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AimTo report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses’ perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC).BackgroundAmidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care.MethodsThis study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument.FindingsThe pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α⩾0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC. [ABSTRACT FROM PUBLISHER]

Diet quality indices (DQIs) are tools used to evaluate the overall diet quality against dietary guidelines or known healthy dietary patterns. This review aimed to evaluate DQIs and their validation processes to facilitate decision making in the selection of appropriate DQI for use in Australian contexts. A search of CINAHL, PubMed and Scopus electronic databases was conducted for studies published between January 2010 and May 2020, which validated a DQI, measuring > 1 dimension of diet quality (adequacy, balance, moderation, variety) and was applicable to the Australian context. Data on constructs, scoring, weighting and validation methods (construct validity, criterion validity, reliability and reproducibility) were extracted and summarised. The quality of the validation process was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias and Joanna Briggs Appraisal checklists. The review identified twenty-seven indices measuring adherence to: national dietary guidelines (n 13), Mediterranean Diet (n 8) and specific population recommendations and chronic disease risk (n 6). Extensiveness of the validation process varied widely across and within categories. Construct validity was the most strongly assessed measurement property, while evaluation of measurement error was frequently inadequate. DQIs should capture multiple dimensions of diet quality, possess a reliable scoring system and demonstrate adequate evidence in their validation framework to support use in the intended context. Researchers need to understand the limitations of newly developed DQIs and interpret results in view of the validation evidence. Future research on DQIs is indicated to improve evaluation of measurement error, reproducibility and reliability. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to validate a nutrition knowledge questionnaire appropriate for use in Australia.Design: Nutrition knowledge is essential in establishing and maintaining strategies that reduce the burden of disease and promote wellbeing. The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the United Kingdom in 1999 and validated for Australia in 2008. Changes in national nutrition recommendations and food availability prompted the redevelopment and revalidation of the UK questionnaire in 2016. However, the Australian questionnaire had not been subsequently updated.Setting: Australia.Participants: Content validity was determined using a sample of academic dietitians in Australia (n 8). Face validity was undertaken with retail employees (n 11) whose highest level of education was secondary school. Ninety-three undergraduate nutrition and engineering students at Queensland University of Technology completed the questionnaire for construct validity, and nineteen students were contacted a week later for test-retest reliability.Results: In the 117-scored questionnaire, nutrition students scored consistently higher in each of the four sections and overall (87 %, M 102, IQR 95, 107) compared with engineering students (77 %, M 82, IQR 76, 87·25, P < 0·01). Internal reliability of the questionnaire was high (α = 0·92) as was test-retest reliability (rs = 0·96, ICC2,1 = 0·99). AUS-R NKQ determined significant differences between individuals with known higher levels of nutrition knowledge and obtained high validity, reliability and consistency within an Australian sample.Conclusions: AUS-R NKQ refined through this research is valid and would be an appropriate questionnaire for assessing the effectiveness of nutrition knowledge-based interventions for public health programmes, clinicians and researchers. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population.Design: Cross-sectional study.Setting: Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index.Subjects: A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years).Results: Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children's food intakes (component two) and progressive/persistent decreases in children's food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS's identification of food insecurity due to reasons other than (and including) limited financial access.Conclusions: The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups. [ABSTRACT FROM AUTHOR]

A balanced diet informed by sound nutrition knowledge is key for operational readiness and the health of military personnel. Unfortunately, research suggests that military personnel have inadequate dietary intakes. This study assessed general nutrition knowledge, diet quality and their association in Australian military personnel. A convenience sample of male military personnel (n 211) including Army soldiers and officers completed a validated general nutrition knowledge questionnaire (GNKQ) and FFQ. The GNKQ assessed knowledge of dietary guidelines (Section A), sources of nutrients (Section B), choosing everyday foods (Section C) and diet-disease relationships (Section D). The Australian Recommended Food Score (ARFS) was used to assess diet quality from FFQ data. Statistical analyses included the χ² test, Spearman's correlation test, t test, median test, ANCOVA and ordinal logistic regression. The mean total GNKQ score was 52⋅7 %. Participants performed best on Section A (58⋅5 %) followed by Sections B (57⋅3%) and C (57⋅0%) and worst on Section D (31⋅0 %). Overall, officers scored significantly higher than soldiers (58⋅7 v. 51⋅9%, P = 0⋅001). Age was weakly but positively correlated with GNKQ total scores (r 0⋅307; P < 0⋅0005), with no significant effects seen for level of education (P = 0⋅463) or living arrangement (P = 0⋅167). Overall ARFS was 37⋅6 (SD 7⋅7) (50⋅8%) with officers scoring significantly higher than soldiers (54⋅7 v. 50⋅3%, P = 0⋅040). No demographic variables influenced total ARFS. The total GNKQ score had a significant, positive but weak relationship with total ARFS (r 0⋅179; P = 0⋅009). Given the importance of nutrition to personnel health and operational readiness, initiatives to improve nutrition knowledge and diet quality are recommended in this population, especially in soldiers. [ABSTRACT FROM AUTHOR]

