Store turnover: Trends in dietary quality at RFNC canteen
In 2005, the canteen bought apples, pears, oranges, pineapples rockmelons and lettuce. In 2006, these lines were continued, with the addition of mandarins, grapes and honeydew melons, carrots, cauliflowers, tomatoes and onions. There was also a shift to buying 100% fruit juices, which have less sugar and more vitamins than lemonade and cola drinks. Fresh beef and chicken were introduced in 2006. These were barbequed, and salad rolls and sandwiches were made on site.
The food groups supplied for 2005 and 2006 are shown in Table
2. To adjust for variations in total amount sold, we expressed the amount of nutrient or food as a density per megajoule (Mj) offered in that year. For context, observed nutrient densities are reported beside "suggested dietary targets" for lowering risk of chronic disease [
36]. In general, the latter equate to the 90
th percentile of daily intake in the Australian population, and are thus somewhat higher than conventional 'recommended daily intakes' which relate to prevention of overt symptoms of nutrient deficiency. Observed food group densities are reported alongside NHMRC core food group recommendations [
23]. For both food and nutrient variables, a density per Mj consistent with a healthy food supply was calculated by dividing the suggested or recommended value by 10 Mj (that is, an estimate of typical daily energy requirement) [
36].
Table 2
Trends in food groups and selected nutrients at RFNC canteen.
Foods
| | | |
fresh fruit, g | 47 | 80 | 33 |
fresh vegetables, g | 1.1 | 2.0 | 31 |
breads, flour, g | 9.3 | 17.6 | 20 |
fresh meat and eggs, g | 1.8 | 8.4 | 10 |
milk and cheese, g | 20 | 24 | 24-72 |
pies, pasties, sausage rolls, g | 14 | 10 |
n/a
|
cakes, sugar, confectionary, g | 13 | 10 |
n/a
|
Nutrients
| | | |
fibre, g | 2.0 | 2.5 | 3.3 |
vitamin E, μg | 0.41 | 0.25 | 1.7 |
vitamin A, μg b
| 39 | 32 | 136 |
vitamin C, mg | 19 | 31 | 21 |
folate, μg | 17 | 25 | 60 |
potassium, mg | 265 | 293 | 470 |
sodium, mg | 364 | 359 | <160 |
There were increases in the contribution of fresh meat and eggs, fruit, vegetables and bread/flour, and decreases in cakes and confectionary and pies. Micronutrient data showed increased densities of vitamins A and C and folate over time and a small but favourable trend in the ratio of sodium to potassium in the food supply (Table
2). The contribution of macronutrients to energy in 2005 and 2006 are shown in Table
3, next to suggested densities. The change from 2005 to 2006 was towards the recommended macronutrient composition, including a reduction in total fat content to within the recommended range [
36] and a fall in total sugar content.
Table 3
Contribution to Energy from macronutrients
protein | 9.7% | 13.5% | 15-25% |
total fat | 37.3% | 31.9% | 20-35% |
saturated fat | 15.8% | 13.6% | <10% |
carbohydrate | 53.0% | 54.7% | 45-65% |
sugars | 31.4% | 23.3% | n/a |
By 2006, the nutrition environment was consistent with the characteristics of a healthy food supply with respect to fruit, dairy products and total fat and carbohydrate content, and approached recommended contents of bread/flour, meat and protein. Saturated fat content remained higher and fibre lower than recommended. For micronutrients in relation to minimal risk of chronic disease, vitamin C content met suggested targets, while the fat soluble vitamins E and A were lower than optimal in 2005 and decreased in parallel with the fall in total fat. Sodium and potassium remained less than ideal for chronic disease prevention (although potassium content approached the more conservative "recommended daily intake" equivalent of 330 mg/Mj).
Ecological analysis
Results of the ecological analysis are summarised in Table
4. The coding of each activity is described below. In each case HP refers to the health promotion program and the ultimate target is 'IND' referring to all individuals who are part of the target population: the Goulburn Murray Aboriginal community.
