Debbie MacLellan

Predictors of physical activity, healthy eating and being smoke-free in teens: a theory of planned behaviour approach.

This paper elicited context specific underlying beliefs for physical activity, fruit and vegetable consumption and smoke-free behaviour from the Theory of Planned Behaviour (TPB), and then determined whether the TPB explained significant variation in intentions and behaviour over a 1 month period in a sample of grade 7–9 (age 12–16 years) adolescents. Eighteen individual interviews and one focus group were used to elicit student beliefs. Analyses of this data produced behavioural, normative and control beliefs which were put into a TPB questionnaire completed by 183 students at time 1 and time 2. The Path analyses from the main study showed that the attitude/intention relationship was moderately large for fruit and vegetable consumption and small to moderate for being smoke free. Perceived behavioural control had a large effect on being smoke free and a moderately large effect for fruit and vegetable consumption and physical activity. Intention had a large direct effect on all three behaviours. Common (e.g. feel better, more energy) and behaviour-specific (e.g., prevent yellow fingers, control my weight) beliefs emerged across the three health behaviours. These novel findings, to the adolescent population, support the importance of specific attention being given to each of the behaviours in future multi-behavioural interventions.

Food Intake and Academic Performance Among Adolescents

Purpose: Prince Edward Island adolescents’ food use was examined, as were possible associations between food use and grade, sex, and academic performance. Methods: Participants (n=325) were purposively selected from four junior high schools. Dietary data were collected using an adaptation of the 2003 Youth Risk Behavior Survey. Demographic information and self-reported academic performance were also assessed. Vegetable and fruit (VF) and milk scores were created, and multivariate analysis was performed to identify which combination of grade, sex, VF score, and milk score predicted academic performance best. Results: Mean daily intakes of VF (4.3 ± 2.9 servings) and milk (1.7 ± 1.4 servings) were below recommended levels. Students with higher academic performance (average grades above 90%) were more likely to consume milk, vegetables, and fruit daily than were those who reported lower grades. There was no significant difference in the proportion of adequate milk intakes between students reporting higher an...Purpose: Prince Edward Island adolescents’ food use was examined, as were possible associations between food use and grade, sex, and academic performance. Methods: Participants (n=325) were purposively selected from four junior high schools. Dietary data were collected using an adaptation of the 2003 Youth Risk Behavior Survey. Demographic information and self-reported academic performance were also assessed. Vegetable and fruit (VF) and milk scores were created, and multivariate analysis was performed to identify which combination of grade, sex, VF score, and milk score predicted academic performance best. Results: Mean daily intakes of VF (4.3 ± 2.9 servings) and milk (1.7 ± 1.4 servings) were below recommended levels. Students with higher academic performance (average grades above 90%) were more likely to consume milk, vegetables, and fruit daily than were those who reported lower grades. There was no significant difference in the proportion of adequate milk intakes between students reporting higher an...

Fruit and vegetable consumption: benefits and barriers.

Few people on Prince Edward Island meet the goal of consuming five or more servings of vegetables and fruit a day. The main objective of this qualitative study was to explore the perceptions of the nutritional benefits and barriers to vegetable and fruit intake among adult women in Prince Edward Island. Participants were 40 women aged 20-49, with or without children at home, who were or were not currently meeting the objective of eating five or more fruit and vegetable servings a day. In-home, one-on-one interviews were used for data collection. Thematic analysis was conducted on the transcribed interviews. Data were examined for trustworthiness in the context of credibility, transferability, and dependability. Most participants identified one or more benefits of eating fruit and vegetables; however, comments tended to be non-specific. The main barriers that participants identified were effort, lack of knowledge, sociopsychological and socioenvironmental factors, and availability. Internal influences, lif...

Developing school nutrition policies: enabling and barrier factors.

PURPOSE The study was conducted to identify the enabling and barrier factors in the development of nutrition policies in Prince Edward Island elementary and consolidated schools. METHODS A document review and in-depth interviews were conducted with key stakeholders (n=12). RESULTS Principals were identified as important champions for change. Working group members created an interface between the school world and the nutrition world, and drew upon common philosophical ground to work together to lead the change process. Successfully navigating the process of policy development required building a case for change, testing policies in the real world, integrating healthy eating within school life, offering support to schools, engaging participants, and acknowledging the need to weigh the costs and benefits of the change. At times, external pressures on schools and available foods varied in the extent to which they enabled or challenged policy development. Finally, resource limitations, competing issues, and the use of unhealthy food as rewards were identified as the primary barriers. CONCLUSIONS The use of a consultative approach that engages key stakeholders early in the process is critical to the successful development of school nutrition policies. This approach also may be an important predictor of the long-term success of such initiatives.

