Nutrition awareness before and throughout different trimesters in pregnancy: a quantitative study among Dutch women.

OBJECTIVE: To examine the nutrition awareness of women before and during pregnancy in order to provide a greater understanding of the life course perspective (LCP) in relation to nutrition behaviours and pregnancy. METHOD: Data were collected in a cross-sectional study with the aid of a face-to-face interview, based on our conceptualization of nutrition awareness and the 'rules of thumb' designed by the Dutch Nutrition Centre. The sample consisted of five groups each of ~100 Dutch nulliparous women: women not trying to conceive a child, women trying to conceive a child and women in their first, second or third trimesters of pregnancy. RESULTS: The measurement tool based on our conceptualization of nutrition awareness resulted in a Cronbach's alpha of 0.84. Pregnant women are significantly more aware of their nutrition than women who are not trying to conceive. The scores on nutrition awareness do not differ significantly between the three trimester groups of pregnant women. Women who are trying to conceive do not have a significantly higher nutrition awareness than women who are not trying to conceive. CONCLUSIONS: Our conceptualization of nutrition awareness has shown to be fruitful in obtaining a better understanding of behavioural changes in health. The study provided indications in favour of the LCP; pregnancy could indeed be an event in a woman's life that causes increased nutrition awareness. This should be kept in mind when healthy nutrition promotion activities are being developed.

Emergent technologies against the background of everyday life: discursive psychology as a technology assessment tool.

To understand prospective users' reactions to emergent technologies, it is crucial to examine the interactional contexts within which these reactions take place as people's reactions are shaped by issues that are not necessarily related to science or technology. These issues are often overshadowed or remain blind spots when descriptions or scenarios of proposed technologies are thematized as being the core objects of reference. We therefore recommend also studying prospective users' everyday-life practices in their own right, and in naturalistic settings. Insight into the social actions people accomplish in their everyday talk, such as establishing a particular identity, can help innovators translate prospective users' concerns into relevant technology characteristics. We propose discursive psychology as an analytic tool to do this and show its merit with a few illustrative examples.

The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

BACKGROUND: Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem. OBJECTIVE: To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype. METHODS: Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight. RESULTS: The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements. CONCLUSION: The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.

Raising awareness on water and climate related risks - an overview.

Climate change is not an easy subject from the perspective of communications studies: it is widely regarded as a most important issue, but its global scope and the lack of consensus on its consequences can make it hard to encompass. This article aims to structure the field and set out the domains of communicative action that are involved, as well identify the actors involved and their role in the overall debate. The different modalities of communication and the dynamics in the use of media in the present time are considered, before discussion of some basic issues with regard to communication, such as the meaning of (scientific) information versus more emotional cues, the opportunities for action that can be offered to citizens/consumers, and the issue of trust in responsible agencies.

Personalized nutrition communication through ICT application: how to overcome the gap between potential effectiveness and reality.

The potential effectiveness of personalized nutrition communication through the Internet is promising in terms of addressing personal relevance, flexibility, interactive options and amount of people that can be reached. However, little research on the contribution to behaviour change has been done. The MyFood program at Wageningen University aims at providing insight into strategies to implement personalized nutrition communication through interactive tools. In this article we present the framework for research on social acceptance of personalized nutrition communication through interactive computer technology as part of the MyFood program.

Nutrition communication styles of family doctors: results of quantitative research.

OBJECTIVE: To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates. DESIGN: A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire. SETTING: The survey was conducted in October and November 2004 in the Netherlands. SUBJECTS: A total of 267 family doctors completed the questionnaire (response rate 45%). METHODS: Principal component factor analyses with varimax rotation were performed to construct factors. Cronbach's alpha was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results. RESULTS: Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%). CONCLUSIONS: In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.

Nutrition-related information-seeking behaviours before and throughout the course of pregnancy: consequences for nutrition communication.

