Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada.

Objective. To explore how food insecurity affects individuals' ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre. Design. Qualitative study comprising of in-depth interviews, using a semistructured interview guide. Setting. Participants were recruited from the local community, three community health centres, and a community-based diabetes education centre servicing a low-income population in Toronto, Ontario, Canada. Participants. Twenty-one English-speaking adults with a diagnosis of diabetes and having experienced food insecurity in the past year (based on three screening questions). Method. Using six phases of analysis, we used qualitative, deductive thematic analysis to transcribe, code, and analyze participant interviews. Main Findings. Three themes emerged from our analysis of participants' experiences of living with food insecurity and diabetes: (1) barriers to accessing and preparing food, (2) social isolation, and (3) enhancing agency and resilience. Conclusion. Food insecurity appears to negatively impact diabetes self-management. Healthcare professionals need to be cognizant of resources, skills, and supports appropriate for people with diabetes affected by food insecurity. Study findings suggest foci for enhancing diabetes self-management support.

Successfully Attaining a Dietetic Internship Position in Ontario on the First Attempt: A Descriptive Survey.

PURPOSE: We explored the characteristics of Ontario-based dietetic internship program applicants who were successful upon their first application attempt, and we made comparisons between those who were successful and unsuccessful on their first internship application attempt. METHODS: A 32-item online survey was distributed to graduates from nutrition programs in Ontario and to members of the Dietitians of Canada Student Network, Toronto Home Economics Association, and Ontario Home Economists in Business. Data from a previous study examining the characteristics of unsuccessful internship applicants were obtained from the authors to compare the two groups. RESULTS: Respondents (n = 76) were mostly female (97%), 20-25 years of age (67%), and had a previous degree (46%). Compared with those who were unsuccessful on their first internship application attempt, those who were successful had a significantly higher mean cGPA (3.69 ± 0.39 vs. 3.35 ± 0.41), were more likely to have a prior degree (46% vs. 29%), spent more time preparing their internship application package, and perceived their internship application packages to be stronger. CONCLUSIONS: Despite some differences, most applicants met the minimum cGPA requirement outlined by internship programs in Ontario. More internship opportunities can help increase the diversity and human potential in the dietetic profession.

The lived experience of Canadian university students with type 1 diabetes mellitus.

OBJECTIVE: The purpose of this study was to examine the lived experiences of university students with type 1 diabetes mellitus. METHODS: University students participated in a 2-part focus group. Transcripts were analyzed thematically using an open-coding approach. Data analysis was guided by a framework analysis method and emergent themes were triangulated between study authors for validity. RESULTS: Three major themes identified in this study were food issues within the university environment, lack of diabetes awareness on campus and internal struggles related to the participants' relationships with their diabetes. CONCLUSIONS: Results illustrate some of the unique challenges that interfere with diabetes self-management, academic performance and quality of life among this sample of university students. Findings can provide insight for diabetes educators and other healthcare practitioners regarding the issues that may interfere with optimal diabetes self-care in this population. Findings also can be used to inform university administrators how to make the university environment more diabetes friendly for its students.

New dietetic practitioners' perspectives on their education and training.

PURPOSE: To elucidate the complex phenomenon of dietitian professional socialization, we examined factors that influence people's decisions to pursue a career in dietetics and how education and training processes influence the professional socialization of dietitians. METHODS: Participants (n=12) had less than three years of work experience and included alumni from three Canadian universities representing different models of entry to practice. Three one-on-one interviews were conducted with each participant. RESULTS: The key influencing factor in participants' decision to pursue dietetics was the perceived congruence between dietetics and other aspects of their lives, including early interests and experiences (sports, food and cooking, an eating disorder), career aspirations (science, health care), and social networks (the desire to be a professional). A pivotal experience during high school or while enrolled in or after graduation from another program prompted participants' awareness of and subsequent decision to pursue a career in dietetics. Supportive relationships were vital to participants' professional socialization. CONCLUSIONS: Recruitment materials and education opportunities should help aspiring dietitians develop a clear idea of what being a dietitian means. Dietetic educators must attend to the informational and relational aspects involved in shaping future practitioners' dietitian identities.

Unsuccessful dietetic internship applicants: a descriptive survey.

