DIET-COMMS is a short, user-friendly, reliable and valid tool for measuring communication skills in patient consultations with both pre- and post-registration dietitians. Additional work is required to develop a training package for assessors and to identify how DIET-COMMS assessment can acceptably be incorporated into practice.
Objective: To explore UK public perceptions of children's sugar consumption, Public Health England's Change4Life Sugar Smart app and the Soft Drinks Industry Levy, using solicited and unsolicited digital data. Methods: Data from three digital spaces were used as follows: (1) an online questionnaire advertised on parenting forums; (2) posts to UK online parenting forums; and (3) English language Tweets from Twitter. Quantitative data were analysed using descriptive statistics and qualitative data using content and inductive thematic analysis.Results: Data were (study 1) 184 questionnaire participants; (study 2) 412 forum posts; and (study 3) 618 Tweets. In study 1, 94.0% (n = 173) agreed that children in the UK consumed too much sugar and this had a negative health effect (98.4%, n = 181). Environments (n = 135, 73.4%), media/advertising (n = 112, 60.9%) and parents (n = 107, 58.2%) were all reported as barriers to changing children's sugar intake. In study 2, more posts were negative towards the Soft Drinks Industry Levy (n = 189, 45.9%) than positive (n = 145, 35.2%), and themes about the inability of the Levy to affect sugar consumption in children and childhood obesity emerged. Other themes related to distrust of the government, food industry and retailers. In study 3, the Sugar Smart app was viewed positively (n = 474, 76.7%) with its function associated solely with identification of sugar content. Conclusions: Participants accepted the necessity of sugar reduction in children, but recognised the complexity of behaviour change. Public health activities were not always perceived as effective strategies for health promotion. There was some distrust in government, public health officials and the food industry. A less simplistic approach to sugar reduction and more credible sources of information may, therefore, be welcomed by the public.
Changing individuals' health behaviour seems to be the key to solving many of the world's health problems. Although there is a multitude of potential influences, many interventions to improve health seek to change intrinsic psychological determinants of health behaviour. To date, most attention has been paid to cognitions, such as attitudes and beliefs, and a number of social cognition models (SCM) are in current use. SCM all describe cognitions as determinants of behaviour, thereby implying that changes in cognitions will lead to changes in behaviour. Although SCM are widely used to predict a range of health behaviours, they are associated with a number of important limitations, including poor levels of predictive power, particularly in relation to eating behaviour, and limited guidance about the operationalisation of theoretical constructs. These limitations may explain why very few interventions to change behaviour are explicitly theory-based, despite the widely-held view that having a clear theoretical underpinning will improve effectiveness. Ultimately, advances in understanding and changing health behaviour will come about only if psychological theory and practice are integrated. The recently-published taxonomy of behaviour-change techniques used in interventions is a good example of integrated research, but more work of this type is essential and will require respectful collaboration between researchers and practitioners working from a range of different disciplines such as health psychology, public health nutrition and health promotion.Behaviour change: Food choice: Psychological theory: Nutrition behaviour Changing behaviour to improve healthIt is widely accepted that engaging in or abstaining from a wide range of behaviours can have a massive impact on health outcomes. The UK National Institute for Health and Clinical Excellence has recently concluded that there is overwhelming evidence for the impact of health-related behaviour on causes of mortality and morbidity (1) . Nowhere is this impact better illustrated than in relation to diet. The total worldwide mortality attributable to low consumption of fruit and vegetables, for example, was recently estimated to be 2 . 635 · 10 6 deaths per year (2) . The same research suggests that increasing an individual's fruit and vegetable consumption to the recommended 600 g/d would reduce the burden of heart disease by 31 % and the total worldwide burden of disease by 1 . 8%. The answer to many of the developed world's health problems therefore seems to lie in changing individuals' health behaviour, and in particular their eating behaviour. However, attempts to change individuals' health behaviour have had mixed success. One suggestion is that this outcome may be explained by the failure of many interventions to take into account the theories and principles that underlie health behaviour (1) .One of the difficulties in considering how to change individuals' health behaviour is that there is an enormous range of physiological, psychological, social and environmen...
HEU infants aged 6-24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.
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