Governments are challenged by the need to ensure that ageing populations stay active and engaged as they age. Therefore, it is critical to investigate the role of mobility in older people's engagement in out-of-home activities, and to identify the experiences they have within their communities. This research investigates the use of transportation by older people and its implications for their out-of-home activities within suburban environments. The qualitative, mixed-method approach employs data collection methods which include a daily travel diary (including a questionnaire), Global Positioning System (GPS) tracking and semi-structured interviews with older people living in suburban environments in Brisbane, Australia. Results show that older people are mobile throughout the city, and their car provides them with that opportunity to access desired destinations. This ability to drive allows older people to live independently and to assist others who do not drive, particularly where transport alternatives are not as accessible. The ability to transport goods and other people is a significant advantage of the private car over other transport options. People with no access to private transportation who live in low-density environments are disadvantaged when it comes to participation within the community. Further research is needed to better understand the relationship between transportation and participation within the community environment, to assist policy makers and city and transportation planners to develop strategies for age-friendly environments within the community. [ABSTRACT FROM AUTHOR]

Identifying toddlers at dietary risk is crucial for determining who requires intervention to improve dietary patterns and reduce health consequences. The objectives of the present study were to develop a simple tool that assesses toddlers' dietary risk and investigate its reliability and validity. The nineteen-item Toddler Dietary Questionnaire (TDQ) is informed by dietary patterns observed in Australian children aged 14 (n 552) and 24 (n 493) months and the Australian dietary guidelines. It assesses the intake of ‘core’ food groups (e.g. fruit, vegetables and dairy products) and ‘non-core’ food groups (e.g. high-fat, high-sugar and/or high-salt foods and sweetened beverages) over the previous 7 d, which is then scored against a dietary risk criterion (0–100; higher score = higher risk). Parents of toddlers aged 12–36 months (Socio-Economic Index for Areas decile range 5–9) were asked to complete the TDQ for their child (n 111) on two occasions, 3·2 (sd 1·8) weeks apart, to assess test–retest reliability. They were also asked to complete a validated FFQ from which the risk score was calculated and compared with the TDQ-derived risk score (relative validity). Mean scores were highly correlated and not significantly different for reliability (intra-class correlation = 0·90, TDQ1 30·2 (sd 8·6) v. TDQ2 30·9 (sd 8·9); P= 0·14) and validity (r 0·83, average TDQ ((TDQ1+TDQ2)/2) 30·5 (sd 8·4) v. FFQ 31·4 (sd 8·1); P= 0·05). All the participants were classified into the same (reliability 75 %; validity 79 %) or adjacent (reliability 25 %; validity 21 %) risk category (low (0–24), moderate (25–49), high (50–74) and very high (75–100)). Overall, the TDQ is a valid and reliable screening tool for identifying at-risk toddlers in relatively advantaged samples. [ABSTRACT FROM PUBLISHER]

The aim of the present study was to investigate and benchmark the level of general nutrition knowledge in elite Australian athletes (EA) against a similar aged community (CM) and criterion sample with dietetic training (DT). EA (n 175), CM (n 116) and DT (n 53) completed the General Nutrition Knowledge Questionnaire (GNKQ), which assesses four domains (sections A–D) of general nutrition knowledge (section A: dietary guidelines; section B: sources of nutrients; section C: choosing everyday foods; section D: diet–disease relationships). Age, sex and education level were collected in all groups, and athletic calibre and sport type (team or individual) in EA. Dietitians and nutrition scientists (n 53) re-examined the GNKQ for content validity, resulting in instrument revision (R-GNKQ; ninety-six items). Psychometric assessment (internal consistency: Cronbach-α; test–retest: Spearman rank correlation) was performed in a sub-sample (n 28). Independent t tests, ANOVA and ANCOVA (χ2 for categorical variables) were used to assess between-group differences. DT scored higher than EA and CM in all sub-sections and overall (P < 0·005). EA scored lower than CM in GNKQ for section B (P < 0·005) and overall (P < 0·005), and in R-GNKQ for section B (P < 0·005), section C (P < 0·005), section D (P = 0·006) and overall (P < 0·005). Overall score was influenced by age (P = 0·036 for GNKQ: P = 0·053 for R-GNKQ), sex (P = 0·016 for GNKQ: P = 0·003 for R-GNKQ) and athletic calibre (P = 0·029 for R-GNKQ only), but not level of education, living situation or ethnicity. EA and CM performed best on section A and worst on D. EA had lower overall general knowledge scores than CM. This was significantly influenced by age and sex. [ABSTRACT FROM PUBLISHER]