Nutrition education and counseling: knowledge and skill levels expected by dietetic internship directors

Development of nutrition education and counseling skills is important in the educational preparation of dietitians. A national survey of dietetic internship directors was conducted to determine competency levels expected of students at the start of an internship, internship training given, and further preparation students need in 32 knowledge/skills areas deemed essential for delivery of nutrition education and counseling services. Completed questionnaires were received from 66 of 102 (65%) internship directors surveyed. The majority of directors expected only basic preparation for group nutrition education and individual counseling knowledge/skills areas. Internship training in nutrition education competencies was "moderate" to "extensive," whereas preparation in nutrition counseling competencies was more likely to be "extensive." Directors perceived the internship to provide adequate preparation in all but the advanced practice skills, such as behavior modification and motivational strategies, for which further preparation was recommended. The majority of internship directors reported that more than 25% of the intern practice experience was in patient counseling, with less experience in group instruction. Implications for undergraduate dietetic education are discussed in relation to internship directors' expectations as well as to present and future trends in the dietetic profession.     

Sexual behavior, knowledge, and attitudes about AIDS among college freshmen.

We surveyed 158 college freshmen on an urban campus to determine their sexual practices and their knowledge and attitudes about acquired immunodeficiency syndrome (AIDS). Many students (47%) were heterosexually active; 1% were homosexual, 1% were bisexual, and 51% had not been sexually active. Among the 77 sexually active students, many engaged in activities that can facilitate transmission of human immunodeficiency virus (HIV): 58% did not always use condoms with a new partner; 31% had had two or more sex partners in the last year; 8% engaged in anonymous sex; and 14% of sexually active women had anal intercourse. Although most sexually active students said they would use condoms more or reduce the number of their sexual partners if they believed these changes would reduce "my risk for getting AIDS," few students had adopted these safer sexual practices. Safer sexual practices were associated with heightened personal concerns about AIDS but not with knowledge, which was at a high level. These findings underscore the need for preventive programs that overcome the gap between knowledge and safer sexual behaviors in this and similar groups of adolescents and suggest that programs that heighten personal concerns may be most effective. Community-based physicians who care for adolescents should develop such preventive programs and integrate them into their practices.     

Nutrition knowledge of female varsity athletes and university students

The objectives of this study were to compare the nutrition knowledge, including knowledge about nutrition in relation to physical activity, of female university students and members of varsity athletic teams and to document selected nutrition practices of those groups. Instruments developed for the study were completed by varsity athletes (no. = 70) and students not on teams (no. = 129). The two groups were similar in education, but the athletes were younger, taller, and heavier than the students and were considerably more active. The athletes used more nutritional supplements (especially iron) and were less likely to exclude red meat from their diet than were students. Scores on the knowledge test (which had a possible range of - 100% to 100%) averaged 34% for both team members and students. Both groups scored higher on general nutrition questions than on questions about nutrition in relation to activity. Among students, age, education, dietary pattern, total number of nutrition information sources, and length of time an activity program had been maintained were positively associated with nutrition knowledge. Those relationships were not detected among varsity athletes. It was concluded that female varsity athletes had levels of both general and sports-related nutrition knowledge that were similar to those of female students not participating on varsity teams.     

中小学生营养知识、态度、行为调查与分析

利用 1998～ 2 0 0 0年在四川、山东、黑龙江和广东省开展的“膳食指南营养教育项目”的基线调查资料 ,对 15 2 4名中、小学生的营养知识、态度和行为三方面的情况进行综合分析。结果显示 ,他们均表现出乐于接受营养知识 ,注重自身营养状况的良好态度 ,但对基础营养知识的了解有待提高。在饮食行为方面 ,78 3%的学生在家吃早餐 ,早餐食物以粥、面包等非油炸谷类食物为主。每天喝奶的学生平均只有 31 4%。曾接触过膳食指南知识的中小学生近 2 0 % ,在知识水平和膳食行为上优于其它学生。营养知识对其饮食行为产生积极影响     

Predictors of nutrition counseling behaviors and attitudes in US medical students

