Student Projects

Monash University Bachelor of Nutrition and Dietetics (Honours) Public Health Nutrition Placements 2016

Regional Principles of Food Security, Outer East Primary Care Partnership

Caitlin Sanders, Elissa Elissa, Karen Szeto, Karyn Chea

Centralising the Food System: A Collaborative Approach to Tackling Food Insecurity in the City of Ballarat, Ballarat Community Health

Madeleine Borg, Stephanie Cowan, Meghan Hockey, Monica Rundle

Food System Change in Casey: A Local Food Access Situational Analysis, Monash Health

Bridey McMahon, Alex Lemon, Sarah Lawless, Lauren Marino

Supporting capacity building of food enterprises in Victoria, Open Food Network

Sid Bhattacharyya, Charmaine Duong, Rianna Shen, Olivia Tegg

Feast on East Direct Evaluation, East Gippsland Food Cluster and Latrobe Community Health Service

Ebony Yin, Eliza Tassone, Christina Zorbas, Karthika Narendra, Randini De Mel

Evaluating the presence of food insecurity in the Mornington Peninsula, Mornington Peninsula Shire Council

Natalie Logan, Michaela Comito, Sarah Shaw,  Erin Russell

School Canteens Research and Evaluation Feasibility Study, Deakin and Monash University Partnership

Marijke Adderley, Natassja Billich, Laura Ford, Isabel Keeton

Raising awareness for consuming the recommended    serves of fruit and vegetables at 8 Frankston-Mornington Peninsula schools

Peninsula Health, Patricia Tan, Yujia Liang

Evaluation of the “What’s for dinner?” social marketing campaign, Eastern Health

Georgina Barber, Rachel Ben-David, Sarah Phillips & Peta Wright

Drink Less Sugar: an evaluation, East Gippsland Primary Care Partnership

Wendy Yan, Po-Man Leung

Closing the Gap on Knowledge, Victorian Aboriginal Community Controlled Health Organisation

Corinne Davis, Helena McDonald, Julia Perruzza, Ruby Svarc

Building sustainability in SRS facilities for improved nutritional intake of residents, Peninsula Health

Kellie Kong, Lin Wen, Shi Ning Lau, Stella Lu

A Case for Change: Evaluating the Evidence on Healthy Food and Drink Initiatives, Inner East Primary Care Partnership

Joshua Chang, Deni Cue, Anthony Khoo, Jess Paciepnik

Regional Principles of Food Security

Outer East Primary Care Partnership

Caitlin Sanders, Elissa Elissa, Karen Szeto, Karyn Chea

A need was recognised to develop a document for: advocating for food security and guiding development and implementation of best practice programs. This need was identified through research that highlighted the Outer East Melbourne Region (OEMR) had a high risk of food insecurity. (1) ‘Food security’ is defined as ‘when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life’. (2) Five Regional Food Principles (RFP) were developed to guide practice and support advocacy in this area. This document aims to explore the literature, and test the application of the RFP by comparing them to current programs in the OEMR. A literature search was completed on four databases and results were analysed. Additionally, interviews were conducted to explore programs running in the OEMR. These results were then compared to each principle, to determine if local programs aligned with the principles. The literature supported the principles, and the case studies demonstrated that some principles were done well, however others can be improved. The literature supported the principles and provided evidence that the RFP should be used as a basis when planning actions to address food insecurity. Overall, principle one, three and five were addressed well, and programs incorporated many different strategies, which aligned with these principles. However the case studies did demonstrate a lack of implementation around principles two and four, which may be due to difficulty in evaluation of food insecurity.

