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Dietitians and Community Mental Health: Setting the Research Agenda

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Dietitians
and Community
Mental Health:
Setting the
Research Agenda
Project Report
March 2015
© Dietitians of Canada. 2015. All rights reserved.
www.dietitians.ca I www.dietetistes.ca
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE i
Dietitians and Community Mental Health: Setting the Research Agenda, a collaborative effort between Dietitians of
Canada (DC), Canadian Mental Health Association Ontario, and the University of British Columbia.
Funding provided by a Planning Grant from the Canadian Institutes of Health Research (CIHR). Funding reference
number 127193.
Suggested Citation:
D’AndreaMatteo C, Davison KM, Mitchell S, Vanderkooy P Dietitians of Canada. Dietitians and Community Mental
Health: Setting the Research Agenda. Toronto: Dietitians of Canada, 2015.
Critical Research in
Health and Healthcare
Inequities (CRiHHI)
Research Unit
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE ii
Table of Contents
Executive Summary.................................................................................................................................. 1
1. Project Overview .................................................................................................................................. 3
1.1 Background......................................................................................................................................................................... 3
1.2 Goals and Objectives......................................................................................................................................................... 5
1.3 Project Timeline .................................................................................................................................................................. 5
2. Methods ............................................................................................................................................. 6
2.1 A Collaborative, Multi-Step Agenda-Setting Process ................................................................................................... 6
2.2 Nutrition and Mental Health Scoping Review (Step I) ................................................................................................... 7
2.3 National Stakeholder Survey (Step II) ............................................................................................................................. 7
2.4 Key-Informant Questionnaire and Interviews (Step III) ................................................................................................. 9
2.5 Stakeholder Workshop (Step IV) .................................................................................................................................... 11
3. Results.............................................................................................................................................. 12
3.1 Summary of the Nutrition and Mental Health Scoping Review (Step I) .................................................................... 12
3.2 National Stakeholder Survey Results (Step II) ............................................................................................................. 14
3.3 Key-Informant Questionnaire and Interview Results (Step III) ................................................................................... 19
3.4 Workshop Results (Step IV) ............................................................................................................................................ 22
3.5 Emerging Directions and Stakeholder Preferences (Step V) ...................................................................................... 23
4. Synthesizing the Research Priorities (Step V)....................................................................................... 24
4.1 Synthesizing the Results of the Collaborative Process ............................................................................................... 24
4.2 Final Research Priorities .................................................................................................................................................. 24
5. Moving the Research Agenda Forward ................................................................................................. 26
5.1 Perceived Barriers ............................................................................................................................................................ 26
5.2 Dissemination of the Project Results ............................................................................................................................ 27
5.3 Next Steps ......................................................................................................................................................................... 30
Appendices ........................................................................................................................................... 32
Appendix A: Committee Members ....................................................................................................................................... 33
Appendix B: National Stakeholder Survey Web-based (Step II) ................................................................................... 34
Appendix C: Key-Informant Questionnaire Web-based (Step III) .................................................................................. 43
Appendix D: Key-Informant Interview Tool Used to Guide Interviewer (Step III) ......................................................... 48
Appendix E: Stakeholder Workshop Agenda (Step IV) ...................................................................................................... 52
Appendix F: Priority-Setting Exercise (Step IV).................................................................................................................... 53
Appendix G: National Survey Top Research Questions (Step II) ................................................................................... 54
Appendix H: Research Priorities By Stakeholder Groups (Step II) ................................................................................ 55
Appendix I: Stakeholder Workshop Priority Ranking of Research Questions (Step IV) ............................................. 56
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Executive Summary
Although nutrition and mental health is becoming an area of increasing investigative interest, no specific
research agendas to help guide research, policy, and practice currently exist. Based on evidence that mixed
approaches that engage diverse stakeholders with an experiential understanding of the nutrition and mental health
system generate meaningful action plans, an integrated, citizen-engaged research agenda-setting project, Dietitians
and Community Mental Health: Setting the Research Agenda, was conducted from 2013 to 2014. This national
initiative was a collaborative effort of Dietitians of Canada (DC), Canadian Mental Health Association Ontario, and the
University of British Columbia, with funding from the Canadian Institutes of Health Research (CIHR). The consultation
process engaged researchers, policymakers, service providers, persons with lived experience of mental illness and/or
family members of persons living with mental health conditions. The end result was the formulation of a Canadian
nutrition and mental health research agenda ultimately aimed at the optimization of nutrition and mental health
services in community settings.
Methods in Developing the Research Agenda
The national nutrition and mental health research agenda-setting project was a mixed methods, participatory initiative
that involved five steps:
I. a scoping review to contextualize current nutrition and mental health knowledge
II. a national online stakeholder survey to prioritize research topics (n=811)
III. key informant consultations to define prioritizing criteria (n=79)
IV. a national workshop involving representatives from research, policy, and practice to further define priorities
(n=16) and
V. synthesis of findings - triangulation of textual, descriptive and inferential data to formulate the final research
agenda/framework.
Summary of Research Priorities
Based on the integrated analysis of this national multi-step initiative, four nutrition and mental health research
priorities were identified:
1. Nutrition and Mental Health Programs and Services
Research Priority: Identify nutrition program/service needs, gaps and barriers for people living with
mental health conditions with respect to healthy diet, food access and skills development.
Research Use: Identify and implement effective models of care to address nutrition and mental health
needs in community settings.
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2. Service Provider Roles in the Provision of Nutrition Care
Research Priority: Explore and define roles and responsibilities of mental health service providers,
including dietitians, in the effective provision of nutrition care to individuals living with mental health
conditions in the community.
Research Use: Enhance collaboration and cross-training among service providers, and improve access to
nutrition care at the most effective points of intervention.
3. Informing Policy through Determinants of Health
Research Priority: Investigate the impact of social determinants (housing, income, education,
employment, etc.) on diet, food security and mental health.
Research Use: Advocate for and establish effective systems-level policies to benefit people living with
mental health conditions.
4. Knowledge Translation and Exchange
Research Priority: Explore and evaluate methods of knowledge translation and exchange to effectively
mobilize evidence from nutrition and community mental health research.
Research Use: Improve dissemination and uptake of new and existing knowledge to strengthen the
impact of community services, inform policy and program decision-makers, and increase food literacy in
the target population.
Moving the Research Agenda Forward
Given the evidence that optimal nutrition supports the mental health of Canadians and the national research priorities
identified from the Dietitians and Community Mental Health: Setting the Research Agenda project, a foundation has
been established that will help direct multiple stakeholders in formulating studies, policies, and knowledge translation
initiatives aimed at the optimization of population nutrition and mental health.
Since the completion of the CIHR-funded consultation, project team members have done preliminary work in
presenting the findings at various conferences and in scientific publications. However, more targeted work is required
to fully disseminate the results and effectively engage investigators and knowledge users to act on the findings in
research, practice, and policy-making. Specifically, a targeted knowledge mobilization plan is needed to develop and
disseminate tailored knowledge products and tools that are related to the four research priorities and that reach
diverse audiences including researchers, policymakers, practitioners, funding agencies, administrators, non-profit
organizations, private industry, and people with lived experience of mental illness.
Identifying and prioritizing research topics in consultation with a broad spectrum of stakeholders has been a
critical element in defining nutrition and mental health investigative targets, particularly in the context of increased
competition for funds. Since the best predictor of research uptake is early and continued involvement of relevant
stakeholders, a sustained and deliberate effort must now be made to engage stakeholders in meaningful dialogue
about the research priorities and initiate investigations that represent a true collaboration between researchers and
knowledge users. Actively engaging stakeholders from research, policy, practice, and those with experiential
understanding will require focused and proactive facilitation. The investment in a process that mediates and directs
diverse stakeholders to engage in identified national research priorities will ultimately lead to the optimization of
nutrition and mental health-related outcomes.
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1. Project Overview
1.1 Background
While nutrition and mental health research has been published for decades, there has been a major surge of
investigations in recent years, particularly in the fields of nutritional and psychiatric epidemiology. There are
many ways in which nutrition and mental health intersect
1
. From an intervention perspective, nutrition is
increasingly being recognized as a cornerstone in psychiatric treatment as targeted strategies can effectively
augment medical approaches to help optimize the structure and function of neurons and brain centres.
Furthermore, nutritional interventions as part of integrative programs aimed at mental health promotion,
contribute to social inclusion, self-reliance, self-determination, food security, healthy body image, and reducing
health and social inequities. Given that mental health conditions associated with long-term disability and
significant mortality are estimated to cost the Canadian economy $51 billion dollars annually
2
, and that diet is
the leading risk factor of global burden of disease
3
, focused research initiatives are needed to define and
advance nutrition and mental health practice with the ultimate goal of improving population health.
While there is a need to engage a broad range of relevant stakeholders to work toward consensus on
research priorities, no collaborative nutrition and mental health research agendas to guide Canadian practice
and policy have been formulated to date. In November 2010, the Institute of Nutrition, Metabolism, and
Diabetes of the Canadian Institutes of Health Research sponsored a workshop aimed at advancing Canadian
food and health research priorities where approximately 80 representatives from food science and nutrition
research, voluntary health organizations, federal and provincial governments, and the food industry
contributed to the articulation of an agenda that identified research priorities in areas such as nutrient
requirements and nutrition intervention studies for special populations (e.g., pregnant women, children,
Aboriginal), community-based interventions, balancing randomized controlled trials and population studies to
determine best practices, interdisciplinary research of food and nutrition policies, food security and diet
quality, understanding population variability in responses to nutrient interventions, and disease prevention. In
the U.S., two research nutrition agendas have recently emerged with peripheral connection to mental health.
The first, conducted by the Rural Food Access Workgroup, convened a national sample of academic and non-
academic researchers, public health and cooperative extension practitioners, and other experts to focus on
rural food access and economic development using a concept mapping process
4
. The second, led by the
American Society of Parenteral and Enteral Nutrition Research Committee, identified research priorities ranging
1
Davison KM, Ng E, Chandrasekera U, Seely C, Cairns J, Mailhot-Hall L, Sengmueller E, Jaques M, Palmer J, Grant-Moore J - for
Dietitians of Canada. Promoting Mental Health through Healthy Eating and Nutritional Care. Toronto: Dietitians of Canada, 2012.
2
Canadian Mental Health Association. Fast Facts: Mental Health/Mental Illness.
http://www.cmha.ca/bins/content_page.asp?cid=6-20-23-43 . Canadian Mental Health Association, 2012.
3
Institute for Health Metrics and Evaluation. Global Burden of Disease Study 2010. http://www.thelancet.com/themed/global-
burden-of-disease . 2012.
4
Johnson DB, Quinn E, Sitaker M et al. Developing an agenda for research about policies to improve access to healthy foods in
rural communities: a concept mapping study. BMC Public Health 2014;4:592.:592.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
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from improving the definition of malnutrition to the design and implementation of RCTs in specific areas and
patient populations
5
. In July 2014, the International Society for Nutritional Psychiatry Research initiated a
Delphi process to inform a consensus statement from experts and stakeholders with an interest in nutritional
psychiatry for the recently formed international organization to help guide research, clinical guidelines, and
public policy
6
.
As occurs in the formulation of many research agendas, the processes tend to be driven largely by singular
processes involving mainly funding bodies and scientists, with little input from policymakers or those with
direct involvement in the health issue being addressed (e.g., frontline workers, affected individuals). Singular
methods that focus on select groups for consensus building inherently lack exploration of differing
perspectives, which can result in specious consensus with limited external validity
7
. Evidence shows, however,
that the use of qualitative and quantitative approaches enables depth of understanding and corroboration
8
and that if those with experiential knowledge are included in the process then investigative results are more
likely to be used to improve the system
9
.
