Educating frontline health workers to support evidence-based management and treatment for chronic obstructive pulmonary disease patients: A literature review.

Problem: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death worldwide, yet frontline workers lack the capacity and education required to provide evidence-based management and support for COPD patients. Purpose: The aim of this review was to: (i) identify the respiratory education gaps within frontline health workers such as nurses, physicians, respiratory therapists, and other allied health professionals, in the initiation of integrated care coordination, and (ii) outline organizational strategies to initiate integrated care coordination towards comprehensive evidence-based management and treatment for COPD patients. Methods: A literature review representing articles published between 2011 and 2021 was conducted. The focus was examining the factors that are involved in educating frontline health workers to support evidence-based COPD management and identifying organizational strategies to provide this comprehensive care. The initial searches yielded 353 articles; 18 were retained for review. Results: Thematic analysis revealed two prominent themes as contributing factors to the challenges and strategic solutions: (i) the perceived challenges of frontline health worker respiratory education and (ii) the current deficits within organizational strategies, collaboration, resources, and educational interventions. Conclusions: Providing respiratory education to frontline health workers is imperative to optimize evidence-based care, patient support, and improve outcomes. The solutions include recognizing and focusing on identified contextual barriers, implementing/disseminating strategic solutions, and engaging specialty trained COPD certified respiratory educators as facilitators of COPD primary care.

Exploring the dietary choices of Chinese women living with breast cancer in Vancouver, Canada.

PURPOSE: To explore how Chinese Canadian patients with breast cancer make dietary choices and to understand their nutritional information needs in order to inform oncology healthcare providers about provision of optimal supportive care for this population. METHODS: Using interpretive description methodology, semi-structured interviews were conducted with first- and second-generation Chinese Canadian women aged 41-73 years living in Vancouver, Canada, who were diagnosed with breast cancer within the last 5 years. A follow-up focus group was held to validate emergent themes. RESULTS: Nineteen women were interviewed; 6 participated in the focus group. Their accounts of dietary experiences following diagnosis focused on three areas: dietary change (including desired and implemented changes that participants believed would benefit their health), facilitators and barriers to dietary change, and information and resource needs. Dietary changes reported included avoiding or consuming greater amounts of certain foods, and taking traditional Chinese medicine (TCM) and natural health products. Barriers to desired dietary change included the interplay between food preferences and family and social life, work-life balance, and cost and availability of specialty foods. Support from family members, however, facilitated participants' consumption of more whole and natural foods after their cancer diagnosis. Participants obtained food and nutrition information from a variety of sources but had difficulty determining the reliability and accuracy of information. They requested timely, credible, culturally-relevant, and easily accessible dietary information. CONCLUSIONS: Oncology healthcare providers would benefit from increased understanding of the dietary practices, including TCM, of Chinese women living with breast cancer. To facilitate communication and improve quality of care, healthcare professionals should provide credible and culturally relevant diet-related information in a variety of forms.

A comparison of Theory of Planned Behavior beliefs and healthy eating between couples without children and first-time parents.

OBJECTIVE: To examine the relationship between Theory of Planned Behavior (TPB) beliefs and eating behavior, explore which beliefs have the greatest association with eating behavior, and explore differences between adults without children and first-time parents. DESIGN: Longitudinal evaluation via questionnaires and food records at baseline and 6 and 12 months. PARTICIPANTS: Couples without children (n = 72) and first-time parents (n = 100). DEPENDENT VARIABLES: fruit and vegetable consumption and fat consumption. INDEPENDENT VARIABLES: TPB beliefs. ANALYSIS: Pearson correlations between TPB beliefs and eating behavior; exploratory data reduction via linear regression. RESULTS: Control beliefs were associated with eating behavior (r = .26-.46; P < .05). After controlling for past behavior, control beliefs were associated with eating behavior for first-time parents only. Control beliefs regarding preparation and time had the strongest associations with fruit and vegetable consumption for mothers (ß = .26; P < .05) and fathers (ß = .38; P < .01). The absence of a ceiling effect for control beliefs suggests room for improvement via intervention. CONCLUSIONS AND IMPLICATIONS: Interventions guided by TPB should target control beliefs to enhance healthy eating among new parents. Strategies (eg, individual, environmental, policy) to enhance control beliefs regarding healthy eating despite limited time and opportunity for preparation may be particularly valuable.

Belief-level markers of physical activity among young adult couples: comparisons across couples without children and new parents.

