"We know what we should be eating, but we don't always do that." How and why people eat the way they do: a qualitative study with rural australians.

BACKGROUND: There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology. METHODS: Three group discussions were conducted with a total of 23 participants: (1) young women aged 18-24 with no children; (2) women aged 35-45 with primary school aged children; and (3) men aged 35-50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food- internal factors; food- external factors; personal-state factors; cognitive factors; and sociocultural factors. RESULTS: We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components. CONCLUSIONS: We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

What do people think of intuitive eating? A qualitative exploration with rural Australians.

Evidence supports that intuitive eating is associated with many indicators of positive physical and mental health, with more recent longitudinal studies establishing causality. Most research, however, comprises either survey data or clinical trials. This study attempts to fill this evidentiary gap by using a qualitative methodology to explore people's understandings and reactions to intuitive eating, including perceived barriers and enablers to implementation. Three focus group discussions were conducted in a non-metropolitan region of Victoria, Australia, with a total of 23 participants. Focus group transcripts were thematically analysed using an inductive descriptive approach within a constructionist perspective. Findings indicate that the concept of intuitive eating was either unknown or misunderstood. Once intuitive eating was explained, most responses to implementing intuitive eating were negative. Participants felt that having complete choice around what they ate was unlikely to equate to a healthy or balanced diet, at least in the short term. They also argued that because everyday life was not intuitive in its structures, it would be difficult to eat intuitively. Despite these difficulties, participants appreciated that if they were able to overcome the various barriers and achieve a state of intuitive eating, they anticipated a range of long-term benefits to health and weight management. For intuitive eating to become a viable public health approach, this research suggests that intuitive eating needs to be much more widely publicised and better explained, and perhaps renamed. More significantly, people would need assistance with how to eat intuitively given the barriers identified.

Improving the accuracy of self-reported height and weight in surveys: an experimental study.

BACKGROUND: Many studies rely on self-reported height and weight. While a substantial body of literature exists on misreporting of height and weight, little exists on improving accuracy. The aim of this study was to determine, using an experimental design and a comparative approach, whether the accuracy of self-reported height and weight data can be increased by improving how these questions are asked in surveys, drawing on the relevant evidence from the psychology and survey research literatures. METHODS: Two surveys from two separate studies were used to test our hypotheses (Science Survey, n = 1,200; Eating Behaviours Survey, n = 200). Participants were randomly assigned to one of six conditions, four of which were designed to improve the accuracy of the self-reported height and weight data ("preamble"), and two of which served as the control conditions ( "no preamble"). Four hypotheses were tested: (H1) survey participants read a preamble prior to being asked their height and weight will report lower heights and higher weights than those not read a preamble; (H2) the impact of question-wording (i.e., preamble vs. no preamble) on self-reported weight will be greater for participants with higher BMIs; (H3) the impact of question-wording on height will be greater for older participants; (H4) either version of the weight question - standard or "weight-specific"-may result in participants reporting more accurate self-reported weight. One-way MANOVA was conducted to test Hypothesis 1; two-way analysis of variance were conducted to test Hypothesis 2; moderation analysis was used to test Hypothesis 3; independent samples t-test was conducted to test Hypothesis 4. RESULTS: None of the hypotheses was supported. CONCLUSIONS: This paper provides an important starting point from which to inform further work exploring how question wording can improve self-reported measurement of height and weight. Future research should explore how question preambles may or may not operationalise hypothesised underlying mechanisms, the sensitivity or intrusiveness of height and weight questions, individual beliefs about one's height and weight, and survey context.

Improving donor retention following a temporary deferral: A cluster randomized controlled trial of deferral educational materials.

BACKGROUND: Providing educational materials to deferred donors has been shown to increase their understanding about their deferral and knowledge about their return. The aim of this study was to determine the effectiveness of educational materials in increasing the retention of deferred donors. STUDY DESIGN AND METHODS: A three-arm cluster randomized controlled trial was conducted, with the following conditions: (a) Incenter Brochure plus Email; (b) Email Only; (c) Control. The Incenter Brochure plus Email condition also included a guided conversation led by staff at the point of deferral. Donors were followed up for 3 months after their deferral had ended to determine if they had attempted to donate. RESULTS: Compared with the Control condition, donors in the Incenter Brochure plus Email condition had increased odds of return at 3 months after their deferral ended (OR: 1.16; 95% CI 1.00-1.33). Subgroup analysis highlighted that novice (OR: 1.38; 95% CI 1.04-1.83) and established donors (OR: 1.36; 95% CI 1.13-1.64) had increased odds of return if they received the incenter materials. Donors who were deferred to maintain their well-being (OR: 1.28; 95% CI 1.03-1.60) and donors with a prior deferral history (OR: 1.55; 95% CI 1.15-1.55) had increased odds of return if they received the incenter materials. No significant differences were found between the Email Only and Control conditions. DISCUSSION: This trial demonstrates the benefits of providing onsite educational materials to donors at the point of deferral. This is a simple, effective strategy to increase the return behavior of donors within 3 months of their deferral ending.

Intuitive eating is positively associated with indicators of physical and mental health among rural Australian adults.

