Using the Internet: Nutrition Information-Seeking Behaviours of Lay People Enrolled in a Massive Online Nutrition Course

Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis

BACKGROUND

The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information.

OBJECTIVE

We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living.

METHODS

The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests.

RESULTS

TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals.

CONCLUSIONS

Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures.

The use of sentiment and emotion analysis and data science to assess the language of nutrition-, food- and cooking-related content on social media: a systematic scoping review

Social media data are rapidly evolving and accessible, which presents opportunities for research. Data science techniques, such as sentiment or emotion analysis which analyse textual emotion, provide an opportunity to gather insight from social media. This paper describes a systematic scoping review of interdisciplinary evidence to explore how sentiment or emotion analysis methods alongside other data science methods have been used to examine nutrition, food and cooking social media content. A PRISMA search strategy was used to search nine electronic databases in November 2020 and January 2022. Of 7325 studies identified, thirty-six studies were selected from seventeen countries, and content was analysed thematically and summarised in an evidence table. Studies were published between 2014 and 2022 and used data from seven different social media platforms (Twitter, YouTube, Instagram, Reddit, Pinterest, Sina Weibo and mixed platforms). Five themes of research were identified: dietary patterns, cooking and recipes, diet and health, public health and nutrition and food in general. Papers developed a sentiment or emotion analysis tool or used available open-source tools. Accuracy to predict sentiment ranged from 33·33% (open-source engine) to 98·53% (engine developed for the study). The average proportion of sentiment was 38·8% positive, 46·6% neutral and 28·0% negative. Additional data science techniques used included topic modelling and network analysis. Future research requires optimising data extraction processes from social media platforms, the use of interdisciplinary teams to develop suitable and accurate methods for the subject and the use of complementary methods to gather deeper insights into these complex data.

Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study

BACKGROUND

The advent of the internet has changed the landscape of available nutrition information. However, little is known about people's information-seeking behavior toward healthy eating and its potential consequences.

OBJECTIVE

We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources.

METHODS

This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations).

RESULTS

The top source of nutrition information was television (1973/5998, 32.89%), followed by web searches (1333/5998, 22.22%), websites of government and medical manufacturers (997/5998, 16.62%), newspapers (901/5998, 15.02%), books and magazines (697/5998, 11.62%), and video sites (eg, YouTube; 634/5998, 10.57%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95% CI 1.09-1.49) to 1.81 (95% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95% CI 1.62-2.44), books and magazines (OR 2.09, 95% CI 1.64-2.66), and video sites (OR 1.53, 95% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95% CI 1.01-1.03) and books and magazines (OR 1.03, 95% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites.

CONCLUSIONS

We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials.

Comparison of Answers between ChatGPT and Human Dieticians to Common Nutrition Questions

Background

More people than ever seek nutrition information from online sources. The chatbot ChatGPT has seen staggering popularity since its inception and may become a resource for information in nutrition. However, the adequacy of ChatGPT to answer questions in the field of nutrition has not been investigated. Thus, the aim of this research was to investigate the competency of ChatGPT in answering common nutrition questions.

Methods

Dieticians were asked to provide their most commonly asked nutrition questions and their own answers to them. We then asked the same questions to ChatGPT and sent both sets of answers to other dieticians (N = 18) or nutritionists and experts in the domain of each question (N = 9) to be graded based on scientific correctness, actionability, and comprehensibility. The grades were also averaged to give an overall score, and group means of the answers to each question were compared using permutation tests.

Results

The overall grades for ChatGPT were higher than those from the dieticians for the overall scores in five of the eight questions we received. ChatGPT also had higher grades on five occasions for scientific correctness, four for actionability, and five for comprehensibility. In contrast, none of the answers from the dieticians had a higher average score than ChatGPT for any of the questions, both overall and for each of the grading components.

Conclusions

Our results suggest that ChatGPT can be used to answer nutrition questions that are frequently asked to dieticians and provide encouraging support for the role of chatbots in offering nutrition support.

