GPs' needs for practice-oriented nutrition education; a Delphi study among Dutch GPs

Interdisciplinary communication and collaboration as key to improved nutritional care of malnourished older adults across health-care settings - A qualitative study

Background

Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement.

Methods

Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach.

Results

Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards.

Conclusion

Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.

Supporting nutrition in frail older people: a qualitative study exploring views of primary care and community health professionals

BACKGROUND

Malnutrition is associated with increased morbidity and mortality, and is very common in frail older people. However, little is known about how weight loss in frail older people can be managed in primary care.

AIMS

To explore the views and practices of primary care and community professionals on the management of malnutrition in frail older people; identify components of potential primary care-based interventions for this group; and identify training and support required to deliver such interventions.

DESIGN AND SETTING

Qualitative study in primary care and community settings.

METHOD

Seven focus groups and an additional interview were conducted with general practice teams, frailty multidisciplinary teams (MDTs), and community dietitians in London and Hertfordshire, UK (n = 60 participants). Data were analysed using thematic analysis.

RESULTS

Primary care and community health professionals perceived malnutrition as a multifaceted problem. There was an agreement that there is a gap in care provided for malnutrition in the community. However, there were conflicting views regarding professional accountability. Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition. Community MDT professionals and dietitians thought that an intervention to tackle malnutrition would be best placed in primary care and suggested opportunistic screening interventions. Education was an essential part of any intervention, complemented by social, emotional, and/or practical support for frailer or socially isolated older people.

CONCLUSIONS

Future interventions should include a multifaceted approach. Education tailored to the needs of older people, carers, and healthcare professionals is a necessary component of any intervention.

Nutrition and physical activity guidance for women in the pre- and post-natal period: a continuing education needs assessment in primary health care

The study objective was to assess primary health care (PHC) providers’ exposure to women in the pre- and post-natal period, current nutrition and physical activity guidance practices, confidence and perceived needs for continuing education relevant to nutrition and physical activity guidance in the peri-natal period. A self-administered cross-sectional questionnaire survey amongst a purposively recruited sample of 226 local primary health care providers evenly distributed across general practice, community nursing, pharmacist and pharmacy assistant worker groups. The questionnaire contained 106 items about primary health care providers’ exposure to women in the pre- and post-natal life-stage, their current nutrition and physical activity guidance practices, confidence and perceived needs for continuing education relevant to nutrition and physical activity guidance in the peri-natal period. Results indicate that PHC providers across general practice, community nursing and pharmacy service settings are frequently accessed by women during this life-stage, and regularly and variably provide guidance on nutrition and physical activity, and report different continuing education needs. Continuing education interventions need to be tailored to match the needs of each PHC group. Pharmacy-based staff are a priority for PHC continuing education about nutrition and physical activity if the potential of the community-based pharmacy as a primary health setting is to be realised.

How to optimize tuberculosis case finding: explorations for Indonesia with a health system model

Background

A mathematical model was designed to explore the impact of three strategies for better tuberculosis case finding. Strategies included: (1) reducing the number of tuberculosis patients who do not seek care; (2) reducing diagnostic delay; and (3) engaging non-DOTS providers in the referral of tuberculosis suspects to DOTS services in the Indonesian health system context. The impact of these strategies on tuberculosis mortality and treatment outcome was estimated using a mathematical model of the Indonesian health system.

Methods

The model consists of multiple compartments representing logical movement of a respiratory symptomatic (tuberculosis suspect) through the health system, including patient- and health system delays. Main outputs of the model are tuberculosis death rate and treatment outcome (i.e. full or partial cure). We quantified the model parameters for the Jogjakarta province context, using a two round Delphi survey with five Indonesian tuberculosis experts.

Results

The model validation shows that four critical model outputs (average duration of symptom onset to treatment, detection rate, cure rate, and death rate) were reasonably close to existing available data, erring towards more optimistic outcomes than are actually reported. The model predicted that an intervention to reduce the proportion of tuberculosis patients who never seek care would have the biggest impact on tuberculosis death prevention, while an intervention resulting in more referrals of tuberculosis suspects to DOTS facilities would yield higher cure rates. This finding is similar for situations where the alternative sector is a more important health resource, such as in most other parts of Indonesia.

Conclusion

We used mathematical modeling to explore the impact of Indonesian health system interventions on tuberculosis treatment outcome and deaths. Because detailed data were not available regarding the current Indonesian population, we relied on expert opinion to quantify the parameters. The fact that the model output showed similar results to epidemiological data suggests that the experts had an accurate understanding of this subject, thereby reassuring the quality of our predictions. The model highlighted the potential effectiveness of active case finding of tuberculosis patients with limited access to DOTS facilities in the developing country setting.

