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Chappell E, Chan E, Deen C, Brimblecombe J, Cadet-James Y, Hefler M, Stubbs E, Ferguson M. Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia. BMC Public Health 2024; 24:785. [PMID: 38481178 PMCID: PMC10935805 DOI: 10.1186/s12889-024-18200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.
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Affiliation(s)
- Emma Chappell
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, 0811, Australia.
| | - Ellie Chan
- Central Australian Aboriginal Congress, Alice Springs, NT, 0871, Australia
| | - Caroline Deen
- Apunipima Cape York Health Council, Bungalow, QLD, 4870, Australia
| | - Julie Brimblecombe
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, 0811, Australia
- Department of Nutrition, Dietetics and Food , Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Yvonne Cadet-James
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- Apunipima Cape York Health Council, Bungalow, QLD, 4870, Australia
- Indigenous Education and Research Centre, James Cook University, Bungalow, QLD, 4870, Australia
| | - Marita Hefler
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, 0811, Australia
| | - Emma Stubbs
- Central Australian Aboriginal Congress, Alice Springs, NT, 0871, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, 0811, Australia
- Department of Nutrition, Dietetics and Food , Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
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Lee AJ, Herron LM, Rainow S, Wells L, Kenny I, Kenny L, Wells I, Kavanagh M, Bryce S, Balmer L. Improving economic access to healthy diets in first nations communities in high-income, colonised countries: a systematic scoping review. Nutr J 2024; 23:10. [PMID: 38225569 PMCID: PMC10790425 DOI: 10.1186/s12937-023-00895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Affordability of healthy food is a key determinant of the diet-related health of First Nations Peoples. This systematic scoping review was commissioned by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC) in Central Australia to identify interventions to improve economic access to healthy food in First Nations communities in selected high-income, colonised countries. METHODS Eight databases and 22 websites were searched to identify studies of interventions and policies to improve economic access to healthy food in First Nations communities in Australia, Canada, the United States or New Zealand from 1996 to May 2022. Data from full text of articles meeting inclusion criteria were extracted to a spreadsheet. Results were collated by descriptive synthesis. Findings were examined with members of the NPYWC Anangu research team at a co-design workshop. RESULTS Thirty-five publications met criteria for inclusion, mostly set in Australia (37%) or the US (31%). Interventions (n = 21) were broadly categorised as price discounts on healthy food sold in communities (n = 7); direct subsidies to retail stores, suppliers and producers (n = 2); free healthy food and/or food vouchers provided to community members (n = 7); increased financial support to community members (n = 1); and other government strategies (n = 4). Promising initiatives were: providing a box of food and vouchers for fresh produce; prescriptions for fresh produce; provision/promotion of subsidised healthy meals and snacks in community stores; direct funds transfer for food for children; offering discounted healthy foods from a mobile van; and programs increasing access to traditional foods. Providing subsidies directly to retail stores, suppliers and producers was least effective. Identified enablers of effective programs included community co-design and empowerment; optimal promotion of the program; and targeting a wide range of healthy foods, particularly traditional foods where possible. Common barriers in the least successful programs included inadequate study duration; inadequate subsidies; lack of supporting resources and infrastructure for cooking, food preparation and storage; and imposition of the program on communities. CONCLUSIONS The review identified 21 initiatives aimed at increasing affordability of healthy foods in First Nations communities, of which six were deemed promising. Five reflected the voices and experiences of members of the NPYWC Anangu research team and will be considered by communities for trial in Central Australia. Findings also highlight potential approaches to improve economic access to healthy foods in First Nations communities in other high-income colonised countries. TRIAL REGISTRATION PROSPERO CRD42022328326.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia.