BACKGROUND: Nutrition counseling by physicians can improve patients' dietary behaviors and is affected by physicians' nutrition practices and attitudes, such as the perceived relevance of nutrition counseling. OBJECTIVE: The objective was to provide data on medical students' perceived relevance of nutrition counseling, reported frequency of nutrition counseling, and frequency of fruit and vegetable intakes. DESIGN: Students (n = 2316) at 16 US medical schools were surveyed and tracked at freshmen orientation, at the time of orientation to wards, and in their senior year. RESULTS: Freshmen students were more likely (72%) to find nutrition counseling highly relevant than were students at the time of ward orientation (61%) or during their senior year (46%; P for trend = 0.0003). Those intending to subspecialize had lower and declining perceptions of counseling relevance (P for trend = 0.0009), whereas the perceived relevance of counseling by primary care specialists remained high (P for trend = 0.5). Students were significantly more likely to find nutrition counseling highly relevant if they were female, consumed more fruit and vegetables, believed in primary prevention, had personal physicians who encouraged disease prevention, or intended to specialize in primary care. Only 19% of students believed that they had been extensively trained in nutrition counseling, and 17% of seniors reported that they frequently counseled their patients about nutrition. Students who consumed more fruit and vegetables, believed that they would be more credible if they ate a healthy diet, were not Asian or white, or intended to specialize in primary care counseled patients about nutrition more frequently. Medical students consumed an average of 3.0 fruit and vegetable servings/d, which declined over time. CONCLUSIONS: The perceived relevance of nutrition counseling by US medical students declined throughout medical school, and students infrequently counseled their patients about nutrition. Interventions may be warranted to improve the professional nutritional practices of medical students.     

Introducing cancer nutrition to medical students: effectiveness of computer-based instruction

BACKGROUND: Computer-based instruction has been introduced at the University of North Carolina at Chapel Hill to augment its nutrition course for first-year medical students. Seven program modules have been completed; 2 more are planned. Each module explains the biochemistry and physiology of nutrition through interactive lessons, exercises, and a video case study. OBJECTIVE: The goal of this study was to evaluate the instructional efficacy and acceptability of the nutrition and cancer module when used by first-year medical students. DESIGN: The module was used by 163 first-year medical students at the university's medical school as an obligatory component of the nutrition course. Before and after using the module, students were asked to answer multiple-choice questions concerning their knowledge and attitudes; each question had 5 possible answers. RESULTS: On average, students spent approximately 3 h studying the lessons. The percentage of correct responses to 20 knowledge questions increased from 22% before the module was used to 86% immediately after its use. When a randomly selected subsample of 25% of the students took the same test 3 mo later, they answered 62% of the questions correctly. The increase in the percentage of students who felt prepared to provide advice regarding nutrition's role in cancer prevention (from 5.7% to 66.9%) suggested a successful subjective learning experience. Neither the students' initial level of interest in cancer nutrition nor their acceptance of computer-based instruction was related to learning outcome. CONCLUSIONS: The tested module is a useful and effective aid for teaching nutritional principles of cancer prevention. The evaluation strategy helped identify areas for instructional improvement.     

Breastfeeding: The neglected guideline for future Dietitian‐Nutritionists?

The objective of the present study is to determine the knowledge, attitudes and beliefs regarding breastfeeding of final‐year nutrition and dietetic students. A cross‐sectional survey of final‐year nutrition and dietetic students at a leading Australian university was conducted using an emailed questionnaire of 50 multiple‐choice questions on knowledge, attitudes, beliefs and future intentions to support and promote breastfeeding. The frequency of response to all questions was determined. Twenty‐seven of the 38 eligible students completed the survey. Significant deficits were identified relating to breastfeeding knowledge. Ninety‐two per cent of respondents reported a future intention to breastfeed or support their partner to do so; yet 69% felt bottle feeding was more socially acceptable and 23% believed that using artificial formula was easier for the mother. Although 85% of respondents believed they could influence breastfeeding initiation and duration rates, no students perceived that their studies had provided a significant amount of information on this subject, while only 8% of respondents had a strong interest in work relating to breastfeeding in the future. Improvements in the curriculum in this context may be required to ensure new graduates have the appropriate knowledge and are motivated to take positive action so that breastfeeding is properly supported. Further research is needed to determine if this issue applies in other nutrition courses and to assess the need to adopt an industry position paper on breastfeeding and associated competency standards for vocational training.     