BACKGROUND: Research has shown that especially pregnant women, and also women with a wish for a child, have increased nutrition awareness. Seeking nutrition information seemed to be an important determinant for nutrition awareness. However, little research has been carried out about nutrition-related information-seeking behaviours before and during pregnancy. OBJECTIVE: This study aimed to explore nutrition-related information sources, nutrition information-seeking behaviours and motives for seeking nutrition information before and throughout the course of pregnancy. DESIGN: Data were collected by means of retrospective in-depth face-to-face interviews of 1 h with five groups of 12 women: women with a child wish, women in their first, second and third trimester of the first pregnancy and women in their first trimester of the second pregnancy. Women were mainly selected via midwifery practices. The interviews took place at conference rooms or at the respondent's home. Qualitative data were analysed with the software program NUD(*)IST (QSR, Melbourne). This was based on the research objectives and relevant text segments of transcripts. RESULTS: Women with a child wish generally sought little nutrition information because they were not pregnant yet. Information sources were the Internet (anonymous) and the social environment (models). In relation to the manifestation of nutrition-related information-seeking behaviours during first-time pregnancies, three groups of women could be distinguished: (1) women who feel like a mother from the moment they know that they are pregnant, (2) women who feel like a mother later in pregnancy and (3) women who do not feel like a mother yet. Each group had its own specific information-seeking behaviour. Important information sources of the first group were the Internet (anonymous and up to date), books (extended) and midwives (expert) during the first trimester; the 9-month calendar (fun and tips), friends (experienced) in the second trimester; and friends (information on breastfeeding) in the third trimester. Information sources of the second group of women were mainly brochures provided by the midwife and the midwife herself. The third group of women mainly relied on their own common sense. Second-time pregnant women mainly relied on their experience, the midwife and books for specific questions. CONCLUSIONS: Pregnant women perceive pregnancy-specific nutrition information as important because it is one of the few things that they can apply in their daily lives to protect the health of the fetus. Nutrition-related information-seeking behaviours mainly were pregnancy specific in character, rather than directed to general nutrition information.

Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study.

OBJECTIVE: For more effective nutrition communication, it is crucial to identify sources from which consumers seek information. Our purpose was to assess perceived relevance and information needs regarding food topics, and preferred information sources by means of quantitative consumer research. DESIGN: Based on qualitative studies, a quantitative questionnaire was developed and administered in face-to-face interviews. SUBJECTS: The study population consisted of Dutch adults aged 18-80 y. A stratified sample of 923 adults was taken from the GfK ScriptPanel; 603 respondents completed the questionnaire. RESULTS: Despite high perceived relevance of food topics regarding dietary guidelines (55-78%), most respondents indicated that they did not want more information about these topics (71-74%). Furthermore, our study revealed information needs regarding safety- and health-related food topics (up to 77% in some subgroups). Differences in perceived relevance and information needs were found in subgroups based on gender, age, perceived weight and socioeconomic status. Education offices of the food sector and the family doctor were mentioned for most food topics, who ranked among the highest regarding perceived reliability, perceived expertise, clearness and accessibility. CONCLUSIONS: With respect to five food topics (losing weight, sports and nutrition, lowering cholesterol, carbohydrates and food composition), interested subgroups should receive tailored information. For other groups and food topics, a population-wide strategy should suffice, utilising the preferred information source. If people who are not yet interested become interested through a life event, information on demand can be put into action. SPONSORSHIP: Dutch Dairy Association.

Nutrition guidance by primary care physicians: models and circumstances.

The perception of primary care physicians of the ability to influence the lifestyle and eating habits of patients is an important factor in nutrition guidance practices. This perception is based on assumptions about the kind of influencing process that is effective or not and on the capacity of primary care physicians to play an effective role in these processes. The first elements is dealt with in this article. Three models are distinguished. The first model is the prescription model, based on a medical optimum and on information transfer as a metaphor. The second model is the persuasion model, based on a medical optimum, but presupposing blockades that have to be cornered by persuasive communication. The third is the interaction model. It is not based upon a medical but on an efficacy optimum, and on sharing of information and continuous involvement of the client in the interaction. Behind these three models we can perceive different views on communication and knowledge. Moreover, these three models are more or less appropriate with regard to different circumstances. The current stress on the psychological, social and cultural meaning of food and the new information context in which clients live, asks for more attention to the interaction model.

Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians.

