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Moreira-Rosário A, Ismael S, Barreiros-Mota I, Morais J, Rodrigues C, Castela I, Mendes IC, Soares MI, da Costa LS, Oliveira CB, Henriques T, Pinto P, Pita D, de Oliveira CM, Maciel J, Serafim T, Araújo J, Rocha JC, Pestana D, Silvestre MP, Marques C, Faria A, Polonia J, Calhau C. Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial. Front Public Health 2023; 11:1277355. [PMID: 38026295 PMCID: PMC10679749 DOI: 10.3389/fpubh.2023.1277355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.
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Affiliation(s)
- André Moreira-Rosário
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Shámila Ismael
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Barreiros-Mota
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Juliana Morais
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Catarina Rodrigues
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Castela
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | | | | | - Patrícia Pinto
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Débora Pita
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | | | - Janaína Maciel
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Thaina Serafim
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - João Araújo
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Diogo Pestana
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta P. Silvestre
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Marques
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Faria
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Polonia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Hypertension and Cardiovascular Risk Unit, Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
| | - Conceição Calhau
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
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van Lonkhuijzen RM, Rustenhoven H, de Vries JHM, Wagemakers A. The role of the partner in the support of a pregnant woman's healthy diet: an explorative qualitative study. BMC Pregnancy Childbirth 2023; 23:760. [PMID: 37898778 PMCID: PMC10612286 DOI: 10.1186/s12884-023-06072-9] [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: 04/19/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Active partner involvement during pregnancy is an effective strategy to enhance both maternal and newborn health outcomes. The presence of a supportive partner equips women with a heightened sense of empowerment to deal with the challenges of pregnancy, including maintaining a healthy diet during pregnancy, which is important for the health of both the mother and child. However, little information exists regarding the partner's role in encouraging a pregnant woman's healthy dietary choices. This study aimed to explore the perspectives of pregnant women and their partners concerning the partner's role in promoting a healthy dietary intake during pregnancy. METHODS Sixteen semi-structured couple interviews were conducted in the Netherlands, involving expecting couples. Based on Berkman's social networks and support theory, we categorized various forms of support as emotional, instrumental, appraisal, and informational. The interviews were accurately recorded, transcribed verbatim, and analysed using an inductive approach. RESULTS In general, pregnant women reported being positive regarding the support they received from their partners. Partners primarily offered instrumental support to pregnant women, such as cooking, grocery shopping, and helping them avoid unsafe foods. Partners provided informational support, mainly about foods considered unsafe during pregnancy. Emotional support was relatively less common. The primary motives for giving support were pregnancy-related symptoms, the importance of the health of the mother and baby, and solidarity with the pregnant woman. Support from the partner was more willingly accepted by pregnant women if the support was perceived as being helpful, showing involvement, and positive. Conversely, partner support was not accepted if it was perceived as judgmental or unwanted. CONCLUSIONS The majority of pregnant women were satisfied with the support received from their partners, although there are opportunities for a partner to provide more support to improve the dietary intake of pregnant women. To optimise this support, partners are advised to tailor their support to the needs and expectations of pregnant women. Personalizing dietary support can be achieved by couples communicating their dietary wishes and expectations regarding support.
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Affiliation(s)
- Renske M van Lonkhuijzen
- Department of Social Sciences, Health and Society, Wageningen University & Research, Hollandseweg 1, bode 60, Wageningen, 6706, KN, The Netherlands.
- Department of Agrotechnology and Food Sciences, Human Nutrition & Health, Wageningen University & Research, Stippeneng 4, bode 62, Wageningen, 6708, WE, The Netherlands.
| | | | - Jeanne H M de Vries
- Department of Agrotechnology and Food Sciences, Human Nutrition & Health, Wageningen University & Research, Stippeneng 4, bode 62, Wageningen, 6708, WE, The Netherlands
| | - Annemarie Wagemakers
- Department of Social Sciences, Health and Society, Wageningen University & Research, Hollandseweg 1, bode 60, Wageningen, 6706, KN, The Netherlands
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Babatunde GB, Schmidt B, Gwelo NB, Akintola O. Defining, conceptualising and operationalising community empowerment: a scoping review protocol. BMJ Open 2022; 12:e056152. [PMID: 35504643 PMCID: PMC9066482 DOI: 10.1136/bmjopen-2021-056152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Community empowerment is a core concept in health promotion theory and practice. Several authors have defined and conceptualised the term differently. However, we did not find any synthesis of the various definitions of, and meanings attached to, community empowerment and the various conceptualisations, operationalisations, and the indicators for measuring community empowerment in the health promotion literature. The aim of this scoping review is to characterise and synthesise various definitions, conceptualisations, operationalisations and indicators for measuring community empowerment in the literature. METHODS AND ANALYSIS This scoping review will follow scoping review methods outlined by Arksey and O'Malley. We will identify relevant studies from 1986 onwards, written in any language, conducted anywhere in the world, and published in PubMed, PsycINFO, CINAHL, Web of Science and Medline. Two reviewers will independently screen titles, abstracts and full-text articles, after which they will carry out data extraction and analysis. We will develop a numerical and narrative synthesis of the definitions, conceptualisations, operationalisations and measurements of community empowerment in relation to health promotion and/health outcomes. ETHICS AND DISSEMINATION This scoping review does not require ethics approval, as we will only include information from previously conducted studies and we will not involve human participants.
