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Yi S, Kanetkar V, Brauer P. Nudging food service users to choose fruit- and vegetable-rich items: Five field studies. Appetite 2022; 173:105978. [PMID: 35247476 DOI: 10.1016/j.appet.2022.105978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/18/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022]
Abstract
Although nudging has been found to promote the choice of healthy foods in lab studies and ad-hoc field studies, relatively little research is available regarding effectiveness in real food venues that operate for profit. The paucity of empirical studies providing "proof of implementation" reveals the difficulty of applying previous empirical findings on nudging to mass-eating food services contexts, which serve meals to a lot of individuals daily. Based on the typology of choice architecture in food choice contexts, we closely collaborated with the in-house food service operator to devise and implement five nudge interventions to promote fruits and vegetables (FV) in university cafeterias. Each study was conducted for one 12-week semester or more over a three-year period. In the first two studies, non-verbal point-of-purchase prompting increased the choice of kale/spinach supplemented smoothies and whole fruits from baskets. In Study 3, the combination of sizing and point-of-purchase non-verbal prompting increased the sale of large size vegetable-rich bowls from a stir-fry grill. In Study 4, the proximity type of nudging by altering the position of the healthier option in a sandwich bar in combination with non-verbal prompting increased the sale of sandwiches containing spinach. In Study 5, the combination of sizing and proximity of large vs. small sized plates and serving spoons had no effect on sale of self-serve items in a salad bar. All the interventions except for Study 5 produced a moderate effect in increasing the choice of FV-rich items. We recommend that hospitality and food service operators consider operational parameters and simultaneously adopt more than one nudging components to achieve a sizable effect. Future randomized controlled trials are needed to implement choice architecture techniques in collaboration with food service companies.
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Affiliation(s)
- Sunghwan Yi
- Department of Marketing & Consumer Studies, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada.
| | - Vinay Kanetkar
- Department of Marketing & Consumer Studies, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada.
| | - Paula Brauer
- Department of Family Relations & Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 2W1, Canada.
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Tirfie M, Tadesse S, Woldie H, Weldegiorgis T, Birhanu M, Shibabaw T. Dietary non-adherence and associated factors among individuals with diabetes who are on treatment follow up at Felege-Hiwot Referral Hospital, Northwest Ethiopia. Heliyon 2020; 6:e04544. [PMID: 32904193 PMCID: PMC7452454 DOI: 10.1016/j.heliyon.2020.e04544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/06/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. The overall proportion of dietary non-adherence among participants was 46.8% (95% CI: 41.1-52.0). Living rurally (AOR = 3. 75; 95% CI: 2.12-6.63), duration of diabetes less than 5 years (AOR = 2. 81; 95% CI: 1.22-6.50), did not receive nutritional education (AOR = 5. 88; 95% CI: 3.30-10.48), poor social support (AOR = 3. 84; 95% CI: 1.74-8.46) and did not make choices when eating out (AOR = 3. 49; 95% CI: 2.09-5.81) were significantly associated with dietary non-adherence. Nearly half of the individuals with diabetes involved in this study did not adhere to the recommended diet. This problem could be addressed through the provision of nutritional education and strengthening social support to adhere to diabetes dietary recommendations. Therefore, health professional and nutritional educators should take appropriate action to increase the proportion of dietary adherence of individuals with diabetes.
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Affiliation(s)
- Mulat Tirfie
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Sebsibe Tadesse
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Haile Woldie
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Teshager Weldegiorgis
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Minyichil Birhanu
- Department of Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Tebkew Shibabaw
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
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Affiliation(s)
- Paula Hunt
- National Unit for Health Promotion in Primary Health Care, Oxford
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Mwanri L, Foley W, Coveney J, Muller R, Verity F, Ward PR, Carter P, Mohr P, Taylor A. Food supply and the obesity scourge: Is there a relationship? Health (London) 2012. [DOI: 10.4236/health.2012.412a210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Preyde M, Brassard K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2011; 8:445-468. [PMID: 22035470 DOI: 10.1080/15433714.2011.542330] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The current health care system is discharging elderly patients "quicker" and "sicker" from acute care facilities. Consequently, hospital readmission is common; however, readmission may be only one aspect of adverse outcomes of importance to social work discharge planners. The early recognition of risk factors might ensure a successful transition from the hospital to the home. A systematic review was conducted to identify factors associated with adverse outcomes in older patients discharged from hospital to home. Using a content analysis, factors were characterized in five domains: demographic factors, patient characteristics, medical and biological factors, social factors, and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. A systematic search identified four discharge assessment tools for use with the general population of elderly patients. Practice and research implications are offered.