In recent years, granting bodies such as the National Institute of Mental Health
10
and CIHR have developed
directives for citizen engagement (i.e., meaningful involvement of individual citizens in research, planning, and
implementation) into their research and policy development role. "Citizens" are defined as those interested
representatives from the general public, consumers of health services, patients, caregivers, advocates, as well
as representatives from affected community and voluntary health organizations, and although their
engagement is viewed as integral to planning processes, little is known about how they may influence the
decision-making process at higher levels of the involvement spectrum
11
. Since the best predictor of research
uptake is early and continued involvement of relevant stakeholders
12
and the principles of citizen engagement
(15), we instituted an integrative, citizen-engaged, mixed methods approach in the establishment of a
Canadian nutrition and mental health research agenda.
5
Chan LN, Compher C, DiBaise JK et al. American Society for Parenteral and Enteral Nutrition research agenda. JPEN J Parenter
Enteral Nutr 2014;38(1):13-8. 13-8.
6
Jacka FN. Delphi process to inform a consensus statement from the ISNPR. Personal Communication 29-06-2014.
7
Keeney S, Hasson F, McKenna H. Debates, Criticisms and Limitations fo the Dephi. In: Keeney S, Hasson F, McKenna H, eds. The
Delphi Technique in Nursing and Health Research. Oxford, UK: Wiley-Blackwell 2011.; Mitroff II, Turoff M. Philosophical and
methodological foundations of Delphi. In (Eds.). In: Linstone HA, Turoff M, eds. The Delphi method: Techniques and applications.
Reading MA: Addison-Wesley Publishing Co. 1975:17-35.; van Bon-Martens MJ, van de Goor LA, Holsappel JC et al. Concept
mapping as a promising method to bring practice into science. Public Health 2014;128:504-14.
8
Creswell JW, Plano Clark VL. The Nature of Mixed Methods Research. In: John W.Creswell, Vicki L.Plano Clark, eds. Designing and
Conducting Mixed Methods Research Second Edition. Thousand Oaks, CA: Sage Publications 2011.
9
Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J, Knowledge Transfer Study Group. How can research organizations
more effectively transfer research knowledge to decision makers? Milbank Q.2003;81(2): 2003;81:221-48.
10
National Institute of Mental Health (NIMH). Bridging science and service: A report by the National Advisory Mental Health
Council's Clinical Treatment and Services Research Workgroup. 1999. Washington, DC, Author.
11
Corporate Consultation Secretariat, Health Policy and Communications Branch Health Canada. The Health Canada Policy Toolkit
for Public Involvement in Decision Making. http://www.hc-sc.gc.ca/ahc-asc/pubs/_public-consult/2000decision/index-eng.php .
2006.
12
Henderson J, Brownlie E, Rosenkranz S, Chaim G, Beitchman J. Integrated Knowledge Translation and Grant Development:
Addressing the Research Practice Gap through Stakeholder-informed Research. J Can Acad Child Adolesc Psychiatry
2013;22:268-74.; see also references in Footnotes 9-11.
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1.2 Goals and Objectives
The primary goal of the Dietitians and Community Mental Health: Setting the Research Agenda project was to
develop a national research agenda aimed at improving nutrition and mental health services in community
settings. Multi-stakeholder engagement and a collaborative, multi-step process for data collection and analysis
were key features of this study which resulted in a set of research priorities intended to meaningfully inform the
broad agenda and guide health research investments and knowledge translation.
The project also aimed to:
1. facilitate collaborations among health professionals, especially dietitians, and the community
mental health sector, to improve and contribute to knowledge exchange and research,
2. strengthen linkages among researchers and knowledge users and facilitate the production,
translation and dissemination of research, and
3. engage people living with mental health conditions and their family members, to provide relevant
input in the research agenda-setting process.
1.3 Project Timeline
The planning, implementation and subsequent preliminary dissemination of results from the Dietitians and
Community Mental Health: Setting the Research Agenda project occurred over 18 months, from June 2013 to
November 2014 (see below). Details are outlined in the Methods section of this report.
Dates
Activities
June to August 2013
Convene advisory committee
Conduct environmental scan
Develop and pilot-test electronic survey; revise electronic survey and prepare for launch
September 2013
Launch electronic survey
Begin planning for stakeholder workshop
October to November
2013
Evaluate data collected from electronic survey; create survey report
Develop key-informant interview tool and questionnaire
December 2013 to
January 2014
Launch electronic key-informant questionnaire
Conduct key-informant interviews
Confirm date for stakeholder workshop and invite participants
January to February 2014
Evaluate data collected from key-informant interviews and questionnaire
Create key-informant report, with prioritizing criteria
Develop content for stakeholder workshop; conduct stakeholder workshop
March to April 2014
Analyze data collected from stakeholder workshop
Determine final priority research areas from all data collected; prepare draft of final report
Develop presentations for dissemination of project results
May to November 2014
Present abstracts and poster presentations of research results
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2. Methods
2.1 A Collaborative, Multi-Step Agenda-Setting Process
The Dietitians and Community Mental Health: Setting the Research Agenda project was a multi-step,
collaborative consultation process that incorporated mixed methodology and generated comprehensive
information aimed at the integrated development of a national nutrition and mental health research agenda
(Figure 1). A dedicated nationally representative group of nutrition and mental health experts formed the
steering and advisory committees (see Appendix A) and guided the project.
Figure 1: Overview of research agenda development process
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2.2 Nutrition and Mental Health Scoping Review (Step I)
A scoping review was conducted by the Project Coordinator, with the assistance of a policy intern
13
working
with Canadian Mental Health Association Ontario to obtain information about nutrition and mental health-
related research and programs available across Canada and beyond. The literature search date limits were
selected based on the nutrition and mental health role paper released by Dietitians of Canada (DC) in
December 2012
14
. The DC role paper provided a synthesis of the research from over 800 nutrition and mental
health research investigations published during 1980 to 2012. For this project, a literature search was
conducted to find clinical and community-based nutrition and mental health articles published from January
2012 to July 2013. Keyword searches completed using academic databases (i.e., Google Scholar, Scopus,
PubMed) utilized terms identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
15
autism, autism spectrum disorder, schizophrenia, psychosis, bipolar disorder, depression, disordered eating
(anorexia nervosa, bulimia nervosa), and neurocognitive disorders (e.g., Alzheimers disease, dementia) in
combination with appropriate key nutrition terms: diet, nutrition, food security, vitamins, minerals. In addition
to published research, some information on studies in progress (i.e. not yet published) was provided by
project steering and advisory team members to further inform the scoping review.
As part of the scoping review, an inventory of active and recently active nutrition and mental health
community-based programs offered within Canada was also created to help formulate research topics for the
online questionnaire. Programs that contained a nutrition component (e.g., food skills development, nutrition
and health presentations) in combination with mental health were identified as relevant for the purposes of the
review. To help locate relevant programs to include in the inventory, steering and advisory committee members
provided a list of contacts from their extensive professional networks.
2.3 National Stakeholder Survey (Step II)
As the initial step in engaging stakeholders, a web-based nutrition and mental health survey (Appendix B) was
nationally distributed in the fall of 2013. The extensive networks and connections provided by the steering
group and advisory team members were utilized to disseminate the survey. A snowball approach encouraged
participants to further extend outreach to a wide diversity of potential respondents. Calls for participation in
the survey were distributed through national newsletters for Dietitians of Canada members, the Canadian
Mental Health Association and affiliates, and workplaces and professional associations to which advisory team
members belonged. Social media (Twitter and Facebook) were also engaged to encourage stakeholders to
complete the online survey.
13
With appreciation: Tony Zhang, Policy Intern, CMHA-Ontario
14
Davison, K.M., et al., (2012). Promoting Mental Health through Healthy Eating and Nutritional Care. Toronto: Dietitians of
Canada, 2012.
15
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:
Author.
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The survey included questions that asked participants to review and prioritize a list of research topics
identified through the scoping review and further refined by the advisory team. Participants were also offered
an opportunity to submit additional nutrition and mental health research topics to consider beyond what was
presented in the survey.
Survey Design
The format of the national stakeholder survey was based on examples of online research priority setting survey
tools found through targeted literature reviews and Internet searches. In addition, the works of Palys &
Atchison
16
provided guidance for survey question design and sequencing. Some of the layout details for the
final version of the online survey were dictated by the software program (FluidSurveys) available for this
project.
Members of the steering group and advisory team worked together to develop content for the online
survey. Efforts were focused on creating a document suited for a diverse range of stakeholders. After multiple
team discussions and survey tool modifications, the project coordinator conducted two in-depth stakeholder
interviews (a person with lived experience and a social worker) to obtain user perspectives the survey. Once
content adjustments were made based on the stakeholder feedback, the survey was pilot-tested with five
individuals (allied health professionals and individuals lived experience). Information gathered from the pilot-
testing helped to shape the flow of the survey, ensure appropriate word usage, and clarify the meaning of each
research topic presented. A SMOG test for readability was conducted
17
.The SMOG results for the full survey
content = 11.9 and the SMOG result for the list of research topics = 10.84. (See Appendix B for the final
version of the national stakeholder survey.)
The national electronic survey was published online on September 4, 2013 and remained open until
October 11, 2013. A snowball method was used to disseminate the survey link. An invitation was distributed
through the partner organizations' websites, newsletters and mailing lists, and followed via social media
channels, including Twitter and Facebook. Steering and advisory committee members circulatedinvitations to
key contacts. Collectively, the survey was advertised toa diverse audience, including:
service providers and health professionals
community members with lived experience
family members of individuals with mental health conditions
policymakers (provincial and federal)
provincial and national community organizations (foundations, networks, societies, associations)
researchers.
16
Palys, T. and Atchison, C. (2014). Research Decisions Quantitative, Qualitative, and Mixed Methods Appraoches, 5th ed.
Toronto, Ontario: Nelson Education Ltd.
17
Readability Score.com. (2011-2014). Retrieved from https://readability-score.com/
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2.4 Key-Informant Questionnaire and Interviews (Step III)
A list of more than 100 key informants was compiled from the national stakeholder survey (Step II).
Respondents had been provided an opportunity to identify names and contact information of any nutrition and
mental health stakeholders that may be interested in contributing further to the project. Each of the individuals
identified was approached via email or telephone to complete a personal key-informant interview with the
project coordinator and/or an additional questionnaire in order to:
help identify priority-setting criteria to apply to nutrition and mental health research topics in Step
IV of the project;
identify possible researchers, research teams, institutions or community partners, and funders
that could potentially carry the research agenda forward; and
identify to whom and how best to disseminate the project results.
An electronic invitation to complete the questionnaire was distributed to the list of contacts obtained in
Step II of this project. The questionnaire (Appendix C) was made available between December 15-23, 2013. A
total of 63 individuals responded.
Nine in-depth key-informant interviews (Appendix D) were conducted by the project coordinator during
December 2013 and January 2014 via telephone. Interviews were recorded (with consent) and transcribed by
independent transcription service providers. A thematic analysis was completed from the data and information
was compiled to help inform further steps of the agenda setting project.
Process for Determining Priority-Setting Criteria
Steps I and II of the nutrition and mental health project allowed for the development and refinement of key
research topics. In accordance with Okello & Chongtrakul
18
, assessing each research concept against a set of
priority-setting criteria was an essential next step to develop a reliable agenda.
After reviewing reports and recommendations from a range of previous priority-setting exercises, the
project team adopted a modified list of priority-setting criteria developed by the Council on Health Research for
Development18. Feedback on these criteria was gathered through the key-informant questionnaire (Appendix
C). Respondents were asked to identify which criteria they considered “important” for determining research
priorities in nutrition and mental health. There were no limits imposed on the number of criteria that could be
selected from the list. Furthermore, respondents were given an opportunity to add to the list of criteria.
The key-informant interviews included an open-ended question asking respondents to identify priority-
setting criteria. This approach was intended to allow for original ideas to emerge. However, when necessary,
the interviewer used the list of criteria from the questionnaire to probe for responses from the interviewee.
