1
|
Kusumawati N, Agritubella SM, Rosy A, Erlin F, Pijl H. Challenges in Type 2 Diabetes Prevention among Senior High School Students: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2024; 12:175-187. [PMID: 39161866 PMCID: PMC11330554 DOI: 10.30476/ijcbnm.2024.101360.2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/20/2024] [Accepted: 06/08/2024] [Indexed: 08/21/2024]
Abstract
Background Schools, a place where students spend much more time than home, play an important role in preventing the nation's future generation from type 2 diabetes mellitus (T2DM). This study aimed to explore challenges in T2DM prevention among senior high school students. Methods The study was conducted in Riau Province, Indonesia, from June to August 2023 using a qualitative content analysis. 31 respondents, determined by data saturation, were recruited using purposeful sampling. They were public senior high schools' principals, vice principals, school health services staff, school canteen tenants, students, parents, and primary health care personnel in six districts. Data were collected through semi-structured face-to-face interviews and document review. Graneheim and Lundman's content analysis method was used to analyze the data in Nvivo version 11 software. The Lincoln and Guba Qualitative research criteria for trustworthiness were used to ensure the rigor of the study. Results The main concepts obtained from the data were classified into three themes entitled, "Nonoptimal existing diabetes prevention programs in schools", "Inadequate knowledge of school community on T2DM", and "Inadequate policies to prevent diabetes in schools". Conclusion An evidence-based, well-organized, and systematic school-based diabetes prevention program is fundamental to help overcome challenges and prevent future T2DM incidence. It requires relevant stakeholders' high level of awareness, strong collaborations with the school community, and effective school policies.
Collapse
Affiliation(s)
- Nila Kusumawati
- Department of Nursing, Faculty of Health Sciences, Universitas Pahlawan Tuanku Tambusai, Riau Province, Indonesia
- Indonesian Diabetes Center, Universitas Pahlawan Tuanku Tambusai, Riau Province, Indonesia
| | | | - Alice Rosy
- Department of Nursing, Poltekkes Kemenkes Riau, Riau Province, Indonesia
| | - Fitry Erlin
- Department of Nursing, Institut Kesehatan Payung Negeri, Riau Province, Indonesia
| | - Hanno Pijl
- Leiden University Medical Center, Faculty of Internal Medicine, Leiden, the Netherlands
| |
Collapse
|
2
|
Czarniecka-Skubina E, Hamulka J, Jeruszka-Bielak M, Gutkowska K. Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project. Foods 2023; 13:61. [PMID: 38201089 PMCID: PMC10778281 DOI: 10.3390/foods13010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.
Collapse
Affiliation(s)
- Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland
| | - Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Marta Jeruszka-Bielak
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Krystyna Gutkowska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland;
| |
Collapse
|
3
|
Al-Jawaldeh A, Matbouli D, Diab S, Taktouk M, Hojeij L, Naalbandian S, Nasreddine L. School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7047. [PMID: 37998278 PMCID: PMC10671197 DOI: 10.3390/ijerph20227047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.
Collapse
Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 11371, Egypt;
| | - Dana Matbouli
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sarah Diab
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Leila Hojeij
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| |
Collapse
|
4
|
Al-Jawaldeh A, Taktouk M, Naalbandian S, Aguenaou H, Al Hamad N, Almamary S, Al-Tamimi HA, Alyafei SA, Barham R, Hoteit M, Hussain M, Massad H, Nasreddine L. Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15:55. [PMID: 36615712 PMCID: PMC9823488 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
Collapse
Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 7608, Egypt
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 11-0236, Lebanon
| | - Hassan Aguenaou
- Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Ibn Tofail University-CNESTEN, Kenitra 14000, Morocco
| | - Nawal Al Hamad
- The Public Authority for Food and Nutrition, Kuwait City 43600, Kuwait
| | | | - Hend Ali Al-Tamimi
- Health Promotion and Non Communicable Disease (NCD) Division, Public Health Department, Ministry of Public Health, Doha 42, Qatar
| | - Salah Abdulla Alyafei
- Health Promotion and Non Communicable Disease (NCD) Division, Public Health Department, Ministry of Public Health, Doha 42, Qatar
| | - Rawhieh Barham
- Nutrition Department, Ministry of Health, Amman 11118, Jordan
| | - Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
| | - Munawar Hussain
- Food Policy Program Consultant, Global Health Advocacy Incubator, Islamabad 45710, Pakistan
| | - Hanan Massad
- National Consumer Protection Association, Amman 11190, Jordan
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| |
Collapse
|
5
|
Aliasgharzadeh S, Ebrahimi-Mameghani M, Mahdavi R, Karimzadeh H, Nikniaz L, Tabrizi JS, Pourali F. Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach. BMC Med Res Methodol 2022; 22:293. [PMCID: PMC9666957 DOI: 10.1186/s12874-022-01761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran.
