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Lifestyle Behaviours as Predictors of Health: Understanding the Importance of Sleep, Diet and Physical Activity on Mental Health and Well-Being
Get PDFThere is now considerable evidence supporting the notion that sleep, diet, and physical activity can benefit mental health and well-being individually. Previous literature suggests young adults who sleep between seven- to nine-hours-per-night have reduced depressive symptoms and anxiety, along with elevated mood, when compared to participants sleeping fewer than seven or greater than nine hours per night. Furthermore, following a healthy diet has also been associated with improvements in mood and well-being, whereby individuals who regularly adhere to a Mediterranean diet show elevated mood and a reduced risk of depression. Finally, regular physical activity has also been associated with greater mental health and well-being, whereby regular aerobic exercise at moderate intensity has been shown to reduce symptoms of major depressive disorder and anxiety. However, health behaviours do not occur in isolation, and instead tend to cluster together. Yet, research considering the way all three behaviours combine to predict mental health and well-being is still in its infancy. Therefore, the aim of the present thesis was to investigate the combined relationship between sleep, diet and physical activity in predicting mental health and well being outcomes, in two separate cross-sectional studies, both with young adults aged 17-25 years old. Study 1 was a large scale, cross-sectional survey of 1533 participants from New Zealand and the United States. Study 2 was a 13-day micro-longitudinal survey based study of 783 participants from New Zealand. Both studies measured multiple self-reported lifestyle behaviours, such as sleep quality and quantity, consumption of fruit and vegetables, and physical activity habits, along with several measures of mental health (depressive symptoms and negative mood) and well-being (life satisfaction, flourishing and positive mood). Study 1 also measured anxiety and vitality. Results of Study 1 supported past research, that when tested in isolation, each health behaviour was associated with greater mental health and well being. However, when tested against each other in regression models, sleep quality was the strongest predictor of all mental health and well-being outcomes. Diet and physical activity were weaker, relatively equal and still statistically significant predictors. Two trends were observed where raw fruit and vegetable consumption moderated the relationship between sleep quality, and both vitality and flourishing. Study 2 showed similar results, where each health behaviour was associated with greater mental health and well-being when tested in isolation. Furthermore, when tested against each other in regression models, sleep quality was again the strongest predictor of all mental health and well-being outcomes. Both diet and physical activity were relatively equal, weak predictors of mental health and well-being. No significant moderation effects were observed. These results suggest that sleep quality may be the strongest predictor of mental health and well-being, meaning intervention research should focus on sleep quality interventions among young adults
Impact of sugar-sweetened beverage taxes on price, import and sale volumes in an island: interrupted time series analysis
No full textObjective
To evaluate the impact of changes in import tariffs on sweetened beverages.
Design
Interrupted time series analysis examined sweetened beverage tariff increases of 40% to 60% in 2008 and to 75% in 2012; and an approximately 11% decrease in 2014 when an excise tax replaced the tariff. Post-tax trends were compared with a counterfactual modelled on the pre-tax trend for: quarterly price of an indicator beverage, monthly beverage import volumes (both 2001 to 2017), and quarterly sales volumes (2012 to 2017). In a controlled analysis taxed beverage imports were compared to a sugary snacks control.
Setting
Cook Islands
Participants NA
Results
In the first year, the 2008 tariff increased the price of the selected indicator soft drink by 7.3% (CI: 6.3% to 8.3%) but after the 2012 tariff increase it decreased by 13.9% (CI: -14.9% to -12.8%). At the same time the import volumes of taxed beverages decreased by 13.2% (CI: -38.1% to 17.8%) and 2.9% (CI: -41.6% to 72.5%) respectively; and decreased by 24.8% (CI: -36.9 to -9.8) and 10.2% (CI: -37.1 to 37.5) in the controlled analysis. After the 2014 tax decrease, the price of the indicator soft drink decreased by 23.6% (CI: -26.0% to -21.1%), sweetened beverage imports increased by 4.5% (CI: -39.5% to 156.0%), and sales of full-sugar soft drinks increased by 31% (CI: -21% to 243%).