Results from the key-informant questionnaire and interviews were used to refine the list of criteria to carry
forward to the stakeholder priority-setting workshop (Step IV).
18
Okello, D., and Chongtrakul, P. A Manual for Research Priority Setting using the ENHR Strategy. Geneva: The Council on Health
Research for Development. March 2000.
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Final Priority-Setting Criteria (to be used in Step IV)
The project team agreed on eight priority-setting criteria grouped under four categories:
Appropriateness: Should we do it?
1) Is the research ethically, morally and culturally appropriate?
2) Do we need more research on this topic? (Does adequate evidence already exist? Can we avoid
duplicating existing research?)
Relevancy: Why should we do it?
3) Will the research contribute to better equity in health? (Will it serve community concern/demand?
Will it be broad in scope?)
4) Will the research reduce the burden of illness? (What is the magnitude of the issue? Will the research
address the social determinants of health?)
Chance of Success: Can we do it?
5) Does our system have the capacity to undertake the research? (Do we have the competency,
infrastructure, mechanisms, support system, and resources?)
6) Can we justify the cost of the research? (Is there a strong likelihood of partnership building?
What is the funding potential? Is the research pragmatic and politically acceptable?)
Impact of the Research Outcome: What do the stakeholders get out of it?
7) What are the chances that recommendations emerging from the research will be implemented?
(Is the research applicable to current practice? Does it represent forward/upstream thinking?
8) Will the research have a significant impact on mental health and quality of life within the population?
(Will it have an economic impact?)
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2.5 Stakeholder Workshop (Step IV)
A group of 16 individuals representing a cross-section of stakeholders were invited to attend a one-day
workshop in February 2014. The events of the workshop focused on applying the priority-setting criteria
(established in Step III) to the list of nutrition and mental health research topics (established in Step II) to help
formulate the national research agenda. Furthermore, the workshop was a platform to foster potential
partnerships that could move forward to address the priorities in future research proposals. Efforts were taken
to include stakeholders at the workshop that would most likely be able to facilitate the implementation of the
research agenda. Workshop participants came from the provinces of Ontario, Alberta, Manitoba, British
Columbia, and Nova Scotia and included representatives from research, management, public policy, and
service provision. (See Appendix E for a copy of the workshop agenda.)
Priority-setting Exercise
Workshop participants collaborated in small groups, each led by a project core team member, and
systematically went through each research question derived from the results of the national online survey and
by consensus applied the defined criteria that included appropriateness, relevancy, chance of success, and
impact of the research outcome (Appendix F). Prior to commencing the group exercise, all participants were
provided with a detailed explanation for each of the criteria categories, to assist with the process and prevent
misinterpretation. After the completion of the group exercise, two workshop facilitators compiled and ranked
the results. The findings were then presented to the large group and served as a catalyst for meaningful
discussion about the process and priorities identified.
After the large group discussion, a second small-group activity was conducted. Four groups were formed to
examine each of the research priorities identified during the previous small-group activity. Participants self-
selected the group they participated in based on their interests and expertise. The second small-group activity
was also led by a core project team member who facilitated discussion about the research priority, perceptions
of what research had already been conducted in this area, the investigative gaps that exist, and potential steps
to take from here to initiate research that would address the gaps. In the final stage of the workshop, a
facilitated large-group discussion was conducted based on the small-group exercise.
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3. Results
3.1 Summary of the Nutrition and Mental Health Scoping Review (Step I)
Findings from both the DC role paper and the initial scoping review were synthesized into a list of potential
research directions (Table 1) to be considered during the multi-step, collaborative agenda-setting process.
Results from the scan fell into two categories: research and community-based programming.
i) Research
Clinical scientific evidence exists to confirm that dietary intake and nutrient status for individuals with mental
illness is compromised. However, these findings require movement forward from the clinical setting to
community-based research that assesses the impact that nutrition and mental health programming has on the
overall nutritional status and wellbeing of individuals living with mental health issues. In addition to the role of
mental health condition-based nutrition interventions, it is necessary to determine the impact that good
nutrition plays in promoting mental health and preventing the onset of mental health disorders.
ii) Community-Based Programming
Community level nutrition programming for individuals living with mental health issues is varied in structure,
content and delivery method across Canada. Interventions are often embedded within a larger program aimed
at overall wellbeing and may simply include a specific module or session on nutrition as it relates to mental
health.
In Summary
Community-based research that provides specific benefits and ideal models would provide policymakers with
evidence to support the implementation of effective nutrition and mental health programming and services
across a large number of settings.
Formulation of Investigative Topics into Researchable Questions
The overall research directions derived from the scoping review were formulated into corresponding
researchable questions for use on the national stakeholder survey (Table 1).
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Table 1: Research Directions Derived from Scoping Review and National Stakeholder Survey
Research Directions Established
from the Scoping Review
Corresponding National Survey Research Questions
Assessing and providing evidence of the extent of
nutritional impact on mental health promotion,
prevention, and conditionbased interventions
How does a healthy diet and/or access to healthy food promote mental health?
How do intakes of certain foods and/or nutrients prevent or delay the onset of mental health conditions?
How does food and/or nutrient intake affect specific mental health conditions?
What food-related policies would help people living with mental health conditions?
For people who live with both a mental health condition and other chronic physical disease(s) (e.g., diabetes, heart
disease), how does diet and/or access to healthy food influence overall health?
Determining appropriate service levels for dietitians
working in mental health settings
How many dietitians would be required to meet nutrition service needs in community mental health settings in Canada?
Conducting epidemiological and intervention research
that defines diets and/or nutrients that promote mental
health
What food-related policies could be implemented to promote mental health and/or prevent or delay the onset of mental
health conditions?
Performing cost-effectiveness studies that quantify how
specific nutritional interventions in mental health
practice are economically beneficial
What are the economic benefits associated with nutrition services in community mental health settings?
Examining new research questions utilizing large
population databases to understand the role of
nutrition and mental health, particularly within the
context of the health determinants
How do life situations (e.g., housing, income, education, employment) affect the type and amount of food that people eat
and what impact does that have on their mental health?
Evaluating food skills of those living with mental illness
For those people living with a mental health condition, does food skills training (e.g., food selection, cooking, and storage)
have an impact on their mental health?
Examining the role of service providers in delivery
and/or support of nutrition information to clients with
mental health conditions
What knowledge and skills are required for dietitians who provide service for individuals living with mental health
conditions?
What are the roles of non-dietitian service providers (e.g., support workers, other health professionals) for providing
nutrition information or support to clients who are living with mental health conditions?
Identifying gaps in community-based mental health
nutrition services
What are the gaps in community health and nutrition services for people living with mental health conditions?
What programs or services do people living with mental health condition(s) need with respect to food access, nutrition,
and/or cooking skills?
Determining perceived barriers to mental health
nutrition program participation and program delivery
What are the barriers to receiving nutrition services (e.g., counselling, cooking programs) for individuals living with mental
health conditions?
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3.2 National Stakeholder Survey Results (Step II)
Demographics
A total of 811 surveys were completed and analyzed using FluidSurveys basic software for response analysis.
A description of participants is detailed in Table 2. Respondents provided representation on key
demographics, all Canadian regions, and stakeholder groups. The number of responses obtained from First
Nations, Métis, and Inuit (3.8%) is reflective of the percentage of the Canadian population that corresponds
with this ethnic origin. More than half (56%) of the respondents reported living in metropolitan and large city
locations. A higher proportion of women (89%) completed the survey compared to men. The majority of
respondents (88%) were between 19 and 59 years of age.
Mental Health Condition-Specific and Population-Specific Research Priorities
Respondents were asked to identify specific mental health conditions that could benefit from nutrition-related
research. Although the answers varied somewhat between stakeholder groups, the conditions most commonly
identified included depression (n=712, 88%), anxiety (n=640, 79%), and disordered eating (n=628, 77%);
pregnancy-related mental health conditions were added by many (n=28, 3%) as an additional area of priority
for research (Figure 2).
The majority of respondents indicated that children and youth (n=470, 58%) were a top priority for
nutrition and mental health research. However, more than half of the participants (n=411, 51%) also indicated
that all population groups require equal priority (Figure 3). Individuals who live in poverty or low-income
circumstances were added by about 3% of respondents (n=29) as a population group that requires higher
priority for nutrition and mental health research.
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Table 2: Characteristics of respondents to national stakeholder online survey
Characteristic
LE
n (%)
(244)
FM
n (%)
(344)
1. Sex
Male
18 (7)
26 (8)
Female
224 (92)
314 (91)
2. Age (years)
18 to 29
50 (20)
58 (17)
30-39
60 (25)
74 (22)
40-49
65 (27)
81 (24)
50-59
46 (19)
87 (25)
60
20 (8)
38 (11)
3. Regions
Region 1: British Columbia plus Yukon
56 (23)
65 (19)
Region 2: Alberta, Saskatchewan, Manitoba, Northwest Territories, and Nunavut
50 (20)
76 (22)
Region 3: Ontario
113 (46)
158 (46)
Region 4: Quebec, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island
19 (8)
34 (10)
4. Community Size
Metropolitan: population 500,000+
66 (27)
93 (27)
Large city: population 100,000 to 499,999
77 (32)
98 (28)
Medium city: population 30,000 to 99,999
44 (18)
67 (19)
Small city: population 1,000 to 29,999
25 (10)
42 (12)
Rural area, town or village: population less 1,000 and rural areas
29 (12)
40 (12)
continued…
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Characteristic
LE
n (%)
(244)
FM
n (%)
(344)
5. Stakeholder Groupsa
Service provider: Working or have worked as a service provider for individuals with a mental health condition(s)b
138 (57)
186 (54)
Registered dietitian: includes community, clinical, administrative
55 (23)
116 (34)
Advocacy: working or have worked in advocacy related to mental health
59 (24)
92 (27)
Volunteer: working or have worked as a volunteer in a nutrition and/or mental health setting
61 (25)
77 (22)
Researcher: working or have worked in nutrition and/or mental health research
36 (15)
53 (15)
Manager/director: working or have worked as manager/director of a mental health program or organizationc
23 (9)
36 (10)
Public policy: working or have worked in public policy; roles included public health professional, health promoter, policy
analyst, health advisor
17 (7)
27 (8)
Lived experience of a mental health condition
--
154 (45)
Family member of someone with a lived experience of a mental health condition(s)
154 (63)
--
a Note: there were 17 respondents who indicated their stakeholder role was as a post-secondary student; due to the small sample size subgroup analysis was not
conducted on this group.
b Respondents indicated their service provider roles included nurse (RN, LPN, NP), support/peer support worker, counsellor, psychologist, psychometrist, social
worker.
c Respondents indicated their manager/director roles included programs and services, executive director, patient/client care, social worker, behavioural therapy.
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Figure 2: Mental Health Condition-Specific Research Priorities
Figure 3: Mental Health Population-Specific Research Priorities
Selected National Survey Respondent Feedback:
Kids are the priority for me because of their general developmental needs.”
Family member of an individual with lived experience
“I think if we start education for children and parents of young children,
this will benefit them and society most as this is when habits begin!”
Survey participant working in nutrition and mental health research
“I feel all mental health conditions require appropriate nutrition related research
to support a healthy mind and healing.”
Lived experience, family member, service provider
“I live on a low income and find it a challenge to eat healthy food. When I am
doing the worst with my illness, it's the hardest to feed myself well, but probably
when I need it the most.”
Lived experience
Selected National Survey Respondent Feedback:
Disordered Eating (broad definition), not just eating disorders
(such as anorexia and bulimia).”
Dietitian, service provider, research, advocate and volunteer
“Post-partum depression and depression during pregnancy, considering the
nutrient demands on the mother during this time, perhaps there is a nutrition
link?”
