1
|
Kearsey JL, West E, Vairinhos N, Constable N, Chu A, Douglas N, Charlton K. Evaluation of a Nutrition Education and Skills Training programme in vulnerable adults who are at high risk of food insecurity. J Hum Nutr Diet 2024; 37:418-429. [PMID: 37964660 DOI: 10.1111/jhn.13264] [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: 08/17/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jade L Kearsey
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elisha West
- OzHarvest Melbourne, Port Melbourne, Victoria, Australia
| | - Nelia Vairinhos
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Angelica Chu
- OzHarvest Sydney, Alexandria, New South Wales, Australia
| | - Nigel Douglas
- OzHarvest Sydney, Alexandria, New South Wales, Australia
| | - Karen Charlton
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
2
|
Healy JD, Dhaliwal SS, Pollard CM, Sharma P, Whitton C, Blekkenhorst LC, Boushey CJ, Scott JA, Kerr DA. Australian Consumers' Attitudes towards Sustainable Diet Practices Regarding Food Waste, Food Processing, and the Health Aspects of Diet: A Cross Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2633. [PMID: 36767997 PMCID: PMC9914991 DOI: 10.3390/ijerph20032633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Environmentally sustainable diets are increasingly aspired to in food-based dietary guidelines across the world. However, little is known about consumer attitudes toward these diets when making food decisions. This study aimed to identify the demographic characteristics of Australian adults based on the level of attention they paid to the healthfulness of their diet, their consideration of the level of food processing, and their concern about household food waste and sustainable packaging disposal. Adults aged from 18 to over 75 years (n = 540) were surveyed online. Thirty-seven percent were concerned about sustainable food waste, 28% considered the level of food processing when making food decisions, and 23% paid attention to the healthfulness of the food they ate. Adults who had higher educational attainment (above Year 12) were twice as likely to be concerned about food waste and sustainable packaging disposal (odds ratio (OR) = 2.10, 95% confidence interval (CI) 1.29-3.4), and processing levels (OR = 2.04, 95% CI 1.23-3.42) (controlling for age and gender). Those earning an income over AUD$100,000 were twice as likely to pay attention to the healthfulness of their food choices than those earning less than AUD$50,000 (OR = 2.19, 95% CI 1.28-3.74). Only 9% percent were concerned about or paid attention to all three of the components of healthy sustainable diets investigated, and 45% paid no attention and were not concerned about all three components. These findings suggest there is a need to educate the public to raise awareness of and concern for healthy, minimally processed, and sustainable food choices.
Collapse
Affiliation(s)
- Janelle D. Healy
- School of Population Health, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
| | - Satvinder S. Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
- Duke-NUS Medical School, National University of Singapore, College Road, Singapore 169857, Singapore
- Institute for Research in Molecular Medicine (INFORMM), University Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia
- Singapore University of Social Sciences, 463 Clementi Road, Singapore 599494, Singapore
| | - Christina M. Pollard
- School of Population Health, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
- Curtin Health Innovation Research Institute, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
- Enable Institute, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Piyush Sharma
- School of Management and Marketing, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
| | - Clare Whitton
- School of Population Health, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
| | - Lauren C. Blekkenhorst
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Royal Perth Hospital Research Foundation, Edith Cowan University, Perth, WA 6000, Australia
| | - Carol J. Boushey
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Jane A. Scott
- School of Population Health, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
| | - Deborah A. Kerr
- School of Population Health, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
- Curtin Health Innovation Research Institute, Curtin University, Kent Street, P.O. Box U1987, Perth, WA 6845, Australia
| |
Collapse
|
3
|