Conclusions
The increased import tariffs on sweetened beverages appeared to be effective for reducing import volumes, but this was partly reversed by the reduced tax/tariff in 2014.Peer Reviewe
The Possibilities of Reducing Food Choice to Improve the Performance of College Foodservices
Get PDFCollege administrative and management leaders, foodservice personnel, and student residents value social, nutritional, financial, and environmental sustainability in their dining expectations. Menu choice reduction looks promising as a strategy to achieve these goals. However, foodservice research about dominant attitudes across these stakeholders is limited. Objective is to identify qualitative views from all stakeholders about choice reduction to ensure that any changes to the meal service are not to the detriment of consumer satisfaction. A comprehensive list of 74 statements representing the spectrum of attitudes surrounding choice was generated by searching a variety of resources, including academic literature and Internet sites, and by conducting semistructured interviews with stakeholders. A final set of 42 statements resulted from researcher scrutiny for optimum balance, clarity, appropriateness, simplicity, and applicability. A new sample of participants was then asked to sort these 42 statements into a normal distribution grid from “strongly disagree” to “strongly agree.” A purposive convenience sample of stakeholders (staff n=5 and residents n=4) was used to identify statements about choice reduction. A second sample of stakeholders (staff n=6 and residents n=29) were recruited to sort the final 42 statements. Q methodology analysis techniques were used. This involved conducting a by-person factor analysis, using the centroid factor extraction method because of the permissiveness it allows for data exploration. A varimax factor rotation to enhance interpretability of the results identified shared viewpoints. Three dominant viewpoints toward the possibility of choice reduction in the meal service were identified. Factor 1 was “health driven” (in which healthiness was paramount). Factor 2 was “variety seekers” (in which choice had instrumental value). Factor 3 was “choice lovers” (in which choice had intrinsic value). Although participants could see a number of benefits of choice reduction, strong attitudinal barriers existed toward adopting choice reduction initiatives. These barriers need to be overcome to avoid dissatisfaction with the foodservice should choice reduction measures be implemented
A new way of being church : a case study approach to Cityside Baptist Church as Christian faith "making do" in a postmodern world
Get PDFNew forms of liturgy and church have recently emerged in Western Protestantism. This includes "alternative worship"; defined as liturgical innovation characterised by communal participation, employment of popular cultural resources, a rediscovery of ancient liturgy and an appreciation of creativity and the arts. This thesis critically examines the claim that such "alternative worship" groups are an expression of postmodern religious life by exploring the practices of Cityside Baptist Church, in Aotearoa New Zealand. It situates their liturgical innovation as a "making do" - multiple transformative processes which creatively subvert their surrounding context. This "making do" is an application of the work of Michel de Certeau and his interpretive work on culture and context.
This thesis employs a practical theology methodology to read communal practices as a body of theological data. This allows the critical excavation of a living theology from "down under." Cityside is located in relation to their surrounding context, firstly of religious decline and charismatic dominance and secondly of a postmodern fragmentation into an individualised search for meaning, an emergence of tribal communities and a re-negotiated relationship with the Other.
Given this contextual siting, survey analysis and focus group interviews are employed to read Cityside as a group in rupture from Evangelical/Pentecostal/Charismatic religious dominance who identify themselves as postmodern. They have developed liturgical practices that value community, creativity and an engagement with culture.
These three themes then guide an examination of Cityside's every[sun]day liturgical practices through participant observation.
Firstly, the fault lines of Cityside are read as a "making do" with a communitarian hermeneutic. In response to experiences of rupture, Cityside offers a unique gathered community of choice in which the individual is invited to find meaning. This "making do" with a communitarian hermeneutic is then applied to re-read tradition as dialogue with other contextual communities one generation removed from Jesus. It is further argued that at Cityside Biblical text is read as a communal experience of shared rupture.
Secondly, Cityside's "making do" with a communitarian hermeneutic creates an imaginative space that allows both a communal and individual "making do." Imagination as rupture, fragmentation and play are used to analyse selected liturgical practices - storytelling, art images and labyrinth as pilgrimage - at Cityside. Imagination is referenced as a play of natality that re-reads both Christian anthropology and the ironic deconstruction of much postmodern discourse.
Thirdly, the ethics of relationship with the Other are a key dimension of postmodern discourse. The metaphor of DJing is introduced to argue that Cityside employs a "tactic" of sampling as a further dimension of its "making do." This allows Cityside a renegotiated relationship with the Other of gospel and culture. The practice of DJ sampling is then located within a tradition of marginal creative communities who produce marginalia as an authentic and creative re-reading of tradition.