Diet-Nutrition Information Seeking, Source Trustworthiness, and Eating Behavior Changes: An International Web-Based Survey

To understand the extent to which different sources of diet and nutrition information are sought, trusted, and relied upon for making dietary changes, the present international web-based survey study gauged participants' (n = 3419) diet-nutrition information-seeking behaviors from 22 interpersonal and general sources with varying quality, trust levels in these sources, and reliance on each source for making dietary changes. Qualitative insights were also captured regarding trustworthiness formation. The results revealed a disconnect between source popularity and perceived trustworthiness. While nutrition-health websites, Google-Internet searches, and diet-health books were most commonly consulted, participants placed the highest level of trust in nutrition scientists, nutrition professionals, and scientific journals, suggesting that frequent information seeking from a subpar source may not be a reliable predictor of the level of trust assigned to it. Although the frequency of source-seeking behaviors and source trustworthiness both contributed to dietary changes, the latter appeared to have a more pronounced influence. When a source was less trusted, there was a reduced likelihood of relying on it for changing diet. Additionally, source seeking may not always translate into effective dietary change, as shown by the less strong correlation between the two. These associations significantly differed depending on the source.

Acquisition behaviours for nutrition-related information based on a health promotion model for older adults in a long-term care facility

AIM

To explore the acquisition behaviours for nutrition-related information of older adults in a long-term care facility.

DESIGN

A qualitative descriptive design was used in this study.

METHODS

Sixteen older adults in a long-term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face-to-face semi-structured interviews, based on open questions regarding acquisition behaviours for nutrition-related information and flexible question formulation, and the data were analysed using an inductive-deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes.

RESULTS

Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition-related information. The second theme described behaviour-specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours.

CONCLUSION

Acquisition behaviours for nutrition-related information of older adults in long-term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long-term care facilities so as to improve the ability of the older people to acquire information independently.

PATIENT OR PUBLIC CONTRIBUTION

All 16 participants actively participated in the interview process and the preliminary preparation of the article.

Perception and attitudes of street food vendors toward the healthiness of meals prepared and sold in Dodoma

Consumption of street meals among urban dwellers has become inevitable, especially in low- and middle-income countries. It has been linked to higher incidence of dietary-related diseases. Vendors' perceptions and attitudes toward the healthiness of meals can influence nutritional quality of the offered meals. Therefore, the study aimed to assess perceptions and attitudes of vendors toward healthy and unhealthy meals as well as the healthiness of meals they prepare and sell. A cross-sectional study was carried out among 384 street food vendors. Face-to-face interviews were conducted using semistructured questionnaire. Pearson Chi-square test and logistic regression analysis were used in comparing and testing for the association of perceptions and attitudes to vendors' characteristics. Street food vendors that took part in this study demonstrated good perceptions based on what they perceived to be healthy meals (58.33%) and positive attitudes (95.57%) toward preparation and provision of healthy meals. Perceptions were associated with sex (p = .007), education level (p = .002), and investment cost (p = .000). Results from logistic regression showed that better perceptions of healthy meals were associated with being female (OR = 2.46, p-value < .031), having higher education (OR = 11.88, p-value < .042), and vending experience of 1-5 years and more than 5 years (OR = 3.17, 2.95, p-value < .019, .039, respectively) while having moderate investment cost showed significant lower chances of having better perceptions (OR = 0.33, p-value < .001). Attitudes were associated with sex (p = .002), age (p = .002), marital status (p = .013), education (p = .009), and vending experience (p = .008). Female vendors, having 25 years of age and above, living with partners, with tertiary education, and having vending experience of more than 1 year had shown to have more positive attitudes toward healthy meals. Generally, street food vendors had good perceptions and attitudes toward healthy meals. This implies possible room for change and adoption of better ways of preparing meals. These findings could be used as a stepping stone in improving nutritional and healthy quality of street meals. Increased efforts are needed on the inclusion of nutritional aspects of healthy meals as they were merely considered by vendors. Future interventions on these vendors should focus more on male vendors, vendors with little vending experience, and little education as they had shown to have relatively poorer attitudes and perceptions compared to other groups.

