Search

Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women’s expectations and goals; (2) the need for flexible, multimodal healthcare; and (3) information sharing throughout antenatal care not meeting women’s information needs. Interventions to improve women’s engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their individual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.

Objectives: Our aim was to incorporate body composition assessment (BCA) into dietetic department procedures using interventions tailored to previously identified barriers and enablers. Introduction: BCA is recommended as part of routine malnutrition assessment and follow-up but is not yet part of usual care. Methods: Evidence-informed strategies to overcome barriers and enablers were operationalized and delivered as three overarching interventions: upskilling (professional development strategy), modelling and reducing fear of change (Clinical Champion project), and embedding as usual practice (departmental integration). Process evaluation assessed intervention fidelity. A survey assessed utilization of BCA devices, (perceived) competency, and attitudes of clinical dietitians towards BCA before and after interventions. Results: Two of the three elements were incorporated as planned (upskilling and embedding as usual practice), with one element (modelling and reducing fear of change) modified through iterative processes. The Clinical Champion project ran for 12 rather than 6 months, and resulted in the majority of champions confident with their skills, completing BCA within their daily clinical workload and feeling BCA was useful. Pre-surveys and post-surveys within the department of 26 dietitians showed a marked reduction in most perceived barriers and improved recognition of enablers across all theoretical framework domains; with a large proportion of 'not applicable' responses given for many barriers at follow-up. Conclusion: This evidence-informed implementation strategy successfully integrated BCA into dietitians' practice and departmental processes highlighting direction for future service changes. Continual assessment of barriers and success of integration into routine workloads is required to facilitate this.

BACKGROUND: Dietary composition influences the composition of the gut microbiota in healthy adults. Little is known about the effect of dietary patterns on gut microbiota composition in pregnancy. This cross-sectional study aimed to investigate the associations between two diet quality scores adapted from the Australian Recommended Food Score (ARFS) and the Mediterranean Dietary Score (MDS) with the composition of the gut microbiota in pregnant women with excess body fat at 28 weeks' gestation. METHODS: Women from the Study of Probiotics IN Gestational diabetes (SPRING) who had completed a food frequency questionnaire (FFQ; n = 395) were classified according to tertiles of ARFS and the MDS. Higher dietary pattern scores in both the ARFS and the MDS represent better diet quality. Gut microbiota composition was assessed using 16S rRNA gene amplicon sequencing and analysed using MicrobiomeAnalyst in a subset of 196 women with faecal samples. RESULTS: No significant difference was found in alpha or beta diversity. A higher ARFS was associated with a higher abundance of Ruminococcus and lower abundance of Akkermansia, whereas a higher MDS was associated with a higher abundance of Ruminococcus and Butyricicoccus, though these changes disappeared after correction for multiple testing. CONCLUSION: These results suggest that dietary patterns defined by the ARFS and MDS were not associated with gut microbiota composition in pregnant women classified as overweight and obese at 28 weeks' gestation within this study.

INTRODUCTION AND AIMS: Dissemination and local adaptation of best practice models of care are often poorly achieved in knowledge translation processes. Understanding and documenting the iterative cycles of improvement can elucidate barriers, enablers and benefits of the process for future adoption and service integration improvements. This project examined the process of local adaptation for a third stage translation of a gestational diabetes dietetic model of care through collaboration with two Queensland (Australia) hospitals. METHODS: Using a hub (research team)-spoke (sites) model, two Queensland Hospital and Health Service Districts were supported to assess and address evidence-practice dietetic model of care gaps in their gestational diabetes mellitus (GDM) services. Sites selected demonstrated strong GDM team cohesiveness and project commitment. The project phases were: Consultation; Baseline; Transition; Implementation; and Evaluation. RESULTS: Despite strong site buy-in and use of a previously successful model of care dissemination and adoption strategy, unexpected global, organisational, team and individual barriers prevented successful implementation of the model of care at both sites. Barriers included challenges with ethics and governance requirements for health service research, capacity to influence and engage multidisciplinary teams, staff turnover and coronavirus disease 2019's (COVID-19's) disruption to service delivery. CONCLUSION: This third iteration of the dissemination of a best practice model of nutrition care for GDM in two Queensland Hospital and Health Service Districts did not achieve successful clinical or process outcomes. However, valuable learnings and recommendations regarding future clinical and research health service redesign aligned with best practice are suggested.