超重和肥胖学生膳食与运动的知·信·行分析

目的了解超重和肥胖学生膳食与运动的知、信、行现状,为儿童肥胖的预防和控制提供理论依据.方法采用分层整群随机抽样方法,对北京、武汉、深圳3个城市小学三～四年级的超重和肥胖学生进行统一问卷调查.结果 41.07%的学生正确回答了6项以上知识问题,答对率在75%以上的比例仅为1.83%;87.48%的学生不知道肥胖对健康的影响,80.48%的学生不了解如何控制体重增长趋势.超重和肥胖学生对膳食与运动的正确态度持有率为53.13%.75%以上的学生表示愿意获取有关膳食与运动的知识,并愿意在获得相关知识的前提下,做出积极健康的行为改变.在15项行为中,65%左右的超重或肥胖学生只能保持3～5种正确行为,而能保证体育课外健身运动时间的学生只有25.04%.结论超重和肥胖学生对膳食与运动的认识比较缺乏,但有强烈的求知欲望.     

Survey of nutrition knowledge of Canadian physicians

OBJECTIVES: Previous reports have indicated that physicians generally have little training in nutrition and a poor knowledge of the subject. A survey was carried out to determine the nutrition knowledge of physicians working in general practice. METHODS: A questionnaire with multiple-choice questions was mailed to 248 physicians working in Alberta, Canada, mainly in Edmonton and Calgary. Non-respondents received a second questionnaire and a phone call. RESULTS: Completed questionnaires were received from 36.1% (84 of 233 eligible physicians). The average correct response was 63.1%. The results indicate that physicians are generally aware of information which has been publicized in the medical press: which nutrients are antioxidants; the nutrient associated with the prevention of neural tube defects (folate); the preventive action of fruit and vegetables against cancer; the energy value of fat (9 kcals/g); and the recommended fat intake (under 30% of energy). By contrast they have a poor knowledge of other important topics in nutrition: the typical salt intake of Canadians; the association between excess protein intake and calcium loss; the type of dietary fiber helpful in lowering the blood cholesterol level (soluble fiber); and the nutrient which helps prevent thrombosis (omega-3 fat). CONCLUSIONS: These results support other data that physicians need more training in nutrition.     

农村贫困地区小学生营养知识现状

了解农村贫困地区小学生对营养知识知晓情况,为农村贫困地区小学生营养改善及营养知识干预提供依据.方法 采用多阶段整群抽样方法,抽取河北平泉县、湖北五峰县、云南隆阳区、湖南平江县、吉林敦化市5个县区二~六年级2 939名小学生.采用自行设计的调查表,收集学生基本信息和营养知识相关信息.结果 学生各项营养知识知晓率为21.4% ~97.4%,其中对营养早餐的食物组成认知率最低,为21.4%,而合理选择零食的(97.4%)正答率最高.住宿生多数知识点的正答率高于走读生(P值均<0.01);父母都没有外出打工或仅父亲外出打工学生的正答率高于父母都外出打工或母亲外出打工的学生(P值均<0.01).各个知识点的正答率随着年级的升高而升高,且地区间差异均有统计学意义(P值均<0.01).高年级学生营养知识平均得分为(6.03±1.75)分,不同年级、地区、是否住宿和父母是否外出打工学生间营养知识得分差异均有统计学意义(P值均<0.01).结论 农村贫困地区小学生营养知识水平较低.应积极开展营养知识宣教,提高小学生营养知识水平.     

Physicians' views of periodic abstinence methods: a study in four countries

A study of the knowledge, perceptions, and behavioral intentions of physicians regarding periodic abstinence (PA) methods was undertaken in Mauritius, Peru, the Philippines, and Sri Lanka. Most respondents considered PA to be useful, although even the PA providers prescribed mainly non-PA methods. Detailed knowledge of PA methods was not evident, but most physicians were willing to initiate general discussion about PA with patients. Physicians favored methods perceived as "scientific" and "modern," which primarily prevent pregnancy and secondarily avoid other health risks. When carefully presented as "scientific" and "modern," methods presented to medical audiences may find acceptance and be more likely to result in referral.     

“中国居民膳食指南”营养教育项目效果分析

通过对山东、广东、四川和黑龙江四省五个城市抽样调查 5 145人的营养知识、态度、行为的分析 ,显示“中国居民膳食指南”营养教育项目的开展是具有成效的 ,特别是在居委会住户、中小学生及一些老年活动站的老年人群中取得了明显的宣传效果。例如在开展“膳食指南”营养教育宣传前后住户了解“膳食指南”的人数百分比从 11 97%上升到 93 38% ,老年人也从 2 9 15 %上升为 99 0 0 % ,中小学生了解“膳食指南”的人数百分比也从 15 2 %上升为 91 9%。有近 90 %的住户和老年人是从项目所发放的宣传材料上获得“膳食指南”知识的。从营养知识得分情况可见 ,以上人群在项目开展宣传前后的营养知识水平得到了明显提高 ,具有良好的学习营养知识的态度 ,同时某些膳食行为和生活方式也有了一些改变。充分说明营养教育对提高大众营养知识水平、改变人们不良的生活和饮食习惯具有极为重要的作用。     

