Applied Human Nutrition -- Graduate Theses

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https://hdl.handle.net/10587/590
Completed Graduate theses from the Master of Science in Applied Human Nutrition program.

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Browsing Applied Human Nutrition -- Graduate Theses by Title

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    A cross-cultural assessment of the feeding environment and maternal-child interactions during breastfeeding in the first 6 months
    (2022-06-22) Hillary Fry
    Human milk is the sole recommended food for infants for the first 6 months of life. Despite this, little is known about whether breastfeeding practices, such as feeding responsiveness, differ across cultures. Responsive feeding practices are based on the cues and responses of a caregiver and infant and are associated with more intuitive eating patterns later in life. However, economic, cultural, and sociodemographic differences between high- and lowand middle-income countries may result in differing responsiveness of caregivers. However, there is a lack of cross-cultural research on responsiveness, particularly among infants under six months.
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    A mixed-methods exploration of peripartum food taboos and food additions in rural Cambodia
    (Mount Saint Vincent University, 2022-08-25) Labonté, Jocelyne
    Food taboos are culturally driven food avoidances that go beyond personal taste or preference. These avoidances are particularly prevalent throughout pregnancy and lactation. In Southeast Asia, common peripartum food taboos include seafood, meats, and various vegetables. Such avoidances could negatively impact the health of women and children if foods of similar nutritional value do not replace avoided foods. There is a paucity of information on dietary modifications during pregnancy and lactation in Cambodia.
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    Accessing Nutritious Food: The Realities of Lone Senior Women in Urban Nova Scotia
    (2008-03) Green, Rebecca; Williams, Patty
    This is the first qualitative study in Canada specifically focused on food insecurity in the senior population. Food insecurity is associated with poverty, increased risk of chronic disease, and poor physical and mental health. With the Canadian population steadily aging, and food security being recognized as one of the social determinants of health, it is imperative decision makers understand how food insecurity affects the growing number of senior citizens so that appropriate programs and policies can be implemented to ensure access to food for this vulnerable population. This thesis had three research objectives, to 1) explore how lower income senior women living alone in urban HRM experience food insecurity and uncover the meanings embedded in their experiences; 2) discover participant- and researcher-identified enablers and barriers to accessing nutritious foods; and, 3) explore how accurately hypothetical household scenarios detailing senior’s public pension incomes and monthly expenses to assess the affordability of a nutritious diet reflects the realities of the participants. To address the above objectives, in-depth semi-structured interviews were conducted. Interviews were transcribed verbatim and data were managed using NVIVO 7 software. The data were analyzed using a phenomenological approach to arrive at a structural description of the experience of food insecurity and expose the underlying and precipitating factors that account for what is being experienced. Bronfenbrenner’s Ecological Systems Theory was used to examine the environment shaping the seniors’ lives at various levels of influence. Eight women meeting study criteria (over 65 years of age, living alone in Halifax Regional Municipality and in receipt of the Guaranteed Income Supplement (GIS)) were interviewed to inform the results of this study. These women were recruited using sitebased recruitment methods through community organizations and a governmental housing program. All women rented their dwellings and seven lived in income-geared housing. Four of the women received a personal pension from the Canada Pension Plan (CPP) while two received a survivor’s benefit. Only one woman reported income from a private pension. Seven themes emerged as the women talked about their experiences with accessing food, including: 1) World View, 2) Health and Health Problems, 3) Use of Community Programs, 4) Transportation, 5) Adequacy of Income, 6) Other Food Management Strategies and, 7) Availability of Family & Friends. World view and health appeared to have the most influencial role on their food security status. Bronfenbrenner’s Ecological Systems Theory provided a model to examine the enablers and barriers to accessing food in relation to the fiver layers of the environment (micro-, meso-, exo-, macro- and chronosystems) influencing the participants’ individual food-related behaviours. Enablers and barriers were both participant and researcher identified
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    Achieving Healthy Body Weights in the Teenage Years: Evidence-based Practice Guidelines for Community Nutrition Interventions
    (2007-10) Rudd, Brenna; Glanville, Theresa