Karimi N, Crawford D, Opie R, Maddison R, O'Connell S, Hamblin PS, Ng AH, Steele C, Rasmussen B, Ball K. EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study. JMIR Res Protoc 2020; 9:e19488. [PMID: 33155571 PMCID: PMC7679211 DOI: 10.2196/19488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/10/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. Objective This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. Methods EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. Results The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. Conclusions This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID) DERR1-10.2196/19488
Collapse
Affiliation(s)
- Nazgol Karimi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Rachelle Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Stella O'Connell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Peter Shane Hamblin
- Diabetes & Endocrinology Centre, Sunshine Hospital, St Albans, Australia.,Department of Medicine-Western Precinct, University of Melbourne, St Albans, Australia
| | - Ashley Huixian Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Cheryl Steele
- Diabetes Education Services, Sunshine Hospital, St Albans, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, Australia.,Centre for Quality and Patient Safety Research, Western Health Partnership, Sunshine Hospital, St Albans, Australia.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| |
Collapse
|
4
|
West EG, Lindberg R, Ball K, McNaughton SA. The Role of a Food Literacy Intervention in Promoting Food Security and Food Literacy-OzHarvest's NEST Program. Nutrients 2020; 12:E2197. [PMID: 32718054 PMCID: PMC7468773 DOI: 10.3390/nu12082197] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/02/2023] Open
Abstract
Food literacy interventions are widely implemented to improve the food security and health of low-socioeconomic adults. The purpose of this study was to conduct an inquiry into the value of OzHarvest's six-week NEST (Nutrition Education and Skills Training) program in promoting food security and food literacy, and to identify the barriers and enablers that participants experienced in sustaining food security, and in utilising their food literacy skills beyond the program. A descriptive evaluation study with pre-post surveys (n = 21) and post-program interviews (n = 17) was conducted, with a convenience sample of NEST program participants living in Sydney, Newcastle, and Melbourne, Australia. Participants demonstrated improvements in food security status (p = 0.030), cooking confidence (p = 0.001), food preparation behaviours (p = 0.006), nutrition knowledge (p = 0.033), vegetable consumption (p = 0.043), and a reduction in intake of sugar-sweetened beverages (p = 0.017), and salty snack foods (p = 0.011). The interviews revealed that participants learned to stretch their food budgets and make meaningful changes to their food utilisation (a key dimension of food security). Interviews also identified enablers (e.g., social support) and barriers (e.g., health conditions) to achieving food security. Acknowledging the need for a multi-faceted approach that also addresses upstream determinants, interventions like NEST may play a role in promoting food security and food literacy.
Collapse
Affiliation(s)
- Elisha G. West
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; (R.L.); (S.A.M.)
| | | | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; (R.L.); (S.A.M.)
| | | |
Collapse
|
5
|
How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial. Public Health Nutr 2019; 23:124-133. [PMID: 31570114 DOI: 10.1017/s1368980019002830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption. DESIGN Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS. SETTING Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia. PARTICIPANTS Analyses included 225 women (116 intervention and 109 control). RESULTS Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects. CONCLUSIONS The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.
Collapse
|
6
|
Harrington RA, Scarborough P, Hodgkins C, Raats MM, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Ni Mhurchu C, Winstone N, Shepherd R, Timotijevic L, Rayner M. A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study. JMIR Form Res 2019; 3:e9910. [PMID: 30958277 PMCID: PMC6482590 DOI: 10.2196/formative.9910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 12/05/2018] [Accepted: 12/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. OBJECTIVE The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. METHODS The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). RESULTS We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). CONCLUSIONS Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. TRIAL REGISTRATION ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40814-015-0015-1.
