Monash University, Bachelor of Nutrition and Dietetics, Public Health and Community Nutrition Placement Project Abstracts 2014
Hayley Collins, Stephanie Morris, Nicola Antiglevich, Atlanta Miall, Nadia Hendricks, Josephine Muttray
Portland District Health / DWECH service
Melissa O'Loughlan, Katy Wood
Carisse Yap, Theresa Pham, Cor Tan, Brionaigh Buchanan
Victorian Aboriginal Controlled Community Health Organization
Beth VanLier, Vanessa Hillgrove
Bass Coast Shire
Lisa McGlashan, Synthia Chandru, Bethany Gilham
Latrobe Community Health Service / Latrobe City Council
Hannah Boreham, Ruby Brooks, Amy Burrowes, Cassandra Stuchbery, Saabira Wazeer
City of Greater Dandenong
Teigan Duketis, Himadi Gambrell, Victoria Laios, Erin Mechelen, Andrea Soh, Sarah Lang
Victorian Aboriginal Controlled Community Health Organisation
Megan Green, Jessica Hamilton
Nellie Baker, Anya Benoit, Marina Chan, Elysha Nheu, Fathima Muhajireen, Liyuan Hong
Peninsula Health- Health Promotion Team
Georgia Somers-Jones, Anita Lao
East Gippsland LGA
Alda Wu, Jasmine Lai, Lily Wong, Daniel Fun
Victorian Eco Innovation Lab
Cally Snare, Bianca Moleta, Margot Rogers, Joanna Joseph
Ballarat Community Health Service / Ballarat City Council
Karli Goegan, Rachael Ewert, Amy Knight, Sarah Busby
Peninsula Health Community Health Mornington
Caroline Deen, Gloria Leung, Li Wen Tay, Zi Toh, Vivian Tsang, Wing Wong
SecondBite's fifth Fresh NEDTM module:
Empowering Community Food Programs to Develop, Implement and Evaluate their own Nutrition Policy.
Nicola Antiglevich1, Hayley Collins1, Nadia Hendriks1, Atlanta Miall1, Stephanie Morris1, Josephine Muttray1, Liza Barbour2
1Monash University, Clayton, VIC, 3800, Australia 2 SecondBite, Kensington, VIC, 3031, Australia
Food insecurity is a significant issue affecting over one million Australians. Emergency Food relief (EFR) provided by Community Food Programs (CFPs) including soup vans, community kitchens and food pantries are the sole source of dietary intake for individuals relying on EFR. Evidence shows food provided does not meet the nutritional requirements of food insecure individuals. This project specifically focuses on the expansion of SecondBite's Nutrition Education Program (Fresh NEDTM) to include a fifth food and nutrition policy module, aiming to build capacity of staff and volunteers from CFPs to develop, implement and evaluate food and nutrition policies. Research into policies was conducted via consultation of Monash databases, Government websites and SecondBite resources. Key stakeholders interested in the project and experienced in policy process were consulted to gain insight into policy process' as well as potential ideas and barriers to the project. Key resources and documents were obtained to inform the module content. Pre- and post-evaluation surveys were developed to measure participants' self-perceived capacity to meet five learning objectives. The module was piloted with staff and volunteers from CFPs in Ballarat (n=4) and NSW (n=5). The percentage of participants who strongly agreed they met all five learning objectives increased seven fold- from 11% prior to participation, to 80% following participation in module five. SecondBite's fifth policy module has the potential to improve service delivery within individualised CFPs, however these results cannot be concluded from this work and should be made an area of future research.
Tailoring SecondBite's Fresh NED program to the Victorian Aboriginal Health Workforce.