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia
| | - Stephan Rainow
- Nganampa Health Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Lisa Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Ingrid Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Leon Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Imogen Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Margaret Kavanagh
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Suzanne Bryce
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Liza Balmer
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Gordillo P, Prescott MP. Assessing the Use of Social Cognitive Theory Components in Cooking and Food Skills Interventions. Nutrients 2023; 15:1287. [PMID: 36904285 PMCID: PMC10005450 DOI: 10.3390/nu15051287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Increased cooking skill development may reduce the risk of disease and promote healthy eating behaviors in the home. The social cognitive theory (SCT) is one of the most common theories used in cooking and food skill interventions. This narrative review aims to understand how commonly each SCT component is implemented in cooking interventions, as well as identifying which components are associated with positive outcomes. The literature review was conducted using three databases: PubMed, Web of Science (FSTA and CAB), and CINHAL, yielding thirteen included research articles. None of the studies in this review comprehensively included all SCT components; at most, five of the seven were defined. The most prevalent SCT components were behavioral capability, self-efficacy, and observational learning, and the least implemented component was expectations. All studies included in this review yielded positive outcomes for cooking self-efficacy and frequency, except for two studies with null outcomes. Findings from this review suggest that the SCT may not be fully realized, and future studies should continue to define how theory influences intervention design for adult cooking interventions.
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Affiliation(s)
| | - Melissa Pflugh Prescott
- Department of Food Science and Human Nutrition, University of Illinois Urbana Champaign, Urbana, IL 61801, USA
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Booth S, Deen C, Thompson K, Kleve S, Chan E, McCarthy L, Kraft E, Fredericks B, Brimblecombe J, Ferguson M. Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities. Soc Sci Med 2023; 320:115726. [PMID: 36753996 DOI: 10.1016/j.socscimed.2023.115726] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/14/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.
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Affiliation(s)
- Sue Booth
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; College of Medicine & Public Health, Flinders University, Australia.
| | - Caroline Deen
- Apunipima Cape York Health Council, Bungalow, Queensland, 870, Australia
| | - Kani Thompson
- Apunipima Cape York Health Council, Bungalow, Queensland, 870, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia
| | - Ellie Chan
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, 0870, Australia
| | - Leisa McCarthy
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
| | - Emma Kraft
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, 0870, Australia
| | - Bronwyn Fredericks
- Office of the Pro-Vice Chancellor (Indigenous Engagement), The University of Queensland Brisbane, Queensland, 4072, Australia
| | - Julie Brimblecombe
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia; Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia; Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, 3168, Australia; Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, 0810, Australia
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6
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McGuffog R, Bryant J, Booth K, Collis F, Brown A, Hughes JT, Chamberlain C, McGhie A, Hobden B, Kennedy M. Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3993. [PMID: 36901001 PMCID: PMC10001772 DOI: 10.3390/ijerph20053993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Romany McGuffog
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Felicity Collis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Brown
- Indigenous Genomics, Australia National University, Canberra, ACT 2601, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jaquelyne T. Hughes
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT 0810, Australia
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexandra McGhie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
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Ferguson M, Tonkin E, Brimblecombe J, Lee A, Fredericks B, Cullerton K, Mah CL, Brown C, McMahon E, Chatfield MD, Miles E, Cadet-James Y. Communities Setting the Direction for Their Right to Nutritious, Affordable Food: Co-Design of the Remote Food Security Project in Australian Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2936. [PMID: 36833632 PMCID: PMC9957436 DOI: 10.3390/ijerph20042936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food security research project in remote Australia and examine how the co-design process considered Indigenous peoples' ways of knowing, being, and doing using the CREATE Tool. Informed by the Research for Impact Tool, together Aboriginal Community Controlled Health Organisation staff, Indigenous and non-Indigenous public health researchers designed the project from 2018-2019, over a series of workshops and through the establishment of research advisory groups. The resulting Remote Food Security Project includes two phases. Phase 1 determines the impact of a healthy food price discount strategy on the diet quality of women and children, and the experience of food (in)security in remote communities in Australia. In Phase 2, community members propose solutions to improve food security and develop a translation plan. Examination with the CREATE Tool showed that employing a co-design process guided by a best practice tool has resulted in a research design that responds to calls for food security in remote Indigenous communities in Australia. The design takes a strengths-based approach consistent with a human rights, social justice, and broader empowerment agenda. Trial registration: The trial included in Phase 1 of this project has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808.