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Affiliation(s)
- Gbotemi Bukola Babatunde
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - B Schmidt
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Netsai Bianca Gwelo
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Olagoke Akintola
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA.
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van Lonkhuijzen RMR, Cremers SS, de Vries JHMJ, Feskens EJME, Wagemakers MAEA. Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality. BMC Public Health 2022; 22:148. [PMID: 35062921 PMCID: PMC8780817 DOI: 10.1186/s12889-022-12543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022] Open
Abstract
Background In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality. Methods/design This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women. Discussion This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase. Trial registration The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12543-z.
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Super S, Wagemakers A. Understanding empowerment for a healthy dietary intake during pregnancy. Int J Qual Stud Health Well-being 2021; 16:1857550. [PMID: 33317432 PMCID: PMC7738301 DOI: 10.1080/17482631.2020.1857550] [Citation(s) in RCA: 7] [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] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose: In order for health professionals to encourage pregnant women with a low socioeconomic status (SES) to move towards empowerment for a healthy dietary intake, crucial steps are to understand the perspectives of pregnant women of food and eating and to identify opportunities for empowerment. This study aimed to examine the perspectives of pregnant women on food and eating and to identify the opportunities for empowerment towards a healthy dietary intake. Methods: This was a qualitative participatory study. Thirteen semi-structured interviews were conducted with low SES pregnant women in the Netherlands and analysed using an inductive approach. Results: Five perspectives on food and eating emerged: 1) health-promoting foods and products, 2) challenges in healthy eating, 3) risky products, 4) strategies for healthy eating, and 5) motivational aspects. Opportunities for empowerment were: searching balanced and personalized information, developing strategies to implement healthy diets, navigating the social environment, and dealing with different motivations. Conclusion: Pregnant women hold diverse perspectives regarding food and eating, signalling the need to adjust dietary support from health-care professionals. Professionals in antenatal care could optimize their interactions by engaging in pregnant women's empowerment processes to make healthy modifications to their dietary intake.
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Affiliation(s)
- Sabina Super
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
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Riddle A, Ramage A, Kroeger CM, Bhutta ZA, Kristjansson E, Taljaard M, Vlassoff C, Wuehler S, Skidmore B, Bennett AL, Rizvi A, Welch V, Wells GA. PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of women of reproductive age in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1183. [PMID: 37051449 PMCID: PMC8988768 DOI: 10.1002/cl2.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The systematic review will answer the follow research questions: (1) What is the effectiveness of different empowerment approaches employed within nutrition interventions on the nutritional status of women of reproductive age in low- and middle-income countries? (2) What implementation and contextual factors contribute to or detract from the effectiveness of these interventions?