Characterizing the Discourse of Popular Diets to Describe Information Dispersal and Identify Leading Voices, Interaction, and Themes of Mental Health: Social Network Analysis

BACKGROUND

Social media has transformed the way health messages are communicated. This has created new challenges and ethical considerations while providing a platform to share nutrition information for communities to connect and for information to spread. However, research exploring the web-based diet communities of popular diets is limited.

OBJECTIVE

This study aims to characterize the web-based discourse of popular diets, describe information dissemination, identify influential voices, and explore interactions between community networks and themes of mental health.

METHODS

This exploratory study used Twitter social media posts for an online social network analysis. Popular diet keywords were systematically developed, and data were collected and analyzed using the NodeXL metrics tool (Social Media Research Foundation) to determine the key network metrics (vertices, edges, cluster algorithms, graph visualization, centrality measures, text analysis, and time-series analytics).

RESULTS

The vegan and ketogenic diets had the largest networks, whereas the zone diet had the smallest network. In total, 31.2% (54/173) of the top users endorsed the corresponding diet, and 11% (19/173) claimed a health or science education, which included 1.2% (2/173) of dietitians. Complete fragmentation and hub and spoke messaging were the dominant network structures. In total, 69% (11/16) of the networks interacted, where the ketogenic diet was mentioned most, with depression and anxiety and eating disorder words most prominent in the "zone diet" network and the least prominent in the "soy-free," "vegan," "dairy-free," and "gluten-free" diet networks.

CONCLUSIONS

Social media activity reflects diet trends and provides a platform for nutrition information to spread through resharing. A longitudinal exploration of popular diet networks is needed to further understand the impact social media can have on dietary choices. Social media training is vital, and nutrition professionals must work together as a community to actively reshare evidence-based posts on the web.

Exploring stakeholder experiences of dietetic service and care delivery: A systematic qualitative review

BACKGROUND

There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.

METHODS

MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.

RESULTS

Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.

CONCLUSIONS

Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.

Evidence-Based Lifestyle Guidelines and Self-Management Strategies Utilized by Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 13% of reproductive-aged women. While lifestyle management is the first-line treatment for improving complications, women experience challenges with implementation. This cross-sectional study aims to identify the types and sources of dietary and physical activity (PA) interventions implemented by women with PCOS and understand how they use self-management strategies to support lifestyle change. An online questionnaire was disseminated via a consumer-based PCOS website (May 2015-2016). Women (n = 1167) were aged 18-45 years and primarily born within the United States (70%). A quarter or less of women (diet 25%, PA 14%) sought lifestyle advice from health professionals (medical clinicians or dietitians) compared to over half (diet 59%, PA 67%) using alternative sources, namely from online platforms. While only 33% and 16% of women reported following formal dietary or PA guidelines, respectively, 57% had implemented a 'special diet' to manage their condition, many of which were inconsistent with evidence-based practice in PCOS. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. These findings suggest that online information may promote inaccurate and ineffective lifestyle advice and emphasize the need to increase engagement with qualified health professionals.

Susceptibility to COVID-19 Nutrition Misinformation and Eating Behavior Change during Lockdowns: An International Web-Based Survey

To understand the susceptibility to nutrition-health misinformation related to preventing, treating, or mitigating the risk of COVID-19 during the initial lockdowns around the world, the present international web-based survey study (15 April-15 May 2020) gauged participants' (n = 3707) level of nutrition-health misinformation discernment by presenting them with 25 statements (including unfounded or unproven claims circulated at the time), alongside the influence of information sources of varying quality on the frequency of changes in their eating behavior and the extent of misinformation held, depending on the source used for such changes. Results revealed widespread misinformation about food, eating, and health practices related to COVID-19, with the 25 statements put to participants receiving up to 43% misinformed answers (e.g., 'It is safe to eat fruits and vegetables that have been washed with soap or diluted bleach'). Whereas higher quality information sources (nutrition scientists, nutrition professionals) had the biggest influence on eating behavior change, we found greater misinformation susceptibility when relying on poor quality sources for changing diet. Appropriate discernment of misinformation was weakest amongst participants who more frequently changed their eating behavior because of information from poor quality sources, suggesting disparities in the health risks/safety of the changes performed.

