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Aim This study aimed to demonstrate how supervisors and students use their time during the three domains of nutrition and dietetic clinical placement and to what extent patient-care and non-patient activities change during placement compared with pre- and post-placement. Methods A cohort survey design was used with students from two Queensland universities, and their supervisors in 2010. Participants recorded their time use in either a paper-based or an electronic survey. Supervisors' and students' time use was calculated as independent daily means according to time-use categories reported over the length of the placement. Mean daily number of occasions of service, length of occasions of service, project activities and other time use in minutes was reported as productivity output indicators and the data imputed. A linear mixed modelling approach was used to describe the relationship between the stage of placement and time use in minutes. Results Combined students' (n = 21) and supervisors' (n = 29) time use as occasions of service or length of occasions of service in patient-care activities were significantly different pre, during and post placement. On project-based placements in food-service management and community public health nutrition, supervisors' project activity time significantly decreased during placements with students undertaking more time in project activities. Conclusions This study showed students do not reduce occasions of service in patient care, and they enhance project activities in food service and community public health nutrition while on placement. A larger study is required to confirm these results. [ABSTRACT FROM AUTHOR]

Aims: Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. Methods: Literature review, multidisciplinary focus groups and end‐user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha. Results: The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub‐scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub‐scale demonstrated good reliability with Cronbach's alpha values all >0.70. Conclusion: This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. Methods: This mixed‐method study (survey and semi‐structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. Results: This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two‐thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. Conclusion: This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial. [ABSTRACT FROM AUTHOR]

Aims: Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school‐age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Methods: The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development—physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school‐based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Results: AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P <.001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P =.020) at school age. Conclusions: Early childhood anaemia is a risk factor for developmental vulnerability at school‐age in this setting. Interventions combining nutrition promotion and multi‐micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement. [ABSTRACT FROM AUTHOR]

Aim: Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence‐based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. Methods: The project used a hub (project team)‐spoke (sites) model in Far North Queensland (Site 1) and regional South‐East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. Results: Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). Conclusions: This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource‐challenged sites. [ABSTRACT FROM AUTHOR]

Aim Three years following a state-wide Nutrition Care Process Terminology ( NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. Methods Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. Results A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved ( P < 0.001). Perceptions of NCPT's importance ( P < 0.020) and benefits of incorporating NCPT into practice ( P = 0.029) increased. Time to complete NCPT documentation ( P < 0.013) and access to mentors decreased ( P < 0.001). Other areas including enhanced attitudes, familiarity, confidence, views, knowledge and incorporation into practice were sustained ( P > 0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. Conclusions Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment. [ABSTRACT FROM AUTHOR]

