Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing

Nutrition Education Improves Intakes of Protein, Polyunsaturated Fatty Acids, and Vitamins C and E in Community-Dwelling Older Adults

This study investigated the effect of nutrition education program on protein and nutrient intake, physical performance, and health-related quality of life (HRQoL) in community-dwelling older adults (≥65 years). The participants were randomized in clusters to intervention (IG, n = 51) and control (CG, n = 45) groups. Those in IG took part in the Eating for Strong Aging education program consisting of nutrition education in peer groups, written materials, and personal advice. Nutrient intake was assessed with 3-day food diaries, physical performance with Short Physical Performance Battery (SPPB) and HRQoL with 15-D-QoL instrument. Total of 89 participants completed the study. The mean age was 76 years (IG) and 74 years (CG). At three months, the mean change in protein intake was 0.10 g/adjusted bodyweight (ABW) kg/d in the IG, and -0.07 g/ABW kg/d in the CG (p = 0.024). Intakes of polyunsaturated fatty acids and vitamins C and E increased in the IG compared to the CG (p < 0.05). Changes in SPPB or total HRQoL scores between the IG and the CG did not differ. HRQoL dimension mobility improved in the IG compared to the CG (p = 0.035). In conclusion, the Eating for Strong Aging educational program improved nutrition and may be beneficial for mobility-related QoL.

A Qualitative Study of Factors Influencing Food Choices and Food Sources Among Adults Aged 50 Years and Older During the Coronavirus Disease 2019 Pandemic

BACKGROUND

The coronavirus disease 2019 pandemic affected food availability and accessibility for many older adults, especially those experiencing food insecurity. Food citizenship is a theoretical framework that encourages the use of alternate over industrial food sources and can characterize where foods are acquired and how food choices are made.

OBJECTIVE

The purpose of this study is to explore how Iowans aged 50 years and older made choices about what foods to acquire and where to acquire foods during the coronavirus disease 2019 pandemic using food citizenship as a theoretical framework.

DESIGN

We used in-depth interviews with Iowans aged 50 years and older (N = 60).

PARTICIPANTS

We recruited respondents through Area Agencies on Aging, food banks, and food pantries. Individuals who contacted the research team, were aged 50 years and older, and spoke English were eligible. Half of the sample screened as food insecure.

STATISTICAL ANALYSIS

We conducted a thematic analysis to identify recurring themes.

RESULTS

Food costs, personal preferences, and the healthfulness of food were cited as the most influential factors. Respondents said that the pandemic had not changed how they make choices, but increased prices had made costs more salient. Respondents primarily got their food from industrial food retailers, government programs, or food pantries. More than half of the respondents also acquired food from an alternate food source, such as a farmers' market. Reasons for not using alternate food sources included cost and transportation barriers.

CONCLUSIONS

It is essential to ensure that older adults have access to affordable, healthy foods, especially during crises such as the coronavirus disease 2019 pandemic. Alternate food sources provided supplementary, healthy food for many respondents, but there are opportunities to expand the use of these food sources. Incentivizing the use of alternate food sources through government programs and connecting the emergency food system to local producers could increase the consumption of healthy food.

"I Always Buy the Purple Ones … If I See Them": Socioecological Factors Influencing Anthocyanin-Rich Food Consumption for Cognitive Health in Older Adults

Despite the positive relationship between anthocyanin-rich foods and cognitive health, a dietary deficit exists in older adults. Effective interventions require an understanding of people's dietary behaviors situated in social and cultural contexts. Therefore, the aim of this study was to explore older adults' perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Following an educational session and the provision of a recipe and information book, an online survey and focus groups with Australian adults aged 65 years or older (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and potential strategies to achieve dietary change. An iterative, qualitative analysis identified the themes and classified the barriers, enablers and strategies onto the Social-Ecological model levels of influence (individual, interpersonal, community, society). Enabling factors included a desire to eat healthily, taste preference and familiarity of anthocyanin-rich foods (individual), social support (community), and the availability of some anthocyanin-rich foods (society). The barriers included budget, dietary preferences and motivation (individual), household influences (interpersonal), limited availability and access to some anthocyanin-rich foods (community) and the cost and the seasonal variability (society). The strategies included increasing individual-level knowledge, skills, and confidence in utilizing anthocyanin-rich foods, educational initiatives about the potential cognitive benefits, and advocating to increase access to anthocyanin-rich foods in the food supply. This study provides for the first time, insight into the various levels of influence impacting older adults' ability to consume an anthocyanin-rich diet for cognitive health. Future interventions should be tailored to reflect the barriers and enablers and to provide targeted education about anthocyanin-rich foods.