Development and validation of a quality assessment tool to assess online nutrition information

Setting

The internet is an important source of health information but is unregulated. Little research has focused on the assessment of digital information related to nutrition.

Aim

To develop and validate a novel online quality assessment tool (OQAT) for quality assessment of online nutrition information.

Method

The OQAT was developed and validated in six distinct stages. After reviewing the literature, a framework and criteria were developed and formalised. Next, the quality assessment criteria were piloted on a subset of data and criteria refined. The established criteria were then validated against a previously validated assessment tool, and reliability was tested. Finally, the validated OQAT was used to assess the quality of articles from a 24-h collection period, 19 April 2021.

Results

The final OQAT consisted of 10 key questions. Twenty-six news articles were assessed independently by two raters. Comparison of scores found moderate internal consistency (α = 0.382). Cohen's Kappa coefficient demonstrated high interrater agreement (k = 0.653, p < 0.001). The OQAT was tested on 291 relevant Uniform Resource Locators (URLs), which were determined to be either poor 3% (n = 9), satisfactory 49% (n = 144), or high-quality 48% (n = 139) articles. There was a statistically significant difference in OQAT scores between blogs, news articles, and press releases, χ2(2) = 23.22, p < 0.001, with a mean rank OQAT score of 138.2 for blogs, 216.6 for news articles, and 188.7 for press releases.

Conclusion

This novel tool provides a reliable and objective method for assessing the quality of nutrition content online. It could potentially be used by researchers to assess the quality of online information in different settings and by organisations to inform readers of the quality of information being accessed.

Motivations for nutrition information-seeking behavior among Belgian adults: a qualitative study

BACKGROUND

Nutrition information-seeking behavior is highly prevalent even though it can be challenging to find reliable nutrition information in the current media landscape. Previous quantitative research has identified which population segments use which sources, yet little is known about motivations underpinning nutrition information-seeking behavior. Understanding motivations for seeking nutrition information can increase the efficacy of future nutrition education efforts. The present study aims to identify motivations for nutrition information-seeking behavior among Belgian adults.

METHODS

In-depth qualitative interviews were conducted with 20 adults (n women = 15, n men = 4, n other = 1). Audio-recorded interviews were transcribed verbatim and analyzed in NVivo 12 using inductive thematic analysis. The coding process involved open and axial coding combined with constant comparison to identify themes.

RESULTS

The interviews revealed a diverse spectrum of motivations for nutrition information-seeking behavior. Five categories of motivations centered on health management, cognitive needs, affective needs, social integrative needs, and personal identity. Participants indicated seeking nutrition information to regain a sense of control over their health and it also helped them express their autonomy. Additionally, participants sought nutrition information out of curiosity or out of a long-standing interest. Nutrition information-seeking was also used as a form of emotion regulation with participants actively engaging in seeking behavior to pursue enjoyment, diversion, confirmation, inspiration, and even relaxation. Furthermore, nutrition information-seeking enabled participants to meet social integrative needs by helping them connect to others, gather social support, help others, and sometimes convince others. Lastly, participants indicated a need for nutrition information to express or defend their identity.

CONCLUSIONS

Our results indicate that beneath the surface of a more apparent need for nutrition information lies a range of motivations demonstrating that nutrition information serves more complex needs than simply information needs. To improve the efficacy of future nutrition education efforts, communication strategies must be tailored to a diverse range of motivations.

