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1.
BMC Public Health ; 19(1): 1146, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429735

RESUMO

BACKGROUND: UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. METHODS: An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. RESULTS: Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. CONCLUSION: Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study.


Assuntos
Terapia Comportamental/educação , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/etnologia , Dieta para Diabéticos/métodos , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Adulto , Grupo com Ancestrais do Continente Africano/educação , Terapia Comportamental/métodos , Região do Caribe/etnologia , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/etnologia , /métodos , Exercício , Feminino , Grupos Focais , Comportamentos Relacionados com a Saúde/etnologia , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Avaliação de Programas e Projetos de Saúde , Autogestão/métodos , Apoio Social , Reino Unido
2.
BMJ Open ; 9(2): e023733, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30826792

RESUMO

INTRODUCTION: Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS: Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION: This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER: NCT03531177; Pre-results.

3.
Eur J Obstet Gynecol Reprod Biol ; 220: 106-112, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29202393

RESUMO

OBJECTIVE: The aim of this study was to identify what components of a postpartum lifestyle intervention would engage postpartum mothers who had a diagnosis of gestational diabetes. STUDY DESIGN: Two online surveys were conducted, one involving postnatal mothers with GDM (n=83), and a second for health professionals (n=46). RESULTS: Seventy-eight percent of mothers were aware that healthy eating, exercise and weight management were all important to reduce risk of subsequent type 2 diabetes. However, 80% of women in this survey were not ready to engage in a postpartum lifestyle intervention within the first 6 months of giving birth; in contrast 52% of health professionals recommended they should be engaged in the first six weeks. Group sessions were the most commonly chosen format to deliver an intervention (30%). A community setting was preferred to a medical one. Mothers wanted recipe ideas (95%) in preference to general dietary advice (76%) or cooking skills courses (39%). Walking was the main form of exercise for 79% of mothers in this sample. Women highlighted difficulty in focusing on their own health goals because of competing demands of looking after a baby (41% agreed, Median 3, IQR 2), tiredness (65% agreed, Md 4, IQR 1) and the need for childcare (64% agreed, Md 4, IQR 2). CONCLUSION: A walking programme, recipe ideas and weight monitoring may be useful components when designing a postpartum lifestyle intervention. Barriers to engagement are evident and the intervention should allow women to engage at a time that is appropriate for them.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional , Estilo de Vida , Período Pós-Parto , Comportamento de Redução do Risco , Adulto , Diabetes Mellitus Tipo 2/etiologia , Exercício , Feminino , Pessoal de Saúde , Humanos , Internet , Mães , Gravidez , Inquéritos e Questionários
4.
Curr Opin Obstet Gynecol ; 28(6): 455-463, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27755129

RESUMO

PURPOSE OF REVIEW: Accurate assessment of dietary intake in interventional trials is the key to evaluate changes in dietary behaviour and compliance. We evaluated the use of dietary assessment tools in randomized trials on diet-based interventions in pregnancy by a systematic review. RECENT FINDINGS: We updated our previous search (until January 2012) on trials of diet and lifestyle interventions in pregnancy using Medline and EMBASE up to December 2015. Two independent reviewers undertook study selection and data extraction. We assessed the characteristics of dietary assessment tools, the timing and frequency of use and any validation undertaken.Two-thirds (39/58, 67%) of the included studies used some form of tools to assess dietary intake. Multiple days' food diaries were the most commonly used (23/39, 59%). Three studies (3/39, 8%) validated the used tools in a pregnant population. Three studies (3/39, 8%) prespecified the criteria for adherence to the intervention. The use of dietary assessment tools was not associated with study quality, year of publication, journal impact factor, type of journal and the study sample size. SUMMARY: Although self-reporting dietary assessment tools are widely used in interventional dietary trials in pregnancy, the quality and applicability of existing tools are low.


Assuntos
Dieta , Avaliação Nutricional , Biomarcadores/metabolismo , Índice de Massa Corporal , Feminino , Humanos , Estilo de Vida , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Tamanho da Amostra
5.
Public Health Nutr ; 17(9): 2094-103, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24029447

