Computerised dietary assessment interviews: Health professionals and patients' opinions about web communications

Aim: To describe the acceptance of DietAdvice, an automated dietary assessment website, by its stakeholders. Methods: One‐month evaluation study using audio‐recorded telephone interviews with 10 patients who had used DietAdvice, 10 dietitians, 10 general practitioners who recruited many patients and 10 general practitioners who recruited few or no patients to the website to obtain their beliefs and opinions about DietAdvice, health, nutrition and technology. Interviews were transcribed verbatim and analysed for categorical themes using NVivo software. Results: Patients were concerned about Internet difficulties and had a preference for face‐to‐face interviews and dietitians felt that DietAdvice could save time prior to dietary education and counselling. Recruiting general practitioners believed that patient computer literacy was a limitation, although increased availability of dietary services created by DietAdvice. Non‐recruiting general practitioners felt that they had a lack of time available to recruit patients, patient computer literacy was limited and there was a need for face‐to‐face contact. Conclusion: The perspectives of patients and health‐care providers show variation based on their experience with DietAdvice, their focus on nutrition and their role in the health‐care system. Automated technologies are likely to play a significant part in the future of dietetics.     

Developing a tool for health professionals involved in producing and evaluating nutrition education leaflets

Introduction Nutrition education leaflets are widely used by dietitians and many dietitians are also involved in their production. However, there does not appear to be a suitable tool to assist health professionals to produce or evaluate nutrition education leaflets. There are Guidelines available that are either specifically concerned with nutrition but for all educational materials or specifically for use with leaflets, but not necessarily to do with nutrition. The aim of this study was to develop a tool suitable to assist health professionals when producing and evaluating nutrition education leaflets.
Methods Patients and dietitians were surveyed by self-completion questionnaire to determine their opinions of the importance of various criteria which might be applied to nutrition education leaflets were.
Results The research revealed significant differences in the opinions of dietitians and patients for seven of 11 criteria.
Conclusion The evaluation tool developed was based on the patients' ranking of all the criteria. Its reliability was assessed amongst a group of dietitians in Dorset but its wider use and acceptability should be looked at. The tool is likely to be appropriate as a checklist for health professionals producing new nutrition education leaflets or as a framework for evaluating existing nutrition education leaflets.     

Care Coordination to Enhance Management of Long‐Term Enteral Tube Feeding

Background: A systematic review and meta‐analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long‐term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods. Methods: We conducted a broad search of 7 databases from inception to May 2012, cross‐referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality. Results: Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta‐analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27–1.05), infections (IRR, 0.77; 95% CI, 0.48–1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13–1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: ?623.08; 95% CI, ?745.64 to ?500.53; P < .01) after the interventions. Conclusion: Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long‐term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.     

Current dietetic practices of obesity management in Saudi Arabia and comparison with Australian practices and best practice criteria

Aim:  To describe the dietetic practices of the treatment of obesity in Saudi Arabia and compare this with best practice criteria and the practice in Australia.
Methods:  Anonymous questionnaires were completed by dietitians in Saudi Arabia. The topics included barriers to obesity management, demand and level of service and strategies and approaches used for weight management. Best practice scores were based on those used to assess Australian dietitians.
Results:  A total of 253 dietitians participated in the survey. Of these, 175 (69%) were involved in the management of obesity. The best practice score for Australian dietitians was slightly greater than the scores of Saudi dietitians (median 43 vs 39). There was also a significant correlation between the best practice score and years of experience (r = 0.26, P < 0.001). The most common assessment approaches were assessment of body mass index (87%) and exercise habits (81%), while the most common strategies for obesity management were: dietary total fat reduction (92%) and increase incidental daily activity (92%). The major barrier for establishment of a weight management clinic reported by 49% of participants was inadequate resources.
Conclusion:  Saudi Arabian dietetic practice for the management of obesity does incorporate most best practice recommendations, but some specific elements are rarely used.     

Framing a set of non-academic selection criteria for occupational therapy students: An Australian study

Background/Aim: Demand for places in occupational therapy programs at Australian universities may place undue emphasis on academic attainment when selecting students … but how else might students be selected? This study investigated those attributes judged by occupational therapy practitioners to be most important. Methods: From a focus group of occupational therapy academics, a list of occupational therapy practice attributes was generated and used to develop a questionnaire completed by 175 Australian occupational therapy practitioners. Results: The most highly rated abilities were communication and problem‐solving skills; the most highly rated qualities were respecting others, self‐responsibility and ethical orientation. Conclusions: This research has identified abilities and personal qualities that could be added to current selection criteria to assist in identifying suitable candidates for entry into occupational therapy education.     

Dietetic care of hip fracture patients across Australia: Are we doing enough?

