Dietary Intake in Law Enforcement Personnel: Occupation Is an Additional Challenge for Changing Behavior

Round 1

Reviewer 1 Report

In general : This article covered a wide scope of material and methods in law enforcement personnel/ occupations. Its seen as a strength in this article and well handled, clear and informative.It was shown these groups had so much in common. Ethics approval well and detailed described and up to date. Results in tabells easy to follow and wish the study to have a good impact on food habits changes in near future.    

Author Response

Thank you, we appreciate your supportive feedback on the manuscript. We have not actioned any specific feedback relating to Reviewer 1's comments as thre were no changes requested.

Reviewer 2 Report

This manuscript is well written and interesting. I have several suggestions for improvements below, mostly related to clarity and additional detail.

Abstract

Lines 12-13: Barriers statements in objectives seem repetitive. “…barriers to achieving a healthy diet and described self-reported barrier…” Select one of the barriers statements and omit the other, unless I’m confused and these two objectives are distinct. If that is the case, please reword for clarity. I see in the objectives statement at the end of the introduction that these are two distinct objectives. Consider rewording or adding punctuation to improve clarity. Can you replicate the objectives from the introduction? Those seemed more clear to me.

Line 16: Can omit “a” prior to “healthy and enjoyable dietary intake.’

Line 17: Consider reducing word repetition in this sentence by revising to “…159 individuals participated” instead of participants participated.

In the methods section of the abstract, please include the type of qualitative data collection used. I see that thematic analysis occurred. Was this based on in-depth interview transcripts? In the first sentence where you introduce your mixed methods approach, perhaps you can include the qual method at the end of the sentence. For example, “A mixed methods study explored cross-sectional data from the Perceived Barriers to healthy eating validated survey using in-depth interviews.” Or “A mixed methods study, combining surveys and in-depth interviews, explored…”

In the conclusions statement “Dietary intake in law enforcement…” Can the authors be more specific and share their primary finding as it relates to occupational considerations? It seems obvious that occupational factors would serve as a barrier in this population, so if the authors could share more specific information as it relates to occupational barriers, that would be helpful.

The introduction section looks good to me. It’s interesting and thorough.

Methods 

Line 87: Can the authors specify which type of mixed methods methodology was used? Was it sequential explanatory? They might also specify why this type of research methodology is important for the investigation. The following reference may be helpful to draw from and cite.

Creswell JW. A concise introduction to mixed methods research. Thousand Oaks, CA: SAGE Publications, Inc., 2015

Similar to my statement regarding methods in the abstract, can the authors include the type of qualitative methodology that was used? It appears that it was a structured interview using the validated survey open ended questions. Is this correct?

Line 94: I think this sentence is incomplete as worded. Consider “In addition, to further explore the self-reported barriers we used a qualitative framework analysis.” Again, is this method consider a structured interview? If so, please state. If not, please include the specific type of qualitative methodology. If “qualitative framework analysis” is its’ own methodology, please briefly explain. Consider adding a little more detail – I understand it once I read the Qualitative Data section on page 3, but clarity early on would be really helpful.

Line 99: How were participants recruited? What recruitment methods were used? This can be a brief description. How many law enforcement departments were contacted? If the methods were previously described in the manuscript from objective 1, please briefly describe here and include reference.

Line 105: Did participants complete validated surveys and a structed interview based on the open ended questions in the survey? Were they compensated? When did data collection occur?

Lines 117: I think moving the sentence that describes that the survey was paper-based to the beginning of the paragraph would help clarify methodology early-on. Were demographics questions also included in the survey? I’m assuming so but please state. Were there any other types of questions asked?

Line 139: Qualitative data section looks good and is very helpful. Consider adding detail earlier in the methods and abstract.

Results

Line 153: Similar to my comments above, please add detail about locations.

Lines 165-173: I think these results could be reworded for clarity. Eg. The majority of participants across age groups… responded neutral to… However, participants between 25-29 years old reported their diet to be somewhat healthy… That might not be quite right but something along those lines?