Are Foods from the COVID-19 Pandemic Lockdown Low in Nutrients? An Analysis of Chinese Psychological Distress Effects

Background: The city-wide COVID-19 lockdown has resulted in psychological anguish, which may have an impact on dietary consumption. This study’s dual goals are to show how Chinese food consumption was altered before and after the lockdown, and to examine the nutrient density for the psychologically affected group. Methods: A cross-sectional study involving 652 people from Mainland China, Taiwan, and Macao was conducted with the aid of a web-based questionnaire. Sociodemographic characteristics, related environmental factors, nutrient consumption, food recommendations, and psychological distress were all measured. 516 trustworthy data revealed that two nutrient-poor foods were consumed less frequently during the lockdown than they were before to the COVID-19 outbreak (i.e., salty snacks and alcoholic beverages). People who endured high levels of psychological distress in particular tended to consume more. Particularly, those who experienced high levels of psychological distress had a tendency to consume far more alcohol than people who only experienced low levels of stress. Comparing the time before the COVID-19 to the present, there has statistically been an increase in the frequency of family members recommending diets. According to research, by food advice, individuals who experience psychological distress should consume more nutrient-dense foods (78.7%) than nutrient-poor ones (61.9%). Thus, food advice plays a role in mediating the relationship between psychological distress and dietary decisions for nutrient-rich (b = 0.186, p < 0.001) or nutrient-poor (b = 0.187, p < 0.001) food groups. This study provides insights for lowering psychological distress through dietary consumption, where the exact mechanisms underlying these connections have not been thoroughly elucidated. It encourages nutrition research by recommending practical nutrition education from family and environmental activities. Chronic psychological anguish may have a crucial relationship to secure access to food and a balanced diet. Along with nutrition instruction, it is critical to develop skills in interventions such as food procurement and culinary knowledge.

Practising pharmacists want more nutrition education

BACKGROUND AND PURPOSE

Although pharmacists are first and foremost medication specialists and suppliers, in Australia they are also ideally positioned within the healthcare setting to encourage and support positive lifestyle choices in the community. Little has been done to assess their nutrition knowledge in over 20 years. We aimed to explore pharmacists' nutrition knowledge and associated practice and to subsequently develop and evaluate a short course to fill identified gaps.

EDUCATIONAL ACTIVITY AND SETTING

The General Nutrition Knowledge Questionnaire was revised for testing nutrition knowledge in the pharmacy setting. Once validated, the questionnaire was distributed to pharmacists using social/professional media advertising. A short course was then developed, and its effectiveness assessed on final-year pharmacy students.

FINDINGS

Pharmacists' (N = 258) mean score was 89.9 out of 121 (SD = 10.6) with significant variation. Nutrition education provision in practice was provided inconsistently and was associated with how strongly participants rated their own knowledge. Most pharmacists (95.7%) agreed they are well-placed to assist in disease burden reduction through nutrition education; however, most (98.4%) felt their knowledge needed improvement. The short course was well received by participants, deemed to be appropriate in context, and resulted in a median improvement in matched scores of 14.7% (P < .001) with no significant decline in knowledge when reassessed three weeks later (P = .383).

SUMMARY

Pharmacists' nutrition knowledge and practice was variable. Further education can improve knowledge without significant time outlay and is likely to improve associated counselling practices.

Nutrition Behavior and Physical Activity of Middle-Aged and Older Adults in Saudi Arabia

As people get older, their nutritional status deteriorates, resulting in increased vulnerability to chronic diseases. The adoption of a healthy lifestyle has been linked to improved health throughout the aging process. The current study aimed to assess nutritional behaviors, dietary patterns, and physical activity among middle-aged and older adults in Saudi Arabia. An electronic questionnaire was completed between September and November 2021 by 419 participants aged 45 years and older. Of those, 65% reported that nutrition was important to them and 19% stated that they were consuming a healthy diet. Participants reported consuming an average of around 6 servings/week each of fruit and vegetables, with mean intake scores of 5.92 ± 0.25 and 5.57 ± 0.22, respectively. It was reported that around 3 servings/week of red meat, 4 servings/week of poultry, and 1 serving/week of fish were consumed, with mean intake scores of 2.65 ± 0.13, 4.34 ± 0.16, and 1.36 ± 0.08, respectively. Most of the participants (60%) reported being inactive. Middle-aged and older adults living in Saudi Arabia have poor dietary patterns and nutritional behaviors. Education and guidance on nutrition are needed for this population to help them improve their diet and lifestyle.

