Development of Interventions to Support Provincial Implementation of the Baby-Friendly Initiative: A Study Protocol.

Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.

Canadian adaptation of the Newest Vital Sign©, a health literacy assessment tool.

OBJECTIVE: The Newest Vital Sign© (NVS) was developed in the USA to measure patient health literacy in clinical settings. We adapted the NVS for use in Canada, in English and French, and created a computerized version. Our objective was to evaluate the reliability of the Canadian NVS as a self-administered computerized tool. DESIGN: We used a randomized crossover design with a washout period of 3-4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar's tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing. SETTING: Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia. SUBJECTS: English- and French-speaking adults aged 18 years or older. RESULTS: A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants' health literacy assessments differed between the two versions. CONCLUSIONS: Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.

Patient and Professional Perspectives on Nutrition in Chronic Respiratory Disease Self-Management: Reflections on Nutrition and Food Literacies.

BACKGROUND: Nutrition literacy (NL) and food literacy (FL) have emerged as distinct forms of the multifaceted concept of health literacy (HL). Despite convincing evidence that changes in dietary behavior can improve health, the role of nutrition in supporting self-management in patients with chronic respiratory disease tends to be overlooked. OBJECTIVE: This study examined patient and key informant (health care professionals, researchers, and policymakers) perspectives on nutrition in the context of self-management practices in asthma and chronic obstructive pulmonary disease with implications for NL and FL. METHODS: Data were collected during 16 focus groups with 93 English- and French-speaking patients in the Canadian Provinces of British Columbia, Ontario, and Quebec, and in-depth interviews with 45 key informants mainly from Canada. Participants' comments, including dietary perception keywords, were extracted and classified using NVivo software. Thematic analysis was applied. KEY RESULTS: Patients' perspectives on nutrition reflected three broad themes: (1) importance of nutrition knowledge in self-management, (2) applying nutrition knowledge in self-management, and (3) challenges in applying nutrition knowledge in self-management. Embedded within the third theme were six sub-themes: Limitations in "accessing nutrition information," "understanding nutrition information," "basic literacy skills," and "ability to act on nutrition information," along with "lack of supports to act on nutrition information," and "competing daily demands in mealtime and medication management." Although less than 10% of key informants provided nutrition-relevant comments, their comments reinforced patients' concerns about barriers to accessing, understanding, and using nutrition information in self-management. CONCLUSIONS: Our findings suggest that more attention be directed to nutrition in the self-management of chronic respiratory disease and warrant further research on the roles of NL and FL in this health practice context. Such research could also contribute to the broader agenda of understanding NL and FL and applying them as subconcepts of HL in chronic disease self-management interventions. [ HLRP: Health Literacy Research and Practice. 2018;2(3):e166-e174.]. PLAIN LANGUAGE SUMMARY: Growing evidence supporting the role of diet in chronic disease calls for more attention to nutrition literacy. This study explored patient and key informant viewpoints on engaging with nutrition information in self-management of chronic lung disease. Findings suggest patients encounter many challenges in accessing, understanding, and acting on relevant nutrition information.

Stronger Together: Use of Storytelling at a Dietetics Conference to Promote Professional Collaboration.

During a Dietitians of Canada conference session (2015), 4 facilitators drew upon "Alice's Adventures in Wonderland" (Alice) to engage participants in discussing the future of dietetic education. The aim was to feature Nova Scotia (NS) collaborative experiences as an example of dietetic education planning that could be implemented elsewhere. Three vignettes from the Alice story were chosen as metaphoric representations of dilemmas and assumptions commonly faced by dietetic educators. Story quotations and facilitator questions related to each vignette-guided discussion. The 3-part story-based arts approach of hearing stories, recognizing stories, and telling stories enabled participants to reflect on their own practice, relate to the challenges of others, and question conventional wisdom. Participants heard the Alice stories, recognized their experiences through the NS examples and had an opportunity to tell their own stories during discussions. Participants identified barriers to and strategies for collaborative planning in their own regions. Evaluation suggests most participants were positively engaged by the storytelling approach. Participants recommended that future offerings allow more time for orientation and for completion of planned activities. Bilingual programming should also be considered. Participants valued the unconventional approach to workshop engagement and planned to implement it in their own workplaces.

The influence of newborn early literacy intervention programs in three canadian provinces.

Low levels of literacy in early childhood can have lasting effects on children's educational and intellectual development. Many countries have implemented newborn literacy programs designed to teach parents pre-literacy promoting activities to share with their children. We conducted 2 quasi-experimental studies using 1) a pre-test/post-test design and 2) a non-equivalent control group design to examine the effect of newborn literacy programs on parents' self-reported literacy intentions/behaviors, values toward literacy, and parent-child interactions. Parents were recruited from 3 provinces, 2 with newborn literacy programs (intervention) and 1 without (control). Parents in the intervention group completed prenatal and postnatal (after participation in program) questionnaires. Parents in the control group completed 1 questionnaire. Questionnaires were designed to capture parents' literacy intentions (prenatal), behaviors (postnatal), values, and parent-child interactions (postnatal). A total of 98 parents were included in study one and 174 were included in study two. Parents' self-reported prenatal intentions and values were higher than their postnatal behaviors and values. Parents in the intervention group exhibited higher literacy behaviors and values and greater enjoyment reading to their children than parents in the control group, though they also reported reading to their children less frequently. Parents in the intervention group had significantly higher Positive Interactive scores than controls. Overall, we found participation in newborn literacy programs positively impacted parenting behaviors and attitudes. Lower postnatal within-group scores (intentions and values versus behaviors and values) may have been the result of participants' high expectations. Given our findings, we recommend that these programs continue.