Aim: A standardised tool was needed to measure a generalist dietitian's confidence about working with clients experiencing psychological issues in order to effectively evaluate mental health ‐ related professional development activities. The aim of this study was to develop, pilot and validate a robust instrument that measures a generalist dietitian's professional confidence for working with clients experiencing psychological issues. Methods: The Dietetic Confidence Scale (DCS) was developed. Two cross ‐ sectional samples of practicing dietitians (n = 185; 458) from various settings and locations were recruited. Study 1: principal components analysis (PCA) helped refine scale items and derive a model, which was then validated using confirmatory factor analysis (CFA, Study 2). Cronbach's alpha estimated scale reliability. Correlations assessed associations between factors. Results: Study 1: A 13 ‐ item, two ‐ factor solution accounted for 69.1% of the total variance. Total Cronbach's α = 0.92. Dietetic confidence was associated with: (i) Confidence using the Nutrition Care Process and (ii) Confidence Advocating for Self care and Client care. Study 2: The CFA supported the proposed scale and model. A Good Fit Index of 0.95 indicated a strong fit. Item ‐ factor correlations ranged from r = 0.50 to 0.91. The final scale showed good reliability (α = 0.93). Conclusions: This is the first self ‐ efficacy scale for dietetic practitioners subjected to PCA and CFA using two independent samples. The DCS is a psychometrically robust instrument with strong internal consistency. It can be used to measure dietetic confidence about working with clients experiencing psychological issues and to highlight areas where additional support or training may be needed. Further validity and reliability testing is needed to enhance scale generalisability and use. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the perceived influences on food and meal choices of Queensland paramedics during shift work. Methods: A qualitative study using individual semi ‐ structured telephone interviews was conducted on a purposive sample of 15 paramedics working on a rotating shift roster in Queensland. Interviews explored the perceived influences on their food choices while working shifts. Interviews were audio recorded, transcribed verbatim and content analysed manually using open ‐ coding inductive thematic analysis. Results: A conceptual model was developed that illustrated four major themes of influences on food choices that emerged from the data analysis. These themes were physiological influences, psychosocial influences, the physical environment and the organisational environment. Of significant influence on the participants' food choice unique to the nature of their shift work was the meal break structure and being ambulance based for the majority of their shift. Conclusions: The specific influences affecting the food choice of paramedics are created by the environmental influences in which they work and result in extended periods of not eating or ‘opportunistic eating’. This has implications for their ability to make ‘healthy food choices’. Further investigation into strategies to enable paramedics to improve food choice within the context of the unpredictable nature of their workload and their work environment is warranted. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the test–retest reliability, relative validity and responsiveness to change of a 20‐item fat and fibre behaviour questionnaire (FFBQ) compared with a semi‐quantitative food frequency questionnaire (FFQ). Methods: Four hundred thirty‐four primary care patients with type 2 diabetes and/or hypertension were randomised to lifestyle intervention or usual care. Data (FFBQ and FFQ) were collected at baseline and 4 months follow‐up. A subset of usual care participants (n = 27) completed the FFBQ 2 weeks after baseline. FFQ‐measured nutrients included total and saturated fat (percentage of energy; energy‐adjusted grams) and fibre (crude grams; energy‐adjusted grams). The FFBQ was scored as a total, fat and fibre index. Test–retest reliability was assessed by intra‐class correlations (ICCs); relative validity by Pearson's correlations between the FFBQ and FFQ; and responsiveness (mean change in intervention group divided by SD of usual care group change). Results: Test–retest ICCs (95% CI) were 0.87 (0.62, 0.95) for total index, 0.87 (0.69, 0.95) for fat index and 0.89 (0.69, 0.95) for fibre index. Pearson's correlations for fat index ranged from −0.50 to −0.54, and for fibre index from 0.42 to 0.56. Total index had correlations of 0.5–0.6 (or −0.5 to −0.6) with all FFQ‐measured nutrients except crude fibre. The fat index showed similar responsiveness compared with FFQ‐measured fat intake while the fibre index was significantly more responsive than FFQ‐measured fibre. Conclusions: The FFBQ may provide a suitable alternative or adjunct to FFQs for use in intervention trials in adults with chronic diseases, because of its ability to detect changes in dietary behaviours. [ABSTRACT FROM AUTHOR]

Aim: Information on attitudes and knowledge of practising dietitians regarding the Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT) would be useful to inform effective implementation. The present study aimed to: (i) explore dietitians' expectations, perceptions and anticipated benefits of NCP/IDNT pre and post implementation; (ii) identify perceived implementation barriers and enablers; and (iii) develop and assess a train ‐ the ‐ trainer NCP/IDNT implementation approach. Methods: All Queensland Government State hospitals from metropolitan, regional and remote areas were included in the study. Dietitian champions (n = 17) attended one face ‐ to ‐ face, train ‐ the ‐ trainer day, then led 14 one ‐ hour educational sessions to 279 district dietitians tailored to local situations, facilities and resources. NCP/IDNT were embedded into local processes and chart audits completed. Pre ‐ /post ‐ implementation surveys were completed by 86 dietitians. Results: Pre ‐ implementation results showed positive attitudes regarding the value of NCP/IDNT (mean 1.89, SD 0.67, 1 = strongly agree, 5 = strongly disagree). Dietitians identified management support; practice, tutorials and workshops; mentor support; and follow up audits as important for successful implementation. Most attendees (81%) completed ≥10/13 tutorials and 86% (415/480) of audited charts included Nutritional Diagnosis statements. Post ‐ implementation familiarity, confidence and knowledge of NCPT (Nutrition Care Process Terminology) significantly improved (P < 0.001). Conclusions: Prior to implementation, respondents viewed the NCP/IDNT as applicable to their practice areas. The train ‐ the ‐ trainer program with frequent teleconference and email support was effective in improving knowledge, confidence, preparedness for implementing NCPT and charting behaviour. Although training was positively received and has achieved good results, dietitians identified the need for ongoing training and support to further increase confidence following implementation. [ABSTRACT FROM AUTHOR]