Collapse
Affiliation(s)
- Richard A Harrington
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Monique M Raats
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Gill Cowburn
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Moira Dean
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aiden Doherty
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Naomi Winstone
- Department of Higher Education, University of Surrey, Guildford, United Kingdom
| | - Richard Shepherd
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Lada Timotijevic
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
7
|
Do Not "Let Them Eat Cake": Correlation of Food-Consumption Patterns among Rural Primary School Children from Welfare and Non-Welfare Households. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:ijerph14010026. [PMID: 28036055 PMCID: PMC5295277 DOI: 10.3390/ijerph14010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/23/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022]
Abstract
Physical and financial access impacts food choice and consumption, while educational attainment, employment, income, gender, and socioeconomic status are also influential. Within this context, the aim of the paper is to examine the association between various foods consumed and eating patterns of children between low and higher income households. A paper-based survey was completed by parents/carers of children in 41 primary schools in rural and regional areas of Victoria. Data collected included demographics and the consumption of fruit, vegetable, and other foods including drinks. Ordinal data were analysed using Spearman's rank-order correlation. The main findings were that children who consumed more fruit and vegetables tended to have a higher intake of healthy drinks (plain milk and water) as well as a lower intake of unhealthy snacks and drinks (sugar sweetened drinks). Those who perceived that fruit and vegetables cost too much reported greater consumption of unhealthy snacks and sugar-sweetened beverages, which was more prominent in low-income households. Changing food consumption behaviours requires a complex systems-based approach that addresses more than just individual issues variables. A participatory approach that works with local communities and seeks to build an understanding of unique challenges within sub-groups has potential for embedding long-lasting and meaningful change in eating behaviours.
Collapse
|
8
|
Ball K, McNaughton SA, Le HN, Abbott G, Stephens LD, Crawford DA. ShopSmart 4 Health: results of a randomized controlled trial of a behavioral intervention promoting fruit and vegetable consumption among socioeconomically disadvantaged women. Am J Clin Nutr 2016; 104:436-45. [PMID: 27413129 DOI: 10.3945/ajcn.116.133173] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Behavioral interventions show potential for promoting increased fruit and vegetable consumption in the general population. However, little is known about their effectiveness or cost-effectiveness among socioeconomically disadvantaged groups, who are less likely to consume adequate fruit and vegetables. OBJECTIVE This study investigated the effects and costs of a behavior change intervention for increasing fruit and vegetable purchasing and consumption among socioeconomically disadvantaged women. DESIGN ShopSmart 4 Health was a randomized controlled trial involving a 3-mo retrospective baseline data collection phase [time (T) 0], a 6-mo intervention (T1-T2), and a 6-mo no-intervention follow-up (T3). Socioeconomically disadvantaged women who were primary household shoppers in Melbourne, Australia, were randomly assigned to either a behavior change intervention arm (n = 124) or a control arm (n = 124). Supermarket transaction (sales) data and surveys measured the main outcomes: fruit and vegetable purchases and self-reported fruit and vegetable consumption. RESULTS An analysis of supermarket transaction data showed no significant intervention effects on vegetable or fruit purchasing at T2 or T3. Participants in the behavior change intervention arm reported consumption of significantly more vegetables during the intervention (T2) than did controls, with smaller intervention effects sustained at 6 mo postintervention (T3). Relative to controls, vegetable consumption increased by ∼0.5 serving · participant(-1) · d(-1) from baseline to T2 and remained 0.28 servings/d higher than baseline at T3 among those who received the intervention. There was no intervention effect on reported fruit consumption. The behavior change intervention cost A$3.10 (in Australian dollars) · increased serving of vegetables(-1) · d(-1)CONCLUSIONS: This behavioral intervention increased vegetable consumption among socioeconomically disadvantaged women. However, the lack of observed effects on fruit consumption and on both fruit and vegetable purchasing at intervention stores suggests that further investigation of effective nutrition promotion approaches for this key target group is required. The ShopSmart 4 Health trial was registered at www.isrctn.com as ISRCTN48771770.
