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Curtis AR, Kiss N, Livingstone KM, Daly RM, Ugalde A. Exploring dietitians' practice and perspectives on the role of dietary patterns during cancer treatment: A qualitative study. PLoS One 2024; 19:e0302107. [PMID: 38743744 PMCID: PMC11093385 DOI: 10.1371/journal.pone.0302107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Dietitians are nutrition professionals equipped with specialised skills required to prevent and treat malnutrition in cancer. Optimisation of dietary intake is recommended as the primary nutrition strategy for the treatment of cancer-related malnutrition. However, it is unclear whether dietary patterns, described as the combination, quantity, and frequency of food consumption, are considered. This study examined dietitians' current food-based management of malnutrition; explored dietitians' awareness of dietary patterns and assessed barriers and enablers to the use of dietary patterns in clinical practice. METHODS This qualitative study consisted of semi-structured interviews with oncology dietitians. Dietitians were recruited through national nutrition societies, social media, and professional networks. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. RESULTS Fourteen oncology dietitians from across four Australian states and territories participated. Three themes were identified: (i) principles to guide nutritional care, (ii) dietary patterns as a gap in knowledge and practice, and (iii) opportunities for better care with systems as both a barrier and enabler. Dietetic practice was food-focussed, encouraging energy and protein-rich foods consistent with nutrient-focussed evidence-based guidelines. Dietitians encouraged one of two nutrition-related approaches, either encouraging intake of 'any tolerated food' or 'foods supportive on longer-term health'. Dietitians were generally unaware of dietary patterns and questioned their relevance in certain clinical situations. A multidisciplinary team approach, adequate food service and dissemination of dietary patterns research and education were identified as opportunities for better patient care. CONCLUSIONS Recommendations for the treatment of malnutrition vary between oncology dietitians and uncertainty exists regarding dietary patterns and their relevance in clinical practice. Further exploration into the role of dietary patterns to treat cancer-related malnutrition and education for dietitians are required prior to implementation of a dietary patterns approach into clinical practice.
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Affiliation(s)
- Annie R. Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Robin M. Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
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Pye C, Parr EB, Flint SA, Devlin BL. Exploring Australian Dietitians' knowledge, experience and perspectives of time-restricted eating in private practice: A qualitative study. Clin Obes 2024:e12671. [PMID: 38661018 DOI: 10.1111/cob.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
Time-restricted eating is a novel nutrition intervention with evidence of beneficial effects on weight loss, blood glucose management, and other metabolic health outcomes. Adherence to time-restricted eating is higher than some traditional nutrition interventions to support individuals living with overweight/obesity and type 2 diabetes mellitus. However, there may be an evidence-practice gap of time-restricted eating in Australian dietetic practice. The present study aimed to explore dietitians' knowledge, experiences, and perspectives of time-restricted eating and timing of eating advice in practice. Semi-structured interviews with 10 private practice dietitians across Australia were conducted. Audio recordings were transcribed and analysed thematically. Six themes were identified: (i) distinction of time-restricted eating to other fasting protocols; (ii) knowledge of health benefits of time-restricted eating; (iii) patient-led advice frequently given: timing of breakfast and dinner; (iv) dietitian-led advice frequently given: eating cut-off time to avoid late night snacking; (v) barriers and facilitators to offering time-restricted eating or timing of eating advice; (vi) timing of eating advice within professional guidelines and resources. These findings suggest the need for development of professional resources and educational development tools for dietitians on time-restricted eating.
