Nutrition Embedding Evaluation Programme: An Evaluation Technical Assistance Model for Supporting Civil Society Organizations to Conduct Quality Nutrition Impact Evaluations.

The Nutrition Embedding Evaluation Programme (NEEP) was a global 4-year program (2013-2017) funded by the United Kingdom Department for International Development created to respond to gaps in the nutrition evidence base. The NEEP implementing agency-PATH-provided grants and evaluation technical assistance (ETA) to civil society organizations (CSOs) from 12 countries to conduct robust nutrition-related impact evaluations. The programmatic approach of having an intermediary agent to manage the funding and ETA mechanisms for nutrition impact evaluations is rare and therefore provides a unique opportunity to understand its effectiveness. Over the program duration, NEEP collected lessons learned that were analyzed and disaggregated into key themes considered critical for the completion of high-quality impact evaluations. From these lessons learned, NEEP provides an ETA program model that can be replicated or adapted to other international development sectors. This model highlights the key role of the three tiers (donor, ETA manager, and CSOs) in ensuring the best value for money and effective technical support for conducting impact evaluations and fostering the importance of knowledge uptake and evaluative culture for maximum knowledge diffusion. In this way, global research can be targeted to approaches that provide options to collaborate with the program implementers and contribute to a holistic evidence base to inform policy and programmatic decisions.

Observation and assessment of the nutritional quality of 'out of school' foods popular with secondary school pupils at lunchtime.

BACKGROUND: The contemporary Scottish diet is unhealthy and a risk factor for poor health outcomes including obesity. Over a third of Scottish children are at risk of being overweight or obese, and there have been calls to strengthen the evidence base on the role of the food retail environment around schools in influencing the consumption of unhealthy foods. METHODS: We examined the food retail environment around five secondary schools in Glasgow city, Scotland. Trained fieldworkers observed the food purchasing behaviour of school pupils in local shops. Samples of the most popular foods were subsequently purchased by the research team and assessed for nutritional content, including energy, total and saturated fat, and salt. This was compared with the nutrient standards for school lunches established by the Scottish Government. RESULTS: There was marked variation in the number of outlets identified within a 10 min walk from each school, ranging from five in the area with the lowest number of outlets to thirty in the area with the highest number of outlets. Outlets identified were heterogeneous and included fish and chip shops, kebab shops, convenience stores, newsagents, bakeries, mobile catering units, cafés, pizzerias, sandwich shops and supermarkets. Lunchtime offers and other marketing strategies targeting school pupils were observed at most outlets. Nutritional analysis of the 45 savoury food items purchased was conducted by laboratory staff. Of the foods analysed, 49% of the samples exceeded recommended calorie intake, 58% exceeded total fat recommendations and 64% exceeded saturated fat recommendations, 42% exceeded recommended salt levels. Over 80% of the 45 food items sampled did not comply with one of more of the nutrient standards for fat, saturated fat and salt. Meal deals and promotions of unhealthy foods aimed at pupils were widely available. CONCLUSIONS: The majority of pupils purchased unhealthy convenience food of poor nutritional value at lunchtime in local shops around their school. Further effort is required to implement regulatory levers such as taxation on unhealthy foods, restriction on the concentration of outlets selling unhealthy foods as well as the development of partnerships and additional measures within and beyond schools to promote healthy foods.

How active are women who play bingo: a cross-sectional study from the Well!Bingo project.

BACKGROUND: The benefits of physical activity are well established, yet large numbers of people are not sufficiently active to gain health benefits. Certain population groups are less physically active than others, including older women from areas of high economic deprivation. The Well!Bingo project was established with the aim of engaging such women in the development of a health promotion intervention in a bingo club. This paper reports on the assessment of health status, physical activity and sedentary behaviour of women attending a bingo club in central Scotland, UK as part of the Well!Bingo project. METHODS: Women attending the bingo club were invited to provide information on demographic characteristics, and self-reported physical activity and sedentary behaviour via a self-complete questionnaire as part of a cross-sectional study (n = 151). A sub-sample (n = 29) wore an accelerometer for an average of 5.7 ± 1.4 days. Differences between younger (under 60 years) and older adults (60 years and over) were assessed using a chi-square test for categorical data and the independent samples t-test was used to assess continuous data (p < 0.05). RESULTS: The mean age was 56.5 ± 17.7 years, with 57% living in areas of high deprivation (Scottish Index of Multiple Deprivation quintile one and two). Sixty-three percent of women (n = 87) reported they were meeting physical activity guidelines. However, objective accelerometer data showed that, on average, only 18.1 ± 17.3 min a day were spent in moderate to vigorous physical activity. Most accelerometer wear time was spent sedentary (9.6 ± 1.7 h). For both self-report and accelerometer data, older women were significantly less active and more sedentary than younger women. On average, older women spent 1.8 h more than younger women in sedentary activities per day, and took part in 21 min less moderate to vigorous physical activity (9.4 mins per day). CONCLUSION: The findings of this study suggest that bingo clubs are settings that attract women from areas of high deprivation and older women in bingo clubs in particular would benefit from interventions to target their physical activity and sedentary behaviour. Bingo clubs may therefore be potential intervention settings in which to influence these behaviours.