Introduction and aims: Clinicians understanding and applying the skills of knowledge translation is essential for the delivery of high value, effective health care. However, many clinicians lack confidence and capacity to undertake knowledge translation. Our team recently piloted a group telementoring knowledge translation support service (KTSS) with allied health professionals (AHPs) undertaking knowledge translation in their practice. This article aims to investigate barriers and enablers to participants’ participation and identify evidence-based strategies to improve future delivery of the initiative.Methods: The evaluation utilized semistructured interviews with participants who completed the first KTSS. Interview transcripts were analysed to identify key themes and subthemes. Subthemes were also mapped to an implementation science framework and model (theoretical domains framework and behaviour change wheel) to guide evidence-based identification of effective strategies to address, overcome, or enhance issues raised.Results: Six of the nine participants invited were interviewed. Five barriers and six enablers of KTSS participation, and five improvement ideas for a future KTSS program, were suggested. Barriers included knowledge gaps, competing time demands, and organizational expectations. Enablers included organizational support, motivation and preparation, and local champions. Additional strategies included additional preparation, an initial rapport building session, and strategies to meet the emotional needs of the participants. These were reinforced by the framework mapping results, with the further addition of a peer modelling strategy.Conclusion: Through a qualitative methodology we have examined and identified the experiences of AHPs who have participated in a knowledge translation telementoring program with clear strategies to enhance further programs offered.

Background: Room Service is a hospital meal service model with demonstrated improved nutrition intake, reduced wastage and cost benefits in some settings compared with traditional models. However, uptake across public hospital settings appears low; the underlying reasons require exploration. In 2019, Room Service was introduced in a Queensland Hospital and Health Service site. The aim of this paper is to identify the barriers and enablers to implementing Room Service to provide recommendations for future implementation of this model. Methods: This qualitative descriptive study utilised semi-structured interviews with staff involved in implementation of the Room Service meal delivery model at The Prince Charles Hospital (Queensland, Australia). A purposive sample of project members and key stakeholders were recruited. Interviews explored project experiences from commencement to completion, barriers and enablers to implementation, strategies to overcome challenges and recommendations for implementation at other sites. Interviews were coded to identify themes and sub-themes. Results: Nine participants were interviewed. Key themes with associated sub-themes were (I) Foundations of transformation; (II) Navigating implementation; and (III) Embedding sustainable practices.Conclusions: This study adds rich information to understand factors that support the implementation of a room service model in a large public hospital. Future implementation of room service should not only consider measuring quantifiable outcomes, but also the importance of qualitative descriptive studies surveying project members and key stakeholders to further explore experiences, barriers and enablers to implementation and develop strategies to overcome challenges to assist further sites implement this model.

Aim: Modifiable behaviours during the first 1000 days of life influence developmental trajectories of adult chronic diseases. Despite this, sub-optimal dietary intakes during pregnancy and excessive gestational weight gain are common. Very little is known about partners' dietary patterns and the influence on women's pregnancy dietary patterns. We aimed to examine dietary intake during pregnancy among women and their partners, and gestational weight gain patterns in the Queensland Family Cohort pilot study. Methods: The Queensland Family Cohort is a prospective, observational study piloted at a Brisbane (Australia) tertiary maternity hospital from 2018 to 2021. Participant characteristics, weight gain, dietary and nutrient intake were assessed. Results: Data were available for 194 pregnant women and their partners. Poor alignment with Australian Guide to Healthy Eating recommendations was observed. Highest alignment was for fruit (40% women) and meat/alternatives (38% partners) and lowest for breads/cereals (