Melissa O'Loughlan1 and Katy Wood1, Jennifer Browne2 and Liza Barbour3
Dhauwurd-Wurrung Elderly and Community Health service, Portland, VIC, 3305
1Monash University, Clayton, VIC, 3800 2Victorian Aboriginal Community Controlled Health Service Inc, Collingwood, VIC, 3066 3SecondBite, Kensington, VIC, 3031
Aboriginal people are five times more likely to be food insecure. Aboriginal health staff are in a position to address the issue, considering their health background and community acceptance. The aim of this study was to build the capacity of Dhauwurd-Wurrung Elderly and Community Health (DWECH) and Winda Mara Aboriginal Co-operation (WMAC) staff to assist in reducing food insecurity within Portland's Aboriginal community by tailoring SecondBite's Fresh NED program to Aboriginal health staff. Portland's Community Food Programs (CFPs) (n=10) and Aboriginal health staff from DWECH and WMAC (n=7) completed questionnaires. Draft materials were developed by the researchers based on own suggestions and from DWECH staff (n=2). Redrafts were completed before delivering the pilot session to Aboriginal health staff from various Aboriginal Community Controlled Health Organisations (n=5). Pre and post-pilot questionnaires and a focus group were completed. Questionnaire data were quantitatively analysed and focus group data were transcribed, coded and thematically analysed. CFP questionnaire data resulted in the program being targeted solely at Aboriginal health staff. Aboriginal Health Workforce questionnaire data resulted in Food Security and Keeping Track modules being tailored. Participants' (n=5) level of knowledge and confidence in module content increased significantly (p<0.05) for most parameters. Focus group data highlighted strengths, weaknesses and further tailoring recommendations. Results were used to develop recommendations for future program modification. The tailored program was successful in achieving objectives. Recommendations will ensure that the program is further modified so that Aboriginal health staff have the capacity to address food insecurity within their communities.
Title: Investigation of Nutrition Training for the Food Service Industry.
Brionaigh Buchanan1, Cor Nie Tan1, Theresa Pham1, Carisse Yap1, Beth Scholes2
1Monash University, Clayton VIC, 3800, Australia 2Heart Foundation Victoria, 500 Collins Street, VIC, 3000, Australia
There is an increasing trend to eat foods prepared away from home which are generally poorer in nutritional quality. The food service industry has a role to play in influencing population nutrition and the Heart Foundation has identified opportunities to increase the nutrition knowledge of chefs. This project aims to investigate the quality of nutrition content taught in current culinary curriculum and review the literature on chef education programs and identify stakeholders for future partnerships. Future training resource provided by Service Skills Australia was assessed against Australian Dietary Guidelines and Heart Foundation key messages. Surveys completed by culinary institutes focused on nutrition qualification of trainers and unit delivery methods. Literature on previous and current chef nutrition training interventions conducted nationally and internationally was reviewed. Stakeholder analysis was completed by mapping stakeholders based on their interest and power. The training resource met 89% of self-developed criteria based on Australia Dietary Guidelines and Heart Foundation key messages. Focus of the unit, resources utilised by culinary institutes, theory/practical breakdown of the unit and contact hour requirements varied across Victorian culinary institutes. Of the 11 interventions the key findings suggested strengths involved chef collaboration with nutritionist, participation incentives and professional development. Eight key stakeholders were also identified. The delivery of nutrition education varied across culinary institutes due to the vagueness of performance criteria, which allowed for misinterpretation amongst trainers. There is an opportunity for Heart Foundation to collaborate with stakeholders to advocate for standardisation of nutrition unit delivery methods and develop professional development programs in order to improve the nutrition knowledge of chefs.
Working together: evaluating the capacity of the current Aboriginal nutrition workforce in Victoria
Vanessa Hillgrove1, Beth Van Lier1 Jennifer Browne2, Claire Palermo1
1Monash University, Clayton, VIC, 3800 2Victorian Aboriginal Community Controlled Health Organisation, Collingwood, VIC, 3066
Aboriginal and Torres Strait Islander people (hereafter referred to as Aboriginal people) experience poorer health outcomes and a shorter life expectancy than non-Aboriginal people. The Aboriginal nutrition workforce is integral to reducing the burden of nutrition related disease in Aboriginal communities, due to the well-established link between nutrition and prevention of chronic disease. However, the size, focus and function of the current nutrition workforce available to Aboriginal people in Victoria are poorly understood. To determine the size, focus and function of the nutrition workforce, semi structured interviews were conducted with Aboriginal Community Controlled Health Organisation (ACCHO) practice managers (n=7) and surveys were conducted with a range of Aboriginal health employees from both ACCHOs (n=49) and mainstream health services (n=54). The multiple methods aimed to determine the size of the workforce, their roles, focus for action and facilitators and barriers to nutrition workforce development. Quantitative and qualitative data from these multiple mixed methods were analysed concurrently. The overall response rate was 38%. The nutrition workforce available to the Victorian Aboriginal community is between approximately 11 and 20 full time equivalents, comprised of full time and part time positions. ACCHO and mainstream employees defined the focus of their roles as 41% primary prevention, 30% secondary prevention and 26% tertiary prevention. The majority of programs aimed to develop personal skills (54%) and create supportive environments (28%) through healthy eating programs. Funding was identified as the major barrier to workforce development. A movement to upstream approaches to nutrition, appropriate partnerships and cross cultural training will contribute to an effective and sustainable Aboriginal nutrition workforce.