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Affiliation(s)
- Michèle Preyde
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
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Mead E, Gittelsohn J, Roache C, Sharma S. Healthy food intentions and higher socioeconomic status are associated with healthier food choices in an Inuit population. J Hum Nutr Diet 2011; 23 Suppl 1:83-91. [PMID: 21158966 DOI: 10.1111/j.1365-277x.2010.01094.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Changing food behaviours amongst Canadian Inuit may contribute to rising chronic disease prevalence, and research is needed to develop nutritional behaviour change programmes. The present study examined patterns of food acquisition and preparation behaviours amongst Inuit adults in Nunavut and associations with psychosocial and socioeconomic factors. METHODS Developed from behavioural theories and community workshops, Adult Impact Questionnaires were conducted with adult Inuit (≥19 years) from randomly selected households in three remote communities in Nunavut, Canada, to determine patterns of healthy food knowledge, self-efficacy and intentions, frequencies of healthy and unhealthy food acquisition and healthiness of preparation methods. Associations between these constructs with demographic and socioeconomic factors were analysed using multivariate linear regressions. RESULTS Amongst 266 participants [mean (SD) age 41.2 (13.6) years; response rates 69-93%], non-nutrient-dense foods were acquired a mean (SD) of 2.9 (2.3) times more frequently than nutrient-dense, and/or low sugar/fat foods. Participants tended to use preparation methods that add fat. Intentions to perform healthy dietary behaviours was inversely correlated with unhealthy food acquisition (β=-0.25, P<0.001), and positively associated with healthy food acquisition (β=0.22, P<0.001) and healthiness of preparation methods (β=0.15, P=0.012). Greater healthy food knowledge and self-efficacy were associated with intentions (β=0.21, P=0.003 and β=0.55, P<0.001, respectively). Self-efficacy was associated with healthier preparation (β=0.14, P=0.025) and less unhealthy food acquisition (β=-0.27, P<0.001), whilst knowledge was associated with acquiring healthy foods (β=0.13, P=0.035). Socioeconomic status was positively associated with healthy preparation and food acquisition behaviours. CONCLUSIONS Interventions to improve diet in Nunavut Inuit should target healthy food intentions, knowledge and self-efficacy. Behaviour change strategies emphasising economic benefits of a healthy diet should be employed to target individuals of low socioeconomic status.
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Affiliation(s)
- E Mead
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
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Mead E, Gittelsohn J, De Roose E, Sharma S. Important psychosocial factors to target in nutrition interventions to improve diet in Inuvialuit communities in the Canadian Arctic. J Hum Nutr Diet 2010; 23 Suppl 1:92-9. [DOI: 10.1111/j.1365-277x.2010.01095.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Rapoport. Integrating cognitive behavioural therapy into dietetic practice: a challenge for dietitians. J Hum Nutr Diet 2008. [DOI: 10.1046/j.1365-277x.1998.00102.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Obayashi S, Bianchi LJ, Song WO. Reliability and validity of nutrition knowledge, social-psychological factors, and food label use scales from the 1995 Diet and Health Knowledge Survey. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2003; 35:83-91. [PMID: 12725714 DOI: 10.1016/s1499-4046(06)60044-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To test the reliability and validity of scales on nutrition knowledge, social-psychological factors, and use of food labels developed from the 1995 Diet and Health Knowledge Survey (DHKS) questions. DESIGN The 1995 DHKS questions within a section were pooled together as a scale and their reliability and validity were examined. PARTICIPANTS US adults (> or =20 years) in the 1995 DHKS who responded to questions selected for this study (n = 1196). VARIABLES Nutrition knowledge about the diet-disease relationship and nutrient content of products, perceived barriers and benefits of food labels, perceived ease of understanding food labels, food label use, and importance of healthful eating. ANALYSIS Scales validity, Cronbach alpha, item total correlation, alpha if the item was deleted, and discriminant, convergence, and correspondence validity. RESULTS Scales on perceived ease of understanding the food label, benefits of using food labels, food label use, and importance of healthful eating were reliable (Cronbach alpha =.78,.82,.91, and.82, respectively) and valid. CONCLUSION AND IMPLICATIONS Accurate findings and interpretation of survey data depend on the use of reliable and valid instruments. This study identified the scales in the DHKS that can substantiate the conclusion on which effective nutrition education strategies should be established.
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Affiliation(s)
- Saori Obayashi
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824-1224, USA
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Gans KM, Ross E, Barner CW, Wylie-Rosett J, McMurray J, Eaton C. REAP and WAVE: new tools to rapidly assess/discuss nutrition with patients. J Nutr 2003; 133:556S-62S. [PMID: 12566502 DOI: 10.1093/jn/133.2.556s] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary changes can be helpful in preventing or treating a variety of prevalent health problems. Physicians can be helpful in helping patients make positive dietary changes, be physically active and lose weight, but, for a variety of reasons, many physicians do little nutrition counseling. There is a need for brief, user-friendly tools to enable physicians to rapidly and accurately assess patients' diets and exercise habits as well as provide information to aid the physician in delivering effective nutrition counseling. The purpose of this paper is to discuss two new tools, WAVE and REAP, that have been developed by the Nutrition Academic Award to help physicians and other health care providers conduct nutrition assessment and counseling with their patients in a practical and effective manner. The WAVE acronym and tool is designed to encourage provider/patient dialogue about the pros and cons of the patients' current status related to Weight, Activity, Variety and Excess. The Rapid Eating and Activity Assessment for Patients (REAP) is a brief validated questionnaire that is designed to aid providers in performing a brief assessment of diet and physical activity. An accompanying Physician Key aids the provider in discussing the patient's answers and counseling them appropriately. REAP and WAVE can be helpful tools to facilitate nutrition assessment and counseling in the provider office. Depending on patients' health priorities and how much time is available, these tools can be used in a variety of ways to discuss nutrition with patients during a clinical encounter in 1-9 min.
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Affiliation(s)
- Kim M Gans
- Institute for Community Health Promotion, Brown University Medical School, Providence, RI 02903, USA.