Barriers and facilitators to adopting healthier lifestyle among low-income women in Saudi Arabia: A qualitative study

INTRODUCTION

Low socioeconomic status (SES) is significantly associated with increased levels of obesity, unhealthy diet, and physical inactivity leading to a higher risk of chronic diseases. This study aimed to explore low SES women's barriers and facilitators to engaging in a healthy lifestyle and their accounts in developing future behaviour change interventions.

METHODS

Qualitative study using focus group interviews informed by the Capability Opportunity Motivation-Behavior (COM-B) framework. Interviews were conducted with a convenience sample, and data were analysed using thematic analysis. This study is conducted in partnership with Alnahda Society, a prominent nongovernmental organization in Riyadh, Saudi Arabia.

RESULTS

We conducted five focus groups with a total of 29 participants. We identified five overarching themes from the data related to participants' definition of a 'healthy life', the difficulties they face that hinder their engagement with a healthy lifestyle, the methods and reasons for changing health behaviour and participants' views of an ideal future behaviour change intervention. Women's definition of a healthy lifestyle did not only include a healthy diet and physical activity but also emphasized the importance of improving mental wellness. Following a healthy lifestyle, although desired, is not always a priority for women with low SES due to the high cost, lack of availability of healthy options and time constraints. Many women in our sample discussed the need to have a routine and discipline to follow and maintain a healthy lifestyle. Family members' support for behaviour change was discussed as a facilitator to maintaining a healthy lifestyle. Women highlighted several reasons that would motivate them to change their health behaviour, including having or preventing health conditions, improving mental health, and managing weight. Participants also discussed the characteristics of an ideal behaviour change intervention.

DISCUSSION

This study suggests that women with low SES are faced with several barriers to adopting a healthy lifestyle. Behaviour change intervention targeting this population needs to be tailored to address these barriers and facilitate behaviour change for people with limited resources. National policies to improve the availability and affordability of healthy options are also needed to reduce health disparities.

PATIENT AND PUBLIC CONTRIBUTIONS

Women of low SES who took part in the study were given a chance at the end of each focus group discussion to reflect on the questions and add any areas important to them that were not covered during the interview. Experts working with disadvantaged populations in a nonprofit organization (Alnahda society) contributed to the design of the topic guide.

Barriers to Creating Healthier Home Food Environments: Process Evaluation Results From 2 Home Food Environment Intervention Studies

Few studies have identified barriers to creating a home environment more supportive of healthy eating. We examined barriers faced by participants in a randomized controlled trial and an adaptation study of the Healthy Homes/Healthy Families intervention, which uses health coaches to support low-income families in creating healthier home food environments. Coaches maintained logs of participant interactions as part of a process evaluation. We thematically analyzed logs from interactions with participants, mostly lower-income African American women (n = 114), to identify barriers for each of 8 healthy actions that serve as core elements of the intervention. Difficulty of changing current habits was a barrier for 5 of the healthy actions. No time/convenience and limited family support each influenced 2 of the healthy actions, with interpersonal barriers also stemming from social situations and visitors, including grandchildren. Cost and economic challenges were barriers for 3 of the actions. Hunger, cravings, and limited access to resources (eg, transportation, fresh fruits and vegetables) were each noted as barriers for 1 healthy action. Overall, these findings provide insight for how to better support families who are trying to improve their home food environments and highlight the need for multilevel interventions.

Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing

BACKGROUND

Older adults living in social housing are a vulnerable population facing unique challenges with health literacy and chronic disease self-management. We investigated this population's knowledge of cardiovascular disease and diabetes mellitus, and self-efficacy to make health behaviour changes (for example, physical activity). This study characterized the relationship between knowledge of health risk factors and self-efficacy to improve health behaviours, in order to determine the potential for future interventions to improve these traits.

METHODS

A cross-sectional study (health behaviour survey) with adults ages 55+ (n = 599) from 16 social housing buildings across five Ontario communities. Descriptive analyses conducted for demographics, cardiovascular disease and diabetes knowledge, and self-efficacy. Subgroup analyses for high-risk groups were performed. Multivariate logistic regressions models were used to evaluate associations of self-efficacy outcomes with multiple factors.

