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Donnelly HR, Clarke ED, Collins CE, Tehan PE. 'Nutrition has everything to do with wound healing'-health professionals' perceptions of assessment and management of nutrition in individuals with diabetes-related foot ulceration. Int Wound J 2024; 21:e14898. [PMID: 38745257 PMCID: PMC11093920 DOI: 10.1111/iwj.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
Determine how healthcare professionals perceive their role in nutrition assessment and management, and explore barriers and enablers to assessment and management of nutrition in individuals with DFU. Mixed methods including a cross-sectional online survey derived from current international guidelines and theoretical domains framework, and semi-structured interviews with conventional content analysis was performed. One hundred and ninety-one participants completed the survey, with 19 participating in interviews. Many health professionals are not confident in their ability in this area of practice, are uncertain their nutrition advice or management will be effective in assisting wound healing outcomes and are uncertain their intervention would result in adequate behaviour change by the individual with DFU. Major barriers to implementation of nutrition assessment and management were: inadequate time, lack of knowledge and lack of clinical guidance and enablers were as follows: professional development, a standardised clinical pathway and screening tool and a resource addressing wound healing and diabetes management. Nutrition assessment and management in individuals with DFU is not consistently applied. Whilst health professionals believed nutrition was important for wound healing, they lacked confidence in implementing into their practice. Further dissemination of existing guidance and implementation of education programs and resources would help overcome cited barriers.
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Affiliation(s)
- Hailey R. Donnelly
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Erin D. Clarke
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Peta E. Tehan
- Food and Nutrition Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- Department of Surgery, School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
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Greenwood H, Davidson AR, Thomas R, Albarqouni L. Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews. BMC PRIMARY CARE 2024; 25:108. [PMID: 38582829 PMCID: PMC10998330 DOI: 10.1186/s12875-024-02321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care. METHODS We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews. RESULTS From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion. CONCLUSIONS We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously. TRIAL REGISTRATION This study was registered in PROSPERO (CRD42022357583).
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Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Alexandra R Davidson
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Tropical Australian Academic Health Centre, Townsville, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Drew KJ, Homer C, Radley D, Jones S, Freeman C, Bakhai C, Ells L. Normalisation and equity of referral to the NHS Low Calorie Diet programme pilot; a qualitative evaluation of the experiences of health care staff. BMC Public Health 2024; 24:152. [PMID: 38200463 PMCID: PMC10782747 DOI: 10.1186/s12889-023-17526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health and wellbeing can be profoundly impacted by both obesity and type 2 diabetes, while the normalisation and equity of care for people living with these non-communicable diseases remain as challenges for local health systems. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We have explored the experiences of health care staff who have made a referral to the LCD programme, while identifying effective and equitable delivery of programme referrals, and their normalisation into routine care. METHODS Nineteen individual semi-structured interviews were completed health care staff in the first year of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including communication and training, referrals, equity, and demands on primary care, before being subjected to a thematic analysis. RESULTS From the data, five core themes were identified: Covid-19 and the demands on primary care, the expertise and knowledge of referrers, patient identification and the referral process, barriers to referrals and who gets referred to the NHS LCD programme. Our findings demonstrate the variation in the real world settings of a national diabetes programme. It highlights the challenge of COVID-19 for health care staff, whereby the increased workload of referrals occurred at a time when capacity was curtailed. We have also identified several barriers to referral and have shown that referrals had not yet been normalised into routine care at the point of data collection. We also raise issues of equity in the referral process, as not all eligible people are informed about the programme. CONCLUSIONS Referral generation had not yet been consistently normalised into routine care, yet our findings suggest that the LCD programme runs the risk of normalising an inequitable referral process. Inequalities remain a significant challenge, and the adoption of an equitable referral process, normalised at a service delivery level, has the capacity to contribute to the improvement of health inequalities.
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Affiliation(s)
- Kevin J Drew
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK.
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU, UK
| | - Duncan Radley
- Obesity Institute, School of Sport, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QW, UK
| | - Susan Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK
| | - Charlotte Freeman
- Public Health Calderdale Metropolitan Borough Council, Halifax, HX1 1TS, UK
| | - Chirag Bakhai
- Larkside Practice, Churchfield Medical Centre, 322 Crawley Green Road, Luton, Bedfordshire, LU2 9SB, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK
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Farzaei M, Shahbazi S, Gilani N, Ostadrahimi A, Gholizadeh L. Nurses' knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus. BMC MEDICAL EDUCATION 2023; 23:192. [PMID: 36978041 PMCID: PMC10053032 DOI: 10.1186/s12909-023-04178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes. METHODS This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis. RESULTS The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008). CONCLUSION Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.
