How Medical Students’ Behaviors and Attitudes affect the Impact of a Brief Curriculum on Nutrition Counseling

Schlair, Sheira; Hanley, Kathleen; Gillespie, Colleen; Disney, Lindsey; Kalet, Adina; Darby, Pamella C.; Frank, Erica; Spencer, Elsa H.; Harris, Jeff; Jay, Melanie

doi:10.1016/j.jneb.2011.08.006

Cited by 43 publications

(57 citation statements)

References 21 publications

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“…Moreover, the few (28 %) participants who received their education in dietary counselling less than one year ago felt more confident about evidence based dietary advice and were to a higher degree positive to LCD advisement, indicating that education and training influences the level of self-estimated knowledge and the attitude toward newer treatment options. This finding is consistent with other studies [23,28].…”

Section: Discussionsupporting

confidence: 94%

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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Background: In 2013, the Swedish Council on Health Technology Assessment (SBU) published a report "Dietary treatment of obesity" where low carbohydrate diet (LCD) was established as one of the evidence based diet options in obesity treatment, even without diabetes. No data exists on how much the health care professionals (HCP) in primary care actually are informed of or to which extent they use the knowledge in the new report. We aimed to investigate the HCPs' current knowledge, attitudes and application of LCD in obesity treatment in primary care. Methods: All primary health care centres (PHCC) in Jönköping County Council (JCC) were invited to participate in this cross sectional descriptive study. HCPs who were working with obese patients were sent an online survey by email from January to March 2014. Data was collected about self-estimated knowledge, clinical practice of dietary advice and attitudes on LCD as well as demographic data and work related information. Chi2 and logistic regression were used to analyse associations between the independent and the outcome variables. Results: Two hundred and seventy-one HCPs completed the survey (70.7 %); 95 % gave dietary advice. Those who gave dietary advice, 49 % were uncertain about evidence based dietary advice; 28 % received education on dietary advice last year; 60 % reported patient requests for LCD; 80 % felt hesitant about LCD; 54 % stated that they have good knowledge about LCD and 47 % recommended LCD. Factors that influenced the advisement on LCD were profession (physician and diabetes nurse), patient requests for LCD (OR 0.46, 95 % CI 0.27-0.77, p = 0.003) and good knowledge (self-estimated) about LCD (OR 0.43, 95 % CI 0.26-0.71, p = 0.001). Recent education on dietary advice affected in a positive way the uncertainty about evidence based dietary advice (OR 0.19, p = 0.0001), the hesitancy about LCD (OR 0.37,, p = 0.002) and self-estimated knowledge about LCD (OR 2.67, 95 % CI 1.49-4.80, p = 0.001). Conclusions: HCPs were positive to dietary advisement but had an ambivalent attitude toward LCD as yet another dietary option. This area may be improved with continuous educational training, supposing that this is prioritized. Thus, it is reasonable to believe that LCD will gradually be more common as a tool to deal with obesity in primary care in the future.

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Section: Discussionsupporting

confidence: 94%

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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“…Eight studies explicitly set out to improve participants’ self-efficacy by increasing their confidence. They adopted strategies like role modelling by practising physicians,68 role playing using either simulated or real patients,41 43 47 58 providing demonstrations and hands-on practice sessions33 41 43 45 47 61 68 and viewing then discussing videos and web-based cases 4368 Four each of these interventions were conducted among future healthcare professionals and practising healthcare professionals.…”

Section: Resultsmentioning

confidence: 99%

“…Four interventions, which stimulated practising45 60 and health professions students58 61 to take better care of their own health, had positive outcomes. These included regular consumption of fruits and vegetables, personal awareness of calorie consumption, engagement in regular physical activity and development of culinary skills.…”

Section: Resultsmentioning

confidence: 99%

“…These included regular consumption of fruits and vegetables, personal awareness of calorie consumption, engagement in regular physical activity and development of culinary skills. In both settings, these led to better self-reported healthy lifestyles and self-reported ability to undertake dietary assessment,61 counselling confidence,45 58 61 self-assessed knowledge60 and even treating a higher proportion of diabetic patients with diet alone 60. Healthcare professionals, who considered themselves role models for patients, felt more confident to advise patients to do as they had done 45…”

Section: Resultsmentioning

confidence: 99%

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Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

et al. 2016

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ObjectiveTo determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work.DesignRealist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations.ResultsOver half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised.ConclusionsThese findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients’ health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it.

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“…Lectures may be a good way of introducing new concepts to students but lectures alone might not enhance self-efficacy as its opportunities for practical and clinical experiences are limited [48]. In identifying teaching and learning methods that could promote self-efficacy as well as attitudes in nutrition care, Mogre et al [34] found the following to be important: role modelling by practicing physicians [49], role playing using either simulated or real patients [50][51][52][53], encouraging clinical bedside nutritional teaching [48], demonstrations and hands on practice sessions [49][50][51][52][54][55][56], viewing and discussion of videos and Web-based cases [51,57].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background Doctors are in a good position to provide nutrition advice to patients. However, doctors and medical students find their nutrition education to be inadequate. We evaluated nutrition-related knowledge, attitudes and self-efficacy in a sample of future doctors. Furthermore, we investigated the association between nutrition-related knowledge, attitude and self-efficacy. We also compared nutrition-related knowledge, attitudes and self-efficacy with level of clinical training. Methods Following a cross-sectional design, the nutritionrelated knowledge, attitudes and self-efficacy of 207 undergraduate clinical-level medical students (referred to as future doctors) was measured using a questionnaire. Items of the questionnaire were derived from previously validated survey instruments. Descriptive statistics of mean and standard deviation was used to describe the data. Results Future doctors had a mean knowledge score of 64%. Their mean knowledge scores in the nutrition topics assessed were 41% for 'malnutrition in children', 59% for 'diabetes and obesity' and 73% for 'nutrients, energy and their deficiencies'. Future doctors' attitudes towards nutrition care were generally positive but were uncertain in the effectiveness of health education in changing the lifestyle of patients. They felt inadequate in their self-efficacy to provide nutrition care. Attitudes towards nutrition care correlated (r = 0.371, p < 0.001) positively with self-efficacy to provide nutrition care. Level of clinical training was associated to nutrition-related knowledge of the students. Conclusion Future doctors had positive attitudes towards nutrition care but showed important knowledge gaps and also felt inadequate in their confidence to provide nutrition care. Attitudes may be important in nutrition care self-efficacy.

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How Medical Students’ Behaviors and Attitudes affect the Impact of a Brief Curriculum on Nutrition Counseling

Cited by 43 publications

References 21 publications

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

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

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