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Shaw S, Muir S, Strömmer S, Crozier S, Cooper C, Smith D, Barker M, Vogel C. The interplay between social and food environments on UK adolescents' food choices: implications for policy. Health Promot Int 2023; 38:daad097. [PMID: 37647523 PMCID: PMC10468012 DOI: 10.1093/heapro/daad097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 09/01/2023] Open
Abstract
Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sarah Muir
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Dianna Smith
- Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
- Centre for Food Policy, City, University of London, London EC1V 0HB, UK
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Vogel C, Shaw S, Strömmer S, Crozier S, Jenner S, Cooper C, Baird J, Inskip H, Barker M. Inequalities in energy drink consumption among UK adolescents: a mixed-methods study. Public Health Nutr 2022; 26:1-28. [PMID: 36472075 PMCID: PMC9989712 DOI: 10.1017/s1368980022002592] [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: 05/18/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine energy drink consumption among adolescents in the United Kingdom (UK) and associations with deprivation and dietary inequalities. DESIGN Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis. SETTING UK. PARTICIPANTS Quantitative data: nationally representative sample of 2587 adolescents aged 11-18 years. Qualitative data: 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK. RESULTS NDNS data showed adolescents' consumption of energy drinks was associated with poorer dietary quality (OR 0.46 per SD; 95% CI 0.37, 0.58; p<0.001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don't know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work. CONCLUSIONS This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents' energy drink intake.
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Affiliation(s)
- Christina Vogel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Food Policy, City, University of London, London, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Sarah Jenner
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Valand IU, Øverby NC, Strömmer S, Barker M, Bjornes C, Nordli J, Pettersen L, Bjørkkjær T, Vik FN, Kiland C, Hillesund ER. "It is really just brilliant to get credits for something that is so important to you!" Skills for Life: University students' perceptions of a planned dietary life skills course. PLoS One 2022; 17:e0260890. [PMID: 35389990 PMCID: PMC8989186 DOI: 10.1371/journal.pone.0260890] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Universities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course. DESIGN Qualitative design including focus group discussions. SETTING A Norwegian university with participating undergraduate students from seven different disciplines. METHOD Data collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers. RESULTS When presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures. CONCLUSION Most students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.
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Affiliation(s)
- Ida Ulrikke Valand
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina C. Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Sout,lhampton, Southampton General Hospital, Southampton, United Kingdom and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mary Barker
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- MRC Lifecourse Epidemiology Unit, University of Sout,lhampton, Southampton General Hospital, Southampton, United Kingdom and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Camilla Bjornes
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Julie Nordli
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Line Pettersen
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Upbringing and Culture, Bjerkreim Municipality, Bjerkreim, Norway
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Frøydis N. Vik
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Charlotte Kiland
- Department of Political Science and Management, Faculty of Social Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet R. Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Neufeld LM, Andrade EB, Ballonoff Suleiman A, Barker M, Beal T, Blum LS, Demmler KM, Dogra S, Hardy-Johnson P, Lahiri A, Larson N, Roberto CA, Rodríguez-Ramírez S, Sethi V, Shamah-Levy T, Strömmer S, Tumilowicz A, Weller S, Zou Z. Food choice in transition: adolescent autonomy, agency, and the food environment. Lancet 2022; 399:185-197. [PMID: 34856191 DOI: 10.1016/s0140-6736(21)01687-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.
