Dexter Harvey

Conceptualizing Dissemination Research and Activity: The Case of the Canadian Heart Health Initiative

Cardiovascular diseases are now the worlds leading cause of death. To reduce high rates of such preventable premature deaths, evidence-based approaches to heart health promotion must be disseminated across public health systems. To succeed, we must build capacity to disseminate strategies that are practical and effective. However, we know little about such dissemination, and we lack both conceptual frameworks to guide our thinking and appropriate scientific methodologies. This article presents conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems. This work is based on the Canadian Heart Health Dissemination Project, a research program examining a national heart health dissemination initiative. The primary focus is the development of a systematic protocol for measuring levels of capacity and dissemination, and determining successful conditions for, and barriers to, capacity and dissemination, as well as the nature of the relationship between these key concepts.

Stress and Anxiety in Women With Gestational Diabetes During Dietary Management

Purpose To explore the stress and anxiety experiences during dietary management in women with gestational diabetes (GDM). Methods Thirty women with GDM from the Winnipeg area participated in the mixed methods study. Each participant completed a Food Choice Map semistructured interview, a Perceived Stress Scale, a Pregnancy Anxiety Scale, a State-Trait Anxiety Inventory–Trait questionnaire, and a demographic questionnaire. Stress and anxiety experiences were identified from interview transcripts and categorized into themes based on the constant comparative method. Questionnaire scores aided in interpreting the stress and anxiety experience in the qualitative data. Results Three major themes were generated from the interviews: (1) stress related to GDM diagnosis and the perception of a high risk pregnancy; (2) stress over losing control of GDM during the process of dietary management; and (3) anxiety related to the fear of maternal and infant complications. Women on insulin experienced significantly higher levels of perceived stress (P < .01), and the dietary management stress was more prevalent in women using insulin compared to the ones on diet treatment only (Fisher exact test, P < .01). Unhealthy diet coping strategies occurred with the stress and anxiety. Conclusions Stress and anxiety were associated with different contexts in this study sample. Women who were on insulin experienced significantly higher levels of perceived stress related to dietary management.

Food Choice Decision-Making by Women with Gestational Diabetes

OBJECTIVE To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional. METHODS Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries. RESULTS Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin. CONCLUSIONS Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control.

Barriers and coping strategies of women with gestational diabetes to follow dietary advice.

OBJECTIVE To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice. DESIGN Qualitative study. PARTICIPANTS Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire. MAJOR OUTCOME MEASURES Underlying beliefs of women with GDM and factors that hinder following dietary advice. ANALYSIS Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction. RESULTS GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan. CONCLUSIONS AND IMPLICATIONS Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.

Canadian Heart Health Initiative: Research Review

The Canadian Heart health Initiative (CHHI) was designed to address the cardiovascular disease epidemic in Canada. The Initiative, a Federal-Provincial partnership, encompasses policy, research, and collaboration within and across sectors at the national, provincial, and local levels in the delivery of community-based heart health promotion activities [1,2].