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Affiliation(s)
- Alison Riddle
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | | | - Cynthia M. Kroeger
- Charles Perkins Centre, Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyAustralia
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
| | | | | | - Carol Vlassoff
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | | | | | | | - Anita Rizvi
- School of PsychologyUniversity of OttawaOttawaCanada
| | - Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - George A. Wells
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
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Noori F, Behboodimoghadam Z, Haghani S, Pashaeypoor S. The Effect of an Empowerment Program on the Health-promoting Behaviors of Iranian Women Workers: A Randomized Controlled Trial. J Prev Med Public Health 2021; 54:275-283. [PMID: 34370941 PMCID: PMC8357542 DOI: 10.3961/jpmph.21.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives The workplace is an ideal place for encouraging health-promoting behaviors. Therefore, the aim of the present study was to determine the effect of an empowerment program on the health-promoting behaviors of women workers. Methods This randomized clinical trial was conducted with 80 women workers employed at a food packaging facility in 2020. The subjects were selected using convenience sampling and were classified into intervention and control groups using block randomization. An empowerment program for women workers was conducted across 6 sessions based on an empowerment model. Data collection tools included a demographic questionnaire and the Health Promoting Lifestyle Profile-II, which participants completed both before the program and 8 weeks after the last session. Data analysis was performed in SPSS version 16 using descriptive analysis and inferential statistics. Results There were no significant differences between the 2 groups in various health-promoting behaviors before the program. However, the intervention group’s scores for nutrition (34.92±1.09 vs. 27.87±4.23), physical activity (24.40±2.94 vs. 17.40±5.03), stress management (26.35±2.60 vs. 23.05±4.27), spiritual growth (34.02±3.00 vs. 30.22±5.40), interpersonal relationships (30.82±2.38 vs. 27.60±4.61), and health responsibility (31.60±2.71 vs. 28.22±4.59) were significantly higher than the control group’s 8 weeks after the program had ended. Moreover, there was a significant difference in the total score of health-promoting behaviors for the intervention group compared to the control group (179.00±9.22 vs. 151.42±20.25, p=0.001). Conclusions An empowerment program for women workers led to significant improvements in the health-promoting behaviors of the participants. Similar programs can ultimately improve women’s health in the workplace.
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Affiliation(s)
- Fatemeh Noori
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Behboodimoghadam
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Community-Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Tribst AAL, Tramontt CR, Baraldi LG. Factors associated with diet changes during the COVID-19 pandemic period in Brazilian adults: Time, skills, habits, feelings and beliefs. Appetite 2021; 163:105220. [PMID: 33785430 DOI: 10.1016/j.appet.2021.105220] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 12/11/2022]
Abstract
This study aimed to identify individual, household and sociodemographic factors associated with changes in food consumption that lead to changes in the diet quality, in the context of the COVID-19 pandemic concerning Brazilian adults. Improvements or worsening in diet quality (IDQ or WDQ) were verified using an exploratory online survey which investigated whether participants (n = 4780) increased or decreased their consumption of food subgroups that mark positive or negative food patterns. Respondents also agreed or disagreed with their beliefs about food safety, cooking skills, family support, home characterization, feelings and behaviors. All factors of influence on the IDQ or WDQ groups were always compared against the general participants (who did not change their diet sufficiently to be classified into these groups). Individuals from the IDQ group spent more time on food (81.4% versus 62.0%), started to cook more often (91.4%), were more confident with their cooking skills (p < 0.01) and positive feelings were at least 2.5 times more prevalent. Adjusted analysis showed the chance to improve diet was 1.39 higher among those who did not feel overworked and increased 1.07 in each additional cooking chore shared between household members. For each additional positive feeling, the odds were 1.41 to IDQ and 0.67 to WDQ. Moreover, for each additional negative feeling the chances for WDQ were 1.21 and 0.90 for IDQ. Those in the WDQ group were more unaware of issues related to contagion during meals, they were not afraid of eating food prepared outside their home and agreed that industrialized food is safer (OR = 1.85). These results highlight the associated factors in improving or worsening diet patterns as a consequence of the COVID-19 pandemic, supporting messages presented in Dietary Guidelines.
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Affiliation(s)
- Alline Artigiani Lima Tribst
- Center for Food Studies and Research at University of Campinas. R. Albert Einstein 291, Campinas, SP, 13083-852, Brazil.
| | - Cláudia Raulino Tramontt
- Center for Food Studies and Research at University of Campinas. R. Albert Einstein 291, Campinas, SP, 13083-852, Brazil.
| | - Larissa Galastri Baraldi
- Center for Food Studies and Research at University of Campinas. R. Albert Einstein 291, Campinas, SP, 13083-852, Brazil.
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Doustmohammadian A, Bazhan M. Social marketing-based interventions to promote healthy nutrition behaviors: a systematic review protocol. Syst Rev 2021; 10:75. [PMID: 33706797 PMCID: PMC7971101 DOI: 10.1186/s13643-021-01625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diet-related non-communicable diseases (NCDs) are rapidly increasing worldwide and constitute one of the leading causes of mortality and morbidity. Improving population diets can play an important role in preventing and managing the diseases. Effective and efficient interventions are needed to promote healthy eating behaviors among people. The objective of this review will be to evaluate the effectiveness of social marketing-based interventions to promote healthy nutrition behaviors. METHOD The following electronic databases will be searched from January 1990 onwards: PubMed/MEDLINE, EMBASE, Web of Science, and CENTRAL. We will include randomized and non-randomized trials, quasi-experimental studies, observational studies (e.g., cohort, cross-sectional, and before and after studies) evaluating the social marketing-based intervention. The primary outcomes will be nutritional behaviors. Secondary outcomes will include the quality of life, nutritional status, and weight status. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random-effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, sex, and socio-economic condition). DISCUSSION This study will summarize the evidence regarding the interventions' components, implementation methods, and effectiveness of interventions based on the social marketing framework to promote healthy nutrition behaviors. This review can provide policymakers with the information needed to make decisions and plan to promote healthy eating behaviors and understand the factors influencing the implementation of these programs. SYSTEMATIC REVIEW REGISTRATION CRD42020163972.