Centralising the Food System: A Collaborative Approach to Tackling Food Insecurity in the City of Ballarat

Ballarat Community Health

Madeleine Borg, Stephanie Cowan, Meghan Hockey, Monica Rundle

The aim of this project was to investigate the viability of a Food Hub within the City of Ballarat, with a specific emphasis on a centralised location to aggregate and distribute food. It arose out of the need to improve food access and address the growing issue of food insecurity within the local community. This study aimed to describe a number of established Food Hub models which have demonstrated sustainability within this sector, providing national and international examples of best practice and adapt this knowledge to the needs of Ballarat, to propose a Food Hub model for the region.  The literature search relating to established Food Hub’s was carried out in two parts; firstly, a search of the academic literature was conducted followed by a detailed analysis of the grey literature. It was specified that all national Food Hubs encompassed a centralised food distribution hub. A separate inclusion criteria was applied to international Food Hubs, requiring them to possess a social justice mandate. A questionnaire was developed and administered to the identified Food Hub’s via various means including in-person, over the phone and through email communication. The data gathered formulated a set of case series which were used to inform the development of the proposed Food Hub model for Ballarat. Demographic data was collected for Ballarat as well as for the regions in which the identified Food Hub’s were located. The consultation process was carried out in two parts and involved discussions with members of the Food Access Alliance Group, as well as various community stakeholders. The thoughts and opinions which came from these consultations were collated into key themes, that further guided the development of Ballarat's proposed Food Hub model. Hubs included were identified from grey    literature alone.    Twelve    Victorian, four    interstate and    three    international    Food    Hubs    met    the specified inclusion criteria. Initial contact was made    via email to all nineteen Food    Hubs; with response rate of 53%.    The proposed Food Hub model is envisioned to be implemented across three evolving phases. This staged approach enables the Food Hub to start small, gather resources and adapt appropriately as the knowledge base grows. The following model is proposed as being the final phase - a Community Food Hub. It incorporates elements of food aggregation and distribution alongside aspects of social enterprising and community development, supporting the long-term sustainability of the Hub.

Food System Change in Casey: A Local Food Access Situational Analysis

Monash Health

Bridey McMahon, Alex Lemon, Sarah Lawless, Lauren Marino

Food insecurity is a growing issue in the City of Casey (CoC). A situational analysis was conducted in 2016 to collect information about the local food system in the CoC and determine the barriers and enablers to access of nutritious food.  Three methods of data collection were used to conduct a food systems situational analysis of the CoC: The ‘Victorian Local Governance Association Municipal (VLGA) scanning tool’,  which determines barriers to food security, fruit and vegetable consumption and obesity; The Victorian Healthy Food Basket (VHFB) Survey, which determines the price of nutritious food; And mapping of residential properties, SEIFA index (per suburb), public transport routes, nonessential and essential food outlets via ‘Geographic Information Systems’ (GIS) mapping, to identify the distribution and access to different food outlets. Five key themes relating to food access emerged from data analysis. Five themes emerged from analysis of the data:

  1. Physical availability of food,
  2. Physical access to food,
  3. Economic access to food,
  4. Influences on food choices,
  5. Community involvement with food.

From these themes, key findings were identified: This research identified the main barriers and enablers to food insecurity, fruit and vegetable intake and obesity in the CoC, and specific areas that can be targeted to address these barriers and inform stakeholders within the CoC food system who have the capacity to help to reduce these barriers.

Supporting capacity building of community food enterprises in Victoria.

Open Food Network

Siddharth Bhattacharyya , Charmaine Duongm, Rianna Shen  , Olivia Tegg

A community food enterprise (CFE) is a type of business with primarily social objectives that are run by communities for their benefit. They are involved in at least one part of growing, processing, distributing or selling local food. CFEs play an important role in improving social, environmental, economic and health outcomes. Supportive local governments are enablers for successful CFEs and facilitating these relationships will positively impact food insecurity. This project aimed to both identify Victorian CFEs and to explore the opportunities and barriers to operating a successful community food enterprise in relation to local government involvement. The project lasted eight weeks in which an extensive Internet search was performed to identify Victorian CFEs. Additionally, between April-May 2016, six out of eight governments identified through purposive sampling were interviewed and a detailed content analysis was performed. Data from the interviews revealed that the main barriers councils experience when assisting CFEs are a lack of knowledge of what they are, how they operate, a lack of funding to facilitate council support and the need for interdepartmental collaboration. It is therefore suggested that more research should be conducted on the long-term cost effectiveness and economic benefits of CFEs to prompt larger efforts to be directed into this area. Overall this study identified 746 CFEs across Victoria. Creating the online map will allow a networking opportunity to increase access to fresh produce in low socioeconomic areas and the next step will be to increase usage of this resource by both consumers and producers.