Hence, Cityside's life contains multiple transformative practices that are both continuous and discontinuous with reference to both postmodern culture and the Christian tradition. Cityside Baptist Church is read as Christian faith "making do" in a postmodern world
The role of personal values in Chinese consumers’ food consumption decisions. A case study of healthy drinks
Get PDFDifferences in culture, language, and behavior between Chinese and Western consumers make entering the Chinese market a challenge. Chinese consumers may desire similar product features (e.g. brand name, quality, and flavor) to Western consumers but the value that consumers attach to the same product may differ cross-nationally. Besides values, an understanding of desired product attributes and the consequences linking to these values is also important. To the authors’ knowledge, there is no published scientific research that investigates how personal values influence Chinese consumers’ food consumption decisions. The aim of this research was to identify the links among product attributes, consequences of these attributes, and personal values associated with healthy drink consumption decisions within the
Chinese market. Specifically, this research employed means-end chain theory and used association pattern technique (APT) as the main data collection technique to identify these links. Focus groups (n = 6) were held in Hangzhou, China to identify the important attributes and consequences involved in the consumption decisions of healthy drinks. These attributes and consequences along with Schwartz’s 10 basic values were used to construct the matrices included in the APT survey. A total of 600 APT surveys were administered in six different companies in Hangzhou, with 570 returned. Construction of the hierarchical value map (HVM) identified four of Schwartz’s personal values influencing Chinese consumers’ healthy drink consumption decisions: security, hedonism, benevolence, and self-direction. Food safety was the foremost concern for Chinese consumers when choosing healthy drinks. Chinese consumers also sought a good tasting and nutritious drink that was good value for money. Results from this study provide food marketers with an in-depth understanding of Chinese consumers’ healthy drink consumption decisions. Implications and recommendations are provided that will assist food marketers to effectively enact marketing strategies in China
Systematics of selected species in the mycorrhizal genus Cortinarius and the utility of whole chloroplast genomes in the population genetics of the mycorrhizal host species Nothofagus menziesii
Get PDFNew Zealand has an interesting history that has shaped its biota through its isolation, almost total absence of terrestrial mammals and climate history. This history is thought to have influenced, for instance, the evolution of flightless birds, rapid speciation and morphological diversification of vascular alpine plants, the high abundance of brightly coloured, epigeous sequestrate fungi and the disjunct distribution of the mycorrhizal host species Nothofagus. However, inferences concerning such concepts are reliant on accurate and informative data, in particular a complete and robust taxonomic treatment of species involved, supported by appropriate genetic data.
This thesis concerns three different areas. Firstly, the systematics of selected species from the New Zealand mycorrhizal genus, Cortinarius. Secondly, automated data retrieval of BLAST search results and associated sequences from the same vouchered specimen. Finally, the potential utility of chloroplast genomes in population genetics of a one of the most wide spread mycorrhizal fungal host species, Nothofagus menziesii.
Accurate taxonomy is fundamental for communicating species concepts and critical in many biological disciplines including biodiversity analyses, conservation and life history studies. Fungi are the second most diverse group of eukaryotic organisms on the planet after insects. Twelve million species are thought to be in the fungal kingdom, with only ca. 120 000 currently described. Cortinarius is a widely distributed genus of ectomycorrhizal fungi in the Agaricales, present in temperate and subarctic-alpine climates in both hemispheres. Cortinarius is highly diverse; with over 3000 species described it is the largest genus in the Agaricales. In New Zealand, Cortinarius is the dominant ectomycorrhizal genus and associates with Nothofagus, Kunzea and Leptospermum. Members of the genus display a wide range of colours from white to almost black, and almost every colour in between. The sexual fruit bodies of Cortinarius taxa are mostly agaricoid in morphology, but many species have a gasteroid or secotioid morphology.
In this thesis, new species of sequestrate and agaricoid Cortinarius are described, covered in chapters 2–4. In particular, four additional species of purple secotioid species were discovered to be hidden under the name of the iconic C. porphyroideus. Members of Cortinarius section Subcastanelli were also investigated. It was discovered that the protologue of C. subcastanellus was based on multiple taxa, other members of this section were found to be synonyms of earlier species. In total seven new Cortinarius species were described, three synonymisations and one emendation are made.
The second objective was to ameliorate some of the manual data retrieval and cleaning for multigene phylogenetics, particularly in relation to fungal taxonomy. In chapter 5, the python script multigene_blastnparse.py is presented. This script retrieves BLAST matches from Genbank and all other markers from the same specimen identifier. BLAST matches are written to a csv file for immediate overview, while the sequences are written to a file in fasta format. All headers in the primary field of the fasta file are unique for each specimen identifier allowing for seamless concatenation of sequences from different regions for multigene phylogenetics. This bioinformatics tool is used in a subsequent chapter and is freely available on GitHub.