宜春学院医学生营养知识、态度及饮食行为调查

[目的]了解宜春学院医学生营养知识、态度及饮食行为,为开展营养健康教育及干预提供依据.[方法]采用自行设计的营养知识、态度及饮食行为问卷,对宜春学院医学院386名一～三年级的大学生进行调查.[结果]医学生的营养知识缺乏,回答正确率总体上在50%左右,并存在一些不合理的饮食行为,有27.2%的学生不能坚持每天吃早餐,而且早餐质量较差,早餐品种较单调.另外,每天喝牛奶的学生仅有9.8%,但他们具有良好的接受营养教育的态度,有89.6%学生愿意为了健康改变不良饮食习惯,92.5%的学生愿意以后更多地关注营养知识.[结论]多数学生缺乏必要的营养知识,饮食行为不合理,但接受营养知识的态度较好,应加强医学生营养知识教育,纠正不良的饮食行为,促进身体健康.     

U.S. medical students' attitudes about patients' access to care

OBJECTIVE: Accessing adequate medical services remains a major struggle for many Americans, but U.S. medical students' beliefs regarding access to care have not been thoroughly examined. METHODS: All medical students in the Class of 2003 at 16 U.S. schools were eligible to complete three questionnaires during their medical training: during freshman orientation, orientation to wards, and their senior year (n=2316, response rate=80.3%). Students responded to three questions about health care provision. RESULTS: Overall, 35% of students strongly agreed that "physicians have a responsibility to take care of patients regardless of their ability to pay;" only 5% disagreed. Only 8% disagreed that "access to basic health care is a fundamental human right." We found the same significant associations with opinions on access as we did with "responsibility to treat," although the associations tended to be stronger for access. Only 10% of students agreed that "Managed care, as it is now delivered, is a good way to deliver health care to the U.S. population." CONCLUSION: Most U.S. medical students support universal access to medical care, though variations in this support, its decline with additional years of medical education, and concerns about managed care are noteworthy, and have policy implications for America's health and health care workforce.     

Computer-assisted teaching of nutritional anemias and diabetes to first-year medical students.

BACKGROUND: Seven computer-based Nutrition in Medicine interactive modules for teaching nutrition are available for instruction in medical schools. OBJECTIVE: The goal of this study was to evaluate the instructional efficacy of the Nutritional Anemias and the Diabetes and Weight Management: Aberrations in Glucose Metabolism modules when used by first-year medical students. DESIGN: The modules were introduced at Meharry Medical College to enhance its nutrition course for first-year medical students. Eighty medical students used the Anemias and Diabetes modules as an obligatory component of the course. Students were divided into 20 study groups of 4 and were required to answer multiple-choice questions to test their nutrition knowledge before and after use of the module. RESULTS: On average, students spent 1.89 +/- 0.99 h studying each module, and most students (70%) reported viewing modules in more than one session. The percentage of correct responses to 12 knowledge questions from each module increased from 25% before use of the module to 74% immediately after its use and remained high (59%) 8 mo later. The pattern of knowledge retention, however, had some unpredictability. On the midterm examination, 72% of the students correctly answered questions related to nutritional anemias and nutrition aspects of diabetes. This was a 15% increase in knowledge of these 2 areas when compared with results obtained from first-year medical students 1 y earlier who had not used the modules. CONCLUSIONS: The modules tested are effective tools for teaching nutritional and health issues of anemias and diabetes to first-year medical students.     

Nutrition support practice: a study of factors inherent in the delivery of nutrition support services

The purpose of this study was to determine the degree of intercorrelation among dietitian, physician, and team nutrition support functions. Eight hundred and eighty dietitians and physicians were asked to respond to a questionnaire describing nutrition support functions as reported in the literature and validated by a panel of nutrition support physicians and dietitians. Two hundred and fifty-four completed questionnaires were included in the study, 84 from physicians and 170 from dietitians. Intercorrelations among function statements were subjected to factor analysis. The magnitude and consistency of factor loadings suggest that nutrition support is not perceived as independent components, but as a comprehensive pattern or structure. However, there was one important difference in perception. The sample tended to have an "enteral" orientation to the dietitian role and a "parenteral" orientation to the physician and team roles. The data support the contention that all members of nutrition support teams need a common core of knowledge and a set of highly developed process skills which can best be attained through an integrated, rather than segmented, approach to team training.     

