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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Ball K. Impact and process evaluation of a primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: pragmatic cluster non-randomized controlled trial. BMC Public Health 2024; 24:657. [PMID: 38429629 PMCID: PMC10905805 DOI: 10.1186/s12889-024-18079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. METHODS FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. RESULTS Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. CONCLUSIONS This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: [ACTRN12620001347954]- Registered prospectively on 14/12/2020.
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Affiliation(s)
- F Karpouzis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
- , Rose Bay Nth, Australia, PO Box 2108, NSW, 2030.
| | - R Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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Karimi N, Opie R, Crawford D, O'Connell S, Ball K. Digitally Delivered Interventions to Improve Nutrition Behaviors Among Resource-Poor and Ethnic Minority Groups With Type 2 Diabetes: Systematic Review. J Med Internet Res 2024; 26:e42595. [PMID: 38300694 PMCID: PMC10870209 DOI: 10.2196/42595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 06/22/2023] [Accepted: 07/30/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Resource-poor individuals, such as those with a low income, are disproportionately affected by diabetes and unhealthy eating patterns that contribute to poor disease self-management and prognosis. Digitally delivered interventions have the potential to address some of the barriers to healthy eating experienced by this group. However, little is known about their effectiveness in disadvantaged populations. OBJECTIVE This systematic review is conducted to assess the effectiveness of digitally delivered interventions in improving nutritional behaviors and nutrition-related health outcomes among disadvantaged people with type 2 diabetes (T2D). METHODS MEDLINE complete, Global Health, Embase, CINAHL complete, Informit Health, IEEE Xplore, and Applied Science and Technology Source databases were searched for studies published between 1990 and 2022 on digitally delivered nutrition interventions for disadvantaged people with T2D. Two reviewers independently assessed the studies for eligibility and determined the study quality using the Cochrane Risk-of-Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 was used to identify behavior change techniques used in the design of interventions. RESULTS Of the 2434 identified records, 10 (0.4%), comprising 947 participants, met the eligibility criteria and were included in the review. A total of 2 digital platforms, web and messaging services (eg, SMS text messaging interventions or multimedia messaging service), were used to deliver interventions. Substantial improvements in dietary behaviors were reported in 5 (50%) of the 10 studies, representing improvements in healthier food choices or increases in dietary knowledge and skills or self-efficacy. Of the 10 studies, 7 (70%) examined changes in blood glucose levels, of which 4 (57%) out of 7 achieved significant decreases in hemoglobin A1C levels ranging from 0.3% to 1.8%. The most frequently identified behavior change techniques across all studies were instruction on how to perform the behavior, information about health consequences, and social support. CONCLUSIONS This review provided some support for the efficacy of digitally delivered interventions in improving healthy eating behaviors in disadvantaged people with T2D, an essential dietary prerequisite for changes in clinical metabolic parameters. Further research is needed into how disadvantaged people with T2D may benefit more from digital approaches and to identify the specific features of effective digital interventions for supporting healthy behaviors among disadvantaged populations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020149844; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149844.
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Affiliation(s)
- Nazgol Karimi
- 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
| | - David Crawford
- 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
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Dening J, Mohebbi M, Abbott G, George ES, Ball K, Islam SMS. A web-based low carbohydrate diet intervention significantly improves glycaemic control in adults with type 2 diabetes: results of the T2Diet Study randomised controlled trial. Nutr Diabetes 2023; 13:12. [PMID: 37633959 PMCID: PMC10460437 DOI: 10.1038/s41387-023-00240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/14/2023] [Accepted: 06/29/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES In people with type 2 diabetes mellitus (T2DM), low carbohydrate diets (LCD), defined as 10-<26% total energy intake from carbohydrate, have indicated improved glycaemic control and clinical outcomes. Web-based interventions can help overcome significant challenges of accessibility and availability of dietary education and support for T2DM. No previous study had evaluated a web-based LCD intervention using a randomised controlled trial (RCT) design. The objective of this study was to assess whether a web-based LCD programme provided in conjunction with standard care improves glycaemic control in adults with T2DM. SUBJECTS/METHODS A 16-week parallel RCT was conducted remotely during Covid-19 among the general community, recruiting adults with T2DM not on insulin aged 40-89 years. Participants were randomly assigned (1:1) to standard care plus the web-based T2Diet healthy LCD education programme (intervention) or standard care only (control). The primary outcome was haemoglobin A1c (HbA1c). Secondary outcomes were weight, body mass index (BMI), anti-glycaemic medication, dietary intake, and self-efficacy. Blinded data analysis was conducted by intention-to-treat. RESULTS Ninety-eight participants were enrolled, assigning 49 to each group, with 87 participants (n = 40 intervention; n = 47 control) included in outcome analysis. At 16 weeks, there was a statistically significant between-group difference favouring the intervention group, with reductions in HbA1c -0.65% (95% CI: -0.99 to -0.30; p < 0.0001), weight -3.26 kg (p < 0.0001), BMI -1.11 kg/m2 (p < 0.0001), and anti-glycaemic medication requirements -0.40 (p < 0.0001), with large effect sizes Cohen's d > 0.8. CONCLUSION This study demonstrated that as an adjunct to standard care, the web-based T2Diet programme significantly improved glycaemic control and clinical outcomes in adults with T2DM. In addition, the results highlight the potential to improve access and availability for people with T2DM to achieve glycaemic control and improved health through web-based dietary education and support.
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
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Evans JT, Stanesby O, Blizzard L, Jose K, Sharman MJ, Ball K, Greaves S, Palmer AJ, Cooper K, Gall SL, Cleland VJ. trips4health: a single-blinded randomised controlled trial incentivising adult public transport use for physical activity gain. Int J Behav Nutr Phys Act 2023; 20:98. [PMID: 37587424 PMCID: PMC10428598 DOI: 10.1186/s12966-023-01500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Public transport users tend to accumulate more physical activity than non-users; however, whether physical activity is increased by financially incentivising public transport use is unknown. The trips4health study aimed to determine the impact of an incentive-based public transport intervention on physical activity. METHODS A single-blinded randomised control trial of a 16-week incentive-based intervention involved Australian adults who were infrequent bus users (≥ 18 years; used bus ≤ 2 times/week) split equally into intervention and control groups. The intervention group were sent weekly motivational text messages and awarded smartcard bus credit when targets were met. The intervention group and control group received physical activity guidelines. Accelerometer-measured steps/day (primary outcome), self-reported transport-related physical activity (walking and cycling for transport) and total physical activity (min/week and MET-min/week) outcomes were assessed at baseline and follow-up. RESULTS Due to the COVID pandemic, the trial was abandoned prior to target sample size achievement and completion of all assessments (N = 110). Steps/day declined in both groups, but by less in the intervention group [-557.9 steps (-7.9%) vs.-1018.3 steps/week (-13.8%)]. In the intervention group, transport-related physical activity increased [80.0 min/week (133.3%); 264.0 MET-min/week (133.3%)] while total physical activity levels saw little change [35.0 min/week (5.5%); 25.5 MET-min/week (1.0%)]. Control group transport-related physical activity decreased [-20.0 min/week (-27.6%); -41.3 MET-min/week (-17.3%)], but total physical activity increased [260.0 min/week (54.5%); 734.3 MET-min/week (37.4%)]. CONCLUSION This study found evidence that financial incentive-based intervention to increase public transport use is effective in increasing transport-related physical activity These results warrant future examination of physical activity incentives programs in a fully powered study with longer-term follow-up. TRIAL REGISTRATION This trial was registered with the Australian and New Zealand Clinical Trials Registry August 14th, 2019: ACTRN12619001136190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377914&isReview=true.
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Affiliation(s)
- Jack T Evans
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | - Oliver Stanesby
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | - Melanie J Sharman
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Stephen Greaves
- Institute of Transport and Logistics Studies, University of Sydney, Sydney, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
| | | | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Verity J Cleland
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart, TAS, 7000, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Salmon J, Arundell L, Cerin E, Ridgers ND, Hesketh KD, Daly RM, Dunstan D, Brown H, Della Gatta J, Della Gatta P, Chinapaw MJM, Shepphard L, Moodie M, Hume C, Brown V, Ball K, Crawford D. Transform-Us! cluster RCT: 18-month and 30-month effects on children's physical activity, sedentary time and cardiometabolic risk markers. Br J Sports Med 2023; 57:311-319. [PMID: 36428089 PMCID: PMC9985722 DOI: 10.1136/bjsports-2022-105825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the efficacy of the Transform-Us! school- and home-based intervention on children's physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles. METHODS A 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010-2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed. RESULTS At 18 months, there were intervention effects on children's weekday SB (-27 min, 95% CI: -47.3 to -5.3) for the PA intervention, and on children's average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children's average day SB (-33.3 min, 95% CI: -50.6 and -16.0) for the SB intervention. Children's BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters. CONCLUSIONS The Transform-Us! PA and SB interventions show promise as a pragmatic approach for reducing children's SB and adiposity indicators; but achieving substantial increases in PA remains challenging. TRIAL REGISTRATION ISRCTN83725066; ACTRN12609000715279.
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Affiliation(s)
- Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Lauren Arundell
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University Faculty of Health Sciences, Melbourne, Victoria, Australia
| | - Nicola Dawn Ridgers
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie D Hesketh
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Robin M Daly
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - David Dunstan
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Deakin University Centre for Sport Research, Geelong, Victoria, Australia
| | - Jacqui Della Gatta
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Paul Della Gatta
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lauren Shepphard
- Institute for Health Transformation, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Clare Hume
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Vicki Brown
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - David Crawford
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
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Mavragani A, Opie R, Crawford D, O'Connell S, Hamblin PS, Steele C, Ball K. Participants' and Health Care Providers' Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study. JMIR Form Res 2023; 7:e37429. [PMID: 36598815 PMCID: PMC9893734 DOI: 10.2196/37429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. OBJECTIVE This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. METHODS This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs' views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention; any concerns or barriers regarding the use of these types of interventions; and feedback from their interactions with patients on the intervention's content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. RESULTS In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. CONCLUSIONS The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19488.
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Affiliation(s)
| | - Rachelle Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.,Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, Deakin University, Geelong, Australia
| | - David Crawford
- 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, Melbourne, Australia.,Department of Medicine-Western Precinct, University of Melbourne, Melbourne, Australia
| | - Cheryl Steele
- Diabetes Education Services, Sunshine Hospital, Melbourne, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Dening J, Zacharia K, Ball K, George ES, Islam SMS. Exploring engagement with a web-based dietary intervention for adults with type 2 diabetes: A mixed methods evaluation of the T2Diet study. PLoS One 2022; 17:e0279466. [PMID: 36584072 PMCID: PMC9803196 DOI: 10.1371/journal.pone.0279466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Improved understanding of participant engagement in web-based dietary interventions is needed. Engagement is a complex construct that may be best explored through mixed methods to gain comprehensive insight. To our knowledge, no web-based dietary intervention in people with type 2 diabetes (T2D) has previously used a mixed methods approach. The aim of this study was to explore factors that may contribute to effective engagement in a web-based dietary program for people with T2D. METHODS This study employed a mixed methods intervention design, with a convergent design embedded for post-intervention evaluation. The convergent design collected and analyzed quantitative and qualitative data independent of each other, with the two datasets merged/compared during results/interpretation. Quantitative data collected from intervention group participants (n = 40) were self-administered questionnaires and usage data with average values summarized. Qualitative data were participant semi-structured interviews (n = 15) incorporating a deductive-inductive thematic analysis approach. RESULTS The results from the quantitative and qualitative data indicated positive overall engagement with the web-based dietary program. Factors that contributed to effective engagement were sustained frequency and intensity of engagement; structured weekly program delivery; participants affective engagement prior to and during the intervention, with positive affective states enhancing cognitive and behavioral engagement; and participants experience of value and reward. In addition, the user-centered development process employed prior to intervention delivery played an important role in facilitating positive engagement outcomes. CONCLUSION This study yielded novel findings by integrating qualitative and quantitative data to explore engagement with a web-based dietary program involving people with T2D. Effective engagement occurred in this intervention through a combination of factors related to usage and participants' affective, cognitive and behavioral states. The engagement outcomes that emerged will be useful to current and future researchers using digital technologies to deliver lifestyle interventions for T2D or other chronic health conditions.
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
- * E-mail:
| | - Karly Zacharia
- Faculty of Health & Medicine, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
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9
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Tighe SA, Ball K, Kayser L, Kensing F, Maddison R. Qualitative study of the views of people living with cardiovascular disease, and healthcare professionals, towards the use of a digital platform to support cardiovascular disease self-management. BMJ Open 2022; 12:e056768. [PMID: 36319055 PMCID: PMC9628687 DOI: 10.1136/bmjopen-2021-056768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This paper focuses on formative research as part of a broader study to develop and evaluate an innovative digital health platform for the self-management of cardiovascular disease (CVD). The primary objective is to better understand the perceptions of key stakeholders towards the proposed platform (Salvio) and to identify the development considerations they may prioritise based on their own experiences of CVD management. DESIGN A qualitative research study using thematic analysis to explore patterns and themes within the various participant contributions. SETTING Triangulation of data collection methods were used to generate data, including focus group discussions, semistructured interviews and guided conversations. PARTICIPANTS Participants (n=26) were people with a diagnosis of CVD (n=18) and relevant healthcare professionals (n=8). RESULTS Findings indicate that the proposed platform would be a beneficial solution for certain groups whose health behaviour change is not currently supported by discrete solutions. Both participant groups perceive the digital health platform more trustworthy than accessing multiple interventions through unsupported digital repositories. Healthcare professionals agreed that they would endorse an evidence-based platform that had been rigorously developed and evaluated. CVD participants prioritised a decision support tool to guide them through the platform, as they perceive an unstructured approach as overly complex. Both participant groups perceived data sharing with certain self-selected individuals (eg, spouse) to be a useful method for gaining support with their health behaviour change. CONCLUSIONS A digital health platform offering a variety of existing, evidence-based interventions would provide users with suitable self-management solution(s) based on their own individual needs and preferences. Salvio could be enhanced by providing adequate support to platform users, guiding the diverse CVD population through a host of digital solutions, ensuring that Salvio is endorsed by trusted healthcare professionals and maintaining connections with usual care. Such a platform would augment existing self-management and secondary prevention services.
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Affiliation(s)
- Sarah Anne Tighe
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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10
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Maple JL, Ananthapavan J, Ball K, Teychenne M, Moodie M. Economic evaluation of an incentive-based program to increase physical activity and reduce sedentary behaviour in middle-aged adults. BMC Health Serv Res 2022; 22:932. [PMID: 35854379 PMCID: PMC9297637 DOI: 10.1186/s12913-022-08294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incentive-based programs represent a promising approach for health insurers to encourage health-promoting behaviours. However, little is known about the value for money of such programs. This study aimed to determine the cost-effectiveness of the ACHIEVE (Active CHoices IncEntiVE) program designed to incentivise increased physical activity and reduced sedentary behaviour in middle-aged adults. METHODS A within-trial cost-efficacy analysis was conducted. Benefits were assessed by evaluating paired t-tests from participants' pre- and post- trial Body Mass Index (BMI) (kg/m2), sitting time (minutes/day) and metabolic equivalents (METS) minutes. A health sector perspective was adopted for the assessment of costs. Pathway analysis was used to determine the resource use associated with the intervention, with costs expressed in Australian dollars (A$) for the 2015 reference year. A long-term cost-effectiveness analysis was undertaken which extended the analysis time horizon and the trial population to the relevant eligible Australian population. Within this analysis, the 16-week intervention was modelled for roll-out across Australia over a 1-year time horizon targeting people with private health insurance who are insufficiently active and highly sedentary. Improved health related quality of life quantified in Health-Adjusted Life Years (HALYs) (based on the health impacts of increased metabolic equivalent (MET) minutes and reduced body mass index (BMI) and cost-offsets (resulting from reductions in obesity and physical inactivity-related diseases) were tracked until the cohort reached age 100 years or death. A 3% discount rate was used and all outcomes were expressed in 2010 values. Simulation modelling techniques were used to present 95% uncertainty intervals around all outputs. RESULTS The within-trial cost-efficacy analysis indicated that the ACHIEVE intervention cost approximately A$77,432. The cost per participant recruited was A$944. The incremental cost-effectiveness ratio (ICER) for MET increase per person per week was A$0.61; minute of sedentary time reduced per participant per day was A$5.15 and BMI unit loss per participant was A$763. The long-term cost effectiveness analysis indicated that if the intervention was scaled-up to all eligible Australians, approximately 265,095 participants would be recruited to the program at an intervention cost of A$107.4 million. Health care cost savings were A$33.4 million. Total HALYs gained were 2,709. The mean ICER was estimated at A$27,297 per HALY gained which is considered cost-effective in the Australian setting. CONCLUSION The study findings suggest that financial incentives to promote physical activity and reduce sedentary behaviour are likely to be cost-effective. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616000158460 (10/02/2016).
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Affiliation(s)
- Jaimie-Lee Maple
- Institute for Health and Sport, Victoria University, Footscray, Australia. .,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia.
| | - Jaithri Ananthapavan
- Deakin Health Economics, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre (GLOBE), Faculty of Health, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre (GLOBE), Faculty of Health, Institute of Health Transformation, Deakin University, Geelong, Australia
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Aktary M, Dunn S, Sajobi T, O'Hara H, Leblanc P, McCormack G, Caron-Roy S, Ball K, Lee YY, Nejatinamini S, Reimer R, Minaker L, Raine K, Godley J, Pan B, Downs S, Nykiforuk CI, Olstad DL. Impact of the British Columbia Farmers’ Market Nutrition Coupon Program on the Diet Quality of Low-Income Adults: A Randomized Controlled Trial. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac054.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Improving diet quality among low-income populations remains a public health priority. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Program (FMNCP) aims to improve the diet quality of low-income households by providing coupons to purchase healthy foods from BC farmers’ markets. This randomized controlled trial, conducted in 2019, examined the impact of the FMNCP on the diet quality of low-income adults.
Methods
Low-income adults ≥18 years were randomized to a FMNCP group (n = 143) that received 16 weeks’ worth of coupons valued at $21/week to purchase fruits, vegetables, dairy, meat, poultry, fish, eggs, and nuts from farmers’ markets, or to a no-intervention control group (n = 142). Participants completed data collection, including two 24-hour dietary recalls, at baseline (0 weeks), post-intervention (10–15 weeks), and 16 weeks post-intervention (26–31 weeks). Dietary intake data from the 24-hour dietary recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) total scores (primary outcome) and subscores (secondary outcomes). Total scores can range from 0–100, with a higher score indicating higher diet quality. Between-group differences in HEI-2015 total scores and subscores at post-intervention and 16 weeks post-intervention were examined using linear mixed effect models. Subgroup analyses were conducted to examine differences in program impacts according to sex and age group (18–59 years, ≥60 years).
Results
Most participants were female (90.5%) and < 60 years of age (79.7%). HEI-2015 total scores did not significantly differ between the FMNCP and control groups at post-intervention (−0.07; 95% CI −4.07, 3.93) or 16 weeks post-intervention (1.22; 95% CI −3.00, 5.44). No significant between-group differences in HEI-2015 scores by sex or age group were identified. HEI-2015 subscores did not significantly differ at post-intervention; however, at 16-weeks post-intervention, the FMNCP group had significantly lower subscores for fatty acids and significantly higher subscores for dairy compared to the control group.
Conclusions
Participation in the FMNCP did not result in significant changes in overall diet quality among low-income adults.
Funding Sources
Canadian Institutes of Health Research and the Maple Leaf Centre for Action on Food Security.
