Nutrition Counselling Practices among General Practitioners in Croatia

COVID-19 vaccine hesitancy among the Chinese elderly: A multi-stakeholder qualitative study

The United Nations reported that the mortality risk of Corona Virus Disease 2019 (COVID-19) is five times higher in the elderly than the global average. Although the COVID-19 vaccine effectively prevents infections and reduce mortality among the elderly, vaccine hesitancy among the Chinese elderly poses a significant threat. This study, utilizing the "Confidence, Convenience and Complacency (3 Cs)" vaccine hesitancy model, aimed to explore factors contributing to vaccine hesitancy among the Chinese elderly and assess national countermeasures and potential improvement approaches. Thirteen elderly with vaccine hesitancy and eleven vaccine-related staff participated in semi-structured interviews. Thematic analysis revealed three key determinants of vaccine hesitancy among the elderly: perceived low threat of COVID-19, lack of confidence in COVID-19 vaccine, and poor accessibility to vaccination. China has implemented strategies, including advocacy through diverse channels, joint multi-sectoral promotion vaccination, and enhancing ongoing vaccination services. Recommendations from the vaccine-related staff emphasize improving vaccine awareness among the elderly, and prioritizing the vaccination environment and process. The study underscores the importance of targeted vaccination promotion programs addressing hesitation reasons to improve vaccination rates. Furthermore, existing countermeasures can serve as a foundation for enhancing vaccination strategies, including improved publicity, administration, and management approaches.

Nutrition and Physical Activity Education in Medical School: A Narrative Review

This review explores the diverse landscape of integrating nutrition and physical activity education into medical school curricula, focusing on the imperative role of physicians in promoting health through lifestyle changes. By examining global medical education structures, we uncovered disparities in nutrition and physical activity training, and highlighted the need for a shared framework to address international and regional challenges. Despite acknowledging the importance of both nutrition and physical activity, studies have consistently uncovered deficiencies in medical school curricula, especially in skills related to providing lifestyle advice and behavioral counseling. Survey studies among medical students have illuminated various perceptions and knowledge gaps, emphasizing the need for more comprehensive and mandatory nutrition and physical activity training. While acknowledging progress, challenges, such as time constraints, resource availability, and faculty expertise, persist. Integrating lifestyle education results in resistance, a demand for strategic communication, and faculty buy-ins. These findings underscore the importance of a holistic approach that balances theoretical knowledge, practical skills, and confidence that medical students need to promote effective nutrition and physical activity in healthcare.

Healthy lifestyle counseling, and barriers perceived by general practitioners in Poland

Introduction

The aim of the study was to determine the influence of the personal factors, such as body mass index (BMI), of general practitioners (GPs), and their counseling on weight management, healthy lifestyle, and their perceived barriers.

Materials and methods

The cross-sectional study was conducted from January 2020 to December 2021 among 161 GPs in the city of Lodz.

Results

Only 3.7% of physicians always advised their patients on diet and physical activity (p < 0.05). Most of the GPs (54%) provide counseling occasionally. GPs gave general advice more often to patients with chronic diseases than to patients who did not. The study showed that the chance of providing advice on eating habits or physical activity was significantly higher for the GPs who practiced physical activity (OR = 2.64; 95%Cl: 1.01-6.91, p < 0.05) and measured patient weight, height, and BMI (OR = 4.86; 95%Cl: 1.86-12.67, p < 0.001). GPs who were overweight (OR = 3.55; 95%Cl: 1.49-8.41, p < 0.01) and measured patient weight, height, and BMI (OR = 3.61; 95%Cl: 1.58-8.25, p < 0.01) were more likely to advise on nutrition or physical activity to "healthy" patients. Doctors who measured patient weight, height, and BMI advised patients with chronic diseases (OR = 6.45; 95%Cl: 2.54-16.34, p < 0.001). Over 40% of GPs believe that they are not effective in counseling. Lack of time turned out to be the main barrier to counseling for 73.3% of GPs, which was associated with heavy workload (>100 visits per week).

Conclusion

As many GPs doubt their effectiveness, it is recommended that GPs attend more training activities regarding counseling. In addition, organizational changes are needed to reduce patient numbers, and financial incentives are needed to improve counseling and patient measurement.

Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners

Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.

Are primary care providers' nutrition care and food insecurity screening practices associated with their perceptions of team-based care?

BACKGROUND

Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition).

METHODS

Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests.

RESULTS

Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling.

CONCLUSION

Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.

Rebalancing meat and legume consumption: change-inducing food choice motives and associated individual characteristics in non-vegetarian adults

BACKGROUND

A shift toward more plant-based foods in diets is required to improve health and to reduce environmental impact. Little is known about food choice motives and associated characteristics of those individuals who have actually reduced their consumption of animal-based foods. The aim of this cross-sectional study was to identify change-inducing motives related to meat and legume consumptions among non-vegetarians. The association between change-inducing motives and individual characteristics was also studied.

