The effect of rural placements on future rural general practice

Background: Providing health care to rural populations is a major issue in Australia. Disease burdenand health risk factorsincrease with remoteness, but the access to appropriate service decrease. The introduction of Rural Clinical Schools, rural locations for internship and residency, and decentralisation of the Australian General Practitioner Training Programaim to address this disparity. This systematic review aimed at determining if rural placements throughout medical training are associated with future rural general practice in Australia.Methods: Medline (Ovid), Pubmed, CINAHL and Science Direct were searched for the period January 2000 to July 2019. Included studies related specifically to rural general practitioners in Australia and studies were excluded if they reported only on intention to practice rurally. Evidence was assessed using the Standards for Quality Improvement Reporting Excellence Guidelines.Results: Eleven articles met the inclusion criteria. Three studies examined the effect of rural placements in medical school on future rural general practice. Three studies looked at placements as a junior doctor on future rural general practice. Four studies looked at the effect of rural general practitioner training on future rural general practice. One study reported on the effect of rural placements during both medical school and junior doctor years on future rural general practice. The studies supported an association between rural placements and future rural general practice, particularly for Australian born doctors, Australian graduates and individuals from rural backgrounds.Discussion: This review suggests that rural placements during medical training increase the likelihood of future rural general practice. The interplay of personal and professional life influence whether rural intention is sufficient to result in rural practice. Addressing human factors that influence rural practice will contribute to achieving equitable rural health care

Giving and receiving written feedback on research reports: a narrative review and guidance for supervisors and students

PurposeWritten feedback on research-related writing is an important educational component of novice researcher development. Limited evidence exists to inform effective written feedback, particularly in relation to research reports by novice researchers. The aim of this narrative literature review was to explore supervisor and novice researcher perspectives on the provision of written feedback, particularly in the context of their evolving supervisory relationship. MethodsA systematic search of peer-reviewed journals in educational and health databases was undertaken for the terms ‘written feedback’ and ‘research report’, from January 2001 to August 2020. Identified literature was critiqued for methodological quality. Findings were coded, grouped and described as themes. Next, the themes and their parts were applied to the development of a two-part written feedback checklist that includes separate but related recommendations for supervisors and novice researchers.FindingsFrom 35 included papers, the four main themes that related to written feedback on research reports by novice researchers were: the emotional impact of receiving or giving written feedback; written feedback in the supervisory power dynamic; communicating written feedback; and the content and structure of written feedback. The changing nature and complexity of factors associated with written feedback from research supervisors reflected the transition from a supervisory relationship to a peer relationship. The checklist developed from the synthesised data is intended to provide guidance for supervisors and students about their respective and shared responsibilities within a supervisory relationship.  ImplicationsIncreased awareness of the characteristics, roles and impact of written feedback will assist supervisors of novice researchers to provide effective written feedback, and for students to effectively utilise written feedback. Progression of written feedback throughout the supervisory period is proposed as a means of transitioning from a teacher-student to a peer researcher relationship.

Consumer Understanding, Perception and Interpretation of Serving Size Information on Food Labels: A Scoping Review

