Exploring the Framing of Animal Farming and Meat Consumption: On the Diversity of Topics Used and Qualitative Patterns in Selected Demographic Contexts.

In various contexts, people talk about animal farming and meat consumption using different arguments to construct and justify their (non-)acceptability. This article presents the results of an in-depth qualitative inquiry into the content of and contextual patterns in the everyday-life framing regarding this issue, performed among consumers in various settings in two extremes in the European sphere: the Netherlands and Turkey. We describe the methodological steps of collecting, coding, and organizing the variety of encountered framing topics, as well as our search for symbolic convergence in groups of consumers from different selected demographic contexts (country, urban-rural areas, gender, age, and education level). The framing of animal farming and meat consumption in everyday-life is not a simple one-issue rational display of facts; people referred to a vast range of topics in the categories knowledge, convictions, pronounced behaviour, values, norms, interests, and feelings. Looking at framing in relation to the researched demographic contexts, most patterns were found on the level of topics; symbolic convergence in lines of reasoning and composite framing was less prominent in groups based on single demographic contexts than anticipated. An explanation for this lies in the complexity of frame construction, happening in relation with multiple interdependent contextual features.

Communication Between HIV Patients and Their Providers: A Qualitative Preference Match Analysis.

Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed.

Quality assessment of practice nurse communication with type 2 diabetes patients.

OBJECTIVE: Nurse self-management support for type 2 diabetes patients may benefit from applying theory-based behavior change counseling. The 5As model was used to assess if, and how, nurses applied the five key elements of self-management support in standard care. METHODS: Seven practice nurses audio-recorded consultations with 66 patients. An existing instrument for assessing counseling quality was used to determine if the 5As were applied. Applied As were compared with quality criteria, to provide an in-depth assessment. RESULTS: In almost every consultation, nurses assessed health behaviors, and arranged a follow-up meeting. However, nurses advised behavior change in less than half of the consultations, while setting goals and assisting patients to overcome barriers were used even less. Comparing applied As with quality criteria revealed several issues that could be improved. CONCLUSION: Nurses consistently discussed health behaviors with patients, but important elements of self-management support were not applied. PRACTICE IMPLICATIONS: Self-management support may benefit from training nurses in performing assessments that form the base for specific advice, setting goals, and addressing barriers to behavior change. Nurses also have to learn how to combine being medical expert and behavioral counselor. Clarifying both roles to patients may facilitate communication and establishing a collaborative relationship.

Effective Nurse Communication With Type 2 Diabetes Patients: A Review.

Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse-patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.

Evaluation of using spot urine to replace 24 h urine sodium and potassium excretions.

OBJECTIVE: The most accurate method to estimate Na and K intakes is to determine 24 h urinary excretions of these minerals. However, collecting 24 h urine is burdensome. Therefore it was studied whether spot urine could be used to replace 24 h urine samples. DESIGN: Participants collected 24 h urine and kept one voiding sample separate. Na, K and creatinine concentrations were analysed in both 24 h and spot urine samples. Also 24 h excretions of Na and K were predicted from spot urine concentrations using the Tanaka and Danish methods. SETTING: In 2011 and 2012, urine samples were collected and brought to the study centre at Wageningen University, the Netherlands. SUBJECTS: Women (n 147) aged 19-26 years. RESULTS: According to p-aminobenzoic acid excretions, 127 urine collections were complete. Correlations of Na:creatinine, K:creatinine and Na:K between spot urine and 24 h urine were 0·68, 0·57 and 0·64, respectively. Mean 24 h Na excretion predicted with the Tanaka method was higher (difference 21·2 mmol/d, P<0·001) than the measured excretion of 131·6 mmol/d and mean 24 h Na excretion predicted with the Danish method was similar (difference 3·2 mmol/d, P=0·417) to the measured excretion. The mean 24 h K excretion predicted with the Tanaka method was higher (difference 13·6 mmol/d, P<0·001) than the measured excretion of 66·8 mmol/d. Bland-Altman plots showed large individual differences between predicted and measured 24 h Na and K excretions. CONCLUSIONS: The ratios of Na:creatinine and K:creatinine in spot urine were reasonably well associated with their respective ratios in 24 h urine and appear to predict mean 24 h Na excretion of these young, Caucasian women.

Planning in Dutch health promotion practice: a comprehensive view.