Aim: Implementation science theories, models and frameworks help to address evidence-practice gaps, which have increasing importance for dietetic practice. This paper aims to provide dietitians with insight into how implementation science can be applied to practice, using multiple ‘real-life’ case studies. Methods: Three case studies were purposively selected across areas of dietetics practice to demonstrate application of commonly-used implementation theories, models and frameworks. Reflections from the authors were provided in response to a structured set of questions outlining how the theoretical approach was selected and used, and considerations for future application. Within and cross-case analysis was undertaken. Results: Dietitians used diverse implementation theories, models and frameworks to identify barriers and enablers, to plan for implementation, and to guide the selection of implementation strategies. Implementation theory was used to evaluate the implementation process in one case study. Cross-case analysis identified that mentoring by those with implementation expertise, multidisciplinary implementation teams, and leadership and investment in research and translation at an organisational and departmental level as key enablers. Conclusions: This paper offers dietitians insight into how implementation science can be applied to improve the uptake of evidence-based practices within nutrition and dietetics, and suggests that there needs to be investment in implementation science as a foundation science within nutrition and dietetics, including education, training and mentoring for dietitians.

There is little known about nutrition intervention research involving consumer co-design. The aim of this scoping review was to identify and synthesise the existing evidence on the current use and extent of consumer co-design in nutrition interventions.This scoping review is in line with the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute using an adapted 2weekSR approach. We searched Medline, EMBASE, PsycInfo, CINAHL and Cochrane. Only studies that included consumers in the co-design and met the 'Collaborate' or 'Empower' levels of the International Association of Public Participation's Public Participation Spectrum were included. Studies were synthesised according to two main concepts: (1) co-design for (2) nutrition interventions.The initial search yielded 8157 articles, of which 19 studies were included (comprising 29 articles). The studies represented a range of intervention types and participants from seven countries. Sixteen studies were published in the past 5 years. Co-design was most often used for intervention development, and only two studies reported a partnership with consumers across all stages of research. Overall, consumer involvement was not well documented. No preferred co-design framework or approach was reported across the various studies.Consumer co-design for nutrition interventions has become more frequent in recent years, but genuine partnerships with consumers across all stages of nutrition intervention research remain uncommon. There is an opportunity to improve the reporting of consumer involvement in co-design and enable equal partnerships with consumers in nutrition research.

Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and a significant clinical and public health problem with lifelong and intergenerational adverse health consequences for mothers and their offspring. The preconception, early pregnancy, and interconception periods represent opportune windows to engage women in preventive and health promotion interventions. This review provides an overview of findings from observational and intervention studies on the role of diet, physical activity, and weight (change) during these periods in the primary prevention of GDM. Current evidence suggests that supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy and enabling women to optimize their weight and health behaviors prior to and between pregnancies have the potential to reduce rates of GDM. Translation of current evidence into practice requires further development and evaluation of co-designed interventions across community, health service, and policy levels to determine how women can be reached and supported to optimize their health behaviors before, during, and between pregnancies to reduce GDM risk.

txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m2, between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans.

Background Implementation science aims to embed evidence-based practice as ‘usual care’ using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). Method Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. Results This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. Conclusion This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.

Background Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at Results Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID) DERR1-10.2196/27196

Background: Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). However, limited literature exists regarding integration of BCA into routine practice. This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.Methods:Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians in our department. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. Results:Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. Conclusions:This study showed that hospital dietitians experience numerous individual, team, and organisational barriers to adopt BCAs in clinical practice. Information on barriers and enablers and implementation strategies have been suggested to overcome these barriers to assist BCA adoption into routine practice.

OBJECTIVE Given the role of gut microbiota in regulating metabolism, probiotics administered during pregnancy might prevent gestational diabetes mellitus (GDM). This question has not previously been studied in high-risk overweight and obese pregnant women. We aimed to determine whether probiotics (Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis) administered from the second trimester in overweight and obese women prevent GDM as assessed by an oral glucose tolerance test (OGTT) at 28 weeks’ gestation. Secondary outcomes included maternal and neonatal complications, maternal blood pressure and BMI, and infant body composition. RESEARCH DESIGN AND METHODS This was a double-blind randomized controlled trial of probiotic versus placebo in overweight and obese pregnant women in Brisbane, Australia. RESULTS The study was completed in 411 women. GDM occurred in 12.3% (25 of 204) in the placebo arm and 18.4% (38 of 207) in the probiotics arm (P = 0.10). At OGTT, mean fasting glucose was higher in women randomized to probiotics (79.3 mg/dL) compared with placebo (77.5 mg/dL) (P = 0.049). One- and two-hour glucose measures were similar. Preeclampsia occurred in 9.2% of women randomized to probiotics compared with 4.9% in the placebo arm (P = 0.09). Excessive weight gain occurred in 32.5% of women in the probiotics arm (55 of 169) compared with 46% in the placebo arm (81 of 176) (P = 0.01). Rates of small for gestational age ( CONCLUSIONS The probiotics used in this study did not prevent GDM in overweight and obese pregnant women.