    Background: Adolescent obesity has become a significant public health problem. Conservative estimates, based on self-reported data, indicate overweight and obesity rates among Canadian adolescents aged 12 to 17 soared from 14% in 1978/79 to 29% in 2004. This persistent upward trend has serious long-term implications on the physical and psychological well being of adolescents and accounts for billions of dollars in health care costs. For this reason, prevention has been recognized as a priority health issue. While interventions have begun to target school-aged children and adults in clinical settings, few advances have been made to halt the escalating problem among adolescents. This population has unique needs with increasing independence transitioning into adulthood. Reversing the trend requires comprehensive interventions that mitigate personal, social and environmental barriers to healthy lifestyle choices. There is currently little consensus on best practices for dietetic adolescent obesity prevention and management. Community strategies are recommended as the most efficacious and feasible way to reach the greatest number of youth and support healthy lifestyle development. Evidence based guidelines are currently not available and are needed to guide nutrition practice in this area. Methods: A thorough systematic review and evidence analysis yielded 48 prevention and treatment interventions meeting the studies inclusion criteria. The evidence was graded and drafted into recommendations and an algorithm guideline displaying how each recommendation relates to nutrition intervention. A panel of independent, national experts assessed the guidelines for validity, acceptability and applicability with a tool adapted from the AGREE Collaborations Appraisal of Guidelines for Research and Evaluation Instrument. These experts covered different areas of expertise, including community nutrition, public health, adolescent health, academia and endocrinology. Results: The research findings confirm the need for comprehensive strategies, which include components of nutrition education and physical activity, address social and environmental influences and use schools as delivery vehicles for health promotion and health education. For obesity treatment interventions, promising strategies incorporated diet plans, family involvement and behaviour modification techniques in multidisciplinary interventions. Computer based strategies and peer modelling may also be developmentally appropriate strategies for health promotion health in the adolescent population. Conclusions: The results of this study indicate several interventions conducted over the past 10 years have had a positive effect in preventing or reducing adolescent obesity over the short and/or long term. The findings support the development of comprehensive, multi-disciplinary obesity prevention and treatment interventions and the use of peer modeling, family based and computer based strategies.
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    The Assessment of Food Management Behaviours that Influence the Diet Quality of Mother-led Families in Nova Scotia
    (2010-04-14T13:44:29Z) Currie, Kristin; Glanville, Theresa
    We have shown in previous research that food management strategies adopted by lowincome families may account for the difference in diet quality within households that have similar economic and structural characteristics. By studying these familial food policies we can better understand how internal and external factors influence diet quality, particularly for vulnerable populations, which may help to develop successful programs and health initiatives aimed at achieving and maintaining diet changes that reflect the recommendations in Eating Well with Canada's Food Guide. The objective of this research was to validate the Food Management Assessment Tool; a tool designed to assess diet quality and food management strategies used by low-income households. The goal was to design a tool that could be implemented and interpreted by a health care practitioner with little or no nutrition background. This required three methodological objectives to develop and validate estimation tools to assess, 1) if a meal contains 30% of food energy from fat; 2) if a food item is a limiting food; and, 3) if a non limiting food item is high in fat. Participants included 48 low-income mother-led families with at least two children between the ages of 2-14 living in Nova Scotia. The mothers completed one 20-60 minute face-to face interview in which they described the supper meal consumed by each family member and completed an interview administered questionnaire designed to assess Food Management Strategies. The data was interpreted using Family Systems Theory. Results found that low-income families that use healthy food management strategies were 13 times more likely to have good diet quality than those that do not use healthy food management strategies. The overall Food Management Score includes components on healthy eating, formal meal structuring, meal planning and on whether or not the family is mother driven, as opposed to child driven. This research was the first to develop an index score able to identify and classify families based on the functionality of their environment in relation to diet quality. Practitioners can use the tool we developed to assess clients and to develop, monitor and evaluate programs.
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    Body esteem, eating attitudes, and adherence in adolescents with cystic fibrosis from Atlantic Canada.
