Table of Contents

Purpose: Photovoice, an innovative qualitative research method in health care, has not been used to its full potential in nutrition/dietetics. We explored the use of Photovoice to determine perceived facilitators of and barriers to healthful eating among university students. Methods: The study included 28 students enrolled in a 2008 introductory nutrition class. The students participated in a camera orientation session to review ethics and privacy issues. They took photographs and selected two for discussion in a focus group moderated by a graduate student who used a semi-structured facilitation guide. Researchers coded the transcripts, analyzed the pictures and students’ written comments about the project, and ensured data trustworthiness through credibility, dependability, confirmability, and transferability of data and methods. Results: Six major themes emerged as facilitators and/or barriers: environment, nutrition knowledge, convenience foods, time, media influence, and food cost. More than onethird of the students thought the study “stimulated their critical thinking.” They felt more empowered in sharing their perceptions and “getting their voices heard.” Conclusions: Photovoice was a useful, “motivating,” and “engaging” method for research on nutrition knowledge and dietary patterns of university students. Registered dietitians and other health professionals may benefit from the use of the Photovoice method when they are working with students.

Purpose: We investigated barriers to healthful eating and vitamin/mineral supplement use among groups at risk for low nutrient intakes, particularly those with low income. Methods: Twelve focus groups (73 participants) and 11 key informant interviews were conducted in Saskatoon, Saskatchewan. Focus group participants represented a diverse population. Key informants included health professionals and personnel from community-based organizations who worked in a lowincome area. Focus group meetings and key informant interviews were audiotaped and transcribed; thematic coding was used to identify key concepts. Results: The focus groups and interviews revealed five themes on barriers to healthful eating and to the use of vitamin/mineral supplements: knowledge, income, accessibility, health, and preferences. Key informants were aware of the barriers, and were able to see not only individual and family reasons but also societal influences. Conclusions: The study results provide valuable information for focusing efforts on reducing barriers to healthful eating and to appropriate vitamin/mineral supplement use.

Purpose: We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. Methods: Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. Results:Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. Conclusions: Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.

Purpose: In order to understand policy-making capacities, we conducted an in-depth examination of three stages of the policy cycle (agenda-setting, formulation, and decision-making) leading to mandatory nutrition labelling, nutrient content claims, and health claims regulations in Canada. Methods: Data were collected through document review and key informant interviews (n=24) conducted with government, industry, health organizations, professional associations, academia, and consumer advocacy groups. Results: The policy-making processes were complex, unpredictable, and often chaotic. In the early stages, progress was hampered by a shortage of resources and negatively affected by policy silos. In spite of formidable barriers, a high degree of stakeholder convergence was achieved, which facilitated ground-breaking policy formulation. Success factors included a common health promotion issue frame that participants adopted early in the consultative process, “champions” within the federal government's health sector, strong advocates within a broad stakeholder community, and an innovative policy-formulation process overseen by an intersectoral advisory committee. Conclusions: Authentic partnerships among government, industry, and key stakeholders strengthened policy-making processes while helping to overcome policy silos at the organizational level. Barriers were reduced through effective change management practices and collaborative advisory and communication processes. Future research should involve an examination of the population health outcomes associated with this policy initiative.