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Affiliation(s)
- Megan Ferguson
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Emma Tonkin
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Julie Brimblecombe
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Amanda Lee
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Bronwyn Fredericks
- Office of the Pro-Vice Chancellor (Indigenous Engagement), The University of Queensland, St. Lucia, QLD 4006, Australia
| | - Katherine Cullerton
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Catherine L. Mah
- School of Health Administration, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Clare Brown
- Apunipima Cape York Health Council, Bungalow, QLD 4870, Australia
| | - Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Mark D. Chatfield
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Eddie Miles
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
| | - Yvonne Cadet-James
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Apunipima Cape York Health Council, Bungalow, QLD 4870, Australia
- Indigenous Education and Research Centre, James Cook University, Bungalow, QLD 4870, Australia
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A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159314. [PMID: 35954672 PMCID: PMC9367833 DOI: 10.3390/ijerph19159314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023]
Abstract
Purpose: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. Study design: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010–2020. Results: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. Conclusions: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.
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Kulshreshtha K, Sharma G. From restaurant to cloud kitchen: Survival of the fittest during COVID-19 An empirical examination. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2022; 179:121629. [PMID: 35317191 PMCID: PMC8930395 DOI: 10.1016/j.techfore.2022.121629] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/21/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
The restaurant industry is experiencing a financial crisis at the moment of COVID-19. The purpose of this paper is to explore and examine the impact of various factors responsible for purchase decisions for generation Z in the context of cloud kitchen. In this endeviour, the researchers used a self-reported survey questionnaire to collect the data. The quality responses were collected using convenience sampling and analysed using SmartPLS. As almost all businesses are hit badly due to the COVID-19 pandemic this paper explored the possibilities for the restaurant business i.e. food and beverage industry in the form of 'cloud kitchen'. In this endeavour, the impact of green aspects, memorable food experience (experiential food under experience economy) along with certain other factors was examined. This study extends the food choice process model by Furst et al. (1996) that in the recent time green aspect, memorable experience are being preferred by consumers. Moreover, the restaurant may choose to work as 'cloud kitchen until the situation (COVID-19) normalizes. The research work will contribute to new theoretical knowledge in the form of an extended food choice process model exploring generation Z purchase decision towards cloud kitchen.
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Affiliation(s)
| | - Gunjan Sharma
- Institute of Business Management, GLA University, Mathura, 281406, India
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George C, Bancroft C, Salt S, Curley C, Curley C, Eddie R, Edison T, de Heer H, Sanderson PR, Yazzie D, Antone-Nez R, Shin S. Successful implementation of the Healthy Diné Nation Act in stores on the Navajo Nation. Prev Med Rep 2021; 24:101573. [PMID: 34976637 PMCID: PMC8683936 DOI: 10.1016/j.pmedr.2021.101573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
In 2014, the Navajo Nation Council passed the Healthy Diné Nation Act (HDNA), a 2% tax on unhealthy foods and beverages and a waiver of the 5% sales tax on healthy foods and water, to support health promotion and disease prevention among the Navajo people. Very little research has assessed implementation accuracy of food or beverage taxes and none were implemented within a sovereign Tribal nation. This study assessed the accuracy of HDNA tax implementation among 47 stores located on the Navajo Nation. A pair of tax-exempt items [e.g. a bottle of water and fresh fruit] and a pair of HDNA-tax eligible items [e.g. sugary beverage and candy bar] were purchased between July-December 2019. Receipts were retained to assess taxation. A total of 87.2% of stores accurately implemented the 2% tax on unhealthy items while 55.3% of the stores accurately implemented the 6% tax waiver on healthy items. In all, 51.1% of the stores accurately applied both taxes. There were no significant differences across store type (convenience or grocery stores and trading posts) or geographic region. In conclusion, almost all stores on the Navajo Nation accurately applied a 2% tax on unhealthy foods and beverages, while the proportion of stores applying a waiver on healthy foods was lower. Successful HDNA tax implementation among stores remains an important priority in achieving the goal to support health promotion and disease prevention among Navajo communities.