    (Mount Saint Vincent University, 2006-09) Faulkner, Colleen
    A study was conducted to investigate the influence of body esteem, nutritional status, nutritional intake, and eating attitudes on adherence to dietary therapy and enzymes in adolescents and young adults with cystic fibrosis. Nine adolescents aged 12.5 to 18 years from the CF clinics at the IWK (Halifax, NS) and the Janeway (St. John’s, NL) participated in the study. The participants completed the following surveys/tools: a Three-Day Food Diary, The Eating Attitudes Test-26 (EAT-26), The Body Esteem Scale for Adolescents and Adults (BBS), and The Adherence Survey. Nutritional analysis determined that study participants had an average caloric intake of 2174 Cal. Only one participant met the adjusted Estimated Energy Requirement (EER + 20%), and was classified as being adherent to dietary therapy. The average Body Mass Index (BMIp) was at the 52"‘' percentile, and the average percent Ideal Body Weight (%IBW) was 100. None of the participants were classified as stunted, according to their height-for-age, but one was classified as wasted, according to his/her BMIp value. BBS scores determined that participants have a relatively positive body esteem, with a mean score of 52.67, 57.25% of the highest possible score. Eating attitudes were also positive, for the most part. However, EAT-26 scores did reveal that one participant was at risk of developing an eating disorder, having a score over 20. In the study, adherence was defined as taking the same dose, or more, of a treatment as prescribed by a doctor and/or dietitian. Adherence to vitamins and nutritional supplements, when prescribed, was extremely poor, at 0%. Adherence to enzymes taken with meals and snacks was similar to rates in the literature, with 56% being adherent. Common reasons cited for non-adherence included forgetfulness, an absence of positive results, time and effort consuming, and a dislike of taking the treatment in front of others. Due to the small sample size, two-tailed independent sample t-tests revealed no statistical significance between adherence, body esteem, eating attitudes, caloric intake, BMIp, and %IBW. Therefore, results of the study indicate that in the population of all adolescents with CF, based on the results of this study, one cannot predict differences in BBS, EAT-26, EER, BMIp, or %IBW based on the individuals’s adherence category.
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    Body esteem, eating attitudes, and adherence in adolescents with cystic fibrosis from Atlantic Canada.
    (2009-04-21T13:58:20Z) Faulkner, Colleen; Taper, Janette
    A study was conducted to investigate the influence of body esteem, nutritional status, nutritional intake, and eating attitudes on adherence to dietary therapy and enzymes in adolescents and young adults with cystic fibrosis. Nine adolescents aged 12.5 to 18 years from the CF clinics at the IWK (Halifax, NS) and the Janeway (St. John’s, NL) participated in the study. The participants completed the following surveys/tools: a Three-Day Food Diary, The Eating Attitudes Test-26 (EAT-26), The Body Esteem Scale for Adolescents and Adults (BES), and The Adherence Survey. Nutritional analysis determined that study participants had an average caloric intake of 2174 Cal. Only one participant met the adjusted Estimated Energy Requirement (EER + 20%), and was classified as being adherent to dietary therapy. The average Body Mass Index (BMIp) was at the 52nd percentile, and the average percent Ideal Body Weight (%IBW) was 100. None of the participants were classified as stunted, according to their height-for-age, but one was classified as wasted, according to his/her BMIp value. BES scores determined that participants have a relatively positive body esteem, with a mean score of 52.67, 57.25% of the highest possible score. Eating attitudes were also positive, for the most part. However, EAT-26 scores did reveal that one participant was at risk of developing an eating disorder, having a score over 20. In the study, adherence was defined as taking the same dose, or more, of a treatment as prescribed by a doctor and/or dietitian. Adherence to vitamins and nutritional supplements, when prescribed, was extremely poor, at 0%. Adherence to enzymes taken with meals and snacks was similar to rates in the literature, with 56% being adherent. Common reasons cited for non-adherence included forgetfulness, an absence of positive results, time and effort consuming, and a dislike of taking the treatment in front of others. Due to the small sample size, two-tailed independent sample t-tests revealed no statistical significance between adherence, body esteem, eating attitudes, caloric intake, BMIp, and %IBW. Therefore, results of the study indicate that in the population of all adolescents with CF, based on the results of this study, one cannot predict differences in BES, EAT-26, EER, BMIp, or %IBW based on the individuals’s adherence category.
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    Breastfeeding Mothers’ Experiences with Infant Feeding: An Interpretive Phenomenological Analysis
    (Mount Saint Vincent University, 2017) Goulden, Ami
    Introduction: Responsive feeding is a reciprocal relationship between infant and caregiver whereby the baby’s feelings of hunger and satiety are recognized and responded to effectively. Responsive feeding and breastfeeding are accepted as ideal feeding methods by the NS Standards for Food and Nutrition in Regulated Child Care Settings and the World Health Organization. With an increasing reliance on child care, early child care centres may have an impact on infant feeding outcomes. The objective was to learn about the infant feeding experiences of mothers with infants in child care centres. Methods: This was a qualitative research study using an interpretive phenomenological approach. Purposive sampling was used to recruit six mothers of children between the ages of six and 18 months attending a child care centre in Halifax. The mothers all attempted breastfeeding and their child was already introduced to complementary foods. Data was collected through semi-structured interactive interviews. Results: Thematic analysis was used to analyze data with the support of MAXQDA. Five themes emerged from the mothers’ stories: infant feeding burden, weaning stress around the “first-year”, resources and recommendations, children’s agency, and child care centre partnership. Conclusion: The areas needing further research and exploration are identified as well as recommendations for current practice.
