Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities.

BACKGROUND: Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. METHODS: Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. RESULTS: Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives. CONCLUSIONS: Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention.

Development of a Comprehensive Household Food Security Tool for Families with Young Children and/or Pregnant Women in High Income Countries.

Despite increasing rates of food insecurity in high income countries, food insecurity and its related factors are inconsistently and inadequately assessed, especially among households with young children (0-6 years) and pregnant women. To fill this gap, researchers from the U.S. and Australia collaborated to develop a comprehensive household food security tool that includes the known determinants and outcomes of food insecurity among parents of young children and pregnant women. A five-stage mixed methods approach, including a scoping literature review, key informant interviews, establishing key measurement constructs, identifying items and scales to include, and conducting cognitive interviews, was taken to iteratively develop this new comprehensive tool. The resulting 78-item tool includes the four dimensions of food security (access, availability, utilization, and stability) along with known risk factors (economic, health, and social) and outcomes (mental and physical health and diet quality). The aim of this novel tool is to comprehensively characterize and assess the severity of determinants and outcomes of food insecurity experienced by households with young children and pregnant women.

Factors Associated with Food Insecurity among Pregnant Women and Caregivers of Children Aged 0-6 Years: A Scoping Review.

With a global focus on improving maternal and child nutrition through the 2030 Sustainable Development Goals, it is important to understand food insecurity in pregnant women and families with young children, as food insecurity at these life stages can have ongoing negative health consequences. However, factors that influence food insecurity among this population group are not well understood. This scoping review investigates the factors that influence food insecurity among pregnant women and households with young children aged 0-6 years living in high-income countries. A scoping literature review was conducted using four electronic databases. The search combined terms relevant to: food security, determinants, pregnancy and family and high-income countries. Only full text and English language articles were included. The search identified 657 titles and abstracts; 29 articles were included in the review. A majority (70%) of the studies were conducted in the United States and were mostly either cross-sectional or secondary data analysis of existing population data. Factors associated with food insecurity were identified and grouped into 13 constructs. These included social, economic and health risk factors, food access and utilization factors and health and dietary outcomes. This scoping review identifies the factors associated with food insecurity among pregnant women and families with young children that could be used to better measure and understand food insecurity, which could assist in developing program and policy responses. This review also highlights the lack of literature from high-income countries outside the US.

Ministry of Health Clinical Practice Guidelines: Lipids.

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.

Fast-food consumers in Singapore: demographic profile, diet quality and weight status.

OBJECTIVE: To determine the demographic profile of fast-food consumers among adult Singapore residents and ascertain whether fast-food consumption frequency is associated with diet quality and weight status. DESIGN: A nationally representative cross-sectional survey including an FFQ and anthropometric measures. Participants were grouped based on their fast-food consumption frequency as non-consumer, occasional consumer or regular consumer, with regular defined as at least once per week. SETTING: Individuals living in the community in Singapore. SUBJECTS: Singapore residents (n 1627) aged 18-69 years of Chinese, Malay and Indian ethnicity. RESULTS: Proportions of regular fast-food consumers were higher in younger age groups, higher income groups and middle education level groups. Mean daily energy intake was positively associated with fast-food consumption frequency (non-consumers 9636 kJ (2303 kcal); occasional consumers 11 159 kJ (2667 kcal); regular consumers 13 100 kJ (3131 kcal); P for trend < 0·001). Fast-food consumers were more likely to exceed the RDA for energy, fat and saturated fat, and less likely to meet wholegrain and fruit recommendations. Both regular consumers (OR = 1·24; 95 % CI 1·03, 1·51) and occasional consumers (OR = 1·52; 95 % CI 1·32, 1·77) were more likely to have a waist:hip ratio indicating abdominal obesity. Occasional consumers were more likely to have a BMI ≥ 23·0 kg/m2 (OR = 1·19; 95 % CI 1·04, 1·37), whereas regular consumers were less likely (OR = 0·76; 95 % CI 0·64, 0·91) to have an 'at-risk' BMI. CONCLUSIONS: Fast-food consumption is most prevalent in young adults, high income and middle education level groups. Frequent fast-food consumption in Singapore is associated with unfavourable dietary and nutrient profiles and abdominal obesity.

Local evidenced-based policy options to improve food security in South Australia: the use of local knowledge in policy development.

OBJECTIVE: To examine realist policy options for the South Australian government to improve food security. DESIGN: Semi-structured interviews with twenty-four key South Australian food security stakeholders. SETTING: Food security is a global issue that affects both developing and developed countries. Governments are well placed to improve food security but the solutions are not always evident. SUBJECTS: Policy makers, leaders of non-government organisations, private enterprise and front-line food security workers in South Australia. RESULTS: The research produced forty-four potential policy options for the South Australian government to improve food security. CONCLUSIONS: Stakeholders offered detailed policy solutions for the local context. This illustrates how gathering local evidence expands understanding on an issue. The process used to generate these policy options is applicable to other public health problems and other contexts.

The future of public health nutrition: a critical policy analysis of Eat Well Australia.

OBJECTIVE: To better understand how public health nutrition has been represented during the past decade in Australia this paper critically analyses Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000-2010 and its accompanying National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. METHOD: The paper uses an interpretive approach, drawing on Bacchi's method of problem representation, to examine the strategies being offered within the policy. It uses this framework to uncover how public health nutrition has been represented and examines if the representation provided considers all aspects of the issue. The paper also considers how contextual factors affected policy development through examination of publicly available documents. RESULTS: The problem is represented as being both an individual one and one due to social, structural and economic circumstances. There is a large focus on collaboration, research and capacity building. The context of the policy's development has affected the solutions contained within. CONCLUSION: The policy's proposed actions reflect the policy-making environment in which it was conceived. A manifestation of this was unclear division of roles and responsibilities, lack of dedicated resources and inadequate focus on the social determinants of health. IMPLICATIONS: As the policy's timeframe is drawing to its end, critical reflection on how the problem of nutrition has been represented over the previous decade provides greater insight and awareness to direct future public health nutrition work.

Representations of childhood obesity in Australian newsprint media and academic literature.

OBJECTIVE: To examine how the issue of childhood obesity is represented in Australian newsprint media and academic literature. METHOD: Australian newsprint media coverage and academic literature on childhood obesity during the first three months of 2009 was analysed using Bacchi's method of problem representation. RESULTS: The two types of literature examined offered two dominant paradigms for childhood obesity treatment and prevention solutions: the individual and the social-structural. The individual behaviour change account emphasises the role of parents in providing children with healthy food and physical activity, placing them at fault for their obese children. The account focusing on the circumstances within which people live--such as the physical environment, lifestyle, socio-economic status, access to services and advertising/marketing of food aimed at children--places responsibility on the government to respond with policy change. CONCLUSION: While both the individual and social-structural paradigms are found in each source, newsprint media favours the individual responsibility account while the academic literature favours the social-structural account. IMPLICATIONS: Public health professionals may need to be more media savvy to shift this focus.