CONTEXT:Grandparents' evolving role as informal caregivers for their grandchildren is likely to influence child nutrition and health outcomes. OBJECTIVE:This systematic review aimed to synthesize the current evidence on the influence of grandparents on diet-related behaviors and body weight of children aged 0-12 years. DATA SOURCES:A 6-databases search (Medline, Embase, PsychINFO, CINAHL, ProQuest, and the Cochrane Library) was conducted for studies published between 2000 and June 2024. Experimental or observational studies were included if they reported outcomes relating to grandparents' child-feeding practices, grandchildren's diet, or body weight status of children. DATA EXTRACTION:Data were extracted into a standard template and were critically appraised using the Quality Criteria Checklist. DATA ANALYSIS:Twenty-four studies were included; the majority were observational studies (n = 21) published between 2006 and 2024, with participant numbers ranging from 45 to 19 734. The most frequently reported grandparents' outcomes were involvement in childcare (n = 15), child-feeding practices (n = 8), co-residing (n = 6), and time spent with grandchildren (n = 3). Grandparental outcomes assessed were predominantly associated with obesogenic dietary practices (n = 14), with 3 studies reporting negative impact on grandchildren's body weight. The diet-related behaviors used by grandparents were using snacks as rewards (n = 4), providing unhealthy snacks (n = 2), higher energy intake (n = 1), fruit juice consumption (n = 1), increased between-meal eating (n = 1), and screen time during meals (n = 1). CONCLUSIONS:Grandparental caregiving roles related to food and feeding were found to be associated with higher weight status, energy intake, and discretionary food intakes of grandchildren. Study heterogeneity and the predominance of cross-sectional and observational studies limited a quantitative meta-analysis of grandparents' involvement in feeding. Future studies focusing on system approaches and considering cultural contexts are needed. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration No. CRD42024592327.

ISSUE ADDRESSED:Health risk behaviours including unhealthy diet, physical inactivity, sedentary behaviour, inadequate sleep, tobacco use and alcohol and illicit drug use are prevalent among university students. Universities are pivotal settings for health promotion; however, existing policy/strategy addressing health risk behaviours is uncertain. This scoping review aimed to identify and synthesise current policies/strategies targeting student health behaviours across Australian universities. METHODS:A systematic search of websites and policy libraries of 39 Australian universities was conducted in January 2025. Policies/strategies were included if they were current, included students within their target group, and addressed at least one health risk behaviour. Data was extracted about policy characteristics and intervention functions and policy categories evaluated using the Behaviour Change Wheel. RESULTS:Fifty-four policies/strategies from 30 universities met the inclusion criteria. Many universities had a policy/strategy focused on smoking (74.4%), alcohol (64.1%) and drug use (43.6%), whereas few addressed physical inactivity (7.7%) or unhealthy diet (2.6%). No university policy/strategy addressed sedentary behaviour or sleep. The most common intervention function and policy category was environmental restructuring and environmental/social planning. CONCLUSIONS:This review highlights a fragmented policy landscape, with significant gaps in addressing health risk behaviours within policy or strategy at Australian universities. These findings provide guidance for future institutional policy/strategy development and to encourage interdisciplinary collaboration in embedding student wellbeing within institutional frameworks. SO WHAT?: These findings emphasise the need for national-level guidance to embed systemic approaches to health promotion within the university setting. This is essential to improve student wellbeing, foster academic excellence, address health inequity and advance community health outcomes.