Theincreaseinpackagedfoodandbeverageportionsizeshasbeenidentifiedasapotential factorimplicatedintheriseoftheprevalenceofobesity. Inthiscontext,theobjectiveofthissystematic scopingreviewwastoinvestigatehowhealthyadultsperceiveandinterpretservingsizeinformation on food packages and how this influences product perception and consumption. Such knowledge is needed to improve food labelling understanding and guide consumers toward healthier portion size choices. A search of seven databases (2010 to April 2019) provided the records for title and abstract screening, with relevant articles assessed for eligibility in the full-text. Fourteen articles met the inclusion criteria, with relevant data extracted by one reviewer and checked for consistency by a second reviewer. Twelve studies were conducted in North America, where the government regulates serving size information. Several studies reported a poor understanding of serving size labelling. Indeed, consumers interpreted the labelled serving size as a recommended serving for dietary guidelines for healthy eating rather than a typical consumption unit, which is set by the manufacturer or regulated in some countries such as in the U.S. and Canada. Not all studies assessed consumption; however, larger labelled serving sizes resulted in larger self-selected portion sizes in three studies. However, another study performed on confectionary reported the opposite effect, with largerlabelledservingsizesleadingtoreducedconsumption. Thelimitednumberofincludedstudies showedthatlabelledservingsizeaffectsportionsizeselectionandconsumption,andthatanylabelled serving size format changes may result in increased portion size selection, energy intake and thus contribute to the rise of the prevalence of overweight and obesity. Research to test cross-continentally labelled serving size format changes within experimental and natural settings (e.g., at home) are needed. In addition, tailored, comprehensive and serving-size-specific food literacy initiatives need to be evaluated to provide recommendations for effective serving size labelling. This is required to ensure the correct understanding of nutritional content, as well as informing food choices and consumption, for both core foods and discretionary foods. Keywords: serving size; portion size; food labeling; nutrition facts label; back of pack; front of pack; health framin

Aboriginal people's perceptions of patient-reported outcome measures in the assessment of diabetes health-related quality of life

Background: Patient-reported outcome measures (PROMs) provide clinicians and consumers a platform to inform and improve healthcare planning and management. Aboriginal people experience disproportionately high rates of chronic diseases, including type 2 diabetes. Treatment and management require holistic approaches that draw on culturally relevant resources and assessment tools. This study explored perceptions of Aboriginal people about two diabetes management-related PROMs (PROMIS-29, PAID Scale). Methods: Twenty-nine Aboriginal people living with diabetes in the Shoalhaven discussed two PROMs in one of four focus groups or at an individual interview. Preliminary data coding was conducted by clinician researchers, with thematic analysis overseen by Aboriginal co-researchers. Subsequent individual interviews with participants were undertaken to seek further feedback and articulate what is needed to improve methods of evaluating Aboriginal people's self-reported quality of life and diabetes management. Results: The PROMs did not capture information or knowledge that Aboriginal people considered relevant to their diabetes-related health care. Participants' recommendations included adapting survey materials to be more culturally sensitive; for example, by improving the alignment of measures with common day-to-day activities. This study also describes a genuine collaborative, Aboriginal community-guided approach to evaluate 'fit-for-purpose' diabetes management tools. Conclusions: Appropriate evaluation methods are paramount to address the disproportionate burden of diabetes experienced by Aboriginal peoples and overcome inverse diabetes care. Our learnings will contribute to development of tools, resources or methods that capture culturally tailored outcome measures. Study findings are relevant to clinicians and researchers using and/or developing Patient Reported Measures, particularly in relation to the practicality of tools for First Nations peoples

Update of the best practice dietetic management of overweight and obese children and adolescents: a systematic review protocol

To update an existing systematic review series of randomized controlled trials (RCT) that include a dietary intervention for the management of overweight or obesity in children or adolescents.Specifically, the review questions are: In randomized controlled trials of interventions which include a dietary intervention for the management of overweight or obesity in children or adolescents

Child Feeding and Parenting Style Outcomes and Composite Score Measurement in the ‘Feeding Healthy Food to Kids Randomised Controlled Trial’