Aim: Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey. Methods: During 2014–2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays. Results: A greater proportion of women accessed the nutrition services in 2014–2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre-pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014–2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P < 0.001) over time. Conclusions: Evidence-based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness-raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes.

Aim: Failure to translate research into practice is common. The present study implemented an evidence-based model of care to address identified evidence-practice gaps in our department's weight management service. Methods: Implementation science frameworks were used to identify barriers to best practice and determine appropriate strategies to overcome them. No practice change occurred pre-implementation. The new model of care incorporated evidence-based interventions into a flowchart, supported by written resources, and integrated routine data collection into clinic processes. Alignment with a statewide telephone counselling program enhanced service capacity. Data were collected for adult patients whose primary intervention was weight management at a South-East Queensland hospital and included service attendance metrics, anthropometry, diet quality, and interventions delivered, and were compared with guidelines. Change in outcomes was calculated at 3 months after initial appointments. Results: Pre-implementation, 69.2% (n = 91) of patients referred were seen by a dietitian. During the new model of care (n = 60), over half (63.3%) were referred to telephone counselling. The remainder were triaged according to the flowchart with 100% attendance. Guideline adherence for reviews significantly increased over time (4.4%–50%, P < 0.001). Follow-up data were available for 31.3% and 54.5% of the pre-implementation and new model of care patients, respectively. No significant differences were observed between outcomes. Conclusions: The present study demonstrated successful implementation of weight management guidelines within routine clinical care. Following a systematic assessment of existing evidence-practice gaps resulted in a pragmatic evidence-based model of care that could be delivered within service capacity.

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. 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. 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 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.

Studies of obstetric outcomes in women consuming low-carbohydrate diets have reported conflicting results. Most studies have defined low-carbohydrate diets by the percentage that carbohydrates contribute to overall energy intake, rather than by an absolute amount in grams per day (g/d). We hypothesised that a low absolute carbohydrate diet affects obstetric outcomes differently than a low percentage carbohydrate diet. Dietary data were collected from overweight or obese women in the Study of Probiotic IN Gestational diabetes at 16- and 28-weeks’ gestation. Obstetric outcomes were compared between women whose carbohydrate intake was in the lowest quintile vs quintiles 2–5. Mean gestation was increased in women whose absolute carbohydrate intake was in the lowest quintile at 16 and at both 16- and 28-weeks’ gestation compared with all other women (16: 39.7 vs. 39.1 weeks, p = 0.008, 16 and 28: 39.8 vs. 39.1, p = 0.005). In linear regression analysis, a low absolute carbohydrate intake at 16 and at 28 weeks’ gestation was associated with increased gestation at delivery (16: p = 0.04, adjusted R2 = 0.15, 28: p = 0.04, adjusted R2 = 0.17). The coefficient of beta at 16 weeks’ gestation was 0.50 (95% CI 0.03–0.98) and at 28 weeks’ gestation was 0.51 (95%CI 0.03–0.99) meaning that consumption of a low absolute carbohydrate diet accounted for an extra 3.5 days in gestational age. This finding was not seen in women whose percentage carbohydrate intake was in the lowest quintile. Low-carbohydrate consumption in pregnancy is associated with increased gestational age at delivery.

