Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension

Dash, Sarah; Delibasic, Victoria; Alsaeed, Sadeem; Ward, Michael; Jefferson, Katherine; Manca, Donna; Arcand, JoAnne

doi:10.1007/s10900-020-00831-x

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…In U.S medical schools, students and most educators consider current nutritional education inadequate, despite the efforts and developments of nutritional counseling programs for the past decades 19,21 . Providers universally endorsed access to dieticians to provide nutritional counseling, in accordance to a previous study where 84.9% of physicians considered dietician involvement to be bene cial for sodium counseling in hypertension patients 17 . In addition to more detailed dietary and nutrition expertise, a dietician also provides an extension to provider education, addressing the barrier of provider time.…”

Section: Discussionsupporting

confidence: 60%

Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management

Park

Billups

Schilling

2020

Preprint

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BackgroundThe Dietary Approach to Stopping Hypertension (DASH) is proven to lower systolic and diastolic blood pressure up to 7.8 and 3.7 mmHg, respectively and is considered first-line therapy per national guidelines. Yet, implementation into clinical practice remains suboptimal. MethodsWe designed a provider survey to identify and characterize physician-identified barriers to providing DASH diet to eligible primary care patients to reduce blood pressure. The survey assessed four domains: (1) provider beliefs/knowledge of DASH benefits (2) patient characteristics influencing likelihood of recommendation, (3) practice barriers to provision of DASH diet advice/education, and (4) resources necessary to facilitate use. We conducted qualitative interviews with 4 primary care physicians and designed a 7-item Likert scale-based survey.Participants: University of Colorado affiliated primary care clinics and School of medicine faculty providers working in Denver metro.ResultsThe survey was sent electronically to 149 providers, with 49 (33%) responders. Most providers (65%) believed DASH diet is as effective at lowering blood pressure as adding a medication for patients with pre-hypertension and established hypertension. Providers identified perceived low patient motivation (88%) and low ability to implement DASH diet into patient’s lifestyle (88%) as patient factors influencing their decision to provide DASH diet education. The most significant practice barriers were lack of time (71%) and lack of patient-directed educational resources (67%). Resources providers would find useful included resources accessible through the electronic medical record, (88%), a dietician (83%), and printed patient education materials (59%).ConclusionMost physicians believe DASH diet is effective at lowering blood pressure. The most common barriers to providing DASH education are low perceived patient ability or motivation, lack of provider time, and lack of patient-directed educational resources. Providers identified that readily available electronic and printed materials and access to dieticians would help improve DASH counseling in practice.

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Section: Discussionsupporting

confidence: 60%

Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management

Park

Billups

Schilling

2020

Preprint

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“…Assessment and promotion of health behaviors and approaches to identifying appropriate lifestyle intervention candidates remain limited in clinical care, [33][34][35][36] making screening tools desirable. The AHA metrics provides both a standard assessment tool and goal-based guidance in addressing health behaviors and associated cardiometabolic risk, serving as a natural complement to a lifestyle intervention program.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Yearlong Diabetes Prevention Program-Based Lifestyle Intervention on Cardiovascular Health Metrics

Devaraj

Rockette‐Wagner

Miller

et al. 2021

J Prim Care Community Health

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Introduction The American Heart Association created “Life’s Simple Seven” metrics to estimate progress toward improving US cardiovascular health in a standardized manner. Given the widespread use of federally funded Diabetes Prevention Program (DPP)-based lifestyle interventions such as the Group Lifestyle Balance (DPP-GLB), evaluation of change in health metrics within such a program is of national interest. This study examined change in cardiovascular health metric scores during the course of a yearlong DPP-GLB intervention. Methods Data were combined from 2 similar randomized trials offering a community based DPP-GLB lifestyle intervention to overweight/obese individuals with prediabetes and/or metabolic syndrome. Pre/post lifestyle intervention participation changes in 5 of the 7 cardiovascular health metrics were examined at 6 and 12 months (BMI, blood pressure, total cholesterol, fasting plasma glucose, physical activity). Smoking was rare and diet was not measured. Results Among 305 participants with complete data (81.8% of 373 eligible adults), significant improvements were demonstrated in all 5 risk factors measured continuously at 6 and 12 months. There were significant positive shifts in the “ideal” and “total” metric scores at both time points. Also noted were beneficial shifts in the proportion of participants across categories for BMI, activity, and blood pressure. Conclusion AHA-metrics could have clinical utility in estimating an individual’s cardiovascular health status and in capturing improvement in cardiometabolic/behavioral risk factors resulting from participation in a community-based translation of the DPP lifestyle intervention.

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“…Lack of time for DASH counseling, reported by 71% of providers, is also comparable the 76-81% of providers reporting this as a barrier to any dietary counseling, despite the compelling evidence for DASH [8,[11][12][13]. Thus, easily accessible educational resources that can be dispensed key, and were supported by survey respondents.…”

Section: Resultsmentioning

confidence: 77%

Physician Perceived Barriers and Solutions to DASH Diet Recommendations for Hypertension Prevention and Management

Park¹,

Billups²,

Schilling³

2021

J Hypertens Manag

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Background:The Dietary Approach to Stopping Hypertension (DASH) is considered first-line therapy for hypertension, yet clinical practice implementation remains suboptimal. Methods:We designed a survey to assess four domains:(1) Provider beliefs/knowledge of DASH benefits, (2) Patient characteristics influencing likelihood of recommendation, (3) Practice barriers to provision of DASH diet advice, and (4) Resources of perceived value. The survey was sent to University of Colorado School of medicine primary care providers practicing in the Denver metro area. Results:The survey was sent electronically to 149 providers, with 49 (33%) responders. Most (65%) believed DASH diet is as effective at lowering blood pressure as adding a medication. The most common patient and practice barriers influencing the decision to provide DASH dietary advice included perceived low patient motivation (90%) or ability (86%) to implement DASH diet, lack of provider time (71%), and lack of patient-directed educational resources (67%). Resources providers identified as useful included resources accessible through the electronic medical record, (88%), a dietician (83%), and printed patient-education materials (59%). Conclusion:Interventions to increase provision of DASH dietary advice should focus on identifying eligible patients, accessible and well-disseminated educational materials, and expanded access to evidence-based interventions involving dieticians.

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Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension

Cited by 22 publications

References 26 publications

Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management

Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management

The Impact of a Yearlong Diabetes Prevention Program-Based Lifestyle Intervention on Cardiovascular Health Metrics

Physician Perceived Barriers and Solutions to DASH Diet Recommendations for Hypertension Prevention and Management

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