Obesity prevention: Where does local government fit in?
Synthia Chandru1, Beth Gilham1, Lisa McGlashan1, Kristen Yates-Matthews2
1 Monash University, Clayton, VIC, 3800, Australia 2 Bass Coast Shire Council, Wonthaggi, VIC, 3995, Australia
A systems-based approach to obesity prevention, where the environment in which a person lives, works and plays is changed to support healthy lifestyles, is emerging as the best method to address the obesity epidemic. However, lack of evaluations conducted on current systems-based obesity interventions illustrate the need to build the evidence to help guide development of effective future efforts. This study aimed to evaluate the Healthy Communities Initiative in the Bass Coast Shire to quantify the effectiveness of using a systems-based approach and assess capacity of local governments to deliver obesity prevention projects. All existing Bass Coast Shire Healthy Communities evaluation reports provided by the project supervisor were analysed. Qualitative interviews with stakeholders (n=8) and other Healthy Communities funding recipients (n=12) were conducted focusing on addressing the aim of the evaluation. Thematic analysis of reports and interview responses was structured on the Public Health Services and Systems Research framework. Results illustrate the Healthy Communities Initiative was effective as it utilised partnerships with stakeholders and targeted some of the determinants of health that contribute to obesity. Results further demonstrated that, with appropriate funding, councils are ideally placed to initiate health promotion projects. Where councils can initiate future effective prevention efforts is through addressing gaps identified from the evaluation including food supply and access, nutrition education and advocacy from within council. It is recommended that council act by creating supportive healthy eating environments, encouraging nutrition and physical activity education across the lifespan in settings, and establishing a health promotion role within council.
Catering for Healthier Workplaces: Investigating the supply of and demand for healthy food in Latrobe
Amy Burrowes¹, Cassandra Simone Stuchbery¹, Hannah Boreham¹, Ruby Brooks¹, Saabira Wazeer¹, Julia McCartan2
1Monash University, Clayton, VIC 3800 2HealthyTogerher Latrobe, Morewell, VIC
Healthy Together Latrobe is an initiative which aims to reduce overweight/obesity in Latrobe City which currently affects 61% of the population. This initiative has identified workplaces as an important setting for improving the health of employees. This study aimed to investigate the supply of, and demand for, healthy food in Latrobe City workplaces. This study interviewed workplaces who provided food to employees (n=19) and locally-owned caterers who provided catering to workplaces (n=16) in 2014. Participants were identified through local knowledge and snowball sampling. Interviews collected in-depth information regarding opportunities to access food in workplaces, attitudes, barriers, enablers, previous attempts and support required to provide healthy food. Interviews were audio-recorded and notes taken. The data was analysed qualitatively via thematic analysis and recommendations for action were developed. Caterers were mostly cafes/takeaway shops with catering services. Opportunities to access food in workplaces included: meetings, canteens, vending-machines, and fundraisers. Attitudes included: healthy food provision is/is not important; it is important to set good examples by providing healthy food; food culture is changing; and workplaces and caterers should provide healthy food however individuals are responsible for making choices. Barriers included: lack of capacity; unhealthy food culture; and demand for unhealthy/convenient foods. Enablers included: a healthy eating culture; organisational level support for healthy food provision; and a personal interest in healthy food. This study identified the key factors that affect supply of and demand for healthy food in workplaces. These factors should be considered in the planning of future interventions in workplaces and caterers.