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Affiliation(s)
- Azam Doustmohammadian
- Gastrointestinal and liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Bazhan
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, #7, Arghavan St, Farahzadi Blvd, Shahrak Gharb, Tehran, Iran
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11
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Onwezen MC, Bouwman EP, van Trijp HCM. Participatory Methods in Food Behaviour Research: A Framework Showing Advantages and Disadvantages of Various Methods. Foods 2021; 10:foods10020470. [PMID: 33672610 PMCID: PMC7924025 DOI: 10.3390/foods10020470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
A trend is visible in the food literature showing an increasing number of publications on studies that incorporate some form of participant engagement, such as citizen science and community-based participatory research. This "participation trend" will inevitably affect the scientific field of food behaviour research. This new trend is however not only associated with advantages, and a critical reflection on both the advantages and disadvantages is needed. The current article is a position paper that contributes to the literature in two main ways. First, participation is still in the developmental stage. Many different forms, methods and definitions are used. By providing a structured overview of a variety of participatory methods derived from a focused search of the literature on food behaviour, we aim to clarify the relationships between the various forms of participation methods. Second, the involvement of citizens in research is increasingly calling for novel research methods (e.g., voluntary recruitment and active involvement), which may be accompanied by both advantages and disadvantages. We add to the literature by developing a framework that indicates the advantages and disadvantages of participatory methods in food behaviour research. Our study highlights the relevance of differentiating the goal of the researcher (efficiency versus engagement) and the role of citizens (collecting versus creating), thus implying a trade-off between cost-effectiveness and involvement, as well as between data richness and data quality. Our work is a first effort to create structure and guidance within a new area. Our efforts could be used in future research aimed at developing more extensive protocols and tools for the application of participation in research, thereby offering a controlled manner to ensure that research stays abreast of our changing society.
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Affiliation(s)
- Marleen C. Onwezen
- Wageningen Economic Research, Wageningen University and Research, 2595 BM The Hague, The Netherlands;
- Correspondence: ; Tel.: +31-703358175
| | - Emily P. Bouwman
- Wageningen Economic Research, Wageningen University and Research, 2595 BM The Hague, The Netherlands;
| | - Hans C. M. van Trijp
- Marketing and Consumer Behaviour Group, Wageningen University and Research, 6708 PB Wageningen, The Netherlands;
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12
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Borges Rodrigues S, Parisod H, Barros L, Salanterä S. Two sides of the same well-child visit: Analysis of nurses' and families' perspectives on empowerment in health counselling. J Adv Nurs 2020; 76:3448-3463. [PMID: 32996623 DOI: 10.1111/jan.14554] [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: 03/05/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS To explore the degree of empowering health counselling in well-child visits, considering nurse and family perspectives and to examine its associated factors. BACKGROUND Empowerment has gained high priority in the world health strategy, being claimed for its benefits for people's health and well-being. DESIGN The design includes an exploratory cross-sectional, correlational study. METHODS We collected data between January 2018-October 2019 from a convenience sample of 82 families attending a 5-year-old well-child visit and 25 nurses at Portuguese health centres. Families and nurses assessed the same counselling session using parallel statements of the Portuguese Empowering Speech Practice Scale, grouped in two subscales (nurses' action and families' action). Questionnaires also included the Parent's Longitudinal Continuity in Primary Care scale, the Family Nutrition and Physical Activity tool and anthropometric and sociodemographic questions. We employed descriptive statistics, paired-samples t-test, analysis of variance and regression analysis. RESULTS Both nurses and families reported that empowerment had been practiced in high degree. The most practiced elements were those from nurses' action subscale (e.g. constructing a positive atmosphere) and the least practiced were from families' action (e.g. disclosure). A discrepancy between nurses' and families' ratings were found for individualized information and advice, disclosure and asking questions, with families reporting higher scores. Nurses' formal training in empowerment and obesity was associated with higher scores on the nurses' action subscale. The families' limited experience with a regular health centre and nurse and families having children with overweight were both associated with lower scores on the two subscales. CONCLUSIONS Although the positive experience by nurses and families is an important finding, the reasons for the differences in perceptions of empowerment require further research. IMPACT The Portuguese Empowering Speech Practice Scale can be a useful tool to evaluate services, both from professionals' and families' perspectives and to identify areas of improvement.