Accessing and engaging women from socio-economically disadvantaged areas: a participatory approach to the design of a public health intervention for delivery in a Bingo club.

BACKGROUND: Our aim was to use participatory methods to investigate the feasibility and acceptability of using Bingo clubs for the design and delivery of an evidence-based physical activity and/or healthy eating intervention to socio-economically disadvantaged women. This paper describes the participatory process that has resulted in a physical activity intervention for women aged >55 years, ready for pilot-testing in a Bingo club setting. METHODS: Studies using different quantitative and qualitative approaches were conducted among customers and staff of a Bingo club in a city of 85,000 inhabitants in central Scotland. These were designed to take the views of different stakeholders into account, with a view to enhancing uptake, engagement and effectiveness with any proposed intervention. RESULTS: Sixteen relevant studies were identified in a literature review that generated ideas for intervention components. A questionnaire completed by 151 women in the Bingo club showed that almost half (47 %) aged >55 years were not meeting physical activity guidelines; evidence backed up by accelerometer data from 29 women. Discussions in six focus groups attended by 27 club members revealed different but overlapping motivations for attending the Bingo club (social benefits) and playing Bingo (cognitive benefits). There was some scepticism as to whether the Bingo club was an appropriate setting for an intervention, and a dietary intervention was not favoured. It was clear that any planned intervention needed to utilise the social motivation and habitual nature of attendance at the Bingo club, without taking women away from Bingo games. These results were taken forward to a 5-h long participative workshop with 27 stakeholders (including 19 Bingo players). Intervention design (form and content) was then finalised during two round table research team meetings. CONCLUSIONS: It was possible to access and engage with women living in areas of socio-economic disadvantage through a Bingo club setting. A physical activity intervention for women >55 years is realistic for recruitment, will address the needs of potential recipients in the Bingo club, appears to be feasible and acceptable to club members and staff, and has been designed with their input. A pilot study is underway, investigating recruitment, retention and feasibility of delivery.

Self-monitoring of blood glucose in type 2 diabetes: patients' perceptions of 'high' readings.

Among 207 non-insulin using patients with type 2 diabetes in Tayside, Scotland, who self-monitored blood glucose, we present evidence that many are tolerant of higher blood glucose levels than are clinically advisable; this may explain the lack of empirical evidence for the clinical benefits of self-monitoring in this group.

Self-monitoring among non-insulin treated patients with type 2 diabetes mellitus: Patients' behavioural responses to readings and associations with glycaemic control.

AIM: To investigate self-monitoring of blood glucose (SMBG) behaviour among non-insulin treated patients with type 2 diabetes mellitus, and to evaluate associations with glycaemic control. METHODS: Eligible patients in 23 GP practices in Tayside, Scotland, were identified (18-75 years, no insulin treatment, SMBG reagent strips dispensed in 2009). Consenting patients were administered questionnaires addressing SMBG behaviour: these primary data were record-linked to clinical data (including HbA1c) from a validated population-based diabetes clinical information system, then anonymised. RESULTS: Among 629 eligible patients, 207 were interviewed and analysed. Mean SMBG reagent strips dispensed in 12 months was 268. In response to a perceived high test result, 80 (38.8%) patients took no action or simply checked later with most of them (61.3%) indicating they did not know what action to take. Of the 126 (61.2%) patients who took some action, 101 made changes to diet, 12 increased physical activity, 10 made changes to medication and 12 mad a HCP appointment. A high score on a Diabetes Knowledge Test was a statistically significant predictor of taking action (odds ratio: 2.07). However, neither taking action nor increased SMBG frequency was associated with improved glycaemic control. CONCLUSIONS: Responding to SMBG test results and increased testing frequency were not associated with improved glycaemic control in the short-term. There is a lack of knowledge surrounding SMBG in non-insulin treated patients.

Promoting changes in diet and physical activity in breast and colorectal cancer screening settings: an unexplored opportunity for endorsing healthy behaviors.

The importance of diet, physical activity, and weight management in breast and colorectal cancer prevention is widely recognized. While there may be many "teachable moments" that could be used to assess and initiate changes in these behaviors by health professionals (to complement public health campaigns), there is little evidence that lifestyle is discussed within cancer screening settings. The lack of advocacy about lifestyle in these settings may endorse poor health behaviors, in particular the absence of guidance to visibly obese patients. To fully use the teachable moment, patients need to be aware of the relationship between diet and physical activity and the risk of cancer and to be able to relate guidance to personal behaviors. Results from cardiovascular and diabetes prevention programs provide evidence about the components of effective behavior change programs which could be used in the screening setting. Findings from interventions initiated in the colorectal cancer screening setting suggest that such programs can be delivered but it is not clear how acceptable these are in routine health services. Effective interventions delivered in this setting also offer an important opportunity to contribute to the reduction of the overall burden of chronic non-communicable diseases.