Bruce Kidd

Engaging with stakeholders/contributors is vital to achieve a comprehensive approach to policymaking about the food (kai) system. The food system in Aotearoa New Zealand (Aotearoa NZ) is associated with high environmental impacts and inequitably distributed health consequences by ethnicity and socio-economic status. We engaged with contributors from government agencies, industry, academics, community, rural and urban Māori communities to develop policy actions to support New Zealanders to eat healthy sustainable food. This paper outlines methods used to score contributor identified policies with follow-up focus groups and interviews where the highest scored policies were discussed, to understand contributor perspectives on the scope, implementation, barriers, and possible unintended consequences of these policies. Semi-structured interviews (12) and focus groups (6) were conducted. The top five scored policies among all contributors were: healthy food and drink policies in schools and kura (Māori-language immersion schools); supporting māra kai (food garden) and community gardens; garden to table programmes in schools and kura; education about sustainable and healthy food; and increasing incomes. The top five policies for Māori were: healthy food and drink policies in schools and kura; garden to table programmes in schools and kura; remove GST from core foods; increase incomes and make local food cheaper by supporting local growers. Considerations for policy implementation involved implementing multiple policies at once, the importance of evaluation, finding existing examples of policies, strong collaboration for long-term outcomes, and centring policies through a Māori framework.

Aotearoa New Zealand (Aotearoa NZ) is an example of a high-income country with high environmental impacts and health consequences associated with its food system. These impacts can be partially addressed by enabling dietary transitions to healthy and sustainable diets. The EAT-Lancet Commission proposed an internationally acceptable reference diet to promote planetary health. We aimed to work with contributors to develop policy actions to support New Zealanders to transition to healthy sustainable diets. These policies were further examined according to the World Cancer Research Fund, NOURISHING and High Level Panel of Experts (HLPE) on Food Security and Nutrition Food System frameworks. Semi-structured interviews (13) and focus groups (6) were conducted with contributors from government agencies, industry, academics, community and rural and urban tangata whenua communities. All interviews and focus groups were first transcribed using Otter.aI then reviewed by the research team. Thematic analysis was used to identify and summarise each policy. 111 policies were suggested across the NOURISHING framework policy domains: 11 (10%) in behaviour change communication; 35 (32%) in the food environment; and 65 (59%) addressing the food system. Participants spoke of behaviour change communication policies of education, awareness campaigns, and workshops such as cooking classes. Food environment policies targeted supermarkets and food retail, local food environments, and government standards and regulations including food taxes and subsidies. Policies in the food system area looked at food waste, supporting local food production and government structures and support. Contributors identified policies that advocate and support planetary health. Key policy insights □ The majority of policies identified by contributors focused on food systems and specifically food production □ Many contributors highlighted existing policies or initiatives already implemented locally and nationally but needed further support □ There is limited research demonstrating the effectiveness of policies and initiatives addressing sustainable food systems in Aotearoa New Zealand □ Funding, resources and research of existing local initiatives and policies supporting sustainable food systems in Aotearoa New Zealand and globally are urgently required

Background: In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, “the Policy”) was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors’ awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy. Methods: Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants. Results: Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that “Hospitals should be good role models.” Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options. Conclusions: The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.

Background: Disordered and problematic addictions are significant public health issues. It has been proposed that mHealth interventions can provide new models and intervention delivery modalities. However, research shows that studies that evaluate mHealth interventions for addiction disorders have low recruitment and high attrition. This study aims to identify published peer-reviewed literature on the recruitment and retention of participants in studies of mHealth interventions for people with addiction or problematic use and to identify successful recruitment and retention strategies. Methods: Relevant studies were identified through Medline, Embase, PsychINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) after January 1998. Studies were limited to peer-reviewed literature and English language published up to 2023. The revised Cochrane Risk of Bias RoB 2 tool was used to assess the risk of bias. Results: Of the 2135 articles found, 60 met the inclusion criteria and were included. The majority of studies were for smoking cessation. Only three studies retained 95% of participants at the longest follow-up, with ten studies retaining less than 80% at the longest follow-up, indicating a high risk of retention bias. Those studies with high retention rates used a variety of recruitment modalities; however, they also recruited from populations already partially engaged with health support services rather than those not accessing services. Conclusions: This review of recruitment and retention outcomes with mHealth interventions highlights the need for multimodal recruitment methods. However, significant gaps in effective engagement and retention strategies limit the positive outcomes expected from mHealth interventions.