Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence

In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children’s Fund convened, on June 3–4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers’ behaviors are given

A Latent Profile Analysis of Health-related Quality of Life Domains in Cancer Survivors

PurposeThe aim of this research was to examine heterogeneity of Health-related Quality of Life (HrQOL) in Cancer Survivors (both undergoing and completed treatment) using latent profile analysis and to determine whether these groups differed by demographic and health characteristics.MethodsParticipants(n=229) recruited through an oncology day ward and outpatient department in a local hospital, completed height, weight and handgrip measures as well as the validated patient generated subjective global assessment and EORTC-QLQ-C30 questionnaires. A latent profile analysis was performed to identify subgroups based on HrQOL domain scores. Multinominal Logistic Regression was conducted to determine the relationship between these subgroups and demographic and health characteristics. ResultsThree latent subtypes were identified: (1)high quality of life(n=122, 52.8%); (2)compromised quality of life(n=79, 34.2%) and (3)low quality of life(n=30, 12.99%). All subtypes scored lower for functioning scales (with the exception of the higher quality of life group for physical, role and emotional functioning) and higher for symptom scales then the reference norm population. There were large clinically meaningful differences between the high quality of life group and the low quality of life group for all HrQOL scales. Those in the low quality of life group were slightly younger than those in the high quality of life group(OR = 0.956, p &lt; .05, CI = 0.917– 0.998). Workers were &gt;7 times more likely to be in low quality of life than the high quality of life group. Compared to the high quality of life group, the odds of belonging to the compromised quality of life group decreased significantly by having higher handgrip strength (OR = .955, p &lt; .05, CI = .924 - .988). The odds of belonging to the low quality of life group increased significantly for those with higher number of nutrition impact symptoms (NIS) (OR = 1.375, p &lt; .05, CI = 1.004 – 1.883).ConclusionsThis is the first study to examine heterogeneity of HrQOL using latent profile analysis in Irish Cancer Survivors. In clinical practice understanding how aspects of HrQOL group together may allow clinicians to better understand and treat cancer survivors, informing more individualised nutrition care.<br/

A Latent Class Analysis of Nutrition Impact Symptoms in Cancer Survivors

Purpose: Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms with prevalence varying by study, group and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms.Methods: 229 individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment Short Form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables as well as by Global health status (GHS) and five functioning scales determined using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Three latent subtypes were identified: (1) Fatigue (n=58, 28%); (2) Low Symptom Burden (n=146, 64%) and (3) High Symptom Burden (n=25, 11%). Those in the High Symptom Burden group were more likely to be female, currently receiving any form of treatment and have consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were more likely were more likely to have reported consuming less food in the previous month and less likely to have reported their food intake to be unchanged than those in the Low Symptom Burden group. Those who received their diagnosis two years+ ago were most likely to be classed in the Fatigue group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p&lt;0.001)Conclusion: This is the first study to examine heterogeneity of nutrition impact symptoms in Irish Cancer Survivors. The findings of this work will inform and allow for more individualised nutrition care.<br/

Group appointments & lifestyle coaching to reduce complications of type 2 diabetes in primary care settings

Type 2 diabetes is a common illness and affects many people. It will afflict approximately 7 million people yearly and reach epidemic proportions by 2025. This project provides an overview of literature from 1998-2008 supporting group medical appointments as a means for overseeing type 2 diabetes care, with an emphasis of self-management and nurse-practitioner coaching in chronic disease management.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b163744

Food literacy and healthy diets of Canadian parents : Associations and evaluation of the Eat Well Campaign