Implementing school nutrition policy: student and parent perspectives.

Purpose: We explored parent and student perceptions of barriers and facilitating factors influencing the implementation of school nutrition policies (SNPs). Specifically, we focused on the changes made to the school food environment and the acceptance of those changes. Methods: This paper is a report on the first phase of the qualitative component of a larger five-year evaluation of nutrition policies in Prince Edward Island elementary schools (grades 1 to 6) and consolidated schools (grades 1 to 8). Focus groups were conducted with 41 students from four schools, and indepth interviews were conducted with 12 parents. Interviews were transcribed and coded; analysis was informed by interpretive description. Results: Four themes were identified as barriers to effective implementation: inadequate communication with parents and students about the policy and menu changes, limited school resources and volunteers, role/responsibility conflict concerning the feeding of children, and student food preferences. The m...Purpose: We explored parent and student perceptions of barriers and facilitating factors influencing the implementation of school nutrition policies (SNPs). Specifically, we focused on the changes made to the school food environment and the acceptance of those changes. Methods: This paper is a report on the first phase of the qualitative component of a larger five-year evaluation of nutrition policies in Prince Edward Island elementary schools (grades 1 to 6) and consolidated schools (grades 1 to 8). Focus groups were conducted with 41 students from four schools, and indepth interviews were conducted with 12 parents. Interviews were transcribed and coded; analysis was informed by interpretive description. Results: Four themes were identified as barriers to effective implementation: inadequate communication with parents and students about the policy and menu changes, limited school resources and volunteers, role/responsibility conflict concerning the feeding of children, and student food preferences. The m...PURPOSE We explored parent and student perceptions of barriers and facilitating factors influencing the implementation of school nutrition policies (SNPs). Specifically, we focused on the changes made to the school food environment and the acceptance of those changes. METHODS This paper is a report on the first phase of the qualitative component of a larger five-year evaluation of nutrition policies in Prince Edward Island elementary schools (grades 1 to 6) and consolidated schools (grades 1 to 8). Focus groups were conducted with 41 students from four schools, and in-depth interviews were conducted with 12 parents. Interviews were transcribed and coded; analysis was informed by interpretive description. RESULTS Four themes were identified as barriers to effective implementation: inadequate communication with parents and students about the policy and menu changes, limited school resources and volunteers, role/responsibility conflict concerning the feeding of children, and student food preferences. The main facilitating factor was parental and student support for healthy eating at school. CONCLUSIONS Study results add to the limited body of knowledge about stakeholder perceptions during early implementation of Canadian SNPs. Dietitians can foster communication, engagement, and education of stakeholders, which will increase the likelihood that students and their families will accept SNPs.

Dietitians' opinions and experiences of client-centred nutrition counselling.

Purpose: The concept of “client-centredness” was explored within a nutrition counselling relationship. Methods: A two-round reactive Delphi survey was used. The first survey was sent to 65 Dietitians of Canada members who indicated in the member database that they had advanced counselling skills. Following analysis of the data, the secondround questionnaire was developed and sent to participants with a report of the first-round results. Analysis of the secondround survey indicated that participants’ responses had remained stable, and the Delphi survey was terminated. Results: Participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice; however, when participants were asked about their experience in these areas, median responses and/ or the interquartile ranges changed, indicating some difficulty in implementing the client-centred approach. Comments also indicated that the reality of their workplaces did not allow participan...Purpose: The concept of “client-centredness” was explored within a nutrition counselling relationship. Methods: A two-round reactive Delphi survey was used. The first survey was sent to 65 Dietitians of Canada members who indicated in the member database that they had advanced counselling skills. Following analysis of the data, the secondround questionnaire was developed and sent to participants with a report of the first-round results. Analysis of the secondround survey indicated that participants’ responses had remained stable, and the Delphi survey was terminated. Results: Participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice; however, when participants were asked about their experience in these areas, median responses and/ or the interquartile ranges changed, indicating some difficulty in implementing the client-centred approach. Comments also indicated that the reality of their workplaces did not allow participan...