INTRODUCTION: Rural Australians have comparatively higher rates of overweight and obesity, as well as some mental health issues. Intuitive eating has been shown to be positively associated with an array of physical and mental health indicators. Few studies, however, have been conducted with general populations, and none has explicitly examined intuitive eating among rural residents. OBJECTIVE: To investigate the prevalence of intuitive eating, and associations between intuitive eating and indicators of physical and mental health, among a general population of rural adults. DESIGN: Cross-sectional telephone survey of 200 randomly selected, non-metropolitan, English-speaking Australian residents aged 18 or older. FINDINGS: The prevalence of intuitive eating in the sample was 17.6%, with a higher level of intuitive eating among men than women (26.1% vs 9.1%). Bivariate associations between intuitive eating and each of the six health indicators were all positive and mostly statistically significant. Particularly strong was the correlation between intuitive eating and self-esteem for women (r = 0.53). After controlling for indication of an eating disorder and demographics, the associations between intuitive eating and the outcome variables held for body mass index (BMI), psychological distress and body esteem for men, and for BMI and self-esteem for women. Post hoc analyses found that BMI did not moderate the relationship for women between intuitive eating and self-esteem and that body esteem mediates the relationships between intuitive eating and BMI and psychological distress for men, and between intuitive eating and self-esteem for women. DISCUSSION: Consistent with most prior research, this study finds that intuitive eating is positively associated with several indicators of both physical and mental health among non-metropolitan residents in Australia. Practice of intuitive eating in this population, however, is low. These findings may help allied health professionals guide rural populations to better health, and may be a particularly effective approach for people for whom the barriers to seeking out health services are high. CONCLUSION: Intuitive eating appears to have substantial correlations with mental health indicators, and to some extent, physical health indicators, among rural Australians and therefore should be further investigated for its potential to inform public health policy targeted to similar populations.

Notifying donors when their deferral is ending: An effective donor retention strategy.

BACKGROUND: The application of a temporary deferral often leads to donor lapse. Contributing factors may be donors not knowing when their deferral ends or not being contacted and asked to return. The aim of this study was to determine the effectiveness of a reminder message notifying donors that their deferral is coming to an end in increasing donors' postdeferral return rates. We evaluated the optimal time, content, and mode of delivery of the reminder message. STUDY DESIGN AND METHODS: Two studies were conducted with deferred donors. Study 1: donors (n = 1676) were randomized to be sent a reminder message at one of three time points (4 weeks before, 1 week before, and 1 week after their deferral ended) or to a no contact control condition. Study 2: donors (n = 1973) were randomized to three message type conditions (emotive email, nonemotive email, nonemotive SMS). Attempted return behavior was extracted (appointments, attendances) at 1 month. RESULTS: In Study 1, being sent the reminder message increased odds of donors attempting to return within 3 months compared with the control group (OR:2.01). Sending the reminder 1 week before the deferral ended was the most effective time point. In Study 2, the nonemotive message increased the odds of attempting to return compared with the emotive message (OR:1.38). No differences were found between email and SMS messages. DISCUSSION: Sending a reminder message to donors when their deferral is coming to an end is a simple, effective, and cost-effective method to retain donors.

Educating donors about deferrals through the provision of tailored materials: Findings from a survey of deferred donors.

BACKGROUND: Receiving a temporary deferral has been shown to negatively affect donor retention. One contributing factor for low donor return may be poor understanding of why the deferral has occurred. The aim of this study was to determine whether new educational materials-a brochure, guided conversation, and follow-up email-increased deferred donors' knowledge about their donation eligibility, satisfaction with the deferral process, intention to return, and odds of rebooking another appointment. STUDY DESIGN AND METHODS: A three-arm cluster randomised controlled trial was conducted to evaluate the impact of the educational materials compared to business as usual deferral procedures: (a) In-center brochure and follow-up email; (b) Email only; (c) Control. A survey was administered to a random sample of trial participants (n = 847). RESULTS: Compared with the control condition, donors in the in-center brochure and email condition were more knowledgeable about the end date of their deferral, and reported higher satisfaction with the deferral information provided, and had fewer questions and/or concerns about the deferral. Similar findings were observed when comparing the email only condition to the in-center brochure and email condition. No differences were found in intention to return. Donors in the in-center brochure plus email condition had increased odds (OR:1.385) of rebooking their next appointment compared to the combined email only and control conditions. CONCLUSIONS: The application of a deferral is often misunderstood by donors. Providing educational materials to donors can increase their understanding and may lead to increased retention of donors through rebooking of subsequent donations.

Gone, but haven't forgotten: insights on plasmapheresis donation from lapsed donors.