Feast on East Direct Evaluation

East Gippsland Food Cluster and Latrobe Community Health Service

Ebony Yin, Eliza Tassone, Christina Zorbas, Karthika Narendra, Randini De Mel

In the City of Latrobe, one of Victoria’s major regional centres, the rate of overweight and obesity is ten percent higher than the state average, and there is a low consumption of fruit and vegetables. Affordability and access to nutritious foods are significant determinants of food choice, and can be altered to improve health. The Feast on East Direct (FoED) initiative, an online farmers market, was implemented in the region in 2015. Customers can order a variety of items from the website including pre-packaged produce boxes which are delivered to four designated pick-up points every Wednesday around the Latrobe Valley region. The aim of this project to build the FoED evidence base, specifically in terms of how the cost of the produce compares with existing options in the Latrobe Valley and social marketing. Predominantly qualitative research methods were used in the forms of observation, surveys and interviews. Thematic analysis of interview data was ultimately conducted to elucidate community perspectives. Two literature reviews aiming to define best practice social marketing strategies for promoting healthy behaviours along with a quantitative cost comparison were also employed to build the FoED evidence base. Additionally, this project used a social marketing framework to reflect the community’s perceptions and ideas around engagement with FoED. The results from each of these research methods collectively informed both our short term and long term recommendations to facilitate Latrobe Valley’s engagement with the initiative. 80 per cent of participants were unaware of FoED. 70 per cent of the study participants displayed interest highlighting a great level of demand. Convenience above all was a key driver for choosing FoED. Perceived cost is the most significant barrier to FoED. Findings support the notion that this initiative provides a cost-competitive fruit and vegetable option and cost appears to be more of a perceived rather than actual barrier. Additional barriers, motivators and community perceptions should further be addressed through multifaceted, long-term social marketing campaigns which incorporate evidence-based frameworks where possible.

Evaluating the presence of food insecurity in the Mornington Peninsula

Mornington Peninsula Shire Council

Natalie Logan, Michaela Comito, Sarah Shaw, Erin Russell

Food security is a complex issue that affects many individuals and communities.  While the Mornington Peninsula has an abundance of nutritious food for all residents, certain population groups may still be facing food insecurity.  This Food Security Scan was conducted to comprehensively assess the status and factors contributing to food insecurity across the Mornington Peninsula. The scan involved data collection and analysis relating to five main areas affecting food security; including the natural, built, economic, socio-cultural, and health environments. A comprehensive Healthy Food Access Basket Survey of all registered supermarkets across the Peninsula was undertaken as a part of this report, while the analysis of this data involved comparison to previous Healthy Food Access annually since 2007.  Means of data collection included exploring published statistics, online research, phone calls, site visits and meetings with key stakeholders. This scan highlighted the multiple aspects of food security and how these factors differ across each ward.  97.6% of the population was found to live outside a 500m radius of any venue that sells fresh produce. In addition to this, Mornington Peninsula was found to be poorly serviced by public transport, further    limiting access     to fresh produce. The    average cost of a Healthy Food Basket varies greatly across each ward, with the average cost for a family of four being $468.62.  This amount     was greater than the Victorian average. The lack of breastfeeding-friendly venues across the municipality contributes as a key socio-cultural factor to food insecurity for babies and young children. Promoting the wide availability of fresh, healthy produce across the shire, supporting existing council community initiatives developing and supporting school based food and nutrition programs, advocating for breastfeeding friendly environments and initiatives and promoting the purchase of locally grown produce are needed