Health promotion has a strong tradition of using planning models based on an a priori set of goals and processes defined by professionals. Those rational models only partly fit with today's view and practice of health promotion, where programmes can be considered as processes because they are guided by principles such as community participation and intersectoral collaboration. The aim of this paper is to provide a comprehensive view on approaches to planning in health promotion practice. To investigate these, Whittington's typology has been used. Whittington identifies four approaches to planning, i.e. classical, evolutionary, processual and systemic. In a retrospective multiple case study, we describe actual planning processes used in the development and implementation of a healthy ageing programme in three Dutch municipalities. These processes were described using data gathered by: interviews, participant observation and document analysis, and external auditing. Characteristics of the four planning approaches were used to interpret the data. The results show that, in practice, all forms of planning approaches were used, depending on the degree of complexity and dynamics of the context, the phase of the health promotion programme, and the time available. Our findings suggest that in the emergent practice of health promotion different approaches to planning are used. To make those planning approaches explicit and manageable for practice and science, discussion and reflection between stakeholders are essential.

'Getting things done': an everyday-life perspective towards bridging the gap between intentions and practices in health-related behavior.

In this paper, we aim to add a new perspective to supporting health-related behavior. We use the everyday-life view to point at the need to focus on the social and practical organization of the concerned behavior. Where most current approaches act disjointedly on clients and the social and physical context, we take the clients' own behavior within the dynamics of everyday context as the point of departure. From this point, healthy behavior is not a distinguishable action, but a chain of activities, often embedded in other social practices. Therefore, changing behavior means changing the social system in which one lives, changing a shared lifestyle or changing the dominant values or existing norms. Often, clients experience that this is not that easy. From the everyday-life perspective, the basic strategy is to support the client, who already has a positive intention, to 'get things done'. This strategy might be applied to those cases, where a gap is found between good intentions and bad behavior.

Cost effectiveness of medication adherence-enhancing interventions: a systematic review of trial-based economic evaluations.

BACKGROUND: In light of the pressure to reduce unnecessary healthcare expenditure in the current economic climate, a systematic review that assesses evidence of cost effectiveness of adherence-enhancing interventions would be timely. OBJECTIVE: Our objective was to examine the cost effectiveness of adherence-enhancing interventions compared with care as usual in randomised controlled trials, and to assess the methodological quality of economic evaluations. METHODS: MEDLINE, PsycInfo, EconLit and the Centre for Reviews and Dissemination databases were searched for randomised controlled trials reporting full economic evaluations of adherence-enhancing interventions (published up to June 2013). Information was collected on study characteristics, cost effectiveness of treatment alternatives, and methodological quality. RESULTS: A total of 14 randomised controlled trials were included. The quality of economic evaluations and the risk of bias varied considerably between trials. Four studies showed incremental cost-effectiveness ratios (ICERs) below the willingness-to-pay threshold. Few studies seemed to evaluate interventions that successfully changed adherence. CONCLUSIONS: Only 14 randomised controlled trials examined the cost effectiveness of adherence interventions. Despite that some studies showe favourable ICERs, the overall quality of studies was modest and the economic perspectives applied were frequently narrow. To demonstrate that adherence interventions can be cost effective, we recommend that proven-effective adherence programmes are subjected to comprehensive economic evaluations.

Determinants of Dutch general practitioners' nutrition and physical activity guidance practices.

OBJECTIVE: General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants. DESIGN: Cross-sectional study, mail questionnaire. SETTING: Dutch general practice. SUBJECTS: Four hundred and seventy-two GP in practice for 5­30 years. RESULTS: Our study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices. CONCLUSIONS: The majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the selfefficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice.

If you can't eat what you like, like what you can: how children with coeliac disease and their families construct dietary restrictions as a matter of choice.

Although it is recognised that a gluten-free diet has many social implications for coeliac disease patients, not much is known about how such patients actually manage these implications in their everyday interactions. This article examines how dietary restrictions are treated by patients and their families. Data from recorded mealtime conversations of seven Dutch families with children suffering from coeliac disease were analysed using discursive psychology. We found two main discursive strategies by which patients and their families manage the diet during mealtime interactions. A reference to pleasure is used to manage the tension between the child's agency and parental responsibility in the face of health requirements and, by softening the denial of food, the diet is normalised and treated as a shared family practice. The analysis shows that the gluten-free diet is demedicalised and treated as a matter of choice rather than prescription. We conclude with the practical implications of these findings.

The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to October 2008: a review.