AIM:To synthesise evidence from RCTs investigating the effectiveness of nutrition interventions on depression, anxiety, stress, and/or diabetes distress outcomes in adults living with diabetes. METHODS:Six online databases were searched using key words between 2000 and February 2024. Included studies were conducted in adult populations (≥18 years), with Type 1 (T1D) or Type 2 Diabetes (T2D), investigating impacts of nutrition interventions on mental health outcomes. Random effects meta-analyses were undertaken for mental health outcomes. RESULTS:Thirty publications met inclusion criteria, all included adults with T2D, with one including both T1D and T2D. The most common interventions were nutrition supplements (n = 17, 57%) and altering macronutrient intakes (n = 5, 17%). Most studies reported on depression (n = 26) and anxiety (n = 14) outcomes, with fewer examining stress (n = 7) or diabetes-related distress (n = 8). Meta-analyses indicated nutrition supplementation when compared to control improved scores for depression (Beck Depression Inventory (BDI): WMD = -3.13; 95% CI: -5.09, -1.17) and anxiety (Beck Anxiety Inventory: WMD = -1.30; 95% CI: -2.08, -0.52) but not for stress. Meta-analyses confirmed that altering macronutrient composition significantly lowered diabetes-related distress (Problem Areas in Diabetes (PAID): WMD = -4.20; 95% CI: -8.18, -0.22). CONCLUSION:This review provides evidence that nutrition interventions, particularly supplement use or altered macronutrient composition, improve depression and anxiety for those with T2D. Future research should evaluate the impact of whole dietary patterns on mental health in adults with diabetes, especially T1D, to inform effective food-based nutrition advice, rather than focusing on individual supplements.

Background: Entering university marks a pivotal developmental transition, marked by increasing independence. However, it is also associated with heightened mental ill-health, with 85 % of first-year students in this study screening positive for symptoms of anxiety, depression, or both. Understanding social determinants of mental health is essential for guiding interventions and policy, although knowledge gaps remain for this population. Objective: This study examined associations between social determinants (sex, gender, sexual orientation, employment, living situation, ethnicity, and First Nations) and mental health outcomes (positive screen for symptoms of anxiety only, depression only, both or neither, and anxiety [Generalized Anxiety Disorder (GAD-7)] and depression [Patient Health Questionnaire (PHQ-9)] symptom severity). Methods: The UNIversity student's LIFEstyle and Mental Health Study (UNILIFE-M) is an international cohort study conducted across 84 universities in 27 countries. This secondary cross-sectional analysis used baseline Australian data collected in 2023/2024 from 974 first-year students (aged 18-35 years) at six Australian universities. Results: Sixty percent of participants screened positive for both depression and anxiety symptoms, 17 % for anxiety symptoms only and 9 % for depression symptoms only. Among GAD-7 responders, 28 % had moderate

Diet is a modifiable determinant of gut microbiome composition, yet the impact of contrasting whole-dietary patterns on microbial metabolic capacity and coordinated host metabolic signatures remains incompletely characterized. In a randomized crossover feeding trial, 34 Australian adults were provided with a Healthy Australian Diet (HAD), aligned with national dietary guidelines, and a Typical Australian Diet (TAD), reflecting average population intake for two weeks each, separated by a two-week washout. Fecal microbiome composition and function were assessed using shotgun metagenomics, plasma and urine metabolites by untargeted metabolomics, with cardiometabolic markers including blood pressure, plasma lipids, and glucose quantified. HAD was associated with reduced taxonomic and functional alpha diversity relative to baseline, with no change following TAD. Species-level responses were modest, 105 functional pathways differed between diets, with 99 increasing following HAD, predominantly related to amino acid and nucleotide biosynthesis and vitamin/cofactor metabolism. Multi-omic integration using DIABLO achieved strong discrimination of dietary responses (held-out accuracy 91.7%; permutation p = 0.005). In total, 77 individual omic feature-cardiometabolic outcome associations survived FDR correction (q < 0.05), spanning microbial gene functions, plasma metabolites, and urinary metabolites linked to cholesterol, blood pressure, and triglyceride responses. These exploratory findings suggest that integrated microbiome-metabolome profiling may capture inter-individual variation in dietary cardiometabolic responses, though replication in larger, independent, robustly designed studies is needed before translational personalized nutrition strategies can be assessed.

