scholarly journals Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study

10.2196/22036 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e22036
Author(s):  
Alice Grady ◽  
Courtney Barnes ◽  
Luke Wolfenden ◽  
Christophe Lecathelinais ◽  
Sze Lin Yoong
Keyword(s):  
Early Childhood ◽  
Digital Health ◽  
Guideline Implementation ◽  
Dietary Guidelines ◽  
Health Interventions ◽  
Cross Sectional ◽  
Childcare Centers ◽  
Health Technologies ◽  
Barriers And Enablers ◽  
Dietary Guideline

Background Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. Objective This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. Methods A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Results Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. Conclusions A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.

scholarly journals Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study (Preprint)

2020 ◽  
Author(s):  
Alice Grady ◽  
Courtney Barnes ◽  
Luke Wolfenden ◽  
Christophe Lecathelinais ◽  
Sze Lin Yoong
Keyword(s):  
Early Childhood ◽  
Digital Health ◽  
Guideline Implementation ◽  
Dietary Guidelines ◽  
Health Interventions ◽  
Cross Sectional ◽  
Childcare Centers ◽  
Health Technologies ◽  
Barriers And Enablers ◽  
Dietary Guideline

BACKGROUND Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. OBJECTIVE This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. METHODS A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. RESULTS Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The <i>changes needed in team interactions</i> subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with <i>organization’s capacity to innovate</i> scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of <i>ease of the adoption decision</i> (<i>P</i>&lt;.001) and <i>identifying work and individuals involved in implementation</i> (<i>P</i>=.001) were significantly associated with high intentions to adopt digital health interventions. CONCLUSIONS A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.

scholarly journals Child-level evaluation of a web-based intervention to improve dietary guideline implementation in childcare centers: a cluster-randomized controlled trial

2020 ◽  
Vol 111 (4) ◽  
pp. 854-863 ◽  
Author(s):  
Sze Lin Yoong ◽  
Alice Grady ◽  
John H Wiggers ◽  
Fiona G Stacey ◽  
Chris Rissel ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Child Outcomes ◽  
Guideline Implementation ◽  
Dietary Guidelines ◽  
Childcare Centers ◽  
Web Based ◽  
Dietary Guideline ◽  
Z Scores ◽  
Cluster Randomized ◽  
The Impact

ABSTRACT Background Although it is recommended that childcare centers provide foods consistent with dietary guidelines, the impact of implementing sector-specific guidelines on child outcomes is largely unknown. Objectives This study aims to examine the impact of a web-based program and support to implement dietary guidelines in childcare centers on children's 1) diet; 2) BMI z scores; and 3) child health-related quality of life (HRQoL). Methods This study was a cluster-randomized controlled trial utilizing a Type-3 Hybrid implementation-effectiveness design conducted between October 2016 and March 2018. This study reports on child outcomes. Fifty-four childcare centers in New South Wales, Australia were randomly assigned to the intervention (a web-based menu-planning tool and support) or control group (usual care). The intervention was designed to address barriers and enablers to dietary guideline implementation according to the Theoretical Domains Framework. A quota of 35 consenting childcare centers undertook child-level evaluation of dietary intake where 522 parents consented to completing ≥1 component of data collection for their child. Child consumption of core and discretionary (unhealthy) foods while in care was assessed via dietary observations by blinded research assistants, childcare diet quality was assessed via educator-completed questionnaires, BMI z scores were assessed via measured weight and height, and child HRQoL was assessed via parent report at baseline and 12-mo follow-up. Results There was a significant increase in mean child consumption of fruit (0.39 servings; 95% CI: 0.12, 0.65 servings) and dairy foods (0.38 servings; 95% CI: 0.19, 0.57 servings) and a significant reduction in consumption of discretionary foods (−0.40 servings; 95% CI: −0.64, −0.16 servings) in care in the intervention group, relative to control at 12-mo follow-up. No significant differences were observed in diet quality, BMI z scores, or HRQoL. Conclusions A web-based intervention to support planning of childcare menus consistent with dietary guidelines can improve child consumption of healthier foods in daycare. This trial was registered at www.anzctr.org.au as ACTRN12616000974404.