To what extent have the characteristics and needs of pregnant women changed over time? This cross-sectional, comparative study describes some socio-demographic, mental health and lifestyle characteristics of two samples of pregnant women assessed 30 years apart.We recruited two samples of pregnant women who were attending their first clinic visit at the same large Queensland maternity hospital 30 years apart between 1981 to 1984 (Sample A, N=6753) and 2011-2012 (Sample B, N=2156). The women were compared using the same survey tool. Descriptive statistics are presented. Pearson's chi-square tests were undertaken (significance at0.05) to determine how the characteristics and needs of pregnant women may be changing over time.Women, recently sampled, were older, more highly-educated and were more likely to be living with, but not married to, their partners, as well as having their first baby, than were women 30 years ago. As well, recently sampled, pregnant women were more likely to be non-smokers, to have higher body mass indexes and more symptoms of anxiety, but were less likely to be having an unplanned pregnancy.This study found a number of differences between the socio-demographic characteristics, lifestyles and mental health of two samples of pregnant women assessed 30 years apart. Our findings suggest the need for ongoing monitoring of pregnant women to determine changing health priorities. Being more educated, today's women may be more amenable to health education interventions. Higher body mass indexes for recently sampled women, highlights an emerging problem that needs to be addressed.

AimThe aim of the present study was to develop a parent-reported tool that will measure health-related quality of life (HRQoL) in children following ketogenic diet (KD) therapies for refractory epilepsy once it has been pilot tested and analysed.

This study aimed to determine dietitians' familiarity with knowledge translation (KT), confidence in undertaking KT, and preferences for receiving KT training. An online questionnaire was designed and disseminated to all dietitians working across hospital and health services in Queensland, Australia, for completion over a 6-week period (April-May 2018). Of the 124 respondents, 69% (n = 85) reported being familiar with KT, but only 28% (n = 35) reported being confident in applying KT to their practice. Higher confidence was reported with problem identification, evidence appraisal, and adapting evidence to local context, compared with implementation, evaluation, and dissemination. Almost all respondents reported an interest in learning more about KT (n = 121, 98%), with a preference for easily accessible and short "snippets" of training aimed at beginner-intermediate level. Lack of management support, difficulty attending multi-day courses, cost, travel requirements, and lack of quarantined time were reported barriers to attending KT training. There is a high awareness and interest but low confidence in undertaking KT amongst dietitians. This highlights an opportunity for workforce development to prepare dietitians to be skilled and confident in KT. Training and support needs to be low-cost and multi-modal to meet diverse needs.

To determine the feasibility and effectiveness of an mHealth intervention promoting healthy diet, physical activity and gestational weight gain in pregnant women. Randomised controlled trial (RCT). Australian tertiary obstetric hospital. One hundred pregnant women who were overweight or obese prior to pregnancy. Women recruited at the first antenatal clinic visit were randomised to either an intervention or a control group. The intervention consisted of a tailored suite of strategies delivered (from first antenatal visit until 36 weeks' gestation) via multiple modalities available on mobile devices. The primary outcome was intervention feasibility and secondary outcomes were objectively measured changes in gestational weight gain (GWG) and self-reported dietary intake and physical activity. Ninety-one women completed the study. Delivery to protocol provides evidence of program feasibility. Most women engaged regularly with the program, with the majority (97.6%) reporting that the intervention was helpful. Secondary outcomes demonstrated a significantly lower GWG in the intervention group (7.8 kg ± 4.7 versus 9.7 kg ± 3.9; P =0.041) compared with the control group at intervention completion. Intervention group women reported significantly smaller reductions in total, light- and moderate-intensity physical activity from baseline to completion of the intervention (P = 0.001) compared with the control group, but no differences in consumption frequencies of key food groups. An intervention that aimed to deliver healthy diet, physical activity and GWG guidance utilising innovative technology can be feasibly implemented and produce positive physical activity and GWG outcomes. TWEETABLE ABSTRACT: txt4two mHealth study improved gestational weight gain and physical activity in pregnant women with high BMIs.

