Advancing Qualitative Health Research Approaches in Applied Nutrition Research

Communication Skills: A Scoping Review of Experiences, Perceptions, and Use in Dietetics Practice

BACKGROUND

Communication skills are a cornerstone of practice for dietitians. The field of dietetics is evolving and there is a need to synthesize the available literature on communication skills to improve the effectiveness of patient consultations and inform practitioner development.

OBJECTIVE

This scoping review aimed to identify the research literature relating to communication skills used in dietetics practice and perceptions and experiences of dietetics students, dietitians, and patients regarding communication skills.

METHODS

This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and best practice guidance. Five databases (Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, and PsycInfo), two theses databases, and conference proceedings for 8 dietetics and health professions education associations were systematically searched for research on dietitians' communication skills. This included skills used in dietitian-patient communication, in communication interactions in different employment contexts, and diverse forms of communication (verbal, written, technological) and the views of dietetics students, dietitians, and patients, regarding communication skills. The search had no geographical or time limits. Studies were independently screened by two authors.

RESULTS

The 70 included studies spanned 45 years and were organized into four thematic categories: importance of communication skills in dietetics practice, development of communication skills, communication skills for dietitian-patient communication, and communication skills for wider dietetics practice. Sixty-five (92.9%) of the studies specifically explored the communication skills used for dietitian-patient consultations, including rapport building, questioning, listening, paraphrasing, and clarifying, whereas skills such as intercultural communication were less researched.

CONCLUSIONS

There is consensus between patients and dietitians regarding the skills that contribute to effective dietitian-patient communication. Areas less explored in the literature include the skills needed for intercultural communication and those needed for science communication. Greater understanding of the communication skills needed for contemporary nutrition and dietetics practice will guide education strategies for the development of dietitians.

A qualitative exploration of barriers, facilitators and best practices for implementing environmental sustainability standards and reducing food waste in veterans affairs hospitals

BACKGROUND

To improve the healthfulness of foods offered while accelerating the use of environmental sustainability practices, it is important to engage hospital food service operators in the adoption of such practices. The purpose of this study was to explore barriers, facilitators and best practices for implementing environmental sustainability standards in food service among veterans affairs (VA) hospitals in the United States.

METHODS

We conducted an online survey with 14 VA hospital food service directors and then 11 qualitative interviews. The survey assessed motivations for initiating sustainability standards and included a self-rating of implementation for each of five standards: increasing plant-forward dishes, procuring and serving sustainable foods that meet organic/fair trade and other certifications, procuring and serving locally produced foods, reducing food waste and reducing energy consumption. Interviews were transcribed verbatim. Qualitative analysis, including coding of themes and subthemes, was conducted by two coders to determine barriers, facilitators and best practices for each of these five standards. Quantitative methods (counts and frequencies) were used to analyse the survey data.

RESULTS

Participants had an average of 5 years of experience implementing sustainability standards. The top three motivators cited were reducing food waste, serving healthier foods and increasing efficiency or cost savings. Barriers revolved around patient preferences, contractual difficulties and costs related to reducing waste. Facilitators included taste testing new recipes that include more sustainable food options and easy access to sustainable products from the prime vendor. Best practices included making familiar dishes plant-forward and plate waste studies to prevent overproduction.

CONCLUSIONS

Although there were many barriers to implementation, food service directors had solutions for overcoming challenges and implementing food service sustainability standards, which can be tested in future sustainability initiatives.

Older adults' perceptions about meat consumption: a qualitative study in Gasabo district, Kigali, Rwanda

BACKGROUND

The global population is increasingly aging, imposing a substantial burden on social and healthcare systems as aging is associated with gradual muscle wasting and functional decline. Consumption of protein-rich foods, such as livestock-based meat, providing high-quality proteins can prevent muscle wasting and related functional decline in older adults. However, there is a lack of data on the older adults' perceptions about meat consumption, particularly in Sub-Saharan Africa.

OBJECTIVE

To explore the perceptions about dietary meat consumption among older adults in Gasabo district, Kigali, Rwanda.