BACKGROUND:Weight, eating behaviours and mental health have a complex interrelationship that is not fully understood. This study aimed to investigate the relationships between weight, eating behaviours and mental health over 12 months among socio-demographically diverse young adults (18-35 years) from the UK and Australia. METHODS:Longitudinal analysis of data from the YOUTH cohort study was conducted. Three timepoints of data were used (baseline, 6 months, 12 months), collected between 2021-2023 using online surveys hosted via the Prolific platform. The dataset includes 507, 371 and 336 participants at the respective timepoints. Random-intercept cross-lagged panel models (RI-CLPM) were used to explore the relationships between eating behaviours (addictive, disordered and emotional eating) and mental health (stress, depression, anxiety, quality of life) with weight (kilograms) over the three timepoints. RESULTS:Significant relationships were found between weight at baseline with Eating Disorder Examination Questionnaire (EDEQ) global score at 6 months (β = 0.028, p = 0.005, 95% CI = 0.009, 0.048); Positive-Negative Emotional Eating Scale (PNEES)-positive score at 6 months (β = -0.217, p = 0.011, 95% CI = -0.386, -0.053); and EDEQ shape concern score at 6 months (β = 0.040, p < 0.001, 95% CI = 0.019, 0.060) and 12 months (β = 0.034, SE = 0.010, p = 0.001, 95% CI = 0.014, 0.056). The relationships between EDEQ shape concern at baseline and weight at 12 months (β = 1.845, p = 0.005, 95% CI = -0.017, 2.927), and weight at baseline with quality of life at 12 months (β = -0.393, p = 0.034, 95% CI = -0.737, 0.031) were significant based on p value only. No other results were statistically significant for the other explanatory variables with weight. CONCLUSION:Longitudinal relationships were identified for higher weight with higher disordered eating, less eating in response to positive emotions and lower quality of life in this young adult cohort. Future research should include more longitudinal analyses of these relationships. Findings also support the need for screening of disordered eating and mental ill-health in young adults within weight management services.

INTRODUCTION:Brief intervention frameworks can support health professionals to motivate patients to adopt lifestyle changes. In New South Wales, Australia, health services use the 5As (ask, assess, advise, assist, and arrange) framework to address unhealthy lifestyles and overweight and obesity in children. This study assessed health professionals' adherence to the 5As framework and factors influencing families' perceptions and propensity to adopt lifestyle changes. METHODS:This observational, cross-sectional study analyzed data from electronic medical records and caregiver surveys from a regional health service in New South Wales, Australia, over 12 months from June 2022 to May 2023. RESULTS:Of n = 461 caregivers who completed valid surveys, 64.9% reported their child received a growth assessment, but only 6.3% received the full 5As framework. Children under 4 years, those attending a community health service, and those with a healthy weight were most likely to receive the complete 5As framework. In contrast, children over 13 years, those attending an emergency department and those with obesity were least likely. Reported adherence with the 5As framework influenced caregivers' perceptions and reported intervention impact. DISCUSSION:Children routinely received growth assessments, but many families did not receive subsequent steps of the 5As framework. Improving health professional adherence to the framework is necessary for promoting behavior change. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Introduction: Eating disorders are more prevalent in people with higher weight than those with low weight. However, contention between the fields of obesity and eating disorders has prevented meaningful progress in research, prevention, identification and coordinated clinical services for people with co-occurring conditions. In Australia, public health approaches and provision of treatment services for people with eating disorders and clinical obesity are siloed, often resulting in contradictory messaging. To address this, a roundtable meeting was held in November 2024 in Sydney, Australia, with 28 experts in one or both of these fields, including researchers, clinicians and service leaders working across paediatric and adult care, and individuals with lived experience. Guided by the National Eating Disorders Collaboration stepped system of care framework, participants identified key challenges and possible solutions, and established five priority actions. Main Recommendations: The priority actions across sectors are: Health Campaigns focused on raising awareness of eating disorders at higher weight, using appropriate language and reducing weight stigma; improved Screening and Assessment using standardised protocols across healthcare settings; supporting Primary Healthcare and improving the use of Medicare items; Tailored Treatment Pathways including integrated care models; and building Workforce Capacity to upskill professionals to provide safe, person-centred care. Changes in Management as a Result of the Statement: These actions aim to promote improved cross-sector collaboration and effective, safe, coordinated and integrated approaches to prevention, identification and treatment across the fields of obesity and eating disorders. They address the complex medical and psychological needs of those with co-occurring eating disorders and higher weight or clinical obesity through a skilled workforce and improved access to care. Effective integration, collaboration and coordination across services is essential for long-term recovery support.