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Affiliation(s)
- Carmen George
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Carolyn Bancroft
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Shine Salt
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Caleigh Curley
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Cameron Curley
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Regina Eddie
- Northern Arizona University, College of Health and Human Services, School of Nursing, Flagstaff, AZ, United States
| | - Tierra Edison
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Hendrik de Heer
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Priscilla R Sanderson
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Del Yazzie
- Navajo Nation, Navajo Department of Health, Navajo Epidemiology Center, Window Rock, AZ, United States
| | - Ramona Antone-Nez
- Navajo Nation, Navajo Department of Health, Navajo Epidemiology Center, Window Rock, AZ, United States
| | - Sonya Shin
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
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Blekkenhorst LC, Ride K, Wallace R, Eades S, McAullay D, Godrich SL. Healthy lifestyle initiatives for increasing fruit and vegetable intake among Aboriginal and Torres Strait Islander peoples: a rapid review. Appl Physiol Nutr Metab 2021; 47:115-123. [PMID: 34797739 DOI: 10.1139/apnm-2021-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adequate fruit and vegetable intake is key to reducing chronic disease risk among Australian Aboriginal and Torres Strait Islander peoples. This rapid review collated evidence on healthy lifestyle initiatives that focused on increasing fruit and vegetable intake among Australian Aboriginal and Torres Strait Islander peoples residing in major cities. Due to limited studies conducted within major cities, we extended our inclusion criteria to regional and remote areas. Sixteen studies were included. Five (31%) studies were rated as good quality (least risk of bias), ten (63%) were rated as fair, and one (6%) was rated as poor (significant risk of bias). Five (31%) studies employed participatory research in the design and/or execution, and seven (44%) studies included minimal community involvement. Only five (31%) studies were undertaken in major cities; four of these combined major cities with regional and/or remote areas. All five studies reported positive findings, such as an increase in fresh fruit availability, usage of fresh vegetables, or self-reported fruit and vegetable intake. This review provides evidence confirming the need for high-quality healthy lifestyle initiatives to increase fruit and vegetable intake targeted at Aboriginal and Torres Strait Islander peoples living in major cities. This evidence will assist community organisations in designing effective health promotion interventions, providing insight into improving the structure and function of such programs. PROSPERO registration number: CRD42020194522 Novelty • Five studies were undertaken in major cities and all reported positive findings; only one study was rated as good quality. • Presented data supports the need for high-quality studies to be conducted among those residing in major cities.
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Affiliation(s)
- Lauren C Blekkenhorst
- Edith Cowan University, 2498, Institute for Nutrition Research, Joondalup, Western Australia, Australia.,The University of Western Australia, 2720, Medical School, Perth, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia;
| | - Katherine Ride
- Edith Cowan University, 2498, School of Medical and Health Sciences, Joondalup, Australia;
| | - Ruth Wallace
- Edith Cowan University, 2498, School of Medical and Health Sciences, Joondalup, Australia;
| | - Sandra Eades
- Curtin University, 1649, Medical School , Perth, Australia;
| | - Daniel McAullay
- Edith Cowan University, 2498, Kurongkurl Katitjin, Mount Lawley, Australia;
| | - Stephanie L Godrich
- Edith Cowan University, 2498, School of Medical and Health Sciences, Bunbury, Western Australia, Australia;
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12
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McKay FH, Godrich SL. Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: a rapid review. Appl Physiol Nutr Metab 2021; 46:1448-1458. [PMID: 34637657 DOI: 10.1139/apnm-2020-1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from 6 databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. Twenty-five publications were included in this review, 24 reported on an intervention, while 9 were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty: Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. Small-scale food security interventions may not provide ongoing and sustained impact. Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne Burwood Campus, Burwood, VIC 3125, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Edith Cowan University, South West Campus, Bunbury, WA 6230, Australia
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13
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Knudsen L, Lyons JG, O’Dea K, Christensen DL, Brimblecombe JK. Antioxidant biomarkers and cardiometabolic risk markers in an Aboriginal community in remote Australia: a cross-sectional study. Public Health Nutr 2021; 24:4937-4948. [PMID: 33261694 PMCID: PMC11082824 DOI: 10.1017/s1368980020004899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/11/2020] [Accepted: 11/26/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High-quality diets, characterised by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardiometabolic diseases. The current study explores relationships between plasma antioxidants and cardiometabolic risk among Aboriginal people in Australia. DESIGN As part of a community-driven health promotion programme, we conducted a cross-sectional study including a health-behaviour questionnaire, plasma antioxidants and cardiometabolic risk markers (anthropometric, blood pressure measurements, fasting