Nutrition knowledge assessment tools for older adults and their carers: a scoping review

Poor nutritional intake is common among older adults. Given that nutrition knowledge is an important determinant of eating behaviour and nutritional status, understanding areas of inadequate knowledge can guide educational interventions to reduce risk of nutritional deficiencies and promote healthy ageing. This review investigated tools assessing general nutritional knowledge of older adults and their carers. Following the Joanna Briggs for Scoping Reviews guidelines, 4 databases (MEDLINE, CINAHL, Global Health and Embase) and grey literature were searched. Studies of any type containing general nutrition knowledge assessment tools for older adults or their carers were included. In total, 6934 articles were identified, of which 24 met the eligibility criteria, and 23 unique nutrition knowledge assessment tools were included. Of these tools, 14 were original, 6 were modified from other tools and 3 used dietary-related responses from national dietary survey questions. 6 tools were developed for carers (mostly nurses) and 17 tools for older adults. Tools had between 4 and 110 items. The most common topics for general nutrition knowledge questions were related to nutrients and roles, food sources of nutrients, and diet-disease relationships. 8 tools were developed prior to 2000. Most studies did not specify or assess psychometric properties of the tool, with only 9 (38 %) and 6 (26 %) studies testing for reliability and validity, respectively, and only 1 tool was considered reliable. Additional research for the development of reliable and validated tools or the validation of existing tools to assess nutrition knowledge of older adults and their carers is needed across different healthcare settings.

Knowledge and awareness of policies and programmes to reduce adolescent pregnancy in Ghana: a qualitative study among key stakeholders

INTRODUCTION

Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana.

METHODS

We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data.

RESULTS

Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies.

CONCLUSION

Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy.

What interventions and programmes are available to support older nurses in the workplace? A literature review of available evidence

BACKGROUND

High exit rates, stalling entry rates, population ageing, and, most recently, the COVID-19 pandemic have placed significant strain on the world's nursing workforce. Both developed and developing countries face similar predicaments. Evidence-based programmes to support older nurses in the workplace are urgently needed to ensure the sustainability of a career in nursing for this group of healthcare professionals.

OBJECTIVES

To scope and synthesise available evidence on evaluated programmes and interventions implemented to support the ageing nursing workforce's health, wellbeing, and retention.

DESIGN

A literature review of available evidence using a systematic approach.

METHOD

Medline, Scopus, PsycINFO and CINAHL were searched for relevant peer-reviewed evidence. Data from the peer-reviewed literature were extracted separately into purpose designed-extraction spreadsheets. Information relevant to study design, intervention design, outcome constructs, intervention outcomes, and barriers and enablers to intervention success were collected. The protocol for this review was registered in PROSPERO [CRD42021274491].

RESULTS

Eighteen published studies were included in this review. We identified a range of interventions and programmes that have been implemented to support older nurses, which included flexible and reduced work arrangements, mentoring programmes, exercise and lifestyle interventions, continued professional development and purpose-designed remote retreats. We found limited evidence of evaluated outcomes from workplace support interventions that addresses the actual challenges faced by ageing nurses as reported in previous literature reviews. Interventions that were designed to promote a sense of purpose at work resulted in positive outcomes and appeared to more directly address the stated needs of older nurses. Holistic programmes and interventions that could potentially promote both physical well-being and psychological well-being required a broader, whole-of-organisation approach rather than more piecemeal interventions addressing individual physical and mental health concerns. Interventions which acknowledged older nurses' clinical expertise and experience (e.g., mentoring programmes) were linked to positive outcomes.

CONCLUSION

Future intervention efforts should acknowledge and balance intervention participation opportunities against existing everyday workload constraints faced by older nurses. Our review suggests the need for further intervention studies assessing specific outcomes such as psychological and emotional health, as well as interventions that more directly address the most pressing concerns that ageing nurses report at personal and organisational levels. A paradigm shift in productivity measurement in clinical nursing work is required in order to increase the value placed on the unique contribution of older nurses working clinically, particularly in sharing their acquired knowledge, skill, and expertise.

Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review

BACKGROUND

Community-based programmes [CBPs], targeting increased physical activity and/or healthier eating, have been used in the prevention and management of non-communicable diseases. However, CBPs are only useful, insofar as they can be scaled up and sustained in some meaningful way. Social networks-defined as "social structures that exists between actors, individuals or organizations"-may serve as an important tool to identify underlying mechanisms that contribute to this process. This scoping review aimed to map and collate literature on the role of social network research in scaling-up and sustaining physical activity and/or diet CBPs in low-and middle-income countries [LMICs].