Aim: To determine the composition of usual nutrition care provided by Australian dietitians to patients with a falls related femoral neck fracture. Methods: A cross‐sectional survey administered via the World Wide Web using SurveyMonkey to dietitians across Australia. Results: One hundred and sixty‐eight dietitians working with patients with a femoral neck fracture in Australia responded to the survey. Few dietitians (n = 7) indicated they worked in the community setting. Nutritional screening was used among respondents (n = 93), but 32/93 indicated they did not use a validated tool. Most commonly used interventions included strategies to increase intake of nutrients, such as provision of nourishing meals, snacks and oral supplements. Conclusions: Some concerns remain regarding provision of optimal nutritional care of femoral neck fracture patients in Australia. There were few respondents working in the community with falls related femoral neck fracture patients, with a greater number of dietitians working in the metropolitan area responding to the survey. The Dietitians working in this area are implementing a great variety of screening methods, with a large number using non‐validated screening tools. Clearer guidelines for health professionals involved in femoral neck fracture aftercare would be beneficial to standardise care in this area. A useful first step for dietitians would be to advocate for the use of evidence‐based practice resources in selection of site and age appropriate nutrition screening tools.     

Cost evaluation of providing evidence‐based dietetic services for weight management in adults: In‐person versus eHealth delivery

Aim

To compare the theoretical costs of best‐practice weight management delivered by dietitians in a traditional, in‐person setting compared to remote consultations delivered using eHealth technologies.

Methods

Using national guidelines, a framework was developed outlining dietitian‐delivered weight management for in‐person and eHealth delivery modes. This framework mapped one‐on‐one patient–dietitian consultations for an adult requiring active management (BMI ≥ 30 kg/m²) over a one‐year period using both delivery modes. Resources required for both the dietitian and patient to implement each treatment mode were identified, with costs attributed for material, fixed, travel and personnel components. The resource costs were categorised as either establishment or recurring costs associated with the treatment of one patient.

Results

Establishment costs were higher for eHealth compared to in‐person costs ($1394.21 vs $90.05). Excluding establishment costs, the total (combined dietitian and patient) cost for one patient receiving best‐practice weight management for 12 months was $560.59 for in‐person delivery, compared to $389.78 for eHealth delivery. Compared to the eHealth mode, a higher proportion of the overall recurring delivery costs was attributed to the patient for the in‐person mode (46.4% and 33.9%, respectively).

Conclusions

Although it is initially more expensive to establish an eHealth service mode, the overall reoccurring costs per patient for delivery of best‐practice weight management were lower compared to the in‐person mode. This theoretical cost evaluation establishes preliminary evidence to support alternative obesity management service models using eHealth technologies. Further research is required to determine the feasibility, efficacy and cost‐effectiveness of these models within dietetic practice.     

Dietitians and naturopaths require evidence-based nutrition information on organic food

A pilot survey was undertaken to identify dietitians’ and naturopaths’ attitudes to and advice about organic foods, and to ascertain whether nutrition education is required. A questionnaire, which was not validated, was mailed to 240 randomly selected private practice dietitians and naturopaths in Australia. The responses were analysed by chi‐squared and independent two‐samples t‐test. Each group had a response rate of 50%. More dietitians (n = 52) than naturopaths (n = 18) (P < 0.01) indicated a lack of difference in protein (88% vs 30%), fat (83% vs 33% where n = 49 dietitians and 20 naturopaths) and carbohydrate (85% vs 38%, n = 50 dietitians and 23 naturopaths) between organic and conventional foods. Significantly more naturopaths (P < 0.01) than dietitians indicated that organic foods contained more vitamins (85% vs 32%, n = 51 naturopaths and 19 dietitians), minerals (82% vs 25%, n = 49 naturopaths and 15 dietitians) and phytochemicals (72% vs 32%, n = 43 naturopaths and 19 dietitians) compared with conventionally produced foods. The majority of naturopaths indicated that organic foods have a favourable effect on health (97%, n = 58) and differ in taste (82%, n = 49). Dietitians were less certain with n = 21 thinking there is an effect on health and n = 15 indicating that there is a difference in taste (P < 0.01). More naturopaths (77%, n = 46) than dietitians (31%, n = 18) indicated that they have sufficient knowledge of organic food. Naturopaths discuss the topic of organic food with their clients ‘sometimes’ (55%, n = 33) or ‘always’ (32%, n = 19) whereas the majority of dietitians ‘seldom’ (51%, n = 30) or ‘never’ (7%, n = 4) do so. Naturopaths recommend organic foods more often than dietitians (P < 0.001). The survey results suggest that evidence‐based educational programs would be useful for both groups of health professionals.     

How do dietitians treat symptoms of gastro-oesophageal reflux disease in adults?

