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INTRODUCTION Practice nurses in general practice are ideally placed to deliver weight management treatments. Teaching people to eat according to their appetite, based on measurements of blood glucose ('hunger training'), is known to lead to weight loss and improved eating behaviour. To effectively translate this research to primary care requires understanding of key stakeholder perspectives. AIM The aim of this study was to explore the perspectives of practice nurses on the suitability of using hunger training as a weight management intervention in general practice. METHODS Ten nurses trialled hunger training for 1 week, followed by a semi-structured interview where they were asked about their experience; perceived patient interest; enablers and barriers; and suggested changes to hunger training. RESULTS All nurses were positive about hunger training and wanted to use it with their patients. They thought it was a useful method for teaching patients about eating according to their appetite, and the impact of food choices on glucose. Motivation was seen to be both an important potential barrier and enabler for patients. Other anticipated patient enablers included the educational value of hunger training and ease of the programme. Other barriers included lack of time and cost of equipment and appointments. For most nurses, 1 week of following hunger training was sufficient training to deliver the intervention. Suggested refinements included adding nutrition advice to the booklet, incorporating other health goals and enabling social support. DISCUSSION These findings suggest that hunger training could be translated to primary care with minor modifications.
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Actitud del Personal de Salud , Automonitorización de la Glucosa Sanguínea/métodos , Conducta Alimentaria/fisiología , Enfermeras y Enfermeros/psicología , Programas de Reducción de Peso/métodos , Adulto , Glucemia/fisiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hambre , Entrevistas como Asunto , Persona de Mediana Edad , Motivación , Investigación CualitativaRESUMEN
BACKGROUND: Hunger training teaches people to eat according to their appetite using pre-prandial glucose measurement. Previous hunger training interventions used fingerprick blood glucose, however continuous glucose monitoring (CGM) offers a painless and convenient form of glucose monitoring. The aim of this randomised feasibility trial was to compare hunger training using CGM with fingerprick glucose monitoring in terms of adherence to the protocol, acceptability, weight, body composition, HbA1c, psychosocial variables, and the relationship between adherence measures and weight loss. METHODS: 40 adults with obesity were randomised to either fingerpricking or scanning with a CGM and followed identical interventions for 6 months, which included 1 month of only eating when glucose was under their individualised glucose cut-off. For months 2-6 participants relied on their sensations of hunger to guide their eating and filled in a booklet. RESULTS: 90% of the fingerpricking group and 85% of the scanning group completed the study. Those using the scanner measured their glucose an extra 1.9 times per day (95% CI 0.9, 2.8, p < 0.001) compared with those testing by fingerprick. Both groups lost similar amounts of weight over 6 months (on average 4 kg), were satisfied with the hunger training program and wanted to measure their glucose again within the next year. There were no differences between groups in terms of intervention acceptability, weight, body composition, HbA1c, eating behaviours, or psychological health. Frequency of glucose testing and booklet entry both predicted a clinically meaningful amount of weight loss. CONCLUSIONS: Either method of measuring glucose is effective for learning to eat according to hunger using the hunger training program. As scanning with a CGM encouraged better adherence to the protocol without sacrificing outcome results, future interventions should consider using this new technology in hunger training programs.
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Apetito , Automonitorización de la Glucosa Sanguínea , Adulto , Glucemia , Humanos , Hambre , Pérdida de PesoRESUMEN
INTRODUCTION: The influence of screens and technology on adolescent well-being is controversial and there is a need to improve methods to measure these behaviors. This study examines the feasibility and acceptability of using automated wearable cameras to measure evening screen use in adolescents. METHODS: A convenience sample of adolescents (aged 13-17 years, n=15) wore an automated camera for 3 evenings from 5:00pm to bedtime. The camera (Brinno TLC120) captured an image every 15 seconds. Fieldwork was completed between October and December 2017, and data analyzed in 2018. Feasibility was examined by quality of the captured images, wear time, and whether images could be coded in relation to contextual factors (e.g., type of screen and where screen use occurred). Acceptability was examined by participant compliance to the protocol and from an exit interview. RESULTS: Data from 39 evenings were analyzed (41,734 images), with a median of 268 minutes per evening. The camera was worn for 78% of the evening on Day 1, declining to 51% on Day 3. Nearly half of the images contained a screen in active use (46%), most commonly phones (13.7%), TV (12.6%), and laptops (8.2%). Multiple screen use was evident in 5% of images. Within the exit interview, participants raised no major concerns about wearing the camera, and data loss because of deletions or privacy concerns was minimal (mean, 14 minutes, 6%). CONCLUSIONS: Automated cameras offer a feasible, acceptable method of measuring prebedtime screen behavior, including environmental context and aspects of media multitasking in adolescents.
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Conducta del Adolescente/fisiología , Técnicas de Observación Conductual/instrumentación , Fotograbar/instrumentación , Tiempo de Pantalla , Dispositivos Electrónicos Vestibles , Adolescente , Estudios de Factibilidad , Femenino , Humanos , Masculino , Nueva ZelandaRESUMEN
Background: Community participation can provide increased understanding and more effective implementation of strategies that seek to improve outcomes for women and newborns. There is limited knowledge on how participatory processes take place and how this affects the results of an intervention. Objective: This paper presents the results of two years of implementing (2013-2015) community groups for maternal health care in Magu District, Tanzania. Method: A total of 102 community groups were established, and 77 completed the four phases of the participatory learning and action cycle. The four phases included identification of problems during pregnancy and childbirth (phase 1), deciding on solutions and planning strategies (phase 2), implementation of strategies (phase 3) and evaluation of impact (phase 4). Community group meetings were facilitated by 15 trained facilitators and groups met monthly in their respective villages. Data was collected as an ongoing process from facilitator and meeting reports, through interviews with facilitators and local leaders and from focus group discussions with community group participants. Results: The majority of groups prioritized problems related to the availability of and accessibility to health services. The most commonly actioned solution was the provision of health education to the community. Almost all groups (95%) experienced a positive impact on the community as results of their actions, including increased maternal health knowledge and positive behaviour changes among health care workers. Facilitators were positive about the community groups, stating that they were grateful for the gained knowledge on maternal health, and positively regarded the involvement of men in community groups, which are traditionally women-only. Conclusion: The process of establishing and undertaking community groups in itself appeared to have a positive perceived impact on the community. However, sustained behaviour change, power dynamics and financial incentives need to be carefully considered during implementation and sustaining the community groups.