Making healthy food choices easy choices in Greater Dandenong
Teigan Duketis1, Himadi Gambrell1, Ellouise Hickelton2, Kate Hills2, Victoria Laios1, Sarah Lang1, Erin Mechelen1, Andrea Soh1
1Monash University, Clayton, VIC, 3800, Australia 2Greater Dandenong City Council, Dandenong, VIC, 3175, Australia
Greater Dandenong developed four projects as part of Healthy Food Connect to improve access to nutritious food and promote the acceptability of a healthy food environment. This settings based approach uses multiple strategies to address the barriers community subgroups experience when making healthy food choices. Initial plans for a Healthy Dining Program were developed to improve the nutritional quality of food in local dining outlets. Interviews were conducted with coordinators of similar initiatives in other municipalities and evidence-based literature was analysed to determine an appropriate strategy for Greater Dandenong. To improve breastfeeding rates, interviews were conducted with the Australian Breastfeeding Association and maternal child health nurses. In conjunction with evidence-based literature, barriers to public breastfeeding and strategies to support breastfeeding were determined. The macronutrient profile of cultural meals was analysed to determine the nutritional quality of Greater Dandenong's multicultural food system. Twenty five cultural food samples underwent a laboratory analysis to determine the fat, sodium, carbohydrate, protein and energy content per 100g. Results indicated cultural cuisines contained similarly high amounts of fat and excessive sodium when compared to publically available nutritional panels of ten popular fast foods. Finally, initial plans have been devised for a Big Healthy Lunch event which will promote healthy eating in schools, workplaces and the community. These projects propose a range of strategies to change the current environment, based on the success of previous initiatives and needs of the community. This will provide the foundations for socio-environmental change, allowing healthy food choices to be easy choices.
Breastfeeding Success Stories: Developing the Evidence-base about what promotes and supports breastfeeding in the Victorian Aboriginal community.
Megan Green1, Jessica Hamilton1, Jennifer Brown2
1Monash University, Clayton, VIC, 3800 2Victorian Aboriginal Community Controlled Health Organisation, Collingwood, VIC, 3066
The World Health Organisation recommends exclusive breastfeeding until around six months of age, however only a small proportion of Aboriginal infants are breastfed at 6 months. There is little evidence available surrounding for what motivates and supports breastfeeding in the Aboriginal population. This project aimed to identify what motivates Victorian Aboriginal women to initiate and continue to breastfeed, and the best practice strategies used by health organisations to promote breastfeeding. Using a strength based approach, such as compiling success stories, breastfeeding success stories were gathered from Aboriginal and mainstream health organisations across rural and metropolitan Victoria (n=22), as well as individuals (n=10), including mothers, partners and grandmothers. Information was obtained via semi-structured interviews that were recorded, transcribed and deductively coded. Thematic analysis found five key themes relating to; what factors and initiatives promote successful breastfeeding in the Victorian Aboriginal community, and what initiatives health organisations would like implemented for future promotion of breastfeeding. Content analysis quantified the frequency of which these themes were mentioned. Analysis of in-depth interviews (n=31) highlighted five key themes; 1. Role models (%), 2. Supportive environments at home (%), in the hospital (%), by health professionals (%) and on at a wider society level (%), 3. Knowledge on an individual (%) and health professional level (%), 4. Personal characteristics (%) and 5. Feasibility (%). Providing breastfeeding training to Aboriginal community members and health professionals, developing Koori-specific resources, and developing and implementing breastfeeding programs that involve and support fathers in parenting may be able to improve breastfeeding rates.
Food Culture in Families with Young Children in the Upper Yarra area of the Yarra Valley region
Baker Nellie1, Benoit Anya1, Chan Marina1, Nheu Elysha1, Muhajireen Fathima1, Hong Charlene1, Carla Johnson2
1Monash University, Clayton, VIC, 3800 2 Eastern Health Yarra Valley Community Health
Food culture - the cultivation, distribution, preparation and appreciation of food - is subject to sociocultural, political, economic and philosophical factors. As a result, food culture influence our food choices. This study aimed to understand food culture, how it influences food choice in the Upper Yarra area, one of the most disadvantaged areas of the Yarra Valley region. The study focused on families with young children as evidence suggests that patterns laid in early childhood provide the foundations for later years. Qualitative analysis of interviews with service providers and focus groups with parents of the Upper Yarra community revealed several opportunities for action. While recognising existing community supports in the area, this report also identified barriers to healthy eating. These included limited access and availability to food, time constraints, limited nutrition knowledge and skills which contributed to the trend that food and healthy eating is not a priority for some families in the area. In the short term, the current study has provided more information specific to the Upper Yarra area to understand the issues related to food culture and food choice. In the long term, the current study combined with literature provides direction for future recommendations to promote healthy eating and well-being. If these recommendations made are implemented concurrently, they are likely to create a supportive environment that promotes a healthy eating culture in the Upper Yarra area.