The health benefits of regular moderate-vigorous intensity physical activity (MVPA) are well established, yet young adults, particularly parents, often show declines in MVPA and may represent a critical population for intervention. Theory-based correlates used to guide future interventions are scant in this population. The purpose of this study was to examine theory of planned behaviour (TPB) belief-level constructs as correlates of directly assessed MVPA across cohorts of couples without children and with their first child over the initial 12 months. Participants were 238 adults (102 not expecting a child, 136 expecting first child) who completed baseline demographics, belief measures of the TPB and seven-day accelerometry, followed by assessments at 6 and 12 months. Results showed select medium-sized belief-PA correlations with sex and cohort interactions. Overall, women had larger affect-based behavioural belief associations with MVPA than men (e.g. PA relieves stress), and among new parents, mothers showed larger associations with control over MVPA than fathers. Mothers also had larger associations between control beliefs and MVPA compared to women without children (e.g. domestic duties, bad weather). Extremely high means and low variability on the behavioural beliefs show limited room for possible changes in intervention while control beliefs had low means suggesting room for change. Interventions targeting control among new mothers may be paramount for increasing MVPA, yet the TPB yielded less insight into the targets for promoting MVPA among young men.

Physical activity and sedentary behavior across 12 months in cohort samples of couples without children, expecting their first child, and expecting their second child.

The onset of parenthood has been reported as a reason for steep declines in moderate-vigorous intensity physical activity (MVPA), but also increases in light activity rather than sedentary behavior. We examined the activity profiles of three cohorts of couples (couples without children, and first-time parents and second time parents) across 12 months. Participants were 314 adults (102 not expecting a child, 136 expecting first-child, 76 expecting second child) who completed baseline demographics and 7-day accelerometry, followed by assessments at 6 and 12 months. Hierarchical linear modeling showed that parents who were expecting their second child had lower MVPA; yet were less sedentary/had higher light intensity activity compared to other couples at baseline. First-time mothers' physical activity pattern changed to match the profiles of parents who were now parenting two children across the first 12 months of child-rearing. Findings support MVPA interventions targeting new mothers.

Social cognitive correlates of physical activity across 12 months in cohort samples of couples without children, expecting their first child, and expecting their second child.

OBJECTIVE: The onset of parenthood has been identified as a critical risk period for physical inactivity, yet limited research has examined the correlates of physical activity (PA) using theoretical models in longitudinal designs with comparison groups of couples without children. The purpose of this study was to predict PA across 12 months among cohorts of couples with and without children using the theory of planned behavior (TPB). METHOD: Participants were 314 adults (102 not expecting a child, 136 expecting first child, and 76 expecting second child) who completed baseline demographics, measures of the TPB, and 7-day accelerometry, followed by assessments at six and 12 months. RESULTS: Hierarchical linear modeling showed some TPB relationships were moderated by parental status and gender. Most notable, time-varying covariate analyses showed perceived behavioral control and intention decreased for new mothers compared to women without children across time. PA was predicted by intention for all cohorts, and intention was predicted by affective and instrumental attitudes and perceived behavioral control for husbands and wives, whereas subjective norm predicted intention only in husbands. For wives, the relationship between intention and instrumental attitudes and perception of behavioral control varied by parental status, and was larger for couples without children compared to second-time parents. Overall, there was considerable coordination in slopes and intercepts among couples, yet individual cognitions were better predictors than partner cognitions. CONCLUSION: The findings provide helpful information for targeting PA interventions among young adults, and suggest that interventions for new mothers may require greater effort to raise the absolute values of control when compared to women without children.

Comparison of the dietary intakes of new parents, second-time parents, and nonparents: a longitudinal cohort study.

The objective of this study was to examine the dietary intake profiles of first-time parents, second-time parents, and couples without children; once during pregnancy, then at 6- and 12-months postpartum. This was an observational, longitudinal, cohort study. Participants were a community-based sample of 153 couples aged 25 to 40 years. Data were collected between 2007 and 2011. Dietary intake was recorded using 3-day dietary recall. Hierarchical linear modeling was used to compare the dietary intakes of groups (ie, parent, sex, and couple days) over time. Percentage of participants per group meeting recommended daily dietary guidelines was also analyzed, as were variables that influenced meeting overall recommended guidelines using a multivariate analysis of variance. First-time mothers had higher overall energy, fat, sugar, fruit, and milk intake compared with women without children, and longitudinally first-time mothers decreased their fruit intake. Second-time mothers had higher overall energy, fat, sugar, and fruit intake compared with nonparent women, and longitudinally second-time mothers increased their meat intake. First-time fathers had overall higher bread intake compared with second-time fathers and men without children, and first-time fathers consumed less sugar than second-time fathers. Longitudinally, first-time fathers increased their fiber intake. At any stage of data collection, from pregnancy to 12-months postpartum, only 2% to 16% of all mothers met recommended overall daily dietary guidelines. The only variable investigated that influenced meeting overall daily dietary guidelines at baseline was parent status.