METHODS

We conducted a descriptive qualitative study, using focus group discussions. A total of eight FGDs, lasting between 55 and 80 min, were conducted with gender-mixed groups, including 31 men and 33 women aged ≥ 55 years old. Eight older adults participated in each FGD session, and all discussions were conducted in the local language (Kinyarwanda) using a pre-designed interview guide. The discussions were audio-recorded and transcribed verbatim and translated into English. The transcript was inductively analyzed using thematic analytical process.

RESULTS

Three themes were identified from the data, predominantly related to motives and barriers of meat consumption. The motives of meat consumption included improved quality and taste of the diet, improving own health, and having a social function. Barriers of meat consumption were perceived to be related to health risks, sustainability concerns (depletion of resources), and religious beliefs. Lastly, it was widely perceived that meat was unavailable and economically inaccessible, thus meat consumption was perceived to be associated with improved wealth.

CONCLUSION

The findings revealed a low and declining meat consumption among older adults due to poverty. Improving financial capacity or strategic public health work to improve protein consumption in the elderly is necessary to meet nutritional needs and facilitate healthy aging.

Nature of the evidence base and approaches to guide nutrition interventions for individuals: a position paper from the Academy of Nutrition Sciences

This Position Paper from the Academy of Nutrition Sciences is the third in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This paper focuses on evidence which guides the application of dietary recommendations for individuals. In some situations, modified nutrient intake becomes essential to prevent deficiency, optimise development and health, or manage symptoms and disease progression. Disease and its treatment can also affect taste, appetite and ability to access and prepare foods, with associated financial impacts. Therefore, the practice of nutrition and dietetics must integrate and apply the sciences of food, nutrition, biology, physiology, behaviour, management, communication and society to achieve and maintain human health. Thus, there is huge complexity in delivering evidence-based nutrition interventions to individuals. This paper examines available frameworks for appraising the quality and certainty of nutrition research evidence, the development nutrition practice guidelines to support evidence implementation in practice and the influence of other sources of nutrition information and misinformation. The paper also considers major challenges in applying research evidence to an individual and suggests consensus recommendations to begin to address these challenges in the future. Our recommendations target three groups; those who deliver nutrition interventions to individuals, those funding, commissioning or undertaking research aimed at delivering evidence-based nutrition practice, and those disseminating nutritional information to individuals.

Pragmatic patchwork ethnography, a call to action for health, nutrition and dietetic researchers

Qualitative research methods are increasingly used in nutrition and dietetics research. Ethnography is an underexploited approach which seeks to explore the diversity of people and cultures in a given setting, providing a better understanding of the influences that determine their choices and behaviours. It is argued that traditional ethnography, that is, the methodology of living within participant communities, is a dated practice, with roots in colonialism, accessible to only researchers with the means, connections and status to conduct such research, typically white, privileged males. This paper proposes a formal interpretation of 'patchwork ethnography', whereby research is carried out in situ around existing modern-day commitments of the researcher, thus enabling more researchers within health, nutrition and dietetic practice to benefit from the rich data that can be discovered from communities. This review proposes the concept that pragmatic patchwork ethnography is required, proposing a framework for implementation, providing researchers, particularly within the fields of human nutrition, dietetics and health, the accessibility and means to deploy a meaningful client-centric methodology. We present pragmatic patchwork ethnography as a modern method for use within multiple healthcare settings, thus adding a progressive brick in the wall of qualitative research.

Living and Coping with Olfactory and Taste Disorders: A Qualitative Study of People with Long-COVID-19