Exploring the healthy eating, oral health and smoking behaviours of school communities in the Frankston Mornington Peninsula Region
Anita Lao1, Georgia Somers-Jones1, Josh Pereira2
1Monash University, Clayton, VIC, 3800, Australia1 2Peninsula Health, Hastings, VIC, 3915, Australia2
Good nutrition and overall health is essential for optimal growth, development and academic performance. Children who develop positive health behaviours in their formative years are more likely to carry these habits into adulthood, resulting in better health outcomes. For this reason, Peninsula Health has selected eight pilot school sites (3 preschools, 3 primary schools, 2 secondary schools) participating in the Healthy Together Victoria Achievement Program to receive intensive support from 2014-2017 to develop a whole school approach to healthy eating, oral health and tobacco control. This project aims to assess current health behaviours, knowledge, attitudes and drivers in students, staff and parents in these sites. The information gathered will allow future health promotion initiatives to be tailored to address the issues most pertinent to each site. Baseline data will be a valuable evaluation tool for sites to determine the effectiveness of these initiatives. Surveys were developed and distributed to collect qualitative and quantitative baseline data. Surveys were distributed to n=2,354 students, n=2.354 parents and n=248 staff, responses were obtained from n=1,451 students, n=216 parents and n=124 staff. Results found between 43-85% and 0-14% of students met the Australian Dietary Guidelines for fruit and vegetable intake respectively. 73-88% of students could not correctly identify the Australian Dietary Guidelines for fruit and vegetable intake. Up to 20% of students across sites consumed soft drink on a daily basis. 29-60% and 82-100% of students did not meet the Australian Dental Association guidelines for brushing and flossing respectively. 2-8% of high school students reported to smoke daily. These behaviours place the population at increased risk of chronic health conditions including type two diabetes, cardiovascular disease, stroke, cancer, emphysema and oral health complications. In light of poor dietary, oral health and smoking habits, health promotion initiatives should focus on the underlying causes for poor health behaviours.
Research supporting the East Gippsland food system to improve residents' fruit and vegetable access and consumption
Daniel Fun1, Jasmine Lai1, Lily Wong1, Alda Wu1 Claire Palermo1, Rhonda James2, Bruce Smith2, Nicola Watts3
1Monash University, Clayton, VIC, 3800, Australia 2East Gippsland Shire Council, Bairnsdale, VIC, 3875, Australia 3East Gippsland Food Cluster, Bairnsdale, VIC, 3875, Australia
Residents of East Gippsland do not consume enough fruit and vegetables to meet dietary requirements. Understanding how to change the local food system to support increased access and consumption is crucial. The aim of this project was to provide strategic direction through area-specific research for both local government and industry to improve access to nutritious food, specifically fruit and vegetables. Two systematic reviews were conducted to investigate how organic versus non-organic, and post-production methods influence nutritional content of fruit and vegetables. Benchmarking of local government area initiatives was conducted by analysing municipal health and wellbeing plans of similar areas for initiatives relating to healthy eating. Intervention research was conducted to identify state and national initiatives relating to food access. The local setting was investigated through qualitative interviews with East Gippsland farmers (n=8) varying from small to large production scale. Thematic analysis of data was used to determine themes or drivers behind farming decisions. The systematic reviews did not reveal statistically significant results in terms of organic versus non-organic farming and post-production methods on nutritional value. Intervention research identified five promising strategies addressing fresh fruit and vegetable access: food co-ops, markets, food hubs, food recovery and community supported agriculture. Thematic analysis of interview data revealed six themes driving farming decisions: ease of management, quality of produce, knowledge, economic margins, ethics and external agreements. Support of the local food system considering both infrastructure and consumer education is pivotal in improving fruit and vegetable consumption in East Gippsland.