glucose, glycated Hb (HbA1c), lipids, C-reactive protein and albumin-creatinine-ratio) continuous and categorised into population-specific cut-offs. Antioxidants (β-carotene, β-cryptoxanthin, lycopene, lutein-zeaxanthin, retinol and α-tocopherol measured using HPLC) were applied to a principal component analysis, which aggregated these into a single component. Linear regression models were applied to investigate associations between the antioxidant component and cardiometabolic risk markers. SETTING Community in a remote area in Northern Territory, Australia. PARTICIPANTS A total of 324 Aboriginal people, mean age 35·5 (range 15-75) years. RESULTS Antioxidant component levels were higher among individuals with higher self-reported vegetable intake (P < 0·01), higher among individuals with higher self-reported fruit intake (P = 0·05) and lower among current smokers (P = 0·06). Linear regression revealed an inverse association between the antioxidant component and C-reactive protein (β = -0·01, P < 0·01) after adjusting for confounders. CONCLUSION Higher plasma antioxidant levels, indicators of diet quality, were associated with lower levels of high-sensitivity C-reactive protein in this Aboriginal population in remote Australia. This association suggests plasma antioxidants may be protective against inflammation; however, longitudinal studies are needed to examine this potentially protective relationship.
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Affiliation(s)
- Lenette Knudsen
- Education Department, Steno Diabetes Center Copenhagen, 2820Gentofte, Denmark
| | - Jasmine G Lyons
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kerin O’Dea
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Julie K Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
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14
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Maugeri IP, Brimblecombe J, Choi TST, Kleve S, Palermo C. For whom and under what circumstances do nutrition-education cooking interventions work: a realist synthesis. Nutr Rev 2021; 79:479-493. [PMID: 32443146 DOI: 10.1093/nutrit/nuaa021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore for whom and under what circumstances nutrition-education cooking interventions affect nutrition outcomes in adults. METHODS A realist synthesis was undertaken. The CINAHL, Ovid Medline, Scopus, and Web of Science databases were searched for literature published between 1980 and 2019, using the terms "cook" and "intervention" and their synonyms; 5759 articles were identified. Grey literature was sourced for further additional program context. A total of 23 articles (n = 11 programs) met inclusion criteria for analysis. Program data were coded in duplicate for context, outcome, and mechanism configurations, and used to build a refined program theory. RESULTS Nutrition-education cooking interventions targeted at low-socioeconomic-status and marginalized populations produced a range of positive nutrition outcomes. Outcomes were observed when the program involved hands-on cooking and a skilled facilitator coupled with individual self-efficacy, knowledge gain, family support, and an expectation of positive health outcomes. CONCLUSION These findings highlight key program components to achieve improvements in nutrition and important recommendations for nutrition-education cooking interventions.
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Affiliation(s)
- Isabella P Maugeri
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.,Honorary Fellow of the Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tammie S T Choi
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
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15
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Nash S, Arora A. Interventions to improve health literacy among Aboriginal and Torres Strait Islander Peoples: a systematic review. BMC Public Health 2021; 21:248. [PMID: 33516186 PMCID: PMC7847024 DOI: 10.1186/s12889-021-10278-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander peoples continue to experience poorer health outcomes than other population groups. While data specific to Indigenous Australians are scarce, a known social health literacy gradient exists linking low health literacy and poor health outcomes within many minority populations. Improving health literacy among Indigenous Australians is an important way to support self-determination and autonomy in both individuals and communities, by enhancing knowledge and improving health outcomes. This review aims to rigorously examine the effectiveness of health literacy interventions targeting Aboriginal and Torres Strait Islander peoples. Methods A systematic review across six databases (The Cochrane Library, PubMed, Embase, SCOPUS, ProQuest Dissertation and Thesis and Web of Science) was performed for publications evaluating interventions to improve health literacy among Indigenous Australian adults using search terms identifying a range of related outcomes. Results Of 824 articles retrieved, a total of five studies met the eligibility criteria and were included in this review. The included studies evaluated the implementation of workshops, structured exercise classes and the provision of discounted fruit and vegetables to improve nutrition, modify risk factors for chronic diseases, and improve oral health literacy. All interventions reported statistically significant improvement in at least one measured outcome. However, there was limited involvement of the Aboriginal and Torres Strait Islander community members in the research process and participant retention rates were sub-optimal. Conclusion There is limited evidence on interventions to improve health literacy in Indigenous Australian adults. Participation in interventions was often suboptimal and loss to follow-up was high. Future studies co-designed with Aboriginal and Torres Strait Islander community members are needed to improve health literacy in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10278-x.