Exploring Impacts of a Nutrition-Focused Massive Open Online Course

The nutrition education landscape is changing due to advances in technology. Massive Open Online Courses (MOOCs) are an example of new education opportunities, made possible by advances in online learning environments. This research aimed to evaluate a nutrition-focused MOOC, applying Kirkpatrick’s theoretical model of learning, to comprehensively describe learners’ reactions, knowledge and behaviours. A mixed-methods approach explored learners’ experiences of participating in a global nutrition MOOC. Quantitative survey data, using descriptive statistics, measured pre-course nutrition knowledge, post-course satisfaction and learning, and changes to fruit/vegetable intake. Qualitative data from discussion forums and semi-structured interviews were thematically analysed and explored participant experiences and perceived impacts on dietary behaviours and nutrition knowledge. All results were mapped to Kirkpatrick’s model. Surveys measuring perceived knowledge, satisfaction, and fruit and vegetable intake were completed by 4941, 1003 and 1090 participants, respectively. Overall reactions to the course were positive. Perceived vegetable intake increased for 62% of participants. Twelve interviews and six hundred and forty-seven forum comments were analysed, identifying eight themes highlighting changes to knowledge and dietary behaviours, and the importance of peer-to-peer learning. All results mapped to Levels 1–3 of Kirkpatrick’s model. MOOCs can be an effective platform to communicate evidence-based nutrition information to large, global audiences.

Cultural Adaptation and Social Media Promotion of Healthy Eating Guides for Spanish Speakers

OBJECTIVE

The internet is a primary source of nutrition information in the US. Minorities and non-English speakers face a digital divide when accessing such information. We aimed to report on the reach of social media dissemination of the cultural adaptation of the evidence-based Kid's Healthy Eating Plate to Spanish-speaking Latinos and of previous versions.

METHODS

The adaptation was based on the Framework for Reporting Adaptations and Modifications-Expanded and was disseminated through social media platforms (116 days). Outcomes were impressions, shares, website link clicks, number of viewers, and access country.

RESULTS

The kids' culturally adapted version had 288,773 impressions and 1,227 shares on social media; the website was linked 9,763 times, predominantly through Facebook (Meta Platforms, Inc). User engagement and pageviews were mostly from Spain, Latin American countries, and the US.

CONCLUSIONS AND IMPLICATIONS

The cultural adaptation of healthy eating guidelines for Spanish-speaking children was accessed in the US and worldwide. Promotion through social media had a significant impact on its reach. Cultural adaptation and paid dissemination of evidence-based materials may help close the digital divide and promote health literacy in diverse populations.

Understanding Preconception Women’s Needs and Preferences for Digital Health Resources: Qualitative Study

Background

Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors.

Objective

This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health.

Methods

This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants’ lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants’ perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework.

Results

In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women’s busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions.

Conclusions

Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors.

Literature Review on MOOCs on Sensory (Olfactory) Learning

Massive Open Online Courses (MOOCs) have been described as a “next development of networked learning”, and they have the potential to mediate sensory learning. To understand this phenomenon, the present systematic review examines the research techniques, subjects, and trends of MOOC research on sensory learning, in order to provide a thorough understanding of the MOOC relevant to sensory (olfactory) learning phenomena by evaluating 65 (four studies are about multisensorial learning and 61 are about multisensorial empirical MOOCs researches) empirical MOOC studies published between 2008 and 2021 by searching through databases: PubMed, Scopus, Web of Science, and Google Scholar. The results indicated that most studies were based on quantitative research methods followed by mixed research methods and the qualitative research approaches; most of the studies were surveys, followed by platform databases and interviews; almost half of the studies were conducted using at least two methods for data collection: survey and interviews; most were replicated. The most highlighted subjects included student retention, learning experience, social learning, and engagement. Implications and studies into the future have been considered in order to obtain a more evolved understanding of the acquisition of knowledge through the senses.

