Bringing the Public into Public Nutrition: How Engagement with Community-Based Participatory Action Research Has Informed Public Health Nutritionists’ Practice in Nova Scotia
Mount Saint Vincent University
Background: Food insecurity is associated with increased risk of disease and poor health and well-being. Nova Scotian households have consistently experienced some of the highest rates of food insecurity in the Canada with serious public health and social implications. Public Health Nutritionists (Nutritionists) have played an important role over the last two decades in helping to address food insecurity in Nova Scotia (NS) through their engagement in Community-Based Participatory Action Research (CBPR) through the Food Action Research Centre (FoodARC). Their significant contributions to the research have been explored, but the influence of their engagement on their own practice and capacities related to addressing food insecurity has not. Purpose: This thesis explored the question of how, if at all, engagement in CBPR has informed the work of Nutritionists in NS. More specifically, it aimed to explore the first-hand experiences of Nutritionists engaging in the CBPR partnership, how any capacities built had influenced Nutritionists’ practice, and to examine what may hinder or enable the ability of Nutritionists to address food insecurity as a part of PH. Methods: The study was completed in two phases using a qualitative, arts-informed, participatory research methodology that was informed by Institutional Ethnography (IE). Phase 1 involved four Nutritionists participating in a Photovoice study to explore their first–hand experiences of and critical reflections on their engagement in CBPR. Phase 2 involved conducting in-depth interviews with five key informants representing leaders within PH. Consistent with elements of IE, Phase 1 explorations were based in the first-hand experiences of Nutritionists and Phase 1 findings informed interviewee recruitment and the content of the interview questions in Phase 2. Results: It was evident from the findings of both phases that engagement in the CBPR had helped Nutritionists build capacities at the individual and organizational levels, including having improved individual and organizational understanding, skills, resources, commitment and partnerships. Although there were multiple barriers and enablers identified in both Phases, there were two enablers and three barriers that overlapped as significant. The enablers were: 1) employing a multidisciplinary and team approach within PH; and 2) having food insecurity named as a PH responsibility within several key PH documents. The barriers were: 1) limited resources within PH to address food insecurity; 2) lack of clarity and provincial PH planning around addressing food insecurity; and 3) having no formalized way to work collaborative across the PH system on food insecurity. Also significant was the finding that clarity was needed around the importance of the facilitational role that PH professionals play within the CBPR partnership. Conclusions/Recommendations: Overall, it was evident that this engagement had enabled the ability of Nutritionists and the PH system to address food insecurity in NS. The PH-academic-community partnership had helped to build a network of partners and created momentum in the work of addressing food insecurity years before it officially became apart of the PH agenda. Stemming from findings, various implications for dietetic training and practice, public health policy and strategy and future research are made. Focus is placed on ensuring the partnership between FoodARC and PH continue, encouraging PH to develop a provincial plan around addressing food insecurity with measurable targets, and investing in building further knowledge and understanding within PH around participatory research and facilitational advocacy role.
Food insecurity, Nova Scotia, nutritionists