G.J. Hiddink

Nutrition-related information-seeking behaviours before and throughout the course of pregnancy: consequences for nutrition communication

Background:Research has shown that especially pregnant women, and also women with a wish for a child, have increased nutrition awareness. Seeking nutrition information seemed to be an important determinant for nutrition awareness. However, little research has been carried out about nutrition-related information-seeking behaviours before and during pregnancy.Objective:This study aimed to explore nutrition-related information sources, nutrition information-seeking behaviours and motives for seeking nutrition information before and throughout the course of pregnancy.Design:Data were collected by means of retrospective in-depth face-to-face interviews of 1 h with five groups of 12 women: women with a child wish, women in their first, second and third trimester of the first pregnancy and women in their first trimester of the second pregnancy. Women were mainly selected via midwifery practices. The interviews took place at conference rooms or at the respondents home. Qualitative data were analysed with the software program NUD*IST (QSR, Melbourne). This was based on the research objectives and relevant text segments of transcripts.Results:Women with a child wish generally sought little nutrition information because they were not pregnant yet. Information sources were the Internet (anonymous) and the social environment (models). In relation to the manifestation of nutrition-related information-seeking behaviours during first-time pregnancies, three groups of women could be distinguished: (1) women who feel like a mother from the moment they know that they are pregnant, (2) women who feel like a mother later in pregnancy and (3) women who do not feel like a mother yet. Each group had its own specific information-seeking behaviour. Important information sources of the first group were the Internet (anonymous and up to date), books (extended) and midwives (expert) during the first trimester; the 9-month calendar (fun and tips), friends (experienced) in the second trimester; and friends (information on breastfeeding) in the third trimester. Information sources of the second group of women were mainly brochures provided by the midwife and the midwife herself. The third group of women mainly relied on their own common sense. Second-time pregnant women mainly relied on their experience, the midwife and books for specific questions.Conclusions:Pregnant women perceive pregnancy-specific nutrition information as important because it is one of the few things that they can apply in their daily lives to protect the health of the fetus. Nutrition-related information-seeking behaviours mainly were pregnancy specific in character, rather than directed to general nutrition information.Sponsorship:Dutch Dairy Association, Zoetermeer, the Netherlands.

Understanding nutrition communication between health professionals and consumers: development of a model for nutrition awareness based on qualitative consumer research

BACKGROUND Consumers have been exposed to nutrition information from a variety of sources, including the family doctor. They are often not aware of their own risk behavior regarding nutrition. OBJECTIVE This study sought to assess food associations, conversation topics, interest in food topics, and use of information sources by means of qualitative consumer research. Another aim was to provide a hypothetical model for nutrition awareness that could be tested in a quantitative survey. DESIGN Three focus groups with 30 Dutch consumers altogether were carried out. Qualitative data were analyzed with the computer software program NUD*IST (QSR, Melbourne) by sorting text blocks into categories, and new themes emerged. In addition, a hypothetical model for nutrition awareness was developed. RESULTS Consumers associated food most often with safe food, and food safety was the topic most often discussed. Tasty food was the most important food conversation topic. The family doctor was the information source most talked about. Furthermore, consumers possibly lacked some nutrition awareness. CONCLUSIONS Careful analysis revealed new themes (new in the past 10 y), such as concerns about food safety and reconsideration of the roles of family doctors and dietitians. Based on these themes, recommendations for nutrition communication were composed.

Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons.

OBJECTIVES This study determined the effect of enriched foods and all-around physical exercise on bone and body composition in frail elderly persons. METHODS A 17-week randomized, controlled intervention trial, following a 2 x 2 factorial design--(1) enriched foods, (2) exercise, (3) both, or (4) neither--was performed in 143 frail elderly persons (aged 78.6 +/- 5.6 years). Foods were enriched with multiple micronutrients; exercises focused on skill training, including strength, endurance, coordination, and flexibility. Main outcome parameters were bone and body composition. RESULTS Exercise preserved lean mass (mean difference between exercisers and non-exercisers: 0.5 kg +/- 1.2 kg; P < .02). Groups receiving enriched food had slightly increased bone mineral density (+0.4%), bone mass (+0.6%), and bone calcium (+0.6%) compared with groups receiving non-enriched foods, in whom small decreases of 0.1%, 0.2%, and 0.4%, respectively, were found. These groups differed in bone mineral density (0.006 +/- 0.020 g/cm2; P = .08), total bone mass (19 +/- g; P = .04), and bone calcium (8 +/- 21 g; P = .03). CONCLUSIONS Foods containing a physiologic dose of micronutrients slightly increased bone density, mass, and calcium, whereas moderately intense exercise preserved lean body mass in frail elderly persons.

Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study

Objective: For more effective nutrition communication, it is crucial to identify sources from which consumers seek information. Our purpose was to assess perceived relevance and information needs regarding food topics, and preferred information sources by means of quantitative consumer research.Design: Based on qualitative studies, a quantitative questionnaire was developed and administered in face-to-face interviews.Subjects: The study population consisted of Dutch adults aged 18–80 y. A stratified sample of 923 adults was taken from the GfK ScriptPanel; 603 respondents completed the questionnaire.Results: Despite high perceived relevance of food topics regarding dietary guidelines (55–78%), most respondents indicated that they did not want more information about these topics (71–74%). Furthermore, our study revealed information needs regarding safety- and health-related food topics (up to 77% in some subgroups). Differences in perceived relevance and information needs were found in subgroups based on gender, age, perceived weight and socioeconomic status. Education offices of the food sector and the family doctor were mentioned for most food topics, who ranked among the highest regarding perceived reliability, perceived expertise, clearness and accessibility.Conclusions: With respect to five food topics (losing weight, sports and nutrition, lowering cholesterol, carbohydrates and food composition), interested subgroups should receive tailored information. For other groups and food topics, a population-wide strategy should suffice, utilising the preferred information source. If people who are not yet interested become interested through a life event, information on demand can be put into action.Sponsorship: Dutch Dairy Association.