Food hubs: evaluating the effectiveness of online marketplaces for healthy local food
Joanna Joseph Aaron1, Bianca Moleta1, Margot Rogers1, Cally Snare1, Kirsten Larsen2
1Monash University, Clayton, VIC, 3800, Australia 2Victorian Eco- Innovation Lab, Melbourne University, Parkville, VIC, 3052, Australia
This work aimed to define the term ‘food hub' and investigate the extent of Australian ‘food hubs' and the role of Open Food Network in linking and supporting Australian regional supply chain communities. Open Food Network is a project of the Open Food Foundation, involving the development of a collaborative online trading network linking farmers to food businesses and individuals. This 8-week study has potential to increase access to affordable, nutritious produce, ultimately reducing Australian food insecurity. Interviews with 13 pre-determined potential ‘food hubs' were conducted to determine business profiles, values, enablers, barriers and possibilities of adopting online marketing software. These organisations included small enterprises, council initiatives, and cooperatives. The desktop review collated characteristics of existing ‘food hubs' in eastern Australia, using search terms identified from a literature review of limited available previous research nationally and internationally, in conjunction with terms developed through brainstorming by researchers. This research facilitated the development of an Australian ‘food hub' definition, and found characteristics of established organisations in eastern Australia. Qualitative data from the desktop review and interviews were coded and compared for key themes, using a framework developed under the guidance of an experienced researcher. These themes were compared to literature. Interview analyses found participating organisations to have common values and enablers including community engagement, however many lacked business planning skills, which was comparable to the desktop review. Conclusions suggest further research is needed in this field to continue refining the ‘food hub' definition and promoting the value of regional supply chain communities.
Food Security: Measuring Food Access and Availability in the City of Ballarat
Sarah Busby1, Rachael Ewert1, Karli Goegan1, Amy Knight1, Megan Ballinger2, Demelza Diacogiorgis2, Tameaka Gower2, Caroline Amirtharajah3
1Monash University, Clayton, VIC, 3800, Australia 2Ballarat Community Health, Ballarat, VIC, 3350, Australia 3City of Ballarat Council, Ballarat, VIC, 3350, Australia
The City of Ballarat experiences a higher than state average rate of food insecurity. Previously, there has been no data to show the access to and affordability of food within the City of Ballarat. This research aims to fill this knowledge gap to provide evidence as a foundation for future health promotion efforts regarding food insecurity. Based on previous research from other areas, three methodologies were developed; Geographical Information Systems mapping of food outlets (n=226), Victorian Healthy Food Basket surveys in all supermarkets (n=19) and green grocers (n=6) and interviews (n=19) to gain the community's perspective on food security in the City of Ballarat. The main findings of this research reveal that within the City of Ballarat, there were 2.8 times as many takeaway outlets (n=147) compared to fresh food outlets (n=52), creating an unsupportive environment, making it difficult for Ballarat residents to make healthy food choices. The surveys indicated that the cost of fruit and vegetables was more expensive when purchased in supermarkets compared to green grocers suggesting a healthy diet is attainable when shopping at affordable outlets. Additionally, community members perceive the major barriers to food security as being nutritional knowledge, skills, transportation and affordability. A combination of recommendations for further research and evaluation of current initiatives, frequently updating map and survey data, and strategies that address the community's identified barriers to food security have been provided. These recommendations encompass a multi-faceted approach across the health promotion continuum in order to address these identified barriers to food security.
Investigating malnutrition in community-dwelling older adults living in the Mornington Peninsula Shire.
Caroline Deen1, Gloria Leung1, Wesley Tay1, Ashley Toh1, Vivian Tsang1, Ivy Wong1, Erin Farnbach2
1Monash University, Clayton, VIC, 3800, Australia 2Mornington Community Health Centre, Mornington, VIC, 3931, Australia
Prevalence of malnutrition in the community is estimated to be 10 to 30 percent yet it is under-recognised and the reasons for this are poorly understood. Malnutrition leads to increased mortality risk and reduced quality of life. This research aimed to determine the prevalence and factors contributing to malnutrition amongst community-dwelling older adults residing in the Mornington Peninsula Shire (MPS). The attitudes and current practices of local dietitians in relation to malnutrition were also explored. A convenient sample of 185 Peninsula Health clients (≥65 years) from community and acute settings (patient stay <3 days) were screened for malnutrition using a Modified-Malnutrition Screening Tool (Mod-MST). At risk clients (Mod-MST ≥2) were interviewed using questions focusing on social causes of malnutrition. A purposive sample of local dietitians' perceptions and current practices towards malnutrition were explored using an interview protocol developed by the research team. Thirty-seven clients (20%) were identified to be at risk of malnutrition and interviews were conducted with 16 residents with no private transportation experienced difficulty accessing shops. 75% did not engage in social activities regularly, which may lead to poor motivation to eat. Only 24% of 17 dietitians interview stated screening is always completed and 71% reported there are inadequate malnutrition referrals. This project provided a preliminary analysis of malnutrition in the MPS. It identified the need for future research to establish direct associations between social and environmental determinants with malnutrition. Review of malnutrition screening and referral protocol in Peninsula Health would also be beneficial.