Oh baby! Motivation for healthy eating during parenthood transitions: a longitudinal examination with a theory of planned behavior perspective.

BACKGROUND: Transitioning to parenthood is a major life event that may impact parents' personal lifestyles, yet there is an absence of theory-based research examining the impact of parenthood on motives for dietary behaviour. As a result, we are unaware of the social cognitive variables that predict eating behaviour among those transitioning to parenthood. The purpose of the study was to examine eating behaviour motives across 12 months within the framework of the theory of planned behavior (TPB) and compare these across groups of new parents, non-parents, and established parents. METHODS: Non-parents (n = 92), new parents (n = 135), and established parents (n = 71) completed TPB questionnaires assessing attitudes, subjective norms, perceived behavioral control (PBC), and intentions and three day food records at baseline, and 6- and 12-months post-delivery (for parents) and 6- and 12-months post-baseline (for non-parents). RESULTS: Repeated measures ANOVAs revealed that among men, new- and established-parents had greater intentions to eat healthy compared to non-parents, F(2) = 3.59, p = .03. Among women, established parents had greater intentions than new- and non-parents, F(2) = 5.33, p = .01. Among both men and women during the first 6-months post-delivery, new-parents experienced decreased PBC, whereas established parents experienced increased PBC. Overall, affective attitudes were the strongest predictor of intentions for men (ß = 0.55, p < .001) and women (ß = 0.38, p < .01). PBC predicted changes in fruit and vegetable consumption for men (ß = 0.45, p = .02), and changes in fat consumption for men (ß = -0.25, p = .03) and women (ß = -.24, p < .05), regardless of parent status. CONCLUSION: The transition to parenthood for new and established parents may impact motivation for healthy eating, especially PBC within the framework of TPB. However, regardless of parental status, affective attitudes and PBC are critical antecedents of intentions and eating behaviour. Interventions should target affective attitudes and PBC to motivate healthy eating and may need to be intensified during parenthood.

Nutritional status of children with attention deficit hyperactivity disorder: a pilot study.

Objectives. This is a pilot study of the dietary intake and nutrient status of children with Attention Deficit Hyperactivity Disorder (ADHD). Method. Nutritional assessment of 43 children aged 6-12 with ADHD was performed using a 3-day food record, 24-hour recall, and serum assessors. Results. Macronutrient intake and consumption of Low-Nutrient Foods were comparable to population norms; however, 66% were found to be deficient in zinc and 23% in copper. Conclusions. This pilot study reports the food intake and nutrient status of children with ADHD and shows a predisposition for low zinc and copper status in ADHD.

Vegetable and fruit intake and factors influencing their intake.

PURPOSE: A food frequency questionnaire (FFQ) and an attitude/behaviour questionnaire (ABQ) were developed, and their validity and reliability were tested to determine adolescents' vegetable and fruit (VF) intakes and factors influencing their food choices. METHODS: High school students living in the lower mainland of British Columbia participated. The FFQ was adapted from the National Cancer Institute VF By-Meal screener, which was designed to be used with adults. After several focus groups with adolescents, the FFQ was revised to make it more user-friendly. The ABQ was developed after a literature review of factors influencing youth VF intake, and was based on the constructs within the Health Belief Model. RESULTS: The FFQ was validated against a written 24-hour dietary record (correlation coefficient = 0.52). The test-retest reliability coefficient for the FFQ was 0.46. A panel of experts tested the ABQ construct validity, and changes were made as a result of the recommendations. Internal consistency reliability and test-retest reliability of the ABQ were 0.71 and 0.59, respectively. Both questionnaires were tested for face validity with students and revised accordingly. CONCLUSIONS: Further validation of these two questionnaires against other standardized tools is required. Future studies with adolescents using these tools can guide program and resource development.

Food sales outlets, food availability, and the extent of nutrition policy implementation in schools in British Columbia.

BACKGROUND: The purpose of this study was to determine the number and types of different food sales outlets, the types of foods offered for sale in all school food outlets, and the extent of nutrition policy implementation in schools in British Columbia. We also directly measured the number and types of snack foods available for sale in each vending machine at each school. METHODS: Based on a thorough literature review and guided by an expert panel of nutritionists, we developed an instrument to measure the quantity and types of foods offered for sale in vending machines, the types of food for sale in all school food outlets, and the extent of nutrition policy development. RESULTS: The survey response rate was approximately 70%. Approximately 60% of surveyed schools had a permanent food sales outlet. Snack and beverage vending machines were most common in secondary schools, while tuck shops and food-based fundraisers were more common in elementary schools. While few snack vending machines were present in elementary schools, tuck shops stocked items commonly found in snack machines. Approximately 25% of schools had a formal group responsible for nutrition. These schools were more likely to have nutrition policies in place. CONCLUSION: "Junk" foods were widely available in elementary, middle, and secondary schools through a variety of outlets. Although snack machines are virtually absent in elementary schools, tuck shops and school fundraisers sell foods usually found in snack machines, largely cancelling the positive effect of the absence of snack machines in these schools. Schools with a group responsible for nutrition appear to have a positive impact on nutrition policy implementation.

