Roger Hughes

Psychosocial factors associated with the abandonment of breastfeeding prior to hospital discharge.

A prospective study of 556 women from Perth, Western Australia, and 503 women from the Darling Downs area, Queensland, Australia, was conducted to identify factors associated with the abandonment of breastfeeding prior to hospital discharge. In total, 88% ofwomen initiated breastfeeding, but 5% discontinued breastfeeding while still in the hospital. Discontinuation of breastfeeding prior to discharge was associated with a number of psychosocial factors, namely, infant feeding method being chosen after becoming pregnant, a perception by the mother that the infant%’s father either preferred formula feeding or was ambivalent about how the infant was fed, and whether the mothers own mother had ever breastfed. Judicious questioning prenatally regarding a womans commitment to, social support for, and prior exposure to breastfeeding will help identify thosewomen most at risk of abandoning breastfeeding prematurely. Such women should be targeted for additional support while in the hospital.

Public Health Nutrition for this decade

You will notice from the contents list beginning with this issue that we have made some adjustments to our journal. These follow from a discussion at a meeting of our editorial board together with representatives of the Nutrition Society and Cambridge University Press, held on the occasion of the International Conference on Nutrition in Bangkok last October. The field of public health nutrition, as learned, taught and practised, is relatively new and rapidly evolving. Its issues are broad, complex and multidisciplinary. In a dynamic environment, our journal needs to ensure that it has optimal relevance to our topic and for you, our readers. Accordingly, we have now adjusted the aims and scope of the journal, and introduced related categories for papers, to give the journal an internal structure and to guide editors, reviewers, contributors and readers.

Competencies for effective public health nutrition practice: a developing consensus.

OBJECTIVES To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice. DESIGN A modified Delphi study involving three rounds of questionnaires. SUBJECTS A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia. RESULTS Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. CONCLUSIONS There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.

A capacity-building conceptual framework for public health nutrition practice

OBJECTIVES To describe a conceptual framework to assist in the application of capacity-building principles to public health nutrition practice. DESIGN A review of the literature and consideration of the determinants of effective public health nutrition practice has been used to inform the development of a conceptual framework for capacity building in the context of public health nutrition practice. RESULT The limited literature supports a greater integration and application of capacity-building strategies and principles in public health nutrition practice, and that this application should be overt and strategic. A framework is proposed that identifies a number of determinants of capacity for effective public health nutrition action. The framework represents the key foundations for building capacity including leadership, resourcing and intelligence. Five key strategic domains supported by these foundation elements, including partnerships, organisational development, project management quality, workforce development and community development, are proposed. This framework can be used to assist the systematic assessment, development and evaluation of capacity-building activity within public health nutrition practice. CONCLUSIONS Capacity building is a strategy within public health nutrition practice that needs to be central to public health nutrition intervention management. The present paper defines, contextualises and outlines a framework for integrating and making explicit the importance of capacity building within public health nutrition practice at many levels.

Nutrition in General Practice: Role and Workforce Preparation Expectations of Medical Educators

Nutrition advice from general practitioners (GPs) is held in high regard by the general public, yet the literature investigating the role of GPs in the provision of nutrition care is limited. This qualitative study aimed to explore the perceptions of general practice medical educators (GPMEs) regarding the role of GPs in general practice nutrition care, the competencies required by GPs to provide effective nutrition care and the learning and teaching strategies best suited to develop these competencies. Twenty medical educators from fourteen Australian and New Zealand universities participated in an individual semi-structured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and thematically analysed. Medical educators identified that nutrition was an important but mostly superficially addressed component of health care in general practice. Numerous barriers to providing nutrition care in general practice were identified. These include a lack of time and associated financial disincentives, perceptions of inadequate skills in nutrition counselling associated with inadequate training, ambiguous attitudes and differing perceptions about the role of GPs in the provision of nutrition care. Further research is required to identify strategies to improve nutrition care and referral practices provided in the general practice setting, in order to utilise the prime position of GPs as gatekeepers of integrated care to the general public.

Public health nutrition workforce composition, core functions, competencies and capacity: perspectives of advanced-level practitioners in Australia.