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Lindberg R, Cirone K, Larkin L, Ball K, Laws R, Margerison C. Strategies used by schools to tackle food insecurity and hunger: a qualitative enquiry in 15 Victorian schools. Aust N Z J Public Health 2022; 46:444-449. [PMID: 35679018 DOI: 10.1111/1753-6405.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Food insecurity is a threat to children's development and in Australia 13.5% of households experience food insecurity. Universal school food programs, however, are not provided nationally. Teachers and not-for-profit organisations have instead mobilised to tackle hunger. The strategies used and their effects on students have limited empirical evidence. The aim of this study is to gain perspectives on the causes and consequences of children's food insecurity in schools and describe food security strategies adopted. METHOD One hundred schools in Victoria, which participate in a not-for-profit lunch program provided by Eat Up were invited to take part in the study. Fifteen staff (including school principals and welfare officers) from 15 schools were recruited for semi-structured interviews. Results: There was evidence that children experience adverse quantity, quality, social and psychological impacts of food insecurity whilst in school settings. Participants described employing multiple strategies including free meals (e.g. lunch, breakfast) and food (e.g. parcels) for food insecure students and their families. Conclusions and implications for public health: In our sample, multiple strategies were being employed by schools to reduce food insecurity, but there remains unmet need for additional wide-scale initiatives to address this critical issue and its causes and consequences.
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Affiliation(s)
- Rebecca Lindberg
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Kathryn Cirone
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | | | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Claire Margerison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
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13
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Dening J, George ES, Ball K, Mohebbi M, Shariful Islam SM. Randomised controlled trial of a web-based low carbohydrate diet intervention for adults with type 2 diabetes: the T2Diet study protocol. BMJ Open 2022; 12:e054594. [PMID: 35190434 PMCID: PMC8862456 DOI: 10.1136/bmjopen-2021-054594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) management frequently involves a multidisciplinary care team. However, standard care for patients with T2D is the central role of the general practice physician, and consists of routine appointments to monitor glycaemic status and overall health. Dietary modification is an essential component of T2D management. Evidence suggests that a low carbohydrate diet (LCD) provides better clinical outcomes for people with T2D compared with other diets. However, providing dietary support in face-to-face settings is challenged by issues of availability and accessibility. Provided in conjunction with standard care, digital interventions can help bridge this gap. The objective of this paper is to describe the protocol of a randomised controlled trial (RCT) of a web-based intervention that will evaluate the effectiveness of standard care plus web-based LCD intervention when compared with standard care only. METHODS AND ANALYSIS In a two-arm parallel RCT, 100 adults with non-insulin-dependent T2D aged between 40 and 89 years will be randomised to either a theoretically informed 16-week automated web-based LCD intervention plus standard care or standard care only. LCD recommendations emphasise consuming nutrient-dense whole foods and encourage a daily carbohydrate goal of 50-100 g, with an objective of achieving 10% to <26% carbohydrates from total energy intake. Assessments will take place at baseline and 16 weeks. The primary outcome will be haemoglobin A1c. Additional data collected will include dietary intake, self-efficacy, weight and height, anti-diabetes medication and dosages, and diabetes-related comorbidities. Process evaluation will consist of a mixed-methods assessment of website engagement metrics, user experience and participants' perspectives. ETHICS AND DISSEMINATION All study procedures have been approved by the Deakin University Human Research Ethics Committee (2020-349). Study findings will be disseminated widely through public, professional and academic presentation and publication. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000096853).
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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14
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Thornton LE, Schroers RD, Lamb KE, Daniel M, Ball K, Chaix B, Kestens Y, Best K, Oostenbach L, Coffee NT. Operationalising the 20-minute neighbourhood. Int J Behav Nutr Phys Act 2022; 19:15. [PMID: 35151334 PMCID: PMC8841074 DOI: 10.1186/s12966-021-01243-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/23/2021] [Indexed: 01/25/2023] Open
Abstract
Background Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia’s second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia). Methods Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs. Results In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide’s 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne. Conclusions The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01243-3.
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15
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Dening J, George ES, Ball K, Islam SMS. User-centered development of a digitally-delivered dietary intervention for adults with type 2 diabetes: The T2Diet study. Internet Interv 2022; 28:100505. [PMID: 35242592 PMCID: PMC8861390 DOI: 10.1016/j.invent.2022.100505] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Web-based interventions can help address challenges of accessibility and availability of dietary support for people with type 2 diabetes (T2D). However, concerns regarding adherence and engagement in web-based interventions have been noted. Implementing a user-centered approach to intervention development has been shown to encourage better participant engagement. The overarching aim of this paper was to describe the user-centered approach used in the T2Diet Study to develop a new web-based dietary intervention for adults with T2D, exploring strategies for enhancing adherence and engagement. METHODS Intervention development was based on a flexible iterative user-centered approach to enable new product development. Twenty-one adults with T2D were engaged in six guided discussion groups across four iterative development phases, alongside reference to evidence and theory throughout the process. The phases of user inquiry progressed from broad discussion on areas to support dietary needs; to design feedback on aspects of site layout; through to further feedback on aesthetics and functionality; then into a two-week field test followed by final user inquiry and participation in user experience polls. A hybrid approach of thematic data analysis was used, incorporating both a data-driven inductive approach and a deductive approach based on a priori identification of themes. RESULTS Group discussion across the four phases highlighted factors the participants considered may motivate them to adhere and engage, which predominantly included relevance of resources, clear and simple positive communication, and flexibility for personal tailoring. Participant feedback provided an actionable list of intervention developments and input to inform intervention structure and theoretical framework. The two-week field test highlighted factors participants valued in terms of the user experience, most notably usability and accessibility. Additionally, the field test indicated a positive user experience, with no significant usability issues identified. CONCLUSION This paper provided the first detailed report of a user-centered approach to iterative development in the context of a web-based T2D dietary intervention. The insights will be useful to inform future digitally-delivered dietary interventions for adults with T2D or to inform a similar user-centered approach for other chronic health conditions.
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Affiliation(s)
- Jedha Dening
- Corresponding author at: Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia.
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Naing P, Musameh M, Vaidya S, Broyd C, Townsend A, Ball K, Oliver K, Hiskens M, Zhang Z. Intravascular Lithotripsy Catheter Balloon for Calcified Coronary Artery Intervention for the First 10 Cases at Mackay Base Hospital. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Wyse R, Delaney T, Stacey F, Lecathelinais C, Ball K, Zoetemeyer R, Lamont H, Sutherland R, Nathan N, Wiggers JH, Wolfenden L. Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e31734. [PMID: 34847063 PMCID: PMC8669584 DOI: 10.2196/31734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. Methods This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. Conclusions This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075
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Affiliation(s)
- Rebecca Wyse
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Hannah Lamont
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - John H Wiggers
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
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Fraser K, Love P, Campbell KJ, Ball K, Opie RS. Meal kits in the family setting: Impacts on family dynamics, nutrition, social and mental health. Appetite 2021; 169:105816. [PMID: 34801628 DOI: 10.1016/j.appet.2021.105816] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
Families face many barriers in providing nutritious home-cooked family meals. Meal kit subscription services are increasingly popular among families and may address obstacles to cooking at home and facilitate shared family meals. This study aimed to understand why families use meal kits and what they perceived to be the main impacts on family dynamics, nutrition, social and mental health. Sixteen primary meal providers with at least one child 18 years and under living at home, were recruited via social media (e.g., Facebook, Twitter) to participate in a semi-structured interview using Zoom videoconferencing. Interviews were conducted with participants who currently purchased and used commercially available meal kits in Australia (e.g., HelloFresh, Marley Spoon). Thematic analysis of interview transcripts revealed that women, as the primary carers responsible for family meals, primarily reported the role that meal kits played in reducing their mental load through reduced food-related decision making, enhanced family participation in meal preparation, and opportunities for food literacy. Additionally, meal kits were reported to reduce food eaten away-from-home with the majority of participants perceiving meal kits to provide nutritionally dense meals and appropriate portion sizes aligned with National dietary guidelines. This study provides important insights into the potential physical, mental and social health benefits of meal kits in supporting families to cook and eat meals together at home. While meal kits have the capacity to positively influence population health and wellbeing, it is necessary that meal kit subscription services address the nutritional quality of their meals and provide evidence-based nutrition messaging to facilitate improvements in food literacy and nutritional intake.
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Affiliation(s)
- Kylie Fraser
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood Victoria, 3125, Australia.
| | - Penny Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood Victoria, 3125, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood Victoria, 3125, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood Victoria, 3125, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood Victoria, 3125, Australia
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Lamb KE, Crawford D, Thornton LE, Shariful Islam SM, Maddison R, Ball K. Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries. BMC Public Health 2021; 21:2108. [PMID: 34789208 PMCID: PMC8597224 DOI: 10.1186/s12889-021-12131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12131-7.
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Affiliation(s)
- Karen E Lamb
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. .,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - David Crawford
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Lukar E Thornton
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Sheikh M Shariful Islam
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Ralph Maddison
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Kylie Ball
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
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Bahri S, Malcomson B, Ball K, Bhrambhatt D, Beatty J. 714 An Evaluation of The Discontinuation of Tamsulosin and Finasteride Post Transurethral Resection of The Prostate (TURP) At UHL. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
A significant proportion of men suffer from lower urinary tract symptoms (LUTS) secondary to prostatic enlargement. If medical management of BPH fails surgical transurethral resection of the prostate maybe required. The continuation of pharmacological therapy post operatively is redundant, however it was noted that several patients remained on these medications post TURP. The aim of this project was to identify if patients following surgical intervention were discontinued from preexisting medications that became redundant post operatively.
Method
A retrospective analysis was performed of patients who underwent TURPs between July- December 2019 within the University Hospitals of Leicester NHS trust to assess if patients preexisting medications used for the treatment of LUTS were discontinued post operatively.
Results
In the above time frame, 104 TURPs were performed in the trust. Out of these, 89 men were already on 5-alpha reductase inhibitors and/or alpha blocker, predominantly tamsulosin and finasteride. Of the 89 men, only 46 were given a clear instruction to stop these drugs on discharge.
Conclusions
Continuation of the above medication is unnecessary post TURPs with potentially avoidable side effects for patients and an unnecessary expense. A series of changes were implemented to improve practice. These will be reevaluated on the recommencement of TURPs following the covid-19 pandemic.