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Affiliation(s)
| | - Heidi Parisod
- Department of Nursing Science, University of Turku, Turku, Finland.,Nursing Research Foundation, Helsinki, Finland
| | - Luísa Barros
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal.,CICPsi, Center for Research in Psychological Science, University of Lisbon, Lisbon, Portugal
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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13
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Nutritional Status and Oral Frailty: A Community Based Study. Nutrients 2020; 12:nu12092886. [PMID: 32967313 PMCID: PMC7551233 DOI: 10.3390/nu12092886] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
Compromised oral health can alter food choices. Poor masticatory function leads to imbalanced food intake and undesirable nutritional status. The associations among nutritional status, oral health behavior, and self-assessed oral functions status were investigated using a community-based survey. In total, 701 subjects more than 50 years old living Ebina city located southwest of the capital Tokyo were investigated. The number of remaining teeth was counted by dental hygienists. Oral health behavior and self-assessed oral functions were evaluated by oral frailty checklist. Nutritional status was evaluated by the brief-type self-administered diet history questionnaire using Dietary Reference Intakes for Japanese as reference. More than 80% of subjects’ intakes of vitamin B12, pantothenic acid, copper, and proteins were sufficient. In contrast, only 19% of subjects’ intake of vitamin A was sufficient and 35.5% for vitamin B1. More than 90% of subjects’ intakes of vitamin D and vitamin K were sufficient. Only 35.5% of subjects’ intakes of dietary fiber were sufficient. Overall, 88.9% of subjects had excess salt. The number of remaining teeth was not correlated with nutritional intakes. Oral health behavior significantly correlated with nutritional intakes. Oral functions are important for food choice; however, oral functions were not directly correlated with nutritional intakes. Comprehensive health instructions including nutrition and oral health education is necessary for health promotion.
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14
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Ortiz K, Nash J, Shea L, Oetzel J, Garoutte J, Sanchez-Youngman S, Wallerstein N. Partnerships, Processes, and Outcomes: A Health Equity-Focused Scoping Meta-Review of Community-Engaged Scholarship. Annu Rev Public Health 2020; 41:177-199. [PMID: 31922931 PMCID: PMC8095013 DOI: 10.1146/annurev-publhealth-040119-094220] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.
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Affiliation(s)
- Kasim Ortiz
- Department of Sociology and Criminology, University of New Mexico, Albuquerque, New Mexico 87131, USA;
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Institute for the Study of "Race" and Social Justice, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Jacob Nash
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Logan Shea
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - John Oetzel
- Waikato Management School, University of Waikato, 3240 Hamilton, New Zealand
| | - Justin Garoutte
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Behavioral Health Research Center of the Southwest (BHRCS), Pacific Institute for Research and Evaluation (PIRE), Albuquerque, New Mexico 87106, USA
| | - Shannon Sanchez-Youngman
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Center for Social Policy, University of New Mexico, Albuquerque, New Mexico 87131, USA
- School of Public Administration, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Nina Wallerstein
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
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Riddle AY, Kroeger CM, Ramage AK, Bhutta ZA, Kristjansson E, Vlassoff C, Taljaard M, Skidmore B, Welch V, Wells GA. PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:CL21042. [PMID: 37131509 PMCID: PMC8356511 DOI: 10.1002/cl2.1042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Alison Y. Riddle
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Cynthia M. Kroeger
- School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child HealthHospital for Sick ChildrenTorontoOntarioCanada
| | | | - Carol Vlassoff
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | | | | | - George A. Wells
- Cardiovascular Research Methods CentreUniversity of Ottawa Heart InstituteOttawaOntarioCanada
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16
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Lassen AD, Fagt S, Lennernäs M, Nyberg M, Haapalar I, Thorsen AV, Møbjerg ACM, Beck AM. The impact of worksite interventions promoting healthier food and/or physical activity habits among employees working 'around the clock' hours: a systematic review. Food Nutr Res 2018; 62:1115. [PMID: 30083088 PMCID: PMC6073101 DOI: 10.29219/fnr.v62.1115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/16/2018] [Accepted: 07/01/2018] [Indexed: 12/19/2022] Open
Abstract
We conducted a systematic review of randomised studies on the impact of worksite interventions to promote healthier food and/or physical activity among people who work irregular hours ‘around the clock’, that is, outside of ordinary daytime working hours. The population–intervention–comparator–outcomes–study (PICOS) design format was used. Data sources were PubMed and CINAHL. An updated search was conducted on October 2017 using Google Scholar and the related articles function in PubMed on initially included studies to identify additional studies. Risk of bias was used to assess study quality. A total of seven studies (reports published in 14 papers) were included in the systematic review: Two interventions with a broader lifestyle approach, three focusing on physical exercise and two on providing healthier food or meal options. The studies had sample sizes from 30 to 1,000 and targeted a mixture of occupations, including both male- and female-dominated occupational groups. The interventions lasted from 2 to 12 months. Only one had an extended follow-up. In general, the studies showed small-to-moderate effect sizes on several measures, including dietary and/or physical activity measures, suggesting acceptable effectiveness for interventions involving community-level behaviour change. Our findings highlight a need to further develop and implement well-designed health promotion interventions with comparable outcome measures and effect size reports. A mixture of health promotion strategies is recommended for future practice in this target population, including individually tailored programmes, improving the food and physical activity environment and using broader lifestyle approaches including the use of participatory and empowerment strategies. While more research is needed in this field, the existing knowledge base on effective approaches awaits translation into practice.