Findings from a web content analysis of resources targeting sporting coaches aimed at educating or upskilling on eating disorders and disordered eating in athletes

BACKGROUND

Eating disorders (ED) and disordered eating (DE) are highly prevalent in athletes. Coaches can play a role in the prevention of EDs and DE behaviours and are well placed to support athletes with an ED. However, coaches feel under-qualified and lack time and resources for supporting athletes and it is unclear the quality of training and resources available to upskill coaches in this space. Therefore, a web-based content analysis was undertaken to determine the type and source of online education resources currently available to coaches to help identify, prevent, manage and refer on for ED/DE behaviours.

METHODS

Three major search engines were searched using a combination of the following terms: (1) DE or ED resource and (2) coaches or sport. Included websites were specific for DE/EDs in athletes; targeted at coaches or sporting organisations; written in the English language; and published by a reputable site.

RESULTS

Twenty four out of 600 websites met inclusion criteria. The main reasons for exclusion were irreputable sites and websites not targeting coaches. The majority of included webpages were from professional bodies (n = 17) and targeted coaches (n = 24) and sporting organisations (n = 15), with an average quality rating of 4.2 out of 6. All websites provided educational resources but none provided official training. The most common topics discussed on these websites was ED/DE signs and symptoms (n = 17), and the effects of ED/DE on performance, mental and physical health (n = 11).

CONCLUSION

Few reputable online resources were identified in the current review. There is a need for more comprehensive education and training resources aimed at coaches and athletic organisations to help prevent, identify, manage and refer on for ED/DE behaviours.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Who We Seek and What We Eat? Sources of Food Choice Inspirations and Their Associations with Adult Dietary Patterns before and during the COVID-19 Lockdown in New Zealand

Research shows the shaping of food choices often occurs at home, with the family widely recognised as significant in food decisions. However, in this digital age, our eating habits and decision-making processes are also determined by smartphone apps, celebrity chefs, and social media. The ‘COVID Kai Survey’ online questionnaire assessed cooking and shopping behaviours among New Zealanders during the 2020 COVID-19 ‘lockdown’ using a cross-sectional study design. This paper examines how sources of food choice inspirations (cooking-related advice and the reasons for recipe selection) are related to dietary patterns before and during the lockdown. Of the 2977 participants, those influenced by nutrition and health experts (50.9% before; 53.9% during the lockdown) scored higher for the healthy dietary pattern. Participants influenced by family and friends (35% before; 29% during the lockdown) had significantly higher scores for the healthy and the meat dietary patterns, whereas participants influenced by celebrity cooks (3.8% before; 5.2% during the lockdown) had significantly higher scores in the meat dietary pattern. There was no evidence that associations differed before and during the lockdown. The lockdown was related to modified food choice inspiration sources, notably an increase in ‘comforting’ recipes as a reason for recipe selection (75.8%), associated with higher scoring in the unhealthy dietary pattern during the lockdown. The lockdown in New Zealand saw an average decrease in nutritional quality of diets in the ‘COVID Kai Survey’, which could be partly explained by changes in food choice inspiration sources.

Getting airtime: Exploring how patients shape the stories they tell health practitioners

INTRODUCTION

Effective communication during health encounters is known to decrease patient complaints, increase patient adherence and optimise health outcomes. While the aim of patient-centred care is to find common ground, health practitioners tend to drive the encounter, often interrupting patients within the first minute of the clinical conversation. Optimal care for people with chronic illnesses requires individuals to interact with health practitioners regarding their health concerns, but given these constraints, we know little about how patients strategise conversations with their care providers. This understanding may further our efforts to educate health practitioners and trainees to learn and practice patient-centred care.