Aim: The aim of the present study was to examine dietitians' use of lifestyle measures in the management of symptoms of gastro-oesophageal reflux disease (reflux). Methods: Questionnaire data were collected by mail from dietitians on the 2001 register of Australian Accredited Practicing Dietitians (dietitians) via the Dietitians Association of Australia mailing system. Bivariate statistical tests were used to assess relationships. Results: The response rate was 65.8% (n = 798) with 699 working in positions where they consulted patients. Of those, 56.7% did not usually see patients who presented specifically for reflux, while 30.6% saw 1–2 such patients and 12.4% saw ≥3 such patients/month. Many dietitians who conducted patient consultations saw ≥1 per month who mentioned reflux during a consultation for another condition, with 24.3% seeing >5/month. These dietitians made the following lifestyle recommendations to reduce reflux symptoms: reduce weight if overweight (92.87%), avoid eating before lying down (94.8%), elevate the head of the bed (78.6%), avoid alcohol (73.7%), avoid spicy food (77.3%) and eat a diet low in fat (79.7%). Additionally, 60.5% made further recommendations ranging from avoiding large meals, caffeine, smoking, carbonated beverages and known precipitants, to increasing protein intake and considering food sensitivity. The number of lifestyle changes that the participants recommended to their patients with reflux was positively related to the number of changes they considered effective in reducing reflux symptoms (r = 0.56; P < 0.001; n = 651). Conclusion: The majority of dietitians recommended lifestyle modifications as treatment for reflux symptoms despite the current lack of evidence. A thorough investigation of the efficacy of this treatment appears warranted.     

Factors associated with knowledge of genetics and nutritional genomics among dietitians

Introduction Knowledge of genetics and nutritional genomics is important for dietitians in the prevention and management of disease. The present study aimed to analyse data from a nationwide postal questionnaire survey in order to investigate the factors associated with knowledge of genetics and nutritional genomics among dietitians in the UK. Methods A nationwide postal questionnaire survey was conducted in a random sample of 600 dietitians in the UK. The questionnaire measured dietitians’ knowledge using 12 multiple choice questions relating to genetics and nutritional genomics. Factors that may impact upon such knowledge were also recorded. Knowledge scores were calculated and compared between dietitians using comparative statistics and univariate analysis of variance. Results A total of 389 (64.8%) usable questionnaires were returned. Overall, the mean ± SD total knowledge score was low at 41 ± 19%. Highest qualification (F_2,372 = 9.1, P < 0.001), the genetics content of university education (F_2,372 = 7.1, P = 0.001) and reading literature or attending a conference relating to genetics or nutritional genomics within the last year (F_1,372 = 11.9, P = 0.001) were all associated with higher total knowledge scores. Conclusion Knowledge of genetics and nutritional genomics among dietitians is currently low, and better knowledge is associated with exposure to these in university education and continuing professional development.     

Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings

Objective : To use existing evaluation data of community‐based HIV prevention peer education workshops (PEWs) for gay men to explore the challenges in evaluating such programs in community settings. Methods : Data came from 33 PEWs conducted with gay and bisexual men. A basic pre/post‐test design was used to measure sexual health capacity. The Sexual Health Capacity Scale (SHCS) was anonymously completed before participation and twice afterward, with the men measuring perceptions of themselves before participation and perceptions of themselves after participation. The anonymous nature of the SHCS created problems for matching data so, for the most part, independent samples tests were used for analysis. Results : Overall, 399 gay and bisexual men participated in PEWs. Participants perceived themselves as having more sexual health capacity after participation than before (p<0.001). Those who had previously been HIV tested before the PEW had higher perceived capacity (p<0.001). Conclusions and Implications : Participation in the PEWs appeared to increase the perceived sexual health capacity of gay and bisexual male participants. Several limitations in the data arose from issues in the original data collection. A mixture of anonymous and identifiable data‐sources meant that data could not always be matched to individuals. Stronger partnerships between HIV researchers and professionals within community organisations could significantly improve evaluation of the effectiveness of HIV peer education.     

The SOMERS Index: a simple instrument designed to predict the likelihood of rural career choice

Objective: The World Health Organization has drawn up a set of strategies to encourage health workers to live and work in remote and rural areas. A comprehensive instrument designed to evaluate the effectiveness of such programs has not yet been tested. Factors such as Stated rural intention, Optional rural training, Medical sub‐specialization, Ease (or self‐efficacy) and Rural Status have been used individually or in limited combinations. This paper examines the development, validity, structure and reliability of the easily‐administered SOMERS Index. Design: Limited literature review and cross‐sectional cohort study. Setting: Australian medical school. Participants: A total of 345 Australian undergraduate‐entry medical students in years 1 to 4 of the 5‐year course. Main outcome measures: Validity of the factors as predictors of rural career choice was sought in the international literature. Structure of the index was investigated through Principal Components Analysis and regression modelling. Cronbach's alpha was the test for reliability. Results: The international literature strongly supported the validity of the components of the index. Factor analysis revealed a single, strong factor (eigenvalue: 2.78) explaining 56% of the variance. Multiple regression modelling revealed that each of the other variables contributed independently and strongly to Stated Rural Intent (semi‐partial correlation coefficients range: 0.20–0.25). Cronbach's alpha was high at 0.78. Conclusions: This paper presents the reliability and validity of an index, which seeks to estimate the likelihood of rural career choice. The index might be useful in student selection, the allocation of rural undergraduate and postgraduate resources and the evaluation of programs designed to increase rural career choice.