Nothofagus is a dominant and widely distributed tree genus in New Zealand. It is one of three genera that host ectomycorrhizal fungi, upon which they are dependent for much of their mineral nutrient acquisition. Nothofagus in New Zealand displays an interesting disjunct distribution on the South Island of New Zealand where it is missing in central Westland, known as the Westland beech gap. Many hypotheses and studies have been put forward for the presence and persistence of the Westland beech gap, including the lack of mycorrhizal symbionts in the beech gap preventing the expansion of Nothofagus into the area. However, there is a paucity of genetic data for confident conclusions to be drawn. Chloroplast markers are often used in population genetic studies as they are generally unilaterally inherited and geneflow is restricted to seed dispersal. However, most traditional chloroplast markers are slow evolving genes that are not suited to population genetics. Advances in sequencing has enabled high throughput sequencing of whole chloroplast genomes. Whole chloroplast genomes have been found to contain highly variable regions between populations, making them valuable for population genetics. Either through identification of variable regions for studies using traditions techniques, or used in their entirety.
In chapter 6, the chloroplast genome of Nothofagus menziesii from a Dunedin individual was sequenced and assembled using short and long read sequencing technologies. The chloroplast genome was 156 145 kb and presented a typical quadripartite structure. The genome contained 130 genes and was comparable to other chloroplast genomes in the Fagales. A chloroplast genome was sequenced using genome skimming from a geographically distant individual (St Arnaud, ~500 km separation) and compared to the Dunedin individual. The comparison revealed 131 polymorphic sites, with 13 regions less than 700 bp containing more than 3 SNPs. These regions may be valuable for future population genetic studies of Nothofagus menziesii.
This thesis makes a significant contribution to the systematics of the mycorrhizal genus Cortinarius in New Zealand. It also accelerates sequence data acquisition for multigene phylogenies. Finally, this thesis presents the first whole chloroplast genomic resource for one of the dominant mycorrhizal fungi host species, Nothofagus menziesii
New Home: New Zealand Health of Migrants and Tuberculosis Elimination
Get PDFBackground
Tuberculosis (TB) disproportionately affects migrants to New Zealand. In 2016, 79% of all cases were in those born overseas. The World Health Organization (WHO) has called for low-TB incidence countries such as New Zealand to aim for TB elimination. A focus on reducing TB in risk groups, including migrants, is necessary to achieve this. Despite radiological screening, TB still occurs in migrants, and little is known about specific risk factors for TB in migrants to this country.
This study aims to reduce the impact of TB in migrants to New Zealand by identifying risk factors and auditing current TB immigration screening procedures.
Objectives
1) To calculate TB incidence in migrants according to nationality, region, visa type, age and sex.
2) To assess if TB was identified at the time of immigration screening, and if not could it have been.
Methods
Cohort study: TB cases were linked to the Statistics New Zealand Integrated Data Infrastructure (IDI) migration records from 01/01/2007 to 31/12/2016. All long-term migrants to New Zealand were included in the study. Border movements for arrivals and departures were used to calculate total time in New Zealand per migrant. TB rates per 100,000 person-years were calculated for nationality, region of origin, visa category, age and sex. Multivariate analysis of incidence rate ratios was calculated for region of origin and WHO incidence in country of origin adjusting for visa type, age and sex.
Clinical audit: TB cases were linked to the Immigration New Zealand (INZ) health screening records from 01/02/2015 to 31/01/2018. Screening records, x-ray reports and specialist letters for TB cases were audited to identify whether TB was diagnosed by screening, and in cases where it was not diagnosed, possible gaps in the screening programme.
Results
Cohort Study: There were 873 TB cases in 1,597,077 migrants, with a total of 2,851,287 person-years of follow up. The highest incidence of TB was seen in those from South-Central Asia, with 104.8 cases per 100,000 person-years (95% CI: 95.7- 114.9), followed by South-East Asia with an incidence of 59.2 per 100,000 (95% CI: 51.9-67.5). Incidence by country was positively associated with incidence in the country of origin, but incidence was less in New Zealand than in the country of origin. Incidence in New Zealand was proportionate to WHO estimated incidence, with the exception of migrants from the highest WHO incidence bracket 350 per 100,000, where New Zealand incidence reduced. Migrants from countries with a WHO incidence of <40 per 100,000 had a New Zealand incidence of 2.8 per 100,000 (95% CI: 2.0-4.0). On multivariate analysis, region of origin and WHO estimated incidence were strongly associated with TB risk in New Zealand. Age <15 was associated with a reduced risk. Visa category was not associated with risk of TB once other factors were adjusted for.