BACKGROUND: Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. OBJECTIVE: To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance practices of PCPs. METHOD: A review of articles published from 1995 to October 2008 (n = 111). RESULTS: It was found that 45% of the articles in this review included theories or theoretical models of behaviour change. No difference in proportion of model use was found with time. Model use differed between type of study. In 29% of the articles, the Transtheoretical Model was used. Little was found on authors' views on theoretical model applicability. CONCLUSIONS: Forty-five per cent of the articles on nutrition guidance practices of PCPs published from 1995 to October 2008 included theories or theoretical models of behaviour change. It would be beneficial for nutrition behaviour change research if more researchers use theoretical models and report on applicability of the selected theory, to increase effectiveness of nutrition guidance by PCPs.

A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007.

BACKGROUND: One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. OBJECTIVE: Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. METHODS: This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, van Woerkum CMJ, Fieren CJ, van t'Hof MA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29-36.) demonstrated that 'noticing patients' overweight and guidance of treatment' was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). RESULTS: This analysis shows both similarity and differences in working mechanism of determinants of noticing patients' overweight and guidance of treatment between 1997 and 2007. The backbone of the mechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. CONCLUSIONS: The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients' overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.

The difficult balance between entertainment and education: a qualitative evaluation of a Dutch health-promoting documentary series.

The development, content and potential health promoting effect of the Dutch documentary series, Voor dik & dun ("For thick and thin") were investigated. This series was based on the entertainment-education (EE) strategy and designed to prevent overweight. Qualitative data were collected from three perspectives: those involved in the program development (in-depth interviews), health communication scientists (in-depth interviews), and viewers (focus groups). In addition, viewing figures and website statistics were collected. Results show that finding a proper balance between entertainment and education is difficult for those involved. Voor dik & dun was not very successful in creating this balance and did not reach its priority audience. Findings suggest that, to achieve the desired health-promoting effects, EE programs should focus first extensively on narrative engagement by means of entertainment and later on, when the viewer is engaged, try to educate by means of positive identification with transitional role models.

Stressors and resources mediate the association of socioeconomic position with health behaviours.

BACKGROUND: Variability in health behaviours is an important cause of socioeconomic health disparities. Socioeconomic differences in health behaviours are poorly understood. Previous studies have examined whether (single) stressors or psychosocial resources mediate the relationship between socioeconomic position and health or mortality. This study examined: 1) whether the presence of stressors and the absence of resources can be represented by a single underlying factor, and co-occur among those with lower education, 2) whether stressors and resources mediated the relation between education and health behaviours, and 3) addressed the question whether an aggregate measure of stressors and resources has an added effect over the use of individual measures. METHODS: Questionnaire data on sociodemographic variables, stressors, resources, and health behaviours were collected cross-sectionally among inhabitants (n = 3050) of a medium-sized Dutch city (Utrecht). Descriptive statistics and bootstrap analyses for multiple-mediator effects were used to examine the role of stressors and resources in mediating educational associations with health behaviours. RESULTS: Higher levels of stressors and lower levels of resources could be represented by a single underlying factor, and co-occurred among those with lower educational levels. Stressors and resources partially mediated the relationship between education and four health- behaviours (exercise, breakfast frequency, vegetable consumption and smoking). Financial stress and poor perceived health status were mediating stressors, and social support a strong mediating resource. An aggregate measure of the stressors and resources showed similar associations with health behaviours compared to the summed individual measures. CONCLUSIONS: Lower educated groups are simultaneously affected by the presence of various stressors and absence of multiple resources, which partially explain socioeconomic differences in health behaviours. Compared to the direct associations of stressors and resources with health behaviours, the association with socioeconomic status was modest. Therefore, besides addressing structural inequalities, interventions promoting financial management, coping with chronic disease, and social skills training have the potential to benefit large parts of the population, most notably the lower educated. Further research is needed to clarify how stressors and resources impact health behaviours, why this differs between behaviours and how these disparities could be alleviated.

Neighbors Connected: the interactive use of multi-method and interdisciplinary evidence in the development and implementation of neighbors connected.

Neighbors Connected is a community-based intervention in the Netherlands. It helps the active older people to organize social activities for their less active older neighbors, facilitated by practical and financial support from the Community Health Service. The intervention is the outcome of a combination of semi-structured interviews with the older people, with organizations for older people and with local policy-makers, epidemiological data and interactive discussions, all of which support the notion that engaging in social activities is a way to enhance healthy ageing within the community. The use of different sources of evidence resulted in a comprehensive picture and actionable local knowledge.