METHODS

This study included 25,393 non-vegetarian participants in the French NutriNet-Santé cohort (77.4% women, mean age 55.4 ± 13.9 y.). The motives related to the declared change in meat and legume consumptions (e.g., taste, environment, social pressure) were assessed by an online questionnaire in 2018. For each motive, respondents could be classified into three groups: no motive; motive, not change-inducing; change-inducing motive. Associations between change-inducing motives and individual characteristics were evaluated using multivariable polytomic logistic regressions. Characteristics of participants who rebalanced their meat and legume consumptions were also compared to those who reduced their meat but did not increase their legume consumption.

RESULTS

Motives most strongly declared as having induced a change in meat or legume consumptions were health and nutrition (respectively 90.7 and 81.0% declared these motives as change-inducing for the meat reduction), physical environment (82.0% for meat reduction only) and taste preferences (77.7% for legume increase only). Other motives related to social influences, meat avoidance and meat dislike were reported by fewer individuals, but were declared as having induced changes in food consumption. Most motives that induced a meat reduction and a legume increase were more likely to be associated with specific individual characteristics, for example being a woman or highly educated for health motives.

CONCLUSIONS

Besides the motives reported as important, some motives less frequently felt important were declared as having induced changes in meat or legume consumptions. Change-inducing motives were reported by specific subpopulations. Public campaigns on health and sustainability could usefully develop new tools to reach populations less willing to change.

TRIAL REGISTRATIONS

The study was registered at ClinicalTrials.gov (NCT03335644).

Developing a protocol based on the Brazilian Dietary Guidelines for individual dietary advice in the primary healthcare: theoretical and methodological bases

To describe the methodology of development of a protocol for application of the Brazilian Dietary Guidelines by primary healthcare professionals in individual dietary advice. A five-step approach was followed: (1) format definition; (2) definition of the instrument for assessment of individuals’ food consumption; (3) Dietary Guidelines’ content extraction; (4) protocol content development; (5) content and face validity. An example from Brazil was displayed with the development of a protocol to guide healthcare professional decision-making when providing nutrition advice based on the Brazilian Dietary Guidelines. The instrument of the Brazilian Nutrition Surveillance System (SISVAN) was chosen to the food consumption assessment, which contains questions about the consumption of seven healthy or unhealthy food groups and one question about eating modes. The Guidelines’ content extraction process led to the identification of recommendations related to the food consumption markers assessed by the SISVAN questionnaire. Then, a protocol was developed in a flowchart format, in which the professional’s conduct is guided by the answer given to each question of the SISVAN instrument. For each ‘non-compliant’ answer (unhealthy eating practice), the professional is instructed how to provide recommendations and identify obstacles. Lastly, experts and healthcare professionals highlighted pertinence, clarity and usability of the protocol. This study provides the blueprint for the phase-wise development of protocols of application of the Dietary Guidelines and may contribute to promote healthier eating and ending malnutrition in all its forms.

Nutrition competence of primary care physicians in Saudi Arabia: a cross-sectional study

OBJECTIVES

Primary care physicians have an opportunity to support healthy dietary behaviours of patients by providing nutrition care. However, it is unclear whether primary care physicians in the Kingdom of Saudi Arabia (KSA) are sufficiently competent in nutrition. This study aimed to assess the nutrition competence of primary care physicians in KSA and identify whether nutrition competence is associated with the provision of nutrition care to patients living with diet-related chronic disease.

DESIGN

A cross-sectional study.

SETTING

Chronic disease clinics across 48 primary care centres under the Ministry of Health in the city of Jeddah, KSA.

PARTICIPANTS

90 primary care physicians completed the survey (response rate: 98%). General practitioners and family medicine residents, specialists, and consultants actively working in chronic disease clinics between February and May 2019 were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measure was nutrition competence of primary care physicians measured via the validated NUTCOMP (nutrition competence) questionnaire.

RESULTS

Primary care physicians perceived themselves as competent in nutrition care but their reported provision of nutrition care was limited. Confidence in their nutrition knowledge and skills elicited the lowest mean scores of 25.8 (±5.4) out of 35 and 29 (±5.2) out of 40, respectively. The reported provision of nutrition care was closely correlated with physicians' confidence in their nutrition knowledge (r=0.57) and communication (r=0.52). Three factors were identified as predicting whether physicians provide nutrition care to patients: confidence in counselling about nutrition (p<0.001), having previous nutrition education (p=0.005) and a higher professional qualification (p=0.008).

