Loretta McKinnon

The contribution of three components of nutrition knowledge to socio-economic differences in food purchasing choices.

OBJECTIVES To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. DESIGN The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. SETTING Brisbane, Australia in 2000. SUBJECTS Main household food shoppers (n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts). RESULTS Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. CONCLUSIONS Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

Cost-effectiveness analyses and modelling the lifetime costs and benefits of health-behaviour interventions

Background: We describe an approach to estimating the cost-effectiveness of an intervention that changes health behaviour. The method captures the lifetime costs and benefits incurred by participants in an ongoing cluster-randomized controlled trial of an intervention that aims to change health behaviour. The existing literature only captures short-term economic and health outcomes. Methods: We develop a state-transition Markov model of how individuals move between different health behaviour states over time. We simulate hypothetical data to describe the costs and health benefits of the intervention, illustrate how the data collected in the ongoing randomized controlled trial can be used and demonstrate how incremental cost-effectiveness ratios are estimated. Results: On the basis of the simulated (i.e. hypothetical) data, we estimate the cost per quality-adjusted life year. The estimate reflects the lifetime health and economic consequences of the intervention. Discussion: The method used for the cost-effectiveness analysis described in this paper is appropriate for investigating whether interventions that change health behaviour in relation to chronic diseases represent good value for money as compared to alternative uses of scarce healthcare resources.

What women want: qualitative analysis of consumer evaluations of maternity care in Queensland, Australia

BackgroundMaternity care reform plans have been proposed at state and national levels in Australia, but the extent to which these respond to maternity care consumers’ expressed needs is unclear. This study examines open-text survey comments to identify women’ss unmet needs and priorities for maternity care. It is then considered whether these needs and priorities are addressed in current reform plans.MethodsWomen who had a live single or multiple birth in Queensland, Australia, in 2010 (n 3,635) were invited to complete a retrospective self-report survey. In addition to questions about clinical and interpersonal maternity care experiences from pregnancy to postpartum, women were asked an open-ended question “Is there anything else you’d like to tell us about having your baby?” This paper describes a detailed thematic analysis of open-ended responses from a random selection of 150 women (10% of 1,510 who responded to the question).ResultsFour broad themes emerged relevant to improving women’s experiences of maternity care: quality of care (interpersonal and technical); access to choices and involvement in decision-making; unmet information needs; and dissatisfaction with the care environment. Some of these topics are reflected in current reform goals, while others provide evidence of the need for further reforms.ConclusionsThe findings reinforce the importance of some existing maternity reform objectives, and describe how these might best be met. Findings affirm the importance of information provision to enable informed choices; a goal of Queensland and national reform agendas. Improvement opportunities not currently specified in reform agendas were also identified, including the quality of interpersonal relationships between women and staff, particular unmet information needs (e.g., breastfeeding), and concerns regarding the care environment (e.g., crowding and long waiting times).

Household size: an overlooked confounder when considering inequalities in food choice.

Recent investigations have explored whether psychosocial factors relevant to food choices (e.g. nutrition knowledge, cost concerns) are socioeconomically patterned and whether they mediate dietary inequalities. Consequently, multiple factors have been identified as promising targets for health promotion. However, it is noteworthy that few confounding variables are typically acknowledged in this field of research. Age and gender are generally considered, however household characteristics, such as household size and composition are rarely addressed. Acknowledgement of these factors could be achieved by providing descriptive information on household characteristics, and may not involve more complex solutions such as modelling household variables or computing household-equivalised socioeconomic measures.