean eating in Scotland experience project: evaluation of an Internet-based intervention promoting the Mediterranean diet

A 6-month intervention study with a quasi-experimental design was conducted to evaluate the effectiveness of an Internet-based, stepwise, tailored-feedback intervention promoting four key components of the Mediterranean diet. Fifty-three (intervention group) and nineteen (control group) healthy females were recruited from the Universities of Glasgow and Glasgow Caledonian, Scotland, respectively. Participants in the intervention group received tailored dietary and psychosocial feedback and Internet nutrition education over a 6-month period, while participants in the control group were provided with minimal dietary feedback and general healthy-eating brochures. Internet education was provided via an innovative Mediterranean Eating Website. Dietary changes were assessed with 7 d estimated food diaries at baseline and 6 months, and data were analysed to calculate the Mediterranean Diet Score, a composite score based on the consumption of eight components of the traditional Mediterranean diet. The 'intention-to-treat' analyses showed that, at 6 months, participants in the intervention group had significantly increased their intake of vegetables, fruits and legumes, as well as the MUFA:saturated fatty acid ratio in their diet, and had significantly increased plasma HDL-cholesterol levels and a reduced ratio of total:HDL-cholesterol. Participants in the control group increased their intake of legumes but showed no other favourable significant changes compared with baseline. This Internet-based, tailored-feedback intervention promoting components of the Mediterranean diet holds promise in encouraging a greater consumption of plant foods, as well as increasing monounsaturated fat and decreasing saturated fat in the Scottish diet; it also shows that the Mediterranean diet can be adopted by healthy individuals in northern European countries.

Nutrition-related information-seeking behaviours before and throughout the course of pregnancy: consequences for nutrition communication

BACKGROUND

Research has shown that especially pregnant women, and also women with a wish for a child, have increased nutrition awareness. Seeking nutrition information seemed to be an important determinant for nutrition awareness. However, little research has been carried out about nutrition-related information-seeking behaviours before and during pregnancy.

OBJECTIVE

This study aimed to explore nutrition-related information sources, nutrition information-seeking behaviours and motives for seeking nutrition information before and throughout the course of pregnancy.

DESIGN

Data were collected by means of retrospective in-depth face-to-face interviews of 1 h with five groups of 12 women: women with a child wish, women in their first, second and third trimester of the first pregnancy and women in their first trimester of the second pregnancy. Women were mainly selected via midwifery practices. The interviews took place at conference rooms or at the respondent's home. Qualitative data were analysed with the software program NUD(*)IST (QSR, Melbourne). This was based on the research objectives and relevant text segments of transcripts.

RESULTS

Women with a child wish generally sought little nutrition information because they were not pregnant yet. Information sources were the Internet (anonymous) and the social environment (models). In relation to the manifestation of nutrition-related information-seeking behaviours during first-time pregnancies, three groups of women could be distinguished: (1) women who feel like a mother from the moment they know that they are pregnant, (2) women who feel like a mother later in pregnancy and (3) women who do not feel like a mother yet. Each group had its own specific information-seeking behaviour. Important information sources of the first group were the Internet (anonymous and up to date), books (extended) and midwives (expert) during the first trimester; the 9-month calendar (fun and tips), friends (experienced) in the second trimester; and friends (information on breastfeeding) in the third trimester. Information sources of the second group of women were mainly brochures provided by the midwife and the midwife herself. The third group of women mainly relied on their own common sense. Second-time pregnant women mainly relied on their experience, the midwife and books for specific questions.

CONCLUSIONS

Pregnant women perceive pregnancy-specific nutrition information as important because it is one of the few things that they can apply in their daily lives to protect the health of the fetus. Nutrition-related information-seeking behaviours mainly were pregnancy specific in character, rather than directed to general nutrition information.

Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study

OBJECTIVE

For more effective nutrition communication, it is crucial to identify sources from which consumers seek information. Our purpose was to assess perceived relevance and information needs regarding food topics, and preferred information sources by means of quantitative consumer research.

DESIGN

Based on qualitative studies, a quantitative questionnaire was developed and administered in face-to-face interviews.

SUBJECTS

The study population consisted of Dutch adults aged 18-80 y. A stratified sample of 923 adults was taken from the GfK ScriptPanel; 603 respondents completed the questionnaire.

RESULTS

Despite high perceived relevance of food topics regarding dietary guidelines (55-78%), most respondents indicated that they did not want more information about these topics (71-74%). Furthermore, our study revealed information needs regarding safety- and health-related food topics (up to 77% in some subgroups). Differences in perceived relevance and information needs were found in subgroups based on gender, age, perceived weight and socioeconomic status. Education offices of the food sector and the family doctor were mentioned for most food topics, who ranked among the highest regarding perceived reliability, perceived expertise, clearness and accessibility.

CONCLUSIONS

With respect to five food topics (losing weight, sports and nutrition, lowering cholesterol, carbohydrates and food composition), interested subgroups should receive tailored information. For other groups and food topics, a population-wide strategy should suffice, utilising the preferred information source. If people who are not yet interested become interested through a life event, information on demand can be put into action.

SPONSORSHIP

Dutch Dairy Association.

Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities

During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed, rearranged into topics, and summarized here. There are situations that call for nutrition advice to be given by general practitioners (GPs). GPs are trusted, they are not selling any particular food, and patients accept that their GPs may talk to them about diet. Compared with dietitians, GPs have much less time to advise about diet, so they must condense information. It is easier for a GP to give dietary advice if the patient is registered on the practice's list and if the GP can be paid for preventive work. Six topics seemed to be particularly new and challenging in our changing world: (1) Use of dietary supplements, herbal preparations, and functional foods; (2) patients as partners; (3) computers in practices; (4) evidence-based medicine; (5) the Internet; and (6) the obesity epidemic. These topics were reported as problems and then discussed as opportunities. The aim of the Heelsum Collaboration on General Practice Nutrition was to facilitate the nutrition work of GPs in their practices by researching the problems and barriers and by testing solutions. In line with this aim, some suggestions for research are provided.