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Affiliation(s)
- S Bahri
- University Hospitals of Leicester, Leicester, United Kingdom
| | - B Malcomson
- University Hospitals of Leicester, Leicester, United Kingdom
| | - K Ball
- University Hospitals of Leicester, Leicester, United Kingdom
| | - D Bhrambhatt
- University Hospitals of Leicester, Leicester, United Kingdom
| | - J Beatty
- University Hospitals of Leicester, Leicester, United Kingdom
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21
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Veitch J, Ball K, Rivera E, Loh V, Deforche B, Timperio A. Understanding children's preference for park features that encourage physical activity: an adaptive choice based conjoint analysis. Int J Behav Nutr Phys Act 2021; 18:133. [PMID: 34627280 PMCID: PMC8501594 DOI: 10.1186/s12966-021-01203-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background Parks are a key setting for physical activity for children. However, little is known about which park features children prefer and which features are most likely to encourage them to be active in parks. This study examined the relative importance of park features among children for influencing their choice of park for engaging in park-based physical activity. Methods Children (n = 252; 8-12 years, 42% male) attending three primary schools in Melbourne, Australia completed a survey at school. They were required to complete a series of Adaptive Choice-Based Conjoint analysis tasks, with responses used to identify the part-worth utilities and relative importance scores of selected park features using Hierarchical Bayes analyses within Sawtooth Software. Results For the overall sample and both boys and girls, the most important driver of choice for a park that would encourage them to be active was presence of a flying fox (overall conjoint analysis relative importance score: 15.8%; 95%CI = 14.5, 17.1), followed by a playground (13.5%; 95%CI = 11.9, 15.2). For the overall sample, trees for climbing had the third highest importance score (10.2%; 95%CI = 8.9, 11.6); however, swings had 3rd highest importance for girls (11.1, 95%CI = 9.3, 12.9) and an obstacle course/parkour area had the 3rd highest importance score for boys (10.7, 95%CI = 9.0, 12.4). For features with two levels, part-worth utility scores showed that the presence of a feature was always preferred over the absence of a feature. For features with multiple levels, long flying foxes, large adventure playgrounds, lots of trees for climbing, large round swings, large climbing equipment, and large grassy open space were the preferred levels. Conclusion To ensure parks appeal as a setting that encourages children to engage in physical activity, park planners and local authorities and organisations involved in park design should prioritise the inclusion of a long flying fox, large adventure playgrounds, lots of trees for climbing, large round swings and obstacle courses/parkour areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01203-x.
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Affiliation(s)
- Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia. .,, Burwood, Australia.
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elise Rivera
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Venurs Loh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Movement and Nutrition for Health and Performance Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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22
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Wyse R, Delaney T, Stacey F, Zoetemeyer R, Lecathelinais C, Lamont H, Ball K, Campbell K, Rissel C, Attia J, Wiggers J, Yoong SL, Oldmeadow C, Sutherland R, Nathan N, Reilly K, Wolfenden L. Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e26054. [PMID: 34491207 PMCID: PMC8456336 DOI: 10.2196/26054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. Objective This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. Methods The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. Results From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. Conclusions Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-030538
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Affiliation(s)
- Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | | | - Hannah Lamont
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Karen Campbell
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Chris Rissel
- School of Public Health, University of Sydney, Sydney, Australia
| | - John Attia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | | | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia
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23
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Vogel C, Crozier S, Penn-Newman D, Ball K, Moon G, Lord J, Cooper C, Baird J. Altering product placement to create a healthier layout in supermarkets: Outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study. PLoS Med 2021; 18:e1003729. [PMID: 34491999 PMCID: PMC8423266 DOI: 10.1371/journal.pmed.1003729] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous product placement trials in supermarkets are limited in scope and outcome data collected. This study assessed the effects on store-level sales, household-level purchasing, and dietary behaviours of a healthier supermarket layout. METHODS AND FINDINGS This is a prospective matched controlled cluster trial with 2 intervention components: (i) new fresh fruit and vegetable sections near store entrances (replacing smaller displays at the back) and frozen vegetables repositioned to the entrance aisle, plus (ii) the removal of confectionery from checkouts and aisle ends opposite. In this pilot study, the intervention was implemented for 6 months in 3 discount supermarkets in England. Three control stores were matched on store sales and customer profiles and neighbourhood deprivation. Women customers aged 18 to 45 years, with loyalty cards, were assigned to the intervention (n = 62) or control group (n = 88) of their primary store. The trial registration number is NCT03518151. Interrupted time series analysis showed that increases in store-level sales of fruits and vegetables were greater in intervention stores than predicted at 3 (1.71 standard deviations (SDs) (95% CI 0.45, 2.96), P = 0.01) and 6 months follow-up (2.42 SDs (0.22, 4.62), P = 0.03), equivalent to approximately 6,170 and approximately 9,820 extra portions per store, per week, respectively. The proportion of purchasing fruits and vegetables per week rose among intervention participants at 3 and 6 months compared to control participants (0.2% versus -3.0%, P = 0.22; 1.7% versus -3.5%, P = 0.05, respectively). Store sales of confectionery were lower in intervention stores than predicted at 3 (-1.05 SDs (-1.98, -0.12), P = 0.03) and 6 months (-1.37 SDs (-2.95, 0.22), P = 0.09), equivalent to approximately 1,359 and approximately 1,575 fewer portions per store, per week, respectively; no differences were observed for confectionery purchasing. Changes in dietary variables were predominantly in the expected direction for health benefit. Intervention implementation was not within control of the research team, and stores could not be randomised. It is a pilot study, and, therefore, not powered to detect an effect. CONCLUSIONS Healthier supermarket layouts can improve the nutrition profile of store sales and likely improve household purchasing and dietary quality. Placing fruits and vegetables near store entrances should be considered alongside policies to limit prominent placement of unhealthy foods. TRIAL REGISTRATION ClinicalTrials.gov NCT03518151 (pre-results).
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Daniel Penn-Newman
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
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24
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Stacey F, Delaney T, Ball K, Zoetemeyer R, Lecathelinais C, Wolfenden L, Seward K, Wyse R. A Cluster Randomized Controlled Trial Evaluating the Impact of Tailored Feedback on the Purchase of Healthier Foods from Primary School Online Canteens. Nutrients 2021; 13:2405. [PMID: 34371914 PMCID: PMC8308818 DOI: 10.3390/nu13072405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students' lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider ('Flexischools') were randomized to either: a graph and prompt showing the proportion of 'everyday' foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students; n = 7604 orders). Primary outcomes were the proportion of foods classified as 'everyday' or 'caution'. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of 'everyday' (OR 0.99; p = 0.88) or 'caution' items purchased (OR 1.17; p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ; p-0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of 'everyday' or 'caution' foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.
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Affiliation(s)
- Fiona Stacey
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC 3125, Australia;
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kirsty Seward
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; (T.D.); (R.Z.); (C.L.); (L.W.); (K.S.); (R.W.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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Sponselee HCS, Kroeze W, Poelman MP, Renders CM, Ball K, Steenhuis IHM. Food and health promotion literacy among employees with a low and medium level of education in the Netherlands. BMC Public Health 2021; 21:1273. [PMID: 34193103 PMCID: PMC8243473 DOI: 10.1186/s12889-021-11322-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prior research indicates a positive association between socioeconomic position and health literacy levels. We hypothesize comparable socioeconomic gradients for food literacy. This study aims to determine the level of self-perceived food literacy and health promotion literacy among adults with a low and medium level of education and from various subgroups, as well as the association between these food and health literacy levels. Furthermore, this study aims to explore the associations of self-perceived food literacy (SPFL) and health promotion literacy (HPL) in BMI. METHODS A cross-sectional study was conducted among employees with a low and medium level of education. Descriptive analyses were performed to compute SPFL and HPL levels. Analyses of variance were performed to test differences between subgroups. The correlation between SPFL and HPL was computed by Pearson's r. Multivariate linear regression analyses were used to explore 1) the association between SPFL and HPL adjusted for demographic characteristics 2) the associations between SPFL and HPL in BMI. RESULTS The majority (63.1%) of all participants (n = 222) scored low on SPFL and 34.5% scored inadequate or problematic on HPL. No significant educational or weight-status differences were found in SPFL or HPL levels. On most levels, women compared to men and older compared to younger employees scored significantly higher. A small positive correlation between the two mean levels was found, r = .25, P < .001 (n = 203). Multivariate linear regression analyses showed a significant association between SPFL and HPL (B = .31, 95% CI = .15-.48). No significant associations between SPFL and HPL in BMI were found. CONCLUSIONS This study suggests there is room for improvement in SPFL and HPL among adults with a low and medium level of education. Future research should consider comparing low and middle socioeconomic with high socioeconomic groups when exploring food and health literacy. Regarding health promotion activities for adults with a low and medium level of education, it is recommended to focus on improving both food and health literacy. Furthermore, more research is needed to explore direct proxies of weight-status to better understand the role of food and health literacy in overweight patterns.
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Affiliation(s)
- Hanne C S Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, 1081 HV, Amsterdam, Netherlands.
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, 1081 HV, Amsterdam, Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, 6717 JS, Ede, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University and Research, 6700 EW, Wageningen, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, 1081 HV, Amsterdam, Netherlands
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, 1081 HV, Amsterdam, Netherlands
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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Lai J, Berner A, Ball K. Evaluating OzHarvest's primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: protocol for a pragmatic cluster non-randomized controlled trial. BMC Public Health 2021; 21:967. [PMID: 34022839 PMCID: PMC8140478 DOI: 10.1186/s12889-021-10302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background The promotion of healthy eating is a public health priority. Poor dietary behaviours, including low fruit and vegetable (F&V) consumption are of particular concern among children. Novel nutrition promotion strategies are needed to improve F&V consumption. Sustainability education could be used to support nutrition education within the school context. The purpose of this paper is to report the protocol for impact and process evaluation of the school-based Food Education and Sustainability Training (FEAST) program, designed to educate children about sustainability, food waste and nutrition, using hands-on cooking activities. Methods A pragmatic, parallel, cluster non-randomized controlled trial with pre- and post-measures, will be implemented among 20 primary schools (10 intervention vs 10 wait-list-control) within NSW, Australia, involving children in Grades 5–6. FEAST is a curriculum-aligned program, delivered as a 1.5-h lesson/week, for a 10-week unit of inquiry, incorporating theory and cooking. FEAST was developed using theoretical frameworks which included Social Cognitive Theory and the Precede-Proceed Planning model. Primary outcomes include children’s self-reported F&V intakes (serves/day). Food literacy constructs such as: nutrition knowledge, food preparation and cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours and food production knowledge, will be assessed as secondary outcomes. Process evaluation will assess program reach, adoption, implementation, maintenance, satisfaction and perceived benefits by teachers and students. An online survey (including quantitative and qualitative questions) was developed for administration at baseline (impact evaluation) and immediately post-intervention (impact and process evaluation). Intervention effects on quantitative study outcomes will be estimated with generalised linear mixed models, including random effects and will follow the intention-to-treat principles. Open-ended questions embedded within the surveys will be analysed qualitatively using content and thematic analyses. Discussion Results from this trial will provide valuable information on the value of adding environmental sustainability strategies to nutrition education in schools. Results will inform the design of future research and programs focused on primary-school children’s nutrition, sustainability-related behaviours and experiential school-based interventions. Trial registration Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10302-0.