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Affiliation(s)
- Anne Dahl Lassen
- Division for Risk Assessment and Nutrition, Technical University of Denmark, Kemitorvet, Lyngby, Denmark
| | - Sisse Fagt
- Division for Risk Assessment and Nutrition, Technical University of Denmark, Kemitorvet, Lyngby, Denmark
| | - Maria Lennernäs
- Department of Occupational and Public Health Science, University of Gävle, Gävle, Sweden
| | - Maria Nyberg
- Department of Food and Meal Science, Kristianstad University, Kristianstad, Sweden
| | - Irja Haapalar
- School of Social and Political Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,School of Applied Educational Sciences and Teacher Education, Savonlinna, Finland
| | - Anne V Thorsen
- Division for Risk Assessment and Nutrition, Technical University of Denmark, Kemitorvet, Lyngby, Denmark
| | - Anna C M Møbjerg
- Institute for Nursing and Nutrition, University College Copenhagen, Copenhagen N, Denmark
| | - Anne M Beck
- Institute for Nursing and Nutrition, University College Copenhagen, Copenhagen N, Denmark.,Clinical Nutrition Research Unit, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
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17
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THE STUDY OF THE POSSIBILITY OF COMBINING FRESHWATER FISH WITH DUCK MEAT IN MEAT-CONTAINING SEMI-FINISHED PRODUCTS. EUREKA: LIFE SCIENCES 2018. [DOI: 10.21303/2504-5695.2018.00682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is an urgent direction of studies to ground a possibility of combining different types of raw materials at producing semi-products.
It is prospective in creating new types of products to combine white silver carp and silver crucian and regional duck in recipes of meat-containing semi-products for raising their functional and technological indices and biological effectiveness at preserving quality organoleptic characteristics in the traditional technology of meat-containing cut semi-products. There were elaborated recipes of meat-containing semi-products and conducted experimental studies of developed products with analyzing results that prove a possibility of combining duck meat and freshwater fish in recipes of meat-containing semi-products by the complete replacement of beef and pork in recipes. There were studied functional-technological indices of model forcemeats, realized the organoleptic assessment of meat-containing semi-products and their correspondence to standard requirements to this segment of products, proved microbiological safety of obtained products. The biological value of a sample of meat-containing semi-products with optimal parameters, namely the amino acid composition, including the content of replaceable and irreplaceable amino acids was studied, amino acid score was calculated, ratios of saturated, monounsaturated and polyunsaturated fatty acids were established.
The obtained experimental data prove the expedience of combining fish and meat raw materials for creating high quality and healthy products.
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18
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Curbach J, Warrelmann B, Brandstetter S, Lindacher V, Rueter J, Loss J. Empowering senior citizens for healthy nutrition in Germany: A pilot study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:675-684. [PMID: 29682844 DOI: 10.1111/hsc.12580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
Main goal of this study was to analyse how empowerment processes and bottom-up activities aimed at healthier food choices and food environment could be initiated among a group of senior citizens (between 60 and 75 years old). The intervention was set up as a pilot study in a rural community (15,000 inhabitants) in the federal state of Bavaria, South Eastern Germany. A process evaluation documented how group formation and empowerment processes developed during the course of the intervention. Extensive field notes were taken in 27 meetings, interviews (n = 13) and focus groups (n = 4) were conducted with participants and key persons at different points of the intervention. Data were analysed using content analysis. The intervention succeeded in motivating senior citizens to participate in regular meetings over 11 months. During the intervention, the group members' awareness of factors influencing their eating behaviour increased. Furthermore, they developed ideas to improve the community's food environment and accomplished duties needed to implement these ideas. However, initiating empowerment processes, especially in terms of fostering leadership and transferring responsibility, took longer than expected and could be realised only partially. The findings support a further use and evaluation of the empowerment approach for addressing nutritional aspects among senior citizens.