Table 4
Characteristics of the six program areas with respect to the ecological model of health promotion
Health Summer School
| Indigenous community (COM) | practitioners themselves | HP → IND |
| | Organisational capacity | HP → ORG → IND |
Hungry for Victory
| RFNC (ORG) | | |
Program launch | | U17 footballers | HP → IND; HP → [IND-IND] |
Breakfast program | | U17 footballers | HP → IND; HP → [ORG-ORG] → IND |
Nutrition workshops | | U17 footballers & netballers | HP → IND |
Mentoring program | | U17 & U14 footballers | HP → INT → IND |
Fruit Share
| RFNC (ORG) | RFNC attendees, club | HP → IND; HP → ORG → IND |
Focus groups on guidelines
| Indigenous community (COM) | Participants | HP → IND |
| | Organisational partnership | HP → [ORG-ORG] → IND |
Women's Wellbeing Group
| VMAMS (ORG) | community women | HP → IND; HP → [IND-IND] |
| | Organisational partnership | HP → [ORG-ORG] → IND |
10-Week body Challenge
| RAC (ORG) | workplace | HP → ORG → IND |
| | RAC-RFNC outreach | HP → [ORG-ORG] → IND |
| | RAC staff (IND) | HP → IND |
Total
|
2
| |
5
|
Health Summer School: a five-day course which provided participants with updated knowledge in nutrition and a forum to develop programs to be implemented back in the community. Since the participants in the summer school were members of the Aboriginal community, and the course acted to increase their nutritional knowledge, this direct effect is coded as HP → IND. The course also acted to increase health promotion program development capacity within the organisations by educating the practitioners to implement programs back in the community. This strategy is coded as HP → ORG → IND.
Hungry for Victory: a nutrition program for junior footballers at RFNC included education, match-day breakfasts and mentoring. It aimed to improve the nutritional knowledge and dietary intake of participants by focusing on the relationship between nutrition and sporting performance. The activity comprised four distinct parts. The first part was a program launch where following speeches each participant was presented with a t-shirt and drink bottle bearing the program logo. This aimed to motivate participants (HP → IND) and foster team spirit (HP → [IND-IND]). The second part involved the provision of a healthy breakfast to the U/14 footballers on home-game days. The objective was both to provide a healthy breakfast (HP → IND) and build friendly relationships between opposition teams (HP → [ORG - ORG] → IND) with the view that this contributes to an environment of healthy eating, which transcends inter-club rivalry. Nutrition workshops were included in the coaching program and aimed to improve knowledge of how nutrition impacts on football performance (HP → IND). The mentoring activity targeted the individual via an interpersonal relationship (HP → INT → IND). In total there were four different strategies used in this activity in one setting (the sporting club);
Fruit-Share aimed to improving the dietary quality of food supplied at RFNC. Fruit was purchased and provided to players and other members on practice and game days (HP → IND), and the nutritional value of food purchased for the canteen was improved. The intermediary target in this case was the organisation (HP → ORG → IND). The activity used two strategies in a single setting.
Focus groups aimed at reviewing and re-designing nutrition guidelines for the target community were conducted with a cross-section of community members in a range of community centres (27 participants, 11 men and 16 women). An educational component to the focus groups aimed to inform participants about the current guidelines (HP → IND). The focus groups also brought representatives of community organisations together to share information and discuss 'whole-of-community' nutrition strategies that would ultimately improve individual food choices (HP → [ORG-ORG] → IND). Thus there were two strategies employed in a single setting (the community);
Cummeragunja Women's Wellbeing Group: a weekly self-directed health-focused meeting for women at Cummeragunja facilitated RFNC staff, targeted the health and wellbeing of the women (HP → IND) and depended on the interaction between participants to share information and ideas (HP → [IND-IND]). In addition, this activity required sharing of resources between the two organisations (HP → [ORG-ORG] → IND). The setting for this activity was the organisation; and lastly
10-week body challenge: a workplace-based activity at Rumbalara Aboriginal Co-operative where a group of employees aimed to achieve 10,000 steps per day for 10 weeks facilitated by RFNC staff. The targets for this activity were three-fold: the workplace itself (eg. provision of pedometers and training to staff) (HP → ORG → IND), the outreach partnership between the sporting club and the workplace (HP → [ORG-ORG] → IND), and the staff themselves (HP → IND). Thus in total there were three strategies in a single setting.
As a whole, the entire program used five different strategies across two settings (organisation and community), receiving a score of 3 of a possible 4 (see Table
1). This shows a high level of consistency with the ecological approach [
33,
37]