Melissa Fuster

A Systematic Review of Stakeholder Engagement in Comparative Effectiveness and Patient-Centered Outcomes Research

ABSTRACTOBJECTIVESWe conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research.METHODS AND RESULTSWe worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs.FINDINGSReports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports.RECOMMENDATIONSTo improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.

Local Notions of Healthy Eating and National Dietary Guidelines: A Comparison in Vulnerable Salvadoran Communities

This study presents an assessment of local definitions and perceptions concerning healthy eating through a study in four resource-poor border communities in El Salvador. The study included focus groups, key-informant interviews, and observations of the food environment. Local definitions of healthy eating elicited through focus groups were compared to the national Salvadoran dietary guidelines recommendations. The comparison revealed several areas of overlap (including the importance of dietary variety, fruits, and vegetables, among others) and omissions (mention of limiting sweets/candy, salt, sugar, and alcohol). Focus group participants expressed concerns over the origin of their foods and whether food contained harmful chemicals. These conversations also revealed the contradictions between nutrition knowledge and preferences for foods classified as unhealthy. This article concludes with a discussion about barriers to healthy eating identified in the focus groups and through the food environment assessment.

Household-level dietary quality indicator for countries in nutritional transition: application to vulnerable communities in El Salvador

OBJECTIVE To develop a household-level diet quality indicator (HDQI) using the Salvadorian dietary guidelines to assess the dietary quality of households in vulnerable communities in El Salvador. DESIGN The Salvadorian dietary guidelines were reviewed and eighteen HDQI components were identified (nine foods and nine nutrients). The components were evaluated using a proportional scoring system from 0 to 1, penalizing over- and under-consumption, where appropriate. The HDQI was validated in consultations with experts in El Salvador and by statistical analyses of the study sample data. Dietary variety and energy, nutrient and food intakes were compared among households above and below the median HDQI score using Students t test. SETTING Vulnerable, border communities in El Salvador. SUBJECTS Households (n 140) provided food consumption information using an FFQ and sociodemographic data. RESULTS The mean HDQI score was 63·5, ranging from 43·6 to 90·0. The indicator showed a positive, significant association with the dietary variety components. The statistical associations of the indicator with the energy and nutrient components were as expected. CONCLUSIONS Based on the indicators demonstrated face validity and the results of the expert consultations, the indicator is suggested as a good measure of diet quality for households in El Salvador.

Erratum to: Changing Places, Changing Plates? A Binational Comparison of Barriers and Facilitators to Healthful Eating Among Central American Communities

To understand the process by which immigrants adopt dietary practices, this study offers a binational comparison of factors that predispose, enable, and reinforce healthful eating in the sending and receiving countries. Data are from two qualitative studies that examined barriers and facilitators to healthful eating in El Salvador (four focus groups, n = 28 adults) and in the US (30 in-depth interviews n = 15 mothers recently migrated from Central America). There was a strong emphasis on hygiene and vitamin-content of foods among participants in El Salvador. In both settings, participants perceived that their respective community food environments (schools, food stores) exposed their families to highly processed, unhealthful foods. In both settings, they described similar struggles to encourage their families to eat foods healthfully (traditional, home-made foods). These results underscore the importance of acknowledging the changing food environment in sending countries where people may already be exposed to processed foods.

The weight of obesity: Hunger and global health in postwar Guatemala

1984–1986, albeit without the attention of the world’s media. McCann argues that the efforts at a ‘green revolution’ through hybrid maize cultivation have resulted in a new ecology that is an ideal breeding ground for Anopheles arabiensis. While some of the data to support this are presented in the chapter, especially in footnotes, it would have been valuable to have more of it included. There may have been an assumption that excluding it would make the chapter more accessible, but including the evidence would enable the reader to better evaluate the findings and their significance. Chapter 6, ‘She sings’, focuses on mosquito behaviour to highlight the quixotic nature of eradication efforts, notably DDT spraying, which has instead resulted in insecticide resistance. The epilogue, ‘The dance continues’, sets out McCann’s view that efforts to find an effective vaccine are just as hopeless. Instead, he argues, health workers need to move away from a global approach to focus on specific local ecologies. This is a short book with many illustrations and apparently written to appeal to a college-aged readership with colloquialisms and theatrical asides. McCann makes extensive use of metaphors – from the dance between mosquitos and humans in the introduction onwards. And he anthropomorphises the mosquito: she is a ‘clever girl’, for example (p. 147). There are also a number of places where material is repeated across, or even within, chapters, which makes it seem that McCann has less to say than he actually does. This book extends our knowledge of the history of malaria and its (and its host’s) ability to adapt to changing ecologies, emphasising the need for a local perspective in an era where the global is prioritised. It should be of interest to historians of Africa, medicine and global public health, and to public health practitioners.