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Affiliation(s)
- F Karpouzis
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
| | - R Lindberg
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - J Lai
- eResearch, Deakin University, Melbourne, VIC, Australia.,Intersect Australia, Sydney, NSW, Australia
| | - A Berner
- OzHarvest, Sydney, NSW, Australia
| | - K Ball
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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Ridgers ND, Timperio A, Ball K, Lai SK, Brown H, Macfarlane S, Salmon J. Effect of commercial wearables and digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas: the RAW-PA cluster-randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:52. [PMID: 33845853 PMCID: PMC8042874 DOI: 10.1186/s12966-021-01110-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/11/2021] [Indexed: 02/05/2023] Open
Abstract
Background There has been increasing interest in using wearable activity trackers to promote physical activity in youth. This study examined the short- and longer-term effects of a wearable activity tracker combined with digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas. Methods The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week, multicomponent intervention that combined a Fitbit Flex (and accompanying app), and online digital behaviour change resources and weekly challenges delivered via Facebook. RAW-PA was evaluated using a cluster-randomised controlled trial with 275 adolescents (50.2% female; 13.7 ± 0.4 years) from 18 Melbourne secondary schools (intervention n = 9; wait-list control group n = 9). The primary outcome was moderate- to vigorous-intensity physical activity (MVPA), measured using hip-worn ActiGraph accelerometers. The secondary outcome was self-reported physical activity. Data were collected at baseline, 12-weeks (immediately post-intervention), and 6-months post-intervention (follow-up). Multilevel models were used to determine the effects of the intervention on daily MVPA over time, adjusting for covariates. Results No significant differences were observed between intervention and wait-list control adolescents’ device-assessed MVPA immediately post-intervention. At 6-months post-intervention, adolescents in the intervention group engaged in 5 min (95% CI: − 9.1 to − 1.0) less MVPA per day than those in the wait-list control group. Males in the intervention group engaged in 11 min (95% CI: − 17.6 to − 4.5) less MVPA than males in the wait-list control group at 6-months post-intervention. No significant differences were observed for females at either time point. For self-reported physical activity, no significant effects were found at 12-weeks and 6-months post-intervention. Conclusions Combining a wearable activity tracker with digital behaviour change resources and weekly challenges did not increase inactive adolescents’ accelerometer-derived and self-reported physical activity levels immediately post-intervention. This contrasts previous research that has suggested wearable activity tracker may increase youth physical activity levels in the short-term. Lower engagement in MVPA 6-months post-intervention was observed for males but not for females, though it is unclear why this finding was observed. The results suggest wearable activity trackers, in combination with supporting materials, may not be effective for increasing physical activity levels in adolescents. Trial registration ACTRN12616000899448. Australian and New Zealand Clinical Trials Registry. Registered 7 July 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01110-1.
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Affiliation(s)
- Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Samuel K Lai
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Helen Brown
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Susie Macfarlane
- Learning Futures, Deakin University, Burwood, Victoria, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Teychenne M, Apostolopoulos M, Ball K, Olander EK, Opie RS, Rosenbaum S, Laws R. Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study. BMC Public Health 2021; 21:361. [PMID: 33593324 PMCID: PMC7885569 DOI: 10.1186/s12889-021-10394-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Physical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform the design and delivery of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up. Methods A descriptive qualitative study was undertaken whereby semi-structured interviews were conducted with representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11). Interviews were conducted between September to November 2019 and explored stakeholder perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Data were analysed thematically using both deductive and inductive coding. Results The relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with ‘adjunct’ programs and services. Conclusions While the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10394-8.
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Affiliation(s)
- Megan Teychenne
- Deakin University, Geelong, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Maria Apostolopoulos
- Deakin University, Geelong, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Kylie Ball
- Deakin University, Geelong, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Rachelle S Opie
- Deakin University, Geelong, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia
| | - Rachel Laws
- Deakin University, Geelong, Australia. .,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
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29
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Teychenne M, Abbott G, Stephens LD, Opie RS, Olander EK, Brennan L, van der Pligt P, Apostolopoulos M, Ball K. Mums on the Move: A pilot randomised controlled trial of a home-based physical activity intervention for mothers at risk of postnatal depression. Midwifery 2020; 93:102898. [PMID: 33290891 DOI: 10.1016/j.midw.2020.102898] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postnatal women are commonly physically inactive, and, when coupled with depressive symptoms, barriers to physical activity can be heightened. This study aimed to 1) examine the feasibility and acceptability of a multi-component home-based physical activity intervention delivered to mothers at risk of postnatal depression, and 2) examine changes in health behaviours (physical activity, sedentary behaviour, sleep, diet) and indicators of mental health. METHODS Sixty-two mothers (3 - 9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms were recruited into a 12-week randomised controlled trial in 2018. Participants were randomised into either a) Intervention group (receiving a theoretically underpinned multi-component program including free exercise equipment at home, access to smartphone web-app, and an online forum); or b) Control group (usual routine). Primary outcomes were program feasibility and acceptability. Secondary outcomes included self-reported and accelerometer-assessed physical activity and sedentary behavior, sleep, diet, determinants of physical activity, and mental health (depressive and anxiety symptoms), measured at baseline and follow-up (12-weeks), with self-reported physical activity, sedentary behaviour and depressive symptoms also measured at weeks 4 and 8. Qualitative data was analysed following inductive content analysis, and quantitative data using linear mixed models. RESULTS Exercise equipment use in the home was shown to be a feasible strategy to re-engage postnatal women in physical activity. Other components of the program (e.g. web-app, online forum) had low compliance. The program had high acceptability, predominately due to its accessibility, flexibility and ability to overcome key barriers to physical activity. The program resulted in improvements in short-term self-reported physical activity (increased 162min/week at 4 weeks, 95% CI: 37.7, 286.2), behavioural skills (B=0.4, 95% CI: 0.0, 0.8) and perceived barriers to physical activity. However, accelerometer measured physical activity decreased in the intervention group, compared to control group at week 12 (B=-1.3, 95% CI:-2.5, -0.1). There were no changes in other outcomes. CONCLUSIONS A home-based physical activity program involving free exercise equipment is acceptable and feasible amongst women experiencing heightened postnatal depressive symptoms. Such programs may be effective in increasing engagement in physical activity, yet additional strategies may be needed to enhance maintenance of physical activity and improvements in mental health.