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Eaton CB, McBride PE, Gans KA, Underbakke GL. Teaching nutrition skills to primary care practitioners. J Nutr 2003; 133:563S-6S. [PMID: 12566503 DOI: 10.1093/jn/133.2.563s] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Primary care physicians have the potential to decrease morbidity and mortality for many chronic diseases if they provide effective nutrition counseling. Given the time constraints of primary care practice, nutrition counseling needs to be brief, be part of an organized office system and refer appropriate patients to qualified nutrition professionals to be effective. This paper reviews a system of primary care nutrition counseling using the 5A's of patient-centered counseling, the elements necessary to develop an office-based system and some successful tools developed by nutrition researchers for the primary care setting to be used in an office-based system.
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Affiliation(s)
- Charles B Eaton
- Department of Family Medicine, Center for Primary Care and Prevention, Brown Medical School, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA.
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Abstract
BACKGROUND Despite the large potential of dietary changes to reduce morbidity and mortality, the frequency, time spent, and factors associated with nutrition counseling in primary care are not well studied. METHODS In a cross-sectional study of 84 family physician practices in northeast Ohio, nutrition counseling was measured by direct observation on 2 days for all consecutive ambulatory visits. The frequency, time spent, and patient and visit characteristics associated with nutrition counseling were determined. RESULTS Among 138 family physicians, only 6% included nutrition counseling in the majority (>50%) of patient encounters. Among 3475 consecutive outpatient visits in adults, nutrition counseling occurred in 24% of all patient visits, 17% of visits for acute illnesses, 30% of chronic illness visits, and 41% of well-care visits. The average time spent on nutrition counseling was 55 seconds, ranging from <20 seconds to >6 minutes. Nutrition counseling occurred in 45% of visits for diabetes, 25% of visits for cardiovascular disease, 31% of visits for hypertension, 26% of prenatal visits, and 33% of visits by obese patients (body mass index >30). Nutrition counseling was more likely to occur during visits by patients who were older or had diabetes mellitus, during visits for well care or chronic illness, and during longer visits. CONCLUSION Despite considerable variability from physician to physician, nutrition counseling occurs in approximately one fourth of all office visits to family physicians. The observed efforts by family physicians to focus nutrition counseling on high-risk patients may increase its impact.
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Affiliation(s)
- Charles B Eaton
- Department of Family Medicine, Brown Medical School, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island 02860, USA.
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Frost G, Lyons F, Bovill-Taylor C, Carter L, Stuttard J, Dornhorst A. Intensive lifestyle intervention combined with the choice of pharmacotherapy improves weight loss and cardiac risk factors in the obese. J Hum Nutr Diet 2002; 15:287-95; quiz 297-9. [PMID: 12153502 DOI: 10.1046/j.1365-277x.2002.00373.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Obesity is on the increase yet within the National Health Service (NHS) treatment approaches differ greatly and service is patchy. Our aim was to compare current practice within a general dietetic clinic with a new clinic developed specifically for patients of higher morbidity risk. METHODS Locally referred patients to the dietitians from within or without Hammersmith Hospitals NHS Trust of higher morbidity risk were invited to attend a new Lifestyle Clinic. Treatment was of a contractual nature and included more time with the dietitian, the offer of pharmacotherapy if appropriate and an emphasis on achieving a realistic weight loss of 10% within a 6-month period. Cognitive behavioural strategies were utilized focusing on achieving changes in dietary intake and physical activity levels. RESULTS A total of 103 patients have been enrolled of whom 34 have been discharged before completion of the clinic programme. Twenty-six patients have completed (18 started pharmocotherapy with Orlistat and eight remained on lifestyle advice only), with the remainder still attending the Lifestyle Clinic. The results for these 26 patients demonstrate clinically significant benefits with regard to exercise tolerance 390.8 +/- 37.5 m vs. 473 +/- 46.6 m (P < 0.001), waist measurement 121.5 +/- 4.4 cm vs. 110.9 +/- 3.6 cm (P < 0.001), and total cholesterol : HDL ratio 1.17 +/- 0.05 mmol L-1 vs. 1.27 +/- 0.07 mmol L-1 (P < 0.05). A weight loss comparison with historical data collected in the general dietetic clinic achieves a 7.8 +/- 0.7 kg reduction in weight (with pharmocotherapy 8.96 +/- 0.98 kg, with lifestyle only 5.23 +/- 0.657) vs. 1.7 +/- 0.4 kg (P < 0.05). CONCLUSION Lifestyle clinics facilitate beneficial lifestyle changes which impact positively on morbidity risk factors demonstrating an improvement on current service offered within the NHS. There is an obvious resource implication of offering an intensive management package. There is need for a randomized control trial with analysis to evaluate whether there is cost benefit from this type of intervention.
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Affiliation(s)
- G Frost
- Department of Nutrition and Dietetics, Hammersmith Hospital, Du Cane Road, London, UK.
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Fitzgibbon ML, Stolley MR, Dyer AR, VanHorn L, KauferChristoffel K. A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr. Prev Med 2002; 34:289-97. [PMID: 11817926 DOI: 10.1006/pmed.2001.0977] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. METHODS The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. RESULTS This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. CONCLUSIONS The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.