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Affiliation(s)
| | - Eduardo B Andrade
- Brazilian School of Public and Business Administration (EBAPE), Getulio Vargas Foundation (FGV), Rio de Janeiro, Brazil
| | | | - Mary Barker
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Lauren S Blum
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | | | - Surabhi Dogra
- Lancet Standing Commission on Adolescent Health and Wellbeing, Noida, India
| | - Polly Hardy-Johnson
- MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK
| | | | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Sofia Strömmer
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK
| | | | - Susie Weller
- Clinical Ethics and Law at Southampton (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing, China; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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Helland SH, Øverby NC, Myrvoll Blomkvist EA, Hillesund ER, Strömmer S, Barker M, Bjørkkjær T. Wow! They really like celeriac! Kindergarten teachers' experiences of an intervention to increase 1-year-olds' acceptance of vegetables. Appetite 2021; 166:105581. [PMID: 34214639 DOI: 10.1016/j.appet.2021.105581] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/27/2021] [Accepted: 06/27/2021] [Indexed: 11/15/2022]
Abstract
Exposure to varied foods in early life is important for short- and long-term health and development. Strategically introducing toddlers to new vegetables is not a common practice in Norwegian kindergartens. Therefore, we developed, conducted, and evaluated a web-based cluster randomised kindergarten intervention, Pre-schoolers' Food Courage 2.0. The purpose of the current qualitative study was to explore kindergarten teachers' experience of implementing this intervention and what they thought facilitated the positive impact of the intervention reported in the quantitative evaluation. Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. Data were transcribed verbatim and subjected to thematic analysis. Five main themes were identified: 1) One-year-olds love food and renewal of the menus was inspiring; 2) One-year-olds are surprisingly willing to try and accept novel foods; 3) Novel food at meals stimulate social interaction; and 4) The Sapere method is a fun and explorative activity for 1-year-olds. These four themes were the features perceived as the effective elements of the intervention by the kindergarten teachers. The fifth main theme was: 5) Sustained impact on kindergarten teachers' practices and beliefs. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced. Interventions targeting healthy feeding practices may potentially have a long-term public health impact by increasing food variety and vegetable intake in toddlers. TRIAL REGISTRATION: ISRCTN98064772.
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Affiliation(s)
- Sissel H Helland
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Nina C Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Eli Anne Myrvoll Blomkvist
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
| | - Mary Barker
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway; MRC Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, UK.
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
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Strömmer S, Shaw S, Jenner S, Vogel C, Lawrence W, Woods-Townsend K, Farrell D, Inskip H, Baird J, Morrison L, Barker M. How do we harness adolescent values in designing health behaviour change interventions? A qualitative study. Br J Health Psychol 2021; 26:1176-1193. [PMID: 33945194 DOI: 10.1111/bjhp.12526] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 05/19/2020] [Revised: 03/19/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Adolescent health behaviours do not support optimal development. Adolescents are reportedly difficult to engage in health behaviour improvement initiatives. Little is known about what adolescents value in relation to diet and physical activity or how best to target these in health interventions. This study explored adolescents' values in relation to diet and physical activity and how these values can inform health intervention design. DESIGN Qualitative semi-structured interviews explored adolescents' lives, what they thought about diet and physical activity and what might support them to improve their health behaviours. METHODS A total of 13 group interviews were conducted with 54 adolescents aged 13-14 years, of whom 49% were girls and 95% identified as White British. Participants were recruited from a non-selective secondary school in a large southern UK city. Inductive thematic analysis was used to identify key adolescent values. RESULTS Adolescents valued being with their friends, doing what they enjoyed and were good at; being healthy was important to them but only if achievable without compromising other things that are important to them. The need to be healthy was not aligned with adolescents' basic psychological needs, nor their strongly held priorities and values. CONCLUSIONS Health is not a motivating factor for adolescents; therefore, interventions designed solely to improve health are unlikely to engage them. Instead, interventions that align with the values and priorities specified by adolescents are more likely to be effective in supporting them to eat well and be more active.