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Affiliation(s)
- Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Victoria, Australia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maria Apostolopoulos
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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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
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Dangerfield F, Lamb KE, Oostenbach LH, Ball K, Thornton LE. Correction: Urban-regional patterns of food purchasing behaviour: a cross-sectional analysis of the 2015-2016 Australian Household Expenditure Survey. Eur J Clin Nutr 2020; 75:733. [PMID: 33139854 DOI: 10.1038/s41430-020-00791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fiona Dangerfield
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
| | - Karen E Lamb
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.,Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Laura H Oostenbach
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Kylie Ball
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Lukar E Thornton
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
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Tighe SA, Ball K, Kensing F, Kayser L, Rawstorn JC, Maddison R. Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions. J Med Internet Res 2020; 22:e16774. [PMID: 33112239 PMCID: PMC7657720 DOI: 10.2196/16774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. OBJECTIVE This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. METHODS A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. CONCLUSIONS Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
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Affiliation(s)
- Sarah A Tighe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Finn Kensing
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang KL, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chimed-Ochir O, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Classen TKD, Cohen AJ, Compton K, Cooper OR, Costa VM, Cousin E, Cowden RG, Cross DH, Cruz JA, Dahlawi SMA, Damasceno AAM, Damiani G, Dandona L, Dandona R, Dangel WJ, Danielsson AK, Dargan PI, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davitoiu DV, De Leo D, Degenhardt L, DeLang M, Dellavalle RP, Demeke FM, Demoz GT, Demsie DG, Denova-Gutiérrez E, Dervenis N, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dibaji Forooshani ZS, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshmangir L, Driscoll TR, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Elyazar IRF, Emmons-Bell S, Erskine HE, Eskandarieh S, Esmaeilnejad S, Esteghamati A, Estep K, Etemadi A, Etisso AE, Fanzo J, Farahmand M, Fareed M, Faridnia R, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrara G, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Flor LS, Foigt NA, Folayan MO, Fomenkov AA, Force LM, Foroutan M, Franklin RC, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Gallus S, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebreslassie AAAA, Geremew A, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghaffarifar F, Ghafourifard M, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Ghosh R, Gill PS, Ginindza TGG, Giussani G, Gnedovskaya EV, Goharinezhad S, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Greaves F, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Gupta T, Haddock B, Hafezi-Nejad N, Hafiz A, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Halvaei I, Hamadeh RR, Hamidi S, Hammer MS, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hasan MM, Hasanpoor E, Hashi A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay SI, Hayat K, Heidari G, Heidari-Soureshjani R, Henrikson HJ, Herbert ME, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Holla R, Hoogar P, Hosgood HD, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Hsieh VCR, Hu G, Hu K, Huda TM, Humayun A, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikeda N, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Iqbal U, Irvani SSN, Irvine CMS, Islam MM, Islam SMS, Iso H, Ivers RQ, Iwu CCD, Iwu CJ, Iyamu IO, Jaafari J, Jacobsen KH, Jafari H, Jafarinia M, Jahani MA, Jakovljevic M, Jalilian F, James SL, Janjani H, Javaheri T, Javidnia J, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Johansson L, John O, John-Akinola YO, Johnson CO, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karim MA, Kassa GM, Katikireddi SV, Kayode GA, Kazemi Karyani A, Keiyoro PN, Keller C, Kemmer L, Kendrick PJ, Khalid N, Khammarnia M, Khan EA, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khazaei S, Kieling C, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Knibbs LD, Knudsen AKS, Kocarnik JM, Kochhar S, Kopec JA, Korshunov VA, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kromhout H, Kuate Defo B, Kumar GA, Kumar V, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lallukka T, Lami FH, Landires I, Lang JJ, Langan SM, Larsson AO, Lasrado S, Lauriola P, Lazarus JV, Lee PH, Lee SWH, LeGrand KE, Leigh J, Leonardi M, Lescinsky H, Leung J, Levi M, Li S, Lim LL, Linn S, Liu S, Liu S, Liu Y, Lo J, Lopez AD, Lopez JCF, Lopukhov PD, Lorkowski S, Lotufo PA, Lu A, Lugo A, Maddison ER, Mahasha PW, Mahdavi MM, Mahmoudi M, Majeed A, Maleki A, Maleki S, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mantilla Herrera AM, Maravilla JC, Marks A, Martin RV, Martini S, Martins-Melo FR, Masaka A, Masoumi SZ, Mathur MR, Matsushita K, Maulik PK, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mereke A, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mills EJ, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei R, Mirzaei-Alavijeh M, Misganaw AT, Mithra P, Moazen B, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed AS, Mohammed H, Mohammed JA, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morawska L, Morgado-da-Costa J, Morrison SD, Mosapour A, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Mukhopadhyay S, Mullany EC, Musa KI, Muthupandian S, Nabhan AF, Naderi M, Nagarajan AJ, Nagel G, Naghavi M, Naghshtabrizi B, Naimzada MD, Najafi F, Nangia V, Nansseu JR, Naserbakht M, Nayak VC, Negoi I, Ngunjiri JW, Nguyen CT, Nguyen HLT, Nguyen M, Nigatu YT, Nikbakhsh R, Nixon MR, Nnaji CA, Nomura S, Norrving B, Noubiap JJ, Nowak C, Nunez-Samudio V, Oţoiu A, Oancea B, Odell CM, Ogbo FA, Oh IH, Okunga EW, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omer MO, Ong KL, Onwujekwe OE, Orpana HM, Ortiz A, Osarenotor O, Osei FB, Ostroff SM, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Palladino R, Panda-Jonas S, Pandey A, Parry CDH, Pasovic M, Pasupula DK, Patel SK, Pathak M, Patten SB, Patton GC, Pazoki Toroudi H, Peden AE, Pennini A, Pepito VCF, Peprah EK, Pereira DM, Pesudovs K, Pham HQ, Phillips MR, Piccinelli C, Pilz TM, Piradov MA, Pirsaheb M, Plass D, Polinder S, Polkinghorne KR, Pond CD, Postma MJ, Pourjafar H, Pourmalek F, Poznańska A, Prada SI, Prakash V, Pribadi DRA, Pupillo E, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiee A, Raggi A, Rahman MA, Rajabpour-Sanati A, Rajati F, Rakovac I, Ram P, Ramezanzadeh K, Ranabhat CL, Rao PC, Rao SJ, Rashedi V, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Rawat R, Razo C, Redford SB, Reiner RC, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro DC, Ribeiro D, Rickard J, Rivera JA, Roberts NLS, Rodríguez-Ramírez S, Roever L, Ronfani L, Room R, Roshandel G, Roth GA, Rothenbacher D, Rubagotti E, Rwegerera GM, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Sadeghi M, Saeedi R, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sajadi SM, Salam N, Salamati P, Salem H, Salem MRR, Salimzadeh H, Salman OM, Salomon JA, Samad Z, Samadi Kafil H, Sambala EZ, Samy AM, Sanabria J, Sánchez-Pimienta TG, Santomauro DF, Santos IS, Santos JV, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Schaeffer LE, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serdar B, Serre ML, Shadid J, Shafaat O, Shahabi S, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsizadeh M, Sharafi K, Sheikh A, Sheikhtaheri A, Shibuya K, Shield KD, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shuval K, Siabani S, Sierpinski R, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Simpson KE, Singh JA, Singh P, Skiadaresi E, Skou ST, Skryabin VY, Smith EUR, Soheili A, Soltani S, Soofi M, Sorensen RJD, Soriano JB, Sorrie MB, Soshnikov S, Soyiri IN, Spencer CN, Spotin A, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein C, Stein DJ, Steiner C, Stockfelt L, Stokes MA, Straif K, Stubbs JL, Sufiyan MB, Suleria HAR, Suliankatchi Abdulkader R, Sulo G, Sultan I, Szumowski Ł, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taherkhani A, Tajdini M, Takahashi K, Takala JS, Tamiru AT, Taveira N, Tehrani-Banihashemi A, Temsah MH, Tesema GA, Tessema ZT, Thurston GD, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Tsatsakis A, Tudor Car L, Tyrovolas S, Uddin R, Umeokonkwo CD, Unnikrishnan B, Upadhyay E, Vacante M, Valdez PR, van Donkelaar A, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vos T, Vukovic R, Waheed Y, Wallin MT, Wang Y, Wang YP, Watson A, Wei J, Wei MYW, Weintraub RG, Weiss J, Werdecker A, West JJ, Westerman R, Whisnant JL, Whiteford HA, Wiens KE, Wolfe CDA, Wozniak SS, Wu AM, Wu J, Wulf Hanson S, Xu G, Xu R, Yadgir S, Yahyazadeh Jabbari SH, Yamagishi K, Yaminfirooz M, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yeheyis TY, Yilgwan CS, Yilma MT, Yip P, Yonemoto N, Younis MZ, Younker TP, Yousefi B, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yu C, Yusefzadeh H, Zahirian Moghadam T, Zamani M, Zamanian M, Zandian H, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao JT, Zhao XJG, Zhao Y, Zhou M, Ziapour A, Zimsen SRM, Brauer M, Afshin A, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3324] [Impact Index Per Article: 831.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Stanesby O, Long M, Ball K, Blizzard L, Cocker F, Greaves S, Harpur S, Johnston F, Jose K, Marshall E, Palmer AJ, Sharman M, Venn A, Williams J, Cleland V. Socio-demographic, behavioural and health-related characteristics associated with active commuting in a regional Australian state: Evidence from the 2016 Tasmanian Population Health Survey. Health Promot J Austr 2020; 32 Suppl 2:320-331. [PMID: 32991774 DOI: 10.1002/hpja.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Physical activity is lower and rates of preventable common diseases are higher in regional/rural than urban Australia. Active commuting (walking/bicycling to get from one place to another) may benefit health through increased physical activity, but most evidence of its correlates come from urban studies. This study aimed to investigate associations between active commuting, socio-demographic characteristics, behaviours, total physical activity and health in a regional/rural Australian state. METHODS This study used data from the 2016 Tasmanian Population Health Survey, a representative cross-sectional self-report survey of 6,300 adults in Tasmania, Australia. Logistic regression modelling investigated associations between socio-demographic, behavioural and health characteristics and past week active commuting frequency. RESULTS In multivariable models, being younger, having tertiary qualifications, living in a socio-economically advantaged area, being physically active, having a healthy body mass index and good/excellent self-rated health were associated with engaging in more active commuting. Inner regional dwellers were no more likely than outer regional dwellers to actively commute after covariate adjustment. CONCLUSION Strategies to promote active commuting in regional/rural areas might consider targeting older adults, those less educated, those living in socio-economically disadvantaged areas, those less physically active, those with poorer health and those with higher body mass index. Research could further investigate why these groups appear to be less active for commuting purposes. SO WHAT?: Increasing physical activity and active commuting may help to reduce rates of preventable common diseases in regional/remote areas.
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Affiliation(s)
- Oliver Stanesby
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michael Long
- Epidemiology Unit, Tasmanian Department of Health, Hobart, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Fiona Cocker
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Stephen Greaves
- Institute of Transport and Logistics Studies, University of Sydney, Sydney, Australia
| | - Siobhan Harpur
- Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | - Fay Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | - Kim Jose
- Institute for the Study of Social Change, University of Tasmania, Hobart, Australia
| | - Elaine Marshall
- Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Melanie Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Julie Williams
- Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Dangerfield F, Lamb KE, Oostenbach LH, Ball K, Thornton LE. Urban-regional patterns of food purchasing behaviour: a cross-sectional analysis of the 2015-2016 Australian Household Expenditure Survey. Eur J Clin Nutr 2020; 75:697-707. [PMID: 32920603 DOI: 10.1038/s41430-020-00746-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/06/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES In many high-income countries people living in regional (rural) areas have higher rates of chronic disease compared to people living in urban areas. Food purchasing behaviour provides a potential pathway linking residential location with dietary intake and health outcomes. This study examined the relationship between geographic location and food expenditure on a range of foods. SUBJECTS/METHODS Data from the 2015-2016 Australian Household Expenditure Survey (number of households = 9827) were used to examine weekly household food expenditure and proportion of total food expenditure on 14 categories of food items. Foods were classified using the Australian Guide to Healthy Eating. Two-part models and zero-one inflated beta regression models were used to assess the association between geographic area and food expenditure. RESULTS Average proportion of total food expenditure on fruit was estimated to be more for households located in major cities compared to households located in inner and outer regional areas. Households located in inner and outer regional areas allocated less to fresh fruit, fish and meals out compared to households in major cities. Households located in inner regional areas allocated a greater proportion of their food budget to sweet cakes, biscuits, puddings, desserts, chocolate and ice-cream compared to households in major cities and outer regional areas. CONCLUSIONS The geographic patterns in food purchasing suggest those in regional areas may be at risk of diets less aligned with healthy guidelines. Given the findings of this study suggesting geographic differences in food purchasing, further research is warranted to enhance contextual understanding of food purchasing behaviours in regional areas.
