Importance of collaboration and contextual factors in the development and implementation of social participation initiatives for older adults living in rural areas.

INTRODUCTION: To encourage isolated and vulnerable older adults to accomplish meaningful social activities, occupational therapists and other healthcare workers must collaborate with community organisations and municipalities to develop and implement initiatives fostering social participation. In a rural Regional County Municipality in Quebec (Canada), four social participation initiatives were selected and implemented: (1) Benevolent Community, (2) urban transportation system, (3) creation of a website on social participation activities, and (4) social participation workshop. Little is known about contextual factors such as the structures and organisations, stakeholders, and physical environment that influence the development and implementation of such initiatives. METHODS: Led by an academic occupational therapist, an action research to implement social participation initiatives was initiated by community stakeholders. The 26 stakeholders were involved in a Management and Partnership Committee, two focus groups and an interview with a trainer, which documented and analysed contextual factors and the implementation process. FINDINGS AND DISCUSSION: Development and implementation were facilitated by stakeholder collaboration, mission of the community organisations, and stakeholders' shared desire to reduce older adults' isolation and vulnerability. The established partnerships and predefined orientations as well as the leadership, motivation, and professional skills of the stakeholders also fostered the initiatives. Among the challenges encountered, the stakeholders' limited involvement in implementation tasks was attributable to important changes in the key stakeholders' organisations and structures and the number of organisations involved. Difficulty reaching a consensus resulting from the different attitudes, vision, and understanding of the stakeholders delayed the development and implementation of some initiatives. Despite regular meetings between stakeholders, geographic distance limited spontaneous exchanges. CONCLUSION: This action research highlighted the importance of collaboration and contextual factors in developing and implementing social participation initiatives with community organisations and municipalities.

Identification and feasibility of social participation initiatives reducing isolation and involving rural older Canadians in the development of their community.

BACKGROUND: Although some social participation initiatives exist to counter the isolation of older adults, none were identified and prioritized according to the needs of rural regional county municipalities (RCM), including in Canada. AIMS: To identify and prioritize social participation initiatives for older Canadians, and to document the feasibility of their implementation in a rural RCM. METHODS: An action research was used to identify, based on a review of scientific and grey literature, social participation initiatives, enriched and prioritized by the community. Facilitators, challenges, and advice for the implementation of these initiatives were documented through nine group discussions (n = 85). RESULTS: Two social participation initiatives were identified as more relevant to the RCM, combined and adapted as the Benevolent Community to locate and assist isolated older adults. Two other initiatives were prioritized to identify transportation needs and solutions, and create a website on social participation activities available. Most participants perceived these initiatives as feasible, and will address older adults' social participation needs. Two facilitators were a field worker for older adults and the preoccupations of the community toward isolated older adults. The main challenges concerned the difficulty in recruiting volunteers and locating isolated older adults, exacerbated by the RCM's vast territory. Main advice involved suggestions of people for the recruitment of volunteers. DISCUSSION: Through valuable collaboration with the community, initiatives were identified and prioritized, and challenges were raised, with anticipated success. CONCLUSIONS: Further studies are needed to document the implementation and effects of these initiatives on the social participation of older adults in the RCM.

Do schools in Quebec foster healthy eating? An overview of associations between school food environment and socio-economic characteristics.

OBJECTIVE: A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment. DESIGN: A cross-sectional survey was conducted in 2008-2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools. SETTING: Quebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools' child-care services. SUBJECTS: A two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66.2%. RESULTS: The primary and secondary schools in low-density areas were more likely to be located near diners (primary: P=0.018; secondary: P=0.007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0.004), to seek student input on menu choices (P=0.001) or to have a long lunch period (P=0.010). The primary schools in deprived areas were less likely to have a food service (P=0.025) and their meal periods were shorter (P=0.033). CONCLUSIONS: The schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.

OBJECTIVE: This study assessed the associations between the perception of self-efficacy related to meal management and food coping strategies among working parents with preschool children. METHODS: In this cross-sectional study, 417 working parents with at least one child between the ages of 2 and 5 years completed a self-administered questionnaire. The association between perceived self-efficacy related to meal management and food coping strategies referred to as home-based or "away from home" food strategies, and was verified with logistic regression analysis. RESULTS: High self-efficacy among working parents was associated with planning a menu for the upcoming week (OR=1.171-1.959), preparation of healthy meals with only few ingredients on hand (OR=1.152-1.495), and preparation of meals in advance (OR=1.131-1.364), which are home-based food strategies. Low self-efficacy was linked to adoption of «away from home¼ food strategies such as eating in fast-food restaurants (OR=0.713-0.898). CONCLUSION: self-efficacy related to meal management stands out as one of the priority consideration in planning nutrition interventions targeting working parents. Actions related to acquiring cooking skills, planning menus, and drawing up grocery lists would also be of value.