RESULTS

Majority were female (75.6%), white (89.4%), and completed high school or less (68.7%). Some chronic disease subgroups had higher knowledge for those conditions. Significant (p < 0.05) associations were observed between self-efficacy to increase physical activity and knowledge, intent to change, and being currently active; self-efficacy to increase fruit/vegetable intake and younger age, knowledge, and intent to change; self-efficacy to reduce alcohol and older age; self-efficacy to reduce smoking and intent to change, ability to handle crises, lower average number of cigarettes smoked daily, and less frequent problems with usual activities; self-efficacy to reduce stress and ability to handle crises.

CONCLUSIONS

Those with chronic diseases had greater knowledge about chronic disease. Those with greater ability to handle personal crises and intention to make change had greater self-efficacy to change health behaviours. Development of stress management skills may improve self-efficacy, and proactive health education may foster knowledge before chronic disease develops.

Feasibility of an MI-CBT ketogenic adherence program for older adults with mild cognitive impairment

BACKGROUND

The National Institutes of Health Obesity-Related Behavioral Intervention Trials model for intervention development was used to establish the feasibility and proof of concept of a motivational ketogenic nutrition adherence program for older adults with mild cognitive impairment.

METHODS

This was a single-arm, single-center feasibility trial. A comprehensive assessment protocol, including a clinical interview, neuropsychological testing, and genetic sequencing was used as an initial screening. Nine participants (aged 64-75) with possible amnestic mild cognitive impairment were consented for the intervention. Participants completed pre- and post-intervention neuropsychological assessments using the updated Repeatable Battery for Assessment of Neuropsychological Status. Participants tracked their macronutrient consumption using food diaries and ketone levels using urinalysis test strips daily. Mood and other psychosocial variables were collected through surveys, and qualitative exit interviews were completed.

RESULTS

100% of participants who began the trial completed the 6-week ketogenic nutrition adherence program, including completion of the pre- and post-assessments. Eight participants achieved measurable levels of ketones during the program. The average self-rated adherence across the program was 8.7 out of 10. A Wilcoxon Signed-Rank test demonstrated significant improvement in cognitive performance from baseline (median = 88) to follow up (median = 96, Z = - 2.26, p = .024). The average difference in cognitive performance from baseline to follow-up was - 7.33 (95% CI - 12.85, - 1.82).

CONCLUSIONS

Results supported the feasibility for moving to the next phase and demonstrated proof of concept for the intervention. The next step is a randomized pilot trial to test clinical signals of effect compared to a control condition.

TRIAL REGISTRATION

This trial was retrospectively registered with clinicaltrials.gov on July 13, 2021. The trial number is NCT04968041.

Fruit and vegetable consumption among older adults: influence of urban food environment in a medium-sized Brazilian city

OBJECTIVE

To examine the association between urban food environment and regular consumption of fruits and vegetables (FV) by older adults from a medium-sized Brazilian city.

DESIGN

Cross-sectional study based on data related to (1) objective assessment of establishments with predominant sale of unprocessed/minimally processed foods, mixed establishments and establishments with predominant sale of ultra-processed foods; (2) regular consumption of FV (≥ 5 times/week), health and socio-demographic variables of community-dwelling older adults. Tertiles of proximity between food establishments and older adults' residence were calculated. Poisson generalised estimating equations with robust variance, adjusted for individual and contextual variables, were used to estimate the independent association between the proximity of establishments and regular consumption of FV.

SETTING

Medium-sized Brazilian city.

SUBJECTS

Representative sample of community-dwelling older adults (n 549).

RESULTS

Older adults travelled the longest distances to establishments with predominant sale of unprocessed/minimally processed foods. The longer the distance to establishments with predominant sale of unprocessed/minimally processed foods, the lower the prevalence of regular consumption of FV (tertile 2: prevalence ratio (PR) = 0·86; 95 % CI = 0·74, 0·99; tertile 3: PR = 0·84; 95 % CI = 0·72, 0·97). Older adults living larger distance tertiles from establishments with predominant sale of ultra-processed foods, mixed establishments or all categories of establishments had 16 % (PR = 0·84; 95 % CI = 0·73, 0·96), 19 % (PR = 0·81; 95 % CI = 0·71, 0·93) and 19 % (PR = 0·81; 95 % CI = 0·70, 0·94) lower prevalence of regular consumption of FV, respectively.