Driving Forces for and Barriers to Nutrition Guidance Practices of Dutch Primary Care Physicians

Abstract Determinants of the nutrition guidance practices of primary care physicians (PCPs) were studied using a mail questionnaire developed on the basis of focus group discussions, in-depth interviews, and literature review. The questionnaire was sent to a nationwide random sample of 1000 PCPs (in practice for between 5 and 15 years).The net response rate was 64%. Multiple regression analysis was used to identify determinants of nutrition guidance practices. The independent variables studied were the perceived barriers to nutrition guidance practices, characteristics of the respondents, and nutrition attitudes and beliefs of PCPs. As determinants of nutrition guidance practices, we identified both perceived barriers (which exert a negative influence) and driving forces (which exert a positive influence).The driving forces observed in PCPs were an active interest in the effect of nutrition on health and disease, a basic level of nutrition knowledge, and positive attitudes towards nutrition guidance practices. Although perceived barriers can be strong, negative determinants of being involved in nutrition guidance practices, in future, it may become more important to stress the driving forces that positively determine the involvement of PCPs in nutrition guidance practices.

Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities

During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed, rearranged into topics, and summarized here. There are situations that call for nutrition advice to be given by general practitioners (GPs). GPs are trusted, they are not selling any particular food, and patients accept that their GPs may talk to them about diet. Compared with dietitians, GPs have much less time to advise about diet, so they must condense information. It is easier for a GP to give dietary advice if the patient is registered on the practices list and if the GP can be paid for preventive work. Six topics seemed to be particularly new and challenging in our changing world: (1) Use of dietary supplements, herbal preparations, and functional foods; (2) patients as partners; (3) computers in practices; (4) evidence-based medicine; (5) the Internet; and (6) the obesity epidemic. These topics were reported as problems and then discussed as opportunities. The aim of the Heelsum Collaboration on General Practice Nutrition was to facilitate the nutrition work of GPs in their practices by researching the problems and barriers and by testing solutions. In line with this aim, some suggestions for research are provided.

Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective

OBJECTIVES To examine whether preconception and pregnancy could be an occasion triggering womens interest, search and need for both general and pregnancy-specific nutrition-related information, in order to: (i) provide a greater understanding of the life course perspective (in this case on nutrition behaviours and pregnancy) and (ii) to contribute to the rationale of nutrition interventions aimed at women of child-bearing age. METHODS Data were collected in a cross-sectional study with the aid of a face-to-face interview. The sample consisted of four groups each of about 100 Dutch nulliparous women each: women trying to conceive and women in the first, second or third trimester of their first pregnancy. RESULTS Pregnant women were more interested in nutrition information than before preconception and before pregnancy, especially the first-trimester group. The frequency of search for nutrition information differed significantly between the groups: the first-trimester group searched for information most frequently. Women wanting to conceive and women in their third trimester of pregnancy found significantly more pregnancy-specific information topics than women in their first and second trimester of pregnancy. Women wanting to conceive had significantly higher needs for general and specific nutrition-related topics compared to pregnant women. Overall, the Internet, the midwife and books were the favourite information sources. CONCLUSIONS The study provided indications that preconception and pregnancy are moments in life that lead to an increased interest, need and search for particularly pregnancy-specific nutrition-related information. This should be borne in mind when healthy nutrition promotion activities are being developed.

The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

BACKGROUND Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem. OBJECTIVE To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype. METHODS Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight. RESULTS The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements. CONCLUSION The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.

Exploration of possible correlates of nutrition awareness and the relationship with nutrition-related behaviours: results of a consumer study

OBJECTIVES To unravel the concept of nutrition awareness, as it relates to risky personal nutrition-related behaviours, and to assess the sociodemographic and psychosocial correlates of nutrition awareness. DESIGN Data were collected in a cross-sectional study with the aid of a face-to-face interview-assisted questionnaire that was based on the Precaution Adoption Process Model and Stages of Change Model. SETTING Dutch consumer homes. SUBJECTS Six hundred and three Dutch adults aged 18 to 80 years, selected from a panel. RESULTS Our model explains nutrition awareness well (explained variance 53.7%). Psychosocial correlates were involvement with nutrition, health awareness, association with healthy food, perceived relevance of eating less fat, association with necessity, perceived relevance of vitamins, and perceived attributes of independent organisations. Sociodemographic correlates were gender and age. The relationship between nutrition awareness and nutrition-related behaviours proved to be very complicated. CONCLUSIONS The value of our study is that it unravels the concept of nutrition awareness. Understanding the correlates of nutrition awareness can contribute to a more effective application of behavioural change models. Our results support increasing involvement with nutrition through personalising and tailoring to the motivational stage.

Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations.

Background/Objective:To examine the content of Dutch practice nurses’ (PNs’) advices about weight, nutrition and physical activity to overweight and obese patients.Subjects/Methods:A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices.Results:About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices.Conclusions:Weight advices often related to the patient’s complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs’ educational programs.