School Canteens Research and Evaluation Feasibility Study

Deakin and Monash University Partnership

Marijke Adderley, Natassja Billich, Laura Ford, Isabel Keeton

Childhood obesity rates have peaked. One third of a child’s diet is consumed at school with discretionary items significantly contributing to their daily energy intake. Previous 2012 research conducted by Woods et al. demonstrated that a large number of schools were offering non-compliant menu items in school canteens. The aim of this study is to assess whether school canteens across Australia are complying with canteen guidelines and to compare the results to 2012 data.  A convenience sample (n=263) of Government schools from Woods et al. was searched for online menus. The number of ‘green’, ‘amber’ and ‘red’ items was calculated on each menu and compliance was assessed against State and Territory guidelines. This methodology was used to develop a detailed protocol intended for future use. A total of 240 school canteen menus was obtained and analysed. Western Australia had the greatest percentage of compliant menus (19%). Compliance in other jurisdictions ranged from 0-12%. Western Australia had the highest proportion of ‘green’ (60%) and lowest proportion of ‘red’ items (3%). Pastries were present on 94% of menus. The cost of a pie was significantly cheaper than salad across Australia (p<0.01). There was a significant difference in the rate of compliance, and both ‘red’ and ‘green’ items significantly increased from 2012 to 2016 (p<0.01). The cost of a pie significantly increased (p<0.01). This study demonstrates that compliance to healthy school canteen guidelines is poor, and a monitoring and evaluating tool is required in order to provide feedback to relevant stakeholders.

Raising awareness for consuming the recommended serves of fruit and vegetables at 8 Frankston-Mornington Peninsula schools

Peninsula Health

Patricia Tan, Yujia Liang

Low intake of fruit and vegetables (F&V) may increase the risk of chronic disease development in later life. It is found that 21% of adolescents in Mornington Peninsula and 13% in Frankston consuming the minimum recommended serves of F&V. Health Promoting School (HPS) is a promising primary intervention for childhood obesity. Thus as part of HPS program, an eight-week campaign was held in eight schools, aiming to increase the knowledge of the recommended serves of F&V. Education sessions and in-school activities were conducted in the eight schools. Surveys were distributed to the schools through online or paper to parents, staff and students. Surveys were used to evaluate the effectiveness of the activities in promoting knowledge in each school or school setting and also to evaluate the effectiveness of the HPS program that has been run for two years in those schools. 1,730 people (41%) were involved in the activities and 1,175 responses of survey (33%) were collected. Overall, there are 19% increase in the knowledge of the recommended serves of fruit and 15% increases in vegetables compared to 2015 data. However, there is 5% reduction in fruit consumption and no changes in vegetable. The objective that 80% of the participants know the recommended F&V serves was not achieved due to low response rates from schools, since health may not be their main priority. However the campaign has successfully increased the awareness of F&V for those involved in. When schools intensively and continuously apply the HPS concept and actively engage in the campaign, changes in student’s behaviour and knowledge will be clearly seen.

Early Years in the Upper Yarra: Evaluation of the ‘What’s for dinner?’ social marketing campaign encompassing a network analysis of partnerships in the Upper Yarra region

Georgina Barber, Rachel Ben-David, Sarah Phillips & Peta Wright

The ‘What’s for dinner?’ social marketing campaign, involving three posters and accompanying pamphlets, was developed in 2015 to increase awareness and improve mealtime behaviours in families with children aged one to five years in the Upper Yarra region. This report evaluated the campaign’s implementation in the community. It also determined partnerships between settings and services to health in the Upper Yarra region through a network analysis. Mixed method research was employed to evaluate campaign success through interviews with stakeholders, Vox Pop surveys and a focus group with parents/carers. The network analysis was conducted via snowball sampling using a questionnaire and developed into a visual logic. Results found that the campaign was successfully implemented throughout settings. Feedback regarding the campaign and associated activities was obtained from 47 parents/carers and ten stakeholders. On average 22% of parents/carers surveyed had seen at least one poster and 28% had seen the pamphlets. Poster B was seen by the greatest number of parents and was found to have the clearest message compared to posters A and C. In the network analysis, 137 partnerships between services were identified, indicating a well-connected early year’s network, however several key family services were not connected to YVCH. Continued implementation of the current campaign is recommended, in addition to other strategies such as social media. Strengthening of partnerships and increasing dietitian involvement in the community is also recommended, particularly in the settings and services that were identified as having a significant impact on food access and intake.