INTRODUCTION:With the growing use of GLP-1/GIP receptor agonist medications, their impact on dietary intake and quality remains unclear. This systematic review examined how randomized controlled trials (RCT) prescribing liraglutide, semaglutide, or tirzepatide assessed and reported dietary intake and quality as outcome measures, alongside weight loss and/or glycemic control, and identified gaps in the use and methodological quality of dietary assessment methods. METHODS:Medline, Embase, Cochrane, Scopus, and CINAHL were systematically searched between January 2008-January 2025 (adults) and January 2014-January 2025 (children/adolescents). The review was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/XPNGY). RESULTS:Forty-three articles from 41 unique RCTs, comprising 50,690 participants (n = 688 children/adolescents, n = 50,002 adults) were included. Except for two studies targeting adults (one published and one unpublished data from an included study), this review found no other studies that assessed or reported dietary intake or changes in diet. Both reported a reduction in the total energy intake and altered macronutrient distribution in the medication plus diet group, although one was not significantly different from medication alone. Quality of assessment methods used was categorized as "poor" and "acceptable," respectively. These results highlight a critical gap in the literature. CONCLUSION:Only 2/41 studies (≈5%) reported or assessed dietary intake or evaluated diet changes secondary to GLP-1/GIP RA medication use. This review highlights a major gap in the evidence requiring urgent attention. More high-quality research, using validated dietary assessment methods as outcome measures in RCTs is needed to understand how these medications impact diet and diet quality, nutrient intake, and chronic disease risk.

Risks associated with sub-optimal dietary intake are one of the leading factors contributing to mortality and morbidity worldwide (1) . Regular and comprehensive data on the intakes of individuals play a key role in informing the development of public health nutrition policy and programs. In low- and lower-middle-income countries (LLMICs), proxy measures of individual intake, such as food balance sheets, are often used. To-date there has been limited application of technology-assisted dietary assessment methods due to resource constraints (2) . This study reports on the relative validity of the Voice-Image Solution for Individual Dietary Assessment (VISIDA) system in a sample of Cambodian women and children. The VISIDA system is a dietary assessment system developed specifically for LLMICs. Intake data is collected in the form of image-voice food records (via a smartphone app) where images and voice recordings of food for consumption are collected prior to eating along with any leftovers at the end of the meal. The image-voice food records are then uploaded to the VISIDA web application and processed by trained analysts to produce estimates of individual nutrient intake. Mothers and one of their children (aged ≤ 5 years) from Siem Reap province, Cambodia were recruited. Intake data was collected for each participant using two dietary assessment methods over three recording periods. The mother used the VISIDA image-voice smartphone app to collect intake data on three days for herself and her child in week 1, with this repeated in week 4. In between VISIDA recording periods, intake data was collected on the mother and her child using interviewer-administered 24-hour recalls collected on three days. A linear mixed model approach was used to evaluate differences between the estimated nutrient intakes for the recording periods for mothers and children. The nutrient intakes for a total of 119 mothers and 91 children were included in the analysis. For both mothers and children, intakes for the majority of nutrients were higher from the 24-hour recalls than intakes reported using the VISIDA system. When 24-hour recall intakes were compared to each VISIDA recording period, mothers had a higher number of nutrients with differences that were statistically significantly than children. In general, the VISIDA system produced lower estimates of nutrient intakes for Cambodian mothers and children when compared to intakes from 24-hour recalls. Further evaluations of the VISIDA system in other LLMICs would provide additional insights into the performance of this method for assessing individual dietary intakes in this context.