北京市某大专院校学生营养知识、态度及饮食行为调查

目的了解大专院校学生营养知识、态度与饮食行为现况及其关系，为培养健康饮食行为和营养健康教育提供科学依据。方法采用整群抽样的方法，对北京市某大专院校745名学生进行营养知识-态度-行为的问卷调查。结果学生营养知识知晓率为66.7％，女生知晓率高于男生，营养素相关知识比较欠缺；2／3的学生对营养知识感兴趣；40.4％的学生不吃或很少吃早餐，分别有27.4％经常吃熏烤食物、经常（或每天）吃零食；女生比男生具有更为正确和健康的营养态度和饮食行为。结论大专院校学生营养知识不足，存在不利于健康的营养态度及饮食行为，需要通过营养健康教育，提高营养认知水平，培养良好的饮食行为。     

Participation in a worksite cholesterol education program in a university setting.

Three hundred ninety-six employees of a large northeastern university participated in a blood cholesterol screening and provided follow-up data about their participation in a videotape cholesterol education program. Ten percent of these employees watched the videotape program; these individuals were significantly more likely to be at high risk for cardiovascular disease than were persons who chose not to watch the videotape. Persons participating in the cholesterol education program significantly increased their nutrition knowledge and significantly decreased their fat intake compared with nonparticipants. The most important reason given for watching the videotape was "concern about my cholesterol level." Reasons given for not watching the videotape were that it was "not well advertised" or that it was shown "at an inconvenient time." Although all 98 employees at high risk for cardiovascular disease were referred to their physicians for diagnostic evaluation, one third of these employees reported not seeing their physicians. These findings indicate that worksite cholesterol screening and education programs can improve nutrition knowledge and dietary behavior; however, these programs should develop strategies to increase participation and should follow up physician referrals.     

郑州市大学生食品营养标签使用情况调查

目的 了解大学生食品营养标签使用情况,为开展相关营养教育提供依据。方法 采取整群抽样的方式,对郑州市三所高校1 960名在校大学生进行问卷调查。结果 大学生食品营养标签知识得分均值12.1±2.8分（总分24分）,不同性别、专业、年级、学习过营养课程与否、家庭居住地、母亲文化程度均值比较,差异有统计学意义(P＜0.05),获取食品营养标签知识的途径主要以电视、广播为主（1 431人占78.9%）,有652（35.9%）人能够完全答对食品营养标签内容;使用营养标签态度上:有1 376（75.8%）人认为在食品包装上标示营养标签有必要,1 015（55.9%）人对营养标签标示内容表示信任;使用行为上:购买食品时经常浏览营养标签的有466（25.7%）人。结论 郑州市大学生的食品营养标签知识水平不高,对食品上标示营养标签态度积极,但使用率低,获取食品营养标签知识途径单一,今后学校应利用多种渠道,加强宣教,引导大学生消费时养成阅读营养标签的习惯。     

Impact of an Expansion of a Clinical Nutrition Curriculum on Pre-Clerkship Medical Students’ Perception of Their Knowledge and Skills Related to Performing a Nutritional Assessment

Learning how to provide nutritional counseling to patients should start early in undergraduate medical education to improve the knowledge, comfort, and confidence of physicians. Two nutrition workshops were developed for first-year medical students. The first workshop, co-led by physicians and registered dieticians, focused on obtaining nutrition assessments. The second workshop focused on the appropriate dietary counseling of patients with chronic kidney disease and cardiovascular risk. We surveyed students before workshop 1, after workshop 1, and after workshop 2 to assess their perceptions of the value of physician nutrition knowledge and counseling skills as well as their own comfort in the area of nutritional knowledge, assessment, and counseling. We found a significant improvement in their self-assessed level of knowledge regarding counseling patients, in their comfort in completing a nutritional assessment, and in their confidence in advising a patient about nutrition by the end of the first workshop. By the time of the second workshop five months later, students continued to report a high level of knowledge, comfort, and confidence. The implementation of clinical nutrition workshops with a focus on assessment, management, and counseling was found to be effective in increasing student’s self-assessed level of knowledge as well as their confidence and comfort in advising patients on nutrition. Our findings further support the previous assertion that clinical nutrition education can be successfully integrated into the pre-clerkship medical school curriculum.