Public health dietitian
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Top Three Research Priorities Emerging from the National Stakeholder Survey
The top three research priorities, ranked by the respondents of the survey that was disseminated across Canada in
Step II of the collaborative agenda-setting process, are outlined in Table 3. For a summary of the overall ranking of
all research priorities established from the results of the stakeholder survey see Appendix G.
Table 3: Top Three Research Priorities From National Stakeholder Survey
Top Three Research Priorities
Supporting Quotes from Survey Participants
Research Question:
How does food and/or nutrient intake affect
specific mental health conditions?
“Nutrition is an important influencing factor for people with
mental health issues. Good nutrition can support people in
their recovery; poor nutrition can do the opposite.”
Survey respondent involved with
mental health knowledge exchange
“There is definitely a connection between mental health
and nutrition and more research needs to be done in this
area. We also need to know how to nutritionally support
people who have mental health conditions…”
Dietitian and family member
Research Question:
How do life situations (e.g., housing, income,
education, employment) affect the type and
amount of food that people eat and what
impact does that have on their mental health?
“Many [of my clients] use the food bank but that is limited,
often rent, other bills and any addictions whether it's
smoking, drinking or something else are often looked at
first, food seems to be last on the priority list. It can be hard
to work with people…if they are constantly hungry or sick
because of lack of nutrition.”
Mental health service provider
Research Question:
What programs or services do people living
with mental health condition(s) need with
respect to food access, nutrition, and/or
cooking skills?
“Better to funnel research dollars into programs, services
and policies that will have tangible benefits.
Survey respondent involved with
mental health knowledge exchange
“I know about the importance of nutrition, I can afford food,
and I can cook, but I don't eat well, because meal
preparation takes too much effort when I'm depressed.”
Lived experience survey participant
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The top three research priorities were similar when analyzed by:
province
ethnicity
duration of time in Canada, and
community size
There was some variation in the ordering of these top three priorities for the individual stakeholder and special
interest (i.e., newcomers to Canada) groups. Where differences occurred the priorities were in agreement on at
least two of the top three investigative topics (see Appendix H).
3.3 Key-Informant Questionnaire and Interview Results (Step III)
The key-informant questionnaire (Appendix C) and interview (Appendix D) were used to create a working list of
research priority-setting criteria that would be carried forward and applied at the stakeholder workshop (Step IV).
Questionnaire Results
A total of 63 questionnaires were completed and analyzed using FluidSurveys basic software for response
analysis. The response rate of the key informant questionnaire was approximately 60%. Participants were
primarily from Ontario and British Columbia (Table 4) and included representation of individuals with lived
experience of mental illness. More than 70% of respondents agreed that "impact on health" and "community
concern/demand" were key criteria for setting research priorities in nutrition and community mental health.
No new criteria were suggested that extended beyond the items proposed on the questionnaire.
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Table 4: Characteristics of key informant online questionnaire respondents
Characteristic
Total
n (%)
(63)
LE
n (%)
(30)
FM
n (%)
(36)
1. Regions
Region 1: British Columbia plus Yukon
16 (25)
10 (33)
11 (31)
Region 2: Alberta, Saskatchewan, Manitoba, Northwest Territories, and Nunavut
9 (14)
7 (23)
6 (17)
Region 3: Ontario
32 (51)
12 (40)
17 (47)
Region 4: Quebec, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island
5 (8)
2
2 (6)
2. Community Size
Metropolitan: population 500,000+
23 (37)
10 (33)
14 (39)
Large city: population 100,000 to 499,999
15 (24)
5 (17)
6 (17)
Medium city: population 30,000 to 99,999
10 (16)
7 (23)
7 (19)
Small city: population 1,000 to 29,999, rural area, town or village: population less 1,000 and rural areas
15 (24)
8 (27)
9 (25)
3. Stakeholder Groups
Service provider: Working or have worked as a service provider for individuals with a mental health condition(s)a
37 (59)
16 (53)
22 (61)
Registered dietitian: includes community, clinical, administrative
25 (40)
8 (27)
13 (36)
Advocacy: working or have worked in advocacy related to mental health
14 (22)
9 (30)
11 (31)
Volunteer: working or have worked as a volunteer in a nutrition and/or mental health setting
16 (25)
14 (47)
12 (33)
Researcher: working or have worked in nutrition and/or mental health research
18 (29)
10 (33)
11 (31)
Manager/director: working or have worked as manager/director of a mental health program or organizationb
2 (3)
2 (7)
2 (6)
Public policy: working or have worked in public policy; roles included public health professional, health promoter,
policy analyst, health advisor
4 (6)
3 (10)
3 (8)
Lived experience of a mental health condition
30 (48)
--
22 (61)
Family member of someone with a lived experience of a mental health condition(s)
36 (57)
22 (73)
--
a Respondents indicated their service provider roles included nurse (RN, LPN, NP), support/peer support worker, counsellor, psychologist, psychometrist, social worker
b Respondents indicated their manager/director roles included programs and services, executive director, patient/client care, social worker, behavioural therapy
Notes: LE: lived experience; FM: family member
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Key Informant Interview Results
Nine key informants from British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario were interviewed. The
informants included service providers, managers and directors, as well as public policy developers.
Key-informant interviewees responded to an open-ended question asking for criteria that should be used to establish
research priorities in nutrition and mental health. Responses were compiled and categorized into the criteria
groupings identified by Okello & Chongtrakul (2000). The top four most “important” criteria, based on frequency of
response, are consistent with the results from the key-informant questionnaire: impact of the research outcome,
relevancy, appropriateness and chance of success.
Additional Research Questions Identified by Stakeholders
During the survey, key-informant questionnaire and interviews, stakeholders were invited to suggest further research
directions in addition to the list presented from the results of the scoping review (Step I). A them atic analysis was
applied to group these new suggestions under four main categories (Table 5).
Table 5: Results of Thematic Analysis of Stakeholder Feedback on Additional Research Directions
Research Directions
Details
Medication-Related Research
Determining the effects of mental health medications on
appetite, metabolism (weight gain in particular), and brain
health
Establishing practice-based evidence to develop intervention
strategies for health care workers to utilize with mental
health clients to assist with preventing or managing weight
gain at the time of medication commencing
Determine the Impact of Geographical Location on
Community-Based Nutrition and Mental Health Prevention
and/or Management
Assessing the influence that geography (i.e. rural, Northern,
remote locations) has on mental health populations re: food
security, programming needs and access
Determine the Nutrition Skill Needs of Non-Dietitian Mental Health
Service Providers
Establishing the required nutrition knowledge and skill set
needed for frontline mental health service providers
Determining how best to provide nutrition and mental health
knowledge transfer to these care providers
Evaluation and Establishment of Effective Approaches to
Addressing Mental Health Nutrition Issues
Formalizing an evaluation of current nutrition and mental
health programs, to establish best-practice across Canada
Investigating the effectiveness of programs with multi-
faceted approaches (ex. nutrition and physical activity) to
addressing mental health conditions
Evaluating the effects of alternative nutrition and mental
health programming delivery to clients (i.e. internet usage,
social media, collective cooking)
Determining best practices for delivering nutrition education
to specialized groups (i.e. newcomers to Canada, First
Nations, Metis, Inuit)
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3.4 Workshop Results (Step IV)
The face-to-face workshop participants included stakeholders that would mostly likely be in a position to carry the
research agenda forward post-workshop. Workshop participants (n=16) included policy analysts, service providers,
researchers, managers, directors, and dietitians.
The collaborative workshop exercise determined a priority rating for each of the 15 nutrition and mental health
research questions (Appendix I). The following four research questions emerged as the top priorities:
What are the barriers to receiving nutrition services (e.g., counselling, cooking programs) for
individuals living with mental health conditions?
What food-related policies would help people living with mental health conditions?
What programs or services do people living with mental health condition(s) need with respect to
food access, nutrition, and/or cooking skills?
What are the roles of non-dietitian service providers (e.g., support workers, other health
professionals) for providing nutrition information or support to clients who are living with mental
health conditions?
Through small- and large-group discussions, participants reflected on the priority-setting exercise and provided
feedback on the process. The group made the following suggestions:
1. Adjust the phrasing of some research topics to improve uptake by diverse stakeholders.
2. Acknowledge the complexity of the research ideas and their implementation.
3. Apply the priority-setting criteria in different contexts (e.g., practice, policy).
4. Identify potential barriers to completing the research.
5. Encourage implementation of research approaches that would enable individuals with lived experience of
mental illness to participate as co-investigators and/or knowledge users.
Participants also helped to identify mechanisms for moving the research agenda forward, as well as potential
barriers:
Knowledge translation: Many workshop participants acknowledged that a significant body of evidence
from nutrition and mental health research already exists but is not being utilized to full capacity in policy
development and everyday practice. More effective knowledge translation is required to help the sectors
act on what we already know and avoid unnecessary duplication of research.
Funding limitations: In the context of intense competition for research funds, it was acknowledged that
limited monies have been directed to nutrition and mental health research. To help overcome this barrier,
participants identified that funding should still be sought from the tricouncil agencies but to also explore
other sources such as international sources, government and non-government agencies, and private
industry. There was also agreement that pre-existing sources of data (e.g., national and provincial data
sources) should be capitalized on to help address the research priorities.
Fostering continued collaborations: Participants acknowledged that being brought together in the
workshop forum was immensely helpful in bridging the distance between nutrition and mental health
stakeholders. They would have welcomed an even longer workshop to allow for in-depth discussion of
possible research projects. The stakeholders also expressed interest in continuing to collaborate around
the priorities after the project’s completion.
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3.5 Emerging Directions and Stakeholder Preferences (Step V)
The most widely supported research directions that emerged from the multi-step collaborative processes are outlined
in Figure 4. The corresponding investigative questions selected to address the overall areas may be different,
depending on the stakeholder group.
There were distinct differences in the research direction and questions when filtering the results by stakeholder
groupings, from Step II and III of the agenda-setting process.
The remaining research directions analyzed by stakeholders during the multi-step process were not identical in
priority value between the national survey and the workshop stakeholders. This may be reflective of the specific lens
that was applied when assessing the research ideas. Specifically, service providers (54%) and family members (43%)
were the most prevalently identified stakeholders from the national survey. The workshop participants included 44%
dietitians and 31% managers/directors.
Figure 4: Flow Chart of Research Directions Defined By All Stakeholders and Specified Stakeholder Groups
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4. Synthesizing the Research Priorities (Step V)
4.1 Synthesizing the Results of the Collaborative Process
Each step of the collaborative process used to establish a national nutrition and mental health research agenda
provided valuable information that helped shape the final results. A preliminary list of possible research directions was
developed from the scoping review and the DC nutrition and mental health role paper. With input from the project
Advisory Committee, the research directions were fleshed out and expressed as specific research questions. This list
was ranked by a large and broadly representative sample of stakeholders (n=811) via online survey. Survey
respondents were first asked to rate each question independently, using a five-point scale (from "not important" to
"very important"), and then asked to select their top three priorities from the full list. No ranking criteria were provided,
and respondents were not asked to explain their choices. Findings from the survey were reviewed by the project team,
with input from the Advisory Committee, and followed by a round of key informant interviews and questionnaires to
identify remaining gaps and establish priority-setting criteria in preparation for the face-to-face workshop. The
resulting list of research questions was reviewed and discussed in the face-to-face workshop by a representative
group of invited experts (n=16). Priority-setting criteria (Appendix F) were used to guide the discussion and
participants were invited, in a series of small-group exercises, to apply the criteria and rank each research question
using a point system. The full group then reconvened to discuss the ranking process, review the top-ranked questions,
and identify barriers and facilitators to moving the research agenda forward.
4.2 Final Research Priorities
The research team reviewed and synthesized all input gathered during the consultation process. Based on the
integrated analysis of this national multi-step initiative, four nutrition and mental health research priorities were
identified.
Nutrition and Mental Health Programs and Services
Research Priority: Identify nutrition program/service needs, gaps and barriers for people living with
mental health conditions with respect to healthy diet, food access and skills development.