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Centros Comunitarios de Salud/organización & administración , Parto Obstétrico/educación , Personal de Salud/educación , Promoción de la Salud/métodos , Servicios de Salud Materna/organización & administración , Mujeres Embarazadas/educación , Población Rural/estadística & datos numéricos , Adulto , Participación de la Comunidad , Femenino , Grupos Focales , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , TanzaníaRESUMEN
OBJECTIVES: Hunger training (HT) is an intervention designed to teach people to eat according to their hunger by connecting physical symptoms of appetite with glucose levels. HT is most effective for weight loss, and improving eating behaviours when adherence is high. However, adherence is a challenge that should be explored prior to wider dissemination. The aim of this study was to explore participants' experience and self-reported adherence and behaviour change related to HT. DESIGN: A qualitative study, nested within a randomised controlled pilot study of two different methods of monitoring glucose during HT. Semistructured interviews were audio-recorded, transcribed verbatim and analysed thematically using a phenomenological approach. SETTING: Single-centre study with participants recruited from the local area. PARTICIPANTS: 40 participants began the pilot study and 38 participants (52.6% women) remained at 1 month and completed interviews. RESULTS: Most participants felt they were able to match their hunger to their glucose levels by the end of the intervention. The main adherence barriers were the social pressure to eat, lack of time and lack of flexibility in participants' meal schedules. Common adherence enablers were having a set routine, social support and accountability. Participants described increased awareness of hungry versus non-hungry eating and better cognition of feelings of hunger and satiety as a result of the intervention, which in turn led to changes of food choice, portion size and adjusted meal timing and frequency. CONCLUSIONS: Findings show that HT is acceptable from a patient perspective, and results can be used to inform the translation of HT programme to healthcare settings. TRIAL REGISTRATION NUMBER: ACTRN12618001257257.
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Glucemia/análisis , Conducta Alimentaria/fisiología , Hambre , Pérdida de Peso , Adulto , Conducta Alimentaria/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Investigación Cualitativa , SaciedadRESUMEN
There is an urgent need for strategic approaches to address the high prevalence of obesity and diabetes in New Zealand. Such approaches rely strongly on input from multiple actors in the diabetes and obesity policy space. We conducted a social network analysis to identify influential actors involved with shaping public opinion and/or policy regarding obesity and diabetes in New Zealand. Our analysis revealed a diverse network of 272 individuals deemed influential by their peers. These individuals represented nine professional categories, particularly academics (34%), health service providers (22%), and government representatives (17%). The network included a total of 17 identified decision-makers. Relative capacity of professional categories to access these decision-makers was highest for representatives of the food and beverage industry (25%), compared with nongovernment organisations (9%) or academics (7%). We identified six distinct brokers, in academic (n = 4), government (n = 1), and nongovernmental (n = 1) positions, who could play a key role in improving communication and networking activities among all interest groups. Such actions should ultimately establish effective networks to foster evidence-based policy development to prevent and reduce the burden of diabetes and obesity.
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Diabetes Mellitus , Política de Salud , Obesidad , Formulación de Políticas , Opinión Pública , Humanos , Nueva Zelanda , Participación de los InteresadosRESUMEN
INTRODUCTION: Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite differences in aetiology, both diseases may lead to peripheral neuropathy and subsequent injuries and permanent impairments. There are also indications of similarities in psychosocial consequences. Prevention of Disability (POD) and self-management are often recommended for both diseases. This led to the idea of exploring the feasibility of combined peer-led self-care interventions for people with these disorders. OBJECTIVE: To explore the opinions of health care professionals about combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. METHOD: An exploratory study was conducted to collect quantitative data by means of an e-questionnaire and qualitative data through in-depth semi-structured interviews with key informants. RESULTS: In total, 227 respondents answered the e-questionnaire and 22 in-depth interviews were conducted. Resemblances in physical complications between leprosy and diabetes were confirmed by the respondents. Psychosocial similarities included limitations in daily activity and in social participation, but stigma in leprosy was thought to be an important difference. Considerable overlap in current practices was found, mainly in patient education in POD, skin assessment and skin care, and the recommendation to use protective footwear. Knowledge exchange between leprosy and diabetes specialists is limited, although combined interventions were reported. The majority of respondents think that combined interventions are 'possible' (33.3%) or 'possible and promising' (30.8%). Professionals working with both diseases are more positive than those working with leprosy or diabetes only. The greatest barriers for combined interventions are perceived to be leprosy-related stigma, differences in underlying socio-economic status, attitudes of health care professionals and the current organization of health care systems. CONCLUSIONS: Responses indicate perspectives for combined interventions for the prevention of disabilities. For this, it is essential to intensify knowledge exchange between leprosy and diabetes professionals, to overcome barriers and to secure government policy support. Opportunities should be assessed in a situation-specific way.