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Frame CJ, Green CG, Herr DG, Myers JE, Taylor ML. The stages of change for dietary fat and fruit and vegetable intake of patients at the outset of a cardiac rehabilitation program. Am J Health Promot 2001; 15:405-13. [PMID: 11523497 DOI: 10.4278/0890-1171-15.6.405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the stages of change for dietary fat and fruit and vegetable intake of cardiac patients entering a rehabilitation program. DESIGN A cross-sectional study using a convenience sample of newly admitted cardiac rehabilitation patients. SETTING Department of Pulmonary and Cardiac Rehabilitation, Moses H. Cone Memorial Hospital, Greensboro, North Carolina. SUBJECTS Subjects (n = 226) were predominantly men, Caucasian, married, smokers with 9 to 12 years of education, and with primary diagnoses of coronary artery bypass graft. MEASURES Stages of change and food frequency questionnaires were completed by subjects upon admission to cardiac rehabilitation. RESULTS Subjects in action and maintenance stages for dietary fat reduction comprised 78.7% of the population. Subjects' percentage of energy from fat decreased linearly from the precontemplation stage (38.8%) to the maintenance stage (30.9%). Eighty-one percent of subjects were in precontemplation/contemplation for increasing fruit and vegetable intake. Daily servings of fruits and vegetables ranged from 2.6 for precontemplation to 5.1 for maintenance subjects. Age, body mass index (BMI), education, and family history for coronary disease were unrelated to stage of change for the dependent variables. CONCLUSIONS Patients were in different stages of change for two nutritional behaviors linked to the same disease. Results support the need to assess patients for food behaviors and apply different educational interventions for each food behavior.
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Affiliation(s)
- C J Frame
- College of Health Sciences and Human Services, Murray State University, 200 North Oakley Avenue, Murray, KY 42071, USA
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Lazovich D, Curry SJ, Beresford SA, Kristal AR, Wagner EH. Implementing a dietary intervention in primary care practice: a process evaluation. Am J Health Promot 2000; 15:118-25. [PMID: 11194695 DOI: 10.4278/0890-1171-15.2.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Physicians acknowledge the need to advise their patients about dietary habits, but they may not have the training or tools to do this efficiently. In the context of a randomized trial, we investigated the feasibility of enlisting physicians to implement a dietary intervention in the primary care setting. METHODS Physicians from 14 primary care practices were assigned via randomization to introduce a self-help booklet to promote dietary change at routine appointments. Delivery of the booklet was recorded by these intervention physicians at the clinic appointment; intervention participants were asked 3 months later in a telephone interview about whether they received and used the booklet. RESULTS According to physician documentation, 95% of intervention participants who kept an appointment (n = 935) received the booklet; among participants completing a 3-month interview (n = 890), 96% reported the same. However, only about 50% of participants reported receiving the booklet from their physician; the remainder received the booklet from other clinic staff. Overall, 93% reported reading at least part of the booklet. Use of the booklet varied little whether it was delivered by a physician or staff person, but it was more likely to be read as time spent discussing the booklet increased. CONCLUSIONS Physician cooperation and evidence of intervention effectiveness support the use of primary care for the delivery of interventions to change diet; training the entire health team and repeating dietary advice at subsequent visits may improve the success of such interventions.
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Affiliation(s)
- D Lazovich
- Division of Epidemiology, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA
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Rapoport L, Perry KN. Do dietitians feel that they have had adequate training in behaviour change methods? J Hum Nutr Diet 2000. [DOI: 10.1046/j.1365-277x.2000.00241.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Nutrition has important influences on health and mortality. Public response to current dietary guidance is indicated by positive movement on some indicators, notably reductions in calories from fat and in blood cholesterol levels. Downstream case finding and intensive educational and behavioral interventions are often effective for high risk and motivated subjects and for persons with diet-related disease. Midstream environmental changes (e.g., in grocery stores, schools) proffer improved nutritional choices and supports. Individualized dietary counseling has yet to become the norm. Despite recent upstream success in developing broad dietary guidance and improving nutrition labeling policies, numerous avenues remain open for aggressive national policy developments. Emerging studies and continuing improvement in intervention methods, measurement, and research design will help realize the preventive effects of healthful diets.
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Affiliation(s)
- K Glanz
- Prevention and Control Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu 96813, USA
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Abstract
Our dialysis unit observed fluid noncompliance over a wide variety of patients. The consequences of fluid abuse that can include systemic and cardiovascular overload are a frequent clinic complication of hemodialysis patients. In spite of all our attempts, our dialysis unit continued to have a substantial group of patients who could not adhere to their fluid restriction. Our dialysis unit needed a novel program to help motivate patients to comply with diet/medication fluid regimens. A method that seems to work well in our dialysis unit is playing unit-wide games. We developed "The Fluid Game," an original patient education idea, for providing renal patients with a fun incentive to keep their interdialytic weight gains within acceptable limits.
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Affiliation(s)
- M C Bushman
- Gambro Healthcare Lombard, Philadelphia, PA 19146, USA
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Abstract
Diet is routinely recommended as the primary strategy for the prevention and treatment of high blood cholesterol. The National Cholesterol Education Program (NCEP), the American Heart Association (AHA), and a host of other health and medical organizations have advocated a diet low in total and saturated fat and cholesterol for reducing risk of cardiovascular disease. What is the evidence supporting these guidelines and the expected efficacy of dietary treatment? There is growing awareness that despite well-documented rationale for the dietary approach, many eligible patients are not routinely prescribed dietary treatment, and among those who are, there is limited response. What are the obstacles in implementing effective dietary intervention for prevention of cardiovascular disease? What are both the theoretical and practical limitations to achieving long-term adherence to diet and what strategies have been shown to be most effective? A review of the data surrounding these diet-lipid relationships is presented along with recently tested and promising behavioral approaches to facilitating patient adherence.