Research Use: Identify and implement effective models of care to address nutrition and mental health
needs in community settings.
Service Provider Roles in the Provision of Nutrition Care
Research Priority: Explore and define roles and responsibilities of mental health service providers,
including dietitians, in the effective provision of nutrition care to individuals living with mental health
conditions in the community.
Research Use: Enhance collaboration and cross-training among service providers, and improve access to
nutrition care at the most effective points of intervention.
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Informing Policy through Determinants of Health
Research Priority: Investigate the impact of social determinants (housing, income, education,
employment, etc.) on diet, food security and mental health.
Research Use: Advocate for and establish effective systems-level policies to benefit people living with
mental health conditions.
Knowledge Translation and Exchange
Research Priority: Explore and evaluate methods of knowledge translation and exchange to effectively
mobilize evidence from nutrition and community mental health research.
Research Use: Improve dissemination and uptake of new and existing knowledge to strengthen the
impact of community services, inform policy and program decision-makers, and increase food literacy in
the target population.
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5. Moving the Research Agenda Forward
5.1 Perceived Barriers
Key-informant stakeholders involved with Step III and workshop participants in Step IV were asked to identify
perceived barriers that could potentially interfere with moving the nutrition and mental health research agenda
forward. Several barriers that were consistently identified are presented below with supporting narratives from key
informants.
Lack of funding
Specifically, lack of funding available for community-based and qualitative research approaches as
opposed to clinical, nutrient-specific quantitative research.
Trouble finding participants and partners
There may be difficulty with:
1. recruiting research participants with lived experience of mental illness;
2. locating dietitians with specific training in mental health nutrition; and
3. finding motivated partners to engage in research.
Low interest
Addressing nutrition and mental health may not be a high priority for national and provincial
governments, funding bodies, or stakeholder organizations.
Indirect barriers may exist due to lack of interest among the media (no coverage to help increase
awareness), pharmaceutical companies (no desire to shift focus from medication to food for mental
health management), and other health professionals (who may be skeptical of the impact that
nutrition can have on mental health).
A still-present stigma related to mental health may partially account for apparent low interest among
various groups.
Complexity of following through with research results
The potential that research findings might result in an increased demand for social funding, program
funding, etc., may deter support for research endeavours.
Once research has been completed, policy support may be lacking, which could deflate interest.
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Stakeholder Comments
“Lack of funding when the project does not involve pharmaceuticals.”
Service provider and family member
“And you know sometimes patients, they’re not always easy to engage, depends on the
nature of their illness so it would have to be something that is interesting to them that
they would want to come forward in and volunteer their time.”
Service provider
“Stigma, preconceived notion that people with mental [illness] are not able to do what is
needed to help themselves.”
Lived experience, family member, dietitian, service provider
[L]ooking at the social determinants of health it’s just sometimes overwhelming right?
I think people shy away from it because how do you tackle all that, right? ”
Policy analyst
5.2 Dissemination of the Project Results
Table 8 provides a list of the preliminary dissemination activities that have taken place since completion of the
multi-step consultation process. Each activity was attended by a member of the steering group or by the project
consultant.
The final project report will be widely disseminated. The document will be posted on each partner’s website
and promoted through their existing newsletters and organizational mailing lists. Advisory Committee members
will be encouraged to disseminate the results through their own networks, and all project participants will be
notified by email, as will the many individuals who contacted the project coordinator throughout the project to
request information about the research agenda.
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Table 8: Initial Dissemination Activities from Dietitians and Community Mental Health:
Setting the Research Agenda Project
Dates
Activities
April 2014
Webinar
Host: Community Food Centres Canada
Location: National
Citation: McKay T, Dunnion K, Davison KM (2014). Food on Our Minds: Diet, Mental Health and
the role of Community Food Programs (webinar). Community Food Centres Canada.
Link: http://thepod.cfccanada.ca/issues-modules
April 2014
Oral Presentation: Nutrition and Mood Disorders: Defining Relationships
Host: Nutrition and Mental Health Symposium, University of Alberta
Location: Edmonton, Alberta
May 2014
Poster Presentation
Host: Canadian Association for Health Services and Policy Research
Location: Toronto, Ontario
Citation: Mitchell S (2014). Dietitians and Community Mental Health: Setting the Research
Agenda. The Canadian Association for Health Services and Policy Research (CAHSPR) 2014
Conference. Link: www.cahspr.ca/en/conferences/past/2014/abstracts/poster
Seminar Presentation: Nutrition and Mental Health: Research Profile with Links to Health Sciences.
Host: University of Ontario Institute of Technology, Faculty of Health Sciences
Location: Oshawa, Ontario
June 2014
Paper Presentation:
Host: Canadian Collaborative Mental Health Care Conference
Location: Toronto, Ontario
Citation: Mitchell S (2014). Dietitians and Community Mental Health: Setting the Research
Agenda. The Canadian Collaborative Mental Health Conference.
June 2014
Oral Presentation
Host: Dietitians of Canada National Conference
Location: Ottawa, Ontario
Citation: D'Andreamatteo C, Davison KM, Mitchell S, Vanderkooy P (2014). Prioritizing a
Canadian research agenda for nutrition and community mental health. Canadian Journal of
Dietetic Practice and Research Sep;75(3):e348.
October 2014
Poster Presentation
Host: Food and Nutrition Conference and Expo, American Academy of Nutrition and Dietetics
Location: Atlanta, Georgia
Citation: D'Andreamatteo C, Mitchell S, Vanderkooy P, Davison KM (2014). Nutrition Research
and Community Mental Health: Defining a Canadian Agenda. Journal of the American Academy of
Nutrition and Dietetics Sep;114(9):A64. DOI: 10.1016/j.jand.2014.06.211
November 2014
Executive Summary Distribution
Host: Food Secure Canada’s National Assembly
Location: Halifax, Nova Scotia continued
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 29
Dates
Activities
March 2015
Scientific journal article submissions - two
Citations:
1. Davison KM, D’Andreamatteo C, Mitchell S, Vanderkooy P. Defining research priorities for nutrition
and mental health: Insights from dietetics practice. Canadian Journal of Dietetic Practice and
Research (submitted March 2015).
Abstract
In 2014, a national initiative aimed at defining a research agenda for nutrition and mental health among
diverse stakeholders was completed and included insights from more than 300 registered dietitians. This study
explores the data from dietitians based on their years of practice, mental health experiences, and community of
practice in relationship to identified mental health and nutrition research priorities. Analysis of numerical data
(n=299) and content-analysis of open-ended responses (n=269) revealed that respondents desired research
for specific mental health conditions (MHCs), emotional eating, food addiction, populations with special needs,
and people encountering major life transitions (e.g., recovery from abuse, refugees). Findings from the
quantitative and textual data suggested that dietitians want research aimed at addressing community concern,
fostering consumer nutrition knowledge and skill acquisition, and developing services that will impact quality of
life. Subgroup analysis indicated that dietitians: 1) in early years of practice want information about specific
MHCs; 2) living in smaller towns and rural areas want data about the cost-benefits of dietetics practice; and
3) with additional stakeholder roles (e.g., service provider) selected priorities that address gaps in mental
health services. This study highlights opportunities to tailor nutrition and mental health research that advance
dietetics practice.
2. Davison KM, D’Andreamatteo C, Mitchell S, Vanderkooy P. Establishing an integrated, multi-
stakeholder and citizen-engaged Canadian research agenda for nutrition and mental health.
(to be submitted in April/May 2015 to psychiatry-focused journal).
Abstract (draft)
Background:
Although multiple intersections between nutrition and mental health exist, no investigative agendas to guide
research, policy, and practice currently exist. Based on evidence that mixed approaches involving stakeholders
with experiential knowledge generate meaningful action plans, we utilized integrated, citizen-engaged
processes to structure a Canadian research agenda for nutrition and mental health.
Methods:
The mixed methods participatory initiative involved five stages: 1) a scoping review to contextualize
knowledge; 2) a national online stakeholder survey to prioritize research topics; 3) key informant consultations
to define prioritizing criteria; 4) a workshop involving representatives from research, policy, and practice to
further define priorities; and 5) triangulation of textual, descriptive, and inferential data to formulate the agenda
and test hypotheses about stakeholder influences on decision-making.
Results:
The scoping review identified that qualitative, epidemiological, economic, and intervention studies are needed
to derive findings that reduce mental health inequities, inform mental health promotion and disease
prevention, and establish appropriate models of treatment services provision. Respondents to the national
online survey (n=811) specified priorities in defining food and/or nutrient intakes, life situations, and nutrition-
related services that foster mental health. Results from nine interviews and 63 online surveys targeting key
informants specified that appropriateness, relevancy, chance of success, and impact be research priority
defining criteria. Sixteen diverse stakeholders utilized this criteria and identified research priorities related to
defining policies, accessible services, and roles of non-dietitian service providers. Results of the integrated
analysis: 1) defined five priority research areas: mental health promotion, prevention, intervention, policy, and
service provision; 2) indicated no significant differences between those with and without lived realities in
establishing top priorities, however, those with lived realities placed emphasis on prevention and mental health
promotion; and 3) specified that research and knowledge translation be interdisciplinary, applied, inclusive and
equity focused, and foster mental health literacy.
Conclusions:
The research agenda formulated from this mixed methods synthesis reflects the perspectives across a
spectrum of stakeholders. Considering scientific and social realities, an ongoing challenge will be to foster
continued engagement in the implementation of the research agenda.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
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DIETITIANS OF CANADA I PAGE 30
5.3 Next Steps
The collaborative, multi-step consultation process fostered a great deal of engagement and discussion
among nutrition and mental health stakeholders. Individuals that participated were generous enough to offer a
wealth of experiential knowledge to apply to the agenda-setting process. The inclusive nature of this process, in
some cases, allowed for stakeholders to meet and begin to think about possible research partnerships to carry the
agenda forward.
As interest groups begin to embark on new research directions, they are encouraged to consider the following
feedback from stakeholders:
There is a strong need for a coordinated provincial and/or national approach to
evaluating current or newly developed nutrition and physical activity programs and the
effects that these initiatives have on the lives of clients with mental health conditions.
Ideally this process will lead to best practices for nutritional management of mental
health conditions based on evidence.
The examination of the required skill sets and knowledge needed for all health care
providers to effectively address nutrition and food issues with mental health clients
should be utilized to help shape post-secondary education and on-the-job training for
all mental health care providers.
While research evidence exists related to specific nutrients and connections with mental
health, the responses received from this project indicate that this knowledge perhaps
has not been transferred to many of those working in the mental health sector, and/or
the research completed to-date does not offer evidence related to the needs of the
population or it is presented in a way that is not pragmatic for use on the front line.
Many stakeholders expressed appreciation for the collaborative process, gratitude for the efforts to establish
a research agenda in this area, and anticipation of the final results. Great enthusiasm was expressed to begin
working towards creating effective nutrition and mental health research to better the lives of all stakeholders.
Stakeholder Comments
This is a major new frontier in mental health that is long overdue, and I think the survey is
an excellent step.
Family member, researcher, advocate
“I think this is really important research and I'm glad to be asked for input.”
Lived experience, service provider
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 31
Thanks for asking. Focus on actionable research that will impact the quality of life of people
living with mental illness." Dietitian
“I want to commend you on this much needed research agenda. As an advocate for both food
security and mental illness, I look forward to exciting new research in this field."
Lived experience, student, volunteer
A very important yet overlooked area of study. Dietitian, service provider
“Very interesting and far eager to see results.” Family member, service provider
Current evidence indicates that optimal nutrition is an important factor in supporting the mental health of
Canadians. The national research priorities identified through the Dietitians and Community Mental Health: Setting
the Research Agenda project establish a foundation that will help direct multiple stakeholders in formulating
studies, policies, and knowledge products aimed at the optimization of population nutrition and mental health.
