How Older Citizens in Germany Perceive and Handle Their Food Environment-A Qualitative Exploratory Study.

Apart from individual factors like knowledge or personal motivation, the environment also influences a person's eating behaviour. Food environments can be described as the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people's food choices and nutritional status. In order to explore how older citizens in rural Germany perceive and handle their food environment, we conducted semi-structured face-to-face interviews with 35 older adults (71 ± 7 years), asking about micro-, meso- and macro-level influences on eating habits. Participants reported social factors to be crucial in shaping their diets, such as preferences of family members or social expectations connected to roles (guest, host). On a physical level, structural aspects and resources in their nearby surroundings influenced shopping and eating behaviour (for example access to an own vegetable garden, local shopping facilities and restaurants). Macro-level influences such as the food industry were hardly mentioned. Participants noticed that the environment affects their diets but dealt with undesired influences using strategies of adaptation and behaviour change, rather than challenging the environmental influences. Public health projects should raise the awareness of the multiple environmental influences on eating behaviour and also help people to create healthier food environments.

Empowering senior citizens for healthy nutrition in Germany: A pilot study.

Main goal of this study was to analyse how empowerment processes and bottom-up activities aimed at healthier food choices and food environment could be initiated among a group of senior citizens (between 60 and 75 years old). The intervention was set up as a pilot study in a rural community (15,000 inhabitants) in the federal state of Bavaria, South Eastern Germany. A process evaluation documented how group formation and empowerment processes developed during the course of the intervention. Extensive field notes were taken in 27 meetings, interviews (n = 13) and focus groups (n = 4) were conducted with participants and key persons at different points of the intervention. Data were analysed using content analysis. The intervention succeeded in motivating senior citizens to participate in regular meetings over 11 months. During the intervention, the group members' awareness of factors influencing their eating behaviour increased. Furthermore, they developed ideas to improve the community's food environment and accomplished duties needed to implement these ideas. However, initiating empowerment processes, especially in terms of fostering leadership and transferring responsibility, took longer than expected and could be realised only partially. The findings support a further use and evaluation of the empowerment approach for addressing nutritional aspects among senior citizens.

Evaluation of Empowerment in Health Promotion Interventions: A Systematic Review.

Although empowerment is one of the core principles of the World Health Organization's approach to health promotion, there are no standards, best practice recommendations, or guidelines for evaluating empowerment within interventions. For the development of effective empowerment promoting interventions, adequate study designs, methods, and indicators for assessing empowerment are essential. In order to better understand which evaluation procedures have been used so far, and which advantages and disadvantages are connected to them, we systematically reviewed empowerment-based health promotion interventions. We included 26 studies, which use a broad variety of quantitative, qualitative, and mixed-methods designs and various data collection methods; qualitative and mixed-methods designs predominated. The quantitative measurement instruments are heterogeneous: Mainly self-designed or modified scales are applied. All studies consider indicators reflecting individual competencies and motivations, whereas indicators capturing the organizational and political components of empowerment are less common. Involving target group members in the development of evaluation procedures and combining different data sources are mentioned as specific steps to improve the quality of data collection. Given the flexible and context-dependent nature of empowerment approaches, the development of a "gold standard" for its evaluation seems unrealistic. However, the analyzed studies can be used to deduce recommendations that may help to conduct high-quality evaluations of empowerment, for example, mixed-methods designs, participation of target groups, and reflective loops within the research team.

Empowerment for healthy nutrition in German communities: a study framework.

Empowerment is seen as a key strategy for sustainable health promotion efforts. However, there is only limited research on how to link the empowerment approach to the promotion of healthy eating, which is a major current public health issue. The article presents the development of a study framework for implementing and evaluating an empowerment intervention for healthy nutrition. This framework was created for a community intervention study meaning to involve elderly citizens in Bavaria, Germany. The study protocol was developed in an iterative process basing on (i) literature reviews on the topics empowerment in relation to healthy nutrition and mixed-methods evaluation, (ii) workshops with empowerment and public health experts and (iii) consultations with local community representatives. Through these measures we identified good practice criteria as well as specific challenges of integrating empowerment and healthy nutrition, e.g. engaging people in healthy nutrition, reconciling participants' nutrition preferences with public health nutrition priorities and evaluating bottom-up activities in the community. Consequences for the study design were deducted from the literature and the consultations, e.g. practical recommendations as to how power could be gradually assigned to group members. A qualitative mixed-method evaluation design was chosen to capture emergent empowerment processes. The study framework presented here is the first on empowerment and nutrition to provide explicit guidance on how empowerment may be applied to healthy nutrition and implemented and evaluated in the community context.