OBJECTIVE: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice ('noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a cross-sectional and a longitudinal approach. DESIGN: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. SUBJECTS: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20y. INTERVENTIONS: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. MAIN OUTCOME MEASURE: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable 'noticing patients' overweight and guidance of treatment' with an adequate fit of the empirical data, both in the cross-sectional and in the longitudinal approach. RESULTS: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time. Two dynamic LISREL-models were developed (the 'determinant-longitudinal approach' and the 'early behaviour longitudinal approach') which explain the dependent variable. The latter model has, as added value, a gain in explained variance. In 5 y time, the dependent variable decreased significantly (P < 0.001). CONCLUSIONS: This study reconfirms that PCPs' nutritional guidance practices are determined partly directly by predisposing factors, and indirectly via driving forces and barriers. However this study also reveals that an important nutrition guidance practice of PCPs, 'noticing patients' overweight and guidance of treatment', shows a significant decrease over the last 5 y. At the same time, two of the four predisposing factors and two of the three driving factors also decreased significantly. As research findings indicate that the role of diet in health and disease becomes of greater influence PCPs need to be activated to apply their responsibility in this field within a multi-faceted approach.

[From inquiry to interactive communication]. / Van informeren tot interactief communiceren.

Three functions of communication are distinguishable in the practice of dentists: the function directly related to the treatment, the function related to 'informed consent' and the preventive function. For these three functions different communication-models are applicable: communication as transfer-of-information, communication as persuasion and communication as interaction. It is argued that the interaction model of communication is the most promising model nowadays.

Consumers' expectations about nutrition guidance: the importance of primary care physicians.

To clarify the role of the primary care physician (PCP) in providing nutrition information to the public, we investigated in a random sample of Dutch consumers their referral to 11 nutrition information sources including the PCP, their perceived expertise of these sources, their interest in nutrition information, and their nutritional attitudes and beliefs. Factor analysis over these 11 sources of nutrition information resulted in two factors: noncommercial sources (alpha = 0.70) and commercial sources (alpha = 0.78). Respondents' referral to and perceived expertise on a five-point scale of noncommercial sources was higher than for commercial sources [respectively, 54% compared with 21%, P < 0.0001, and 3.9 +/- 0.6 compared with 2.7 +/- 0.6 (mean +/- SD), P < 0.01]. The individual Spearman correlation coefficient between referral scores and perceived expertise was p = 0.35 +/- 0.36 (mean +/- SD). For most sources, referral to that source was dependent on a higher interest in information about a healthy diet and on perceived expertise of the source. There were three leading noncommercial sources: the PCP, the dietitian, and the Netherlands Food and Nutrition Education Bureau (FNEB). Careful analysis revealed that because of their high referral scores, high perceived expertise, and reach to nearly all segments of the population, PCPs are in a unique position compared with dietitians and the FNEB.

Information sources and strategies of nutrition guidance used by primary care physicians.

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also PCPs' implementation of different strategies of nutrition guidance of patients. This was done by means of a questionnaire mailed to a nationwide random sample of 1000 PCPs in the Netherlands. The net response rate was 64%. The two most important nutrition information sources for PCPs were a dietitian (72% of respondents) and the literature (34% of respondents). Eighty-five percent of PCPs reported that they were actively involved in seeking nutrition information. For nutrition education of patients, PCPs gave personal information to patients, referred patients to a dietitian, and made publications available in the surgery. As preferred methods of obtaining nutrition information themselves, PCPs listed scientific journals, postgraduate nutrition education, congresses and study days, and publications. Determinants of nutrition information seeking behavior of PCPs as well as their implementation of different strategies of patient nutrition education were identified and discussed. PCPs were familiar with the body mass index, which is encouraging because treatment of overweight and obesity starts with a valid assessment. The findings in this study lead to a prudent positive conclusion about PCPs and nutrition information in practice. From this study and others it can be concluded that there are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients.

Media choice in nutrition education of general practitioners.

In the traditional model of communicating information, a general practitioner receives information from his or her teacher (when they choose to give it) and from print media (books and journals) and in turn can pass on the information didactically to patients (whether they asked for it or not). The arrival and development of new electronic media are changing the system and the possibilities. Patients now have access to more information independently (some of it correct, some misleading). GPs cannot trust their own solid body of knowledge any longer. To keep up with new and rising expectations they must become professional information seekers. New media will give opportunities for GPs to look for information by electronic means at the time that they need it, eg, through on-line connections with databases or through use of CD-roms. The role of journals will change from simply providing detailed data; journals can concentrate on the questions behind the questions.

