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Whiteoak B, Dawson SL, Callaway L, de Jersey S, Eley V, Evans J, Kothari A, Navarro S, Gallegos D. Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study. Nutrients 2024; 16:1319. [PMID: 38732568 PMCID: PMC11085356 DOI: 10.3390/nu16091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.
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Affiliation(s)
- Bree Whiteoak
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
| | - Samantha L. Dawson
- Food & Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia;
| | - Leonie Callaway
- Women’s and Newborns Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Susan de Jersey
- Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia
| | - Victoria Eley
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
| | - Joanna Evans
- Maternity Services, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia;
| | - Alka Kothari
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD 4020, Australia
| | - Severine Navarro
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
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Martin É, Bergeron D, Gaboury I. The Use of Vignettes to Improve the Validity of Qualitative Interviews for Realist Evaluation. QUALITATIVE HEALTH RESEARCH 2024:10497323241237411. [PMID: 38501324 DOI: 10.1177/10497323241237411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Although realist evaluation (RE) requires multiple data collection methods, qualitative interviews are considered most valuable and are most frequently used. The guiding principles of RE may limit the emergence of new Context-Mechanism-Outcome (CMO) configurations by evoking particular underlying mechanisms. This paper proposes a new method for conducting semi-structured interviews in the RE context by drawing on the literature and examining the ability of vignettes to explore perceptions about specific situations. Vignettes are developed based on researchers' knowledge of the setting and program theory and are updated through an iterative process throughout data collection. Interviews focus on situations illustrated in the vignette to capture variations in interviewees' perceptions. This method constrains interviewees to using retroduction to identify the hidden underlying mechanisms that link contextual elements to outcomes based on their experiences. This method allows researchers to focus on CMO configurations without evoking mechanisms, which contributes to the rigor of the method.
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Affiliation(s)
- Élisabeth Martin
- Département de médecine de Famille, Université de Sherbrooke, Longueuil, QC, Canada
| | - Dave Bergeron
- Département des sciences de la santé, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Isabelle Gaboury
- Département de médecine de Famille, Université de Sherbrooke, Longueuil, QC, Canada
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Chambers S, Machray K, Fergie G. Food insecurity in children and young people in Scotland. Proc Nutr Soc 2024:1-13. [PMID: 38250796 DOI: 10.1017/s0029665124000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.
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Affiliation(s)
- Stephanie Chambers
- School of Social and Political Sciences, University of Glasgow, 28 Bute Gardens, GlasgowG12 8RS, Scotland
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kathryn Machray
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Gillian Fergie
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Parnham J, Millett C, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, Vamos EP. Is the healthy start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom? BMC Public Health 2021; 21:2220. [PMID: 34915897 PMCID: PMC8680244 DOI: 10.1186/s12889-021-12222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. METHODS Cross-sectional analyses of the Living Costs and Food Survey dataset (2010-2017). All households with a child (0-3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households). RESULTS Of 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. CONCLUSION This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet.
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Affiliation(s)
- Jennie Parnham
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK.
| | - Christopher Millett
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Kiara Chang
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Anthony A Laverty
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
| | - Stephanie von Hinke
- University of Bristol, Bristol, UK
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Fiscal Studies, London, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Northumbria Healthcare NHS Foundation Trust, London, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Eszter P Vamos
- Department of Primary Care, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP, UK
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Lam S, Dodd W, Wyngaarden S, Skinner K, Papadopoulos A, Harper SL. How and why are Theory of Change and Realist Evaluation used in food security contexts? A scoping review. EVALUATION AND PROGRAM PLANNING 2021; 89:102008. [PMID: 34600337 DOI: 10.1016/j.evalprogplan.2021.102008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
The complex ways in which food security actions lead to nutrition and other health outcomes make it important to clarify what programs work and how, with theory-driven evaluation emerging as a promising approach to evaluate complex programs. However, it is unclear how and why theory-driven evaluation is applied in food security contexts. Our objective is to examine the development and use of Theory of Change and Realist Evaluation to support food security programs globally. Using a systematic search and screening process, we included studies that described a food security program, used a Theory of Change or Realist Evaluation, and presented original research or evaluations. We found a total of 59 relevant Theory of Change studies and eight Realist Evaluation studies. Based on our analysis, Theories of Change arose in response to three main problems: 1) the need to evaluate under complexity; 2) challenges with evaluation; and, 3) information gaps surrounding a program. In contrast, Realist Evaluation was reported to be developed primarily to understand a program's outcomes. Reflecting on the problem to be addressed in the evaluation would help improve understandings of the evaluation context, which would then inform the choice and design of an evaluation approach.