Taste and smell disorders are common symptoms of SARS-CoV-2 acute infection. In post-COVID-19 condition, symptoms can persist leading to disruption in patients' lives, to changes in their coping skills, and to the need to develop strategies for everyday life. This study aimed to describe the perspective of a group of patients with Long-COVID-19, a condition where loss of taste and/or smell was the most predominant symptom. A qualitative descriptive study was conducted. Participants who had suffered SARS-CoV-2 infection and had Long-COVID-19 loss of taste and/or smell were recruited. Purposive sampling was applied, and participants were recruited until data redundancy was reached. In-depth interviews were used for data collection and thematic analysis was applied. Twelve COVID-19 survivors (75% women) were recruited. The mean age of the participants was 55 years, and the mean duration of post-COVID-19 symptoms was 25 months. Three themes were identified: (a) Living with taste and smell disorders, describing the disorders they experience on a daily basis, how their life has changed and the accompanying emotions, (b) Changes and challenges resulting from the loss of taste and smell, changes in habits, self-care and risk in certain jobs or daily activities, (c) Coping with taste and smell disorders, describing the daily strategies used and the health care received. In conclusion, Long-COVID-19 taste and/or smell disorders limit daily life and involve changes in habits, meal preparation, and the ability to detect potentially dangerous situations.

Nutrition intervention goals from the perspectives of patients at risk of malnutrition: A qualitative study

BACKGROUND

Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self-management. Little is known about goal-setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions.

METHODS

Semi-structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid-Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six-phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data.

RESULTS

The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight.

CONCLUSIONS

The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal-setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person-centred nutrition care, new strategies and tools are needed to facilitate collaborative goal-setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes.

'Good, honest food': older adults' and healthcare professionals' perspectives of dietary influences and food preferences in older age in Ireland

BACKGROUND

This study aimed to explore older adults' and healthcare professionals' (HCPs) perceptions of dietary influences and food preferences in older age.

METHODS

The research design was phenomenological qualitative description. Semistructured one-to-one interviews and focus groups were held separately with community-dwelling older adults and HCPs involved in care of the older person in Ireland. Data were analysed using inductive thematic analysis.

RESULTS

A total of 47 adults aged 55+ years were recruited (50% male; 49% aged 60-69 years; 28% aged above 70 years), and 26 HCPs were involved, comprising dietitians (n = 8); geriatricians (n = 6); clinical therapists (n = 4); and nurses, pharmacists, catering managers and meal delivery service coordinators (n = 2 each). There are strong desires for 'good, honest food' within the diet for an older person; however, gaps in current nutrition priorities, dietary guidance and health promotion were perceived. There were differences in the perspectives held by HCPs and adults aged 55+ years, as some HCPs centred their discussion around nutrition for preventing sarcopenia, frailty or cognitive decline, whereas many adults aged 55+ years desired foods which promote cardiometabolic health and reflect wider personal health and environmental values. Other themes included the impact of health and lifestyle changes accompanying ageing on dietary priorities, the importance of personal and psychosocial values in determining food choice and the impact of the external food environment on accessibility and shopping experiences.

CONCLUSIONS

Influences on dietary choice for the older person are multifactorial, driven by a range of health, psychological, sociocultural and environmental perspectives. Future nutrition priorities for older adults should encourage health-promoting approaches and not just disease-mitigating efforts.

Social supermarkets, nutritional implications and healthy eating: exploration of members and their views

BACKGROUND

The Covid-19 pandemic has increased the need for food support but simultaneously enabled substantial innovation in food support provision, including the evolution of social supermarkets (SSM). These allow consumers to choose from a range of low-cost products, minimise stigma and reduce food waste. Data from members of two Sussex SSM were gathered for their perspectives and experiences, as well as potential nutritional implications of the SSM.

METHODS

Questionnaires administered face-to-face during site visits and optional telephone interviews were used. Data were collected during three site visits; 111 participants completed questionnaires, and an additional 25 detailed interviews with members of the SSM were completed. All data were gathered between December 2021 and May 2022.

RESULTS

Overall, the SSMs were valued by their members. Social, economic and nutritional benefits were identified. SSM increased consumer choice and reduced stigma. Most members visited regularly, using SSM to supplement other food purchases. They valued the opportunity to choose their own foods and opportunities to socialise, in addition to the range of food and household items offered. The majority agreed that healthy eating was important but time and cost were barriers especially for younger members. SSM introduced members to novel foods and dishes, potentially diversifying dietary intakes. Challenges included restrictions on the amounts of food available, depending on the timing of visits. This was a greater challenge for those more reliant on SSM for household needs.