Drink Less Sugar: an evaluation, East Gippsland Primary Care Partnership

Wendy Yan, Po-Man Leung

The consumption of sugar sweetened beverages (SSB) are associated with weight gain and obesity as well as a range of negative health outcomes. In East Gippsland, 19.9% of the population consume SSB daily, with an excessive average consumption of 0.5 litres per day. Evaluating the Drink Less Sugar Project will allow project objectives to be measured and enrich the intelligence database, namely the rates of SSB consumption and a preliminary understanding of behaviours associated with SSB consumption in workplaces of East Gippsland. The pre-implementation survey was conducted via SurveyMonkey® one week prior to the commencement of the program. The survey was designed to collect data on workplace demographics and to assess nutrition knowledge, motivation and confidence to change before project implementation to measure extent of objectives achieved by the program. The survey link was emailed to nominated program coordinators of each 8 participating organisations which was then released to approximately 1700 employees.  
A Healthy Workplace Review was distributed to all participating workplaces to complete independently in May 2016. Questions for process evaluation can be found in the workplace review. Process evaluation was conducted for Gippsland Ports (Bairnsdale office), East Gippsland Water (Bairnsdale office) and Omeo Regional Health.  311 survey responses were collected, corresponding to a response rate of 18%. In analysis, participants were categorised into groups of consumers (42%) and non-consumers (58%) of SSBs. 2 participants were excluded from analysis as they did not report consumption data. Taste was reported most frequently as the top factor when choosing a beverage by 53% of consumers and 41% of non-consumers. Sugar content was reported to be the top factor by more non-consumers (31%) than consumers (14%). The top three SSBs consumed at the workplace were identified as: tea and coffee with added sugar (79%), regular soft drink (16%) and flavoured milk or iced coffee (14%). Workplaces were the main supplier of SSBs consumed in the workplace (43%). Most consumers agreed and strongly agreed that their health would improve from a decreased intake of SSBs. Most consumers also reported that they started or made a change to reduce their SSB consumption. While similar proportions of consumers and non-consumers correctly identified the sugar content in regular soft drink, only 2% of consumers were able to identify sugar content in sports drinks compared to 21% of non-consumers. 51% of respondents proposed strategies such as increasing alternatives, limiting availability of SSBs and point-of-sale signage to support employees in reducing their SSB consumption. This data forms the baseline measure and will be used for comparison in post-implementation evaluation.

Closing the Knowledge Gap: Evaluating the impact of Aboriginal health placement experiences on career choice and cultural competency of dietetic graduates

Victorian Aboriginal Community Controlled Health Organisation

Corinne Davis, Helena McDonald, Julia Perruzza, Ruby Svarc

Aboriginal Australians are at greater risk of poor health, with some of the main causes of illness and death attributable to diet-related diseases. Cultural competency of the dietetic workforce is considered crucial in providing appropriate health care for Aboriginal Australians, as racism and a lack of cultural safety have been linked to an increased risk of ill health. Aboriginal health student placements at university are one potential method of both increasing likelihood of pursuing a career in Aboriginal health and increasing cultural competency of dietitians. The aim of this project was to investigate whether an Aboriginal health placement experience influences career choice and/or perceived cultural competence of dietetic graduates. A quantitative survey was used to collect demographic data and assess career choice, attitudes and behaviours regarding Aboriginal health using a five-point Likert scale. Semi-structured interviews were used to gather more in-depth qualitative information about the impact that Aboriginal health placements had on the attitudes and future work practices of participants who had these experiences. Sixty-nine (69) participants completed the survey and 15 participants who had a placement experience were interviewed. Both quantitative and qualitative analysis showed a relationship between having an Aboriginal health placement experience and subsequently going on to work in this health field, in addition to increased perceived cultural competency. Preliminary thematic analysis identified that cultural immersion, interaction with Aboriginal people, and a safe learning environment are key components in building cultural competency. Aboriginal health placement experiences are valuable in increasing students’ desire to work in Aboriginal health, in addition to building their perceived cultural competency for future work practice.

