The effect of complex workplace dietary interventions on employees dietary behaviours, nutrition knowledge and health status

Background The growing prevalence and associated burden of diet-related non-communicable diseases is a global public health concern. The environments in which people live and work influences their dietary behaviours. Aim The focus of this thesis was on the effectiveness of complex workplace dietary interventions. The comparative effectiveness of a complex workplace environmental dietary modification intervention and an educational intervention were assessed both alone and in combination relative to a control workplace setting. Methods The systematic review was guided by the PRISMA statement. In a cluster controlled trial, four workplaces were purposively allocated to control, nutrition education alone (Education), environmental dietary modification alone (Environment) and nutrition education and environmental dietary modification (Combined intervention). The interventions were guided by the MRC framework. In the control workplace, data were collected at baseline and follow-up. In the intervention related sub-study, the relationships between nutrition knowledge, diet quality and hypertension were examined. Results The systematic review provided limited evidence. In the FCW study, 850 employees aged 18-64 years were recruited at baseline with N(response rate %) in each workplace as follows: Control: 111(72%), Education: 226(71%), Environment: 113(91%), Combined intervention: 400(61%). Complete follow-up data was obtained for 517 employees (61%). There were significant positive changes in dietary intakes of saturated fat(p=0.013), salt(p=0.010) and nutrition knowledge(p=0.034) between baseline and follow-up at 7-9 months in the combined intervention versus the control workplace in the fully adjusted multivariate analysis. Small but significant changes in BMI(-1.2kg/m2 (p=0.047) were also observed in the combined intervention. In the sub-study, nutrition knowledge was positively significantly associated with diet quality and blood pressure but no evidence of a mediation effect of the DASH score was detected between nutrition knowledge and blood pressure. Conclusion This thesis provides critical evidence on the effectiveness of complex workplace dietary interventions in a manufacturing working population.

The 'Arc of prosperity' revisited: Homelessness policy change in north western Europe

This paper compares continuity and change in homelessness policy in Ireland, Scotland and Norway with a particular focus on the period of post-crisis austerity measures (2008-2016). The analytical approach draws on institutional theory and the notion of path dependency, which has rarely been applied to comparative homelessness research. The paper compares welfare and housing systems in the three countries prior to presenting a detailed analysis of the conceptualisation and measurement of homelessness; the institutions which address homelessness; and the evidence of change in the post-2008 period. The analysis demonstrates that challenges remain in comparing the nature of homelessness and policy responses across nation states, even where they have a number of similar characteristics, and despite some EU influence towards homelessness policy convergence. Similarly, national-level homelessness policy change could not be interpreted as entirely a result of the external shock of the 2008 general financial crisis, as existing national policy goals and programmes were also influential. Overall, embedded national frameworks and institutions were resilient, but sufficiently flexible to deliver longer term policy shifts in response to the changing nature of the homelessness problem and national policy goals. Institutionalism and path dependency were found to be useful in developing the comparative analysis of homelessness policy change and could be fruitfully applied in future longitudinal, empirical research across a wider range of countries.