Toward increased capacity for practice-based research among health professionals: implementing a multisite qualitative research project with dietitians.

Despite repeated efforts to encourage health professionals to conduct practice-based research, including qualitative research, few practitioners have become active researchers. Mentoring, networking, and hands-on experience have been identified as potential approaches for changing this situation. In this article, the authors describe how they implemented a research mentoring/training component in a national study exploring Canadian dietitians' attitudes and practices with regard to obesity and weight management. They discuss the successes and challenges experienced by mentors and trainees, and provide recommendations for future initiatives to enhance capacity for qualitative, practice-based research among health care practitioners.

Canadian dietitians' understanding of non-dieting approaches in weight management.

PURPOSE: How Canadian dietitians define and use non-dieting and size acceptance approaches (SAAs) in the context of weight management was explored. METHODS: Fifteen focus groups with 104 dietitians were conducted in seven Canadian cities. Questions were designed to explore participants' understanding and use of non-dieting and SAAs, including counselling goals, techniques, and outcome measures. Sessions were tape-recorded, transcribed verbatim, coded, and analyzed using qualitative methods. RESULTS: Participants generally agreed that non-dieting involves promoting healthy lifestyles and avoiding restrictive diets. Participants also agreed that size acceptance means accepting all body shapes and sizes and promoting comfort with one's body. Many dietitians said they use size acceptance only with appropriate clients, most often with those who are lighter or without other health risks. Others said that size acceptance, by definition, is appropriate for everyone. Opinions varied about the appropriateness of teaching portion sizes or using meal plans, and whether weight loss could be a goal of non-dieting and SAAs. CONCLUSIONS: Views on the usefulness of non-dieting and size acceptance strategies in weight management counselling were related, at least partially, to the different understanding that dietitians had of these approaches. Terminology needs to be clarified when we speak about non-dieting and SAAs. The varied understanding about these concepts should help dietitians reflect on their own perspectives and practice.

Definitions of healthy eating among university students.

PURPOSE: To identify definitions of healthy eating in terms of food characteristics, eating behaviours, barriers, and benefits in university students. METHODS: Four focus groups were conducted; verbatim transcripts were analyzed and coded using qualitative methods. Participants were nine students of dietetics and six students of other subjects. All were females in their third or fourth year at the University of British Columbia (UBC). RESULTS: Participants often described healthy eating as consuming all food groups of Canada's Food Guide to Healthy Eating, with the associated notions of moderation and balance. Benefits of healthy eating were cited as a healthy weight, good physical appearance, feeling better, preventing disease, and achieving personal satisfaction. Barriers to healthy eating included lack of time, choice, taste preferences, and finances. There was some discrepancy between what the dietetics students perceived as barriers for clients (e.g., lack of information), and barriers the potential clients (other students) perceived for themselves. CONCLUSIONS: As dietitians, we must try to understand our clients' definitions of healthy eating and their barriers to achieving it, which likely differ from our own.

Canadian dietitians' approaches to counseling adult clients seeking weight-management advice.

This study describes Canadian dietitians' approaches to counseling adults seeking weight-management advice. Fifteen focus groups were conducted at seven sites across Canada. The participants, most of whom worked in clinical or private practice, discussed their approach to specific weight-management counseling scenarios, including women clients with and without associated risk factors (impaired glucose tolerance, hypertension, family history of cardiovascular disease) and long histories of dieting. Results indicate that participants used a lifestyle approach for weight-management counseling, where the main goal was improved client health through healthful eating and increased physical activity. In contrast to clients' perceived weight loss goals, participants rarely included weight loss as a goal for clients with no additional chronic disease risk factors. For clients with risk factors, some participants advocated moderate weight loss, while others aimed for health at any size. Participants also discussed the importance of clients' psychological well-being, particularly in relation to feelings about food and body image. Individualized approaches to setting goals, gathering information, and giving advice/educating were identified as key counseling strategies. Further research to evaluate the effectiveness of dietitians' weight-management approaches and additional counseling training for dietitians will enhance practitioners' skills and confidence in this area.

