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J Prim Health Care ; 12(1): 79-87, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32223854


INTRODUCTION Practice nurses in general practice are ideally placed to deliver weight management treatments. Teaching people to eat according to their appetite, based on measurements of blood glucose ('hunger training'), is known to lead to weight loss and improved eating behaviour. To effectively translate this research to primary care requires understanding of key stakeholder perspectives. AIM The aim of this study was to explore the perspectives of practice nurses on the suitability of using hunger training as a weight management intervention in general practice. METHODS Ten nurses trialled hunger training for 1 week, followed by a semi-structured interview where they were asked about their experience; perceived patient interest; enablers and barriers; and suggested changes to hunger training. RESULTS All nurses were positive about hunger training and wanted to use it with their patients. They thought it was a useful method for teaching patients about eating according to their appetite, and the impact of food choices on glucose. Motivation was seen to be both an important potential barrier and enabler for patients. Other anticipated patient enablers included the educational value of hunger training and ease of the programme. Other barriers included lack of time and cost of equipment and appointments. For most nurses, 1 week of following hunger training was sufficient training to deliver the intervention. Suggested refinements included adding nutrition advice to the booklet, incorporating other health goals and enabling social support. DISCUSSION These findings suggest that hunger training could be translated to primary care with minor modifications.

Atitude do Pessoal de Saúde , Automonitorização da Glicemia/métodos , Comportamento Alimentar/fisiologia , Enfermeiras e Enfermeiros/psicologia , Programas de Redução de Peso/métodos , Adulto , Glicemia/fisiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fome , Entrevistas como Assunto , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa
Appetite ; 151: 104691, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32246953


BACKGROUND: Hunger training teaches people to eat according to their appetite using pre-prandial glucose measurement. Previous hunger training interventions used fingerprick blood glucose, however continuous glucose monitoring (CGM) offers a painless and convenient form of glucose monitoring. The aim of this randomised feasibility trial was to compare hunger training using CGM with fingerprick glucose monitoring in terms of adherence to the protocol, acceptability, weight, body composition, HbA1c, psychosocial variables, and the relationship between adherence measures and weight loss. METHODS: 40 adults with obesity were randomised to either fingerpricking or scanning with a CGM and followed identical interventions for 6 months, which included 1 month of only eating when glucose was under their individualised glucose cut-off. For months 2-6 participants relied on their sensations of hunger to guide their eating and filled in a booklet. RESULTS: 90% of the fingerpricking group and 85% of the scanning group completed the study. Those using the scanner measured their glucose an extra 1.9 times per day (95% CI 0.9, 2.8, p < 0.001) compared with those testing by fingerprick. Both groups lost similar amounts of weight over 6 months (on average 4 kg), were satisfied with the hunger training program and wanted to measure their glucose again within the next year. There were no differences between groups in terms of intervention acceptability, weight, body composition, HbA1c, eating behaviours, or psychological health. Frequency of glucose testing and booklet entry both predicted a clinically meaningful amount of weight loss. CONCLUSIONS: Either method of measuring glucose is effective for learning to eat according to hunger using the hunger training program. As scanning with a CGM encouraged better adherence to the protocol without sacrificing outcome results, future interventions should consider using this new technology in hunger training programs.

Apetite , Automonitorização da Glicemia , Adulto , Glicemia , Humanos , Fome , Perda de Peso
Am J Prev Med ; 57(3): 417-424, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31377085