CONCLUSIONS

SSM represent an innovative and less stigmatising model of food support. Greater variety of food offered suggests their potential to diversify and improve dietary intakes. Challenges include ensuring stability of food supply and reducing stigma further.

Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children

BACKGROUND

Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods.

METHODS

Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach.

RESULTS

Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention.

CONCLUSIONS

The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

A framework for selecting data generation strategies in qualitative health research studies

BACKGROUND

Qualitative health research has the potential to answer important applied health research questions to inform nutrition and dietetics practice, education and policy. Qualitative health research is a distinct subdiscipline of qualitative inquiry that purposefully draws upon the context of healthcare and emphasises health and wellness.

METHODS

Qualitative health research is defined by two parameters: (1) the focus of the study and (2) the methods used. When considering the methods to be used, decisions are required about the type of data to be generated (e.g., transcripts, images and notes) and the process involved in data generation (e.g., interviews, elicitation strategies and observations) to answer the research question(s). Drawing upon examples from nutrition and dietetics literature, this paper provides a framework to support decision-making for nutrition and dietetics researchers and clinician researchers designing conducting qualitative health research.

RESULTS

The guiding questions of the framework include: What types of data will be generated? Who is involved in data generation? Where will data generation occur? When will data generation occur? How will data be recorded and managed? and How will participants' and researchers' emotional safety be promoted?

CONCLUSION

Questions about the types of data, those involved, where and when, as well as how safety can be maintained in data generation, not only support a more robust design and description of data generation methods but also keep the person at the centre of the research.

Barriers and Facilitators to Adherence to a Mediterranean Diet Intervention during Chemotherapy Treatment: A Qualitative Analysis

Patients undergoing chemotherapy are at risk for malnutrition and a high symptom burden, and nutritional interventions can address clinical and supportive care outcomes. Herein, we identified barriers and facilitators to adhering to a Mediterranean Diet (MedDiet) intervention during chemotherapy. Patients with cancer (any type) who were undergoing chemotherapy were enrolled into a clinical trial testing the effects of an 8-week MedDiet intervention on cancer-related fatigue. Participants were randomized 2:1, MedDiet:control. The intervention entailed food provision, education, a cookbook, a session with a nutritionist, and weekly check-ins. Post-intervention, all participants completed semi-structured exit interviews. The interviews were transcribed and open coding was conducted to describe the facilitators and barriers to MedDiet adherence. Participants (n = 29, n = 21 in the intervention group) were 51.0 ± 15.1 years old and 93.1% had breast cancer. Educational materials and convenient food delivery were the highest reported facilitators. Many patients offered that changing their diet gave a sense of control and empowerment. Barriers to adherence were that the frozen food was unappetizing, participants' (or their spouse/children's) food preferences did not align with the MedDiet, and chemotherapy-induced side effects that prevented food consumption (eg, mouth sores, lack of appetite). This project helps understand the patient experience within nutritional interventions to optimize dietary programs during chemotherapy treatment.

Older adults and healthcare professionals have limited awareness of the link between the Mediterranean diet and the gut microbiome for healthy aging

Objectives

Strategies to improve the gut microbiome through consuming an improved diet, including adopting the Mediterranean Diet (MD), may promote healthy aging. We explored older adults' and healthcare professionals' (HCPs) perspectives of the MD, gut health, and microbiome for their role in healthy aging.

Design

Phenomenological qualitative.

Setting

Community-dwelling older adults and HCPs in primary and secondary care in Ireland.

Participants

Older adults (aged 55 + years), recruited through social, retirement and disease-support groups. HCPs recruited through researcher networks and professional associations.

Measurements

Semi-structured 1:1 interviews and focus groups (FGs) conducted remotely with older adults and HCPs separately. Interviews/FGs were recorded, transcribed, and coded using inductive thematic analysis.