Dietary supplement use by varsity athletes at a Canadian university.

The purpose of this study was to assess reasons for and prevalence of supplement use among varsity athletes and nonvarsity athlete students (controls) at a Canadian university. A questionnaire, distributed to 247 varsity athletes and 204 controls, included variables regarding sports participation, supplements used, reasons for usage, perceived effects, and areas of interest about supplements. Response rates were 85.5% among varsity athletes and 44.6% among controls. Supplements were used by 98.6% of varsity athletes and 94.3% of controls. Varsity men most often reported using sports drinks, and used these (and carbohydrate gels, protein powder, and creatine) more than varsity women. Caffeine products were most often reported by other groups. Health professionals and the Internet were the most reported information sources, while friends most often recommended supplements. Many subjects indicated knowing little about supplements and wanting to learn more. Results indicate a need for nutrition education among both varsity athletes and university students.

Implementing the British Columbia Nutrition Survey: perspectives of interviewers and facilitators.

The British Columbia Nutrition Survey was the last of ten provincial nutrition surveys completed between 1988 and 1999. A qualitative process evaluation was conducted to identify strengths and weaknesses of British Columbia Nutrition Survey procedures, as perceived by 27 public health nurses and dietitians directly involved in data collection. Data for the process evaluation were collected through in-depth telephone interviews, during which interviewers and facilitators described their experiences working for the survey. Qualitative analysis of interview transcripts identified codes that were then organized into eight categories, including issues arising from interviewer and facilitator training, challenges in recruiting survey participants, reflections on safety for survey personnel and participants, facilitators' key role, the flexibility required to implement the protocol, and communication within the survey research team. Two final categories related to rewarding aspects of the job: insights affecting professional practice, and meeting survey participants and personnel. Evaluation findings show the importance of establishing open communication between research planners and those conducting surveys. This communication is needed to ensure that workers' needs are met, the quality of the study is maximized, and evaluations of study protocols include the perspectives of those directly involved in data collection.

Folate intakes and awareness of folate to prevent neural tube defects: a survey of women living in Vancouver, Canada.

OBJECTIVE: To estimate folate intake and knowledge in women of childbearing age, in relation to risk of neural tube defects. SUBJECTS/SETTING: One hundred forty-eight women (aged 18 to 45 years) in the Vancouver area of British Columbia, Canada. DESIGN: Using an interviewer-administered survey, we examined women for folate knowledge and the relation of folate knowledge to intake in a random sample. Contribution of folate from food, fortified grain products, and supplements was assessed by validated semiquantitative food frequency questionnaire. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics, t tests, Chi;(2), Pearson correlation analysis. RESULTS: Mean daily folate intake from food, fortified foods, and supplementation was 812+/-710 Dietary Folate Equivalents (DFE)/day. Fortification of bread and grain products contributed 104+/-68 microg synthetic folic acid (SFA)/day (equal to 174+/-114 DFE), and supplements contributed 205+/-388 microg SFA/day. Although 86% of women met the Estimated Average Requirement (320 DFE/day) for folate, only 26% met the recommendation (400 microg SFA/day) for women capable of becoming pregnant. Most (95%) of the women had heard of folate, but only 25% knew that it could prevent birth defects. One-fourth of the women had good or very good knowledge of folate-rich foods. However, folate knowledge was not related to its intake. The most common sources of folate information were magazines/newspapers, doctors, and television/radio. Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy. However, 78% of the women indicated that, with knowledge of the benefits of folate, they would use supplemental folic acid daily to reduce the risk of birth defects. APPLICATIONS/CONCLUSIONS: Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation. Targeting physicians to educate women on the importance of folate could be a potentially successful route. J

Weight management in childhood: Canadian dietitians' practices.

Canadian dietitians specializing in pediatric practice were surveyed to provide a preliminary profile of the strategies they use to manage overweight youth. The survey was mailed to 298 dietitians belonging to the Dietitians of Canada's (DC) Pediatric Nutrition and Consulting Dietitians' Networks and to the head dietitians in Canadian pediatric hospitals across the country. It was also posted on the DC website and sent by electronic mail. Of the 164 respondents, 65 reported that they provide an intervention program to overweight youth. Growth charts, ideal body weight, and body mass index were mostly used to assess and monitor overweight. However, about 20% of the respondents did not define overweight in their client population. The majority of the clients were girls aged seven to 18. Most respondents used the healthful lifestyle approach via one-on-one consultation, included parents and collaborated with two or more health professionals for the management of these children. As the discussion on best practices for the prevention and treatment of overweight youth continues, we need further evidence to determine what strategies, if any, support positive outcomes in this group.