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Affiliation(s)
- L Van Horn
- Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL 60611-4402, USA
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Macario E, Emmons KM, Sorensen G, Hunt MK, Rudd RE. Factors influencing nutrition education for patients with low literacy skills. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1998; 98:559-64. [PMID: 9597029 DOI: 10.1016/s0002-8223(98)00125-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center-based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients' social networks; appear in a visually based, interactive format; and be culturally appropriate.
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Affiliation(s)
- E Macario
- Dana-Farber Cancer Institute, Boston, Mass. 02115, USA
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Abstract
This paper summarizes key behavioral research contributions to the promotion of healthful diets and identifies the outstanding behavioral research needs that could lead to positive dietary changes in the United States. Nutrition plays an important role in the initiation, promotion, and progression of cancer. Dietary guidelines for health promotion and cancer prevention recommend diets that are lower in fat and higher in fiber, fruits, and vegetables. Behavioral research on dietary change has become more rigorous and sophisticated in the past decade, with noteworthy contributions in four areas: behavioral research within clinical trials, self-help or minimal contact intervention strategies, school nutrition programs and services, and advances in the development of measures. Work in progress includes large-scale randomized intervention trials, with the majority of funding for studies to increase fruit and vegetable consumption. There are many needs for further research. Six priority areas for behavioral research are identified and discussed: (1) determinants of dietary behavior and change processes; (2) policy, environmental, and organizational interventions; (3) studies of dietary change and exercise and interventions with persons at high risk for diet-related cancers; (4) methodological research; (5) research on diffusion and dissemination; and (6) systematic behavioral research on dietary change in clinical trials. A concerted research effort in the area of dietary change has great potential benefits for cancer prevention and control and for public health in general.
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Affiliation(s)
- K Glanz
- Prevention and Control Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu 96813, USA.
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Smith AM, Owen N, Baghurst KI. Influence of Socioeconomic Status on the Effectiveness of Dietary Counselling in Healthy Volunteers. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0022-3182(97)70143-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glanz K, Sorensen G, Farmer A. The health impact of worksite nutrition and cholesterol intervention programs. Am J Health Promot 1996; 10:453-70. [PMID: 10163311 DOI: 10.4278/0890-1171-10.6.453] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To summarize and provide a critical review of worksite health promotion program evaluations published between 1980 and 1995 that address nutrition and hypercholesterolemia. The article discusses and critiques both intervention methods and research methodologies to identify the most effective strategies. METHODS Core articles are 26 original, data-based studies that report on measures of health status, behavior, attitudes, and knowledge as outcomes of worksite nutrition and cholesterol interventions. Only work published since 1980 that clearly describes nutrition or cholesterol interventions and that includes identifiable nutrition-related outcomes is reviewed. The main search method was the same one used for this special issue; supplementary sources included those found in earlier reviews or identified through backward searches or expert contact. SUMMARY OF IMPORTANT FINDINGS Ten worksite nutrition education programs were reviewed and were categorized as group education, group education plus individual counseling/instruction, cafeteria-based programs, and group education plus cafeteria-based programs. Four of these were randomized studies, and one used the worksite as the unit of randomization and analysis. Sixteen worksite cholesterol programs were reviewed, in five categories: monitoring; individual counseling; group sessions or classes; mediated methods using print, audiovisual, telephone, and self-help kits; and combination approaches. Of these, eight were randomized controlled trials; most tested interventions for persons with elevated cholesterol levels, although four studies reported cholesterol education programs for the general employee population. Six large controlled trials of worksite nutrition and cholesterol interventions in progress are also described. MAJOR CONCLUSIONS The conclusions that can be drawn from this review are limited by the study designs used, which often lacked control groups, used nonrandomized designs, or relied on self-selected high-risk or volunteer participants. Our rating for the quality of the evidence in the literature as a whole lies between suggestive and indicative. It is clear that worksite nutrition and cholesterol programs are feasible and that participants benefit in the short-term. Conclusive evidence about a causal relationship between worksite nutrition and cholesterol programs and improved behavior or health is not yet available, although studies currently underway hold promise for providing more solid evidence about the potential efficacy of these interventions.
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Affiliation(s)
- K Glanz
- University of Hawaii, Honolulu, USA
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26
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Raats MM, Sparks P. Unrealistic optimism about diet-related risks: implications for interventions. Proc Nutr Soc 1995; 54:737-45. [PMID: 8643711 DOI: 10.1079/pns19950073] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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27
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Elliott H. Community nutrition education for people with coronary heart disease--who attends? AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:205-10. [PMID: 7786950 DOI: 10.1111/j.1753-6405.1995.tb00375.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A qualitative food-frequency questionnaire was administered by mail to a representative sample of 137 people previously diagnosed with possible or definite myocardial infarct. Seventy-eight percent of subjects returned a completed questionnaire and were subsequently invited to attend local tastings of foods with the National Heart Foundation Tick of Approval. These tastings were organised and promoted with the active involvement of the local branch of the Australian Cardiac Association. The purpose of this study was to measure voluntary participation by people with coronary heart disease in community nutrition education and to identify any self-selection bias with respect to eating habits among the participants. A dietary risk score, which was the proportion of all food choices that were high in fat, was calculated from the data. Eighteen per cent of subjects who answered also participated in the food tastings; there was a statistically significant association between membership of the Australian Cardiac Association and being a participant. Participants had a significantly lower risk score (P < 0.01) after adjustment for age, sex and membership of the association. The results suggest that voluntary participation by people with heart disease in community nutrition education is low and that there is a self-selection bias, with those at highest dietary risk being least likely to attend. The use of existing community networks to recruit participants is also discussed.
