Emma Tonkin

Trust in and through labelling – a systematic review and critique

Purpose – Distrust of conventional food supply systems impacts consumer food choice. This in turn has implications for consumer nutrition outcomes and acceptance of expert advice regarding food and health. The research exploring consumer trust is found across a broad range of research streams, and is not cohesive in topic or approach. The purpose of this paper is to synthesise the disparate literature exploring the interaction between food labelling and consumer trust to determine what is known, and gaps in knowledge regarding food labelling and consumer trust. Design/methodology/approach – A systematic search of trust and food labelling literature was conducted, with study results synthesised and integrated. Studies were then critically analysed for the conceptualisation of the consumer, the label, and their interaction with a framework developed using social theories of trust. Findings – In total, 27 studies were identified. It was found that not only is the current literature predominantly atheoretical...

Consumer trust in the Australian food system - The everyday erosive impact of food labelling.

Consumer trust in food system actors is foundational for ensuring consumer confidence in food safety. As food labelling is a direct communication between consumers and food system actors, it may influence consumer perceptions of actor trustworthiness. This study explores the judgements formed about the trustworthiness of the food system and its actors through labelling, and the expectations these judgements are based on. In-depth, semi-structured interviews with 24 Australian consumers were conducted. Theoretical sampling focussed on shopping location, dietary requirements, rurality, gender, age and educational background. The methodological approach used (adaptive theory) enabled emerging data to be examined through the lens of a set of guiding theoretical concepts, and theory reconsidered in light of emerging data. Food labelling acted as a surrogate for personal interaction with industry and government for participants. Judgements about the trustworthiness of these actors and the broader food system were formed through interaction with food labelling and were based on expectations of both competence and goodwill. Interaction with labelling primarily reduced trust in actors within the food system, undermining trust in the system as a whole. Labelling has a role as an access point to the food system. Access points are points of vulnerability for systems, where trust can be developed, reinforced or broken down. For the participants in this study, in general labelling demonstrates food system actors lack goodwill and violate their fiduciary responsibility. This paper provides crucial insights for industry and policy actors to use this access point to build, rather than undermine, trust in food systems.

Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Smartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings.

A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants

This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks’ gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother’s own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.

Development of a short-item diet quality questionnaire for Indigenous mothers and their young children: The Menzies remote short-item dietary assessment tool

Development of a short-item diet quality questionnaire for Indigenous mothers and their young children: The Menzies remote short-item dietary assessment tool Athira Rohit, PhD,* Julie Brimblecombe, GCertATSI Studies PhD,* Kerin O’Dea, PhD, Emma Tonkin, BNutrDiet(Hons) PhD, Ḻ€awurrpaMaypilama, HonDLitt, and LouiseMaple-Brown, MBBS FRACP PhD Menzies School of Health Research, Darwin, The University of Melbourne, Melbourne, Victoria, and Charles Darwin University, Darwin, Northern Territory, Australia

A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing

Background The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake. Objective This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs. Methods The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (“think aloud shop”), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing. Results Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group. Conclusions This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development.

Obtaining consumer perspectives using a citizens’ jury: does the current country of origin labelling in Australia allow for informed food choices?

BackgroundContemporary food systems are vast and complex, creating greater distance between consumers and their food. Consequently, consumers are required to put faith in a system of which they have limited knowledge or control. Country of origin labelling (CoOL) is one mechanism that theoretically enables consumer knowledge of provenance of food products. However, this labelling system has recently come under Australian Government review and recommendations for improvements have been proposed. Consumer engagement in this process has been limited. Therefore this study sought to obtain further consumer opinion on the issue of CoOL and to identify the extent to which Australian consumers agree with Australian Government recommendations for improvements.MethodsA citizens’ jury was conducted with a sample of 14 South Australian consumers to explore their perceptions on whether the CoOL system allows them to make informed food choices, as well as what changes (if any) need to be made to enable informed food choices (recommendations).ResultsOverall, jurors’ perception of usefulness of CoOL, including its ability to enable consumers to make informed food choices, fluctuated throughout the Citizens’ Jury. Initially, the majority of the jurors indicated that the labels allowed informed food choice, however by the end of the session the majority disagreed with this statement. Inconsistencies within jurors’ opinions were observed, particularly following delivery of information from expert witnesses and jury deliberation. Jurors provided recommendations for changes to be made to CoOL, which were similar to those provided in the Australian Government inquiry.ConclusionsConsumers in this study engaged with the topical issue of CoOL and provided their opinions. Overall, consumers do not think that the current CoOL system in Australia enables consumers to make informed choices. Recommendations for changes, including increasing the size of the label and the label’s font, and standardising its position, were made.

Estimating the Dietary Intake of Breastfeeding Preterm Infants

Aim: To determine how accurately the daily prescribed feed volume (mL/day) estimates the actual intake of breastfeeding preterm infants and to characterise the volume taken during a breastfeed at differing gestational and postmenstrual ages. Methods: A cross sectional study was conducted on preterm infants born <37 weeks gestation from two Australian neonatal units. To determine the volume taken in a 24-h period infants were weighed before and after each breastfeed. This volume was added to the charted intake to determine the total intake and then compared to the prescribed feed volume. Bland Altman analyses were used to assess the level of agreement between the two methods. Results: Fifty six infants were studied on 206 breastfeeding occasions. There was a small bias (27 mLs/day) but large 95% limits of agreement (–76 to 130 mL/day). The volume taken during a single breastfeed ranged from 0 to 101 mL (median 23 mL, IQR 9 to 31 mL) and was greater in more mature infants. Conclusions: Using the prescribed feed volume to estimate total intake has limited clinical utility for the individual infant, however the relatively small bias means that it may be useful within a population or for comparison between groups in which population means are compared. There was a large variation in volume taken during a breastfeed across all gestational and postmenstrual ages.

The Relative Validity of the Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) in Aboriginal Australian Children Aged 6–36 Months

The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6–36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.

Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review

Early Childhood Education and Care (ECEC) settings have a pivotal role in shaping children’s dietary food habits by providing the contextual environment within which they develop these behaviours. This study examines systematic reviews for (1) the effectiveness of interventions to promote healthy eating in children aged 2–5 years attending centre-based childcare; (2) intervention characteristics which are associated with promoting healthy eating and; (3) recommendations for child-health policies and practices. An Umbrella review of systematic reviews was undertaken using a standardized search strategy in ten databases. Twelve systematic reviews were examined using validated critical appraisal and data extraction tools. Children’s dietary food intake and food choices were significantly influenced. Interventions to prevent obesity did not significantly change children’s anthropometric measures or had mixed results. Evidence was more convincing if interventions were multi-component, addressed physical activity and diet, targeted individual-level and environmental-level determinants and engaged parents. Positive outcomes were mostly facilitated by researchers/external experts and these results were not replicated when implemented in centres by ECEC providers without this support. The translation of expert-led interventions into practice warrants further exploration of implementation drivers and barriers. Based on the evidence reviewed, recommendations are made to inform child-health directed practices and policies.