Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: Results of a randomized, controlled study

Abstract

OBJECTIVE:The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual's recommendations by primary care practices was evaluated by examining two strategies: physician training on how to implement the manual's recommendations versus simple mailing of the manual. This article reports on the results of a randomized controlled trial to evaluate the effectiveness of these two strategies. DESIGN:A three-arm, randomized, controlled study. SETTING:Free-standing primary care physician practices in Pennsylvania and New Jersey. INTERVENTION:Each study practice was randomly assigned to one of three groups. The training group practices were invited to send one member from their practice of their choosing to a 3-hour "train-a-trainer" workshop, the manual-onlygroup practices were mailed the nutrition manual, and the control group practices received no intervention. For training group practices, training was provided in the four major components of the nutrition manual: how to organize the office environment to support cancer prevention nutrition-related activities; how to screen patient adherence to the NCI dietary guidelines; how to provide dietary advice/referral; and how to implement a patient follow-up system to support patients in making changes in their nutrition-related behaviors. MEASUREMENTS:The primary outcomes of the study were derived from two evaluation instruments. The observation instrument documented the tools and procedures recommended by the nutrition manual and adopted in patient charts and the office environment. The in-person structured interview evaluated the physician and staff's self-reported nutrition-related activities reflecting the nutrition manual's recommendations. Data from these two instruments were used to construct four adherence scores corresponding to the areas: office organization, nutrition screening, nutrition advice/referral, and patient follow-up. MAIN RESULTS:The adoption of the manual's recommendations was highest among the practices in the training group as reflected by their higher adherence scores. They organized their office ( P ‫؍‬ .005) and screened their patients regarding their eating habits ( P ‫؍‬ .046) significantly more closely to the recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training group practices were only 54.9% adherent to the manual's recommendations regarding nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition screening, and 14.6% adherent to its patient follow-up recommendations. CONCLUSIONS:Primary care practices exposed to the nutrition manual in a training session adopted more of the manual's recommendations. Specifically, practices invited to training were more likely to perfor...

Management practice adoption and productivity of commercial aquaculture farms in selected areas of Bangladesh

“…Farmers can learn different management techniques from training programs provided by government and different NGOs. Sakiband Afrad (2014), Njankoua et al (2012), Bucciarelli et al (2010), Kashem (2005), Tziraki et al (2000) and Hussain et al (1994) got similar result for education and training. Besides, positive and significant coefficient of extension services implies that the farmers those had better communication with extension services providers were higher adopter.…”

Diffusion and dissemination of evidence-based dietary srategies for the prevention of cancer

“…Of these, nine reports of seven distinct studies are included: three reports about one study [9-11] and six other studies [12-17] are presented in Evidence Table 1(see additional file 1). Ninety-two papers were excluded for lack of relevance; they did not address dissemination and diffusion strategies for dietary interventions.…”

“…Six reports were published since 1998; the other four were published between 1989 and 1993[12,13,15,16]. All seven projects were funded: five by the National Cancer Institute (NCI),[9,14-17] one by the National Institute of Health (NIH),[12] and one by a private foundation[13]. …”

“…Four of the studies were randomized trials[9,14,16,17,23]. None of the other studies included a comparison group; three articles were descriptive,[11,13,15] one article was a cohort study[12] (Table 1)(see additional file 1).…”

Future Doctors’ Nutrition-Related Knowledge, Attitudes and Self-Efficacy Regarding Nutrition Care in the General Practice Setting: A Cross-Sectional Survey

“…This has been corroborated by medical doctors reporting inadequate training in nutrition education during medical school, inadequate knowledge and skills in nutrition and feeling less efficacious in their ability to effectively provide nutrition care to patients [10,[16][17][18][19]. A number of factors have been noted for this situation including time limitations in the medical curriculum, resistance to the addition of new courses or lecture, and low priority for nutrition education [20][21][22][23].…”