AIMS:This study aimed to test the feasibility and acceptability of mental health clinicians using a multifaceted nutrition-risk screening tool in Australian mental health settings. METHODS:A mixed-methods cross-sectional design was used. Mental health clinicians implemented the multifaceted NutriMental screener at seven sites across Australia and provided feedback via a standardised form. Primary outcomes were the feasibility, acceptability and appropriateness domains of the feedback questionnaire. Additional outcomes included association/agreement between the consumer's desire for dietetic support, clinicians' impression of need for dietetic support, and total nutrition risks reported. Directed content analysis was employed to analyse open-ended sections of the clinician feedback questionnaire. RESULTS:Fifty-four clinicians participated, completing the NutriMental screener with a total of 256 mental health consumers. Mean total nutrition risks reported were 6.4 ± 1.8 (out of nine). Mean implementation outcomes (out of five) were 3.1 ± 0.8 for acceptability, 3.7 ± 0.5 for appropriateness, and 4.3 ± 1.7 for feasibility. There was moderate agreement between consumer's desire for dietetic support and clinicians' impression of need for dietetic support κ = 0.32 (95% CI: 0.21-0.43), p < 0.001, and positive correlations between the number of nutrition risks reported and consumer's desire for dietetic support (r = 0.29, p < 0.001) and clinicians' impression of need for dietetic support (r = 0.29, p < 0.001). Six themes and 17 subthemes related to barriers and facilitators to the screener's implementation were identified. CONCLUSION:The multifaceted risk screening tool appears to be feasible, acceptable and appropriate for use within Australian mental health services. Refinements of the NutriMental screener based on clinician feedback may further improve its implementation.

ISSUE ADDRESSED:University students experience higher rates of poor mental health compared with the general adult population. In 2022, Orygen released the University Mental Health Framework (the Framework) to guide universities on creating mentally healthy universities. This document review assesses the extent to which Australian universities' current policies or strategies align with the Framework. METHODS:A systematic search of all Australian universities' websites was undertaken in January 2024. Results that met the inclusion criteria had data extracted for alignment with the six principles of the Framework. The policy was scored a 0 if the principle was absent/not considered, 1 if it was partially considered, and 2 if all aspects were considered. Each policy received a total score from 0 to 12 for alignment with the Framework principles. RESULTS:Twenty-five of the 39 Australian universities (64%) had a policy/strategy publicly available on their website focused on promoting optimal mental health of students. The mean score for alignment with the Framework principles was 3.9 ± 3.9 (Range 0-12). Principle 5, which focuses on students' access to services, was the most considered (n = 23, 58.9%) Principle 4, which focuses on collaborative and coordinated actions, was the least considered (n = 13, 33%). CONCLUSIONS:This document review demonstrates the considerable scope and opportunity to improve the policies and strategies currently being implemented across Australian universities to support the mental health of students. Universities and the mental health sector therefore should work collectively, alongside students, to guide mental health policy development in the university setting.

BACKGROUND:Carotenoids are pigments abundant in fruits and vegetables and can be measured in plasma and skin. This study aimed to evaluate associations between carotenoid intake, assessed by self-reported usual diet against plasma carotenoid and skin yellowness concentrations in Australian adults (n = 50, aged 39.3 ± 15.4 years, 68% female). METHODS:Dietary carotenoid intakes were quantified using the Australian Eating Survey (AES) food frequency questionnaire (total, α- and β-carotene, lycopene, β-cryptoxanthin, and lutein/zeaxanthin). Plasma concentrations of these carotenoids were measured using high-performance liquid chromatography, while skin yellowness was measured using skin reflectance spectroscopy as a proxy for skin carotenoids. Associations between AES carotenoids, plasma carotenoids and total skin yellowness were analysed using linear regressions. RESULTS:AES-derived carotenoid intakes were positively associated with skin yellowness for all dietary carotenoids (β range 0.25-0.46, p < 0.05) and total dietary carotenoids (β = 0.35 [95% CI 0.07, 0.63], p < 0.05), except lycopene. Similarly, each individual plasma carotenoid was significantly positively associated with their respective individual dietary carotenoids (β range 0.42-0.53, p < 0.05) and total dietary carotenoids (β = 0.38 [95% CI 0.04, 0.73], p < 0.05), except for lycopene. Significant positive associations were identified between skin yellowness and total (β = 0.36 [0.20, 0.52], p < 0.001) and individual plasma carotenoids (β range 0.30-0.37, p < 0.01), excluding α-carotene and lycopene. CONCLUSION:Dietary carotenoid intakes were significantly associated with plasma carotenoid concentrations and skin yellowness values. Results support use of all three methods for assessment of carotenoid intake, with the exception of lycopene. Future studies should consider cost, accessibility of assessment methods and participant burden when selecting dietary assessment methods. TRIAL REGISTRATION:The original study was registered with Australian New Zealand Clinical Trials Registry (ANZCTR-12619001415190).

