Development and Validation of the General Dietary Behavior Inventory (GDBI) in Scope of International Nutrition Guidelines

Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process

BACKGROUND

The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model.

METHODS

Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions.

RESULTS

Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included.

CONCLUSIONS

Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.

Assessing Electronic Health Literacy in Individuals With the Post-COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study

BACKGROUND

The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post-COVID-19 condition. This is particularly important as people with the post-COVID-19 condition are frequently affected by false information from the internet.

OBJECTIVE

The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post-COVID-19 condition.

METHODS

A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status- and internet use-related variables, sociodemographic data, and (post)-COVID-19-related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed.

RESULTS

In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker-Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86).

CONCLUSIONS

The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post-COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post-COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS.

Le comportement alimentaire des étudiants de l'Université de Yaoundé I, Cameroun : entre la littératie alimentaire, la littératie en santé et l'e-littératie alimentaire

CONTEXTE

Il est connu que les maladies non transmissibles s'originent dans les habitudes et les choix alimentaires, et la littératie en santé est le meilleur déterminant de la santé d'un individu au 21e siècle. Or, cet aspect reste peu exploré en contexte camerounais. Dès lors, cette étude examine la relation entre la littératie en santé, la littératie alimentaire, la littératie alimentaire numérique et le comportement alimentaire des étudiants de l'Université de Yaoundé I.

MÉTHODES

Un total de 240 étudiants âgés de 18 à 48 ans (M = 21,97 ans, ET = 7,03), dont 149 (62,1 %) femmes, sélectionnés par commodité, ont rempli un questionnaire composite comprenant des échelles de mesure de la littératie en santé (Health Literacy Survey European Union Questionnaire Short Form), de la littératie alimentaire (Short Food Literacy Questionnaire), de la littératie alimentaire numérique (eHealth Literacy Scale) et du comportement alimentaire (General Dietary Behavior Inventory). Les données ont été analysées grâce au logiciel SPSS, v.20, en utilisant des tests de Mann-Whitney, de Kruskal-Wallis, de Spearman et des modèles linéaires généralisés.

RÉSULTATS

Les résultats ont montré que le comportement alimentaire n'est pas associé aux caractéristiques sociodémographiques des étudiants. L'analyse des modèles linéaires généralisés a démontré que le comportement alimentaire des étudiants est influencé par la littératie alimentaire (β = 1,503, p < 0,001), la littératie en santé (β = 1,191, p < 0,05) et la littératie alimentaire numérique (β = 1,263, p < 0,001). De même, prises ensemble, elles entrainent une variation de 6,929 sur le comportement alimentaire (χ²(3) = 63,070, β = 6,929, p < 0,001).

CONCLUSION

L'étude suggère que plus de recherches sur d'autres sous-groupes de population sont nécessaires afin de fournir des données pour des interventions en faveur d'une alimentation saine.

Exploring the Applicability of General Dietary Recommendations for People Affected by Obesity

(1) Obesity has emerged as a major public health challenge with increasing prevalence globally. The General Dietary Behavior Inventory (GDBI) was developed based on official dietary recommendations. However, little is known about whether general dietary recommendations also apply to people affected by obesity and whether the GDBI can be used appropriately. (2) A cross-sectional study was conducted. A total of 458 people meeting the inclusion criteria participated in the study. The assessment consisted of the GDBI and behavioral, dietary, and health-related variables. We used descriptive analysis to examine the item characteristics of the GDBI and inferential statistics to investigate the associations between the GDBI score and behavioral, dietary, and health-related outcomes. (3) Several items of the GDBI were concerned by ceiling effects. A higher GDBI score (indicating a higher adherence to dietary recommendations) was related to higher age, higher nutrition knowledge, more restrained eating behavior, lower impulsivity, and higher body mass index. There were no associations between the GDBI score and reported physical and mental health or quality of life. (4) The GDBI showed inconsistent relationships with the study outcomes. General dietary recommendations do not appear to be applicable to people with obesity. Hence, there is an urgent need for specific recommendations and subsequent assessments of behavioral adherence for people affected by obesity.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

Dietary experiences during fixed orthodontic treatment

Objectives:

Orthodontists generally recommend avoidance of certain foods during fixed appliance (FA) treatment, based on anecdotal information. This study aimed to identify the dietary preferences and experiences of patients undergoing FA treatment as a step toward the preparation of evidence-based dietary guidelines.

Material and Methods:

Questionnaires regarding dietary preferences and experiences of patients undergoing FA treatment were applied to a convenience sample of 38 adolescents (12 M; 26 F). Open-ended responses were summarized and visualized in a world cloud generator. 5-point Likert and Visual Analog Scales (VAS) were used to record the closed-ended responses. Descriptive statistics and multivariate analysis of variance were used to analyze questionnaire findings.