Exploring Dietitians' Engagement with Health Literacy: Concept and Practice.

PURPOSE: Recognition of health literacy as a serious problem in Canada calls for all health practitioners to rethink how they provide health information. This qualitative research study explored how Canadian dietitians understand the multifaceted concept of health literacy and, if and how, they apply it in their practice. METHODS: Nine dietetic or nutrition practitioners from different practice settings were purposely selected through an environmental scan of health literacy interventions, professional networks, and interviewee snowballing. Qualitative data were collected using conversational-style personal interviews and thematically analyzed through an iterative process of constant comparison. RESULTS: All participants recognized value in addressing health literacy in their practice with many barriers and enablers to its application identified. Participants referred to difficulties in communicating nutrition information to people with low levels of functional literacy, reflective of a deficit approach to health literacy. However, practices consistent with the more empowering concepts of interactive and critical health literacy, reflective of an asset-based approach, were also described. CONCLUSION: This research provides a preliminary picture of how dietitians engage with health literacy in various settings in Canada and suggests implications for developing strengths-based health literacy approaches to dietetic practice.

Breastfeeding, skin-to-skin contact, and mother-infant interactions over infants' first three months.

The effects of skin-to-skin contact (SSC) on the maintenance of mothers' decision to breastfeed, the effects of breastfeeding and SSC on mother-infant interactions, and whether maternal depressive symptoms mediate these effects were investigated over infants' first 3 months. When infants were 1 week, 1 month, 2 months, and 3 months of age, mothers in the SSC and control groups reported the type of infant feeding provided and completed the Edinburgh Postnatal Depression Scale (EPDS; J.L. Cox, J.M. Holden, & R. Sagovsky, 1987); mother-infant interactions were coded on the Nursing Child Assessment Feeding Scale (NCAFS; G. Summer & A. Spietz, 1994). Percentage of breastfeeding dyads in the SSC group was stable over the 3 months; yet, fewer dyads in the control group were breastfeeding at the 2- and 3-month visits than at the 1-week visit. Breastfeeding dyads had higher NCAFS Caregiver subscale scores, indicating more positive maternal interactions, at 1 week, 2 months, and 3 months. NCAFS scores did not differ for the SSC and control groups. EPDS scores did not mediate the effect of SSC on breastfeeding or breastfeeding on NCAFS Caregiver subscale scores.

Enhanced dietetics education through collaboration: a study to identify opportunities.

With the aim of enhancing dietetics education in Nova Scotia, key stakeholders were engaged in identifying current practice issues along with opportunities for collaboration to address them. A survey containing five open-ended questions was distributed by email to a purposive sample of 24 participants affiliated with three universities with dietetics programs. Participants fell into five categories: internship coordinators, dietetics educators, recent internship graduates, current interns, and prospective interns. The response rate was 58%. Data were thematically analyzed through a process of constant comparison. Primary themes emerged, which reflected survey participants' concerns about three current practice issues: province-wide standards, internship placement availability, and the overall educational experience. Additional comments suggested that overall dietetic educational experiences could be improved if relevant clinical experiences were offered and preceptor workloads were accommodated. The creation of province-wide standards for assessing interns' level of competency was perceived to offer multiple benefits, including decreased preceptor workloads. Participants believed that collaborative actions might increase internship placements and improve the overall dietetic internship experience for interns and preceptors.

Multiple domains of health literacy as reflected in breastfeeding promotion practice: a Canadian case study.

A model of multiple domains of health literacy was mapped to 30 practitioners' accounts of their breastfeeding promotion practice in a region of Canada. Fundamental/basic literacy themes were consistent with earlier literature regarding practitioners' discomfort in addressing literacy issues with their clients. Scientific literacy was reflected in practitioners' dilemmas about using jargon and scientific evidence when discussing breastfeeding. Cultural literacy themes related to practitioners' understandings of the sociocultural context influencing adoption of breastfeeding. Civic literacy was reflected in the use of advocacy for creating supportive breastfeeding environments. Building capacity for health literacy, however, was not a conscious focus of practice.

A participatory food costing model in Nova Scotia.

In recognition of the growing challenge that food insecurity has on population health, a multisectoral partnership in Nova Scotia has been working since 2001 to address province-wide accessibility to a nutritious diet. The participatory food costing (PFC) model has been at the forefront of provincial and national efforts to address food insecurity; a local foods component was incorporated in 2004. This model has engaged community partners, including those affected by food insecurity, in all stages of the research, thereby building capacity at multiple levels to influence policy change and food systems redesign. By putting principles of participatory action research into practice, dietitians have contributed their technical, research, and facilitation expertise to support capacity building among the partners. The PFC model has provided people experiencing food insecurity with a mechanism for sharing their voices. By valuing different ways of knowing, the model has facilitated much-needed dialogue on the broad and interrelated determinants of food security and mobilized knowledge that reflects these perspectives. The development of the model is described, as are lessons learned from a decade of highly productive research and knowledge mobilization that have increased stakeholders' understanding of and involvement in addressing the many facets of food security in Nova Scotia.