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Affiliation(s)
- H Elliott
- Department of Nutrition and Dietetics, Mater Misericordiae Hospital, Waratah, NSW
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28
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Diet-cancer related beliefs, knowledge, norms, and their relationship to healthful diets. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/s0022-3182(12)80348-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Smith AM, Baghurst KI, Owen N. Dietary behaviours of volunteers for a nutrition education program, compared with a population sample. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:64-9. [PMID: 7734597 DOI: 10.1111/j.1753-6405.1995.tb00299.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The dietary behaviours of and recent dietary change by volunteers for a nutrition education program were compared with those of a more population-representative sample. The population sample was randomly selected from the electoral rolls of three Australian cities. Those selected received questionnaires which were to be completed and returned by mail. The sample of volunteers was recruited from the electoral rolls of suburbs of either high or low social status in one of these cities. Volunteers were posted a questionnaire, to be returned in person. A quantified food frequency questionnaire was used to estimate relative intake of 19 nutrients, plus energy intake. Occupation, age, sex, reported recent dietary change and diet-related beliefs were also assessed. The population sample was weighted to the age and occupational distribution of the education program sample. Compared to the 874 respondents in the population sample (70.4 per cent response rate), the 487 volunteers (24.2 per cent response rate) for the nutrition education program had healthier nutrient intakes and reported more dietary behaviour changes. Recruitment in the education program was greater in areas of higher social status (32 per cent) than in areas of lower social status (20 per cent). The potential effect of such a program on the whole population was demonstrated by the proportions that volunteered and the characteristics of these volunteers. The need to provide a range of opportunities for changing dietary behaviour, according to the health-related behaviours and beliefs of target groups and their socio-economic circumstances, was highlighted.
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Affiliation(s)
- A M Smith
- CSIRO Division of Human Nutrition, Adelaide
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Splett PL, Reinhardt MA, Fleming P. Physicians' expectations for quality nutrition expertise and service in prenatal care. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1994; 94:1375-80. [PMID: 7963186 DOI: 10.1016/0002-8223(94)92538-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To identify physicians' needs and expectations related to quality nutrition services in prenatal care; to rank service characteristics by importance in making nutrition referral decisions; and to identify nutrition services physicians would likely add to their practice. DESIGN We used a market research survey based on the quality service management model. SETTING We selected prenatal care as the setting because diet plays an important role in the health of the mother and the infant; specific recommendations exist for physicians to provide for nutrition assessment and counseling during pregnancy; and dietitians are not uniformly represented and used in obstetrics practices. SUBJECTS The survey population consisted of all members of a state obstetrics and gynecology society (N = 352). A return rate of 37% was achieved. ANALYSIS Data were analyzed using descriptive statistics and qualitative analytic methods. RESULTS Responses from 130 physicians revealed an expectation that dietitians working in prenatal care must have expertise in prenatal nutrition and skillfully work with patients to achieve compliance with individualized care plans. To be judged excellent, physicians indicated that nutrition care would have to produce desired outcomes in patients. Good communication, documentation, and availability of the dietitian were also important. Financial issues were not of great concern to the respondents. APPLICATION The findings from this study help pinpoint opportunities for dietitians to develop and strengthen relationships with physician-customers for the provision of quality nutrition service in prenatal care. Important characteristics of quality nutrition service include timely and effective counseling followed by conscientious documentation and feedback to physician.
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Affiliation(s)
- P L Splett
- School of Public Health, Division of Epidemiology, University of Minnesota, Minneapolis 55454-1015
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31
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Glanz K, Patterson RE, Kristal AR, DiClemente CC, Heimendinger J, Linnan L, McLerran DF. Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake. HEALTH EDUCATION QUARTERLY 1994; 21:499-519. [PMID: 7843980 DOI: 10.1177/109019819402100412] [Citation(s) in RCA: 195] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.
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Affiliation(s)
- K Glanz
- Cancer Research Center, University of Hawaii, Honolulu 96813
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32
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Schlundt DG, Rea MR, Kline SS, Pichert JW. Situational obstacles to dietary adherence for adults with diabetes. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1994; 94:874-6, 879; quiz 877-8. [PMID: 8046181 DOI: 10.1016/0002-8223(94)92367-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To develop a taxonomy of everyday situations that create obstacles for adherence to dietary management in patients with diabetes. SUBJECTS Twenty-six adults with diabetes (12 with insulin-dependent diabetes mellitus and 14 with non-insulin-dependent diabetes mellitus) were recruited from an outpatient diabetes clinic. MAIN OUTCOME MEASURES Subjects were interviewed to identify problem situations that create obstacles for dietary adherence. The resulting 69 situations were judged for the presence or absence of 32 environmental features using a reliable coding system. STATISTICAL ANALYSIS A hierarchical cluster analysis was used to identify homogeneous groups of dietary adherence obstacles. RESULTS Twelve types of problem situations were identified: negative emotions, resisting temptation, eating out, feeling deprived, time pressure, tempted to relapse, planning, competing priorities, social events, family support, food refusal, and friends' support. CONCLUSIONS The resulting taxonomy provides an outline for the detailed assessment of obstacles to dietary adherence. An individual's ability to cope with this array of obstacles to dietary adherence should be assessed so treatment can be individualized.