Child feeding practices and parenting style each have an impact on child dietary intake, but it is unclear whether they influence each other or are amenable to change. The aims of this study were to measure child feeding and parenting styles in the Feeding Healthy Food to Kids (FHFK) Randomized Controlled Trial (RCT) and test a composite child feeding score and a composite parenting style score. Child feeding and parenting style data from 146 parent-child dyads (76 boys, aged 2.0–5.9 years) in the FHFK study were collected over a 12-month intervention. Parenting style was measured using parenting questions from the Longitudinal Study of Australian Children and the Child Feeding Questionnaire (CFQ) was used to measure child feeding practices. Data for both measures were collected at baseline, 3 and 12 months and then modelled to develop a composite child feeding score and a parenting score. Multivariate mixed effects linear regression was used to measure associations between variables over time. All child feeding domains from the CFQ were consistent between baseline and 12 months (p < 0.001), except for monitoring (0.12, p = 0.44). All parenting style domain scores were consistent over 12 months (p < 0.001), except for overprotection (0.22, p = 0.16). A significant correlation (r = 0.42, p < 0.0001) existed between child feeding score and parenting style score within the FHFK RCT. In conclusion, composite scores have potential applications in the analysis of relationships between child feeding and dietary or anthropometric data in intervention studies aimed at improving child feeding or parenting style. These applications have the potential to make a substantial contribution to the understanding of child feeding practices and parenting style, in relation to each other and to dietary intake and health outcomes amongst pre-school aged children

An investigation into parental influences on the dietary intake of Australian preschool aged children

Research Doctorate - Doctor of Philosophy (PhD)The dietary intake of children aged two to five years determines childhood nutritional status and predicts lifelong eating habits. Under-nutrition, over-nutrition and mal-nutrition in the early years of life have all been associated with an increased risk of obesity and chronic diseases in later life. With evidence suggesting that average child dietary intake is high in energy density but low in nutrient density there is a need to optimise dietary interventions and strategies for reduction in chronic disease risk factors. The primary purpose of this thesis was to investigate current dietary intake of Australian children aged between two and five years; determine the effect of a parent-focused nutrition intervention on child dietary intake, child feeding practices and parenting style; and identify factors that influence the child feeding practices of parents. Three research studies were undertaken to meet the aims of this body of research. A randomised controlled trial involving 146 rural Australian parents with preschool aged children was undertaken to examine the intervention effect of providing evidence-based, self-directed child feeding and nutrition resources on participants’ child feeding and parenting practices, and the dietary intake of children aged two to five years. The study showed that parents are receptive to nutrition and child feeding information in a self-directed format, the use of which had limited impact on child dietary intake and child feeding practices and parenting style. It was identified that improved tools for measurement of overall quality of child dietary intake, child feeding practices and parenting style were needed for use in preventative health research. The perceptions of parents in relation to their own child feeding practices relative to the Australian dietary guidelines and compared to parent peers were investigated in a qualitative study with a sub-group of 21 participants from the randomised controlled trial. Based on the Theory of Planned Behaviour, this study identified that parents’ child nutrition attitudes and beliefs contributed to subjective norms and normative beliefs, which in turn influenced their child feeding-related behaviours. This study identified peer nutrition education as a potential model of improving the child feeding practices of parents, and thereby improving child dietary intake. A subsequent pilot study involving 34 mothers of children aged under two years established the feasibility of peer nutrition education to improve child feeding “norms” that are used by parents as a reference point for their own behaviours. In conclusion, the study findings presented in this thesis highlight the need for improved access to the Australian Dietary Guidelines in the early childhood setting, and more support for parents in implementing the dietary guidelines within home and community settings. The findings also demonstrated that parents’ perceptions of child feeding and dietary intake “norms” are more influential than the dietary guidelines. This research demonstrates the need for strategies to promote and support preventive child feeding behaviours in parents that improve the dietary intake of their preschool aged children. Peer nutrition education for parents commencing when children are infants is proposed as an area for subsequent research

Child Feeding and Parenting Style Outcomes and Composite Score Measurement in the ‘Feeding Healthy Food to Kids Randomised Controlled Trial’

