Purpose: The COVID-19 pandemic has had a multitude of flow-on effects on populations around the world. In Australia, lockdowns mandated people to stay at home and food retail outlets such as cafes and restaurants to close. Between March and July 2020, almost 300,000 jobs were lost. The objective of this study was to determine the changes in consumer food behaviours before and during the COVID-19 pandemic in Australia as part of a broader survey on salt.

Methods: A nationally representative cross-sectional survey of the Australian adult population was conducted in 2020 to assess the current knowledge, attitudes, and behaviours towards salt. As part of the survey, participants were asked to complete three COVID-19 behaviour questions about planning and purchasing foods, barriers to cooking, and types of foods consumed. A probability proportional to size sampling was used to recruit participants from all states, stratified by age group and sex, through a commercial online research panel provider. Logistic regression was used to determine changes over time. Analyses were weighted using the 2016 Australian census data.

Results: 4022 participants completed the survey. Positive behaviour changes were observed, including planning meals ahead of time (+6.1%), making a list before going shopping (+4.1%), planning meals to include all food groups (+4.3%), and checking the nutrition information panel and other information on food labels to make food choices (+2.1 and +2.2%; all p’s<0.001). Participants perceived time as less of a barrier to cooking during COVID-19 (-5.9%; p<0.001), however access to food was perceived as more of a barrier (+2.4%; p<0.001). Regarding foods consumed, intake of salty snacks increased (+2.5%; p<0.001), although positively, reduced consumption of processed meats (-4.8%; p<0.001), and small increases in consumption of fruit (+1.2%; P=0.056) and legumes/pulses (+1.3%; P=0.023) were observed.

Conclusions: Positive behaviour changes regarding planning and purchasing of foods during the COVID-19 pandemic compared to before may indicate motivation of Australians to improve the healthiness of their diets as well as reflect increased time to do so. However, changes in barriers to cooking and types of foods consumed were mixed suggesting differential experiences of COVID-19 in subgroups within the Australian population.  

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting 13% of reproductive-aged women. Lifestyle management (diet, physical activity and behavioural) and is the first-line treatment for improving reproductive, metabolic and psychological complications in PCOS, however women experience challenges with this. There is a need to better understand how women with PCOS engage with evidence-based dietary and physical activity (PA) interventions. The primary aim of this study was to identify the types and sources of dietary and PA interventions implemented by women with PCOS. A secondary aim was to understand how they use behavioral and cognitive self-management strategies to support behavioral change. In this cross-sectional study an online questionnaire was disseminated via the PCOS Nutrition Centre (a consumer-based website) and a PCOS symposium hosted by the largest non-profit PCOS organization (PCOS Challenge: The National Polycystic Ovary Syndrome Association) between May 2015-May 2016. Women (n=1167) were aged 18-45 years, primarily born within the United States (70%) and self-reported a PCOS diagnosis. While only 33% and 16% of women reported following formal nutrition or PA guidelines (respectively), 57% had implemented a ‘special diet’ to help manage their PCOS. Many of these diets, including ketogenic, dairy and gluten free diets, were not supported by evidence-based PCOS practice. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. The internet was the primary source of nutrition (36%) and PA (32%) information, with few turning to health professionals including doctors (nutrition 16%; PA 13%) and dietitians (nutrition 4.8%; PA 2.4%). These findings suggest that online information may promote inaccurate non-evidence-based lifestyle advice, and indicates a need to increase engagement with qualified health professionals. As current lifestyle advice for PCOS management utilized by health professionals are based on generic national guidelines, it is possible that this one-size-fits-all approach does not satisfy their desire for more personalized recommendations. It is also likely that health professionals will need to diversify their mode of communication through the delivery of online lifestyle education.

Purpose: In urban areas, shifting trips to walking contributes to physical activity and independent movement, but also climate action and noise reduction. While research on walkability has made significant progress, there is still no consensus on what people perceive as barriers. This study examined the barriers as perceived by 56 adults with diverse disabilities and ages, living in Auckland New Zealand. The theoretical framework is the Social Model of Walkability, assuming that people’s perceptions and individual characteristics play a key role as moderators between walking environments and walking as a behaviour.

Methods: In audio-taped 1-on-1 interviews, participants reported on (1) the trips usually walked (purpose, reasons to choose walking, specific features considered as difficult or unpleasant, or conversely enjoyed); and (2) desired destinations usually not walked to, within a distance perceived as walkable (type of destination, reasons why the trip is not walked, specific barriers). Trips and barriers were mapped on paper with the participants. Content analysis was used to better understand perceived difficulties and the choice of walking.

Results: Three major dimensions were found: (1) the importance of the quality of walking environments, including traffic and infrastructure, identifying aspects most cited as barriers; (2) the importance of transport alternatives and their quality in the choice of walking; and (3) the disproportionate burden of the transport system placed on disabled users.

Conclusions: This study tested the Social Model of Walkability and contributes to a better understanding of walking as a behaviour across ages and abilities. It also contributes to transport planning and urban design by providing insights into specific features perceived as barriers to walking, in a car-dominated environment. Future research should measure and characterise the encountered barriers.

Purpose: Type 2 Diabetes (T2D) is a global health concern. A healthy diet is the cornerstone of diabetes management but usually requires behaviour change. Understanding how dietary change occurs may contribute to better-targeted intervention strategies for individuals. Well-established models of behaviour change can help deepen this understanding. The current study explored the psychological decision-making processes involved in dietary change after a T2D diagnosis.

Methods: A descriptive, interpretive methodology was used. Adults diagnosed with T2D who had consulted with a dietitian were purposively sampled from the “3D Study” participant database, a longitudinal case series study exploring dietary changes after a T2D diagnosis. Twenty-one semi-structured interviews were conducted. Theoretical thematic analysis was guided by the Integrated Behaviour Change (IBC) model to deductively match themes to the motivational, volitional, and implicit decision-making processes involved in dietary change.

Results/findings: Nineteen themes were identified and categorised under the motivational, volitional, and implicit processes of the IBC model. Motivation to change diet stemmed from wanting to improve diabetes health status, reduce further complications, and to not take medication. Participants described making use of support networks such as family, friends, and attended diabetes group meetings. Most had an intrinsic desire to change and felt capable and responsible for making positive changes. Some had post-diagnosis realisations that caused them to prioritise their health. Volitional influences included coping self-efficacy, action planning to meet behaviour goals, and awareness of boundaries related to food. Implicit influences on dietary change included unlearning habits and planning for the availability of recommended foods. Individual difference factors and emotions were identified in the data as influencing diet change but are not in the IBC model.

Conclusions: This study was the first to our knowledge to use the IBC model to understand dietary change in adults with T2D. There are substantial decision-making processes involved in dietary change after a T2D diagnosis. Interventions need to address the psychological processes involved in decision-making to support positive change. Health care professionals can use the findings of this research to understand the patient experience and the influence early intervention may have in supporting optimal dietary behaviour change for T2D management.

Purpose: Insufficient physical activity (PA) is a major public health problem and is associated with a range of chronic diseases and associated morbidity. Individuals with chronic disease morbidity are frequent users of complex hospital services, and hospitals need effective and accessible prevention programs targeting high-risk individuals to increase PA and promote individual self-management. This study aimed to test the effectiveness of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic.

Methods: One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention or control group. The intervention group received an education session and five 20-min telephone sessions of PA coaching. The control group received the education session only. Secondary outcome measures included anthropometrics, PA self-efficacy, and health-related quality of life. Outcome measures were assessed at baseline, post-intervention (3-months) and follow-up (9-months). A series of mixed-model ANOVAs (within:time; between:intervention) were used to assess the effects of the PA coaching intervention on each outcome variables separately.

Results: At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m2, respectively. The attrition rate was low, with 90% of participants remaining at 9-months. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p<0.001) and 9 months follow-up (p<0.001). At the 9-month follow-up the measured MVPA was 22 min/day (95%CI: 20 to 25 min/day) in the intervention group, which was sufficient to meet the recommended PA guidelines. The intervention group also demonstrated beneficial changes in body mass (p<0.001), waist circumference (p<0.001), BMI (p<0.001), PA self-efficacy (p<0.001), and health-related quality of life (p<0.001) at the 9-month follow-up.

Conclusion: This study demonstrates that for insufficiently active adults presenting to an ambulatory hospital clinic, a PA coaching intervention resulted in improvements in PA and health-related outcomes that were maintained to 9 months follow-up. Ambulatory hospital appointments provide an important opportunity for initiating PA behaviour change, and PA coaching is an efficacious tool for the prevention and management of chronic disease.

Eligible patients were adults referred by surgeons over 23 months who engaged in VLCD-based treatment (n=78). Weight loss targets were set by the surgeon in order to proceed to surgery. The dietitian prescribed individualised VLCD-based treatment and provided individual fortnightly nutrition education and counselling incorporating behaviour change strategies. Patients attended fortnightly appointments, and dietitian treatment was generally limited to 12 weeks but continued until surgery. The primary outcome of the study was efficacy, which was evaluated through effectiveness of treatment, feasibility, and stakeholder value (patients and surgeons). Data were collected from medical charts, and patients and surgeons were surveyed. Descriptive analyses were used.
Seventy-eight eligible patients were treated (45±13yrs, 90%F, BMI 44.3±6.2kg/m2). Weight loss achieved was 9.0±6.7kg (7.4±5.3% body weight). Most patients (70%, n=50/71) achieved sufficient weight loss over median 10 weeks to proceed to surgery. Fifty-six percent of patients (n=43/77) reported side effects, most of which were resolved. All surveyed patients (n=24) reported being satisfied with the dietitians’ counselling and agreed that they had learned knowledge/skills to improve their long-term health. Surgeons reported that VLCD treatment assisted with ease of operation (83%, n=10/12) and shortened operating time (75%, n=9/12).