Mental health policies and practice guidelines emphasise the importance of collaboration with informal carers of people with mental illness, but this does not routinely occur in practice. Understanding the perspective of different parties regarding collaboration is a step towards ensuring an alignment between policy and routine clinical practice. This study explored the meaning of collaboration from the perspectives of informal carers and mental health clinicians in a rural Australian mental health service. This qualitative descriptive study used purposive sampling to recruit informal carers (n = 7) and mental health clinicians (n = 14) from an acute mental health inpatient facility. Data was generated from focus groups and semi-structured interviews and analysed using thematic analysis. Three overarching themes were identified: three-way partnership, purposeful exchange and communication is everything. Clinician and informal carer participants described collaboration as a respectful partnership that necessarily involves the consumer, their carers and clinicians. The purpose of the partnership was identified as providing holistic care to the consumer, which essentially includes support for their carer. Open and clear communication, as well as information sharing, were identified as important to collaboration. However, the experiences of informal carers did not reflect this description of collaboration. Adequate support for informal carers, recognition of their expertise and open and consistent communication are key to a collaborative process that delivers better outcomes for consumers and their carers. Proactive clinician training and a practical guide to inform the delivery of routine informal carer engagement in mental health services are required to achieve an effective three-way collaboration.

Dietary intake and sub-optimal nutrition have a significant impact on clinical risk, outcomes and mortality in people with an eating disorder. Despite the range of dietary patterns and nutritional issues, there is limited evidence to guide effective use of dietary assessment methods. The aim of this pilot study was to examine the validity of the diet history against routine nutritional biomarkers in female adults with an eating disorder attending a regional outpatient service. This secondary data analysis utilised demographics, nutrient intakes from diet history and nutritional biomarker data. Spearman’s rank correlation, simple and quadratic weighted kappa statistics and the Bland-Altman method were used to explore validity of the diet history compared to nutritional biomarkers. Thirteen female participants (median age 24 years; median BMI 19 kg/m2) with an eating disorder were included. Energy-adjusted dietary cholesterol and serum triglycerides showed moderate agreement (simple kappa K = 0.56, p = 0.04), and dietary iron and serum total iron-binding capacity showed moderate-good agreement (simple kappa K = 0.48, p = 0.04; weighted kappa K = 0.68, p = 0.03). Dietary iron and serum total iron-binding capacity were only significantly correlated when dietary supplements were included (r = 0.89, p = 0.02). Dietary estimates of protein and iron improved with larger intakes. This pilot study suggests the diet history may be useful for assessing dietary intake in people with an eating disorder and highlights the importance of targeted questioning around dietary supplement use. Determining the validity of dietary assessment methods across ages, diagnoses and settings is required.

BACKGROUND:Youth experiencing socio-economic disadvantage often have elevated rates of health risk behaviours. Although adolescence is a time of increasing autonomy for youth, parents continue to play a significant role in their health. Parent-based interventions can reduce barriers faced by families experiencing disadvantage and improve adolescent outcomes. However, few such interventions addressing multiple risk behaviours exist for this population. This study aims to: i) systematically test the individual and synergistic effects of four parent-based intervention components, and ii) assemble an optimised intervention in which all components are effective in improving parental encouragement of adolescent health habits, while imposing the least possible burden on parents. METHODS:Guided by the Multiphase Optimisation Strategy, we will conduct a 24 factorial trial with 389 parents of adolescents in Australia. All parents will receive six online modules (screen time, smoking/vaping, alcohol, sleep, food/nutrition, physical activity). Parents will be randomised to receive 1 of 16 combinations of additional components: text messages, tailored feedback, stress management, and health coaching. Parents will complete surveys at baseline and 3-months post-baseline. The primary outcome is change in parental encouragement of adolescent health habits at 3-months (proximal outcome). Parent's health behaviours, self-efficacy, stress, communication and the acceptability and burden (perceived effort to complete) of each component will also be assessed. DISCUSSION:This study will result in a digital intervention for families experiencing socio-economic disadvantage that is as effective as possible in improving parental encouragement of adolescent health habits, and that can be delivered with minimal burden, which is critical for translation. TRIAL REGISTRATION:The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12624001492549 date registered: 20/12/2024).