Results

Forty-seven older adults were recruited (50% male; 49% aged 60-69 years; 28% 70 +), and 26 HCPs including dietitians (n = 8); geriatricians (n = 6); clinical therapists (n = 4); nurses, pharmacists, catering managers, and meal-delivery service coordinators (n = 2 each). Older adults considered the MD "a nice way to enjoy food," good for cardiovascular health and longevity, but with accessibility and acceptability challenges (increased salads/fish, different food environments, socio-cultural differences). HCPs felt the MD is included in healthy eating advice, but not overtly, mostly through the promotion of mixed-fiber intake. Older adults considered "live" yogurt and probiotics, and to a lesser extent fiber, to maintain a "healthy gut," suggesting the gut has "something to do with" cognitive and digestive health. Overall, microbiota-health effects were considered "not common knowledge" among most older adults, but becoming more topical among both professionals and the public with advancing scientific communication.

Conclusion

While "gut health" was considered important, specific effects of the MD on gut microbiota, and the significance of this for healthy aging, was under-recognized. Future efforts should explain the importance to older adults of maintaining the gut microbiota through diet, while appreciating perspectives of probiotic products and supplements.

Investigating 'treat culture' in a secure care service: a study of inpatient NHS staff on their views and opinions on weight gain and treat giving for patients in a forensic secure care service

BACKGROUND

Obesity is a significant health inequality within forensic secure care mental health/learning disability inpatient settings. Patients may be at increased risk of developing preventable long-term conditions/premature death. This study investigated staff views on patient weight gain, how it affects patients and how to better manage patient weight in this setting. Furthermore, the research explored the culture of food being used as a 'treat' and the perceived impact of 'treats' on weight.

METHODS

A two-phase mixed methods approach was taken to explore staff views on patient weight gain and the 'treat' culture on adult forensic secure care inpatient wards in one NHS Mental Health Trust in the north-east of England. Phase one was an online survey, and phase two consisted of semi-structured qualitative interviews. The quantitative survey data were analysed using descriptive statistics. Thematic analysis was used for the open-ended survey questions and interview data.

RESULTS

The survey had 49 responses out of a possible 380 (13%). Ninety-two per cent of staff participants viewed patient weight gain as an area for concern, citing a range of reasons for weight gain. Weight gain was considered a risk to developing long-term health conditions and poor mental health. Nine participants were interviewed. Six themes were identified suggesting why patients might gain weight in forensic secure care, for example, patient history, staff behaviours, the surrounding 'treat' culture in this environment, along with suggestions of what could be improved to manage patient weight.

CONCLUSIONS

People detained in forensic secure care may be more at risk of weight gain due to their history, the secure care environment and the 'treat' culture adopted in these environments.

Factors influencing implementation of food and food-related waste audits in hospital foodservices

BACKGROUND

Designing a food waste audit tool for novel hospital foodservice practice does not guarantee uptake. Intended users must be consulted to understand the tool's feasibility and face validity. This study aimed to identify the perspectives of staff involved in the operation of hospital foodservices on (1) how an evidenced based consensus pathway food waste audit tool is perceived to translate into practice, and (2) to determine the factors that influence the completion of food and food-related waste audits within this setting.

MATERIALS AND METHODS

Purposeful sampling was used to recruit staff with knowledge on the operation/governance of foodservices within hospitals in Victoria, Australia. Semi-structured interviews (n = 20) were conducted via Zoom to explore barriers and enablers to completing food and food-related waste audits and a previously published food waste audit tool. NVivo was used for inductive thematic analysis.

RESULTS

Three factors determined the completion of food and food-related waste audits in hospital foodservices, and each factor could be a barrier or an enabler; (1) capacity: the availability of time, labour and materials to complete an audit (2) change: staff resistance to audit procedures and how to gain their buy-in (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present. The consensus tool appeared to have face validity. Planning audit operations, conducting stakeholder meetings, providing education/training to foodservice team members, and facilitating communication between managers and staff were described to support consensus tool use and audit completion.

CONCLUSION

The consensus tool can be used to support hospital foodservices to complete food and food-related waste audits, although it may need to be customised to be fit for purpose. Optimising the capacity, change management and processes, governance and leadership of the foodservice department may improve the experience and success of a food and food-related waste audit.