CONCLUSION

The food environment is associated with regular consumption of FV among older adults. Longer distances from the residence of older adults to food establishments are independently associated with lower prevalence of regular consumption of FV.

'There is always a way to living with illness'-Self-management strategies reported by Chinese hospitalized patients with cardiovascular disease: A descriptive qualitative study

OBJECTIVES

Patients living with cardiovascular diseases use different strategies to solve various problems. This study aimed to identify the category, type and specific self-management strategies reported by hospitalized patients with cardiovascular diseases.

METHODS

This is a qualitative descriptive study. Twenty-eight individuals with cardiovascular diseases from a Cardiology Department affiliated with a school in China were recruited by purposive sampling. Face-to-face semi-structured interviews were used. The interviews were audio-recorded, transcribed, translated and analysed by using content analysis.

RESULTS

Five self-management strategy categories (medical and alternative therapy uptake, risk assessment and avoidance, resource seeking and utilization, maintaining normality, and optional management), and seventeen self-management strategy types, encompassing one hundred and ten specific strategies were identified. The most commonly used self-management strategy types were lifestyle adjustment (eleven strategies), self-maintenance (nine strategies) and problem-solving (nine strategies). Additionally, the most described explicit self-management strategies were receiving family/colleague support, maintaining daily routines, monitoring symptoms and managing side effects, discussing with professionals, using medicines, and improving awareness.

CONCLUSION

This study identified diverse strategies reported by some Chinese cardiovascular patients. It may inform the design and development of personalized self-management interventions for health practitioners and policymakers, helping cardiovascular patients in Chinese communities worldwide receive culture-tailored services.

Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy

Background

The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life.

Methods

This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years.

Results

Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only.

Conclusions

Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet)

OBJECTIVE

The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40-55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life.

DESIGN

This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet.

SETTING

Northern Ireland.

PARTICIPANTS

Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face.

RESULTS

Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food.

CONCLUSIONS

This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Built and social environmental factors influencing healthy behaviours in older Chinese immigrants to Australia: a qualitative study

Background

Neighbourhood environments influence older adults’ health and health-enhancing behaviours, such as physical activity, eating a healthy diet and socialising. However, little is known about the effects of the neighbourhood environment on the health of older immigrants, the number of which is rapidly increasing in developed countries. Using Nominal Group Technique (NGT) sessions, this study of older Chinese immigrants to urban Melbourne, Australia, examined built and social environmental facilitators of and barriers to regular engagement in physical activity, eating a healthy diet and regular contact with other people.

Methods

Participants were recruited from four types of neighbourhoods stratified by walkability and proportion of Chinese dwellers. Twelve NGTs, four specific to each of physical activity, healthy diet and social contacts were conducted in Mandarin or Cantonese (91 participants). NGT responses from groups addressing the same questions were aggregated, similar items were combined, and scores combined across groups. Inductive thematic analysis was used to categorise answers into higher-order themes of factors associated with each behaviour.

Results

For physical activity, 29 facilitators and 28 barriers were generated with the highest ranked facilitator and barrier being “proximity to destinations” and “poor/inadequate public transport”, respectively. For healthy diet, 25 facilitators and 25 barriers were generated, the highest ranked facilitator and barrier were “high food safety standards/regulations” and “lack of family/household members’ social support for a healthy diet”. The social contacts NGTs generated 23 facilitators and 22 barriers, with the highest ranked facilitator and barrier being “proximity to destinations and activities” and “poor public transport”, respectively.

Discussion

Independent living arrangements and the accessibility of destinations of daily living (e.g., bilingual health services, libraries, places of worship and grocery stores / supermarkets), recreational facilities, affordable public transport, and community centres and activities for Chinese people are key elements for promoting regular engagement in physical activity, healthy eating and socialising in older Chinese immigrants. Governments should plan for the provision of this basic infrastructure of community facilities for older immigrants.

Self-management behaviors in adults with chronic hepatitis B: A structural equation model

BACKGROUND

Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications.

OBJECTIVES

To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B.

DESIGN

A cross-sectional study.

SETTINGS

Hepatology units in two hospitals in Chongqing, China.

PARTICIPANTS

A total of 306 patients with chronic hepatitis B were recruited.

METHODS

Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data.

RESULTS

The final model showed good model fit. Social support directly influenced self-management behaviors (β = 0.19, p < 0.01), and indirectly influenced self-management behaviors (β = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (β = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (β = 0.12, p < 0.05) through self-efficacy.

CONCLUSIONS

Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.