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Affiliation(s)
- Caitlin Pye
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Evelyn B Parr
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Steve A Flint
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Brooke L Devlin
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Soguel L, Lapointe A, Burnand B, Desroches S. Descriptive and Content Analysis of Questionnaires Used to Assess Evidence-Based Practice Among Dietitians: A Systematic Review. J Acad Nutr Diet 2024; 124:80-101. [PMID: 37673334 DOI: 10.1016/j.jand.2023.08.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence-based practice (EBP) is described as the integration of the following 3 main dimensions in health professionals' decision making: best currently available research evidence, professional expertise, and patient's values and circumstances. Barriers to EBP at an individual level have been assessed using questionnaires. Knowing which EBP dimensions are actually explored in these questionnaires is essential to promote EBP and its adoption. OBJECTIVE The aim of this review was to identify and describe questionnaires that have been used among dietitians to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP, and to perform a content analysis of these, drawn on the EBP dimensions explored. METHODS Questionnaires were identified through a systematic review in MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (last search was November 2022). Eligibility criteria were studies using, evaluating, or developing questionnaires meant to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP among dietitians. The content analysis was conducted to identify the EBP dimensions explored (ie, research evidence, professional expertise, and/or patient's values and circumstances). Questionnaire items were categorized as follows: 1 sole EBP dimension, a combination of dimensions, or no identifiable dimension. RESULTS Thirty reports (25 studies) were included. The analysis of the 847 items extracted from the 25 questionnaires used showed that the main EBP dimension explored was the integration of research evidence into decision making, found in 75% of items, solely or in combination with another dimension. Professional expertise was explored in 18% of the items, patient's values and circumstances were found in 3%, and the combination of these 3 dimensions was found in <1%. CONCLUSIONS The important imbalance of explored EBP dimensions in the questionnaires used may lead to a partial and misleading evaluation that prevents efficient strategies to foster EBP. There is an important need to develop more integrative and accurate evaluations of EBP targeting dietitians to promote and develop high-quality dietetics practice.
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Affiliation(s)
- Ludivine Soguel
- School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada; Nutrition and Dietetics Department, Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland HES-SO, Geneva, Switzerland.
| | - Annie Lapointe
- Centre Nutrition, Santé et Société, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Unisanté and University of Lausanne, Lausanne, Switzerland
| | - Sophie Desroches
- School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada; Centre Nutrition, Santé et Société, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
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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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Itsiopoulos C, Mayr HL, Thomas CJ. The anti-inflammatory effects of a Mediterranean diet: a review. Curr Opin Clin Nutr Metab Care 2022; 25:415-422. [PMID: 36039924 DOI: 10.1097/mco.0000000000000872] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide and the majority are preventable with a healthy diet and lifestyle, but controversy remains as to the best approach. Greater adherence to a traditional Mediterranean diet has consistently been associated with lower morbidity and mortality from cardiovascular disease, diabetes and many cancers, and lower all-cause mortality. Despite the well known benefits on chronic disease risk there remains some scepticism as to the effects of this dietary pattern across populations outside the Mediterranean and the mechanisms of action of this traditional plant-based dietary pattern.This narrative review aims to summarize the latest evidence on the health protective effects of a traditional Mediterranean diet on chronic noncommunicable diseases, specifically focussing on the anti-inflammatory effects of this highly published dietary pattern. RECENT FINDINGS Recent high-quality evidence now supports a Mediterranean diet in secondary prevention of cardiovascular disease with impacts on atherosclerosis progression, likely through reduction of systemic inflammation and irrespective of changes in cholesterol or weight. The Mediterranean diet has a low Dietary Inflammatory Index illustrating its anti-inflammatory potential. This dietary pattern beneficially modulates the gut microbiota and immune system, including emerging evidence for efficacy against severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019). Emerging evidence shows clinicians are not routinely recommending a Mediterranean diet despite well known evidence due to barriers such as lack of training, patient materials and concerns about potential patient adherence. SUMMARY The physiological mechanisms of action of this healthy diet pattern are becoming better understood to be multisystem and involving the gut. Larger controlled trials investigating mechanistic effects in broader non-Mediterranean populations are warranted. Although reflected in therapeutic guidelines for chronic disease management worldwide there are individual, clinical practice and health system barriers to its implementation that need a multisectoral approach to address.