“We like Fried Things”: Negotiating Health and Taste among Hispanic Caribbean Communities in New York City

ABSTRACT The study was conducted to understand fried-food (FF) consumption among Hispanic Caribbean (HC) communities in New York City. Data were collected through qualitative interviews with 23 adults self-identified as Cuban, Dominican, or Puerto Rican. Most informants considered FFs an important part of their traditional diet. Potential explanations included taste, cost, convenience, and the emotive values attached to FF. FF consumption was contextualized in local foodscapes. Results include strategies to diminish FF consumption and differences across HC groups and migratory generations. The relevance for future nutrition interventions addressing health disparities in this community is discussed

Writing Cuisine in the Spanish Caribbean: A Comparative Analysis of Iconic Puerto Rican and Cuban cookbooks

Abstract Puerto Rico and Cuba, linked by a common colonial history, culture, and tropical environments, have similar cuisines. The islands’ shared historical trajectories have been increasingly divergent in the last century, especially since the 1959 Cuban Revolution. This paper analyzes the concurrent social changes since the 1950s in these two contexts, through the work of two iconic cookbook writers, Carmen Valldejuli (Puerto Rico) and Nitza Villapol (Cuba). Writing and publishing during the second half of the twentieth century, these women’s books became an important part of the culinary imagination in their respective islands and diaspora communities. This article analyzes how their work reflects their personal stories and changing social contexts by comparing the earliest and latest editions of their books. Differences between Puerto Rican and Cuban cuisines, as portrayed in the cookbooks, are assessed and contextualized in their respective sociopolitical contexts. This analysis of the production and transmission of culinary traditions offers a novel insight on local and transnational manifestations of these islands’ sociopolitical transformations during these decades.

Eating right in America: The cultural politics of food and health

332 b o o k r e v ie w s are produced, where, by whom and under what conditions. The last article, by Arun Saldanha, is on the violence of the Dutch when developing the spice trade in Indonesia. The author adheres to the opinion of Georges Bataille, who saw the push to increase the spice trade as “soaked with ambiguous desires and outbursts of destructive and self-destructive animosity” (p. 313). The Dutch used biopolitical techniques, blocking the importation of staple foods and destroying crops to drive up prices. This form of mercantilism had racialized populations before colonialization; the underlying ideology was the superiority of religion, not that of whiteness. The diversity of the articles exploring the relationship between race and food, from production to consumption, in history and in the contemporary world makes the book unique and stimulating for readers interested in the fields of food and agriculture, as well as of developmental and gender studies. One may nevertheless regret that some articles, favoring a discursive approach, would have benefited from more extensive empirical content in order to highlight the racialization process. Moreover, the classification of the articles under three defined parts is not very pertinent and the impact on health of dispossession of land and food, marginalization of populations, migration or transformation of eco-systems has not sufficiently engaged contributors. The editors have covered a wide range of situations and, even though this diversity entails an important heterogeneity with regard to the gravity of conditions stemming from the racialization of food and land, certain fields have not been explored. Subjects such as internal migration due to seasonal work or displacement by development projects or armed conflicts—phenomena which are drastically increasing in developing countries—would be very relevant to grasping new forms of racialization which deny populations land and/or food, forcing them to change their diet with adverse consequences for their health.

Eating Puerto Rico: A History of Food, Culture and Identity: By Cruz Miguel Ortiz Cuadra

Ortiz Cuadra lays bare the historical construction of Puerto Rican cuisine in this remarkably researched, recently translated and revised version of the Spanish book, Puerto Rico en la olla: ¿Somos aún lo que comimos? (Ortiz Cuadra 2006). He addresses such questions as: why do we eat what we eat; why do we still eat it; what are the social and spatial coordinates of what we eat; and what changes and continuities do we observe in contemporary Puerto Rican cookery? (p. 13). Eating Puerto Rico in many ways explores the maxim, “tell me what you eat and I’ll tell you who you are.” This examination is particularly interesting in the case of the Caribbean, where diets (and perhaps national identities) are an amalgamation of indigenous Arawak people, colonial settlers, African slaves and other foreign laborers brought to these islands at different points in their histories (Houston 2005). Puerto Rico was a Spanish colony until 1898, when the island was ceded to the United States after the Spanish-American war. To this day, Puerto Rico remains a territory of the United States, and its people have been US citizens since 1917. The island’s relationship with the United States is a subject of continuous debate, and concordantly, the subject of Puerto Rican identity is discussed between and within Puerto Ricans in the island and those living in the United States. While Ortiz Cuadra does not directly address the question of the Puerto Rican political status, the situation is the backdrop of Eating Puerto Rico and adds further significance to issues of food and identity in this particular context. The book’s introduction provides the theoretical underpinnings of the work, alongside rationale for its organization. Ortiz Cuadra arranges the empirical information into chapters dedicated to specific food items “according to how frequently particular foods are eaten by the majority of people in Puerto Rico” (p. 10): rice, beans, cornmeal, codfish, viandas and meat. This arrangement provides the reader with a detailed and easily accessible reference for each of the foods discussed. Each food-related chapter presents a historical account of how the food arrived on the Puerto Rican table, including information on cooking methods and changes in preferences and trends concerning production, consumption and