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Affiliation(s)
- Fiona Dangerfield
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia.
| | - Karen E Lamb
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia.,Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, Victoria, 3053, Australia
| | - Laura H Oostenbach
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia
| | - Kylie Ball
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia
| | - Lukar E Thornton
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia
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Gao L, Maddison R, Rawstorn J, Ball K, Oldenburg B, Chow C, McNaughton S, Lamb K, Amerena J, Nadurata V, Neil C, Cameron S, Moodie M. Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease. BMJ Open 2020; 10:e038178. [PMID: 32847918 PMCID: PMC7451486 DOI: 10.1136/bmjopen-2020-038178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION It is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with coronary heart disease (CHD) are unknown. This economic protocol outlines the methods for undertaking a trial-based economic evaluation of SCRAM in the real-world setting in Australia. METHODS AND ANALYSIS The within-trial economic evaluation will be undertaken alongside a randomised controlled trial (RCT) designed to determine the effectiveness of SCRAM in comparison with the usual care cardiac rehabilitation (UC) alone in people with CHD. Pathway analysis will be performed to identify all the costs related to the delivery of SCRAM and UC. Both a healthcare system and a limited societal perspective will be adopted to gauge all costs associated with health resource utilisation and productivity loss. Healthcare resource use over the 6-month participation period will be extracted from administrative databases (ie, Pharmaceutical Benefits Scheme and Medical Benefits Schedule). Productivity loss will be measured by absenteeism from work (valued by human capital approach). The primary outcomes for the economic evaluation are maximal oxygen uptake (VO2max, mL/kg/min, primary RCT outcome) and quality-adjusted life years estimated from health-related quality of life as assessed by the Assessment of Quality of Life-8D instrument. The incremental cost-effectiveness ratio will be calculated using the differences in costs and benefits (ie, primary and secondary outcomes) between the two randomised groups from both perspectives with no discounting. All costs will be valued in Australian dollars for year 2020. ETHICS AND DISSEMINATION The study protocol has been approved under Australia's National Mutual Acceptance agreement by the Melbourne Health Human Research Ethics Committee (HREC/18/MH/119). It is anticipated that SCRAM is a cost-effective cardiac telerehabilitation programme for people with CHD from both a healthcare and a limited societal perspective in Australia. The evaluation will provide evidence to underpin national scale-up of the programme to a wider population. The results of the economic analysis will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001458224).
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Jonathan Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Clara Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah McNaughton
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Karen Lamb
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Amerena
- Cardiac Services, Barwon Health, Geelong, Victoria, Australia
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, Bendigo, Victoria, Australia
| | - Christopher Neil
- Western Clinical School, The University of Melbourne, Saint Albans, Victoria, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Burwood, Victoria, Australia
| | - Marj Moodie
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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Sharman MJ, Ball K, Greaves S, Jose KA, Morse M, Blizzard CL, Wells G, Venn AJ, Palmer AJ, Lester D, Williams J, Harpur S, Cleland VJ. trips4health: Protocol of a single-blinded randomised controlled trial incentivising adults to use public transport for physical activity gain. Contemp Clin Trials Commun 2020; 19:100619. [PMID: 32775761 PMCID: PMC7394862 DOI: 10.1016/j.conctc.2020.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 12/03/2022] Open
Abstract
Background Public transport (PT) users typically accumulate more physical activity (PA) than private motor vehicle users yet redressing physical inactivity through transport-related PA (TRPA) interventions has received limited attention. Further, incentive-based strategies can increase leisure-time PA but their impact on TRPA, is unclear. This study's objective is to determine the impact of an incentive-based strategy on TRPA in a regional Australian setting. Methods trips4health is a single-blinded randomised controlled trial with a four-month intervention phase and subsequent six-month maintenance phase. Participants will be randomised to: an incentives-based intervention (bus trip credit for reaching bus trip targets, weekly text messages to support greater bus use, written PA guidelines); or an active control (written PA guidelines only). Three hundred and fifty adults (≥18 years) from southern Tasmania will be recruited through convenience methods, provide informed consent and baseline information, then be randomised. The primary outcome is change in accelerometer measured average daily step count at baseline and four- and ten-months later. Secondary outcomes are changes in: measured and self-reported travel behaviour (e.g. PT use), PA, sedentary behaviour; self-reported and measured (blood pressure, waist circumference, height, weight) health; travel behaviour perspectives (e.g. enablers/barriers); quality of life; and transport-related costs. Linear mixed model regression will determine group differences. Participant and PT provider level process evaluations will be conducted and intervention costs to the provider determined. Discussion trips4health will determine the effectiveness of an incentive-based strategy to increase TRPA by targeting PT use. The findings will enable evidence-informed decisions about the worthwhileness of such strategies. Trial registration ACTRN12619001136190. Universal trial number U1111-1233-8050.
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Affiliation(s)
- M J Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - S Greaves
- Institute of Transport and Logistic Studies, The University of Sydney, Sydney, New South Wales, Australia
| | - K A Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Morse
- Metro Tasmania, Hobart, Tasmania, Australia
| | - C L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - G Wells
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - D Lester
- Local Government Association of Tasmania, Hobart, Tasmania, Australia
| | - J Williams
- Department of Health, Tasmanian Government, Hobart, Tasmania, Australia
| | - S Harpur
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - V J Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Koorts H, Salmon J, Timperio A, Ball K, Macfarlane S, Lai SK, Brown H, Chappel SE, Lewis M, Ridgers ND. Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation. J Med Internet Res 2020; 22:e13573. [PMID: 32763872 PMCID: PMC7442941 DOI: 10.2196/13573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/30/2019] [Accepted: 04/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Anna Timperio
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | | | - Samuel K Lai
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Stephanie E Chappel
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Marina Lewis
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicola D Ridgers
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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McNaughton S, Ball K, Crawford D. Research skills. Public Health Nutr 2020. [DOI: 10.4324/9781003116929-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.)
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Aktary ML, Caron-Roy S, Sajobi T, O'Hara H, Leblanc P, Dunn S, McCormack GR, Timmins D, Ball K, Downs S, Minaker LM, Nykiforuk CI, Godley J, Milaney K, Lashewicz B, Fournier B, Elliott C, Raine KD, Prowse RJ, Olstad DL. Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation. BMJ Open 2020; 10:e035143. [PMID: 32371514 PMCID: PMC7228519 DOI: 10.1136/bmjopen-2019-035143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03952338.
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Affiliation(s)
- Michelle L Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather O'Hara
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Peter Leblanc
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gavin R McCormack
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Timmins
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Shauna Downs
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Katrina Milaney
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Fournier
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Charlene Elliott
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Jl Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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Veitch J, Denniss E, Ball K, Koorts H, Deforche B, Timperio A. Increasing translation of research evidence for optimal park design: a qualitative study with stakeholders. Int J Behav Nutr Phys Act 2020; 17:49. [PMID: 32295650 PMCID: PMC7160899 DOI: 10.1186/s12966-020-00952-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The design of parks is critical to ensure they are appealing, meet the needs of the community and optimise opportunities for physical activity, relaxation, exposure to nature and social interaction. There is currently a lack of understanding on how research evidence is informing park design and how to reduce the many challenges associated with research-practice-policy translation. Understanding how organisations use evidence for decision-making regarding park design is critical for reducing the research-practice-policy gap and ensuring evidence based strategies inform park design to support healthy active living. This study explored stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence for optimal park design into policy and practice. Methods One-on-one in-depth interviews were conducted with 23 stakeholders within the park design, planning and management sector. Participants shared experiences regarding: influences on park development and design; current park development policies; ways to facilitate use of evidence; and priorities for future research. Interviews were recorded and transcribed verbatim and content analysis performed using NVivo 12. Results Research evidence is used and considered important for park planning; however, several barriers were highlighted: time and cost constraints; difficulties accessing research; and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing evidence in a more accessible format such as short summaries/reports, infographics, presentations, research updates and dedicated research databases emerged as key enablers. The main research gaps identified included research into park features to encourage visitation and cost-benefit analyses studies. Conclusions This research is a first step to better understand strategies to promote more effective uptake and use of evidence to inform park planning. Researchers must develop multi-sectoral collaborations and generate policy-relevant research in a readily accessible, timely and user-friendly format to ensure evidence is used to enhance park design and ultimately public health.
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Affiliation(s)
- Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Emily Denniss
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Physical Activity, Nutrition and Health Research Unit, Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Opie RS, Ball K, Abbott G, Crawford D, Teychenne M, McNaughton SA. Adherence to the Australian dietary guidelines and development of depressive symptoms at 5 years follow-up amongst women in the READI cohort study. Nutr J 2020; 19:30. [PMID: 32276594 PMCID: PMC7149932 DOI: 10.1186/s12937-020-00540-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depression is the single largest contributor to global disability. There is growing evidence that a healthy diet is associated with reduced depression risk. However, beyond the Mediterranean diet, few longitudinal studies have explored the relationship between adherence to national dietary guidelines and depression. Hence, this study investigates the relationship between adherence to Australian Dietary Guidelines and depressive symptoms. METHODS Data was drawn from the READI longitudinal study, a prospective cohort study of socioeconomically disadvantaged Australian women. This analysis includes a sub-sample of 837 women. A generalized linear model was used to explore whether baseline diet (assessed using the Dietary Guideline Index (DGI-2013; score range 0 to 85)) was associated with risk of developing depressive symptoms (measured by the Centre for Epidemiologic Studies Depression (CES-D)) at 5 years follow-up, whilst adjusting for potential confounders. A fixed-effects model was used to assess associations between concurrent changes in diet quality and depressive symptoms from baseline to 5 years follow-up. RESULTS An association between baseline diet quality and risk of developing depressive symptoms at follow-up was observed, where a 10 unit increase in DGI-2013 score was associated with an estimated 12% lower risk of developing heightened depressive symptoms (RR = 0.875, 95%CI 0.784 to 0.978, p = 0.018). The fixed-effects model indicated that an increase in DGI score over 5 years follow-up was associated with a lower (improved) CES-D score (B = -0.044, 95% CI - 0.08 to - 0.01, p = 0.024). CONCLUSIONS Our results provide evidence that better adherence to the Australian Dietary Guidelines may result in improved depressive symptoms. The growing high-quality evidence regarding the diet-depression relationship provides us with a rationale for developing strategies for supporting dietary behaviour change programs to lower depression rates.