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Affiliation(s)
- Janina Curbach
- Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Berit Warrelmann
- Medical Sociology, University of Regensburg, Regensburg, Germany
| | | | - Verena Lindacher
- Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Jana Rueter
- Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Julika Loss
- Medical Sociology, University of Regensburg, Regensburg, Germany
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Beer-Borst S, Luta X, Hayoz S, Sommerhalder K, Krause CG, Eisenblätter J, Jent S, Siegenthaler S, Aubert R, Haldimann M, Strazzullo P. Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees. BMC Public Health 2018; 18:421. [PMID: 29606103 PMCID: PMC5879608 DOI: 10.1186/s12889-018-5366-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics. METHODS Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples. DISCUSSION Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees. TRIAL REGISTRATION German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.
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Affiliation(s)
- Sigrid Beer-Borst
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
| | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Stefanie Hayoz
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kathrin Sommerhalder
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Corinna Gréa Krause
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Julia Eisenblätter
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Sandra Jent
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Stefan Siegenthaler
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Rafael Aubert
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Max Haldimann
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Pasquale Strazzullo
- Department of Clinical Medicine & Surgery, Federico II University of Naples Medical School, via S. Pansini 5, 80131, Naples, Italy
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Brandstetter S, Curbach J, Lindacher V, Rueter J, Warrelmann B, Loss J. Empowerment for healthy nutrition in German communities: a study framework. Health Promot Int 2018; 32:500-510. [PMID: 26447192 DOI: 10.1093/heapro/dav092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Empowerment is seen as a key strategy for sustainable health promotion efforts. However, there is only limited research on how to link the empowerment approach to the promotion of healthy eating, which is a major current public health issue. The article presents the development of a study framework for implementing and evaluating an empowerment intervention for healthy nutrition. This framework was created for a community intervention study meaning to involve elderly citizens in Bavaria, Germany. The study protocol was developed in an iterative process basing on (i) literature reviews on the topics empowerment in relation to healthy nutrition and mixed-methods evaluation, (ii) workshops with empowerment and public health experts and (iii) consultations with local community representatives. Through these measures we identified good practice criteria as well as specific challenges of integrating empowerment and healthy nutrition, e.g. engaging people in healthy nutrition, reconciling participants' nutrition preferences with public health nutrition priorities and evaluating bottom-up activities in the community. Consequences for the study design were deducted from the literature and the consultations, e.g. practical recommendations as to how power could be gradually assigned to group members. A qualitative mixed-method evaluation design was chosen to capture emergent empowerment processes. The study framework presented here is the first on empowerment and nutrition to provide explicit guidance on how empowerment may be applied to healthy nutrition and implemented and evaluated in the community context.
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Affiliation(s)
- Susanne Brandstetter
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
| | - Janina Curbach
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
| | - Verena Lindacher
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
| | - Jana Rueter
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
| | - Berit Warrelmann
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
| | - Julika Loss
- Medical Sociology, University of Regensburg, Dr.-Gessler-Straße 17, D-93051 Regensburg, Germany
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21
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Perignon M, Dubois C, Gazan R, Maillot M, Muller L, Ruffieux B, Gaigi H, Darmon N. Co-construction and Evaluation of a Prevention Program for Improving the Nutritional Quality of Food Purchases at No Additional Cost in a Socioeconomically Disadvantaged Population. Curr Dev Nutr 2017; 1:e001107. [PMID: 29955680 PMCID: PMC5998781 DOI: 10.3945/cdn.117.001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/21/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socioeconomically disadvantaged individuals. Objective: This study aimed to describe the co-construction and evaluation of the Opticourses prevention program, which promotes healthy eating among participants in socioeconomically deprived situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals were recruited in poor districts of Marseille, France. The intervention and evaluation tools and protocols were co-constructed with 96 individuals. Then, 93 adults willing to participate in a standardized intervention comprising 5 participative workshops on diet and budget were enrolled. Impact on food purchases was estimated with experimental economics: 2-d experimental food purchase intents were observed at baseline and endline for workshop participants (WPs, n = 35) and controls (n = 23), with the use of monetary incentives to limit social-desirability bias. Changes in food and nutrient content and energy cost (expressed in €/2000 kcal) of experimental purchases were assessed. Results: The co-constructed participative workshops included playful activities around food purchase practices and the nutritional quality, taste, and price of foods. Experimental purchases contained a large amount of energy at baseline for both WPs and controls (5114 and 4523 kcal ⋅ d-1 ⋅ person-1, respectively). For WPs only, the mean energy content decreased between baseline and endline (-1729 kcal ⋅ d-1 ⋅ person-1; P < 0.01; medium effect size: Cohen's d = 0.5), and the percentage of energy from free sugars and from foods high in fat, sugar, and salt also decreased (both P < 0.05 and medium effect sizes), whereas energy cost remained unchanged. No significant changes between baseline and endline were observed for the controls. Conclusions: After the intervention, the energy content of participants' experimental purchases was closer to their needs, suggesting that the workshops helped them plan and rationalize their food purchases better. The nutritional quality of the experimental purchases increased but energy cost did not, showing that the co-constructed Opticourses prevention program can favorably change food purchasing behaviors of socioeconomically disadvantaged individuals with no additional cost. This trial was registered at clinicaltrials.gov as NCT02383875.