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia J. Lucas ◽  
Alastair D. Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract Background Type 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aims To gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups. Methods A purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically. Results A diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender. Conclusion This research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

scholarly journals The association between socio-economic position and diet quality in Australian adults

2015 ◽  
Vol 19 (3) ◽  
pp. 477-485 ◽  
Author(s):  
Kathryn Backholer ◽  
Elizabeth Spencer ◽  
Emma Gearon ◽  
Dianna J Magliano ◽  
Sarah A McNaughton ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Diet Quality ◽  
Adult Population ◽  
Total Sample ◽  
Cross Sectional Study ◽  
Dietary Guidelines ◽  
Economic Disadvantage ◽  
Cross Sectional ◽  
Dietary Guideline ◽  
Economic Position

AbstractObjectiveWe aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population.DesignCross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years).SettingA large randomly selected sample of the Australian adult population.SubjectsAustralian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study.ResultsA higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage.ConclusionsA higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.

scholarly journals Diet quality in young adults and its association with food-related behaviours

2013 ◽  
Vol 17 (8) ◽  
pp. 1767-1775 ◽  
Author(s):  
Maree G Thorpe ◽  
Mark Kestin ◽  
Lynn J Riddell ◽  
Russell SJ Keast ◽  
Sarah A McNaughton
Keyword(s):  
Young Adults ◽  
Diet Quality ◽  
Maternal Education ◽  
Cross Sectional Study ◽  
Dietary Guidelines ◽  
Cross Sectional ◽  
Cooking Skills ◽  
Meal Preparation ◽  
Dietary Guideline ◽  
Sample Characteristics

AbstractObjectiveTo determine the diet quality of a group of young adults and explore its associations with two food-related behaviours (involvement in meal preparation and consumption of commercially prepared meals).DesignCross-sectional study of young adults. Sample characteristics, food-related behaviours and dietary intake were assessed using a self-administered questionnaire including an FFQ. Diet quality was measured using the fifteen-item Dietary Guideline Index (DGI) designed to assess adherence to Australian dietary guidelines. One-way ANOVA, t tests and multiple linear regression analyses were used to explore the relationships between DGI scores, sample characteristics and food-related behaviours.SettingUniversity students enrolled in an undergraduate nutrition class, Melbourne, Australia.SubjectsStudents (n 309) aged 18–36 years.ResultsThe DGI score was normally distributed, with a mean score of 93·4 (sd 17·1) points (range 51·9–127·4 points), out of a possible score of 150 points. In multivariate analyses adjusted for age, sex, nationality, BMI and maternal education, cooking meals for oneself was positively associated with DGI score (β = 0·15; 95 % CI 1·15, 10·03; P = 0·01); frequency of takeaway and frequency of convenience meal consumption were inversely associated with DGI score (β = −0·21; 95 % CI −9·96, −2·32; P = 0·002 and β = −0·16; 95 % CI −7·40, −0·97; P < 0·01, respectively).ConclusionsCooking meals for oneself was linked to higher diet quality among young adults, while consumption of commercially prepared meals was associated with poorer diet quality. Maintaining education programmes that promote cooking skills within young adults has the potential to improve DGI scores.

scholarly journals Effectiveness of digital health interventions for diabetes: systematic review of systematic reviews

2021 ◽  
Author(s):  
Bonkana Maiga ◽  
Cheick O Bagayoko ◽  
Mohamed Ali Ag Ahmed ◽  
Abdrahamane Anne ◽  
Marie-Pierre Gagnon ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Digital Health ◽  
Scientific Evidence ◽  
Relevant Information ◽  
Health Interventions ◽  
Care Utilization ◽  
Clinical Indicators ◽  
Health Technologies ◽  
Digital Interventions ◽  
Effective Interventions

Abstract Background The use of digital health technologies to tackle diabetes has been particularly flourishing in recent years. Previous studies have shown to varying degrees that these technologies can have an impact on diabetes prevention and management. Objective The aim of this review is to summarize the best evidence regarding the effectiveness of digital health interventions to improve one or more diabetes indicators. Methods We included all types of interventions aimed at evaluating the effect of digital health on diabetes. We considered at all types of digital interventions (mobile health, teleconsultations, tele-expertise, electronic health records, decision support systems, e-learning, etc.). We included systematic reviews published in English or French over the last 29 years, from January 1991 to December 2019, that met the inclusion criteria. Two reviewers independently reviewed the titles and abstracts of the studies to assess their eligibility, and extracted relevant information according to a predetermined grid. Any disagreement was resolved by discussion and consensus between the two reviewers, or involved a third author as referee. Results In total in our review of journals, we included 10 reviews. The outcomes of interest were clinical indicators of diabetes that could be influenced by digital interventions. These outcomes had to be objectively measurable indicators related to diabetes surveillance and management that are generally accepted by diabetes experts. Six of the ten reviews showed moderate to large significant reductions in glycated hemoglobin (HBA1c) levels compared to controls. Most reviews reported overall positive results and found that digital health interventions improved health care utilization, behaviours, attitudes, knowledge and skills. Conclusion Based on a large corpus of scientific evidence on digital health interventions, this overview could help identify the most effective interventions to improve diabetes indicators.

