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

Abstract

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ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature.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.

The effect of nutrition training for health care staff on learner and patient outcomes in adults: a systematic review and meta-analysis

“…The results of the current review are consistent with the findings of others (8,10,16,18) in this area in that there is a lack of evidence of either effectiveness or ineffectiveness of staff nutrition training interventions. In a review assessing the impact of interventions to indirectly support food and drink intake in people with dementia, Abdelhamid et al (12) reported that the training interventions were too small and/or short-term for any definitive conclusions to be drawn regarding effectiveness.…”

“…Malnourished individuals experience longer hospital stays (1,2) and are more likely to be institutionalized (3)(4)(5), and as a result, the costs associated with malnutrition have been estimated as £14 billion, V120 billion, and $432 billion each year in the United Kingdom, Europe, and the United States, respectively. Although the need to improve nutritional care has long been recognized and clinical guidance for the detection and management of malnutrition exists (6), nutritional care is often inadequate (7,8).…”

“…A number of systematic reviews and meta-analyses have investigated the impact of a variety of interventions designed to support staff in improving the nutritional care of patients or residents, including staff training in nutrition (6)(7)(8)(11)(12)(13)(14). None of these reviews, however, took into consideration the training strategies used even though training strategies may have a significant impact on learner and patient outcomes (15,16).…”

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

“…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].…”

“…In such settings, it would be most imperative to conduct an evaluation of the situation of nutrition education, the confidence, knowledge and attitudes of future medical doctors as a necessary step towards empowering them to be able to provide nutrition care to prevent and reduce the burden of diet-related diseases [27][28][29][30][31][32][33]. The findings of a recent realist review of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals highlighted the importance of undertaking a needs assessment in this direction [34].…”