Results:

Lollies, apples, and nuts frequently caused problems with FA. The most frequent reason for avoiding certain types of food was worry about appliance breakage, followed by pain and sensitivity. VAS scores indicated that toffee and caramel scored highest (65.1% F and 54.1% M) for discomfort followed by corn on the cob (64.4% F and 48.7% M) and apples (56.6% F and 55.3% M). VAS scores did not differ significantly between the sexes (P > 0.05). Nearly, a quarter of the sample reported that FA negatively affected their eating behaviors, causing pain and discomfort during eating. No sex differences (P > 0.05) were found for negative experiences with food.

Conclusion:

Dietary preferences and experiences of patients undergoing FA treatment were identified concerning a New Zealand diet profile. A future study with a larger sample size will help formulate evidence-based dietary guidelines during FA treatment.

Development and Validation of Dietary Behavior Inventory-Surgery (DBI-S) in the Scope of International Post-Bariatric Surgery Guidelines and Recommendations

(1) Dietary behavior is highly relevant for patients after bariatric surgery. No instrument exists assessing adherence to medical guidelines concerning the dietary behavior of patients after bariatric surgery. The aim of this study was to develop and validate such an instrument. (2) Data from patients after bariatric surgery (n = 543) were collected from March to May 2022. The development of the DBI-S was theory-based and interdisciplinary. Items’ and content validity of the DBI-S were examined. (3) The final version of the DBI-S consists of 13 items. Convergent validation was confirmed by significant correlations between DBI-S score and attitude towards healthy food (r = 0.26, p = <0.001) and impulsivity (r = −0.26, p = <0.001). Criterion validity was confirmed by significant correlations between DBI-S score and pre-/post-surgery BMI difference (r = −0.14, p = 0.002), pre-/post-surgery weight difference (r = 0.13, p = 0.003), and quality of life (r = 0.19, p = <0.001). Cluster analysis confirmed the ability to distinguish between two dietary behavior clusters (rather healthy and rather unhealthy). (4) The DBI-S is an economic and valid instrument to assess the adherence of post-bariatric surgery patients to the relevant dietary behavior recommendations and guidelines and can distinguish between rather unhealthy and healthy dietary behavior.

Validation of the English Version of the General Dietary Behavior Inventory (GDBI-E)

In medical science and practice, dietary behavior is mostly assessed by item-extensive questionnaires (e.g., food-frequency-questionnaires) or by questionnaires focusing on psychological aspects of dietary behavior neglecting dietary quality or quantity. In consequence, these questionnaires do not capture the full bandwidth of dietary behavior or are less effective in the assessment of dietary behavior because of the large item pools. Therefore, the aim of this validation study was to translate the existing General Dietary Behavior Inventory (GDBI), which was constructed as a behavior-related, as well as effective, instrument, and verifying its construct and criterion validity. This inventory is based on the general nutrition recommendations of the World Health Organization (WHO). Our English-speaking convenience sample consisted of 263 participants. The study results confirmed convergent, as well as criterion validity of the English version of the GDBI (GDBI-E). Discriminant validity of the GDBI-E could mainly be verified. Different dietary behavior clusters were identified in a cluster analysis. The found clusters represented a rather healthy and a rather unhealthy dietary behavior in the sample according to the recommendations of the WHO. The results underpinned the validity of the GDBI-E. The GDBI-E is applicable in research and clinical practice to assess dietary behavior in the English-speaking population.

Body Mass Index, Practice of Physical Activity and Lifestyle of Students During COVID-19 Lockdown

Purpose

Several factors influence the student’s physical activity and lifestyle. The coronavirus disease (COVID‐19) lockdown has restricted student’s activity and altered their routine lifestyle. This prospective cohort study aimed to determine the significant changes in body mass index (BMI), physical activity, and lifestyle of the students including diet, sleep, and mental health before and during COVID-19 lockdown.

Methods

The study participants were 628 students studying bachelor’s degree programs, between 18 and 30 years of age, both genders from the university of Al-Ahsa, Saudi Arabia. The lockdown began on 23 March and ended on 21 June 2020 in Saudi Arabia. The students were interviewed before (March 2020) and during (June 2020) lockdown. The structured tool included baseline information of the students, anthropometric data, global physical activity questionnaire (GPAQ), dietary recall, Pittsburgh sleep quality index (PSQI), and perceived stress scale (PSP). Chi-square tests were used to associate the baseline information with BMI changes during the lockdown.

Results

BMI of the students showed that 32% increased their weight, 22% lost their weight and 46% maintained the same weight during COVID-19 lockdown. The physical activity significantly decreased and sedentary time increased (p = 0.0001). Regarding the lifestyle components, fast and fried food consumption decreased, and calorie intake increased significantly (p = 0.001). Stress level (p = 0.001) significantly decreased, and sleep level (p = 0.001) increased during lockdown. The variables associated with weight changes were the level of students (p < 0.05) and time spent on social media per day (p < 0.0001).

Conclusion

Though half of the students maintained the same BMI during the lockdown, students who increased BMI were associated with physical activity and lifestyle. Hence, health awareness on weight maintenance, active physical activities, and a healthy lifestyle must be created among the students, which help in creating and implementing policies in the future.

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