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Alston L, Heaney S, Kent K, Godrich S, Kocanda L, Herbert J, Schumacher T, Brown LJ. Rural nutrition and dietetics research-Future directions. Aust J Rural Health 2023; 31:1027-1031. [PMID: 37723938 DOI: 10.1111/ajr.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
AIM The aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities. CONTEXT Clear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade. APPROACH A review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts. CONCLUSION Establishing strong, collaborative place-based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition-related disease disparity between rural and metropolitan Australia.
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Affiliation(s)
- Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Victoria, Warrnambool, Australia
- Research Unit, Colac Area Health, Victoria, Colac, Australia
| | - Susan Heaney
- Department of Rural Health, University of Newcastle, New South Wales, Port Macquarie, Australia
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
| | - Katherine Kent
- School of Health Science, Western Sydney University, New South Wales, Campbelltown, Australia
- School of Health Sciences, University of Tasmania, Tasmania, Launceston, Australia
| | - Stephanie Godrich
- Centre for People, Place and Planet, Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Bunbury, Australia
| | - Lucy Kocanda
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
- Dietetics Department, Tamworth Rural Referral Hospital, New South Wales, Tamworth, Australia
| | - Jaimee Herbert
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Victoria, Warrnambool, Australia
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
| | - Leanne J Brown
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
- Department of Rural Health, University of Newcastle, New South Wales, Tamworth, Australia
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Squires K, Brighton A, Urquhart L, Kocanda L, Heaney S. Informing online professional dietetics practice: The development and pilot testing of the Social Media Evaluation Checklist. Nutr Diet 2023; 80:351-361. [PMID: 36631069 DOI: 10.1111/1747-0080.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
AIM To develop and pilot a tool to evaluate Australian dietitians' and student dietitians' ethical and professional practice using social media. METHODS A Social Media Evaluation Checklist was developed based on checklist development literature with a four-staged process. Stage one included a literature review and input from an expert panel to ensure content validity. Stages two and three were to ensure face validity by categorising the checklist and pilot testing the tool. Instagram profiles and posts were audited by two authors using the checklist in the final stage to analyse ethical and professional use. An account purposely created for this study was used, and the first 25 dietitian and first 25 student dietitian profiles identified using the key words 'dietitian', 'student dietitian' and 'dietitian student' and the hashtag '#australiandietitian' were reviewed. RESULTS A total of 50 Instagram profiles and 250 posts were audited based on seven categories; (1) financial disclosure, (2) cultural awareness, (3) evidence-based information, (4) transparency, (5) privacy/confidentiality, (6) professionalism and (7) justifiability. Areas for improvement included advertising transparency which was met in only 12% of dietitian posts, and the provision of evidence-based information, which was met in 56% of dietitian posts and 72% of student dietitian posts. CONCLUSIONS This study provides insight into the ethical and professional use of social media by Australian dietitians and dietetics students. With the evolving nature of social media, guidance is required. This will ensure dietitians remain, now and in the future, the credible source of nutrition information for the public.
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Affiliation(s)
- Kelly Squires
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Alisha Brighton
- Hunter New England Local Health District, New Lambton, Australia
| | - Lisa Urquhart
- Department of Rural Health, University of Newcastle, Callaghan, Australia
| | - Lucy Kocanda
- Department of Rural Health, University of Newcastle, Callaghan, Australia
| | - Susan Heaney
- Department of Rural Health, University of Newcastle, Callaghan, Australia
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3
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Kocanda L, Schumacher TL, Plotnikoff RC, Whatnall MC, Fenwick M, Brown LJ, Rollo ME, Jansson A, Burrows TL, Duncan MJ, Britton B, May J, Kerr J, Rutherford J, Boyle A, Inder K, Collins CE. Effectiveness and reporting of nutrition interventions in cardiac rehabilitation programmes: a systematic review. Eur J Cardiovasc Nurs 2023; 22:1-12. [PMID: 35672581 DOI: 10.1093/eurjcn/zvac033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/14/2023]
Abstract
AIMS Dietary modification is essential for the secondary prevention of cardiovascular disease. However, there are limited published evidence syntheses to guide practice in the cardiac rehabilitation (CR) setting. This systematic review's objective was to assess effectiveness and reporting of nutrition interventions to optimize dietary intake in adults attending CR. METHODS AND RESULTS Randomized controlled trials (RCTs) of nutrition interventions within CR were eligible for inclusion and had to have measured change in dietary intake. MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and The Cochrane Library were searched from 2000 to June 2020, limited to publications in English. Evidence from included RCTs was synthesized descriptively. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. This review is registered on PROSPERO; CRD42020188723. Of 13 048 unique articles identified, 11 were eligible. Randomized controlled trials were conducted in 10 different countries, included 1542 participants, and evaluated 29 distinct dietary intake outcomes. Five studies reported statistically significant changes in diet across 13 outcomes. Most nutrition interventions were not reported in a manner that allowed replication in clinical practice or future research. CONCLUSION There is a gap in research testing high-quality nutrition interventions in CR settings. Findings should be interpreted in the light of limitations, given the overall body of evidence was heterogenous across outcomes and study quality; 6 of 11 studies were conducted more than 10 years old. Future research should investigate strategies to optimize and maintain nutrition improvements for patients attending CR. REGISTRATION PROSPERO; CRD42020188723.