Aim Preterm birth has been described as a ‘nutritional emergency’, with these infants often born with minimal nutrition reserves. Failure to provide adequate early nutrition jeopardises growth and neurodevelopment. Consensual nutrition guidelines exist for infants who weigh

Background Pregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, evidence-practice gaps often exist. To address pregnancy weight management barriers, a stepped implementation science approach was used, comprising targeted in-services, provision of scales for clinic rooms, and changes to routine weight recording in a hospital electronic medical record. The aim of this study was to assess the cumulative influence of evidence-based interventions on staff’s compliance to recording of antenatal weights. Methods Retrospective data analysis of weight recording over three 15-month cohorts across April 2014–December 2017. Variables calculated from data included: proportion of women with weight recorded at booking and proportion of women who had a weight recorded at each visit. Generalised estimating equation modelling was used to examine differences in weight recording compliance rates between cohorts, pre-pregnancy body mass index categories, model of care and clinicians. Results There were approximately 13,000 pregnancies in each cohort. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts from 4.2% (baseline), 18.9% (scales and in-services) to 61.8% (medical record prompts), p

Aim To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science. Methods The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied. Results Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50). Conclusions We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit.

This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM). The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed. The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition. Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients.

The composition of the gut microbiota can be influenced by dietary composition. In pregnancy, the maternal gut microbiome has associations with maternal and infant metabolic status. There is little known regarding the impact of a vegetarian diet in pregnancy on maternal gut microbiota. This study explored the gut microbiota profile in women who were vegetarian or omnivorous in early gestation. Women were selected from participants in the Study of PRobiotics IN Gestational diabetes (SPRING) randomised controlled trial. Nine women identified as vegetarians were matched to omnivorous women in a 1:2 ratio. Microbiota analyses were performed using 16S rRNA gene amplicon sequencing and analysed using the Quantitative Insights Into Microbial Ecology (QIIME) and Calypso software tools. There was no difference in alpha diversity, but beta diversity was slightly reduced in vegetarians. There were differences seen in the relative abundance of several genera in those on a vegetarian diet, specifically a reduction in Collinsella, Holdemania, and increases in the relative abundances of Roseburia and Lachnospiraceae. In this sub-analysis of gut microbiota from women in early pregnancy, a vegetarian as compared to omnivorous diet, was associated with a different gut microbiome, with features suggesting alterations in fermentation end products from a mixed acid fermentation towards more acetate/butyrate.

Failure to translate research into practice is common. The present study implemented an evidence-based model of care to address identified evidence-practice gaps in our department's weight management service.Implementation science frameworks were used to identify barriers to best practice and determine appropriate strategies to overcome them. No practice change occurred pre-implementation. The new model of care incorporated evidence-based interventions into a flowchart, supported by written resources, and integrated routine data collection into clinic processes. Alignment with a statewide telephone counselling program enhanced service capacity. Data were collected for adult patients whose primary intervention was weight management at a South-East Queensland hospital and included service attendance metrics, anthropometry, diet quality, and interventions delivered, and were compared with guidelines. Change in outcomes was calculated at 3 months after initial appointments.Pre-implementation, 69.2% (n = 91) of patients referred were seen by a dietitian. During the new model of care (n = 60), over half (63.3%) were referred to telephone counselling. The remainder were triaged according to the flowchart with 100% attendance. Guideline adherence for reviews significantly increased over time (4.4%-50%, P0.001). Follow-up data were available for 31.3% and 54.5% of the pre-implementation and new model of care patients, respectively. No significant differences were observed between outcomes.The present study demonstrated successful implementation of weight management guidelines within routine clinical care. Following a systematic assessment of existing evidence-practice gaps resulted in a pragmatic evidence-based model of care that could be delivered within service capacity.

The gut microbiota contributes to the regulation of glucose metabolism in pregnancy. Abundance of the genus Collinsella is positively correlated with circulating insulin; however, it is unclear what determines Collinsella abundance. This study aims to validate the correlation between Collinsella and insulin and to elucidate if macronutrient intake alters Collinsella abundance and gut microbiota composition. Gut microbiota profiles were assessed by 16S rRNA sequencing in 57 overweight and 73 obese pregnant women from the SPRING (Study of PRobiotics IN Gestational diabetes) trial at 16 weeks gestation and correlated with metabolic hormone levels and macronutrient intake. Gut microbiota composition in the top and bottom 10% of dietary fiber intake was evaluated through network analysis. Collinsella abundance correlated positively with circulating insulin (rho = 0.30, p = 0.0006), independent of maternal BMI, but negatively with dietary fiber intake (rho = −0.20, p = 0.025) in this cohort. Low dietary fiber intake was associated with a gut microbiota favoring lactate fermentation while high fiber intake promotes short-chain fatty acid-producing bacteria. Low dietary fiber may enable overgrowth of Collinsella and alter the overall fermentation pattern in gut microbiota. This suggests that dietary choices during pregnancy can modify the nutritional ecology of the gut microbiota, with potential deleterious effects on the metabolic and inflammatory health of the host. Trial registration: ANZCTR 12611001208998, registered 23/11/2011

Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey.During 2014-2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays.A greater proportion of women accessed the nutrition services in 2014-2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre-pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014-2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P0.001) over time.Evidence-based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness-raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes.

Aim: Poorly controlled gestational diabetes mellitus can result in negative pregnancy and delivery outcomes. A reduced need for insulin was documented in the validation of American gestational diabetes Nutrition Practice Guidelines, which recommend at least three dietitian visits. No Australian gestational diabetes mellitus nutrition guidelines exist. This paper evaluates the implementation of a dietetic model of care based on the American guidelines in an Australian hospital. Methods: The implementation plan consisted of a nine-month pre (usual care)/post (new model of care) design with a month for ‘integration’ across 2012–2013. Primary outcomes were uptake of the new dietetic model of care and requirement for pharmacotherapy. Results: Both phases ran for seven months; integration required four months. Pre-intervention, only one woman received a review appointment. Significantly more women received best-practice care post-implementation (P = 0.02); of the 162 women seen, 50.6% received two review appointments. As a result of heavy clinical demand, only 31.5% of the women seen post-implementation received an individual dietitian assessment and education session, deviating from best practice. Clinically relevant changes were seen in medication requirements with a decrease in women requiring pharmacological treatment (31.1% (pre); 26.9% (post)). The difference was more pronounced in women who received best-practice care (27.2% (no) vs 25.0% (yes)). Conclusions: This project successfully increased the proportion of women seen according to best practice. Service limitations impaired the delivery of optimal care. The present study illustrates the opportunities and challenges of conducting evidence-based implementation research in routine clinical care.

Aims. To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m2to delay or prevent Type 2 Diabetes Mellitus.Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m2were randomized to an intervention (I) (n=16) or a control (C) (n=15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours.Results. Median (IQR) results were as follows: weight: I −2.5 (2.3) kg versus C +0.2 (1.6) kg (P=0.009), waist: I −3.6 (4.5) cm versus C −0.1 (3.6) cm (P=0.07), and hip: I −5.0 (3.3) cm versus C −0.2 (2.6) cm (P=0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition.Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.

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.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.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% (P0.001) (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).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.

Background A demonstrated link exists between maternal diet and maternal and infant health outcomes during and after pregnancy. A dietetic maternity service (0.6FTE for 3500 births) was introduced in 2012 at our hospital in a socially-disadvantaged area. We needed to develop evidence-based, patient-oriented improvements to nutrition services within resource limitations. Aim This cross-sectional study gathered knowledge, eating behaviours, and nutrition-related needs of our women ante- and postnatally to inform this process. Methods Women (≥18 years) admitted to the postnatal ward completed our survey. Data including dietary quality, nutritional knowledge and interest in nutrition education were collected. Analysis included descriptive, chi-squared and t-tests. Findings Three hundred and nine eligible women responded (28 ± 6 years, 27 ± 7 kg/m2 pre-pregnancy body mass index, 12% gestational diabetes). Two-fifths (42%) self-reported gaining excess weight during pregnancy. One quarter reported knowing their gestational weight gain goals, yet only 1.6% was correct. Half reported interest in receiving nutrition education during pregnancy and post-delivery (45%, n = 134; 43%, n = 123, respectively). Women had poor diet quality (daily serves – fruit: 1.8 ± 1.0; vegetables: 2.0 ± 1.2; dairy: 1.9 ± 1.2), despite identifying healthy eating as a personal priority. Nutrition topics requested included healthy eating for development of baby pre- and post-delivery and maternal weight management. Conclusion Women attending our hospital have dietary issues and levels of interest in nutrition similar to women in tertiary maternity centres. Service changes planned will explore formats that meet higher and lower education levels; group workshops may be supplemented by formats such as internet and DVD-delivered education to overcome access and literacy issues, respectively.