A comparison of Dutch family doctors' and patients' perspectives on nutrition communication

BACKGROUND

In recent years, we have investigated both patients' and family doctors' communicative characteristics towards nutrition communication in general practice with several qualitative and quantitative studies. A sound comparison of the survey results between both conversation partners has not been made before.

OBJECTIVE

The aim of the present study was to put together data obtained by earlier studies for the first time in order to make comparisons of patients' and family doctors' communicative characteristics regarding nutrition communication.

METHODS

In The Netherlands, 603 patients completed a face-to-face interview-assisted questionnaire (65% response rate) and 267 family doctors completed a questionnaire (45% response rate).

RESULTS

When comparing communicative characteristics, patients stronger believed that nutrition was an influence on health than family doctors. They also attributed a greater role to personal hygiene, stress and heredity, while family doctors were more convinced of the role of alcohol use and smoking on health. Patients more often rated their own nutrition knowledge as good than family doctors. In contrast, family doctors showed higher interest in nutrition and nutrition information than patients. As a result, a collinear model for family doctors and nutrition communication towards patients was provided.

CONCLUSIONS

Significant differences between patients and family doctors were found for several communicative characteristics towards nutrition communication. It is important that family doctors become convinced that patients perceive them as a reliable and expert source of nutrition information. It is recommended that family doctors raise nutrition awareness among patients. Finally, we advise family doctors to pay attention to nutrition communication styles.

[Priorities in health promotion according to primary care health professionals: a Delphi study]

OBJECTIVES

To find out the opinions of primary care professionals on prevention activities in clinical practice, as well as the perceived obstacles to carrying them out and ways of overcoming them.

PARTICIPANTS

A total of 129 professionals participated, including primary care doctors, nurses, technicians, primary care service managers, and public health professionals.

DESIGN

Delphi questionnaire sent by e-mail.

SETTING

Primary care in Catalonia, Spain.

MAIN MEASUREMENTS AND RESULTS

Two rounds were made with response rates of 48.9% and 67.4%, respectively. Convergence of over 40% was obtained in all the questions after the second round. The main problems for prevention in clinical practice were lack of time, lack of training and the attitudes of the professionals themselves towards prevention. To improve implementing prevention in the practice, the professionals pointed out, training in communication skills, advice methodology and the use of clinical practice guidelines.

CONCLUSIONS

Health professionals pointed out some specific needs in training which could help to improve the inclusion of prevention activities. On the other hand, it was noted that the attitudes of the professionals themselves towards prevention need to be improved.

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs

OBJECTIVE

The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables.

METHODS

Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST.

RESULTS

Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses.

CONCLUSION

The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted.

PRACTICE IMPLICATIONS

We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Arbor Clinical Nutrition Updates: evidence-based clinical nutrition education using the Internet

The Arbor Clinical Nutrition Updates (ACNU) is a weekly electronic nutrition journal for health professionals. Each issue summarises several recent clinical research papers appearing in the general medical and nutrition literature and which deal with a common nutrition topic. A commentary is added on how this research fits in with previous work, and what it all means for the practising clinician. ACNU is the world's most widely read electronic nutrition publication, with over 100,000 largely health-professional readers in 186 countries. It is published in nine languages and distributed by email without charge in both plain text and Acrobat formats. ACNU utilises a number of the Internet's unique characteristics to facilitate broad reach, currency and active reader feedback. This, together with its brevity and summarising format, helps to maintain its relevance to the nutrition education needs of health professionals, particularly those in clinical practice, and to overcome the factors most commonly reported by health professionals as obstacles to their greater adoption of evidence-based medicine. ACNU is intended to be a collaboration with the primary research journals to extend the reach of new nutrition research findings to a wider community of researchers, academics and clinicians than each journal might otherwise reach individually. As such, ACNU utilises the Internet to promote the goals of open-access publishing and evidence-based medicine.

Nutrition communication styles of family doctors: results of quantitative research

OBJECTIVE

To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates.

DESIGN

A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire.

SETTING

The survey was conducted in October and November 2004 in the Netherlands.

SUBJECTS

A total of 267 family doctors completed the questionnaire (response rate 45%).

METHODS

Principal component factor analyses with varimax rotation were performed to construct factors. Cronbach's alpha was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results.

RESULTS

Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%).

CONCLUSIONS

In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.