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    Breastfeeding support in Nova Scotia: Exploring the gap between policy, health professionals’ work practices and the everyday experience of mothers facing food insecurity.
    (Mount Saint Vincent University, 2016-10-06) Waddington, Madeleine
    Background: Breastfeeding is an important contributor to household and community food security. However, lower breastfeeding rates among low-income families represent a health inequity with negative impacts on infant, household and community food security, as well as the health of future generations. Furthermore, despite breastfeeding and food security being public health priorities in Nova Scotia (NS), compared with the rest of Canada, Nova Scotian mothers have lower breastfeeding initiation and duration rates, and relatively higher rates of food insecurity. Although there is some research suggesting why these disparities occur, the direct impacts of the experience of food insecurity on infant feeding decisions are not well understood. Purpose: This research explores the experience rural NS mothers facing food insecurity in making infant feeding decisions. It aims to explicate the social interactions between mothers and health professionals (HPs), including but not limited to PHNs, and how they are shaped by institutional factors at the health system level that pose structural barriers to breastfeeding among this population. Methods: Phase 1 involved secondary data analysis of interviews and focus groups conducted among mothers who both met and did not meet their breastfeeding goals. Transcripts were selected for analysis based on the vulnerability of participants to food insecurity, identified by transcript content or recruitment channels. Phases 2 and 3 involved primary data collection through in-depth interviews using a critical health literacy perspective; all participants were recruited from Antigonish, Guysborough or Cape Breton Island. Phase 2 interviews were conducted with 5 mothers who recently breastfed (or tried to breastfeed) and had experienced food insecurity, as identified by the Household Food Security Survey Module. Phase 3 interviews were conducted with 5 PHNs working in breastfeeding promotion. Results: Perceptions of HPs as “experts” may influence mothers’ decisions to breastfeed; however, “breast is best” discourse can contribute to feelings of shame and guilt when breastfeeding is unsuccessful. Most mothers had positive experiences with PHNs and other HPs and felt their support was important to achieving success with breastfeeding. However, mothers also recognized the importance of peer support in empowering mothers to trust their own experiential knowledge, allowing them to reject expert discourse and to make infant feeding decisions that were appropriate for their life circumstances. Although almost all participating mothers in Phase 2 mentioned cost savings as a key motivation for breastfeeding, some described a lack of nutritious food for themselves as a significant breastfeeding barrier, showing how food and income supports can be important in helping to alleviate stress around their own food intake and their ability to successfully breastfeed. In contrast, PHNs interviewed did not perceive food insecurity itself as a barrier to breastfeeding, but described how stressful life circumstances associated with food insecurity make breastfeeding more difficult. Despite this understanding, PHNs described a limited ability to address food insecurity among breastfeeding mothers in their practice. PHNs descriptions of their role in breastfeeding support were often limited to information provision and encouragement only. Trends towards upstream, health promotion strategies in public health and recent changes in structure of the NS health system were barriers to providing vulnerable women living in rural communities with sufficient breastfeeding support. Conclusions & Recommendations: PHNs, as well as other HPs, can play an important role in supporting breastfeeding and enabling mothers to exercise autonomy in their infant feeding decisions. However, mothers vulnerable to food insecurity may require unique supports in order to successfully breastfeed. A breastfeeding literacy approach may help to situate breastfeeding within community food security, potentially countering unsupportive “breast is best” discourse. Ideally, a more critical approach combining both expert and experiential knowledge may help HPs to further understand the complexity of infant feeding, which in turn may empower mothers. These results also demonstrate a disconnection between breastfeeding as a named priority for public health and a lack of mandate to address food insecurity in PHNs’ practice. Policies around breastfeeding support should consider the first voice experience of mothers with experience of food insecurity to ensure that institutional changes do not disproportionately affect those vulnerable to food insecurity. Overall, achieving a balance between upstream action and individual support to address breastfeeding among mothers experiencing food insecurity will require thoughtful coordination of inter-professional practice across all levels of the NS health system.