Une mauvaise alimentation est un facteur de risque important contribuant au fardeau des maladies chroniques. La littéracie alimentaire contribue à l’adoption de saines habitudes alimentaires et aide les consommateurs à développer de la résilience envers les effets négatifs de l’environnement alimentaire malsain qui offre une grande variété d’aliments à petits prix, souvent riches en énergie et de pauvre qualité nutritionnelle. Un besoin de réaliser de la recherche au Canada sur les déterminants de la littéracie alimentaire et leur association à la qualité de l’alimentation a déjà été identifié. La campagne « Bien manger » est une initiative portant sur la saine alimentation développée par Santé Canada pour sensibiliser les parents canadiens à la saine alimentation et augmenter leurs connaissances ainsi que leur participation à la planification des repas familiaux – une composante de la littéracie alimentaire. Les partenariats multisectoriels avec les détaillants alimentaires, les médias et les organisations de santé ont facilité la diffusion de la campagne et ont contribué à l’accroissement de sa portée et de son efficacité auprès des parents canadiens. La planification de repas n’est pas une composante de la littéracie alimentaire qui a été bien documentée dans la littérature, et jamais aucune intervention populationnelle sur ce sujet n’a fait objet d’une évaluation. De telles évaluations sont nécessaires pour fournir de la rétroaction aux parties prenantes concernant des pistes d’améliorations d’initiatives en santé et pour identifier des stratégies optimales visant à soutenir les progrès en santé publique. L’objectif principal de cette thèse est de mener des évaluations de processus et d’impacts de la campagne « Bien manger », explorer les associations entre la littéracie alimentaire et la qualité de l’alimentation des parents canadiens et de transférer les connaissances auprès des décideurs et des parties prenantes. Pour réaliser les objectifs, un échantillon composé de partenaires multisectoriels de Santé Canada a été interrogé et une enquête a été réalisée auprès de parents canadiens. Dans un premier temps, une évaluation qualitative du processus d’implantation a été effectuée avec 21 partenaires pour déterminer quels facteurs ont influencé leur décision d’adopter la campagne « Bien manger » et pour identifier les iv facteurs facilitants et les obstacles reliés à l’implantation de la campagne. Dans un deuxième temps, une évaluation quantitative a été effectuée auprès de 964 parents canadiens pour caractériser la portée de la campagne et déterminer les effets sur les attitudes reliés à la planification des repas familiaux. Dans un troisième temps, des associations entre la littéracie alimentaire, le statut d’emploi et la qualité de l’alimentation ont été examinés au sein de 767 parents. L’évaluation de processus a mis au jour de nombreux éléments clés à prendre en considération lors de futures collaborations. Notamment, indépendamment de la mission de chaque organisation, celles partageant des valeurs compatibles ont de bonnes chances d’être de bons partenaires. En revanche, la planification collaborative et la communication sont nécessaires pour maintenir l’engagement de l’organisation et pour soutenir l’implantation des activités. L’évaluation d’impact a dévoilé que le rappel de la campagne était plus important chez les francophones, les personnes sans éducation universitaire et les personnes à faibles revenus. Les taux de rappels ont largement varié à travers le pays, avec les taux les moins élevés à Vancouver, Winnipeg et Toronto et les taux les plus élevés à Québec et dans les régions rurales du Québec. De plus, le rappel de la campagne était associé à des attitudes plus favorables envers la planification de repas. Finalement, les analyses exploratoires ont dévoilé que le statut d’emploi n’est pas associé à la littéracie alimentaire, que le temps était un obstacle important à la préparation de repas, et que les dimensions de connaissances en nutrition et conceptualisation d’aliments étaient associées à une meilleure qualité alimentaire. En conclusion, les futures initiatives de santé publique en matière de nutrition peuvent être renforcées par l’implication de partenaires avec des valeurs semblables dès l’étape de planification de l’intervention. Les initiatives futures devraient être élaborées en ciblant les dimensions de littéracie alimentaire qui ont la plus grande chance d’influencer des facteurs nutritionnels positives telles que les dimensions de connaissances alimentaires ou conceptualisation alimentaire, et prendre en considération des stratégies permettant aux parents de surmonter les obstacles reliés au manque de temps.Poor diet is a major risk factor for non-communicable chronic diseases such as obesity, cardiovascular disease and certain cancers. Food literacy supports healthy eating practices and can help individuals build resilience to food environments that provide consumers with a large variety of energy-dense nutrient poor foods in abundance at low-costs. A need for further research in Canada on the determinants of food literacy and their relationship to diet quality has previously been identified. The Eat Well Campaign (Food Skills) (EWC) is a healthy eating initiative developed by Health Canada to increase parents’ awareness, knowledge of and engagement in meal planning – a component of food literacy. Cross-sector partnerships with the retail food industry, media and health organizations facilitated the diffusion of the EWC and were pivotal to extend its reach and effectiveness. Meal planning is not well described in the literature and no population-wide communication interventions targeting meal planning have been evaluated to date. Evaluations are essential to provide feedback to stakeholders on improving health initiatives, identify optimal strategies to support advances in public health and ensure government accountability. The main objective of this thesis was to conduct process and impact evaluations of the EWC, explore associations between food literacy and diet quality of Canadian parents and put this information into context for decision makers and stakeholders. To achieve these objectives, a purposeful sample of Health Canada’s cross-sector partners were interviewed and a cross-section of Canadian parents were surveyed. First, a qualitative process evaluation was conducted with 21 cross-sector partners to determine which factors influenced their decision to adopt the EWC and identify facilitators and barriers that they experienced during the EWC implementation. Second, a quantitative impact evaluation was conducted with 964 parents from across Canada to characterise the reach (i.e., awareness) of the EWC and determine whether the campaign’s awareness influenced meal planning attitudes, behaviors and self-efficacy. Third, associations between different food literacy dimensions, employment status and diet quality were investigated in a subsample of 767 parents. The process evaluation revealed several key considerations for future collaborations with partners from multiple sectors. Of note, regardless of mission, organizations with similar values are likely to make stronger partnerships; however, advanced collaborative planning and consistent communication are necessary to maintain organizational engagement and activity implementation. The impact evaluation revealed that the highest rates of campaign awareness were among French-speakers, parents without university education and those from low-income households. Awareness varied greatly across the country with the lowest rates in Vancouver, Winnipeg and Toronto, and the highest rates in Quebec City and rural Quebec. Additionally, campaign awareness was associated with more positive attitudes towards meal planning. Finally, exploratory analyses of different food literacy dimensions revealed that employment status was not associated with food literacy, time was a major limitation for home-based meal preparation and nutrition knowledge and food conceptualisation are significantly associated with diet quality. In conclusion, future public health nutrition initiatives can be strengthened by involving partners with similar values during the intervention planning stage. Future interventions should target dimensions of food literacy that are most likely to influence dietary outcomes such as nutrition knowledge or food conceptualisation and need to consider strategies to overcome time barriers to healthy eating

The second physical therapy summit on global health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n=32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.info:eu-repo/semantics/acceptedVersio