Sections on lines 182 and 188: Can the authors share more information in these sections? These are the most innovative and insightful parts of the research and manuscript. I appreciate the additional detail from the table and wonder if there’s a way to integrate some of that into these sections?

Table 3 and Figure 1 are excellent and informative.

Discussion

 Line 314: Can the authors share some general details of previous interventions that focused on improving the health and nutrition of shift workers?

In limitations, can the authors comment on high proportions of responses in ‘neither agree nor disagree’ for survey? Sometimes we leave out the neutral response categories to force respondents to make a decision.

Conclusions

Line 359: Similar to the detail included for individual preferences, can the authors include specifics in parentheses for social influences and the other barriers? (Similar to how they described previous research in lines 336-338.)

Author Response

Lines 12-13: Barriers statements in objectives seem repetitive. “…barriers to achieving a healthy diet and described self-reported barrier…” Select one of the barriers statements and omit the other, unless I’m confused and these two objectives are distinct. If that is the case, please reword for clarity. I see in the objectives statement at the end of the introduction that these are two distinct objectives. Consider rewording or adding punctuation to improve clarity. Can you replicate the objectives from the introduction? Those seemed more clear to me.

Thank you for finding this, we have removed the repetition.

Line 16: Can omit “a” prior to “healthy and enjoyable dietary intake.’

This has been omitted.

Line 17: Consider reducing word repetition in this sentence by revising to “…159 individuals participated” instead of participants participated.

This has been changed to ‘were surveyed’.

In the methods section of the abstract, please include the type of qualitative data collection used. I see that thematic analysis occurred. Was this based on in-depth interview transcripts? In the first sentence where you introduce your mixed methods approach, perhaps you can include the qual method at the end of the sentence. For example, “A mixed methods study explored cross-sectional data from the Perceived Barriers to healthy eating validated survey using in-depth interviews.” Or “A mixed methods study, combining surveys and in-depth interviews, explored…” 

We have now added the following information into the abstract:

“The survey included eight questions obtaining quantitative data and two open ended question obtaining qualitative data. A framework thematic analysis using the theory of planned behavior was undertaken to describe the qualitative responses of self-reported barriers to a healthy and enjoyable dietary intake.”

We have now added to the first sentence where we introduce the mixed methods approach:

“This study was a mixed-methods design, with qualitative and quantitative data obtained from surveys, and had two objectives.”

We have also reiterated that the qualitative framework analysis was “to investigate the qualitative data obtained from the questionnaire regarding self-reported barriers”.

In the conclusions statement “Dietary intake in law enforcement…” Can the authors be more specific and share their primary finding as it relates to occupational considerations? It seems obvious that occupational factors would serve as a barrier in this population, so if the authors could share more specific information as it relates to occupational barriers, that would be helpful.

We have now added further detail – however it does mean the additional occupational detail is only mentioned in the conclusion (as the word count does not allow it elsewhere). We are happy to include it or for it to be removed.

The introduction section looks good to me. It’s interesting and thorough.

Thank you.

Methods

Line 87: Can the authors specify which type of mixed methods methodology was used? Was it sequential explanatory? They might also specify why this type of research methodology is important for the investigation. The following reference may be helpful to draw from and cite.

The mixed methods methodology combined elements of qualitative and quantitative; both obtained through the questionnaire. Two questions in the questionnaire were open ended providing qualitative data.

We have now added to the first sentence where we introduce the mixed methods approach:

“This study was a mixed-methods design, with qualitative and quantitative data obtained from surveys, and had two objectives.”

Similar to my statement regarding methods in the abstract, can the authors include the type of qualitative methodology that was used? It appears that it was a structured interview using the validated survey open ended questions. Is this correct?

We report the two open ended questions used in the survey

“The final questions provide the opportunity for qualitative responses to the questions “Please state your biggest challenge/barriers to eating a healthy and enjoyable food intake” and “Do you have any additional comments?”

