Different settings, different approaches: a qualitative comparison of Portuguese dietitians’ beliefs, attitudes and practices about obesity in public and private settings

Teixeira, Filipa; Pais-Ribeiro, José; Maia, Ângela

doi:10.1017/s1368980017002543

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…Ainda assim, uma revisão integrativa indicou que as atitudes negativas dos profissionais em relação à obesidade tendem a melhorar com o tempo 28 . Estudos realizados em Portugal 25,26,29 sinalizaram que, apesar dos nutricionistas 26,29 e enfermeiros 26 , semelhantemente aos médicos, atribuírem o "fracasso" do tratamento aos pacientes obesos, eles acreditam em sua competência profissional e na efetividade da terapêutica e, consequentemente, assumem um papel mais ativo e positivo no processo 26,29 quando comparados aos médicos 26 . No entanto, diferenças no salário, no ambiente de trabalho e nos recursos disponíveis, ou seja, questões relacionadas com a organização institucional afetaram suas práticas 29 .…”

Section: Discussionunclassified

Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil

et al. 2020

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Resumo: O Brasil vem instituindo políticas de prevenção e controle da obesidade por meio do Sistema Único de Saúde, e o estudo analisou as características dos “modelos assistenciais” propostos e referidos por profissionais da atenção básica no Estado do Rio de Janeiro. Os métodos incluíram entrevistas e grupos focais com profissionais e gestores da atenção básica e das Áreas Técnicas de Alimentação e Nutrição (ATAN) dos 92 municípios do Rio de Janeiro, e análise documental de normativas federais e estaduais. A análise foi norteada pelas dimensões organizativa e técnico assistencial, e considerou os princípios da atenção integral em saúde. Os principais desafios referidos pelos profissionais estão relacionados com: a adesão aos processos terapêuticos e consequente sentimento de frustração e impotência; a atuação em equipe multiprofissional; e a constatação de despreparo para lidar com a complexidade do processo saúde/doença relacionado com a obesidade. Alguns princípios e diretrizes pautados nos documentos de políticas governamentais são estratégicos para enfrentar esses desafios, especialmente: a corresponsabilização entre profissional e usuário, pois pode contribuir para evitar os extremos da culpabilização e/ou vitimização; a valorização de outros ganhos para além da perda de peso, que pode ressignificar a concepção de adesão ao tratamento; a atuação multiprofissional para que se desenvolva uma compreensão contextualizada do processo saúde/doença e seus múltiplos condicionantes, e para que os profissionais consigam lidar com os seus próprios sentimentos e estigmas em relação à pessoa com obesidade.

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Section: Discussionunclassified

Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil

et al. 2020

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“…7 Thus, NWFAs could reduce the adverse health and psychological impacts of weight stigma, which has been associated with higher cortisol levels, systemic inflammation, anxiety, depression, disordered eating behaviours, weight cycling and medication non-adherence. [8][9][10][11][12] The use of NWFAs is increasing among dietitians in Canada, as well as globally, 4,13 with approximately 50% of Canadian dietitians using some variation of NWFAs. 3 However, implementing a new practice approach is particularly fraught when it challenges longstanding practices and beliefs of healthcare providers and clients, such as the importance of weight loss for higher weight clients.…”

Section: Introductionmentioning

confidence: 99%

“…The use of NWFAs is increasing among dietitians in Canada, as well as globally, 4,13 with approximately 50% of Canadian dietitians using some variation of NWFAs 3 . However, implementing a new practice approach is particularly fraught when it challenges longstanding practices and beliefs of healthcare providers and clients, such as the importance of weight loss for higher weight clients 14 .…”

Section: Introductionmentioning

confidence: 99%

The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

Lichtfuss,

Franco‐Arellano,

Jefferson

et al. 2024

J Human Nutrition Diet

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BackgroundAn increasing number of dietitians use non‐diet approaches, referred to as non‐weight focused practice approaches (NWFAs), in clinical practice when working with higher weight adult clients. However, the factors that impact dietitians' ability to successfully implement these approaches in practice are unknown.MethodsAiming to examine how implementing NWFAs in clinical practice differs based on the extent to which a dietitian uses NWFAs with their clients, we conducted a cross‐sectional online survey among Canadian registered dietitians who work with higher weight adults (May to July 2021), developed and validated following the Consolidated Framework for Implementation Research. Descriptive statistics were conducted to identify barriers and facilitators with respect to implementing NWFAs. The Kruskal–Wallis was used to test for differences in barriers and facilitators with respect to implementing NWFAs among five different practice approaches. The results showed that, among participants (n = 383; 82% white; 95% women) the most important barriers for implementation of NWFAs were clients' focus on weight as an outcome, when losing weight is a condition to access enhanced services, requiring changes to their practice philosophy, difficulty funding professional development and not having sufficient skills or knowledge to implement NWFAs in practice. Top‐rated facilitators included the use of clinical guidelines, scientific publications and educational materials, which were rated with higher agreement across all implementation stages (p < 0.001).ConclusionsThe present study highlights important factors that may impact the effective implementation of NWFAs in dietetic practice for higher weight adult clients, which is essential to minimise barriers in practice.

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Private practice dietetics: A scoping review of the literature

Donnelly,

Lane,

Walsh

et al. 2024

Nutrition & Dietetics

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AimPrivate practice is one of the most rapidly growing, but under‐researched employment sectors for graduate dietitians in Australia, limiting evidence‐based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities.MethodsThe databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research.ResultsA total of 72 peer‐reviewed and grey literature sources were included, with 65% of the studies being Australian‐based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners.ConclusionsThe literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced‐based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

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Different settings, different approaches: a qualitative comparison of Portuguese dietitians’ beliefs, attitudes and practices about obesity in public and private settings

Cited by 3 publications

References 33 publications

Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil

Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil

The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

Private practice dietetics: A scoping review of the literature

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