Building sustainability in SRS facilities for improved nutritional intake of residents

Peninsula Health

Kellie Kong, Lin Wen, Shi Ning Lau, Stella Lu

Supported Residential Services (SRS) are private businesses that offer accommodation, meals and support services for Victorians who require assistance with daily activities. Considering that disability and chronic health conditions are highly prevalent in SRS residents, they are a vulnerable population, particularly with regard to attaining good nutrition for their complex health needs. Since 2013, Peninsula Health has been collaborating with three Supporting Accommodation for Vulnerable Victorians Initiative (SAVVI) funded SRS facilities (Acacia Place, Eliza Park and Sandy Lodge). The main aim is to improve the nutritional status of residents in these SRS facilities via the provision of nutritious food meeting the Australian Guide to Healthy Eating (AGHE) recommendations. This project aimed to investigate: The three SRS facilities’ adherence to the implemented menu that meets AGHE recommendations; The enablers and barriers of the three SRS facilities’ adherence to the implemented menu that meets AGHE recommendations; The nutritional quality of food and drinks provided in vending machines at the three SRS facilities; The mealtime environment (lighting, table settings, smells, sounds etc.) at the three SRS facilities; The enablers and barriers to sustaining change in other similar setting. Menu, SRS Staff and resident interviews and a vending machine and mealtime environment audit were conducted. Overall, none of the facilities met all of AGHE recommendations. Training and resources from dietitians, knowledge and beliefs regarding healthy eating, as well as menu caters to residents’ preferences and needs were identified from the interviews. Barriers to sustaining menu change that were consistent across the three SRS facilities include budget limitations, perceived residents’ preference for unhealthy food, time constraints, and diverse roles and responsibilities. All food items provided in vending machines were discretionary. Two SRS had a significantly more appropriate mealtime environment. Work needs to continue to ensure SRS residents have capacity to meet their daily nutritional recommendations.

A Case for Change: Evaluating the Evidence on Healthy Food and Drink Initiatives

Inner East Primary Care Partnership

Joshua Chang, Deni Cue, Anthony Khoo, Jess Paciepnik

This evidence brief has been developed for local government and community health services within Melbourne’s Inner East Catchment (Boroondara, Manningham, Monash and Whitehorse) to support identification of opportunities to change the food environment and improve access to healthy food options. It intends to advocate for and guide the implementation of initiatives to develop sound Healthy Food and Drink policies and guidelines within a local context. Case studies and examples were collated through investigation of grey literature and semi-structured interviews with key individuals involved in each initiative, including health promotion officers and program managers. Cases with strong outcomes, and where available supporting data, were selected to highlight key learnings. The cases and examples cover a range of settings including sports and recreation centres, workplaces, and local food businesses. Key challenges have also been identified to acknowledge the potential barriers that may be faced during implementation.  Common themes for success include: Engaging stakeholders and gaining their support. Building trust and rapport with stakeholders. Support for knowledge development of staff and stakeholders in policy or guideline use and food/drink classification. Community involvement instils a sense of ownership in the programs. Community champions enable and maintain community engagement.   Success was further exemplified as profits for food retailers were unaffected by the implementation of healthy food and drink policies.  This document acknowledges that state and federal frameworks limit the ability of local council to affect prominent change within the wider food environment. However, local government is instrumental in initiating action through local level implementation and subsequent advocacy for healthy food and drink policy or guideline creation. Overall, approaches that prioritise collaboration and unity across a range of environmental settings, from government and industry to organisations and communities is crucial in addressing obesity.