Women are the primary food providers within Cambodian families, however little is known about what influences their food choices. Despite recent economic improvements, Cambodia remains the second poorest country in south-east Asia (1) . Twenty-two percent of Cambodian children have stunting and 16% are underweight (2) . Cambodian women of reproductive age exhibit the double burden of malnutrition, with 44% having anaemia and 33% with overweight or obesity (2) . Nearly half of Cambodian women do not achieve minimum dietary diversity, with diets consistently low in vitamin A, thiamine, calcium, zinc and iron (3) . Strategies to improve Cambodian families’ dietary intake are therefore needed. Factors influencing food choice are complex and multidimensional (4) , and no previous studies have explored how Cambodian women make food decisions. This study aimed to understand Cambodian women’s food-related decision-making for themselves and their families. This qualitative study applied a descriptive methodology consistent with the experiential paradigm. Four 90-minute focus groups were conducted in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged 18+ years with at least one child aged under five who have primary responsibility for food provision within their family. Focus groups were facilitated by an Australian researcher (JW), using an interpreter to translate between Khmer and English languages. Groups discussed perceptions about food related to health, prompted by ‘conversation cards’ depicting food sources and nutritional benefits of five key nutrients. Reflexive thematic analysis was used to analyse the focus group data (5) . Three themes were identified: 1) food access impacts choice; 2) responsible nurturing food provision role; and 3) dichotomous perceptions of food. Access to food strongly influenced food choices made by Cambodian women. High cost and low availability prompted women to forage for easily accessible ingredients such as water plants, fish, crabs and fruit, or choose cheaper, lower-quality foods from the market. Cambodian women strived to fulfil their responsibility to provide healthy, nourishing meals for their family within their capabilities, prioritising their husband and children over themselves. Nutritional awareness included understanding that fruit and vegetables contained vitamins, and meat was a good source of iron. They perceived certain traditional Khmer soups as ideal healthy meals, providing adequate energy and strength for hard-working husbands and growing children, and preventing sickness. Cambodian women considered healthy food using a range of dichotomous factors beyond their nutritional value, including ‘wet or dry’ food, ‘helpful or harmful’ in relation to immediate body symptom responses to food, cultural food taboos and use of chemicals on fresh vegetables. These findings indicate the need for future nutrition interventions targeting Cambodian communities to address women’s perceptions about the health-related qualities of foods, and access to nutritious foods so that behaviour change strategies are practical, culturally appropriate and acceptable.

Existing evidence supports the benefits of radiation therapy (RT) for cancer patients however, it is underutilised. This scoping review aims to synthesise the current literature investigating patient and department level barriers and facilitators influencing the utilisation trends of RT. A systematic search strategy was developed to identify articles dated from 1993 to 2023. Four online databases (Medline, Embase, Scopus and CINAHL) were searched using key words. Eligible studies needed to report outcomes related to barriers and facilitators influencing utilisation of RT. Data was extracted and categorised into health professional, patient, and department level influences. The review resulted in 340 included studies with 298 (88 %) studies reporting on patient influences. More than half of these studies (n = 164; 55 %) reported accessibility concerns including distance and travel burden. Patient acceptability was reported in 88 (30 %) studies, patient affordability in 138 (46 %) studies, patient knowledge, and education in 92 (31 %) studies and patient health and demographics in 235 (79 %) studies. Of the department level influence papers (n = 242, 71 %), department availability such as infrastructure, staffing and waitlists were reported in 167 (69 %) papers. Department adequacy, including the quality, reputation and technology suitability of departments was reported in 60 (25 %) papers. Clinical pathway use was reported in 107 (44 %) papers. This scoping review identifies the broad range of patient and department level influences and facilitators affecting the global utilisation of RT. Recognition of such influences reducing access to RT will inform proposed interventions or educational strategies to overcome and address such barriers.