Methods
We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1: n = 50, round 2: n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking.
Results
Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives.
Conclusion
MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.
Collapse
|
6
|
Babashahi M, Omidvar N, Joulaei H, Zargaraan A, Veisi E, Kelishadi R. Food Products with the Child-Targeted Packaging in Food Stores around Primary Schools in Tehran, Iran. JOURNAL OF PREVENTION (2022) 2022; 43:513-527. [PMID: 35476310 DOI: 10.1007/s10935-022-00679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The local retail food environment around schools can have an important role in encouraging children to low-quality food choices; and may act as a potential risk factor in their diet. Thus, evaluating the food environment is essential for adopting policies and programs that support healthy nutrition in children. This study aimed to investigate the frequency and nutritional characteristics of packaged processed/ultra-processed food and beverage products with child-oriented marketing attributes in food stores around primary schools in Tehran, Iran. This cross-sectional study was conducted on 239 food stores located within a 500-meter buffer around 64 primary schools in Tehran province. The presence of marketing strategies directed at children and nutrition information from traffic light labels of packaged foods available in these stores were extracted. Data were analyzed overall and separately for the subset of foods placed on front shelves at the entrance of stores. Among 445 discrete food products marketed to children via their packaging, 198 (44.49%) were placed on shelves in front of the stores entrance. Potato chips and bulky cereals group had the highest energy density (507.15 ± 44.05 Kcal/100gr). Due to the color code of traffic light labels, 100% of fruit juices had high levels of sugar. Of potato chips and bulky cereals, 89.38% were assigned a red color traffic light for total fat levels. Moreover, 62.50% of processed fruit and vegetables contained high levels of salt. The level of trans-fatty acids were not high in any of the food products. The high amount of sugar, salt, and fat in a remarkable proportion of food products marketed to children can be considered a risk factor for children's health. Initiation and implementation of appropriate policies to control the food environment around schools in Iran is recommended.
Collapse
Affiliation(s)
- Mina Babashahi
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azizollaah Zargaraan
- Department of Food and Nutrition Policy and Planning Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Veisi
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
7
|
Developing a Catering Quality Scale for University Canteens in China: From the Perspective of Food Safety. SUSTAINABILITY 2022. [DOI: 10.3390/su14031281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to create a catering quality scale for university canteens in China. It is based on a questionnaire survey, with a total of 1302 distributed and 844 valid retrieved questionnaires, yielding a 64.8% recovery rate. Catering safety management, employee hygiene management, catering service, food quality, environmental atmosphere, and corporate social responsibility are the six topics primarily covered. In the first step of the scale, the dimensions were developed through EFA. Catering safety management includes kitchen safety, storage safety, and food safety. Employee hygiene management has two dimensions: Employee hygiene knowledge and employee management. Catering service includes service consciousness and a focus on consumers. Environmental atmosphere includes place management and place design. Further, corporate social responsibility encompasses social responsibility and taking care of employees. The second step of the scale involved conducting a CFA, which found a good overall fit of the scale. The results indicated good discriminant validity, convergent validity, and reliability. Moreover, the model comparison showed that the two-level, six-factor model was significantly better than other models.
Collapse
|