Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Nutrition plays an important role in cancer survivorship. This systematic review and meta-analysis aim to critically assess and quantify the effectiveness of nutrition care interventions provided by dietitians to survivors who have completed treatment for cancer. METHODS: A systematic review of randomized controlled trials (RCTs) published from January 2004 to November 2023 reporting the effectiveness of primary care dietetic interventions with adult cancer survivors was conducted. PubMed, Scopus, CINAHL, Embase, ProQuest and PsycINFO databases were searched for key terms. Meta-analyses were conducted where there were sufficient studies of the same cancer type and outcomes. RESULTS: Twelve RCTs representing 1138 cancer survivors (519 breast cancer; 75 prostate cancer; 544 colorectal cancer) were included. Primary outcome measures included weight loss (n = 6), quality of life (n = 2), reducing lymphedema-related arm volume (n = 2), nutritional status (n = 1) and increasing fruit and vegetable intake (n = 1). Weight loss was observed in studies where this was the primary outcome. Results for quality of life varied. Meta-analyses of RCTs with breast cancer survivors showed that dietitian intervention achieved a mean of 3.7 kg greater intentional weight loss and 2.3% greater body fat decrease than control (p < 0.0001). CONCLUSIONS: This study provides evidence for the effectiveness of primary care dietetic interventions by dietitians with cancer survivors, particularly with respect to intentional weight and fat loss in breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Dietitians can play a key role in managing weight and improving long term health outcomes and prognosis for cancer survivors beyond the acute care setting.

Community Organising Frameworks, Models, and Processes to Improve Health: A Systematic Scoping Review.

Community involvement engages, empowers, and mobilises people to achieve their shared goals by addressing structural inequalities in the social and built environment. Through this review, we summarised published information on models, frameworks, and/or processes of community organising used in the context of health initiatives or interventions and documented the outcomes following their use. A systematic scoping review was conducted in three databases with no restrictions on the date of publication, country, or written language. Out of 5044 studies, 38 met the inclusion criteria and were included in the review. The targeted health outcomes explored by the studies were diverse and included sub-domains such as the promotion of a healthy lifestyle, sexual and reproductive health, access to healthcare and equity, and substance abuse and chronic disease management. The outcomes of most initiatives or interventions were promising, with positive changes reported for the target populations. A wide variation was noted in the models, frameworks, or processes of community organising utilised in these studies. We concluded that variation implies that no single model, framework, or process seems to have predominance over others in implementing community organising as a vehicle of positive social change within the health domain. The review also highlighted the need for a more standardised approach to the implementation and evaluation of these initiatives. We recommend that it is essential to foster public and non-governmental sector partnerships to promote community-driven health promotion efforts for a more sustainable approach to these initiatives.

Multicomponent approaches to promoting healthy behaviours in people with Type 2 diabetes: an integrative review.

The progression of diabetes-related complications can be delayed with multifactorial interventions that support healthy behaviours. However, many initiatives have focused on educational or individual-level activities and observed limited or modest sustained improvements in healthy behaviours. A multicomponent approach to behaviour change, which simultaneously considers numerous social determinants of health across multiple socio-ecological model levels, may be required to achieve meaningful health outcomes for people with Type 2 diabetes. Applying a multicomponent method of inquiry, this integrative review aimed to synthesize the evidence on interventions using multifactorial interventions to promote healthy behaviours in adults with Type 2 diabetes. Interventions promoting healthy behaviours in adults with Type 2 diabetes were considered for the review. A total of 7205 abstracts retrieved from eight databases were screened for inclusion. Thirteen articles were included, of these 11 achieved statistically significant clinical and/or behavioural changes in outcomes such as glycated haemoglobin, blood pressure, cholesterol, diet and physical activity. The multifactorial components utilized included the coordination of multi-disciplinary health care teams, in-person self-care classes, group activities, incorporation of peer-leaders, the development of community partnerships, economic relief and built-environment support. The proportion of included studies published within recent years indicates a trend towards multicomponent interventions and the growing recognition of this approach in promoting public health. Our findings provide early support for the potential of extending intervention components beyond educational, individual-level and health care system-level focus to incorporate multiple socio-ecological model components that contribute to the system of influence affecting the health of people with diabetes.

Effectiveness of interventions to improve health behaviours of health professionals: a systematic review.

OBJECTIVE: To evaluate the effectiveness of interventions designed to improve the health behaviours of health professionals. DESIGN: Systematic review. DATA SOURCES: Database searches: Medline, Cochrane library, Embase and CINAHL. REVIEW METHODS: This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare randomised controlled trials of health professionals, published between 2010 and 2021, which aimed to improve at least one health behaviour such as physical activity, diet, smoking status, mental health and stress. Two independent reviewers screened articles, extracted data and assessed quality of studies and reporting. The quality of articles was assessed using the Effective Public Health Practice Project quality assessment tool and the completeness of intervention reporting was assessed. OUTCOME MEASURES: The outcome assessed was change in behaviour between intervention and control groups from baseline to follow-up. RESULTS: Nine studies met the eligibility criteria, totalling 1107 participants. Health behaviours targeted were mental health and stress, physical activity, and smoking cessation, physical activity and nutrition. Six interventions observed significant improvements in the health behaviour in the intervention compared with control groups. Seven of the studies selected in person workshops as the mode of intervention delivery. The quality of the included studies was high with 80% (7/9) graded as moderate or strong. CONCLUSIONS: Although high heterogeneity was found between interventions and outcomes, promising progress has occurred across a variety of health behaviours. Improving reporting and use of theories and models may improve effectiveness and evaluation of interventions. Further investigation is needed to recommend effective strategies. PROSPERO REGISTRATION NUMBER: CRD42021238684.

Exploring health professionals' perceptions of how their own diet influences their self-efficacy in providing nutrition care.

OBJECTIVE: Supporting health professionals' dietary behaviours is important to their own health and may influence the quality of care they provide. Understanding health professionals' perceptions on the experiences which have shaped their views on nutrition is important to inform interventions. DESIGN: A cross-sectional qualitative design utilised in depth interviews via telephone or videoconference. Health professionals with direct interaction with patients were recruited through the media channels of Australian national health professional associations. A semi-structured interview guide was used. Interview data analysis was conducted using thematic analysis. Twenty-two health professionals participated in the study including dietitians. RESULTS: Three themes emerged from the data: (1) Life experiences influence health professionals' feelings of self-efficacy in providing nutrition care. (2) Learning through observation and role modelling occurred continually and shaped health professionals' attitudes and beliefs on nutrition care. (3) Social interactions influenced self-efficacy through social persuasion and social pressure. The social environment played a role in both facilitating and/or hindering adoption of a dietary behaviour in their own lives. CONCLUSIONS: Health professionals perceive their personal dietary experiences strongly influence their self-efficacy to provide nutrition care. Strategies which enable health professionals to improve their diets could lead to improvements in nutrition care. Creating socially supportive environments in the workplace warrant investigation to support health professionals to eat well and provide nutrition care to patients.