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Affiliation(s)
| | - Hannah L Mayr
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba
- Greater Brisbane Clinical School, Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Colleen J Thomas
- Department of Physiology, Anatomy and Microbiology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora
- Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora
- Florey Institute of Neuroscience and Mental Health, Pre-Clinical Critical Care Unit, University of Melbourne, Melbourne, Victoria, Australia
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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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Papamichou D, Panagiotakos DB, Holmes E, Koutsakis P, Katsoulotos H, Loo RL, Itsiopoulos C. The rationale and design of a Mediterranean diet accompanied by time restricted feeding to optimise the management of type 2 diabetes: The MedDietFast randomised controlled trial. Nutr Metab Cardiovasc Dis 2022; 32:220-230. [PMID: 34836715 DOI: 10.1016/j.numecd.2021.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Substantial scientific evidence supports the effectiveness of a Mediterranean diet (MedDiet) in managing type 2 diabetes mellitus (T2DM). Potential benefits of time restricted feeding (TRF) in T2DM are unknown. The MedDietFast trial aims to investigate the efficacy of a MedDiet with or without TRF compared to standard care diet in managing T2DM. METHODS AND RESULTS 120 adults aged 20-75 with a body mass index (BMI) of 20-35 kg/m2 and T2DM will be randomised in a 3-arm parallel design to follow an ad libitum MedDiet with or without 12-h TRF or the standard Australian Dietary Guidelines (ADG) for 24 weeks. All groups will receive dietary counselling fortnightly for 12 weeks and monthly thereafter. The primary outcome is changes in HbA1c from baseline to 12 and 24 weeks. Secondary outcomes include fasting blood glucose, insulin, blood lipids, weight loss, insulin resistance index (HOMA), Glucagon-like peptide 1 (GLP-1) and high-sensitivity C- reactive protein (hs-CRP). Data on medical history, anthropometry, wellbeing, MedDiet adherence and satiety will be measured at a private clinic via self-report questionnaires at baseline, 6, 12 and 24 weeks. Additionally, specimens (blood, urine and stool) will be collected at all time points for future omics analysis. CONCLUSION The MedDietFast trial will examine the feasibility and effectiveness of a MedDiet with/without TRF in T2DM patients. Potential synergistic effects of a MedDiet with TRF will be evaluated. Future studies will generate microbiomic and metabolomic data for translation of findings into simple and effective management plans for T2DM patients. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12619000246189.
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Affiliation(s)
- Dimitra Papamichou
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia
| | - Elaine Holmes
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA 6150, Australia; Centre for Computational Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA6150, Australia
| | - Polychronis Koutsakis
- Discipline of Information Technology, Media and Communications, Murdoch University, NSW, 2217, Australia
| | | | - Ruey L Loo
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA 6150, Australia; Centre for Computational Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA6150, Australia
| | - Catherine Itsiopoulos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia.
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McLaren-Hedwards T, Hickman IJ, Campbell KL, Macdonald GA, Mayr HL. A Qualitative Study of Clinician Barriers and Enablers to Implementing the Mediterranean Dietary Pattern with Kidney and Liver Transplant Recipients. Prog Transplant 2021; 31:337-344. [PMID: 34726088 DOI: 10.1177/15269248211046001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Solid organ transplant recipients experience greater cardiometabolic risk than the general population. Following a Mediterranean dietary pattern has been shown to reduce cardiometabolic risk. This study aimed to assess multidisciplinary clinician perspectives of routine nutrition care for kidney and liver transplant recipients and barriers and enablers to implementation of the Mediterranean dietary pattern. METHODS Semi-structured individual interviews were conducted with clinicians in a metropolitan health service at tertiary/quaternary transplant centres involved in longer-term management of kidney and liver transplants recipients. Audio-recorded interviews were transcribed verbatim and analysed using thematic content analysis. FINDINGS Nineteen clinicians (9 medical officers, 5 dietitians, 3 nurses and 2 other allied health professionals) were interviewed. Four themes with 11 subthemes were identified: the Mediterranean dietary pattern is not part of routine care (there are competing clinical priorities; healthy eating principles aligned with but not the full dietary pattern are recommended); variation in knowledge and acceptance of this dietary approach (variances in information sources and degree of knowledge of Mediterranean dietary pattern clinical evidence); nutrition advice is influenced by service delivery and culture (there is lack of consistent nutrition advice; limited consultation time; and reliance on existing patient education resources); and patient-centred care influences decisions on nutrition advice (clinicians do not know how to recommend this dietary pattern in a patient-centred manner). DISCUSSION The Mediterranean dietary pattern is not considered part of routine post-transplant nutrition care. To be implemented in these services intervention strategies which address the identified barriers and potential enablers need to be considered.