INTRODUCTION: The influence of screens and technology on adolescent well-being is controversial and there is a need to improve methods to measure these behaviors. This study examines the feasibility and acceptability of using automated wearable cameras to measure evening screen use in adolescents. METHODS: A convenience sample of adolescents (aged 13-17 years, n=15) wore an automated camera for 3 evenings from 5:00pm to bedtime. The camera (Brinno TLC120) captured an image every 15 seconds. Fieldwork was completed between October and December 2017, and data analyzed in 2018. Feasibility was examined by quality of the captured images, wear time, and whether images could be coded in relation to contextual factors (e.g., type of screen and where screen use occurred). Acceptability was examined by participant compliance to the protocol and from an exit interview. RESULTS: Data from 39 evenings were analyzed (41,734 images), with a median of 268 minutes per evening. The camera was worn for 78% of the evening on Day 1, declining to 51% on Day 3. Nearly half of the images contained a screen in active use (46%), most commonly phones (13.7%), TV (12.6%), and laptops (8.2%). Multiple screen use was evident in 5% of images. Within the exit interview, participants raised no major concerns about wearing the camera, and data loss because of deletions or privacy concerns was minimal (mean, 14 minutes, 6%). CONCLUSIONS: Automated cameras offer a feasible, acceptable method of measuring prebedtime screen behavior, including environmental context and aspects of media multitasking in adolescents.

Comportamento do Adolescente/fisiologia , Técnicas de Observação do Comportamento/instrumentação , Fotografação/instrumentação , Tempo de Tela , Dispositivos Eletrônicos Vestíveis , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Masculino , Nova Zelândia
BMJ Open ; 9(12): e032248, 2019 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-31892654


OBJECTIVES: Hunger training (HT) is an intervention designed to teach people to eat according to their hunger by connecting physical symptoms of appetite with glucose levels. HT is most effective for weight loss, and improving eating behaviours when adherence is high. However, adherence is a challenge that should be explored prior to wider dissemination. The aim of this study was to explore participants' experience and self-reported adherence and behaviour change related to HT. DESIGN: A qualitative study, nested within a randomised controlled pilot study of two different methods of monitoring glucose during HT. Semistructured interviews were audio-recorded, transcribed verbatim and analysed thematically using a phenomenological approach. SETTING: Single-centre study with participants recruited from the local area. PARTICIPANTS: 40 participants began the pilot study and 38 participants (52.6% women) remained at 1 month and completed interviews. RESULTS: Most participants felt they were able to match their hunger to their glucose levels by the end of the intervention. The main adherence barriers were the social pressure to eat, lack of time and lack of flexibility in participants' meal schedules. Common adherence enablers were having a set routine, social support and accountability. Participants described increased awareness of hungry versus non-hungry eating and better cognition of feelings of hunger and satiety as a result of the intervention, which in turn led to changes of food choice, portion size and adjusted meal timing and frequency. CONCLUSIONS: Findings show that HT is acceptable from a patient perspective, and results can be used to inform the translation of HT programme to healthcare settings. TRIAL REGISTRATION NUMBER: ACTRN12618001257257.

Glicemia/análise , Comportamento Alimentar/fisiologia , Fome , Perda de Peso , Adulto , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Saciação
Nutrients ; 10(11)2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30380721


There is an urgent need for strategic approaches to address the high prevalence of obesity and diabetes in New Zealand. Such approaches rely strongly on input from multiple actors in the diabetes and obesity policy space. We conducted a social network analysis to identify influential actors involved with shaping public opinion and/or policy regarding obesity and diabetes in New Zealand. Our analysis revealed a diverse network of 272 individuals deemed influential by their peers. These individuals represented nine professional categories, particularly academics (34%), health service providers (22%), and government representatives (17%). The network included a total of 17 identified decision-makers. Relative capacity of professional categories to access these decision-makers was highest for representatives of the food and beverage industry (25%), compared with nongovernment organisations (9%) or academics (7%). We identified six distinct brokers, in academic (n = 4), government (n = 1), and nongovernmental (n = 1) positions, who could play a key role in improving communication and networking activities among all interest groups. Such actions should ultimately establish effective networks to foster evidence-based policy development to prevent and reduce the burden of diabetes and obesity.

Diabetes Mellitus , Política de Saúde , Obesidade , Formulação de Políticas , Opinião Pública , Humanos , Nova Zelândia , Participação dos Interessados