Nutrition guidance by primary-care physicians: LISREL analysis improves understanding.

BACKGROUND: When determinants of nutrition guidance practices for primary care physicians (PCPs) are identified, the key question remains: what is the mechanism of action? This knowledge is essential in order to understand how PCPs practice nutrition guidance. METHODS: Mail questionnaires (result of focus-group discussions and in-depth interviews) were sent to a nationwide random sample of 1,000 PCPs in the Netherlands, who had been in practice for between 5 and 15 years (633 respondents). The mechanism of action of determinants of nutrition guidance practices of PCPs was identified by means of linear structural relationship analysis (LISREL) using a postulated model. RESULTS: The postulated model on the mechanism of action was confirmed. The model demonstrates that nutrition guidance practices of PCPs are directly and significantly based on a few predisposing factors; driving forces and perceived barriers may act as significant intermediary variables. The predisposing factors, driving forces, and perceived barriers were identified. CONCLUSION: Policies to improve nutrition guidance practices of PCPs may, in the future, benefit from a LISREL model analysis of determinants of these practices to become more effective. Using multiple regression analysis to ascertain the determinants of these practices could result in missing important predisposing factors and "hidden" intermediary factors and lead, therefore, to an incomplete understanding of the mechanism of action.

Nutrition guidance by primary-care physicians: perceived barriers and low involvement.

OBJECTIVE: To investigate the activities of general practitioners (GPs) in nutritional matters and the factors that influence their attitudes, knowledge and behaviour, especially perceived barriers. DESIGN: Postal questionnaires (result of focus group discussions and in-depth interviews) were sent to a nationwide random sample of GPs in the Netherlands. SUBJECTS: 1000 GPs, in practice for between 5 and 15 years. MAIN OUTCOME MEASURES: The identification of GPs' perceived barriers to nutritional guidance of their patients, their nutritional attitudes and behaviours. RESULTS: Net response rate was 64% (633/990). GPs perceived smoking to be the greatest health hazard, followed by dietary pattern and genome. 70% expressed considerable interest in the role of nutrition in health. In daily practice nutrition plays a minor role in the work of the GP. 28% of GPs gave daily nutrition information to about 10% of their patients and 48% to about 5% of their patients. It is found that GPs do perceive strong barriers of being involved in nutrition issues during their practice. The most important barriers expressed were: not being trained in nutrition, lack of time to address nutrition issues and the perception that patients lack motivation to change lifestyle and/or dietary patterns. CONCLUSIONS: The involvement of GPs in nutritional matters is very low. The fact that lack of training is considered as the most important barrier is, however, unexpected. This finding offers possibilities for improvement in which in-service courses and inter-active distant-learning programmes on nutrition for GPs should get special attention.

Correlates of toothbrushing in preschool children by their parents in four ethnic groups in The Netherlands.

A previous study among Amsterdam 5-year-old children showed that on average, the older the child at the onset of toothbrushing and the less frequent the toothbrushing, the more life time caries experience it had. The aim of the present study was to assess correlates of these two caries risk factors, in four ethnic groups. A further aim was to evaluate the putative role of correlates as intervening variables between ethnicity and caries risk factors. Questionnaire data were available from the Amsterdam study, in which a stratified sample of 103 Turkish, 258 Moroccan, 59 Dutch and 56 Surinamese parents were interviewed at home in their mother tongue. Results showed 69 per cent of the Turkish, 45 per cent of the Moroccan, 17 per cent of the Dutch and 11 per cent of the Surinamese parents had commenced brushing their child's teeth only after its second birthday or even never at all. Moreover, many parents had not brushed their child's teeth every day. Almost all potential correlates in six domains, namely parental habits, attitudes, evaluative beliefs, behavioural beliefs, perceived role of the child and that of the partner, were found to be related crudely to the risk factors. Large differences in score patterns on the correlates were observed between ethnic groups. Multiple logistic regression analyses showed substantial parts of the differences in risk factor scores between the Turkish group and a combined Dutch and Surinamese reference group could be attributed to the intervening role of the correlates, as could only minor parts of the difference in risk factor scores between the Moroccan group and the reference group.(ABSTRACT TRUNCATED AT 250 WORDS)