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Affiliation(s)
- Marlène Perignon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
| | - Christophe Dubois
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Rozenn Gazan
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- MS-Nutrition, Marseille, France
| | | | - Laurent Muller
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Bernard Ruffieux
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Hind Gaigi
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Nicole Darmon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
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Logren A, Ruusuvuori J, Laitinen J. Group members' questions shape participation in health counselling and health education. PATIENT EDUCATION AND COUNSELING 2017; 100:1828-1841. [PMID: 28511803 DOI: 10.1016/j.pec.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/07/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study examines how group members' questions shape member participation in health counselling and health education groups. METHODS The study applies conversation analytic principles as a method. The data consist of video-recorded health education lessons in secondary school and health counselling sessions for adults with a high risk of Type 2 diabetes. RESULTS Group members' questions accomplish a temporary change in participatory roles. They are used to 1) request counselling, 2) do counselling or 3) challenge previous talk. They are usually treated as relevant and legitimate actions by the participants, but are occasionally interpreted as transitions outside the current action or topic. CONCLUSION Group members' questions result in a shift from leader-driven to member-driven discussion. Thus they constitute a pivot point for detecting changes in participation in group interventions. PRACTICE IMPLICATIONS Observing the occurrence of group members' questions helps group leaders to adjust their own actions accordingly and thus facilitate or guide group participation. Comparison of the type and frequency of members' questions is a way to detect different trajectories for delivering group interventions and can thus be used to develop methods for process evaluation of interventions.
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Affiliation(s)
- Aija Logren
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | | | - Jaana Laitinen
- Finnish Institute of Occupational Health, Oulu, Finland.
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Lindacher V, Curbach J, Warrelmann B, Brandstetter S, Loss J. Evaluation of Empowerment in Health Promotion Interventions: A Systematic Review. Eval Health Prof 2017; 41:351-392. [PMID: 29172696 DOI: 10.1177/0163278716688065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although empowerment is one of the core principles of the World Health Organization's approach to health promotion, there are no standards, best practice recommendations, or guidelines for evaluating empowerment within interventions. For the development of effective empowerment promoting interventions, adequate study designs, methods, and indicators for assessing empowerment are essential. In order to better understand which evaluation procedures have been used so far, and which advantages and disadvantages are connected to them, we systematically reviewed empowerment-based health promotion interventions. We included 26 studies, which use a broad variety of quantitative, qualitative, and mixed-methods designs and various data collection methods; qualitative and mixed-methods designs predominated. The quantitative measurement instruments are heterogeneous: Mainly self-designed or modified scales are applied. All studies consider indicators reflecting individual competencies and motivations, whereas indicators capturing the organizational and political components of empowerment are less common. Involving target group members in the development of evaluation procedures and combining different data sources are mentioned as specific steps to improve the quality of data collection. Given the flexible and context-dependent nature of empowerment approaches, the development of a "gold standard" for its evaluation seems unrealistic. However, the analyzed studies can be used to deduce recommendations that may help to conduct high-quality evaluations of empowerment, for example, mixed-methods designs, participation of target groups, and reflective loops within the research team.
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Affiliation(s)
- Verena Lindacher
- 1 Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Janina Curbach
- 1 Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Berit Warrelmann
- 1 Medical Sociology, University of Regensburg, Regensburg, Germany
| | | | - Julika Loss
- 1 Medical Sociology, University of Regensburg, Regensburg, Germany
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