Child feeding practices and parenting style each have an impact on child dietary intake, but it is unclear whether they influence each other or are amenable to change. The aims of this study were to measure child feeding and parenting styles in the Feeding Healthy Food to Kids (FHFK) Randomized Controlled Trial (RCT) and test a composite child feeding score and a composite parenting style score. Child feeding and parenting style data from 146 parent-child dyads (76 boys, aged 2.0–5.9 years) in the FHFK study were collected over a 12-month intervention. Parenting style was measured using parenting questions from the Longitudinal Study of Australian Children and the Child Feeding Questionnaire (CFQ) was used to measure child feeding practices. Data for both measures were collected at baseline, 3 and 12 months and then modelled to develop a composite child feeding score and a parenting score. Multivariate mixed effects linear regression was used to measure associations between variables over time. All child feeding domains from the CFQ were consistent between baseline and 12 months (p < 0.001), except for monitoring (0.12, p = 0.44). All parenting style domain scores were consistent over 12 months (p < 0.001), except for overprotection (0.22, p = 0.16). A significant correlation (r = 0.42, p < 0.0001) existed between child feeding score and parenting style score within the FHFK RCT. In conclusion, composite scores have potential applications in the analysis of relationships between child feeding and dietary or anthropometric data in intervention studies aimed at improving child feeding or parenting style. These applications have the potential to make a substantial contribution to the understanding of child feeding practices and parenting style, in relation to each other and to dietary intake and health outcomes amongst pre-school aged children

Parents' perceptions of child feeding: a qualitative study based on the theory of planned behavior

Objective: The aim of this qualitative study was to investigate the child-feeding behaviors and attitudes of parents of children aged 2 to 5 years, within the theory of planned behavior (TPB) framework. Methods: Semistructured telephone interviews were conducted in October 2011. The interviewer conducted and recorded the interviews from a community health center, to interviewees who were in their own home environment. Verbatim transcription of interviews preceded manual coding of data. Emergent themes were mapped into a matrix against a priori-coded TPB constructs (attitudes, beliefs, subjective norms, perceived behavioral control, and behavioral intention). Results: Twenty-one consenting parents participated in interviews. Participants were predominantly tertiary-educated (65%) mothers (85%) who were older than 30 years (76%). Parents believed that optimal child nutrition is important but difficult to achieve. Behavioral intention to change feeding practices was limited by a belief that child’s dietary intake is above average compared with their peer group. Perceived control over child dietary intake was influenced by food advertising, extended family, and peer influences. Parents supported targeting nutrition education directly at children and a policy approach to offset the costs of fresh foods by taxing “junk” foods. Conclusions: The application of TPB to child feeding may explain the disparity between parents’ child-feeding intentions and behaviors. Parents’ feeding behaviors are more influenced by peers than by dietary guidelines. Future interventions need to target parents’ perceived child-feeding responsibilities, influence subjective norms, and increase parents’ perceived control over child feeding. Peer nutrition education is proposed as an intervention model

Experiences of Parent Peer Nutrition Educators Sharing Child Feeding and Nutrition Information

The aim of this study was to describe the experiences of parents as peer educators disseminating nutrition and child feeding information. Parents of infants aged from birth to three years were trained as peer educators in a face-to-face workshop, and then shared evidence-based child feeding and nutrition information via Facebook, email, and printed resources for six months to peers, family, and social media contacts. Semi-structured telephone or group interviews were conducted after a six-month online and face-to-face peer nutrition intervention period investigating peer educator experiences, barriers, enablers of information dissemination, and the acceptability of the peer educator model. Transcripts from interviews were independently coded by two researchers and thematically analysed. Twenty-eight participants completed the study and were assigned to either group or individual interviews. The cohort consenting to the study were predominantly female, aged between 25 and 34 years, non-indigenous, tertiary educated, and employed or on maternity leave. Dominant themes to emerge from the interviews included that the information was trustworthy, child feeding practice information was considered most helpful, newer parents were the most receptive and family members the least receptive to child feeding and nutrition information, and sharing and receiving information verbally and via social media were preferred over print and email. In conclusion, parents reported positive experiences as peer nutrition educators, and considered it acceptable for sharing evidence-based nutrition information. Further research may determine the impact on diet quality and the food-related behaviours of babies and young children on a population level