CONCLUSIONS

Primary care physicians felt confident in providing nutrition care to patients living with diet-related chronic disease. Primary care physicians would benefit from higher levels of nutrition knowledge and skills to effectively support patients to improve their dietary behaviours and health conditions, leading to a positive impact on public health.

Nutrition care by primary-care physicians: advancing our understanding using the COM-B framework

OBJECTIVE

To investigate the nutrition education provided by primary-care physicians (PCP).

DESIGN

An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms.

SETTING

USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand.

PARTICIPANTS

Primary-care physicians.

RESULTS

Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations.

CONCLUSIONS

The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.

Metabolic syndrome and its association with the Dietary Inflammatory Index (DII)® in a Croatian working population

BACKGROUND

Metabolic syndrome (MetS) is a global public health concern, although its association with the inflammatory potential of the diet is still indefinite. The main objective of the present study was to investigate the association of MetS and its components with the inflammatory potential of the diet in a Croatian working population with sedentary occupations.

METHODS

In a cross-sectional study, Croatian workers (n = 366) self-administrated questionnaires for sociodemographic and health-related data. Their anthropometric measurements and fasting blood samples were collected for evaluation of MetS. The inflammatory potential of the diet was assessed with a Dietary Inflammatory Index (DII)^® , scored using dietary data collected from a food frequency questionnaire. Multivariable logistic regression analysis, adjusted for sex, age, body mass index, education, smoking, physical activity and energy intake, was used to establish the association between DII and MetS.

RESULTS

MetS prevalence was 25% and was significantly associated with a pro-inflammatory diet [mean (SD) 3.28 (1.45); P < 0.01]. The pro-inflammatory diet was statistically associated with women, university degree, moderate physical activity, snacking between meals, central obesity, hypertriglyceridaemia, hypertension, low high-density lipoprotein-cholesterol, MetS prevalence and lower adherence to a Mediterranean diet. Multivariable logistic regression analysis showed a statistically positive association for a one-unit increase in the DII and MetS prevalence (odds ratio = 2.31; 95% confidence interval = 1.61-3.31; P < 0.01) and hypertension (odds ratio = 1.28; 95% confidence interval = 1.01-1.64; P = 0.04).

CONCLUSIONS

Further longitudinal studies in different parts of Croatia, including inflammation biomarkers, are needed to enable a more defined view of the inflammatory potential of a diet and its association with various inflammatory-based health conditions. The results obtained in the present study indicate the need for the development of anti-inflammatory dietary interventions for population health protection.

The Nutrition Knowledge of Croatian General Practitioners

Nutrition care delivered in primary health care setting is an effective and necessary preventive health care measure. General practitioners (GPs) nutrition knowledge is related to their nutrition care practice. The aim of this study was to explore the nutrition knowledge of Croatian GPs, and to investigate its connection with the implementation of nutrition care in GPs’ offices. A cross-sectional study was conducted among 17.0% of randomly selected GPs, from May to July 2013, via an anonymous questionnaire. The study showed that only 35.8% of the Croatian GPs had an adequate level of nutrition knowledge (five or more correct answers to nutrition questions). The study further revealed that females, GPs with additional education in nutrition and GPs who had not suffered from chronic diseases with poor nutrition posing as a risk factor had better nutrition knowledge (p = 0.029, p < 0.001 and p = 0.041, respectively). The Spearman rank correlation between GPs’ nutrition knowledge and the implementation of nutrition care in their offices during daily work with patients was r_s = −0.190 (p < 0.001). To provide nutrition care in GPs’ offices in Croatia, strategies for improving GPs’ nutrition knowledge are needed.

Attitudes toward Nutrition Care among General Practitioners in Croatia

Nutrition care should be an integral part of general practitioners' (GPs') daily work with patients. The aim of this study was to assess the attitudes of Croatian GPs toward nutrition and nutrition care, and to evaluate the interconnection between their attitudes and implementation of nutrition care in GPs offices. A cross-sectional study was conducted among 17.0% of randomly selected GPs, from May to July of 2013, via a specially designed anonymous questionnaire. The study showed that 36.0% of the Croatian GPs had satisfactory number of positive attitudes (5 or more) toward nutrition and nutrition care. There was statistically significant difference in the median number of positive attitudes based on the additional education of GPs in nutrition and their ailment from chronic diseases (p < 0.001 and p = 0.022, respectively). The Spearman rank correlation between GPs' attitudes toward nutrition and nutrition care and their practice, i.e., the implementation of nutrition care in GPs' everyday work with patients was r_s = -0.235 (p < 0.001). In order to provide nutrition care in GPs' offices in Croatia, strategies for changing GPs' attitudes toward nutrition and nutrition care are needed.