Promoting nutrition equity for individuals with physical challenges: A systematic review of barriers and facilitators to healthy eating.

Impaired mobility is the most common form of functional disability in the US, affecting one out of every sixteen working-age adults. Little is known about the barriers to and facilitators of healthy eating among people with impaired mobility (PWIM), who are at increased risk for diet-related chronic disease. The pathways by which impaired mobility influence dietary intake are unclear, yet likely involve a complex interplay between structural determinants of health and individual factors. To help advance nutrition equity initiatives for PWIM, this systematic review aimed to qualitatively synthesize factors associated with dietary intake across four levels of ecologic influence. An interprofessional team devised a comprehensive search strategy to identify these factors among working-age (18-64 years) PWIM. We queried Ovid MEDLINE, Web of Science, Scopus, and Embase via Ovid for articles published between January 1, 1990 and April 25, 2021. Twelve studies met our review criteria. We classified factors within one of four ecologic levels of influence: individual, social, environmental, and policy/program. Most studies disproportionately reported on personal level factors of influence, with less information on other levels of influence. This systematic review is an important first step for informing the design of evidence-based strategies to support healthy eating among PWIM. However, it also reveals a wide chasm in the needed information to adequately bridge structural determinants of this nutrition divide. More studies are needed that include rigorous measures of dietary intake and that aim to elicit how social, environmental, and policy-level factors contribute to dietary disparities among PWIM.

The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour & improve safety.

BACKGROUND: Prescribing alerts of an electronic health record are meant to be protective, but often are disruptive to providers. Our goal was to assess the effectiveness of interruptive medication-prescriber alerts in changing prescriber behaviour and improving patient outcomes in ambulatory care settings via computerised provider order entry (CPOE) systems. METHODS: A standardised search strategy was developed and applied to the following key bibliographical databases: PubMed, Embase, CINAHL and The Cochrane Library. Non-comparison studies and studies on non-interrupted alerts were eliminated. We developed a standardised data collection form and abstracted data that included setting, study design, category of intervention alert and outcomes measured. The search was completed in August 2018 and repeated in November of 2019 and of 2020 to identify any new publications during the time lapse. RESULTS: Ultimately, nine comparison studies of triggered alerts were identified. Each studied at least one outcome measure illustrating how the alert affected prescriber decision-making. Provider behaviour was influenced in the majority, with most noting a positive change. Alerts decreased pharmaceutical costs, moved medications toward preferred medications tiers and steered treatments toward evidence-based choices. They also decreased prescribing errors. Clinician feedback, rarely solicited, expressed frustration with alerts creating a time delay. CONCLUSION: The current evidence shows a clear indication that many categories of alerts are effective in changing prescriber behaviour. However, it is unclear whether these behavioural changes lead to improved patient outcomes. Despite the rapid transition to CPOE use for patient care, there are few rigorous studies of triggered alerts and how workflow interruptions impact patient outcomes and provider acceptance.

Library Space: Assessment and Planning through a Space Utilization Study.

The objective of this article is to describe the recent space and furniture utilization study conducted through direct observation at the small, academic-centered Schusterman Library. Student workers from the library's reference desk monitored two semesters of use and went on to observe a third semester after electrical power upgrades were installed. Extensive use details were collected about where library patrons sat during which parts of the day, and certain areas of the library were ultimately identified as much more active than others. Overall, the information gathered proved useful to library planning and will be valuable to future space initiatives. This article further demonstrates feasible means for any library to implement a similar study with minimal resources.

Focused library instruction for occupational therapy, physical therapy, and respiratory care students and faculty: library instruction in allied health.

The integration of librarians into allied health programs presents many exciting opportunities for collaboration. This column will describe how a library instruction program is integrated into the occupational therapy, respiratory care, and physical therapy curricula at the University of Texas Health Science Center at San Antonio. The allied health faculty have welcomed and recognized the librarians' expertise in teaching evidence-based practice and library research skills.

Web usability testing with a Hispanic medically underserved population.

OBJECTIVES: Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS: METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. RESULTS: Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. CONCLUSIONS: User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

New "starting points" for resources by subject.

The objective of the Starting Points Web page series at The University of Texas Health Science Center at San Antonio (UT HSC) Libraries is to provide specialized information resources in an organized online format. Highlighted resources include databases, journals, UT HSC campus information, funding sources, PubMed RSS article feeds, and information about professional associations. This paper discusses the development process, planning, challenges, and outcomes of the Starting Points series.