PURPOSE: We examined the demographic characteristics of applicants who applied and were unsuccessful in securing an internship position, what these applicants did afterward in their efforts to obtain an internship position, and which career paths they pursued. We also searched for any differences in eligibility between applicants who had not obtained an internship position and those who eventually were successful. METHODS: A 68-item online survey was administered. RESULTS: The study sample (n=84) was relatively homogeneous: female (99%), heterosexual (98%), Caucasian (70%), Canadian-born (75%), having English as a first language (73%), multilingual (40%), and having completed a previous degree (29%). Mean self-reported cumulative grade point average (3.35) exceeded the minimum (3.0) required by most Ontario internship programs. Over 25% eventually secured an internship position. Applicants who rated their packages strong in community nutrition were less successful in attaining an internship. Little difference in qualification was found between those who were eventually successful and not-yet-successful applicants. CONCLUSIONS: Unsuccessful applicants met academic and other requirements for admission to dietetic internship programs in Ontario. Insufficient training opportunities, costs associated with internship, and competition may be contributing to a loss of human potential in dietetics.

A team-based approach to qualitative inquiry: the collaborative retreat.

A team of researchers undertook a collaborative qualitative study to explore beginning dietitians' life experiences and the meaning ascribed to those experiences in the context of dietetic practice. Data were collected using Seidman's three-step in-depth phenomenological interviewing method with 12 beginning dietitians who were graduates of the three participating dietetic programs. We outline the collaborative research process and highlight a writing and data analysis technique described as the collaborative retreat, a face-to-face, two-day gathering that facilitated the researchers' collective decision-making and organization, discussion, and analysis of this complex qualitative data set. Use of a listening guide aided researchers' understanding and interpretation of participant voices. Researchers concluded that the overall collaborative qualitative research process was positive and self-fulfilling, and that it resulted in multiple benefits for them individually and the research project collectively. Researchers were able to work through methodological and theoretical issues as these arose, with the assistance of technology, writing, listening, and dialogue. Relationship building and relationship maintenance emerged as factors critical to the success of the research process. Collaborative research teams that are committed to listening, writing, and dialogue will find that the collaborative retreat can be a productive site of knowledge generation and mentorship.

Professional socialization in dietetics: a review of the literature.

The process of professionalization has been widely studied in nursing, but little is known about it in dietetics. We explored the process of professionalization using an integrative review of nursing literature. Three research questions were addressed: 1. What are the stages of professional socialization? 2. Who are the participants in the socialization process? 3. What challenges are associated with the socialization process? From an initial list of 322 articles compiled from a search of relevant databases, 49 English-language primary research papers were selected for review. A form of constant comparative analysis was conducted to extract relevant data into categories based on the research questions. Findings suggest that the process of professional socialization is a complex and stressful process, which occurs in three phases and begins before entry into the formal education system. Within the formal education system, faculty and preceptors can have a positive or negative impact on an individual's professional growth and development. Much work is needed to develop an understanding of this process in dietetics, but the findings will have immediate relevance to dietitians' educational and practice contexts.

Coming and going: dietetic students' experience of their education.

PURPOSE: Nutrition students' expectations for and experiences of their education were explored, as was the influence of the educational process on the students. METHODS: In this qualitative research guided by a phenomenological approach, eight students in the first year and six in the final year of an undergraduate program completed semi-structured interviews. RESULTS: Although the students were diverse in terms of age, ethnicity, and class background, all stated that they wanted to become dietitians. Our findings illuminate the ways in which dietetic education influences students' relationship with food, their bodies, bodies of knowledge, and family and friends. Professionalization, as initiated through discourse, necessitates a particular loss of relationship with the self. Although students enter with an awareness of professional norms and discourses, their education fosters an identity shift based on the kinds of nutrition knowledge and discourses they are learning, as these are performed by educators. CONCLUSIONS: Acknowledging that an embodied curriculum has an impact on professionalization is important for educators and students because education is a critical site for developing a professional identity; this identity then influences how dietitians practise. This research has implications for recruitment language, professional practice curricula, faculty development, the scholarship of teaching and learning, and ongoing support for students as they enter practice contexts.

Body image of chronic dieters: lowered appearance evaluation and body satisfaction.

This study was conducted to determine the body image of a group of female chronic dieters. Participants were asked to complete a body image questionnaire, and their results were compared with age- and sex-matched reference norms. Chronic dieters possessed significantly lower appearance evaluation, lower body satisfaction, and higher self-classified vs actual body weight compared with reference norms. Body image dissatisfaction may prevent individuals from incorporating beneficial lifestyle behaviors, and thus it is important to address body image dissatisfaction with chronic dieters for the best chance at improving health, regardless of body size.