OBJECTIVES To investigate the attitudes, experiences and beliefs of advanced-level public health nutritionists with respect to public health nutrition workforce composition, core functions, competency requirements and existing workforce capacity. DESIGN Qualitative study using structured interviews. SETTING Australia. SUBJECTS Forty-one advanced-level public health nutritionists employed in academic and senior technocratic positions in state health systems. RESULTS Advanced-level public health nutritionists recognise the diversity of the public health nutrition workforce but clearly identify the need for a specialist public health nutrition workforce tier to provide workforce leadership. Nominated core functions for public health nutrition reflect broader public health core functions but, in the context of nutrition, specific problem resolution. Opinions about competency needs were similar to many of the cross-cutting competencies identified in the public health field but with specific application to nutrition problems. Competency in the scientific underpinning of nutrition was considered particularly important and delineated this public health nutrition workforce from the broader public health workforce. Public health nutrition was identified as a specialisation within public health and dietetics. Workforce capacity assessments by this group indicate a need for workforce development. CONCLUSIONS Qualitative data from a large proportion of the Australian public health nutrition leadership group have identified core functions, competencies and workforce development priorities that can be a basis for further systematic research and workforce strategy development.

Phenotypical Characterisation of the Isolated Norfolk Island Population Focusing on Epidemiological Indicators of Cardiovascular Disease

Objectives: Only 193 people from Pitcairn Island, all descended from 9 ‘Bounty’ mutineers and 12 Tahitian women, moved to the uninhabited Norfolk Island in 1856. Our objective was to assess the population of Norfolk Island, several thousand km off the eastern coast of Australia, as a genetic isolate of potential use for cardiovascular disease (CVD) gene mapping. Methods: A total of 602 participants, approximately two thirds of the island’s present adult population, were characterized for a panel of CVD risk factors. Statistical power and heritability were calculated. Results: Norfolk Islander’s possess an increased prevalence of hypertension, obesity and multiple CVD risk factors when compared to outbred Caucasian populations. 64% of the study participants were descendents of the island’s original founder population. Triglycerides, cholesterol, and blood pressures all had heritabilities above 0.2. Conclusions: The Norfolk Island population is a potentially useful genetic isolate for gene mapping studies aimed at identifying CVD risk factor quantitative trait loci (QTL).

Definitions for public health nutrition: a developing consensus.

OBJECTIVES To assess the level of agreement amongst a panel of public health nutrition leaders regarding the key descriptors used to define the field of public health nutrition. DESIGN Cross-sectional survey requiring quantitative and qualitative responses representing the first round of a consensus development Delphi technique. SETTING International. SUBJECTS Expert panel of 24 public health nutrition leaders from nine countries in the European Union, the USA and Australia. RESULTS All but one of the panel agreed it was important to have a consensus definition for public health nutrition to describe the field consistently. Opinion about the length and complexity of this definition tended to vary depending on the intended use of the definition. The large majority (18/24) supported the inclusion of specific reference to physical activity in a definition of public health nutrition, although there was not consensus (> 83% agreement as criterion) on this point. Consensus descriptors regarded as important in a definition of public health nutrition included: population-based, focus on health promotion, food and nutrition systems focus, wellness maintenance, primary prevention, applies public health principles, education, environmental and political descriptors. Treatment as a descriptor was rated as unimportant by a majority (14/24) of panellists, delineating public health nutrition from clinical practice. CONCLUSIONS There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of descriptors that can be used to define public health nutrition. The limitations of using word-for-word definitions between and within countries may be overcome by explicit use of the consensus descriptors identified in this process.

A conceptual framework for intelligence-based public health nutrition workforce development

OBJECTIVE This paper describes a conceptual framework and associated intelligence requirements for problem-based workforce development for public health nutrition. METHODS A conceptual framework for public health nutrition workforce development was constructed based on a review of the literature and consideration of the intelligence needs to inform workforce development planning. RESULTS A cyclical conceptual framework including five intelligence-linked components including public health nutrition problems and priorities, solutions and best buys, work needed, capacity to do the work and workforce development needs. This framework applied to the Australian situation illustrates its applications in workforce development research and planning. Although the existing availability of workforce development intelligence in each of these components varies, the framework does provide a systematic approach for workforce development research and planning directly related to public health nutrition problem resolution. CONCLUSIONS This framework highlights deficiencies in the existing public health nutrition workforce development intelligence and the need for further research to inform workforce development strategy planning.

Consensus on the competencies required for public health nutrition workforce development in Europe - the JobNut project

OBJECTIVE To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts. DESIGN A modified Delphi study involving three rounds of questionnaires. SETTING European Union. SUBJECTS Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries. RESULTS A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study. CONCLUSIONS Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.