Since the completion of the CIHR-funded consultation, project team members have done preliminary work
presenting the findings at various conferences and in scientific publications. However, more targeted work is
required to fully disseminate the results and effectively engage investigators and knowledge users to act on the
findings in research, practice, decision-making, and policy. Specifically, a targeted knowledge mobilization plan
needs to be developed that is centered on developing and disseminating tailored knowledge translation products
and tools related to the four research priorities and that reach diverse audiences including researchers,
policymakers, practitioners, funding agencies, administrators, non-profit organizations, private industry, and
consumers.
Identifying and prioritizing research topics in consultation with a broad spectrum of stakeholders has been a
critical element in defining nutrition and mental health investigative targets, particularly in the context of
increased competition for funds. In alignment with evidence that indicates that the best predictor of research
uptake is early and continued involvement of relevant stakeholders, a sustained and deliberate effort must now
be made to engage stakeholders in meaningful dialogue about the research priorities and initiate investigations
that represent a true collaboration between researchers and knowledge users. Actively engaging stakeholders
from research, policy, practice, and those with experiential understanding will require focused and proactive
facilitation. The investment in a process that mediates and directs diverse stakeholders to engage in identified
national research priorities will ultimately lead to the optimization of nutrition and mental health-related
outcomes.
DIETITIANS OF CANADA I PAGE 32
.
Appendices
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 33
Appendix A: Committee Members
STEERING COMMITTEE
Karen Davison
Researcher
University of British Columbia
Scott Mitchell
Director, Knowledge Transfer
Canadian Mental Health Association, Ontario
Pat Vanderkooy
Public Affairs
Dietitians of Canada
Carla D’AndreaMatteo
Project Coordinator
Winnipeg, Manitoba
ADVISORY COMMITTEE
Shana Calixte
Executive Director
Northern Initiative for Social Action
Mike Gawliuk
Director of Service Delivery and Program Innovation
Canadian Mental Health Association, Kelowna
Linda Greene-Finestone
Nutrition Advisor and Epidemiologist
Public Health Agency of Canada
Nick Kates
Chair and Professor, Psychiatry and Behavioural Neurosciences
Associate Member, Department of Family Medicine
McMaster University
Director of Programs, Hamilton Family Health Teams
Craig Larsen
Executive Director
Chronic Disease Prevention Alliance of Canada
Vikki Madden
Occupational Therapist
Guelph ACT Team, Homewood Health Centre
Lynette McGarrell
Dietitian
Mental Health Program: Eating Disorders Clinic
Halton Healthcare Services
Eric Ng
Dietitian
Public Health Ontario
Nandini Saxena
Manager, Knowledge Exchange
Centre for Addiction and Mental Health
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 34
Appendix B: National Stakeholder Survey Web-based (Step II)
Nutrition and Mental Health Research Priorities
Survey on Nutrition and Mental Health Research Priorities
“Dietitians and Community Mental Health: Setting the Research Agenda” is a one-year project
funded by the Canadian Institutes of Health Research. In partnership, Dietitians of Canada, the
Canadian Mental Health Association Ontario and the University of British Columbia are working
together to establish research priorities in nutrition and mental health, especially in community
settings.
WHY is this survey being conducted?
The information from this survey will help to identify research topics that will contribute to
improving community-based nutrition services for people with mental health conditions.
WHO should respond to this survey?
You are a “stakeholder” in this project if you have an interest in nutrition and mental health in
Canada. Stakeholders may include:
- anyone living with a mental health condition(s);
- family members of someone living with a mental health condition(s);
- anyone who is a Registered Dietitian;
- providers of mental health services, whether an employer, employee or volunteer
e.g., case workers, support workers, nurses, occupational therapists, dietitians, social
workers, psychiatrists;
- anyone working or volunteering in nutrition and/or mental health program
development, policy making, research, advocacy.
Start of Survey
The survey questions are designed to give all respondents an opportunity to have their say in
choosing research priorities for future nutrition and mental health research.
Your individual
responses and any identifying information will be kept confidential.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 35
1. Which of the following statements describes your interest in nutrition and mental health?
(check all that apply)
I have lived experience of a mental health condition(s).
I am a family member of someone with a lived experience of a mental health condition(s).
I am a Registered Dietitian. How many years have you worked as a dietitian?
I am working or have worked as a service provider for individuals with a mental health
condition(s). Job title or profession: ____________________________
I am working or have worked as a manager/director of a mental health program or organization.
Job title or profession: _______________________________________
I am working or have worked in nutrition and/or mental health research.
I am working or have worked in public policy. Job title or profession:
I am working or have worked in advocacy related to mental health.
I am a student (post-secondary) in a program of study related to nutrition and/or mental health.
I am working or have worked as a volunteer in a nutrition and/or mental health setting.
Other (please describe): __________________________________________
2. Briefly describe why you are interested in nutrition and mental health.
3a. For which of the mental health condition(s) listed below do you think there could be a benefit
from more nutrition-related research?
Select all that apply.
With each selection you make, a text box will allow you to make additional comments,
suggest research questions, or explain why you have identified the condition as a priority.
Anxiety
Autism, autism spectrum disorder
Attention deficit hyperactivity disorder (ADHD)
Bipolar disorder or manic depression
Depression
Disordered eating (anorexia nervosa, bulimia nervosa)
Neurocognitive disorders (e.g., Alzheimers disease, dementia)
Neurodevelopment disorders (e.g., Tourette’s syndrome)
Obsessive-compulsive disorder
Schizophrenia, psychosis
Substance use, addictions
Trauma and stressor related disorders (e.g., post-traumatic stress disorder)
All of the above
None of the above
Don’t know
3b. Please describe any other mental health conditions that you think need nutrition-related research.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 36
4a. Select the group(s) of people for whom you think nutrition and mental health research should
be a priority.
Select all that apply.
With each selection you make, a text box will allow you to make additional
comments, suggested research questions, or explain why you have identified the group as a
priority.
Children and youth
First Nations, Inuit, and Metis
Homeless or marginally housed
Newcomers to Canada
Older adults
Persons living in remote locations
Persons living in rural locations
Persons living in a group setting (home or institution)
Persons living with a developmental disability
Pregnant women (including prenatal and post-partum)
All of the above
None of the above
Don’t know
4b. Please describe any other groups of people for whom you think nutrition and mental health
research should be a priority.
5a. In order to improve the health of people living with mental health conditions, how important
do you think it is for researchers to answer the following research questions?
Consider each question on its own - you are not being asked to rank the questions against each other.
Rate each question on a scale of importance:
VERY important
Important
Moderately important
Of little importance
NOT important
No opinion
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 37
How does food and/or nutrient intake affect specific mental health conditions?
For those people living with a mental health condition, does food skills training (e.g., food selection,
cooking, and storage) have an impact on their mental health?
How do life situations (e.g., housing, income, education, employment) affect the type and amount of
food that people eat and what impact does that have on their mental health?
For people who live with both a mental health condition and other chronic physical disease(s) (e.g.,
diabetes, heart disease), how does diet and/or access to healthy food influence overall health?
What food-related policies would help people living with mental health conditions?
5b. From the list below, please select the ONE research question you think is the most important
in order to improve the health of people living with mental health conditions.
How does food and/or nutrient intake affect specific mental health conditions?
For those people living with a mental health condition, does food skills training (e.g., food selection,
cooking, and storage) have an impact on their mental health?
How do life situations (e.g., housing, income, education, employment) affect the type and amount of
food that people eat and what impact does that have on their mental health?
For people who live with both a mental health condition and other chronic physical disease(s) (e.g.,
diabetes, heart disease), how does diet and/or access to healthy food influence overall health?
What food-related policies would help people living with mental health conditions?
5c. Please suggest any other research questions that YOU think should be answered in order to
improve the health of people living with mental health conditions.
6a. In order to improve community nutrition and mental health programs and services, how
important do you think it is for researchers to answer the following research questions?
Consider each question on its own - you are not being asked to rank the questions against each other.
Rate each question on a scale of importance:
VERY important
Important
Moderately important
Of little importance
NOT important
No opinion
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 38
What programs or services do people living with mental health condition(s) need with respect to food
access, nutrition, and/or cooking skills?
What are the barriers to receiving nutrition services (e.g., counselling, cooking programs) for individuals
living with mental health conditions?
What knowledge and skills are required for dietitians who provide service for individuals living with
mental health conditions?
What are the roles of non-dietitian service providers (e.g., support workers, other health professionals)
for providing nutrition information or support to clients who are living with mental health conditions?
What are the gaps in community health and nutrition services for people living with mental health
conditions?
How many dietitians would be required to meet nutrition service needs in community mental health
settings in Canada?
What are the economic benefits associated with nutrition services in community mental health settings?
6b. From the list below, please select the ONE research question you think is the most important
in order to improve community nutrition and mental health programs and services.
What programs or services do people living with mental health condition(s) need with respect to food
access, nutrition, and/or cooking skills?
What are the barriers to receiving nutrition services (e.g., counselling, cooking programs) for individuals
living with mental health conditions?
What knowledge and skills are required for dietitians who provide service for individuals living with
mental health conditions?
What are the roles of non-dietitian service providers (e.g., support workers, other health professionals)
for providing nutrition information or support to clients who are living with mental health conditions?
What are the gaps in community health and nutrition services for people living with mental health
conditions?
How many dietitians would be required to meet nutrition service needs in community mental health
settings in Canada?
What are the economic benefits associated with nutrition services in community mental health settings?
6c. Please suggest any other research questions that YOU think should be answered in order to
improve community nutrition and mental health programs and services.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 39
7a. In order to promote mental health and/or prevent or delay the onset of mental health
conditions, how important do you think it is for researchers to answer the following research
questions?
Consider each question on its own - you are not being asked to rank the questions against each other.
Rate each question on a scale of importance.
VERY important
Important
Moderately important
Of little importance
NOT important
No opinion
How does a healthy diet and/or access to healthy food promote mental health?
How do intakes of certain foods and/or nutrients prevent or delay the onset of mental health
conditions?
What food-related policies could be implemented to promote mental health and/or prevent or delay
the onset of mental health conditions?
7b. From the list below, please select the ONE research question you think is the most important
in order to support mental health promotion and/or prevent onset of mental health conditions.
How does a healthy diet and/or access to healthy food promote mental health?
How do intakes of certain foods and/or nutrients prevent or delay the onset of mental health
conditions?
What food-related policies could be implemented to promote mental health and/or prevent or delay
the onset of mental health conditions?
7c. Please suggest any other research questions that YOU think should be answered in order
to support mental health promotion and/or prevent onset of mental health conditions.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 40
8a. Below, you will see all the research questions you've rated for importance. Please select the
top 3 research questions YOU believe would have the greatest impact on nutrition and mental
health in the community.
How does food and/or nutrient intake affect specific mental health conditions?
For those people living with a mental health condition, does food skills training (e.g., food selection,
cooking, and storage) have an impact on their mental health?
How do life situations (e.g., housing, income, education, employment) affect the type and amount of
food that people eat and what impact does that have on their mental health?
For people who live with both a mental health condition and other chronic physical disease(s) (e.g.,
diabetes, heart disease), how does diet and/or access to healthy food influence overall health?
What food-related policies would help people living with mental health conditions?
What programs or services do people living with mental health condition(s) need with respect to food
access, nutrition, and/or cooking skills?
What are the barriers to receiving nutrition services (e.g., counselling, cooking programs) for
individuals living with mental health conditions?
What knowledge and skills are required for dietitians who provide service for individuals living with
mental health conditions?
What are the roles of non-dietitian service providers (e.g., support workers, other health professionals)
for providing nutrition information or support to clients who are living with mental health conditions?
What are the gaps in community health and nutrition services for people living with mental health
conditions?
How many dietitians would be required to meet nutrition service needs in community mental health settings in
Canada?