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Affiliation(s)
- Steven Lam
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Sara Wyngaarden
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Jenkins G, Maugeri I, Palermo C, Hardwick R. Using realist approaches in nutrition and dietetics research. Nutr Diet 2021; 78:238-251. [PMID: 34155774 PMCID: PMC8361699 DOI: 10.1111/1747-0080.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/14/2023]
Abstract
AIM The aim of this study was to explore the use and future potential of realist approaches to research in nutrition and dietetics. METHODS A targeted literature review was used to search key journals (n = 7) in nutrition and dietetics to identify existing research using a realist approach. A narrative synthesis was conducted to explore findings in relation to the research aim. RESULTS Nine research papers (four realist evaluations, five realist reviews) describing seven nutrition interventions were found, which revealed the application of realist research in nutrition and dietetics has focused on public health interventions. Realist research provided a deeper, more nuanced understanding of varied outcomes including the role of context, and contributed to the development of theory about how and why interventions work. As a theory-driven research method, realist research was able to assist in overcoming methodological shortcomings to contribute to meaningful, transferable findings. CONCLUSION The results highlight the potential contribution of the realist research in nutrition and dietetics to evaluate interventions and inform future practice.
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Affiliation(s)
- Gemma Jenkins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Isabella Maugeri
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.,Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Hardwick
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, England
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Gillies C, Super S, Te Molder H, de Graaf K, Wagemakers A. Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography. Int J Qual Stud Health Well-being 2021; 16:1942416. [PMID: 34151755 PMCID: PMC8216252 DOI: 10.1080/17482631.2021.1942416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success. Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK. Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants’ attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants’ engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants. Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.
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Affiliation(s)
- Christina Gillies
- Strategic Communication Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Sabina Super
- Health and Society Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Hedwig Te Molder
- Department of Language, Literature, and Communication, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kees de Graaf
- Human Nutrition & Health Chair Group, Department of Agrotechnology and Food Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
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Ohly H, Crossland N, Dykes F, Lowe N, Moran VH. A realist qualitative study to explore how low-income pregnant women use Healthy Start food vouchers. MATERNAL AND CHILD NUTRITION 2018; 15:e12632. [PMID: 29956890 DOI: 10.1111/mcn.12632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022]
Abstract
Healthy Start is the UK government's food voucher programme for low-income pregnant women and young children. It was introduced in 2006, but the impact of the programme on nutritional outcomes remains understudied. This study sought to explore potential outcomes of the Healthy Start programme (including intended and unintended outcomes) and develop explanations for how and why these outcomes might occur. A realist review preceded this study, in which programme theories were developed and tested using existing evidence. This qualitative study aimed to further refine and consolidate the programme theories from the realist review while remaining open to new and emerging theories (or hypotheses) about how low-income pregnant women use Healthy Start vouchers. Semistructured interviews were conducted with 11 low-income women from North West England, who received Healthy Start vouchers during pregnancy. A realist logic of analysis was applied to generate clear and transparent linkages between outcomes and explanations. The findings suggested that some women used the vouchers to improve their diets during pregnancy (intended outcome), whereas some women were diverted towards alternative or unintended outcomes. Women's circumstances, values, beliefs, and motivations influenced how they perceived and responded to the vouchers. This paper presents four evidence-based programme theories to explain four contrasting (and potentially overlapping) outcomes: dietary improvements (theory refined from review), shared benefits (new theory), financial assistance (theory refined from review), and stockpiling formula (new theory). It considers how the Healthy Start programme could be improved, to increase the possibilities for low-income women to experience the intended outcome of dietary improvements.
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Affiliation(s)
- Heather Ohly
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Fiona Dykes
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Nicola Lowe
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Victoria Hall Moran
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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