METHODS

Arksey and O'Malley's framework and its enhancement were followed. Inclusion criteria were peer-reviewed articles exploring the role of social networks in scaled-up and/or sustained physical activity and/or diet CBPs in adult populations, published in English since 2000, and based in a LMIC. Databases searched were PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, International Bibliography of the Social Sciences, and Google Scholar. Books, conference abstracts, and programmes focused on children were excluded. Two reviewers independently selected and extracted eligible studies. Included publications were thematically analysed using the Framework Approach.

RESULTS

Authors identified 12 articles for inclusion, covering 13 CBPs. Most were based in Latin America, with others in the Caribbean, the Pacific Islands, Iran, and India. All articles were published since 2009. Only three used social network analysis methods (with others using qualitative methods). Five main social network themes were identified: centralisation, cliques, leaders, quality over quantity, and shared goals. Contextual factors to be considered when scaling-up programmes in LMICs were also identified.

CONCLUSIONS

This review has shown that the evidence of the use of social network research in programme scale-up has not yet caught up to its theoretical possibilities. Programmes aiming to scale should consider conducting social network research with identified network themes in mind to help improve the evidence-base of what network mechanisms, in what contexts, might best support the strengthening of networks in physical activity and diet programmes. Importantly, the voice of individuals and communities in these networks should not be forgotten.

Models of care for non-communicable diseases for displaced populations in Iraq: a scoping review

Non-communicable diseases (NCDs) are the leading cause of death and disability globally. Their importance in humanitarian settings is increasingly recognised, but evidence about how best to address NCDs in these setting is limited. This scoping review aimed to explore models of NCD care for displaced populations in Iraq, in order to build evidence to design context adapted models of care. A search of key databases (Medline, Embase, Scopus, EconLit, Global Health, Web of Science, and the Iraqi Academic Scientific Journals) was conducted and complemented with grey literature and snowballing searches. Documents were included if they referred to models of NCD care for displaced populations. We synthesised the data using a conceptual model of care framework. The findings were reported according to the PRISMA guidelines for scoping reviews. We identified 4036 documents of which 22 were eligible for inclusion. Only six documents were peer-reviewed studies with most being internal reports, commentaries, or press releases. Of the 14 documents that reported on their methods, most applied quantitative approaches (n = 7), followed by mixed-methods (n = 5) and qualitative approaches (n = 2). Only one document reported on outcome data and none applied longitudinal study designs. Documents generally described individual framework dimensions, mostly centring around medicines, facility-based services, and selected access dimensions. Most dimensions had few or no references. The most common model for displaced populations in Iraq was primary-level centred care that complemented or supported existing—mostly tertiary—public health system structures. Additionally, private facilities played an important role and were frequently accessed by displaced populations in most settings. Quality of care, particularly patient-perceived quality, emerged as a critical factor for designing context-adapted models of NCD care. This review also identified a strong regionality of NCD care, particularly in terms of access rates and barriers. We concluded that there is a scarcity of evidence on the effectiveness of models of NCD care for displaced populations in Iraq, calling for capacity building initiatives focused on implementation research and evaluation.

Facilitating factors and challenges of the implementation of multisectoral nutrition programmes at the community level to improve optimal infant and young child feeding practices: a qualitative study in Burkina Faso

OBJECTIVES

To identify the drivers and challenges of successful nutrition programme implementation in a multisectoral, community-level approach to improve infant and young child feeding (IYCF) practices in northern Burkina Faso.

DESIGN

A qualitative study was conducted in 2019 through (i) individual interviews with key informants from five different sectors (health, agriculture, environment, livestock and education) and association staff, agents and community leaders and (ii) focus groups with mothers of children under the age of 2 years.

SETTING

Three health districts in the northern region of Burkina Faso implemented a multisectoral community nutrition programme to improve IYCF practices.

PARTICIPANTS

Forty-seven implementing actors and twenty-four beneficiary mothers.

RESULTS

Factors influencing successful implementation include community participation; sector commitment and involvement; the existence of nutrition champions; capacity building; the integration of interventions; micronutrient powder distribution; the introduction of nutrition-sensitive interventions, such as the promotion of the consumption of orange-fleshed sweet potatoes; improved food production and small livestock rearing and the effective coordination of actors and complementary funding. The main challenges of the implementation of multisectorality are low participation among nutrition-sensitive sectors, a tendency for siloed work among sectors, scheduling conflicts, high actor mobility, differences in the target population by sector, a lack of technical skills among community workers, insufficient financial resources, low geographic convergence and coverage of beneficiaries, a lack of a multisectoral monitoring mechanism and accountability and insecurity.