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Affiliation(s)
- Simone Nash
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, Westmead, NSW, 2145, Australia. .,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, 2010, Australia.
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16
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Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Med J Aust 2021; 213 Suppl 11:S3-S32.e1. [PMID: 33314144 DOI: 10.5694/mja2.50881] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022]
Abstract
CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN Rapid review of articles published between January 2000 and May 2020. DATA SOURCES We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.
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Characterizing Dietary Intakes in Rural Australian Adults: A Systematic Literature Review. Nutrients 2020; 12:nu12113515. [PMID: 33203105 PMCID: PMC7697691 DOI: 10.3390/nu12113515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 01/14/2023] Open
Abstract
Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians. A systematic literature review aimed to synthesize the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention, and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes. Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available and a lack of consistency between dietary outcomes collected in research to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities.
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18
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Savage A, Bambrick H, Gallegos D. From garden to store: local perspectives of changing food and nutrition security in a Pacific Island country. Food Secur 2020. [DOI: 10.1007/s12571-020-01053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Tonkin E, Kennedy D, Hanieh S, Biggs BA, Kearns T, Gondarra V, Dhurrkay R, Brimblecombe J. Dietary intake of Aboriginal Australian children aged 6-36 months in a remote community: a cross-sectional study. Nutr J 2020; 19:34. [PMID: 32295575 PMCID: PMC7161145 DOI: 10.1186/s12937-020-00550-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 03/31/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Scarce literature comprehensively captures the transition to solid foods for children in remote Aboriginal Australian communities, a population expected to be especially vulnerable to nutritional inadequacy for largely socio-economic reasons. This study describes the dietary intake of children aged 6-36 months in a remote Aboriginal community during the years of solids introduction and establishment. Specifically, we aimed to explore milk feeding practices, major sources of nutrition and traditional food consumption, dietary patterns and nutrient and food group intakes, and compare these to national and international recommendations. METHODS This dietary assessment was conducted as part of an observational, cross-sectional Child Health and Nutrition study. Three 24-h dietary recalls were completed with the parent/care-giver of each participant over 2-4 weeks, capturing a pay-week, non-pay-week and weekend day from October 2017-February 2018. Additional information collected included sociodemographic data, food security status, usual cooking practices, and attendance at playgroup. RESULTS Diet histories for 40 children were included in the analysis (~ 40% of the population). Breast feeding rates were high (85%), with mothers exclusively feeding on demand. Very few participants met recommended intakes for wholegrains (n = 4, 10%), vegetables (n = 7, 18%), dairy (n = 5, 18%) and fruit (n = 13, 33%), while more children met the guidelines for meat (n = 19, 48%) and discretionary food intake (n = 28, 70%). Traditional foods were always nutritionally dense and consumed frequently (n = 22, 55% of children). Statistically significant pay-cycle differences in intakes of all macro-, and numerous micro-nutrients were observed. CONCLUSIONS Many positive early feeding practices are currently enacted in remote Aboriginal communities including responsive and long duration breastfeeding, and nutrient-dense traditional food consumption from earliest solids introduction. However, the non-pay-week/pay-week cycle is impacting the quality and quantity of children's diets at a time of rapid growth and development.
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Affiliation(s)
- Emma Tonkin
- Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, 3168, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5042, Australia.
| | - Dani Kennedy
- Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, 0810, Australia
| | - Sarah Hanieh
- Department of Medicine at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Beverley-Ann Biggs
- Department of Medicine at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Therese Kearns
- Child Health, Menzies School of Health Research, Spring Hill, Queensland, 4000, Australia
| | - Veronica Gondarra
- Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, 0810, Australia
| | - Roslyn Dhurrkay
- Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, 0810, Australia
| | - Julie Brimblecombe
- Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, 3168, Australia.,Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, 0810, Australia
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Alston L, Partridge SR. Limited dietary interventions in rural Australian communities: A systematic review. Nutr Diet 2020; 78:57-68. [PMID: 32160401 DOI: 10.1111/1747-0080.12612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 01/13/2023]
Abstract
AIM This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia. METHODS Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data. RESULTS In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia. CONCLUSION Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.
