A qualitative study exploring parental accounts of feeding pre-school children in two low-income populations in the UK.

Good nutrition in the early years of life is essential, yet the diets of many pre-school children in the UK are known to be poor. Understanding the decisions parents make when feeding young children is very important in determining what type and nature of interventional support may be developed to promote good nutrition. The aim of this study was to explore using qualitative methods, parental perceptions of feeding their children in order to inform the development of a nutrition intervention. Focus groups (n = 33) and individual interviews (n = 6) were undertaken with parents, most of whom were attending children's centres in two deprived populations from one urban (Islington, north London) and one rural (Cornwall) location in England. Accounts of feeding pre-school children were primarily concerned with dealing with the practicalities of modern life, in particular the cost of food and the need to manage on a restricted household budget. Time pressures, a lack of perceived knowledge and confidence in preparing food and managing conflict over food choices between family members were also strong themes. Parents commonly reported differences between how they would like to feed their children and the reality of what they were able to do in their circumstances. These findings suggest that the poor eating habits of many pre-school children may be less a case of parental ignorance but rather the product of a range of coping strategies. Designing an intervention, which helps parents to build their confidence and self-efficacy, may enable them to make positive changes to their children's diets.

Methodological development of an exploratory randomised controlled trial of an early years' nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young).

Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings.

Front-of-pack nutrition labelling: are multiple formats a problem for consumers?

BACKGROUND: Nutrition labels are a potentially valuable tool to assist consumers in making healthy food choices. Front-of-pack labels are a relatively new format and are now widely used across many European countries, but it is unclear which of the many formats in use are best understood by consumers. It is also unclear whether the existence of multiple formats impedes understanding and use. This article addresses this question with findings from a study commissioned by the UK Food Standards Agency to provide evidence to inform policy decisions in this area. METHODS: In-depth qualitative interviews were used to explore consumers' decision-making processes when using two different front-of-pack label formats to judge the relative healthiness of a pair of products. Participants were presented with product pairs differently labelled and a series of structured prompts were used to access their internal dialogues and to identify any difficulties encountered. RESULTS: The interviews revealed that making product comparisons using different label formats was challenging for participants and particularly for those product pairs where there was not an obvious answer. When the label formats on the product pairs lacked a common element, such as text, this also caused difficulties and misinterpretation. The comparisons also took time and effort that would be a deterrent in real-life situations. CONCLUSIONS: These findings indicate that the existence of multiple front-of-pack label formats in the marketplace may impede consumer comprehension and discourage use. They suggest that a single format may encourage consumers to use front-of-pack labels in making healthy food choices.

Using participatory approaches with older people in a residential home in Guyana: challenges and tensions.

Participatory approaches are a popular and entrenched strategy in community development, yet a number of unresolved issues and tensions persist regarding the definition, rationales, outcomes and ethics of participation. Despite its popularity there are relatively few examples of participatory projects with older people or in institutional settings so their potential with this group is poorly understood. This case study presents some of the practical and ethical challenges that arose over the course of a participatory project that aimed to analyse and improve quality of life in a residential home for older people in Guyana. Through a qualitative process evaluation it examines the degree of participation achieved, the determinants of the participatory process, the benefits the approach brought and the ethical dilemmas encountered. Although the degree of participation achieved was limited, beneficial outcomes were observed, notably the selection of appropriate and desirable interventions and the effect on the residents themselves, who valued their part in the project. The participatory process was unpredictable and complex, however, and key determinants of it included the organizational dynamics of the home and the skills, actions and attitudes of the researcher. Adopting a participatory approach brought valuable benefits in a residential home, but others adopting the approach should ensure they critically consider at the outset the ethical and practical dilemmas the setting and approach may produce and have realistic expectations of participation.

Public understanding of food risks in four European countries: a qualitative study.

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor naïve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.

The principles and application of qualitative research.

The present paper provides an overview of the methodological principles that underpin qualitative research and how these principles differ from those of quantitative research. It is intended to set the scene for the following papers that outline two specific approaches to the analysis of qualitative data. Within the tradition of qualitative research there are many different theoretical perspectives, of which these approaches are only two examples, but they need to be set within this broader tradition in order to highlight their specific features. Qualitative and quantitative research differ from each other in far more than their methods and data. They are each based on very different premises about both the nature of the world and the nature of our knowledge of it and how this information is generated. These approaches have implications for all aspects of research strategy, including the assessment of the quality of research findings and their wider utility or application. In relation to the latter, lack of detail in the reporting of qualitative research and small sample sizes has tended to create the impression that the findings of qualitative research have little application outside the particular research setting. While there is need for more rigor in reporting, it needs to be recognized that qualitative research can offer insights and understandings with wider relevance, although these outcomes are of a different type from those provided by quantitative research.