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Affiliation(s)
- D G Schlundt
- Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN 37212
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33
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Schlundt DG, Pichert JW, Rea MR, Puryear W, Penha ML, Kline SS. Situational obstacles to adherence for adolescents with diabetes. DIABETES EDUCATOR 1994; 20:207-11. [PMID: 7851234 DOI: 10.1177/014572179402000305] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty adolescents with insulin-dependent diabetes mellitus were interviewed to obtain samples of problem situations that create obstacles to dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 stimulus features. A hierarchical cluster analysis was used to identify 10 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbidden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when home, alone, or bored; and social pressure to eat. Diabetes educators should consider an individual's ability to cope with this array of obstacles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.
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34
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35
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Affiliation(s)
- M Toeller
- Heinrich-Heine University, Clinical Department, Düsseldorf, Germany
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36
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Janas B, Bisogni C, Campbell C. Conceptual model for dietary change to lower serum cholesterol. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/s0022-3182(12)81113-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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37
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Underbakke G, Plane MB, McBride PE. A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1993; 93:301-4. [PMID: 8440828 DOI: 10.1016/0002-8223(93)91555-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as "high risk"; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.
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Affiliation(s)
- G Underbakke
- Department of Family Medicine and Practice, University of Wisconsin Medical School, Madison 53715-1849
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38
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Rimer BK. Participant enrollment, participation, and compliance in chemoprevention trials. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1992; 320:111-7. [PMID: 1442275 DOI: 10.1007/978-1-4615-3468-6_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chemoprevention trials offer exciting opportunities for decreasing the risk for cancer. Close attention to the recruitment, enrollment, and compliance of participants will aid greatly in both the cooperation of participants and the long-term adherence that are essential for the success of these trials.
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Affiliation(s)
- B K Rimer
- Fox Chase Cancer Center, Cheltenham, Pennsylvania
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39
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Abstract
This paper discusses the contributions of public health to compliance in five areas: clinical trials, smoking cessation, dietary compliance, breast cancer screening and hypertension control. Public health programs have been based on a number of theoretical foundations, most notably, social learning theory and the health belief model. Social marketing, community organization, and, more recently, consumer information processing models also are important. The strongest public health programs embody an ecological approach, with interventions directed not only at individuals, but also at groups, communities and changing institutional norms. Among the most important contributions of public health interventions are: multiple levels of intervention and evaluation, tailoring to target audiences, use of social support and community organization for behavior change. Together, community health and clinical compliance-enhancing strategies can exert a synergistic impact on health behavior change.
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Affiliation(s)
- B K Rimer
- Duke Comprehensive Cancer Center, Duke Univ. Medical Center, Durham, NC 27710
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40
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Carleton RA, Dwyer J, Finberg L, Flora J, Goodman DS, Grundy SM, Havas S, Hunter GT, Kritchevsky D, Lauer RM. Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction. A statement from the National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health. Circulation 1991; 83:2154-232. [PMID: 2040066 DOI: 10.1161/01.cir.83.6.2154] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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42
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Wilson A, Leeder S, Isacsson SO. Health education, health promotion or drugs? Cholesterol and coronary heart disease. Med J Aust 1990; 152:561-3. [PMID: 2190073 DOI: 10.5694/j.1326-5377.1990.tb125381.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Wilson
- Department of Community Medicine, Westmead Hospital, NSW
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43
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Albright CL, Flora JA, Fortmann SP. Restaurant menu labeling: impact of nutrition information on entree sales and patron attitudes. HEALTH EDUCATION QUARTERLY 1990; 17:157-67. [PMID: 2347693 DOI: 10.1177/109019819001700203] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study examined changes in sales of low fat/low cholesterol foods targeted in a restaurant menu labeling program. Sales of labeled items were tracked before and after the program was introduced, and a subsample of patrons were surveyed for information on visibility and comprehension of the menu labels. Two of the four restaurants had significant increases in the sales of targeted foods following labeling. Comparisons between patrons dining in restaurants which had an increase in sales (I--increase restaurants) to those dining in restaurants which had no overall shift in sales (NI--no increase restaurants) revealed no differences in patron awareness or comprehension of the menu labels. There were age and gender differences between I and NI restaurants, with I restaurants having proportionally more males, and a younger clientele. Taste was the primary reason given by patrons for their entree choice, regardless of whether or not it was labeled. In all four restaurants women and older patrons were more aware of the program and more responsive to its recommendations. These findings suggest that environmental strategies may be an effective method of encouraging dietary changes in the general population, but patron characteristics such as age and gender may influence receptivity to this type of intervention. Future studies aimed at developing effective point of purchase education programs should evaluate these patron characteristics and include more powerful behavior change strategies.
