Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres

Influence of the 2019 Canada's Food Guide on the Food Environment in Childcare and Early Learning Centres

Purpose: This study investigated the potential influence of the 2019 Canada's Food Guide (CFG) on the eating environment and food provided in early learning and childcare centres across Canada.Methods: Directors of childcare centres were invited to complete an online survey about their awareness and adoption of the 2019 CFG and submit their menus for analysis.Results: Twenty-five directors completed the survey, and eighteen cycle menus were analyzed. Frequency and the types of foods offered in childcare centres were assessed. Ninety-two percent reported being aware of the changes in the food guide. Many challenges including the lack of support and resources, cost of food, and food reluctance could affect their ability to apply the changes, especially the incorporation of plant-based protein and the uncertainty around the amount of dairy products to provide. Menu analysis indicated frequency of offering items from the various food groups. Vegetables were mostly offered during lunchtime with an average offering rate of 4.83 ± 0.24 times per week.Conclusion: Representatives of early learning and childcare centres identified having difficulties in interpreting and applying the changes in the 2019 CFG. Dietitians have the knowledge and skills required to support childcare centres through training opportunities, workshops, toolkits, and advocacy.

Implementation of Healthy Eating Interventions in Center-Based Childcare: The Selection, Application, and Reporting of Theories, Models, and Frameworks

PURPOSE

To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare.

DATA SOURCE

We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter experts.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included studies in center-based settings for preschoolers that addressed the development, delivery, or evaluation of interventions or implementation strategies related to healthy eating and related subjects and that explicitly used TMF. Exclusion criteria include not peer reviewed or abstracts and not in English, French, German, and Korean.

DATA EXTRACTION

The first author extracted the data using extraction forms. A second reviewer verified data extraction.

DATA SYNTHESIS

Direct content analysis and narrative synthesis.

RESULTS

We identified 8222 references. We retained 38 studies. Study designs included quasi-experimental, randomized controlled trials, surveys, case studies, and others. The criteria used most often for selecting TMFs were description of a change process (n = 12; 23%) or process guidance (n = 8; 15%). Theories, models, and frameworks used targeted different socioecological levels and purposes. The application of TMF constructs (e.g., factors, steps, outcomes) was reported 69% (n = 34) of times.

CONCLUSION

Reliance on TMFs focused on individual-level, poor TMF selection, and application and reporting for the development of implementation strategies could limit TMF utility.

The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

Women's perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study

Background

Maternal body weight is an indicator of the health of a mother and her developing fetus. Risks of poor maternal and fetal health issues increase when women gain too little or too much weight during pregnancy. A study of 600 women from Alberta, Canada, reported approximately 30, 46, 80, and 80% of underweight, healthy weight, overweight, and obese women, respectively, gained in excess of Health Canada gestational weight gain guidelines. Behavioural interventions during pregnancy have shown to be effective at supporting women achieve gestational weight gain (GWG) recommendations and return to their pre-pregnancy weight postpartum, yet few women are counseled about weight gain during pregnancy. A discrepancy exists between health care providers’ (HCP) reported counseling behaviours and women’s perceptions of counseling by HCPs; most HCPs report counseling women about GWG; conversely, most women report not receiving counseling about GWG. This study explored women’s experiences with GWG and their perceptions of discussions about GWG with HCPs during pregnancy and postpartum. This will help to identify gaps in service delivery and highlight areas for improvement that may better support women to achieve GWG recommendations leading to better health outcomes for women and children.

Methods

Five focus groups (n = 26) were conducted with women up to 1 year postpartum across the five Alberta health zones. Focus groups were transcribed verbatim and analyzed using qualitative content analysis.

Results

GWG is important to women, for their health and for the health of their baby. In-depth conversations with HCPs about GWG or weight loss do not occur; however, women want the opportunity to discuss weight gain/loss with HCPs. Women would like discussions about gestational weight gain/loss to become part of standard care and offered to all women.

Conclusions

Women suggested that discussions about GWG should occur with all women, and that HCPs should initiate these discussions by asking women how they feel about discussing weight. Conversations should begin early on in pregnancy and continue through to the postpartum period. Interventions assessing discussions about GWG should be implemented and evaluated as this has been identified as a gap in prenatal service delivery.