Browsing by Author "Douglas, Joy W."

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    Dietary Interviews and Survey of Habits in Parkinson Disease: the Dish Mixed Methods Study
    (University of Alabama Libraries, 2021) Ferguson, Christine C.; Ellis, Amy C.; University of Alabama Tuscaloosa
    Background: The pathophysiology of Parkinson disease (PD) may influence the ability of a person living with PD (PwP) to perform food-related activities (FRA) such as meal planning, food procurement, food preparation, eating and drinking. Their abilities may be further impacted by other internal and external factors, including the novel coronavirus disease 2019 (COVID-19) pandemic.Purpose: The purpose of this mixed methods study was to explore personal, behavioral, and environmental factors that are associated with the ability of people living with PD (PwPs) to perform FRA as well as the impact of the COVID-19 pandemic on their overall dietary patterns. Methods: Using a convergent parallel design, PwPs and their care-partners completed virtual dyadic qualitative interviews about their experiences with FRA during the COVID-19 pandemic. Semi-structured interviews were guided by the Social Cognitive Theory. PwPs completed a Food Frequency Questionnaire (FFQ) to quantify their dietary intake in the previous 12 months. Sociodemographic data, medical history, and symptom severity were also assessed among PwPs. Qualitative data were analyzed independently by two coders using both inductive and deductive techniques. Quantitative data from the FFQ were descriptively analyzed and utilized to calculate diet scores. Results: Eleven dyadic interviews were conducted to uncover the following subthemes by the personal, environmental, and behavioral levels of the SCT: perception of a healthy diet, perception of how nutrition influences PD symptoms and progression, confidence in following a healthy diet, barriers & perceived challenges to performing FRA, previous sources of nutrition information, willingness to changing their diet with a Registered Dietitian, modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Participants experienced changes in their typical FRA and routines due to COVID-19. Specifically, they cooked more at home, consumed fewer meals with non-household members, and altered their grocery shopping habits. These changes often led to an increase in the care-partners’ responsibilities and overall burden. The average diet scores among PwPs were 73.0+6.3 for the Healthy Eating Index 2015 (scale of 0-100), 29.2+6.6 for the Mediterranean diet (scale of 0-55), and 10.4+1.8 for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet (scale 0-15). Conclusions/Implications: Although diet scores indicated healthy dietary patterns among PwPs, findings from this study highlight the need for tailored nutrition education for PwPs and care-partners, and the results provide talking points for healthcare providers to address with their PD patients. Results also point to the need for future nutrition intervention research to inform evidence-based guidelines for this patient population. Interviews with PwPs and their care-partners revealed the need for healthcare providers and researchers to address increases in caregiver burden that resulted from changes in FRA due to the COVID-19 pandemic.
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    Internal and external factors influencing registered dietitians' recommendations for feeding tube use among older adults with advanced dementia: an application of the social ecological model
    (University of Alabama Libraries, 2017) Douglas, Joy W.; Lawrence, Jeannine C.; Turner, Lori W.; University of Alabama Tuscaloosa
    Background: While feeding tubes are commonly used to provide nutrition to patients with advanced dementia, research indicates that this fails to improve nutritional status or survival, and often yields harmful complications. As Registered Dietitians (RDs) are often consulted to provide clinical recommendations for older adults with advanced dementia, is important to understand factors influencing RDs’ feeding tube recommendations. Purpose: This study developed and validated a theory-based instrument to assess knowledge, beliefs, attitudes, and perceptions of RDs regarding feeding tube use among older adults with advanced dementia. Additionally, internal and external factors that influenced RDs’ recommendations were explored. Methods: The standardized survey development process included a comprehensive literature review, expert panel review, pilot testing, an efficacy survey, and test-retest analysis. A random sample of U.S. RDs was invited to participate. Exploratory factor and regression analyses determined factors associated with RDs’ feeding recommendations for people with advanced dementia. Results: Of the 662 RDs who completed the survey, 72.2% responded that they were unlikely to recommend feeding tubes for patients with advanced dementia. Factor analysis yielded five factors, each with adequate internal consistency: I) Knowledge Self-Efficacy, II) Religion/Spirituality/Culture, III) Personal Values, IV) Perceived Organization and Training, and V) Perceived Policy. Test-retest correlation coefficients ranged .602 - .812. The multivariate regression analysis included 580 RDs who were either likely or unlikely to recommend a feeding tube (‘neutral’ responses were removed), revealing five factors associated with RDs making evidence-based recommendations: Total Knowledge [OR = 1.40, 95% CI (1.26, 1.57)], Personal Values [OR = 1.30, 95% CI (1.19, 1.43)], Perceived Policy [OR 1.20, 95% CI (1.02, 1.40)], Perceived Organization and Training [OR = .87, 95% CI (.77, .99)], and working in long-term care or hospice settings [OR 3.68, 95% CI (1.51, 8.93)]. This model predicted 53.2% of the variance in RDs’ recommendations. Discussion: The instrument was deemed valid and reliable. Factor analysis indicated that internal and external factors influenced RDs’ recommendations, findings consistent with the Social Ecological Model. Most RDs made recommendations consistent with evidence-based guidelines, an encouraging finding. Work setting and RD knowledge were important modifiable influences, providing direction for future continuing professional education.
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    A Mixed Methods Exploration of the Impact of the COVID-19 Pandemic on Food-Related Activities and Diet Quality in People with Parkinson Disease
    (MDPI, 2022) Ferguson, Christine C.; Jung, Seung E.; Lawrence, Jeannine C.; Douglas, Joy W.; Halli-Tierney, Anne; Bui, Chuong; Ellis, Amy C.; University of Alabama Birmingham; University of Alabama Tuscaloosa
    Objective: The purpose of this mixed methods study was to explore the impact of COVID-19 on the ability of people with Parkinson disease (PwPs) and their care-partners to perform food-related activities (FRA) and PwPs' overall diet quality. Methods: Using a convergent parallel mixed methods design, PwPs and their care-partners completed virtual dyadic semi-structured interviews about their FRA during the COVID-19 pandemic. PwPs completed Food Frequency Questionnaires (FFQ) to quantify their dietary intake in the previous 12 months. Qualitative data were analyzed by two coders using thematic analysis, and quantitative data from FFQs were descriptively analyzed to calculate diet quality scores. Results: Eleven dyadic interviews revealed the following key themes: cooking more at home; changes with grocery shopping; less meals with non-household members. These changes were described to increase the care-partners' responsibilities and overall burden. Diet scores among PwPs were 73.0 +/- 6.3 for the Healthy Eating Index 2015 (scale of 0-100), 29.2 +/- 6.6 for the Mediterranean diet (scale of 0-55), and 10.4 +/- 1.8 for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet (scale 0-15). Conclusions: Diet scores revealed that PwPs consumed a high-quality diet during the pandemic. Findings from this study highlight the need for tailored nutrition education to support PwPs' care-partners.