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Affiliation(s)
- Rachelle S. Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
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Lamb KE, Thornton LE, King TL, Ball K, White SR, Bentley R, Coffee NT, Daniel M. Methods for accounting for neighbourhood self-selection in physical activity and dietary behaviour research: a systematic review. Int J Behav Nutr Phys Act 2020; 17:45. [PMID: 32238147 PMCID: PMC7115077 DOI: 10.1186/s12966-020-00947-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-selection into residential neighbourhoods is a widely acknowledged, but under-studied problem in research investigating neighbourhood influences on physical activity and diet. Failure to handle neighbourhood self-selection can lead to biased estimates of the association between the neighbourhood environment and behaviour. This means that effects could be over- or under-estimated, both of which have implications for public health policies related to neighbourhood (re)design. Therefore, it is important that methods to deal with neighbourhood self-selection are identified and reviewed. The aim of this review was to assess how neighbourhood self-selection is conceived and accounted for in the literature. METHODS Articles from a systematic search undertaken in 2017 were included if they examined associations between neighbourhood environment exposures and adult physical activity or dietary behaviour. Exposures could include any objective measurement of the built (e.g., supermarkets), natural (e.g., parks) or social (e.g., crime) environment. Articles had to explicitly state that a given method was used to account for neighbourhood self-selection. The systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (number CRD42018083593) and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Of 31 eligible articles, almost all considered physical activity (30/31); few examined diet (2/31). Methods used to address neighbourhood self-selection varied. Most studies (23/31) accounted for items relating to participants' neighbourhood preferences or reasons for moving to the neighbourhood using multi-variable adjustment in regression models (20/23) or propensity scores (3/23). Of 11 longitudinal studies, three controlled for neighbourhood self-selection as an unmeasured confounder using fixed effects regression. CONCLUSIONS Most studies accounted for neighbourhood self-selection by adjusting for measured attributes of neighbourhood preference. However, commonly the impact of adjustment could not be assessed. Future studies using adjustment should provide estimates of associations with and without adjustment for self-selection; consider temporality in the measurement of self-selection variables relative to the timing of the environmental exposure and outcome behaviours; and consider the theoretical plausibility of presumed pathways in cross-sectional research where causal direction is impossible to establish.
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Affiliation(s)
- Karen E Lamb
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia. .,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Lukar E Thornton
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Tania L King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Simon R White
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Neil T Coffee
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Canberra, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
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46
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Cleland V, Cocker F, Canary J, Teychenne M, Crawford D, Timperio A, Ball K. Social-ecological predictors of physical activity patterns: A longitudinal study of women from socioeconomically disadvantaged areas. Prev Med 2020; 132:105995. [PMID: 31954139 DOI: 10.1016/j.ypmed.2020.105995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/10/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
Limited longitudinal evidence of the predictors of physical activity (PA) patterns over time exists, particularly among high-risk groups such as women living in socioeconomically disadvantaged areas. This study aimed to: 1) describe leisure-time PA (LTPA) and transport-related PA (TRPA) patterns over time; and 2) identify individual, social and physical environmental predictors of LTPA and TRPA patterns over five years. Baseline (2007-08) data were collected and analysed (2016-18) from n = 4349 women (18-46 years) from disadvantaged areas of Victoria, Australia. Three- and five-year follow-up data were collected in 2010-11 (n = 1912) and 2012 (n = 1560). LTPA and TRPA were self-reported using the International Physical Activity Questionnaire, and patterns categorised as consistently low, persistently increasing, persistently decreasing, or inconsistent. Compared to a consistently low LTPA pattern, greater family support predicted both persistent decreases (odds ratio [OR] 1.20, 95% CI 1.05-1.36) and persistent increases (OR 1.17, 95% CI 1.04-1.32) in LTPA, while access to childcare predicted inconsistent LTPA patterns (OR 1.66, 95% CI 1.03-2.65). For both LTPA and TRPA, PA enjoyment predicted persistent increases (LTPA: OR 1.05, 95% CI 1.02-1.10; TRPA: OR 1.03, 95% CI 1.00-1.07), persistent decreases (LTPA: OR 1.04, 95% CI 1.00-1.08; TRPA OR 1.04, 95% CI 0.99-1.08), and inconsistent patterns (LTPA: OR 1.04, 95% CI 1.02-1.07; TRPA: OR 1.03, 95% CI 1.01-1.06). Although directionality was inconsistent, and the magnitude of effects were small, PA enjoyment, family social support for PA and access to childcare warrant further investigation and consideration as potentially key factors impacting PA patterns among women living in socioeconomically disadvantaged areas.
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Affiliation(s)
- Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Fiona Cocker
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jana Canary
- Department of Developmental Studies, University of Alaska Fairbanks, Fairbanks, AK, United States of America
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
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47
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Vogel C, Crozier S, Dhuria P, Shand C, Lawrence W, Cade J, Moon G, Lord J, Ball K, Cooper C, Baird J. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open 2020; 10:e036758. [PMID: 32047023 PMCID: PMC7044911 DOI: 10.1136/bmjopen-2020-036758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Poor diet is a leading risk factor for non-communicable diseases and costs the National Health Service £5.8 billion annually. Product placement strategies used extensively in food outlets, like supermarkets, can influence customers' preferences. Policy-makers, including the UK Government, are considering legislation to ensure placement strategies promote healthier food purchasing and dietary habits. High-quality scientific evidence is needed to inform future policy action. This study will assess whether healthier placement strategies in supermarkets improve household purchasing patterns and the diets of more than one household member. METHODS AND ANALYSES This natural experiment, with a prospective matched controlled cluster design, is set in discount supermarkets across England. The primary objective is to investigate whether enhanced placement of fresh fruit and vegetables improves household-level purchasing of these products after 6 months. Secondary objectives will examine: (1) differences in intervention effects on purchasing by level of educational attainment, (2) intervention effects on the dietary quality of women and their young children, (3) intervention effects on store-level sales of fruit and vegetables and (4) cost-effectiveness of the intervention from individual, retailer and societal perspectives. Up to 810 intervention and 810 control participants will be recruited from 18 intervention and 18 matched control stores. Eligible participants will be women aged 18-45 years, who hold a loyalty card and shop in a study store. Each control store will be matched to an intervention store on: (1) sales profile, (2) neighbourhood deprivation and (3) customer profile. A detailed process evaluation will assess intervention implementation, mechanisms of impact and, social and environmental contexts. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Southampton, Faculty of Medicine Ethics Committee (ID 20986.A5). Primary, secondary and process evaluation results will be submitted for publication in peer-reviewed scientific journals and shared with policy-makers. TRIAL REGISTRATION NUMBER NCT03573973; Pre-results.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Calum Shand
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham Moon
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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48
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Rawstorn JC, Ball K, Oldenburg B, Chow CK, McNaughton SA, Lamb KE, Gao L, Moodie M, Amerena J, Nadurata V, Neil C, Cameron S, Maddison R. Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease. JMIR Res Protoc 2020; 9:e15022. [PMID: 32012103 PMCID: PMC7011127 DOI: 10.2196/15022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. Objective The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. Methods In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. Results The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. Conclusions The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. International Registered Report Identifier (IRRID) DERR1-10.2196/15022
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Affiliation(s)
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen Elaine Lamb
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lan Gao
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - John Amerena
- Geelong Cardiology Research Unit, Barwon Health, Geelong, Australia
| | | | - Christopher Neil
- Department of Medicine, Western Health and University of Melbourne, Sunshine, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Geelong, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Abstract
Changing academic landscapes, including the increasing focus on performance rankings and metrics, are impacting universities globally, contributing to high-pressure environments and anxious academic staff. However, evidence and experience shows that fostering a high performing academic team need not be incompatible with staff happiness and wellbeing.
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Affiliation(s)
- Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - David Crawford
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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50
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Milte CM, Ball K, Crawford D, McNaughton SA. Diet quality and cognitive function in mid-aged and older men and women. BMC Geriatr 2019; 19:361. [PMID: 31864295 PMCID: PMC6925482 DOI: 10.1186/s12877-019-1326-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/23/2019] [Indexed: 01/24/2023] Open
Abstract
Background To date much research into nutrition and cognitive function has been at the nutrient or food level, with inconsistent results. There is increasing interest in the dietary pattern approach to assess whole diet quality and its association with cognitive function. This study investigated if diet quality is associated with cognitive function in men and women aged 55 years and over. Methods Adults aged 55–65 years in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 617) completed a postal survey including a 111-item food frequency questionnaire in 2010 and 2014. Diet quality was assessed via the revised dietary guideline index (DGI-2013) and also by its individual components which assessed key food groups and dietary behaviours from the Australian Dietary Guidelines. The Telephone Interview of Cognitive Status (TICS-m) measured cognitive function in 2014. Associations between past (2010) and recent (2014) diet quality and its components, and cognitive function were assessed by linear regression adjusted for covariates. Results After adjustment for age, sex, education, urban/rural status and physical activity there were no associations between diet quality in 2010 and cognitive function in 2014. However participants who reported higher dietary variety (B = 0.28, 95% CI 0.03, 0.52) and women who reported “sometimes” adding salt to food after cooking (B = 0.98, 95% CI 0.25, 1.71) in 2010 displayed better cognitive function in 2014. In 2014, usual consumption of higher fibre bread choices in the total sample (B = 1.32, 95% CI 0.42, 2.23), and higher diet quality (B = 0.03, 95% CI 0.00, 0.07) and greater fluid consumption (B = 0.14, 95% CI 0.01, 0.27) in men were all associated with better cognitive function. In addition, men who reported “usually” adding salt to their food during cooking displayed poorer cognitive function (B = -1.37, 95% CI -2.39, − 0.35). There were no other associations between dietary intake and cognitive function observed in the adjusted models. Conclusion An association between dietary variety and some limited dietary behaviours and cognitive function was observed, with variation by gender. Future research should consider trajectories of dietary change over longer time periods as determinants of health and function in older age.
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Affiliation(s)
- Catherine M Milte
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Vic 3125, Australia.
| | - Kylie Ball
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Vic 3125, Australia
| | - David Crawford
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Vic 3125, Australia
| | - Sarah A McNaughton
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Vic 3125, Australia
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