Healthy ageing in a salutogenic way: building the HP 2.0 framework.

Healthy ageing is influenced by a variety of interacting determinants. Because no one agency can tackle all these determinants, the promotion of healthy ageing requires an intersectoral approach. The aim of this article is to describe a theoretical basis, the development and possible applications of a framework within a municipality in the Netherlands. This framework supports intersectoral collaboration by guiding and stimulating the development, implementation and evaluation of health promotion activities for healthy ageing. It is based on the principles of health promotion and on the theory of salutogenesis and built upon three interrelated central concepts: (1) sense of coherence, (2) resources for health, and (3) health. The framework visualises the interrelationships of the three concepts within health promotion and salutogenesis. This visualisation makes explicit the value and the contribution with respect to content of intersectoral collaboration and the participation of older people in health promotion. The relationships between the concepts of the framework also indicate the need to undertake different types of research and gather different kinds of data to develop, implement and evaluate healthy ageing strategies.

Quitting is not an option: An analysis of online diet talk between celiac disease patients.

This is an empirical study of the way in which celiac disease patients manage the risk of gluten intake in their everyday life.The article examines naturally occurring conversational data in order to study how patients cope interactionally with constantly being at risk in their day-to-day living. They reject quitting the diet as a valid option, and instead construct a 'diet world' in which dietary transgression is presented as an integrated part of everyday life. In this way, patients can manage occasional diet lapses without putting the validity of the diet itself at stake. By examining how the gluten-free diet is treated in interaction, we find out more about the pre-existing everyday strategies that have to be taken into account when new therapies are being introduced.

I eat healthfully but I am not a freak. Consumers' everyday life perspective on healthful eating.

The gap between the awareness and understanding of healthful eating on the one hand and actual eating practices on the other has been addressed in several ways in the literature. In this paper, we consider it from an everyday life perspective. Using discourse analysis, we analyse how Dutch consumers account for their everyday food choices. We show how Dutch consumers use three interpretative repertoires to confirm the importance of health, while not portraying themselves as too self- and health-conscious eaters. The first repertoire associates healthful eating with common knowledge and 'scripted' actions, thereby suggesting that such eating is self-evident rather than difficult. The second repertoire constructs eating for health and pleasure as uncomplicated, by emphasizing consumers' relaxed way of dealing with both. The third repertoire constructs unhealthful eating practices as naturally requiring compensation in the form of certain products or pills. We discuss how the use of these repertoires may pose socio-interactional barriers to the pursuance of healthful eating behaviour. The depiction of one's eating habits as uncomplicated, self-evidently healthful and - when bad - easy to compensate for, does not seem to provide a basis for critical considerations about these eating habits. If structural change in eating practices is to be achieved, nutrition promotion must invest in creating a new social standard that both avoids 'overdoing' bio-medical health and challenges people's construction of their eating habits as naturally healthful.

Written nutrition communication in midwifery practice: what purpose does it serve?

OBJECTIVE: to obtain an in-depth understanding of verbal and written nutrition communication in Dutch midwifery practice. DESIGN, SETTING AND PARTICIPANTS: data were collected by recording 12 initial antenatal consultations (12 weeks into the pregnancy) with primiparous women from four Dutch midwifery practices spread over The Netherlands, followed by two semi-structured qualitative interviews with the women. The interviews were undertaken on the day after the consultation and two weeks later. FINDINGS: analysis of the recordings revealed that a nutrition brochure was offered in an information pack, but it was not used or referred to by the midwives. Verbally, clients were informed about healthy nutrition in general terms. Specific, personally relevant nutrition-related questions and motivators of nutrition behaviour were rarely clarified and addressed. Midwives tried to create a good relationship with their clients by being friendly, complimentary, confirmative and supportive. Women appreciated talking about nutrition with the midwife because of her expertise. The subsequent interviews with the women revealed, however, that nutrition communication took place relatively late in pregnancy at a point when women were more interested in 'hearing the baby's heart beat'. Furthermore, clients seldom looked through the nutrition brochure at home. KEY CONCLUSION: the provision of a nutrition brochure does not serve any real purpose. IMPLICATIONS FOR PRACTICE: to reach optimal synergy between verbal and written nutrition communication in midwifery practice, midwives should actively refer to a nutrition brochure in addition to verbal communication. Moreover, health organisations should realise that the provision of nutrition brochures to midwives does not mean that these brochures will be used as an integral part of midwives' nutrition communication with clients.