RESUMO

OBJECTIVE: To assess understanding of the Department of Health weaning guidelines and weaning influences in a self-selected sample of black and minority ethnic (BME) parents, residing in London. DESIGN: A face-to-face, questionnaire-facilitated survey among Black African, Black Caribbean and South Asian parents. SETTING: An opportunistic sample of parents was recruited from Sure Start centres, churches and play groups across key London boroughs. SUBJECTS: Three hundred and forty-nine interviews were included; 107 Black African, fifty-four Black Caribbean, 120 South Asian and sixty-four of Black mixed-race ethnicity. RESULTS: Fifty-two per cent of Black and 66 % of South Asian parents had accurate understanding of the guidelines. Inaccurate knowledge of the guidelines was associated with weaning before 17 weeks (P < 0·001); 36 % of Black Africans and 31 % of Black Caribbeans were weaned before 4 months compared with 16 % of South Asians. All BME groups were most influenced by weaning information from the previous generations of mothers in their families, which was associated with earlier weaning (21·5 (SD 6·5) v. 24·1 (SD 4·2) weeks; F(2,328) = 5·79, P = 0·003), and less so by professional infant feeding advice, which was associated with a later weaning age (23·7 (SD 5·1) v. 20·7 (SD 5·7) weeks; F(1,344) = 34·7, P < 0·001). CONCLUSIONS: Lack of awareness of the Department of Health weaning guidelines is common among these BME populations, whose weaning behaviour is strongly influenced by informal advice. Further research is necessary to elucidate the influences on weaning in these populations and to facilitate the development of infant feeding support which is salient for BME groups in the UK.


Assuntos
Métodos de Alimentação , Promoção da Saúde , Comportamento Materno , Medicina Tradicional , Cooperação do Paciente , Desmame , Adulto , África/etnologia , Ásia/etnologia , Região do Caribe/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Masculino , Comportamento Materno/etnologia , Saúde das Minorias/etnologia , Política Nutricional , Inquéritos Nutricionais , Cooperação do Paciente/etnologia , Controles Informais da Sociedade , Reino Unido , Desmame/etnologia , Adulto Jovem
6.
Matern Child Nutr ; 10(3): 410-21, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22708552

RESUMO

The UK weaning guidelines recommend the introduction of solid food at or around 6 months. The evidence suggests that knowledge of the guidelines is high, although only a small minority of parents wait until 6 months to wean. The aim of this study was to assess understanding of the UK weaning guidelines in a sample of UK parents and investigate the associations of this understanding with weaning timing, and in comparison to other influencing factors. This study conducted an online survey of UK parents. Eligible participants had weaned a child since the introduction of the current guidelines. Of 3607 participants, 86% accurately understood the guidelines. Eighty-seven per cent of health visitors were reported to have advised weaning at or around 6 months. Knowledge of the guidelines was associated with later weaning (independently of demographic factors) (P < 0.001) but did not ensure compliance: 80% of mothers who weaned before 24 weeks and 65% who weaned before 17 weeks were aware of the guidelines. Younger mothers (P < 0.001), those receiving benefits (P < 0.001), those educated only to 16 (P < 0.001) and minority ethnic groups (P < 0.001) had lower levels of awareness. Poor understanding of the guidelines was the most reliable predictor of early weaning (P = 0.021) together with young maternal age (P = 0.014). Following the baby-led weaning approach was the most reliable predictor of those weaning at 26 weeks, together with the Internet being the most influential source of advice. Understanding of the current weaning guidelines is high and is a key independent predictor of weaning age in this population.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Enfermeiras de Saúde Comunitária/normas , Desmame , Adulto , Feminino , Guias como Assunto , Humanos , Lactente , Internet , Mães , Projetos Piloto , Fatores Socioeconômicos , Inquéritos e Questionários , Reino Unido
7.
Public Health Nutr ; 15(9): 1661-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22632545

RESUMO

OBJECTIVE: The aim of the present study was to explore knowledge of the UK weaning guidelines and the sources of weaning advice used by UK first-time mothers. DESIGN: An online survey of UK parents; analysed using mixed methods. SETTING: Participants were recruited from a selection of parenting websites that hosted a link to the survey. SUBJECTS: In total, 1348 UK first-time mothers were included in the analysis. RESULTS: Knowledge of the guidelines was high (86 %) and associated with later weaning (P < 0·001), although 43 % of this sample weaned before 24 weeks. The majority of parents used multiple sources of information, the most influential being the health visitor (26 %), the Internet (25 %) and books (18 %). Fifty-six per cent said they received conflicting advice. Younger mothers and those of lower educational attainment were more likely to be influenced by advice from family, which was likely to be to wean earlier. Furthermore, those most influenced by their mother/grandmother were less likely to have accurate knowledge of the guidelines. In this population the Internet was used for weaning advice across all sociodemographic groups and was associated with a later weaning age, independently of sociodemographic factors (P < 0·001). Data from responses to a free-text question are used in illustration. CONCLUSIONS: The study suggests that first-time mothers have a good understanding of the weaning guidelines but seek weaning information from multiple sources, much of which is conflicting. Informal sources of weaning advice appear most influential in younger mothers and those of lower educational attainment, and result in earlier weaning.


Assuntos
Inquéritos sobre Dietas , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Desmame , Adulto , Aleitamento Materno , Enfermagem em Saúde Comunitária , Feminino , Humanos , Lactente , Alimentos Infantis , Internet , Mães/educação , Fatores Socioeconômicos , Software , Inquéritos e Questionários , Fatores de Tempo , Reino Unido , Adulto Jovem
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