What are the economic benefits associated with nutrition services in community mental health
settings?
How does a healthy diet and/or access to healthy food promote mental health?
How do intakes of certain foods and/or nutrients prevent or delay the onset of mental health
conditions?
What food-related policies could be implemented to promote mental health and/or prevent or delay
the onset of mental health conditions?
8b. If possible, briefly explain WHY you think the 3 questions you selected are the most important.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 41
9. Please share ANY final comments you have about nutrition and mental health research
priorities.
You’re almost done. Just a few questions about you.
10. I am: (check one)
Female
Male
Prefer not to answer
11. My age category is: (check one)
Under 18 years of age
18 29 years
30 39 years
40 49 years
50 59 years
60 years or older
Prefer not to answer
12. I currently live in:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
13. I consider myself to be (ethnic or cultural group):
First Nations, Metis, Inuit (including Status and Non-Status)
A newcomer to Canada within the past 10 years
None of the above
Prefer not to answer
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
International
Prefer not to answer
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 42
14. The community I live in is best described as:
metropolitan (500, 000 people or more)
large city (100, 000 - 499,999 people)
medium city (30,000 99,999 people)
small city (more than 1,000 29,999 people)
town or village (less than 1,000 people)
rural
don’t know
15. My community is considered to be remote northern.
yes
no
don't know
The Dietitians and Community Mental Health project team will be conducting interviews with
selected stakeholders for more detailed discussion about research priorities. If you are interested
in this interview opportunity, or would like to nominate someone else with mental health and
nutrition expertise as a potential interviewee, provide names and contact information below.
One final step! To complete this survey please click on "SUBMIT" below.
Thank you for completing this survey!
HOW else can you help?
Share this survey with other people or groups of people who are stakeholders.
Copy and paste this link to share the survey with others.
http://fluidsurveys.com/surveys/dietitians-of-canada/nutrition-and-mental-health-research-
priorities/
WHERE will the final results of this project be made available?
Results of this project will be posted on the project webpage at www.dietitians.ca/MHSurvey
Note: Your personal information will not be connected to the survey responses you just provided.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 43
Appendix C: Key-Informant Questionnaire Web-based (Step III)
Nutrition and Mental Health Research Priorities
Stakeholder Questionnaire: Nutrition and Mental Health Research Priorities
On behalf of the project steering group, we thank you for taking the time to complete this online
questionnaire. Your additional feedback will be a very helpful contribution to the process of
setting research priorities for nutrition and mental health. Individual responses to the questions
and any identifying information will be kept confidential.
The survey will be open until midnight Monday December 23, 2013.
Start of Questionnaire
The questionnaire is designed to give all respondents an opportunity to have their say in the
criteria setting for future nutrition and mental health research priorities. Additionally, respondents
will have the opportunity to provide feedback on the dissemination of the results from this
national project.
1. Which of the following statements describes your interest in nutrition and mental health?
(select all that apply)
I have lived experience of a mental health condition(s).
I am a family member of someone with a lived experience of a mental health condition(s).
I am a Registered Dietitian. How many years have you worked as a dietitian?
I am working or have worked as a service provider for individuals with a mental health
condition(s). Job title or profession: _______________________________
I am working or have worked as a manager/director of a mental health program or organization.
Job title or profession: __________________________________________
I am working or have worked in nutrition and/or mental health research.
I am working or have worked in public policy. Job title or profession:
I am working or have worked in advocacy related to mental health.
I am a student (post-secondary) in a program of study related to nutrition and/or mental health.
I am working or have worked as a volunteer in a nutrition and/or mental health setting.
Other (please describe): _____________________________________________
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 44
2a. Thinking of criteria that can be used to establish research priorities for nutrition and mental
health, which of the following criteria do you think are important to use?
Select all that apply if you think an item is useful but not really that important, you do NOT need
to select that option.
Adequacy of the current knowledge base (avoidance of duplication)
Applicability of research outcome
Feasibility
Community concern/demand
Economic impact
Ethical acceptability
Partnership building
Funding support potential
Impact on health
Magnitude of the problem
Political acceptability
Urgency
Relevance
Equity focus
All of the above are equally important
None of the above
2b. Please describe any other criteria you think should be considered in order to establish
research priorities in the area of nutrition and mental health?
3. Are there areas of nutrition and mental health research that you believe are missing in current
research, but should be addressed?
Please comment:
Don't know / Prefer not to answer
4. What barriers might prevent researchers, research partners, and/or funders from acting on the
recommendations produced by this project?
Response:
Don't know / Prefer not to answer
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 45
5. Please identify any specific researchers, research teams, institutions or community partners
you think would be key to engage in nutrition and community mental health research in Canada.
Response:
Don't know / Prefer not to answer
6. Please identify any funders you believe might support nutrition and community mental health
research in Canada?
Response:
Don't know / Prefer not to answer
7. Do you have recommendations regarding who should receive the results of our project (so we
can be sure to share with them, during dissemination)?
Response:
Don't know / Prefer not to answer
8. In your opinion, HOW should the results of this project be shared with nutrition and mental
health stakeholders? (e.g., people with lived experience of mental health conditions, dietitians,
service providers, policy makers, academics, funders etc.)
Response:
Don't know / Prefer not to answer
9. How might YOU use the nutrition and community mental health research recommendations
emerging from this project? (e.g., advocate, apply for grant, share with colleagues)
Response:
Don't know / Prefer not to answer
10. Please share ANY final comments you have about nutrition and mental health research
priorities.
Just a few more questions to ask that will help to categorize the information you have provided.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 46
11. I currently live in:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
12. I consider myself to be:
select all that apply
First Nations, Metis, Inuit (including Status and Non-Status)
a newcomer to Canada within the past 10 years
a person that has experienced racial marginalization
None of the above
Prefer not to answer
13. The community I live in is best described as:
metropolitan (500, 000 people or more)
large city (100, 000 - 499,999 people)
medium city (30,000 99,999 people)
small city (1,000 29,999 people)
town or village (less than 1,000 people)
rural
don’t know
14. My community is considered to be remote northern.
yes
no
don't know
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
International
Prefer not to answer
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 47
That completes all of the questions. If you have any other information or comments you would
like to share please provide in the space below.
Thank you for taking the time to complete this questionnaire!
The results of this study will be publicly available on the Dietitians of Canada website some time
during mid-2014. If you would like us to send you an individual copy of the report by email please
provide an email address in the space provided below:
One final step! To complete this survey please click on "SUBMIT" below.
Thank you for completing this questionnaire!
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 48
Appendix D: Key-Informant Interview Tool Used to Guide Interviewer (Step III)
Initial invitation by email/phone:
I’m [insert name], a member of the steering group for a national project called “Dietitians and
Community Mental Health: Setting the Research Agenda”. This is a one-year project funded by
the Canadian Institutes of Health Research and is a collaboration among Dietitians of Canada, the
Canadian Mental Health Association Ontario and the University of British Columbia. This project
aims to identify and recommend research priorities to improve policy and practice in the area of
nutrition and community mental health across Canada. An important step in our effort is to
conduct interviews with key stakeholders to gather experiential knowledge in order to inform our
priority-setting process as well as our knowledge translation strategy.
We invite you to participate in a telephone interview as a key informant based on your expertise
and dedication to the field of nutrition and/or community mental health.
The interview appointment could be as brief as half an hour or as long as one hour, depending on
the amount of information you can contribute. All individuals and organizations will remain
anonymous in the reporting of results. You will be identified only in the list of interviewees.
Your contribution of expertise will be valuable for this work. We hope you can be available for an
interview. If you are interested in completing an interview please respond to this email and
indicate your availability for someone to conduct the interview with you over the next few weeks.
We will follow up to confirm a date and time that works best for you.
Sincerely,
Project team
Date: ___________________ Name of Interviewer: __________________________
Start Time: ______________ End Time: ______________
Interviewee Details:
First name: __________________________________
Province of residence: __________________________________
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 49
Interview introduction:
I’m [insert name] calling for your key informant interview today. I am a member of the steering
committee for the Dietitians and Community Mental Health project.
Our goal is to identify and recommend research priorities to improve policy and practice in the
area of nutrition and community mental health across Canada. Our final recommendations will be
based on input from a broad array of stakeholders, including researchers, dietitians, policy
makers, mental health service providers, and people with lived experience of mental health
conditions.
You have been identified as a key stakeholder based on your expertise and dedication to the field
of nutrition and/or community mental health.
Thank you for accepting the invitation to participate in a key informant interview. Before we
conduct the interview, I need your consent to audio record during the interview to use in our
analysis.
Yes: _______ No: _______
If “yes”, turn on recording devise.
If “no”, continue with interview and record all information directly on interview tool.
Did you complete the online nutrition and mental health survey that was available during
September/October 2013?
Yes: _______ No: _______
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 50
Start of the interview:
Note: Questions in italics are “prompts” for the interviewer.
1. Could you briefly describe your current role and/or interest in nutrition and mental health?
Do you work, volunteer, have lived experience with nutrition and/or mental health?
How would you describe this work/volunteer/lived experience?
How long have you been involved with this type of work/volunteering/experience?
2. Based on your knowledge of nutrition and mental health, are there any gaps in the area of
nutrition and community mental health research?
Are there areas of nutrition and mental health research that you believe are not presently being
considered but should be?
What nutrition and mental health research questions would be of interest to you based on your
current role or experience?
Why do you think these issues should be researched?
3. Are there any priority-setting criteria that you feel are important?
4. What barriers might prevent researchers, research partners, and/or funders from acting on the
recommendations produced by this project?
Are there sensitive issues that should be considered?
5. Can you identify any specific researchers, research teams, institutions or community partners
that would be key to engage in nutrition and community mental health research in Canada?
How these partnerships be fostered to implement nutrition and community mental health research
projects?
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 51
6. Who are some of the funders that you think would be most likely to support nutrition and
community mental health research in Canada?
Provincial funders?
National funders?
Private funders?
7. Who do you think needs to know about the results of our project?
Who is the audience? (researchers, funders, service providers (including dietitians), policy
makers, advocates, any other interested individuals (those with lived experience of mental health
condition, family, volunteer, etc.)
8. Do you have any suggestions about how the results from this project could best be shared with
nutrition and mental health stakeholders? (ex. those with lived mental health experience,
dietitians, service providers, policy makers, etc.)
What approaches to knowledge dissemination would work best?
Are there any approaches you would avoid based on your experiences?
How can we increase the chances of uptake of our research recommendations?
Can you recommend any individuals or organizations that could help us spread the results?
9. How would you see yourself using the nutrition and community mental health research
recommendations emerging from this project?
10. That completes all of the questions I have for you today. Do you have any other information or
comments you would like to share?
Thank you for taking the time to complete this interview with me today. The results of this study
will be publicly available on the Dietitians of Canada website some time during mid-2014.
Would you like us to send you an individual copy of the report by email?
If “yes”, obtain email contact: ___________________________________________________
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 52
Appendix E: Stakeholder Workshop Agenda (Step IV)
February 10, 2014
9:00am 4:00pm
Location: Toronto, Ontario
A G E N D A
8:30am Mix and mingle
9:00am Roundtable introductions and housekeeping items
9:30am Overview of the Nutrition and Community Mental Health: Setting the Research
Agenda project
9:45am Results of the consultation processes utilized for the project
10:15am Introduction to the workshop exercises
10:30am Break
10:45am Priority Setting exercise
12:00pm Lunch
12:45pm Results of priority setting exercise
Discussion and revision
1:00pm Review of recommendations outlined in Dietitians of Canada role paper
1:15pm Improving Access exercise
2:30pm Break
2:45pm Research Proposal exercise
3:15pm Next steps: project dissemination strategies and ongoing advocacy for nutrition and
MH research in the community
4:00pm Workshop concludes
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 53
Appendix F: Priority-Setting Exercise (Step IV)
Criteria Category
19
Asks1
Factors to Consider
APPROPRIATENESS
Should we do it?