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Affiliation(s)
- Mahsa Farzaei
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, P.O. Box 51745347, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical- Surgical Nursing, Faculty of Nursing and Midwifery& Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, P.O. Box 51745347, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Postal code: 166614711 Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Postal code: 5166614711 Iran
| | - Leila Gholizadeh
- Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007 Australia
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Boocock RC. Dietary management of adults with type 2 diabetes and the role of the nurse. Nurs Stand 2023; 38:57-61. [PMID: 36688331 DOI: 10.7748/ns.2023.e11960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 01/24/2023]
Abstract
Dietary strategies for the management of patients with type 2 diabetes can be effective in maintaining glycaemic control. In some cases, the use of specific and supervised dietary strategies can result in remission of the condition. Despite this, the use of anti-diabetes medicines remains the prevailing focus of treatment guidelines. Nurses in primary care are involved in all aspects of management of patients with type 2 diabetes, including advising on lifestyle changes such as diet. This article considers some of the barriers and enablers to dietary management of patients with type 2 diabetes and offers practical advice that nurses can share with their patients. The author also discusses remission of type 2 diabetes and the dietary approaches used to achieve this.
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Mayr HL, Savill H, Law L, Campbell KL, Hill J, Palmer M, Hickman IJ, Kelly JT. ‘We work in silos’: Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service. Nutr Diet 2022. [DOI: 10.1111/1747-0080.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Hannah L. Mayr
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Centre for Functioning and Health Research Metro South Hospital and Health Service Brisbane Queensland Australia
| | - Holly Savill
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
| | - Lynette Law
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
| | - Katrina L. Campbell
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Metro North Hospital and Health Service Brisbane Queensland Australia
| | - Jan Hill
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
| | - Michelle Palmer
- Department of Nutrition and Dietetics Logan Hospital Brisbane Queensland Australia
| | - Ingrid J. Hickman
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Jaimon T. Kelly
- Centre for Online Health, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
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Langley-Evans SC. Open research: Enhancing transparency in peer review. J Hum Nutr Diet 2022; 35:421-424. [PMID: 35578389 DOI: 10.1111/jhn.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rehackova L, Taylor R, Lean M, Barnes A, McCombie L, Thom G, Brosnahan N, Leslie WS, Sniehotta FF. Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: Experiences of healthcare professionals. Diabet Med 2022; 39:e14752. [PMID: 34837259 DOI: 10.1111/dme.14752] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/25/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes (T2D) in 36% of participants after 2 years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). We evaluated HCPs' experiences with DiRECT. RESEARCH DESIGN AND METHODS Healthcare professionals delivering DiRECT were interviewed at 12 months, while general practices (GPs) were sent an implementation questionnaire. The interviews were analysed thematically. The questionnaires were analysed using frequencies and a narrative synthesis. RESULTS Healthcare professionals representing 11 of 22 intervention practices were interviewed and 10 of 22 GPs completed questionnaires. HCPs' initial concerns over perceived potential negative intervention effects, particularly withdrawing anti-diabetes and anti-hypertensive medications, were barriers to engagement. Trust of HCPs towards the research team and perceived credibility of the study facilitated engagement and adoption. Ongoing support by research dietitians was key to the management of participants. Involvement in DiRECT inspired more focus on behaviour modification in the treatment of other people living with T2D in routine practice. CONCLUSIONS Diabetes Remission Clinical Trial was considered highly appropriate for the management of T2D in primary care when supported by trained dietitians. Addressing limitations, including varying training needs of HCPs may improve intervention scale-up and tailoring to clinical contexts.
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Affiliation(s)
- Lucia Rehackova
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mike Lean
- Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alison Barnes
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - George Thom
- Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Falko F Sniehotta
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Behavioural, Management and Social Sciences (BMS), Twente University, Enschede, The Netherlands
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Mayr HL, Kelly JT, Macdonald GA, Russell AW, Hickman IJ. Clinician perspectives of barriers and enablers to implementing the Mediterranean dietary pattern in routine care for coronary heart disease and type 2 diabetes: A qualitative interview study. J Acad Nutr Diet 2022; 122:1263-1282. [DOI: 10.1016/j.jand.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
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