[Food environment in childcare settings in Quebec: results from a descriptive study]. / L'environnement alimentaire dans les milieux de garde au Québec : résultats d'une étude descriptive.

PURPOSE: The goal of this study was to describe different components of the food environment in childcare settings. METHODS: Visits were made to 33 early childcare centres (CPEs) in the Estrie region of Quebec, Canada. Data were collected between March and July 2008 using a questionnaire based on the Cohen model. The goal of the questionnaire was to collect information about meal organization, menu composition and food preparation methods. RESULTS: Although few CPEs had adopted a food policy, descriptive analyses showed that the food environment in these settings was generally adequate. In 97% of the CPEs, menu planning was performed by the food technician. The meals offered as well as the food preparation methods employed were consistent with the general guidelines of Canada's Food Guide (CFG). However, a lack of professional training was observed. Furthermore, only 25% of the CPEs offered a snack made up of two food groups. CONCLUSIONS: Certain improvements must be made to the food environment in Quebec childcare settings, which underscoresthe need to create and implement a food policy for childcare centres.

Use of health services for psychological distress symptoms among community-dwelling older adults.

ABSTRACTTo document the use of health services for psychological distress symptoms, we collected data from a cross-section of adults aged 65 years and over. Nearly 13 per cent met DSM-IV criteria for mood or anxiety disorders. In addition, 42.4 per cent of those having at least one DSM-IV diagnosis reported having used health services. Results show a direct association between the presence of a probable DSM-IV diagnosis and health service use. However, our results show no significant association between gender and health service use, and do not support the hypothesis that minimal social support increases the probability of older adults using health services for psychological distress. The analysis suggests unmarried elders are more likely than married elders to use health services. Furthermore, this study shows that older adults having a high level of daily hassles reported using health services for psychological distress than those reporting a low stress level. We conclude that a large proportion of elderly mental health needs in Quebec are potentially not being met.

[Multivitamin supplement for primary prevention of birth defects: application of a preventive clinical practice]. / Prise de suppléments multivitaminiques pour la prévention primaire des anomalies congénitalies: application d'une pratique clinique préventive.

OBJECTIVE: To determine whether the recommendations health care professionals make to women of childbearing age on the importance of taking folic acid encourage these women to take folic acid supplements. DESIGN: Survey. SETTING: The Centre de santé et de services sociaux at the Institut universitaire de gériatrie de Sherbrooke in Sherbrooke, Que. PARTICIPANTS: A total of 323 Francophone women 18 to 45 years old. MAIN OUTCOME MEASURES: Whether or not women had consumed vitamin and mineral supplements during the past year. Descriptive, bivariate statistical analyses and logistic regression modeling were carried out to determine whether the association between health care professionals' recommendations and the consumption of vitamin and mineral supplements persisted after controlling for certain variables (consulting documentation, knowledge, sources of information, perception, age, education, income, marital status, and plans to become pregnant). RESULTS: About 41% of the women reported that their physicians had recommended that they take vitamin and mineral supplements. After adjusting for all the variables in the model, it became clear that there was a significant association between the recommendations of healthcare professionals and the consumption of vitamins and minerals by women of childbearing age. CONCLUSION: Health care professionals can improve the health of the population through preventive clinical practices. It is important that we support them in their efforts to integrate and apply scientific knowledge in their practice.

Foods offered in Quebec school cafeterias: do they promote healthy eating habits? Results of a provincial survey.

OBJECTIVE: A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The aim of this paper is to describe the food offered for lunch in the cafeteria service lines in Quebec schools on regular school days. METHODS: A cross-sectional survey was conducted between November 2008 and June 2009 with a representative sample of 207 French-speaking schools in the province of Quebec. The response rate was 71%. The cafeteria food available from the service line was observed directly and systematically by research assistants trained in observational procedures. Bivariate and descriptive analyses were performed. RESULTS: While most schools offered a vegetable side dish, only 71% of primary schools, 71% of public secondary schools, and 54% of private secondary schools did not offer cold-cut dishes, stuffed pastry, or a fried food on their daily menus. The sandwiches available were rarely made with whole-grain bread. Public secondary schools had more cookies, biscuits, muffins, and chewing gum than private primary and secondary schools. Milk was available in 85% of the primary schools. Most of the schools had eliminated sodas but were still offering fruit cocktails instead of 100% fruit juice. CONCLUSION: The school eating environment changed significantly from 2002 to 2009, presumably as a result of the government action plan and the Framework Policy. Improvements must be made with respect to reducing added sugar in beverages and desserts and promoting baked rather than fried snacks. Vigilance is required since many new products are making their way into the market.