Ethical and cultural issues
Ethically and morally acceptable
Culturally appropriate
(Non-reliance on food industry)
Availability & adequacy of current information
Adequacy of current research-based information
(avoid duplication)
Availability of pre-existing data
RELEVANCY
Why should we
do it?
Equity-focused & community
concern/demand
Contribution to better equity in
health
Serves community concern/demand
Broad in scope
Burden of illness (size & severity of problem)
Burden of illness
Magnitude of the issue
Inter-connected with social determinants of health (poverty, food
insecurity, housing)
CHANCE OF SUCCESS
Can we do it?
Capacity of the system to
undertake the research
Competency
Infrastructure, mechanisms
Support system
Resources
Cost justification
Likelihood of partnership building
Reasonable approach
Funding potential
Political acceptability
Pragmatic
IMPACT OF THE
RESEARCH OUTCOME
What do the
stakeholders
get out of it?
Chances of implementation of
research recommendations
Applicability to current practice
Forward/upstream thinking
Reduction of the burden, including costs & quality of life
Impact of research on mental health & quality of life within the population
Economic impact
Fiscal rewards for balancing healthy living and healthy mind
19
Okello, D., and Chongtrakul, P. A Manual for Research Priority Setting using the ENHR Strategy. Geneva: The Council on Health Research for Development. March 2000.
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 54
Appendix G: National Survey Top Research Questions (Step II)
OVERALL TOP RESEARCH QUESTIONS TO ADDRESS
Researchable Question
%
How does food and/or nutrient intake affect specific mental health conditions?
42
How do life situations (e.g., housing, income, education, employment) affect the
type and amount of food that people eat and what impact does that have on their
mental health?
35
What programs or services do people living with mental health condition(s) need
with respect to food access, nutrition, and/or cooking skills?
31
What are the barriers to receiving nutrition services (e.g., counselling, cooking
programs) for individuals living with mental health conditions?
24
What are the gaps in community health and nutrition services for people living with
mental health conditions?
22
How does a healthy diet and/or access to healthy food promote mental health?
21
For those living with a mental health condition, does food skills training (e.g., food
selection, cooking, and storage) have an impact on their mental health?
20
How do intakes of certain foods and/or nutrients prevent or delay the onset of
mental health conditions?
19
For people who live with both a mental health condition and other chronic physical
disease(s) (e.g., diabetes, heart disease), how does diet and/or access to healthy
food influence overall health?
19
What food-related policies could be implemented to promote mental health and/or
prevent or delay the onset of mental health conditions?
17
What food-related policies would help people living with mental health conditions?
16
What knowledge and skills are required for dietitians who provide service for
individuals living with mental health conditions?
13
What are the economic benefits associated with nutrition services in community
mental health settings?
11
What are the roles of non-dietitian service providers (e.g., support workers, other
health professionals) for providing nutrition information or support to clients who
are living with mental health conditions?
6
How many dietitians would be required to meet nutrition service needs in
community mental health settings in Canada?
3
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 55
Appendix H: Research Priorities By Stakeholder Groups (Step II)
INDIVIDUAL STAKEHOLDER AND SPECIAL INTEREST GROUPS
The top 3 research priorities that surfaced from Step II (national survey) were consistently supported
by stakeholder and special interest groups for at least 2, and most often on all 3, of the top priorities.
Footnote:
1= first choice research priority, 2 = second choice for research priority, 3 = third choice for research priority
Stakeholder
Group
Research Priority
How does food and/or
nutrient intake affect
specific mental health
conditions?
How do life situations (e.g.,
housing, income, education,
employment) affect the type
and amount of food that
people eat and what impact
does that have on their
mental health?
What programs or services
do people living with
mental health condition(s)
need with respect to food
access, nutrition, and/or
cooking skills?
Lived Experience
1
2
3
Family Member
1
2
3
Service Provider
1
2
3
Registered Dietitian
2
1
Advocate
2
1
3
Volunteer
1
3
2
Researcher
1
3
2
Manager/Director
1
2
Public Policy
1
3
Student
(Post-Secondary)
1
2
3
DIETITIANS AND COMMUNITY MENTAL HEALTH:
SETTING THE RESEARCH AGENDA
DIETITIANS OF CANADA I PAGE 56
Appendix I: Stakeholder Workshop Priority Ranking of Research Questions
(Step IV)
RESEARCH QUESTIONS TO ADDRESS BASED ON OVERALL PRIORITY-SETTING SCORE
Research Questions
Priority
Score (24)
What are the barriers to receiving nutrition services (e.g., counselling, cooking
programs) for individuals living with mental health conditions?
23
What food-related policies would help people living with mental health conditions?
23*
What programs or services do people living with mental health condition(s) need
with respect to food access, nutrition, and/or cooking skills?
22.5
What are the roles of non-dietitian service providers (e.g., support workers, other
health professionals) for providing nutrition information or support to clients who are
living with mental health conditions?
22.5
How does food and/or nutrient intake affect specific mental health conditions?
22
What knowledge and skills are required for dietitians who provide service for
individuals living with mental health conditions?
21
What food-related policies could be implemented to promote mental health and/or
prevent or delay the onset of mental health conditions?
21*
How do life situations (e.g., housing, income, education, employment) affect the
type and amount of food that people eat and what impact does that have on their
mental health?
20.3
For people who live with both a mental health condition and other chronic physical
disease(s) (e.g., diabetes, heart disease), how does diet and/or access to healthy
food influence overall health?
20
How many dietitians would be required to meet nutrition service needs in community
mental health settings in Canada?
18
How does a healthy diet and/or access to healthy food promote mental health?
18*
What are the economic benefits associated with nutrition services in community
mental health settings?
15
What are the gaps in community health and nutrition services for people living with
mental health conditions?
13*
How do intakes of certain foods and/or nutrients prevent or delay the onset of
mental health conditions?
10*
For those living with a mental health condition, does food skills training (e.g., food
selection, cooking, and storage) have an impact on their mental health?
n/a*
*Value based on one group score.
... Full details about the project are provided in Dietitians of Canada report "Dietitians and Community Mental Health: Setting the Research Agenda" available at www.dietitians.ca/ mentalhealth [5]. The study was approved by the University of British Columbia Behavioural Research Ethics Board. ...
... The analysis was guided by the exploratory question "What are the perceptions of dietitians in defining research priorities in nutrition and mental health?" All results were also contextualized in the broader findings of the project [5]. ...
Article
In 2014, a national initiative aimed at defining a research agenda for nutrition and mental health among diverse stakeholders was completed and included insights from more than 300 registered dietitians. This study explores the data from dietitians based on their years of practice, mental health experiences, and community of practice in relationship to identified mental health and nutrition research priorities. Analysis of numerical data (n = 299) and content analysis of open-ended responses (n = 269) revealed that respondents desired research for specific mental health conditions (MHCs), emotional eating, food addiction, populations with special needs, and people encountering major life transitions (e.g., recovery from abuse, refugees). Findings from the quantitative and textual data suggested that dietitians want research aimed at addressing the concerns of those in the community, fostering consumer nutrition knowledge and skill acquisition, and developing services that will impact quality of life. Subgroup analysis indicated that dietitians: (i) in early years of practice want information about specific MHCs; (ii) living in smaller towns and rural areas want data about the cost benefits of dietetics practice in mental health; and (iii) who also had additional stakeholder roles (e.g., service provider) selected priorities that address gaps in mental health services. This study highlights opportunities to tailor nutrition and mental health research that advance dietetics practice.
... Full details about the project are provided in Dietitians of Canada report "Dietitians and Community Mental Health: Setting the Research Agenda" available at www.dietitians.ca/ mentalhealth [5]. The study was approved by the University of British Columbia Behavioural Research Ethics Board. ...
... The analysis was guided by the exploratory question "What are the perceptions of dietitians in defining research priorities in nutrition and mental health?" All results were also contextualized in the broader findings of the project [5]. ...
... Representatives from each of these agencies and institutions as well as a hired project coordinator formed the core working group. A detailed project report, including measurement tools, is available (32) . ...
Article
Objective To develop a national nutrition and mental health research agenda based on the engagement of diverse stakeholders and to assess research priorities by stakeholder groups. Design A staged, integrated and participatory initiative was implemented to structure a national nutrition and mental health research agenda that included: (i) national stakeholder consultations to prioritize research questions; (ii) a workshop involving national representatives from research, policy and practice to further define priorities; (iii) triangulation of data to formulate the agenda; and (iv) test hypotheses about stakeholder influences on decision making. Setting Canada. Subjects Diverse stakeholders including researchers, academics, administrators, service providers, policy makers, practitioners, non-profit, industry and funding agency representatives, front-line workers, individuals with lived experience of a mental health condition and those who provide care for them. Results This first-of-its-kind research priority-setting initiative showed points of agreement among diverse stakeholders ( n 899) on research priorities aimed at service provision; however, respondents with lived experience of a mental health condition (themselves or a family member) placed emphasis on prevention and mental health promotion-based research. The final integrated agenda identified four research priorities, including programmes and services, service provider roles, the determinants of health and knowledge translation and exchange. These research priorities aim to identify effective models of care, enhance collaboration, inform policy makers and foster knowledge dissemination. Conclusions Since a predictor of research uptake is the involvement of relevant stakeholders, a sustained and deliberate effort must continue to engage collaboration that will lead to the optimization of nutrition and mental health-related outcomes.
Article
Full-text available
Five questions--What should be transferred to decision makers? To whom should it be transferred? By whom? How? With what effect?--provide an organizing framework for a knowledge transfer strategy. Opportunities for improving how research organizations transfer research knowledge can be found in the differences between the answers suggested by our understanding of the research literature and those provided by research-organization directors asked to describe what they do. In Canada, these opportunities include developing actionable messages for decision makers (only 30 percent of research organizations frequently or always do this), developing knowledge-uptake skills in target audiences and knowledge-transfer skills in research organizations (only 20 to 22 percent frequently or always do this), and evaluating the impact of knowledge-transfer activities (only 8 to 12 percent frequently or always conduct an evaluation). Research funders can help research organizations take advantage of these opportunities.
Article
Learning Outcome: The participant will be able to describe the process of developing a research agenda for nutrition and community mental health that engages stakeholders with experiential understanding of the system. Background: Nutrition and mental health research tends to be directed by clinicians, scientists , and funding agencies. The evidence suggests, however, that collaborative engagement of various stakeholders with experiential understanding of the system can better inform research activities. The aim of this project was to develop a collaborative framework to guide research relevant to nutrition and community mental health.
Article
We describe our stakeholder engagement process for grant application development that occurred as part of our integrated knowledge translation plan and make recommendations for researchers. In phase 1, a stakeholder consultation group was developed. In phase 2, surveys regarding knowledge gathering, research agenda, and research collaboration preferences were sent to 333 cross-sectoral youth-serving organizations in Ontario, including family and consumer organizations. In phase 1, 28 stakeholders from six sectors participated in the consultation group and provided input on multiple aspects of the proposal. Through this process, 19 stakeholders adopted formal roles within the project. In phase 2, 206 surveys were received (response rate = 62%). Survey responses supported the grant focus (concurrent youth mental health and substance use problems). Respondents also prioritized project goals and provided specific feedback on research and knowledge translation. Finally, although some stakeholders chose greater involvement, most survey respondents indicated a preference for a moderate level of participation in research rather than full team membership. Despite short timelines and feasibility challenges, stakeholders can be meaningfully engaged in and contribute to the grant proposal development process. Consideration is needed for the practical challenges that stakeholder organizations face in supporting and participating in research.
Delphi process to inform a consensus statement from the ISNPR. Personal Communication
  • F N Jacka
Jacka FN. Delphi process to inform a consensus statement from the ISNPR. Personal Communication 29-06-2014.