BACKGROUND AND OBJECTIVES: Blood Collection Agencies in several countries have implemented strategies to increase the number of plasmapheresis collections. Despite this, a sizable minority of plasma donors lapse from donation each year, with little research conducted on this topic. An understanding of the plasma donation experience from the perspective of lapsed donors, insights into why they stopped donating and their views on returning to donate may provide opportunities to intervene to increase the retention and reactivation of plasma donors. MATERIALS AND METHODS: A qualitative approach was used in this study, with 17 lapsed plasma donors (no plasma donation for at least 13 months) interviewed. A purposive recruitment strategy was used to obtain a sample with diversity in gender (47% men), age (M = 36·2 years, SD = 13·6) and donation experience (M = 9·2 years, SD = 9·6). Semi-structured, narrative interviews were conducted, with participants describing their plasma donation careers chronologically from first donation to most recent. RESULTS: The majority of participants described at least some aspect of the plasma donation procedure as unpleasant. However, adverse experiences were only attributed to lapsing in a minority of cases, with other participants reporting significant life events, perceived ineligibility and concerns about the safety of the procedure as the reason why they lapsed. CONCLUSION: It is common for lapsed plasma donors to intend to donate again in the future. Recommendations are given for strategies to address barriers to returning, noting the potential role of tailored education and support.

Assessing the impact of an automated Web-based motivational interview on the intention and return behavior of Australian O-negative donors.

BACKGROUND: O-negative donors are a critical resource for blood collection agencies, and their recruitment and retention provides an ongoing challenge. Motivational interviewing shows promise as a tool to promote donor retention, although concerns about scalability remain. The current study examined the effect of an automated Web-based interview drawing on motivational interviewing and self-determination theory on O-negative donors' motivation, intention, and behavior. STUDY DESIGN AND METHODS: Within 13 days of donating, 2820 O-negative donors completed baseline measures of motivation and intention before being randomly assigned to complete either a motivational interview (MI) or active control interview (ACI). Motivation and intention were assessed at 2 days and at 7 weeks after participation in the MI or ACI, with return behavior tracked for 6 months following trial completion. RESULTS: Changes in donor motivation and intention, rate, and time to return did not vary by participation in the MI or ACI. When compared with O-negative donors who experienced business-as-usual practices, donors completing the MI or ACI returned to donate more, and they returned more quickly. However, subsequent exploratory analyses considering the behavior of those who did not accept the invitation to participate and those who completed only baseline measures showed that the improved return behavior of donors in the MI or ACI conditions was likely not due to any specific properties of the MI or ACI activities. CONCLUSIONS: Australian O-negative donors were highly internally motivated and committed to donating. An automated Web-based motivational interview appears to be of limited effectiveness in promoting the return of such donors.

Thank you for donating: a survey of Australian donors' and nondonors' orientations toward noncash incentives for blood donation.

BACKGROUND: The aim of this study was to understand Australian donors' and nondonors' orientations toward 13 noncash incentives for blood and plasma donation and the associations between orientations and intention to donate (nondonors) and subsequent donation (donors). STUDY DESIGN AND METHODS: A survey of 1028 donors and 1201 nondonors was conducted online and by telephone. Donors were randomly selected from the Australian Red Cross Lifeblood donor panel; nondonors were selected from randomly generated fixed line and mobile telephone numbers across Australia. Incentives were chosen to reflect a wide array of possible noncash incentives that might be introduced by blood donation organizations (BDOs). Differences between donors and nondonors, as well as other subgroups, were investigated. RESULTS: Orientations toward most types of incentives were positive or neutral. No significant differences were observed between incentive orientations for whole blood versus plasma donations. Many subgroup differences were small but statistically significant. There were mostly small, positive, significant associations between nondonors' intention to donate and orientations toward noncash incentives; there were mostly no significant associations between donors' orientations and subsequent donation behaviors. CONCLUSION: The findings from this study suggest that BDOs that wish to trial noncash incentives in voluntary nonremunerative systems can be confident that neither donors nor potential donors will react negatively. They also indicate that BDOs have some flexibility in deciding which incentives to trial.

Innovation in youth mental health services in Australia: common characteristics across the first headspace centres.

AIM: headspace centres comprise a significant innovation in community-based youth mental health service delivery in Australia. This paper examines the service activity of the first headspace centres to determine common and unique practice characteristics across headspace centres in this new approach to mental health service delivery. METHODS: Data come from quarterly progress reports provided by the first 30 headspace centres during the 2010-2011 financial year. The information from 120 reports was analysed qualitatively using thematic analysis techniques to determine the types of activities reported by centres against key performance indicators. RESULTS: The main finding was the large number and wide range of centre activity. This heterogeneity may be explained in part by the diversity of communities across Australia and the importance that headspace places on addressing the specific needs of the local community as well as drawing upon the existing capacity that is available within a community. The most common activities were community engagement, building local partnerships and providing a youth friendly environment. There was a particularly strong focus by the majority of centres on establishing and supporting a Youth Reference Group to guide centre development and implementation. CONCLUSIONS: The progressive upscaling of headspace centres across Australia provides a unique opportunity to observe how a significant reorientation in health service delivery is implemented in practice to meet the needs of diverse communities. Further investigation of the headspace experience will provide critical lessons for other countries investing in new approaches to youth mental health.

Relationships between intuitive eating and health indicators: literature review.

OBJECTIVE: To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons. DESIGN: We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include 'intuitive eating' or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators. RESULTS: We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. CONCLUSIONS: Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.