Date of Award

2017

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Medical and Health Sciences

First Supervisor

Professor Amanda Devine

Second Supervisor

Dr Christina Davies

Third Supervisor

Jill Darby

Fourth Supervisor

Dr Johnny Lo

Abstract

Living in a community with adequate availability of nutritious food, and the capacity to access and utilise it, are key food security determinants (FSD). However, inequities relating to these determinants exist between regional and remote Western Australian (WA) communities, particularly regarding fruit and vegetables (F&V). This negatively impacts vulnerable populations, especially children. In order to understand determinants, prevalence and predictors of F&V and food security (FS), three concepts were explored in this PhD; (1) F&V consumption among regional and remote WA children (including determinants of F&V consumption, quantities, types, varieties of F&V consumed); (2) FS among regional and remote WA children (children’s FSD, prevalence of child food insecurity (FI) and socio-demographic predictors of FI); and (3) the relationship between FSD and F&V consumption among regional and remote WA children (FSD predictors of F&V consumption).

Methods This mixed-methods study included semi-structured interviews with 20 key informants, to explore determinants of F&V consumption and FS among regional and remote WA children. Cross-sectional surveys were completed by caregiver-child dyads (n = 256), to understand children’s F&V consumption behaviours, determine child FI prevalence and assess whether FSD predicted adequate F&V consumption. Twenty-four hour food diaries measured F&V amounts and varieties consumed. Data analyses were conducted using IBM SPSS (version 23), Microsoft Excel and QSR NVivo (version 10).

Results The determinants of children’s F&V consumption were explored using an Ecological Model of Health Behaviour. F&V quantities, types and varieties consumed were then quantified; more children achieved adequate fruit serves (65.8%) than vegetable serves (15.4%). Quantities consumed did not differ between regional and remote locations, however, F&V types and varieties consumed did. The FSD across food availability, access and utilisation dimensions were examined, illuminating inequities relating to food supply, social support and nutrition education. The calculation of prevalence and socio-demographic predictors of child FI revealed that one in five children were FI; family receipt of government income support (p = 0.022) and residency in a location of ‘Medium disadvantage’ (p = 0.023) predicted child FI. Subsequently, the association between FSD and adequate fruit intake among WA children was examined. After controlling for socio-demographic predictors, no determinants were significantly associated with fruit intake. However, FSD were associated with vegetable consumption; varieties and types of vegetables consumed (p = 0.007), health message promotion (p = 0.017), location of food outlets (p = 0.027) and price (p = 0.043) significantly predicted adequate vegetable consumption.

Conclusion This study contributed a greater understanding of the complex, interwoven factors that influence FS among regional and remote WA children, namely food availability, access, utilisation, and the impact on F&V consumption. Findings provide a basis for advocacy to improve inequities across WA, relating to food supply, social support and nutrition education. It also provides focus for health promotion practitioners who work with target groups affected by FI, to customise strategies to improve F&V consumption based on FSD, and has identified valuable future research pathways.

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