CONCLUSIONS

Strengthening sector participation, identifying a common targeting strategy and mobilising financial resources have the potential to significantly reduce barriers and improve the quality of implementation.

Identifying the priorities for midwifery education across Australia and New Zealand: A Delphi study

PROBLEM

In countries where education programmes are assessed as meeting international standards there is limited knowledge about the challenges facing midwifery education.

BACKGROUND/AIM

The positive impact of quality midwifery education on maternal and newborn health is acknowledged by the World Health Organisation. However, there is limited research identifying the issues faced in providing quality midwifery education. The aim of this study was to identify the challenges and determine priority projects to strengthen midwifery education across Australia and New Zealand.

METHODS

A two-round Delphi study with experts in midwifery education was undertaken.

FINDINGS

In round one, 85 participants identified an initial 366 issues for midwifery education. Through thematic content analysis these were categorised into 89 statements reflecting five major themes: In round two, 105 midwifery experts from Australia n=86 (79%) and New Zealand n=23 (21%) rated the 89 statements in order of priority. Across the combined data (Australia and New Zealand) a total of 19 statements gained consensus of ≥80%.

DISCUSSION

Five priority themes were identified including; (1) enabling success of First Peoples/Māori midwifery students; (2) increasing the visibility and influence of midwifery within regulation, accreditation and university governance; (3) determining how best to deliver the clinical practicum component of programmes; (4) reviewing midwifery programmes to enhance design, content and delivery; and (5) ongoing education and support for the midwifery workforce.

CONCLUSION

In Australia and New Zealand, it is imperative that collaborative work is undertaken to design and action identified projects addressing these priorities.

Evaluation of the scholastic performance of students in 12 programs from a private university in the south-west geopolitical zone in Nigeria

Cumulative grade point average (CGPA) is a system for calculation of GPA scores and is one way to determine a student's academic performance in a university setting. In Nigeria, an employer evaluates a student's academic performance using their CGPA score. For this study, data were collected from a student database of a private school in the south-west geopolitical zone in Nigeria. Regression analysis, correlation analysis, and analysis of variance (F-test) were employed to determine the study year that students perform better based on CGPA. According to the results, it was observed that students perform much better in year three (300 Level) and year four (400 Level) compared to other levels. In conclusion, we strongly recommend the private university to introduce program that will improve the academic performance of students from year one (100 level).

Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity

Background

Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used.

Methods

To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring.

Results

Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired.

Conclusion

Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5042-4) contains supplementary material, which is available to authorized users.

Education and social inclusion of people with disabilities in five countries in West Africa: a literature review

PURPOSE

An estimated 1 billion people worldwide live with some form of disability. With the adoption of the Sustainable Development Goals and the "Leave no one behind" agenda, there is a global momentum to ensure that disadvantaged groups, not least people with disabilities, are included and accounted for, in mainstream development efforts. However, in many low-income settings little is known about disability and the policies and programs in place to improve the lives of those affected.

METHOD

This literature review describes the extent and quality of published and unpublished literature on education and social inclusion of people with disabilities in five West African countries: Cameroon, Liberia, Mali, Sierra Leone and Senegal.

RESULTS

Fifty-four unique documents met inclusion criteria of the review and described related policy and legislation; national and international stakeholders; intervention programs and primary research related to disability and inclusion. The majority of documents were from Sierra Leone (19); and four described more than one country. Primary research included mainly qualitative studies and cross-sectional surveys; 33 sources were critically appraised with the majority being attributed unclear risk of bias (20).

CONCLUSIONS

The findings call for (i) standardized tools for monitoring the implementation of programs and policies at national level; (ii) improved stakeholder coordination mechanisms; (iii) development and adoption of coordinated approaches to measuring disability and social exclusion; (iv) rigorous evaluations of the effectiveness of disability programs and (v) disaggregation of routine data by disability. Implication for Rehabilitation There is a need for standardized tools for monitoring the implementation of programs and policies at national level. Countries that have not yet ratified the UNCRPD or the protocol should be supported to do so. Stakeholder coordination mechanisms need to be improved. Improved coordination between stakeholders involved in disability at the country level could help improve the quality of services delivered. Development and adoption of coordinated approaches is key to measuring disability and social exclusion. There are few, if any, rigorous evaluation of the effectiveness of disability-specific evaluations in the five countries. There is a need for disaggregation of routine data from development programs by disability to inform implementation.

Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning by malaria control programmes in sub-Saharan Africa

BACKGROUND

Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning.

METHODS

Nested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5-14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2-9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016-2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria.

RESULTS

In projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts.

DISCUSSION

Spectrum-Malaria's user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module's linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.

The important role of food composition in policies and programmes for better public health: A South African case study

Most governments have committed to the set of Sustainable Development Goals established by the United Nations (UN) to be achieved by 2030. Subsequently the governments have drafted, or are in process of drafting, policies and programmes which aim to answer to these global requests. South Africa provides a unique case study: despite economic growth, undernutrition has not improved when compared to other industrialised nations, while at the same time, diet-related non-communicable diseases and obesity have exponentially increased. Access to healthy food is a constitutional right of all South Africans, and towards increasing food security and improving population health, various policies, programmes and regulations have been developed and implemented by the government to rectify the situation. The paper presents an overview of food composition within these public health policies, programmes and regulations and unpacks the important role of accurate food composition data.

Workplace nutrition knowledge questionnaire: psychometric validation and application

Workplace dietary intervention studies in low- and middle-income countries using psychometrically sound measures are scarce. This study aimed to validate a nutrition knowledge questionnaire (NQ) and its utility in evaluating the changes in knowledge among participants of a Nutrition Education Program (NEP) conducted at the workplace. A NQ was tested for construct validity, internal consistency and discriminant validity. It was applied in a NEP conducted at six workplaces, in order to evaluate the effect of an interactive or a lecture-based education programme on nutrition knowledge. Four knowledge domains comprising twenty-three items were extracted in the final version of the NQ. Internal consistency of each domain was significant, with Kuder-Richardson formula values>0·60. These four domains presented a good fit in the confirmatory factor analysis. In the discriminant validity test, both the Expert and Lay groups scored>0·52, but the Expert group scores were significantly higher than those of the Lay group in all domains. When the NQ was applied in the NEP, the overall questionnaire scores increased significantly because of the NEP intervention, in both groups (P<0·001). However, the increase in NQ scores was significantly higher in the interactive group than in the lecture group, in the overall score (P=0·008) and in the healthy eating domain (P=0·009). The validated NQ is a short and useful tool to assess gain in nutrition knowledge among participants of NEP at the workplace. According to the NQ, an interactive nutrition education had a higher impact on nutrition knowledge than a lecture programme.

How prevention curricula are taught under real-world conditions: Types of and reasons for teacher curriculum adaptations

PURPOSE

As interventions are disseminated widely, issues of fidelity and adaptation become increasingly critical to understand. This study aims to describe the types of adaptations made by teachers delivering a school-based substance use prevention curriculum and their reasons for adapting program content.

DESIGN/METHODOLOGY/APPROACH

To determine the degree to which implementers adhere to a prevention curriculum, naturally adapt the curriculum, and the reasons implementers give for making adaptations, the study examined lesson adaptations made by the 31 teachers who implemented the keepin' it REAL drug prevention curriculum in 7th grade classrooms (n = 25 schools). Data were collected from teacher self-reports after each lesson and observer coding of videotaped lessons. From the total sample, 276 lesson videos were randomly selected for observational analysis.

FINDINGS

Teachers self-reported adapting more than 68 percent of prevention lessons, while independent observers reported more than 97 percent of the observed lessons were adapted in some way. Types of adaptations included: altering the delivery of the lesson by revising the delivery timetable or delivery context; changing content of the lesson by removing, partially covering, revising, or adding content; and altering the designated format of the lesson (such as assigning small group activities to students as individual work). Reasons for adaptation included responding to constraints (time, institutional, personal, and technical), and responding to student needs (students' abilities to process curriculum content, to enhance student engagement with material).

RESEARCH LIMITATIONS/IMPLICATIONS

The study sample was limited to rural schools in the US mid-Atlantic; however, the results suggest that if programs are to be effectively implemented, program developers need a better understanding of the types of adaptations and reasons implementers provide for adapting curricula.

PRACTICAL IMPLICATIONS

These descriptive data suggest that prevention curricula be developed in shorter teaching modules, developers reconsider the usefulness of homework, and implementer training and ongoing support might benefit from more attention to different implementation styles.

ORIGINALITY/VALUE

With nearly half of US public schools implementing some form of evidence-based substance use prevention program, issues of implementation fidelity and adaptation have become paramount in the field of prevention. The findings from this study reveal the complexity of the types of adaptations teachers make naturally in the classroom to evidence-based curricula and provide reasons for these adaptations. This information should prove useful for prevention researchers, program developers, and health educators alike.