scholarly journals Coding Public Health Interventions for Health Technology Assessments: A Pilot Experience With WHO's International Classification of Health Interventions (ICHI)

2021 ◽  
Vol 9 ◽  
Author(s):  
Markus Wübbeler ◽  
Sebastian Geis ◽  
Jovana Stojanovic ◽  
Lise Elliott ◽  
Iñaki Gutierrez-Ibarluzea ◽  
...  
Keyword(s):  
Public Health ◽  
Health Technology ◽  
International Classification ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Technologies ◽  
Prevention Interventions

Introduction: An important requirement for successful public health interventions is a standardized classification in order to make these health technologies comparable in all contexts and recognized by all parties. The WHO International Classification of Health Interventions (ICHI), including an integrated public health component, has been developed to propose such an international standard.Methods: To test (a) the translation of public health interventions to ICHI codes and (b) the technical handling and general coding in public health, we used a set of public health interventions from a recent cross-sectional survey among Health Technology Assessment professionals.Results: Our study showed that handling of the ICHI interface is stable, that there is a need for specificity and adequate detail of intervention descriptions and desired outcomes to code adequately with ICHI and that the professional background of the coder, as well as his/her sex might influence the selection of codes.Conclusion: International Classification of Health Interventions provides a good coverage of public health interventions. However, the broader character of system wide interventions, often involving a variety of institutions and stakeholders, may present a challenge to the application of ICHI coding. Based on this experience, we would tailor future surveys more specifically to the needs of the classification and we advise training for health professionals before coding with ICHI. Standards of reporting will likely strengthen insights about the efficiency of primary prevention interventions and thus benefit long-term health of populations and structured HTA reporting process.

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2020 ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia Lucas ◽  
Alastair D Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

MO003ADHERENCE TO DIETARY GUIDELINES IN ADULTS UNDERGOING MAINTAINANCE HAEMODIALYSIS: THE DIET-HD STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Valeria Saglimbene ◽  
Guobin Su ◽  
Marinella Ruospo ◽  
Juan Jesus Carrero ◽  
Giovanni Strippoli
Keyword(s):  
Best Practice ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Cross Sectional ◽  
Best Practice Guidelines ◽  
Adherence To Diet ◽  
Nutritional Recommendations ◽  
Dietary Guideline ◽  
Sectional Analysis

Abstract Background and Aims While clinical guidelines emphasize dietary modifications as a cornerstone component in the management of patients undergoing dialysis, the adherence to these recommendations has been poorly quantified. The aim of this study is to evaluate the extent of adherence to diet guidelines for adults treated with long-term haemodialysis within the European patients included in the multinational cohort of the “DIETary intake, death and hospitalization in adult with ESKD treated with Haemodialysis” (DIET-HD) study. Method Cross-sectional analysis of the DIET-HD study in 6906 adults undergoing haemodialysis in 10 European countries. Patients responded to the Global Allergy and Asthma European Network (GA2LEN) Food Frequency Questionnaire, and dietary intakes were estimated to evaluate the adherence to the European Best Practice Guidelines nutritional recommendations. Results Patients showed low adherence to the daily recommended intake of phosphorous (&lt;1000mg, met by 25% of participants) and potassium (&lt;2730mg, met by 28% of participants). Almost half the participants achieved targets for energy (&gt;30 kcal/kg, 45% of participants) and calcium (&lt;800mg/day, 53% of participants) intake, while the recommended sodium (&lt;2300mg/day) and proteins intake (≥1.1g/kg) was achieved in 85% and 67% of participants, respectively. Adherence to renal guidelines varied across participating countries, but followed the same pattern. Only 1% of patients adhered to all six recommendations at the same time. Conclusion Adherence to dietary guideline recommendations is poor, particularly regarding phosphorus, potassium, calcium and energy intake.

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