Health literacy and fruit and vegetable intake in rural Australia.

OBJECTIVE: Adequate fruit and vegetable intake is important in the prevention of chronic disease. Health literacy is associated with health outcomes but its role in dietary behaviour has received little attention. The present study investigated the association between a multidimensional measure of health literacy, sociodemographic characteristics, and fruit and vegetable intake in rural Australia. DESIGN: A cross-sectional survey on intake of fruits and vegetables (servings/d), demographic characteristics and health literacy profile using a nine-scale Health Literacy Questionnaire (HLQ). Associations between health literacy and fruit and vegetable intake were assessed using logistic regression. SETTING: A large rural area of Victoria. SUBJECTS: Adults residing in the Grampians region (n 1154; 61 % female, mean age 52 (sd 17) years). RESULTS: The HLQ scale 'Actively managing my health' predicted (OR; 95 % CI) fruit (2·31; 1·87, 2·84) and vegetable (1·81; 1·45, 2·26) intake. The scales 'Appraisal of health information' (fruits: 1·73; 1·41, 2·13; vegetables: 1·49; 1·20, 1·86), 'Social support for health' (fruits: 1·31; 1·06, 1·63; vegetables: 1·40; 1·10, 1·76) and 'Ability to find good health information' (fruits: 1·25; 1·05, 1·48; vegetables: 1·36; CI 1·13, 1·63) also predicted fruit and vegetable intake. These associations remained significant after adjusting for age, gender, educational attainment and having private health insurance. CONCLUSIONS: Health literacy, particularly being proactive, appraising information and having social support for health, is associated with greater fruit and vegetable intake. Future interventions should consider the health literacy needs of the community to improve fruit and vegetable intake.

Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program.

BACKGROUND: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. METHODS AND FINDINGS: In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: -0.23 kg body weight in intervention group (95% CI -0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference -0.95 kg, 95% CI -1.87, -0.04; group by treatment interaction p = 0.04); -2.24 cm waist measurement in intervention group (95% CI -3.01, -1.42) compared with -1.74 cm in usual care group (95% CI -2.52, -0.96) (change difference -0.50 cm, 95% CI -1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference -0.05 mmol/l, 95% CI -0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. CONCLUSIONS: Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000338066.

Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia.

This study explored the association between health literacy, barriers to breast cancer screening, and breast screening participation for women from culturally and linguistically diverse (CALD) backgrounds. English-, Arabic- and Italian-speaking women (n = 317) between the ages of 50 to 74 in North West Melbourne, Australia were recruited to complete a survey exploring health literacy, barriers to breast cancer screening, and self-reported screening participation. A total of 219 women (69%) reported having a breast screen within the past two years. Results revealed that health literacy was not associated with screening participation. Instead, emotional barriers were a significant factor in the self-reported uptake of screening. Three health literacy domains were related to lower emotional breast screening barriers, feeling understood and supported by healthcare providers, social support for health and understanding health information well enough to know what to do. Compared with English- and Italian-speaking women, Arabic-speaking women reported more emotional barriers to screening and greater challenges in understanding health information well enough to know what to do. Interventions that can improve breast screening participation rates should aim to reduce emotional barriers to breast screening, particularly for Arabic-speaking women.

Comparing a telephone- and a group-delivered diabetes prevention program: Characteristics of engaged and non-engaged postpartum mothers with a history of gestational diabetes.

AIMS: To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. METHODS: Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention. RESULTS: In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion. CONCLUSIONS: Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.

Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: an update to the study protocol for a randomized controlled trial.

BACKGROUND: The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial (RCT) that aims to assess the effectiveness of a structured diabetes prevention intervention for women who had gestational diabetes. METHODS/DESIGN: The original protocol was published in Trials (http://www.trialsjournal.com/content/14/1/339). This update reports on an additional exclusion criterion and change in first eligibility screening to provide greater clarity. The new exclusion criterion "surgical or medical intervention to treat obesity" has been added to the original protocol. The risks of developing diabetes will be affected by any medical or surgical intervention as its impact on obesity will alter the outcomes being assessed by MAGDA-DPP. The screening procedures have also been updated to reflect the current recruitment operation. The first eligibility screening is now taking place either during or after pregnancy, depending on recruitment strategy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066.

Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial.

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals. METHODS/DESIGN: The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups. DISCUSSION: This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066.