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Affiliation(s)
- Lucy Kocanda
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Ronald C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Megan C Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Matthew Fenwick
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Leanne J Brown
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Megan E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Anna Jansson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tracy L Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Mitch J Duncan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jennifer May
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia
| | - Jane Kerr
- Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - Julie Rutherford
- Hunter New England Local Health District, Maitland, NSW 2320, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kerry Inder
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
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Hollis JL, Seward K, Kocanda L, Collins CE, Tully B, Brett K, Hunter M, Foureur M, Schumacher T, Lawrence W, MacDonald-Wicks L. Evaluating a train-the-trainer model for scaling-up Healthy Conversation Skills training: A pre-post survey using the Theoretical Domains Framework. Patient Educ Couns 2022; 105:3078-3085. [PMID: 35779983 DOI: 10.1016/j.pec.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Healthy Conversation Skills (HCS) training is an established method of upskilling health professionals in person-centred behaviour change communication. A Train-the-Trainer (TtT) model was adopted to scale-up delivery of HCS training. This study examined the impact of the TtT course on new Trainers' perceived barriers and enablers to delivering HCS training using the Theoretical Domains Framework (TDF). METHODS The TtT course was delivered in 2019-2020. Pre-training (T1) and post-training (T2) surveys collected data on barriers and enablers to delivering HCS training based on 10 TDF domains. Data were summarised using descriptive statistics, and differences between pre- and post-training scores analysed using paired t-tests. RESULTS Forty-six trainees participated, including 43 women and 10 Aboriginal people. Scores for nine domains increased post-training, including knowledge, skills, social and professional role/identity, beliefs about capabilities, intentions, goals, environmental context and resources, social influences, and behavioural regulation. Knowledge, beliefs about consequences and intentions were no longer barriers to delivering HCS training after participating in the TtT course. CONCLUSIONS The TtT model supports new Trainers by addressing barriers to delivering HCS training. PRACTICE IMPLICATIONS The HCS TtT model builds healthcare workforce capacity for person-centred approaches to behaviour change. The findings facilitate the refinement of the TtT course.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, Australia.
| | - Kirsty Seward
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
| | - Lucy Kocanda
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, Australia; Department of Rural Health, University of Newcastle, Tamworth, Newcastle, Australia.
| | - Clare E Collins
- Hunter Medical Research Institute, Newcastle, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Katie Brett
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Mandy Hunter
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, Australia.
| | - Maralyn Foureur
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia; Nursing and Midwifery Research Centre, Hunter New England Health, Newcastle, Australia.
| | - Tracy Schumacher
- Hunter Medical Research Institute, Newcastle, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, Australia; Department of Rural Health, University of Newcastle, Tamworth, Newcastle, Australia.
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Lesley MacDonald-Wicks
- Hunter Medical Research Institute, Newcastle, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
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Abstract
PURPOSE This study sought to determine current practice regarding nutrition care within cardiac rehabilitation (CR) programs, including perceived barriers and facilitators to providing nutrition care in this setting. METHODS A cross-sectional survey was conducted in October and November 2019. Potential participants were program coordinators, identified through the Australian Cardiovascular Health and Rehabilitation Association program directory and invited to participate via e-mail. RESULTS Forty-nine respondents (response rate: 13%) are included in this analysis. Programs provided group (n = 42, 86%) and/or individual (n = 25, 51%) nutrition education, and most were supported by a dietitian (63%). However, the availability of dietitians and nutrition care provided at CR was variable. For example, individual education was consistently provided at 13 programs and usually by health professionals other than dietitians. Eight programs (16%) used a formal behavior change framework for nutrition care. Generally, respondents were positive about the role of nutrition; CR coordinators perceived nutrition as a valuable component of the program, and that they had good nutrition knowledge. An identified barrier was the financial resources available to support the provision of nutrition care. CONCLUSIONS To ensure that patients receive the benefits of evidence-based nutrition care, program staff may require additional support, particularly regarding the use of evidence-based behavior change techniques. Key facilitators that may be leveraged to achieve this include the high value and priority that CR program coordinators place on nutrition care.