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Jenner
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Social Sciences, Southampton Education School, University of Southampton, Southampton, UK
| | - David Farrell
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, Southampton, UK.,School of Primary Care, Population Health and Medical Education, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
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Strömmer S, Weller S, Morrison L, Soltani H, Stephenson J, Whitworth M, Rundle R, Brewin J, Poston L, Lawrence W, Barker M. Young women's and midwives' perspectives on improving nutritional support in pregnancy: The babies, eating, and LifestyLe in adolescence (BELLA) study. Soc Sci Med 2021; 274:113781. [PMID: 33676159 DOI: 10.1016/j.socscimed.2021.113781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Revised: 01/05/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
RATIONALE Teenage pregnancy has a high risk of poor outcomes for both mother and baby. Teenage girls have the poorest diets of any population group in the UK, which compounds the risk of poor pregnancy outcomes. Pregnant teenagers trust advice from their midwives, but midwives feel they do not have time, confidence, or knowledge to discuss nutrition. OBJECTIVE This study examined how the relationship between pregnant teenagers and their midwives could be utilised to deliver support to improve diet quality. METHOD Qualitative interviews were conducted across three urban sites in the UK: Manchester, Doncaster, and Southampton with adolescent mothers and their midwives regarding diet and lifestyle, and what form of support would be helpful. In total, 106 young women and 20 midwives were interviewed. Most of the young mothers were 19 or younger (67%). Half had had their first child in the past year (52%) and 21% were pregnant during the study. Thematic analysis was used to identify ways to better support young mothers to eat well. RESULTS Young women found it difficult to prioritise healthy eating; they often felt isolated and not in control of their own lives and wanted support from their midwife. Midwives felt that it was their role to support young mothers with diet in pregnancy but were anxious about initiating conversations and felt they lacked clear guidance. CONCLUSIONS Pregnant teenagers and their midwives lack reliable resources and strategies for healthy eating support. An effective intervention to improve pregnant teenagers' diet quality must empower, inform, and motivate young mothers and their midwives, and enable connections between young mothers.
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Susie Weller
- Clinical Ethics and Law at Southampton (CELS), University of Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, Southampton, UK; Primary Care, Population Health and Medical Education, Southampton, UK
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Rachel Rundle
- Food and Nutrition Group, Sheffield Hallam University, Sheffield, UK
| | | | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; Health Sciences, University of Southampton, UK
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Shaw S, Crozier S, Strömmer S, Inskip H, Barker M, Vogel C. Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey. Nutr J 2021; 20:5. [PMID: 33430892 PMCID: PMC7802176 DOI: 10.1186/s12937-020-00658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/17/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors. METHODS Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one. RESULTS The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores. CONCLUSIONS The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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9
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Strömmer S, Barrett M, Woods-Townsend K, Baird J, Farrell D, Lord J, Morrison L, Shaw S, Vogel C, Lawrence W, Lovelock D, Bagust L, Varkonyi-Sepp J, Coakley P, Campbell L, Anderson R, Horsfall T, Kalita N, Onyimadu O, Clarke J, Cooper C, Chase D, Lambrick D, Little P, Hanson M, Godfrey K, Inskip H, Barker M. Engaging adolescents in changing behaviour (EACH-B): a study protocol for a cluster randomised controlled trial to improve dietary quality and physical activity. Trials 2020; 21:859. [PMID: 33059762 PMCID: PMC7557314 DOI: 10.1186/s13063-020-04761-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Poor diet and lack of physical activity are strongly linked to non-communicable disease risk, but modifying them is challenging. There is increasing recognition that adolescence is an important time to intervene; habits formed during this period tend to last, and physical and psychological changes during adolescence make it an important time to help individuals form healthier habits. Improving adolescents' health behaviours is important not only for their own health now and in adulthood, but also for the health of any future children. Building on LifeLab-an existing, purpose-built educational facility at the University of Southampton-we have developed a multi-component intervention for secondary school students called Engaging Adolescents in Changing Behaviour (EACH-B) that aims to motivate and support adolescents to eat better and be more physically active. METHODS A cluster randomised controlled trial is being conducted to evaluate the effectiveness of the EACH-B intervention. The primary outcomes of the intervention are self-reported dietary quality and objectively measured physical activity (PA) levels, both assessed at baseline and at 12-month follow-up. The EACH-B intervention consists of three linked elements: professional development for teachers including training in communication skills to support health behaviour change; the LifeLab educational module comprising in-school teaching of nine science lessons linked to the English National Curriculum and a practical day visit to the LifeLab facility; and a personalised digital intervention that involves social support and game features that promote eating better and being more active. Both the taught module and the LifeLab day are designed with a focus on the science behind the messages about positive health behaviours, such as diet and PA, for the adolescents now, in adulthood and their future offspring, with the aim of promoting personal plans for change. The EACH-B research trial aims to recruit approximately 2300 secondary school students aged 12-13 years from 50 schools (the clusters) from Hampshire and neighbouring counties. Participating schools will be randomised to either the control or intervention arm. The intervention will be run during two academic years, with continual recruitment of schools throughout the school year until the sample size is reached. The schools allocated to the control arm will receive normal schooling but will be offered the intervention after data collection for the trial is complete. An economic model will be developed to assess the cost-effectiveness of the EACH-B intervention compared with usual schooling. DISCUSSION Adolescents' health needs are often ignored and they can be difficult to engage in behaviour change. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their long-term health and that of their future children. TRIAL REGISTRATION ISRCTN 74109264 . Registered on 30 August 2019. EACH-B is a cluster randomised controlled trial, funded by the National Institute for Health Research (RP-PG-0216-20004).
