Nutrition programmes for individuals living with disadvantage in supported residential settings: a scoping review

Increasing linkage to hepatitis C care following trauma-informed rehabilitation: An education and quality improvement project among women

INTRODUCTION

The on-going substance use crisis has led to unprecedented rates of hepatitis C virus (HCV) in Canada, with increasing positivity among women who use drugs (WWUD). Despite efforts to reduce barriers to HCV testing and treatment, follow-up remains a major issue.

METHODS

In this quality improvement project (QIP), we partnered with a short-stay trauma-informed residential drug treatment facility specifically for WWUD, to provide an engaging peer-led HCV education session, followed by low-barrier nurse and peer-led testing and treatment. We sought to evaluate these interventions, as well as determine what factors could improve engagement after women leave.

RESULTS

The session was attended by 217 participants, 130 completed the survey and 153 opted into testing. Survey results indicated that participants were highly motivated to access general care as well as HCV testing and treatment. The most frequently reported barriers to testing and treatment were a previous negative test and being asymptomatic, respectively. Follow-up facilitators included a non-judgmental provider (88%), monetary incentives (67%), follow-up phone calls (77%), e-mails (66%) and text messages (58%). Of those who were RNA positive, 5 of 13 initiated treatment on-site. By using the results of the QIP in real-time, 6 of 13 were started after leaving the centre (one pending and one lost to follow-up).

DISCUSSION AND CONCLUSIONS

The implementation of co-localised peer-led testing and treatment for HCV, along with persistent follow-up efforts, led to increases in linkage to care and treatment. Co-localisation of testing and care with substance-use services, especially if residential, is a viable, low-barrier strategy for increasing linkage to care among WWUD.

Evaluation of a Nutrition Education and Skills Training programme in vulnerable adults who are at high risk of food insecurity

BACKGROUND

In Australia, the prevalence of food insecurity increased by 1.5% between 2014 and 2016 and 2018 and 2020 due to effects of the COVID-19 pandemic. OzHarvest offers a 6-week Nutrition Education and Skills Training (NEST) programme to adults at risk of food insecurity. NEST provides 2.5-h weekly cooking workshops on simple, healthy and affordable meals. This study aimed to determine the immediate (post) and longer-term (6 months) impacts of participation in NEST.

METHODS

A quasi-experimental study with pre-post surveys (n = 258) and 6-month follow-up surveys (n = 20) was conducted from June 2019 to July 2022. Survey results were obtained from NEST programme participants (≥18 years) from six major Australian cities.

RESULTS

Participants demonstrated immediate improvement in nutrition knowledge (p < 0.001), food preparation behaviours (p < 0.001) and confidence and self-efficacy (n = 222; p < 0.001). Intake of discretionary foods decreased (p < 0.001), whereas fruit, vegetable and water intake increased (p < 0.001). Food security improved from 57% to 68% immediately after the completion of the programme (p < 0.001). Participants demonstrated longer-term improvements in nutrition knowledge (p < 0.001), cooking confidence (n = 8; p = 0.03), food preparation behaviours (p = 0.003) and increased vegetable (p = 0.03) and fruit intake (p = 0.01).

CONCLUSIONS

Participation in OzHarvest's NEST programme results in short-term improvements in food security levels and dietary behaviours. Over the longer term, these changes were sustained but to a lesser degree, indicating that systemic changes are required to address underlying socio-economic disadvantages.

Food provision to support improved nutrition and well-being of people experiencing disadvantage - perspectives of service providers

OBJECTIVE

Diet quality is significantly impacted by social and environmental factors. People experiencing socio-economic disadvantage face inequitable barriers to accessing nutritious foods and health services, resulting in significant health disparities. This study aimed to explore the barriers faced by organisations that provide food support to people experiencing disadvantage as well as to identify potential strategies to enhance this support for improved well-being of clients.

DESIGN

Semi-structured interviews using an exploratory approach and inductive thematic analysis.

SETTING

Australia.

PARTICIPANTS

Individuals from organisations involved in the provision of food support for people experiencing disadvantage aged ≥16 years.

RESULTS

Two major themes were identified from thirteen interviews. 'Dignity and respect for clients' serves as a guiding principle for food-related services across all organisations, while 'food' was a point of connection and a potential gateway to additional support pathways. Five additional subthemes included 'food as a platform to reduce social isolation, foster connection and promote participation', challenges with 'servicing clients with diverse experiences and needs', 'dependence on staff and volunteers with varying knowledge and skillsets', ensuring 'adequate access to services, resources and facilities' and 'necessity of community collaboration'.

CONCLUSIONS

This study highlights the unique position of organisations involved in food support to identify client-specific needs and implement broader holistic health support. Future interventions should prioritise dignity, respect and social connection in design. Organisations require an adequately trained, sustainable workforce, with shared or enhanced services, resources and facilities, and greater community coordination with other services to maximise effectiveness.

Nutrition and Food Literacy: Framing the Challenges to Health Communication

Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.