Clinical Audit: There were 120 cases of TB included for audit. Immigration screening detected TB, or was likely to have detected TB in 46 (38%) cases. In 74 (62%) cases, screening did not detect TB. In those not detected by screening, 13 (18%) were notified within six months of screening, and thus were likely cases of prevalent, active TB. Six of these cases were pulmonary TB, and five of these either had old, or no x-ray submitted as part of their immigration medical. Seven were cases of extrapulmonary TB. There were 50 (68% of those not detected by screening) cases of likely reactivation of latent TB (LTBI). The remaining cases not detected by screening were likely due to inactive or early TB (8 cases) or possibly infection in New Zealand (3 cases).
Conclusion
This study is the first to describe risk factors for a large cohort of migrants to New Zealand and is the first audit of the country’s screening programme. The cohort study identified the main risk factors for TB in migrants are the world region and TB incidence in the country of origin. The clinical audit showed that there is limited scope to improve on currently used x-ray screening of migrants, with most TB not detected by screening being due to reactivation of LTBI.
This study has identified high-risk migrant groups that could benefit from enhanced TB screening. Overall findings support the idea that LTBI is the cause of most TB in migrants in New Zealand. Further study is needed to assess possible benefits and costs with additional screening, such as for LTBI in high risk groups. There is a low incidence of TB in New Zealand in migrants from low WHO incidence countries, and consideration should be given to abandoning screening in these groups. A change in screening procedures will reduce the incidence of TB in New Zealand and its considerable impact on migrant communities, and help progress New Zealand towards TB elimination
On Common Ground: How landlords & tenants shape thermal performance of private rental properties.
Get PDFMuch of New Zealand’s private rental housing is energy inefficient, and this is an unnecessary source of greenhouse gas emissions and often unhealthy for the occupants. There have been limited inroads to improve the thermal performance of private rented housing and their lack of action is frequently (but only partially) explained as resulting from split incentives. Increasing attention is being paid to the complex factors involved in landlord decision making around home energy performance. An under-studied area is how landlords and their tenants interact over energy-related matters. This study investigates the dynamics between landlords and tenants, using the framing of their ‘energy cultures’. I undertook a qualitative study of how landlords and tenants of the same private rental property made decisions about energy performance. Key findings include: that landlord and tenant often shared aspirations for the quality and performance of private rental properties; and that a two-way influence between the landlord and the tenant shapes the thermal performance of the property. I developed the energy cultures framework to propose the concept of Shared Energy Cultures. This depicts the relationships and pathways of influence between landlords and tenants and how this in turn shapes the thermal performance of rental properties
Supporting physical activity behaviour change in adults with obstructive sleep apnoea
Get PDFBackground: Low physical activity represents a potentially modifiable risk factor in the management of obstructive sleep apnoea (OSA). The benefits to this population of being more physically active include improved apnoea severity and reduced risk of hypertension, cardiovascular disease, type 2 diabetes and obesity. There is currently little available information regarding the type and level of physical activity undertaken in adults with diagnosed OSA. Moreover, potential barriers to activity have not been explored. Beyond provision of continuous positive airway pressure to manage periods of apnoea, there is limited support available to address lifestyle factors in this population.
Aim: The aim of this thesis was to establish physical activity levels in a cohort of adults with OSA, determine barriers to activity and explore the feasibility of supporting a change in physical activity behaviour in this cohort.
Methods: An initial literature review on physical activity in the population with OSA formed the basis for an exploratory study to determine physical activity levels in a cohort of 60 participants at risk of OSA, recruited from the local Sleep Clinic. Physical activity levels were compared with current World Health Organization guidelines. Levels of inactivity, time engaged in sedentary behaviour and barriers to activity were ascertained. A second literature review explored the use of text messaging as a means of motivation to support physical activity behaviour. A focus group and individual interviews were then conducted to determine the acceptability of motivational text messaging to end users with OSA. Using these findings an intervention study was developed to establish the feasibility of a text messaging intervention in conjunction with personalised exercise prescription to increase physical activity behaviour and increase exercise self-efficacy in a cohort of 30 participants recruited from the Clinic. Individual interviews with a cohort of the participants were then undertaken in an effort to understand the benefits and limitations of the intervention from the participants’ perspective.