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44
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Food group contributions to nutrient intake in whites, blacks, and Mexican Americans in Texas. ACTA ACUST UNITED AC 1989. [DOI: 10.1016/s0002-8223(21)02311-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lewis JC, Taylor RG. Effects of varying dietary fatty acid ratios on plasma lipids and platelet function in the African green monkey. Atherosclerosis 1989; 77:167-74. [PMID: 2751748 DOI: 10.1016/0021-9150(89)90078-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The influence of varying dietary fatty acid ratios on plasma lipids, platelet function and the potential for thrombosis was evaluated in the African green monkey (Cercopithecus aethiops), an animal model widely used in cardiovascular research. Ten adult animals, 5 males and 5 females, at intervals of 2 months, were fed a series of 7 diets with fatty acid ratios (P:S) ranging from 3:1 to 1:4. Platelet aggregation in vitro, plasma levels of beta-thromboglobulin and platelet factor 4, platelet membrane fatty acid composition and plasma lipids including total cholesterol, HDL and LDL were monitored at the end of each dietary period. Platelet hypersensitivity to ADP aggregation (3 and 10 microM) and plasma beta-thromboglobulin were elevated in both males and females when dietary P:S exceeded 1.5:1 (beta-TG = 45 ng/ml) as compared to control diets either reflecting current North American or that recommended as a desirable dietary goal (P:S = 1:1, beta-TG = 10 ng/ml). Diets enriched in saturated fatty acids (P:S = 1:2) also altered platelet function, but the effects were most consistently observed in female animals (beta-TG = 32 ng/ml). Platelet hypersensitivity was lost and beta-TG levels were at baseline when the animals were returned to the control diets. Platelet sensitivity did not correlate with membrane composition which generally reflected dietary composition. Both the saturated and the polyunsaturated fatty acid enriched diets lowered plasma HDL levels, and the saturated fatty acid diets elevated plasma LDL.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J C Lewis
- Department of Pathology, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, NC 27103
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46
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Glanz K, Mullis RM. Environmental interventions to promote healthy eating: a review of models, programs, and evidence. HEALTH EDUCATION QUARTERLY 1988; 15:395-415. [PMID: 3068206 DOI: 10.1177/109019818801500403] [Citation(s) in RCA: 128] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Environmental interventions are an important part of efforts to improve health in populations. With respect to strategies to encourage positive nutrition behavior, environmental approaches help create opportunities for action by removing barriers to following a healthy diet. This article reviews the rationale, conceptual models, program examples, and recent empirical evidence regarding the extent and effects of environmental interventions to promote healthy eating. The state of the art is described for five types of interventions: (1) changes in the food supply; (2) point of choice nutrition information; (3) collaboration with private sector food vendors; (4) worksite nutrition policies and incentives; and (5) changes in the structure of health and medical care related to nutrition. Environmental approaches to dietary behavior change can reach large segments of the population through increased availability of nutritious foods, provision of quality nutrition services in workplace and health care settings, and accessible information about healthful food choices. Nutrition intervention can also serve as a model for other types of health promotion initiatives using multidimensional environmental and educational technologies.
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Affiliation(s)
- K Glanz
- Department of Health Education, Temple University, Philadelphia, PA 19122
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47
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Glanz K. Patient and public education for cholesterol reduction: a review of strategies and issues. PATIENT EDUCATION AND COUNSELING 1988; 12:235-257. [PMID: 10303037 DOI: 10.1016/0738-3991(88)90007-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Elevated blood cholesterol is a major risk factor for coronary heart disease and a significant public health problem, affecting as many as 50% of all adults in the U.S. Public, professional and patient education are central to current widespread efforts to increase awareness and effective management of high cholesterol. Screening/case-finding, follow-up and nutrition education are the most widely applicable strategies for cholesterol reduction. The following topics are reviewed: current guidelines for treatment of elevated cholesterol levels; trends in awareness, attitudes and practices of the public and health professionals; reports of interventions for cholesterol reduction; and health policy issues and research needs related to cholesterol education. This review suggests that several major challenges lie ahead for widespread and effective educational management of high cholesterol levels. These include development of practical screening and education systems, establishment of feasible financing arrangements, effective communication of complex information to patients, and techniques for long-term maintenance of reductions in cholesterol levels.
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48
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Fridlund B, Falk B, Ladeborn B, Landin K, Larsson PA. The Northern Halland Project: the effect of a caring rehabilitation programme on diet habits, blood lipids and body weight after myocardial infarction. Scand J Caring Sci 1988; 2:185-6. [PMID: 3241909 DOI: 10.1111/j.1471-6712.1988.tb00040.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bernard B, Dominique H, Martin R, Fabrizio B, Felix G. [Body weight, food habits and physical activity in the Swiss population: the project MONICA]. SOZIAL- UND PRAVENTIVMEDIZIN 1987; 32:78-86. [PMID: 3591002 DOI: 10.1007/bf02083854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Within the framework of the first risk factor survey among the two reporting units of MONICA-Switzerland (cantons of Vaud and Fribourg; canton of Tessin), body mass index (BMI) was also analysed. One in four adults (25-74 years) presents with overweight, this proportion being even 1 in 3 among males of the canton of Tessin. However, this health risk can probably be changed, as every third female and every fifth male indicated to have modified their nutritional habits in a more healthy sense within the last 12 months preceeding the survey. On the other side, less than half of the population engages in a degree of physical activity conducive to cardiovascular prevention and reduction of overweight. In order to increase the level of physical activity in the population, it is primarily leisure time sports activities that have to be developed as only very few adults experience a heavy physical work load within their profession.
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