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Affiliation(s)
- Laura Alston
- The Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia.,Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia.,Research Department, Colac Area Health, Colac, Victoria, Australia
| | - Stephanie R Partridge
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sjöholm P, Pahkala K, Davison B, Juonala M, Singh G. Socioeconomic status, remoteness and tracking of nutritional status from childhood to adulthood in an Australian Aboriginal Birth Cohort: the ABC study. BMJ Open 2020; 10:e033631. [PMID: 31992605 PMCID: PMC7045147 DOI: 10.1136/bmjopen-2019-033631] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To determine prevalences of underweight and overweight as well as low and high waist-to-height ratio (WHtR) in three prospective follow-ups and to explore tracking of these measures of nutritional status from childhood to adolescence and adulthood. The influence of socioeconomic status, remoteness, maternal body mass index (BMI) and birth weight on weight status was assessed. DESIGN Longitudinal birth cohort study of Indigenous Australians. SETTING Data derived from three follow-ups of the Aboriginal Birth Cohort study with mean ages of 11.4, 18.2 and 25.4 years for the participants. PARTICIPANTS Of the 686 Indigenous babies recruited to the study between 1987 and 1990, 315 had anthropometric measurements for all three follow-ups and were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES BMI categories (underweight, normal weight, overweight and obesity),WHtR categories (low and high), sex, areal socioeconomic disadvantage as defined by the Indigenous Relative Socioeconomic Outcomes index, urban/remote residence, maternal BMI and birth weight. Logistic regression was used to calculate ORs for belonging to a certain BMI category in adolescence and adulthood according to BMI category in childhood and adolescence. RESULTS Underweight was common (38% in childhood and 24% in adulthood) and the prevalence of overweight/obesity increased with age (12% in childhood and 35% in adulthood). Both extremes of weight status as well as low and high WHtR tracked from childhood to adulthood. Underweight was more common and overweight was less common in remote and more disadvantaged areas. Birth weight and maternal BMI were associated with later weight status. There were significant sex differences for prevalences and tracking of WHtR but not for BMI. CONCLUSIONS Socioeconomic factors, remoteness and gender must be addressed when assessing nutrition-related issues in the Indigenous communities due to the variation in nutritional status and its behaviour over time within the Indigenous population.
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Affiliation(s)
- Pauline Sjöholm
- Department of Medicine, University of Turku, Turku, Finland
- Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Belinda Davison
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Gurmeet Singh
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
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22
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Wright KM, Dono J, Brownbill AL, Pearson Nee Gibson O, Bowden J, Wycherley TP, Keech W, O'Dea K, Roder D, Avery JC, Miller CL. Sugar-sweetened beverage (SSB) consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review. BMJ Open 2019; 9:e023630. [PMID: 30819702 PMCID: PMC6398687 DOI: 10.1136/bmjopen-2018-023630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN Systematic scoping review. RESULTS 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed.
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Affiliation(s)
- Kathleen M Wright
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Dono
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Odette Pearson Nee Gibson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Jacqueline Bowden
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas P Wycherley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Wendy Keech
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Health Translation SA, Adelaide, South Australia, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jodie C Avery
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Caroline L Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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23
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Magnus A, Cobiac L, Brimblecombe J, Chatfield M, Gunther A, Ferguson M, Moodie M. The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled in remote Australia to improve Indigenous health. PLoS One 2018; 13:e0204005. [PMID: 30260984 PMCID: PMC6160015 DOI: 10.1371/journal.pone.0204005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/01/2018] [Indexed: 11/21/2022] Open
Abstract
This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.
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Affiliation(s)
- Anne Magnus
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Linda Cobiac
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Mark Chatfield
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Anthony Gunther
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Megan Ferguson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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