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Millie Barrett
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - David Farrell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
- Hampshire County Council, Winchester, UK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Donna Lovelock
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Lisa Bagust
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Patsy Coakley
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Lyall Campbell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Ross Anderson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Tina Horsfall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Olu Onyimadu
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | | | - Danielle Lambrick
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mark Hanson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith Godfrey
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
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10
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Morris T, Strömmer S, Vogel C, Harvey NC, Cooper C, Inskip H, Woods-Townsend K, Baird J, Barker M, Lawrence W. Improving pregnant women's diet and physical activity behaviours: the emergent role of health identity. BMC Pregnancy Childbirth 2020; 20:244. [PMID: 32334540 PMCID: PMC7183631 DOI: 10.1186/s12884-020-02913-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/28/2019] [Accepted: 03/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background Women who gain too much weight in pregnancy are at increased risk of disease and of having children with increased risk. Interventions to improve health behaviours are usually designed for a general population of pregnant women, and trial outcomes show an average impact that does not represent the differences between individuals. To inform the development of future interventions, this study explored the factors that influenced women’s diet and physical activity during pregnancy and aimed to identify the needs of these women with regards to lifestyle support. Methods Women who completed a trial of vitamin D supplementation and nurse support in pregnancy were invited to take part in an interview. Seventeen women were interviewed about their lifestyles during pregnancy, the support they had, and the support they wanted. Interview transcripts were coded thematically and analysed to understand the factors that influenced the diets and physical activity levels of these women and their engagement with resources that could provide support. Results Women identified barriers to eating well or being physically active, and pregnancy-specific issues like nausea and pain were common. Women’s interest in maintaining a healthy lifestyle and their engagement with lifestyle support was related to the extent to which they self-identified as healthy people. Health-disengaged women were disinterested in talking about their lifestyles while health-focused women did not feel that they needed extra support. Women between these ends of the ‘health identity’ spectrum were interested in improving their health, and were able to identify barriers as well as sources of support. Conclusions Lifestyle interventions in pregnancy should be adapted to meet the needs of individuals with different health identities, and encouraging a change in health identity may be one way of supporting sustained change in health behaviours.
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Affiliation(s)
- T Morris
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK. .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - S Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - J Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - W Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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11
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Lawrence W, Vogel C, Strömmer S, Morris T, Treadgold B, Watson D, Hart K, McGill K, Hammond J, Harvey NC, Cooper C, Inskip H, Baird J, Barker M. How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health? Matern Child Nutr 2020; 16:e12900. [PMID: 31736283 PMCID: PMC7038869 DOI: 10.1111/mcn.12900] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 01/30/2023]
Abstract
Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.
