S.M.E. van Dillen

Greenspace in urban neighbourhoods and residents' health: adding quality to quantity

Background Previous research shows a positive link between the amount of green area in ones residential neighbourhood and self-reported health. However, little research has been done on the quality of the green area, as well as on quantity and quality of smaller natural elements in the streetscape. This study investigates the link between the objectively assessed quantity and quality of (1) green areas and (2) streetscape greenery on the one hand and three self-reported health indicators on the other. Methods 80 Dutch urban neighbourhoods were selected, varying in the amount of nearby green area per dwelling, as determined by Geographic Information System analysis. The quality of green areas, as well as the quantity and quality of streetscape greenery, was assessed by observers using an audit tool. Residents of each neighbourhood were asked to complete a questionnaire on their own health (N=1641). In multilevel regression analyses, we examined the relationship between greenspace indicators and three health indicators, controlling for socio-demographic and socioeconomic characteristics. Results Both indicators for the quantity of greenspace were positively related to all three health indicators. Quantity and quality indicators were substantially correlated in the case of streetscape greenery. Nevertheless, the quality indicators tended to have added predictive value for the health indicators, given that the quantity information was already included in the model. Conclusions The quantity and also the quality of greenspace in ones neighbourhood seem relevant with regard to health. Furthermore, streetscape greenery is at least as strongly related to self-reported health as green areas.

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.

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.

Nutrition communication styles of family doctors: results of quantitative research

Objective:To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates.Design:A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire.Setting:The survey was conducted in October and November 2004 in the Netherlands.Subjects:A total of 267 family doctors completed the questionnaire (response rate 45%).Methods:Principal component factor analyses with varimax rotation were performed to construct factors. Cronbachs α was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results.Results:Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%).Conclusions:In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.Sponsorship:Dutch Dairy Association.

Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study

Background/objective:To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs’ compliance with the Five A’s Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A’s) and communication styles will be examined.Subjects/methods:In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs’ registration of patient’s complaint. The quality of weight-loss counseling was assessed by the Five A’s Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs’ communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05.Results:PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A’s, were stronger related to communication styles than patient characteristics.Conclusions:PNs reasonably complied with the Five A’s Model. The quality of PNs’ weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.

Nutrition communication in general practice

General practitioners (GPs) are frequently confronted with patients who suffer from obesity or other nutritionrelated diseases, such as diabetes and coronary heart disease. There is increasing evidence that nutrition communication is effective in changing nutrition behaviour. Moreover, it is widely argued that GPs are ideally placed to provide nutrition information. The aim of this review is to provide an overview of the state of the art regarding nutrition communication in general practice. First, an overview of the occurrence of nutrition communication in general practice is provided. Next, it is established that patients perceptions regarding nutrition communication are positive. Although there are many opportunities for nutrition communication in general practice, these opportunities are often not taken up. Even though GPs perceptions regarding nutrition communication were positive, they also perceive barriers, like lack of time and patient non-compliance. For more effective nutrition communication between GPs and patients, GPs perceived barriers should be overcome and GPs self-efficacy should be strengthened. Moreover, we recommend that GPs adapt their nutrition communication style, dependent of the specific circumstances.

Determinants of Dutch general practitioners’ nutrition and physical activity guidance practices

OBJECTIVE General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants. DESIGN Cross-sectional study, mail questionnaire. SETTING Dutch general practice. SUBJECTS Four hundred and seventy-two GP in practice for 5–30 years. RESULTS Our study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices. CONCLUSIONS The majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the selfefficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice.