BackgroundThis study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups.MethodsA systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition.ResultsIn total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials.ConclusionsTo tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.

The placement of nutrition information on the front of food packages has been proposed as a method of providing simplified and visible nutrition information. This study aimed to determine the most acceptable and effective front-of-pack food labelling system for Australian consumers. Consumers' preferences and ability to compare the healthiness of mock food products were assessed for different front-of-pack labelling systems. Four systems were tested, including two variations of the Percentage Daily Intake system (Monochrome %DI and Colour-Coded %DI), which displays the proportion of daily nutrient contribution that a serve of food provides; and two variations of the Traffic Light (TL) system (Traffic Light and Traffic Light + Overall Rating), which uses colour-coding to indicate nutrient levels. Intercept surveys with 790 consumers were conducted, where each participant was exposed to a single labelling system for performance testing. Participants indicated strong support for the inclusion of nutrient information on total fat, saturated fat, sugar and sodium on the front of packages, and a consistent labelling format across all products. Using the TL system, participants were five times more likely to identify healthier foods compared with the Monochrome %DI system [odds ratio (OR) = 5.18; p < 0.001], and three times more likely compared with the Colour-Coded %DI system (OR = 3.01; p < 0.05). Consumers supported the introduction of consistent front-of-pack food labelling. The TL system was the most effective in assisting consumers to identify healthier foods. Mandatory TL labelling regulations are recommended to assist consumers in making healthy food choices.

These findings raise questions about how preconception care should be provided to women with diabetes and highlight the pivotal importance of supportive, familiar relationships between health professionals and women with diabetes in the provision of individualized care and advice. By improving the quality of relationships and communication between health care providers and patients, we will be better able to provide care and advice that is perceived as relevant to the individual, whatever her stage of family planning.

BackgroundPolicies restricting children’s exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children’s energy intake and body weight. Food advertising exposure increases children’s immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear.MethodsWe conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7–12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children’s food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status.ResultsAll children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80–308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46–317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups.ConclusionOnline (‘advergame’) advertising combined with TV advertising exerted a stronger influence on children’s food consumption than TV advertising alone. The lack of compensation at lunch for children’s increased snack intake after food advertising exposure suggests that unhealthy food advertising exposure contributes to a positive energy-gap, which could cumulatively lead to the development of overweight.Trial registrationAustralian New Zealand Clinical Trials Registry, number ACTRN12617001230347 (Retrospectively registered).

Objective: Proposed Australian regulation of claims on food labels includes requirements for products carrying a health claim to meet nutrient profiling criteria. This would not apply to nutrition content claims. The present study investigated the number and healthiness of products carrying claims and the impact of the proposed regulation. Design: Observational survey of claims on food packages across three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products carrying claims to determine their eligibility to carry health claims under the proposed regulation. Setting: Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in August 2011. Subjects: All claims on 1028 products were recorded. Nutrition composition and ingredients were collected from the packaging, enabling nutrient profiling. The proportion of products in each category carrying claims and the proportion of these that did not meet the nutrient profiling criteria were calculated. Results: Two-thirds of products in the three categories (ranging from 18 to 78 %) carried at least one claim. Of those carrying health claims, 31 % did not meet the nutrient profiling criteria. These would be ineligible to carry these claims under the proposed regulation. Additionally, 29 % of products carrying nutrition content claims did not meet the nutrient profiling criteria. Conclusions: The number of products carrying nutrition content claims that did not meet the nutrient profiling criteria suggests that comprehensive regulation is warranted. Promotion of unhealthy foods using claims is potentially misleading for consumers and hinders their ability to select healthier foods. Implementation of the proposed regulation represents an improvement to current practice.