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Affiliation(s)
- Wendy Lawrence
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Christina Vogel
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Taylor Morris
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Bethan Treadgold
- School of Primary Care and Population SciencesUniversity of SouthamptonSouthamptonUK
| | - Daniella Watson
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Kate Hart
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Karen McGill
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Julia Hammond
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Janis Baird
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Mary Barker
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
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12
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Strömmer S, Lawrence W, Rose T, Vogel C, Watson D, Bottell JN, Parmenter J, Harvey NC, Cooper C, Inskip H, Baird J, Barker M. Improving recruitment to clinical trials during pregnancy: A mixed methods investigation. Soc Sci Med 2018; 200:73-82. [PMID: 29421474 PMCID: PMC6033317 DOI: 10.1016/j.socscimed.2018.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 08/07/2017] [Revised: 12/31/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify reasons underlying women's refusal to participate in a pregnancy trial and to identify ways of increasing recruitment. DESIGN Mixed methods study using a questionnaire and qualitative interviews. SAMPLE A questionnaire asking them to indicate reasons for their decision was completed by 296 pregnant women who declined to participate in one of two trials of nutritional supplementation in a large teaching hospital in southern England. Qualitative interview data were collected from two samples of pregnant women: 1) 30 women who declined to participate in a trial but completed the questionnaire; and 2) 44 women who participated in a trial. RESULTS Questionnaire data from pregnant women who declined to participate suggested the major barriers to participation were study requirements, including taking study medication, having a bone scan or blood tests, or being too busy. Thematic analysis of interview data identified differences in self-efficacy and levels of trust in medical research between participants and decliners. Participants believed that the research would cause no harm, while decliners felt they or their unborn child would be at risk. When faced with potential obstacles, participants found ways around them while decliners felt they were insurmountable. CONCLUSIONS Recruitment methods for pregnancy trials should focus on building women's trust in the trial, and on enhancing women's self-efficacy so they feel able to meet trial requirements. Suggestions for building trust include investing time in open, honest discussion of the risks and benefits of participation, improving visibility of the research team, testimonials from previous participants and advertising study safety and ethical conduct. Self-efficacy can be enhanced by training research staff in empowering styles of communication enabling women to feel heard and supported to problem-solve. These strategies could be implemented relatively easily into pregnancy trial protocols, and their effectiveness tested through their impact on recruitment rates.
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK.
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Daniella Watson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Joanne N Bottell
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Janice Parmenter
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Oxford Musculoskeletal Biomedical Research Unit, University of Oxford, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
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13
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Rose T, Barker M, Jacob C, Morrison L, Lawrence W, Strömmer S, Vogel C, Woods-Townsend K, Farrell D, Inskip H, Baird J. A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents. J Adolesc Health 2017; 61:669-677. [PMID: 28822682 PMCID: PMC5702542 DOI: 10.1016/j.jadohealth.2017.05.024] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [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: 01/05/2017] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 02/03/2023]
Abstract
Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data.
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Affiliation(s)
- Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom.
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Chandni Jacob
- Academic Unit of Human Development and Health, Faculty of Medicine,
University of Southampton, Southampton UK SO16 6YD
| | - Leanne Morrison
- Academic Unit of Psychology, University of Southampton, Southampton
UK SO17 1BJ
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD,Southampton Education School, Faculty of Social and Human Sciences,
University of Southampton, Southampton UK SO17 1BJ
| | | | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
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14
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Barker M, Baird J, Tinati T, Vogel C, Strömmer S, Rose T, Begum R, Jarman M, Davies J, Thompson S, Taylor L, Inskip H, Cooper C, Nutbeam D, Lawrence W. Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change. Healthcare (Basel) 2017; 5:E17. [PMID: 28335519 PMCID: PMC5371923 DOI: 10.3390/healthcare5010017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/03/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health.
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Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Tannaze Tinati
- NIHR Dissemination Centre, University of Southampton, Alpha House, Enterprise Road, Southampton SO16 7NS, UK.
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Rufia Begum
- Formerly of NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Megan Jarman
- Li Ka Shing Centre for Health Research Innovation, Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, AB T7X 5A1, Canada.
| | - Jenny Davies
- Formerly of Southampton City Council Public Health Team, Southampton City Council, Civic Centre, Southampton SO14 7LY, UK.
| | - Sue Thompson
- Commissioner, Integrated Commissioning Unit, Southampton City Council, Civic Centre, Southampton SO14 7LY, UK.
| | - Liz Taylor
- Former Senior Commissioning Manager for NHS Southampton, NHS Southampton HQ, Oakley Road, Millbrook, Southampton SO16 4GX, UK.
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Don Nutbeam
- Sydney Medical School, Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Southampton SO16 6YD, UK.
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15
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Strömmer S, Lawrence W, Barker M. Commentary on 'Young parents' views and experiences of interactions with health professionals': tools for engaging and supporting teenage parents to improve their lives. J Fam Plann Reprod Health Care 2016; 42:185-6. [PMID: 27387583 DOI: 10.1136/jfprhc-2016-101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Sofia Strömmer
- Postdoctoral Research Fellow, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Wendy Lawrence
- Associate Professor of Health Psychology, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mary Barker
- Associate Professor in Psychology, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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