Introduction: Providing specialty trainees with take-home laparoscopic simulators may overcome known barriers to simulation-based surgical training such as limited time and access to equipment; however, programs utilising these simulators have reported suboptimal engagement from trainees. The purpose of this study was to understand factors influencing the use of take-home laparoscopic simulators and make suggestions to optimise engagement in future programs. Methods: We interviewed 10 of the 16 gynaecology trainees who participated in a take-home laparoscopic box trainer simulation program. Interview transcripts were analysed and themes sorted using the Theoretical Domains Framework. Articulation of these domains with the Behaviour Change Wheel directed the formulation of targeted interventions. Results: Trainees had positive attitudes towards simulation training; however, they experienced numerous under-recognised barriers to training. Trainees found their professional role, duties and competing life priorities limited time for training. Trainees experienced feelings of inertia and did not train as much as they anticipated. They were disengaged from training by a lack of real operating, a perceived poor relationship between training tasks and surgery and difficulties with equipment set-up. Self-directed practice, goal setting, task deadlines, perceived supervision, a recognition of personal skill development and an understanding of the need for simulation enabled training. Interventions were proposed to address the barriers to training. Conclusions: Trainee attitudes towards simulation and take-home trainers were positive, yet numerous barriers prevented them from training. Following a theory-driven process, we were able to devise targeted, evidence-based interventions, which may be incorporated into future versions of the program.

Postpartum weight retention can predict future weight gain and long-term obesity. Moreover, failure to lose weight gained during pregnancy can lead to increased body mass index for subsequent pregnancies, increasing the risk of adverse maternal and foetal pregnancy outcomes. This systematic review evaluates the effectiveness of lifestyle interventions aimed at reducing postpartum weight retention. Seven electronic databases were searched for intervention studies and trials enrolling women with singleton pregnancies and published in English from January 1990 to October 2012. Studies were included when postpartum weight was a main outcome and when diet and/or exercise and/or weight monitoring were intervention components. No limitations were placed on age, body mass index or parity. Eleven studies were identified as eligible for inclusion in this review, of which 10 were randomized controlled trials. Seven studies were successful in decreasing postpartum weight retention, six of which included both dietary and physical activity components, incorporated via a range of methods and delivered by a variety of health practitioners. Few studies utilized modern technologies as alternatives to traditional face-to-face support and cost-effectiveness was not assessed in any of the studies. These results suggest that postpartum weight loss is achievable, which may form an important component of obesity prevention in mothers; however, the optimal setting, delivery, intervention length and recruitment approach remains unclear.

Objective to investigate correlates of pregnant women's gestational weight gain (GWG) knowledge commensurate with GWG guidelines. Design cross sectional quantitative study. Setting an Australian tertiary level maternity hospital. Participants pregnant women ( n =1032) following their first antenatal visit. Measurements survey to assess GWG knowledge and a range of potential correlates of knowledge including socio-economic characteristics, pregnancy characteristics (parity, gestation, pre-pregnancy BMI) and GWG information procurement and GWG attitudinal variables. Findings participants ( n =366; 35.4% response) averaged 32.5 years of age with 33% speaking a language other than English. One third of women reported GWG knowledge consistent with guidelines. Women overweight prior to pregnancy were less likely to underestimate appropriate GWG (RRR 0.23, 95% CI=0.09–0.59). Conversely, women in the overweight (RRR 8.80, 95% CI=4.02–19.25) and obese (RRR 19.62, 95% CI=8.03–48.00) categories were more likely to overestimate GWG recommendations, while tertiary educated women were less likely to overestimate GWG (RRR 0.28, 95% CI=0.10–0.79). No associations were found between GWG knowledge and pregnancy, GWG information source or attitudinal variables. Conclusions and implications for practice the findings highlight women's lack of GWG knowledge and the role of pre-pregnancy body mass index and women's education as correlates of GWG knowledge. Women susceptible to poor GWG knowledge should be a priority target for individual and community-based education.