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Affiliation(s)
- Lucy Kocanda
- Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia (Ms Kocanda and Drs Schumacher, May, and Brown); School of Medicine and Public Health, Faculty of Health and Medicine (Ms Kocanda and Dr May), Priority Research Centre for Physical Activity and Nutrition (Ms Kocanda and Drs Schumacher, Rollo, and Brown), Priority Research Centre for Health Behaviour (Ms Kocanda and Dr Schumacher), and School of Health Sciences, Faculty of Health and Medicine (Drs Schumacher, Rollo, and Brown), The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia (Ms Kocanda and Dr Schumacher); Hunter New England Local Health District, Tamworth, Australia (Ms Kerr); School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland (Dr Neubeck); and The Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia (Dr Neubeck)
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Brown LJ, Urquhart L, Squires K, Crowley E, Heaney S, Kocanda L, Schumacher T. Starting from scratch: Developing and sustaining a rural research team lessons from a nutrition and dietetics case study. Aust J Rural Health 2021; 29:729-741. [PMID: 34672058 DOI: 10.1111/ajr.12787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the development of and key factors for sustaining a rural-based research team focussed on nutrition and dietetics. DESIGN A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub-units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. SETTING University of Newcastle Department of Rural Health across 4 rural sites. PARTICIPANTS Publicly available data sources from existing team members. MAIN OUTCOME MEASURES Staffing levels, research supervision, internal and external grant outcomes and peer-reviewed journal publications. RESULT Academic staffing has increased by 4 full-time equivalent positions over 18 years, with 6 current higher-degree research students. Key factors identified in the development of a discipline-specific research workforce included staff higher degree by research completions, longevity of staff in research-active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. CONCLUSION Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand.
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Affiliation(s)
- Leanne J Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Coffs Harbour, NSW, Australia
| | - Kelly Squires
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, Australia
| | - Elesa Crowley
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, Australia.,Tamworth Rural Referral Hospital, Hunter New England Local Health District, Tamworth, NSW, Australia
| | - Susan Heaney
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Port Macquarie, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Lucy Kocanda
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, Australia
| | - Tracy Schumacher
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
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7
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Hollis JL, Kocanda L, Seward K, Collins C, Tully B, Hunter M, Foureur M, Lawrence W, MacDonald-Wicks L, Schumacher T. The impact of Healthy Conversation Skills training on health professionals' barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework. BMC Health Serv Res 2021; 21:880. [PMID: 34452634 PMCID: PMC8394191 DOI: 10.1186/s12913-021-06893-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Changing people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using ‘open discovery questions’ increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants’ confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001). Conclusions Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06893-4.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia. .,Hunter Medical Research Institute, Newcastle, New South Wales, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia. .,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.
| | - Lucy Kocanda
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
| | - Kirsty Seward
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare Collins
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mandy Hunter
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, New South Wales, Australia
| | - Maralyn Foureur
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Nursing and Midwifery Research Centre, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley MacDonald-Wicks
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
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8
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Kocanda L, Brain K, Frawley J, Schumacher TL, May J, Rollo ME, Brown LJ. The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review. J Acad Nutr Diet 2021; 121:2046-2070.e1. [PMID: 34247977 DOI: 10.1016/j.jand.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dietary intake is an important modifiable risk factor for cardiovascular disease. However, to our knowledge, there are no systematic reviews of nutrition interventions in the context of cardiovascular disease prevention and management within rural communities. This is important to investigate, given the unique geographic, social, and contextual factors associated with rurality. OBJECTIVE Our primary objective was to systematically assess evidence on the effectiveness of randomized controlled trials to improve dietary intake in the context of cardiovascular disease prevention and management in rural communities. METHODS Nine electronic databases were searched from inception to June 2020, including MEDLINE, The Cochrane Library, Embase, Emcare, PsycINFO, Scopus, Rural and Remote Health, CINAHL, and AMED. Randomized controlled trials that reported results of interventions with adult, rural populations and measured change in dietary intake compared to usual care, alternative intervention, or no intervention controls were included. Included randomized controlled trials were also assessed according to the TIDieR (Template for Intervention Description and Reporting) checklist and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. RESULTS Thirteen articles reporting results of randomized controlled trials were identified. Included articles reported a range of nutrition interventions and measured 18 dietary intake outcomes. Most studies (n = 10) demonstrated effectiveness in altering at least 1 dietary intake outcome, including fruit and/or vegetable (n = 9), fiber (n = 2), Dietary Risk Assessment score (n = 2), energy, dairy, carotene, vitamin C and sodium (all n = 1). However, there was wide variation in the reporting of intervention components (according to the TIDieR checklist) and impact (according to RE-AIM framework), resulting in difficulty interpreting the "real-world" implications of these results. CONCLUSIONS Through this systematic review, we found limited evidence of improvement in dietary intakes due to nutrition interventions in the context of cardiovascular disease prevention and management in rural communities. Fruit and/or vegetable intakes were the most frequently reported dietary intake outcomes, and most likely to be improved across the included studies. Included studies were generally not well reported, which may hinder replication by clinicians and consolidation of the evidence base by other researchers. Given the substantial burden of cardiovascular disease experienced by those living in rural areas of developed countries, additional high-quality nutrition research that acknowledges the complexities of rural health is required.
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Kocanda L, Fisher K, Brown LJ, May J, Rollo ME, Collins CE, Boyle A, Schumacher TL. Informing telehealth service delivery for cardiovascular disease management: exploring the perceptions of rural health professionals. AUST HEALTH REV 2021; 45:241-246. [PMID: 33715764 DOI: 10.1071/ah19231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.
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Affiliation(s)
- Lucy Kocanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Corresponding author.
| | - Karin Fisher
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ;
| | - Leanne J Brown
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ;
| | - Jennifer May
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ;
| | - Megan E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ;
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