Collapse
Affiliation(s)
- Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, and
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, and
| | - Ha Nd Le
- Population Health Strategic Research Centre, Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, and
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, and
| | - David A Crawford
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, and
| |
Collapse
|
9
|
Abstract
Supermarket receipts have the potential to provide prospective, objective information about the household food supply. The aim of this study was to develop an index to estimate population diet quality using food purchase data. Supermarket receipt data of 1 month were available for 836 adults from a corporate office of a large retail chain. Participants were aged 19-65 years (mean 37·6 (sd 9·3) years), 56 % were female and 63 % were overweight or obese. A scoring system (Healthy Trolley Index (HETI)) was developed to compare food expenditure with the Australian Guide to Healthy Eating. Monthly expenditure per food group, as a proportion of total food expenditure, was compared with food group recommendations, and a HETI score was calculated to estimate overall compliance with guidelines. Participants spent the greatest proportion on discretionary foods, which are high in fat/sugar (34·8 %), followed by meat including beef and chicken (17·0 %), fresh and frozen vegetables (13·5 %) and dairy foods (11·3 %). The average HETI score ranged from 22·6 to 93·1 (out of 100, mean 58·8 (sd 10·9)). There was a stepwise decrease in expenditure on discretionary foods by increasing HETI quintile, whereas expenditure on fruit and vegetables increased with HETI quintile (P<0·001). The HETI score was lower in obese compared with normal-weight participants (55·9 v. 60·3; P<0·01). Obese participants spent more on discretionary foods (38·3 v. 32·7 %; P<0·01) and less on fruits and vegetables (19·3 v. 22·2 %; P<0·01). The HETI may be a useful tool to describe supermarket purchasing patterns and quality of the household food supply with application for consumer feedback to assist improved quality of foods purchased.
Collapse
|
10
|
Ball K. Traversing myths and mountains: addressing socioeconomic inequities in the promotion of nutrition and physical activity behaviours. Int J Behav Nutr Phys Act 2015; 12:142. [PMID: 26572225 PMCID: PMC4647810 DOI: 10.1186/s12966-015-0303-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In developed countries, individuals experiencing socioeconomic disadvantage - whether a low education level, low income, low-status occupation, or living in a socioeconomically disadvantaged neighbourhood - are less likely than those more advantaged to engage in eating and physical activity behaviours conducive to optimal health. These socioeconomic inequities in nutrition and physical activity (and some sedentary) behaviours are graded, persistent, and evident across multiple populations and studies. They are concerning in that they mirror socioeconomic inequities in obesity and in health outcomes. Yet there remains a dearth of evidence of the most effective means of addressing these inequities. People experiencing disadvantage face multiple challenges to healthy behaviours that can appear insurmountable. With increasing recognition of the role of underlying structural and societal factors as determinants of nutrition and physical activity behaviours and inequities in these behaviours, and the limited success of behaviour change approaches in addressing these inequities, we might wonder whether there remains a role for behavioural scientists to tackle these challenges. DISCUSSION This debate piece argues that behavioural scientists can play an important role in addressing socioeconomic inequities in nutrition, physical activity and sedentary behaviours, and that this will involve challenging myths and taking on new perspectives. There are successful models for doing so from which we can learn. Addressing socioeconomic inequities in eating, physical activity and sedentary behaviours is challenging. However, successful examples demonstrate that overcoming such challenges is possible, and provide guidance for doing so. Given the disproportionate burden of ill health carried by people experiencing socioeconomic disadvantage, all our nutrition and physical activity interventions, programs and policies should be designed to reach and positively impact these individuals at greatest need.
Collapse
Affiliation(s)
- Kylie Ball
- Deakin University, Centre for Physical Activity and Nutrition Research, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| |
Collapse
|
11
|
Scarborough P, Hodgkins C, Raats MM, Harrington RA, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Matthews A, Mizdrak A, Mhurchu CN, Shepherd R, Tiomotijevic L, Winstone N, Rayner M. Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial). Pilot Feasibility Stud 2015; 1:21. [PMID: 27965800 PMCID: PMC5153808 DOI: 10.1186/s40814-015-0015-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 05/15/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Traffic light labelling of foods-a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods-has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions. METHODS/DESIGN The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial. DISCUSSION The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial. TRIAL REGISTRATION ISRCTN: ISRCTN19316955.
Collapse
Affiliation(s)
- Peter Scarborough
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Monique M. Raats
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Richard A. Harrington
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Gill Cowburn
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Moira Dean
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Charlie Foster
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Matthews
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Anja Mizdrak
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Richard Shepherd
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Lada Tiomotijevic
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Naomi Winstone
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Mike Rayner
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| |
Collapse
|