METHODS

A constructivist grounded theory approach with iterative data collection and analysis was used to explore the processes patients use to present and shape their stories for interactions with health practitioners. Twenty-one patients (n = 16 female; 5 male) representing a variety of chronic illnesses participated in semi-structured interviews. Using the constant comparative method of analysis, salient themes were ascertained.

RESULTS

Patients engage in extensive strategic preparations for productive health encounters. From the data, we identified four related elements comprising patients' process of planning, preparing, and strategising for health encounters: deciding to go, organising to get airtime, rehearsing a game plan, and anticipating external forces. By focusing on the extensive preparatory work patients engage in, our study expands the dimensions of how we understand illness-related work. Assembling personal health information, gathering disease information and achieving equanimity represent the dimensions of this 'health interaction work'.

CONCLUSION

The work patients engage in for health encounters is noteworthy yet often invisible. And work that is unseen may also be undervalued. Acknowledging, illuminating and valuing patients' preparatory work for health encounters add to how we understand patient-centred care, and this offers new targets for us to effectively teach and deliver it.

Trends, challenges, opportunities, and future needs of the dietetic workforce: a systematic scoping review

CONTEXT

Issues related to nutrition and health are prominent, yet it is unclear if the dietetics workforce is being used optimally.

OBJECTIVE

Trends, challenges, opportunities, and future needs of the international dietetic workforce are investigated in this review, which was registered with Open Science Framework (10.17605/OSF.IO/DXNWE).

DATA SOURCES

Eight academic and 5 grey-literature databases and the Google search engine were searched from 2010 onward according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Of 2050 articles screened, 184 were eligible for inclusion.

DATA EXTRACTION

To chart data, a directed content analysis and a constant comparison technique were used.

DATA ANALYSIS

The following 13 themes were identified: 1) emerging or expanding areas of practice; 2) skill development; 3) economic considerations; 4) nutrition informatics; 5) diversity within the workforce; 6) specific areas of practice; 7) further education; 8) intrapersonal factors; 9) perceptions of the profession; 10) protecting the scope of practice; 11) support systems; 12) employment outcomes; and 13) registration or credentialing.

CONCLUSIONS

The dietetics profession is aware of the need to expand into diverse areas of employment. Comprehensive workforce data are necessary to facilitate workforce planning.

Healthfulness Assessment of Recipes Shared on Pinterest: Natural Language Processing and Content Analysis

Background

Although Pinterest has become a popular platform for distributing influential information that shapes users’ behaviors, the role of recipes pinned on Pinterest in these behaviors is not well understood.

Objective

This study aims to explore the patterns of food ingredients and the nutritional content of recipes posted on Pinterest and to examine the factors associated with recipes that engage more users.

Methods

Data were collected from Pinterest between June 28 and July 12, 2020 (207 recipes and 2818 comments). All samples were collected via 2 new user accounts with no search history. A codebook was developed with a raw agreement rate of 0.97 across all variables. Content analysis and natural language processing sentiment analysis techniques were employed.

Results

Recipes using seafood or vegetables as the main ingredient had, on average, fewer calories and less sodium, sugar, and cholesterol than meat- or poultry-based recipes. For recipes using meat as the main ingredient, more than half of the energy was obtained from fat (277/490, 56.6%). Although the most followed pinners tended to post recipes containing more poultry or seafood and less meat, recipes with higher fat content or providing more calories per serving were more popular, having more shared photos or videos and comments. The natural language processing–based sentiment analysis suggested that Pinterest users weighted taste more heavily than complexity (225/2818, 8.0%) and health (84/2828, 2.9%).

Conclusions

Although popular pinners tended to post recipes with more seafood or poultry or vegetables and less meat, recipes with higher fat and sugar content were more user-engaging, with more photo or video shares and comments. Data on Pinterest behaviors can inform the development and implementation of nutrition health interventions to promote healthy recipe sharing on social media platforms.