Kiki S. N. Liu

Chronic knee and back (knee/back) problems are common, painful, and disabling. Routine health-related quality of life (HRQOL) measurement may enhance doctor-patient communication and person-centred care by identifying unmet biopsychosocial needs, guiding personalized care, and encouraging engagement. We examined whether routine measurement and reporting of HRQOL using the electronic EuroQol 5-Dimension 5-Level (e-EQ-5D-5L) could improve HRQOL in participants allocated to the intervention (IG) or control (CG) groups. Participants were Chinese adult patients with a doctor-diagnosed knee/back problem with a scheduled follow-up visit within 12 months. The IG completed the e-EQ-5D-5L before each consultation at baseline and each scheduled follow-up visit, with reports available to their doctors during consultations. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes were Patient Enablement Instrument-version 2 (PEI-2), Pain Rating Scale (PRS), and Short-form 6-Dimension (SF-6D) health utility scores and management options. The effects of the intervention on the outcomes were assessed by generalised estimating equations (GEE) with linear function. 1200 participants were randomised to the IG (n = 595) and CG (n = 605). At 12 months, both groups reported higher (worse) WOMAC scores, with a greater increase in the IG than the CG (β = 2.43, p = 0.018). The IG reported higher (better) PEI-2 than the CG (β = 0.99, p = 0.010). There was no difference in PRS and SF-6D scores between groups. The IG received more oral medications, while the CG had more referrals to orthopaedic specialists. Routine measurement of HRQOL by the e-EQ-5D-5L did not improve HRQOL or pain, but was associated with better self-care enablement in primary care patients with chronic knee/back problems. HRQOL data may prompt primary care doctors to offer more conservative treatments before specialist referral, potentially easing the burden on secondary care.

Healthy eating is vital in preventing obesity and long-term non-communicable diseases. This study explores potential family facilitators of, barriers to and strategies for healthy eating among adolescents in Chinese families to guide the development of effective interventions in the future. Parent–adolescent dyads were purposively sampled by age, gender, fruit and vegetable intake and household income. Key family factors were identified by thematic analysis. Fourteen themes under five domains were identified: family health with (1) illness experienced in the family; parental knowledge of (2) dietary recommendations, (3) the preparation of healthy food and (4) healthy food choice; parental attitudes towards (5) the importance of healthy eating and (6) the priority of family health; socioeconomic factors of (7) time concerns and (8) cost concerns; and food parenting practices in (9) nutritional education, (10) role modeling, (11) food provision, (12) child involvement, (13) parental supervision and (14) the cultivation of food preference. Useful strategies included incorporating healthy ingredients in adolescents’ favorite recipes and providing a variety of fruit and vegetables at home. There is a need to empower parents with practical nutrition knowledge, to be more authoritative in food parenting practices, to discuss healthy eating with children and to acquire practical skills related to time- and cost-saving healthy cooking.

To tackle unhealthy eating among adolescents, it is crucial to understand the dietary knowledge, attitudes, and practices (KAP) on which adolescent eating habits are based. This qualitative study identifies the gaps in KAP by exploring what Chinese adolescents know, perceive, and practice regarding healthy eating to better inform targeted interventions for this important health problem. Parent–adolescent dyads were purposively sampled based on, for example, the dietary intake, age, and gender of the adolescent and household income, and each completed a 30 to 60 min interview. Twelve themes were synthesized: knowledge: (1) dietary recommendations, (2) health outcomes of healthy eating, (3) nutrition content in food, and (4) access to healthy meals; attitudes: (5) outcome expectation for healthy eating, (6) food preferences, and (7) self-efficacy regarding adopting healthy eating; and practices: (8) going grocery shopping for healthy food, (9) eating home-prepared meals. (10) eating out in restaurants or consuming takeaway food, (11) fruit and vegetable consumption, and (12) snacking, perceived unhealthy eating to be low risk, made unhealthy choices regarding snacking and eating out, and had insufficient fruit and vegetable intake. Programs should emphasize the positive short-term health outcomes of healthy eating and empower adolescents to acquire food preparation skills to sustain healthy eating habits.

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.