Results: From the initial cohort 37% did not meet World Health Organization guidelines for weekly physical activity. This group demonstrated higher rates of hypertension, type 2 diabetes and obesity, and higher levels of sedentary behaviour. Low motivation and pain were the main barriers to activity in those not meeting the physical activity guidelines; 91% reported wanting to be more active. Text messaging was considered an acceptable form of motivation by end-users. The feasibility study showed that text messages offered the potential to support the uptake of physical activity in adults with OSA.
Conclusion: Low levels of physical activity represent an additional risk factor in those at risk of OSA. In our study, although there was recognition of the benefits of being active, lack of motivation was a barrier. A physical activity intervention using telehealth as a motivational component offers a potentially feasible method of supporting physical activity behaviour change in adults with OSA. Addressing lifestyle factors in this population offers a previously unmet need, which could contribute to reducing associated health risks
Bridging the gap between evidence and what people value from osteoarthritis care in New Zealand using multi-criteria decision analysis (MCDA)
Get PDFInternational clinical practice guidelines (CPG) for osteoarthritis (OA) consistently recommend core management strategies of exercise, weight-loss and self-management education. However, these interventions are not routinely delivered or taken up by people experiencing OA, resulting in a tendency to deliver low-value care. Tailoring the delivery of recommended OA care to the preferences of stakeholders in a health system may help support greater implementation of high-value OA care. However, little is known about the preferences of stakeholders for evidence and recommendations for OA care in a CPG.
The aim of this research was to establish a framework to prioritise knee interventions for managing OA and evaluate the relative importance of these interventions across the healthcare sector in New Zealand (NZ) using multi-criteria decision analysis (MCDA).
This research used a mixed-methods approach to develop the MCDA framework. The first stage involved focus group discussions to generate a thematic framework of what OA consumers, health care providers, policy-makers, Māori representatives and OA experts consider in their choice of knee OA interventions. A Delphi survey was used to verify the thematic analysis and rank the most important criteria concerning the characteristics of interventions; these findings informed the criteria selected in the second stage.
In the second stage, interventions were indirectly prioritised by systematically combining preference data with intervention performance data on the criteria. First, a survey involving trade-offs was used to measure stakeholders’ preferences, represented as ‘weights’, within and between the criteria. Evidence for the performance of 15 recommended knee OA interventions were then extracted from a CPG for hip and knee OA, and rated on the criteria according to their level of achievement (e.g. high, medium, low). To prioritise the interventions, a total score for each intervention was calculated by summing the weights associated with the intervention ratings, after which they were ranked by importance. Associations between the weights and stakeholder groups were explored using regression analysis.
Thematic analysis of data from six focus groups produced a framework comprising three overarching categories, consisting of characteristics of the: (i) intervention, (ii) consumer and (iii) health system. Participants identified and ranked nine characteristics of interventions; the most important eight were included in the MCDA framework. The choice-based survey revealed that stakeholders valued the intervention characteristics, in decreasing order of importance (weight): Recommendation (19.0%), Quality of evidence (17.7%), Effectiveness (15.0%), Duration of effect (13.2%), Risk of serious harm (12.8%), Risk of mild side-effects (9.4%), Cost (6.6%) and Accessibility (6.3%). Total scores for the 15 guideline-recommended interventions revealed that for first-, second- and third-line OA care respectively, all land-based exercise (total score= 71.7%), NSAIDs (topical) (74.2%) and total joint replacement (74.3%) were ranked first. For first-, second- and third-line OA care, the recommended core interventions of weight management and self-management education ranked between 11th and 15th (48.0% to 56.0%). Regression analysis identified only small differences in weights (≤5.7%; p<0.01) between stakeholder groups. These findings suggest that stakeholders’ preferences for the core interventions of weight management and self-management education represent a system-wide barrier to their implementation.
This research addresses an important knowledge gap concerning cross-sectoral stakeholders’ preferences for knee OA interventions in a CPG. By inclusively, systematically and transparently incorporating what matters to people with evidence and recommendations in a CPG, the MCDA framework developed in this thesis can help support the design of patient-centred, high-value healthcare for people experiencing OA