Nutritional quality of children's school lunches: differences according to food source

OBJECTIVE To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school). DESIGN Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed. SETTING Elementary schools in Prince Edward Island, Canada. SUBJECTS Grade 5 and 6 students (n 1980). RESULTS Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school. CONCLUSIONS The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

The influence of student-level normative, control and behavioral beliefs on staying smoke-free: An application of Ajzen's theory of planned behavior

This study, the first to examine the utility of the Theory of Planned Behavior (TPB) in explaining intentions and behavior to remain smoke-free, generated smoke-free related beliefs in adolescents and examined their association to the TPB global constructs (i.e., attitudes, subjective norm, perceived behavioral control (PBC), intention, and behavior) 1 month later in a population of intermediate students (N = 214) in Prince Edward Island, Canada. The results showed that intentions to remain smoke-free were significantly predicted by attitudes and PBC, whereas smoke-free behavior was determined by PBC. From a global TPB perspective, PBC appears to be the dominant variable within the TPB framework on which to guide a smoke-free adolescent intervention. These results have the potential to inform new interventions that address remaining smoke-free that are relevant to adolescents. However, the preliminary nature of these findings warrant further study before any firm conclusions can be drawn.

Dietetic students' understanding of what becoming a dietitian means.

Purpose: We explored dietetic students’ beliefs about what becoming a dietitian means. Methods: A phenomenological approach to inquiry was used. Thirteen undergraduate students enrolled in a dietetics program were interviewed, and data were analyzed thematically. Results: The overarching theme was students’ expectations of what being a dietitian means and how those expectations change throughout their education. Exposure to a variety of dietitians in practice helped shape participants’ understanding of being a dietitian. Conclusions: For dietetic students to develop a strong identity as dietitians and to strengthen the profession, they must be exposed to practising professionals early and often.Purpose: We explored dietetic students’ beliefs about what becoming a dietitian means. Methods: A phenomenological approach to inquiry was used. Thirteen undergraduate students enrolled in a dietetics program were interviewed, and data were analyzed thematically. Results: The overarching theme was students’ expectations of what being a dietitian means and how those expectations change throughout their education. Exposure to a variety of dietitians in practice helped shape participants’ understanding of being a dietitian. Conclusions: For dietetic students to develop a strong identity as dietitians and to strengthen the profession, they must be exposed to practising professionals early and often.

What Do Adults in Prince Edward Island: Know About Nutrition?

Purpose: To assess adults’ knowledge of dietary recommendations, food sources of key nutrients, food choices, and diet-disease relationships. Methods: A previously validated survey, designed to assess nutrition knowledge, was adapted for use in Prince Edward Island and mailed to a random sample of 3,500 adults (aged 18 to 74). Dillmans Total Design Method was followed and a response rate of 26.4% achieved. Mean scores and 95% confidence intervals (CIs) were calculated for the overall survey and for each section. Demographic variations were assessed by univariate analysis. Results: Of an overall possible score of 110 points, the mean score with 95% CI was 71.0 (70.1, 71.9). Respondents scored higher on the sections on dietary recommendations, food sources, and food choices than diet-disease relationships. Demographic differences existed in gender, age, education, and income. Findings suggest that adults have good general knowledge of dietary recommendations, but lack knowledge about how to make healthier ...Purpose: To assess adults’ knowledge of dietary recommendations, food sources of key nutrients, food choices, and diet-disease relationships. Methods: A previously validated survey, designed to assess nutrition knowledge, was adapted for use in Prince Edward Island and mailed to a random sample of 3,500 adults (aged 18 to 74). Dillmans Total Design Method was followed and a response rate of 26.4% achieved. Mean scores and 95% confidence intervals (CIs) were calculated for the overall survey and for each section. Demographic variations were assessed by univariate analysis. Results: Of an overall possible score of 110 points, the mean score with 95% CI was 71.0 (70.1, 71.9). Respondents scored higher on the sections on dietary recommendations, food sources, and food choices than diet-disease relationships. Demographic differences existed in gender, age, education, and income. Findings suggest that adults have good general knowledge of dietary recommendations, but lack knowledge about how to make healthier ...