Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project

Abstract

Providing nutritional education for chronic kidney disease (CKD) patients in South Africa is complicated by several conditions: the population is composed of diverse ethnic groups, each with its own culture and food preferences; eleven languages are spoken and illiteracy is common in the lower socio-economic groups. Food preparation and storage are affected by the lack of electricity and refrigeration, and this contributes to a monotonous diet. In traditional African culture, two meals per day are often shared “from the pot”, making portion control difficult. There is both under- and over-nutrition; late referral of CKD is common. Good quality protein intake is often insufficient and there are several misconceptions about protein sources. There is a low intake of vegetables and fruit, while daily sodium intake is high, averaging 10 g/day, mostly from discretionary sources. On this background, we would like to describe the development of a simplified, visual approach to the “renal diet”, principally addressed to illiterate/non-English speaking CKD patients in Southern Africa, using illustrations to replace writing. This tool “Five steps to improve renal diet compliance”, also called “Eating like a Rainbow”, was developed to try to increase patients’ understanding, and has so far only been informally validated by feedback from users. The interest of this study is based on underlining the feasibility of dietary education even in difficult populations, focusing attention on this fundamental issue of CKD care in particular in countries with limited access to chronic dialysis.

How do patients and carers make sense of renal dietary advice? A qualitative exploration

“…Participants also suggested that patient education resources be available in formats which were easy to read and understand with illustrations to facilitate sensemaking. The evidence substantiates that utilising these formats for patient education resources are particularly effective, and have been shown to be superior to traditional methods of instruction (Houts et al 2006;Peregrin 2010;Pratt & Searles 2017;Verseput & Piccoli 2017).…”

“…Furthermore, carers also assisted with shopping and meal planning decisions. These findings suggest that to facilitate sensemaking for patients, it is important for dietetic services to be attentive to meeting the renal diet information needs of carers (Pratt & Searles ; Verseput & Piccoli ), by routinely inviting and involving them in education sessions (Hollingdale et al ). Specific carer training about the renal diet (such as cooking or meal preparation classes) may also be of use, because it may help to reduce carer burden and improve psychosocial outcomes for both patients and carers (Tong et al .…”

“…The evidence substantiates that utilising these formats for patient education resources are particularly effective, and have been shown to be superior to traditional methods of instruction (Houts et al . ; Peregrin ; Pratt & Searles ; Verseput & Piccoli ).…”

Knowledge, attitude and practices of patients receiving maintenance haemodialysis in Bloemfontein, South Africa

“…Health literacy, in turn, is defined by the US Institute of Medicine as 'the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'. 28 Verseput and Piccoli 29 recently suggested that nutrition education aimed at the South African patient population with CKD should be posed at the SA school system Reported that they understood some of it, but not all of it 30 47.6…”

Keeping the Diet Simple and Natural in Chronic Kidney Disease: A South African-Based Dietary Infographic

“…4,5 The South African population is multicultural, multiethnic, and has a large population from a lower socioeconomic status with many issues regarding food security and dietary diversity. 6 Unemployment and a low level of education affect patients' understanding of their prescribed diet for CKD, limiting their purchasing power and ultimately adherence to their prescribed diet. 7 Recent studies exploring dietary patterns and its relationship to renal outcomes show some promising results which suggest that CKD diets do not need to be so restrictive.…”