To clarify to readers, we have added addition detail under heading 2.4.2 Qualitative data:

“The procedure for analysis first included transcribing handwritten survey responses verbatim,”

Line 94: I think this sentence is incomplete as worded. Consider “In addition, to further explore the self-reported barriers we used a qualitative framework analysis.” Again, is this method consider a structured interview? If so, please state. If not, please include the specific type of qualitative methodology. If “qualitative framework analysis” is its’ own methodology, please briefly explain. Consider adding a little more detail – I understand it once I read the Qualitative Data section on page 3, but clarity early on would be really helpful.

We have added additional details:

“In addition, this study aimed to investigate the qualitative data obtained from the questionnaire regarding self-reported barriers using a qualitative framework analysis which involved mapping data to the theory of planned behavior.” However, with this additional information it is hard to meet our abstract word target so we have needed to compromise on abstract inclusions.

Line 99: How were participants recruited? What recruitment methods were used? This can be a brief description. How many law enforcement departments were contacted? If the methods were previously described in the manuscript from objective 1, please briefly describe here and include reference.

The text has been updated ‘Personnel were recruited from one US law enforcement agency while undergoing face-to-face training as part of their usual occupation’ and in the limitations we have added ‘Considering the exploratory nature of the project, extremely diverse nature of US law enforcement training standards, delivery, and confidentiality required, this survey delivery method was appropriate.’

Line 105: Did participants complete validated surveys and a structed interview based on the open ended questions in the survey? Were they compensated? When did data collection occur?

This has been addressed as per the above. The methodology has been described in more detail, there were no interviews.

Lines 117: I think moving the sentence that describes that the survey was paper-based to the beginning of the paragraph would help clarify methodology early-on. Were demographics questions also included in the survey? I’m assuming so but please state. Were there any other types of questions asked?

In line 148 we now refer to the ‘handwritten survey’  and moved the reference to paper-based survey to line 114. In addition, we have noted the demographic questions – no other question types were asked except the validated surveys.

Line 139: Qualitative data section looks good and is very helpful. Consider adding detail earlier in the methods and abstract.

Thank you, this has been done.

Results Line 153: Similar to my comments above, please add detail about locations.

Thank you, this has been done

Lines 165-173: I think these results could be reworded for clarity. Eg. The majority of participants across age groups… responded neutral to… However, participants between 25-29 years old reported their diet to be somewhat healthy… That might not be quite right but something along those lines?

This has been re-written as ‘A higher proportion of the age group 25-29 reported ‘somewhat healthy’ eating in comparison to the other age groups who reported ‘neutral. Additionally, a higher proportion of of sworn deputy and police officer trainees responded as “Somewhat healthy” in comparison to more custody assistants or civilian jailers, and 55% of the reserve peace officers responding as neutral as outlined in Table 2.’  

Sections on lines 182 and 188: Can the authors share more information in these sections? These are the most innovative and insightful parts of the research and manuscript. I appreciate the additional detail from the table and wonder if there’s a way to integrate some of that into these sections?

We appreciate this feedback; we have reviewed and believe that these sections represent the data well at the level that is appropriate as they are survey questions.

Table 3 and Figure 1 are excellent and informative.

Thank you!

Discussion Line 314: Can the authors share some general details of previous interventions that focused on improving the health and nutrition of shift workers?

We have kept this broad as follows ‘Dietary interventions and health promotion programmes at the workplace have been shown to benefit the wellbeing and dietary behaviors of shift workers through education and a supportive environment (24, 42).’ Line 330

In limitations, can the authors comment on high proportions of responses in ‘neither agree nor disagree’ for survey? Sometimes we leave out the neutral response categories to force respondents to make a decision.

The likert scale was administered as per it’s validation including a neutral response category.

Conclusions

Line 359: Similar to the detail included for individual preferences, can the authors include specifics in parentheses for social influences and the other barriers? (Similar to how they described previous research in lines 336-338.)

We have now added additional information:

“social influences (friends, peers, and family), internal drive and capacity to change (knowledge, skill, willpower, and tiredness), and occupational influences (busy schedules, long working hours, inconsistent meal breaks, and shift work).”