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Affiliation(s)
- Taya McLaren-Hedwards
- School of Human Movement and Nutrition Sciences, 1974the University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, 1966Princess Alexandra Hospital, Brisbane, Australia.,420004Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Katrina L Campbell
- Department of Nutrition and Dietetics, 1966Princess Alexandra Hospital, Brisbane, Australia.,420004Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Graeme A Macdonald
- 420004Faculty of Medicine, the University of Queensland, Brisbane, Australia.,Department of Gastroenterology and Hepatology, 1966Princess Alexandra Hospital, Brisbane, Australia
| | - Hannah L Mayr
- Department of Nutrition and Dietetics, 1966Princess Alexandra Hospital, Brisbane, Australia.,420004Faculty of Medicine, the University of Queensland, Brisbane, Australia
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Moutou KE, England C, Gutteridge C, Toumpakari Z, McArdle PD, Papadaki A. Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study. J Hum Nutr Diet 2021; 35:179-190. [PMID: 34370332 DOI: 10.1111/jhn.12939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines. METHODS Semi-structured interviews were conducted with 12 UK-registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis. RESULTS Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low-carbohydrate, low-fat, low-glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient-centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence. CONCLUSIONS The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.
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Affiliation(s)
- Konstantina E Moutou
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Callum Gutteridge
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Zoi Toumpakari
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Paul D McArdle
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Angeliki Papadaki
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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'Focus on diet quality': a qualitative study of clinicians' perspectives of use of the Mediterranean dietary pattern for non-alcoholic fatty liver disease. Br J Nutr 2021; 128:1220-1230. [PMID: 33766176 DOI: 10.1017/s0007114521001100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Practice guidelines for non-alcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians' perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multi-ethnic setting. Semi-structured individual interviews were conducted with fourteen clinicians (seven doctors, three nurses, three dietitians and one exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinicians described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone's role, whereby doctors and nurses raise awareness and dietitians provide individualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss; in-depth knowledge of the dietary pattern; access to patient education and monitoring resources and; service culture, including an interdisciplinary clinic goal, and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from diverse cultural and socio-economic backgrounds and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.
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Understanding the Self-Perceived Barriers and Enablers toward Adopting a Mediterranean Diet in Australia: An Application of the Theory of Planned Behaviour Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249321. [PMID: 33322111 PMCID: PMC7764290 DOI: 10.3390/ijerph17249321] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
The transferability of a Mediterranean diet (MedDiet) in non-Mediterranean populations is appealing. However, little is known about the perceived enablers or barriers toward adherence, particularly in Australia. This study aimed to investigate the perceived beliefs, barriers, and enablers toward adherence to a MedDiet in Australian adults. Barriers and enablers were assessed using a self-administered online questionnaire, which included questions aligned with the Theory of Planned Behaviour (TPB). The survey was completed by n = 606 participants. Barriers and enablers toward adherence to MedDiet were grouped under the three core constructs of the TPB: attitudes (suitability, taste, restrictive, food waste); social norms (food culture); and perceived behavioural control (PBC) (motivation, affordability, time/effort, food access, knowledge, food outlets, natural conditions, cooking skills). PBC emerged as the most prominent construct influencing intention to follow a MedDiet. Perceived health benefits (n = 445; 76.5%) and improved diet quality (n = 224; 38.5%) were identified as major advantages. In contrast, dietary adherence (n = 147; 39.7%) was perceived as an important disadvantage. Future MedDiet interventions, in both research and clinical settings, should consider adopting strategies aimed at improving self-efficacy to reduce self-perceived barriers and facilitate dietary adherence.
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