The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review

Kocanda, Lucy; Brain, Katherine; Frawley, Julia; Schumacher, Tracy; May, Jennifer; Rollo, Megan E.; Brown, Leanne

doi:10.1016/j.jand.2021.05.025

Cited by 7 publications

(10 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Development processes for face‐to‐face and telehealth nutrition interventions for CVD prevention in rural areas across the globe have not been well documented to date 49,53 . Nutrition interventions for CVD currently focus on reporting effectiveness and feasibility outcomes rather than providing a comprehensive description of the intervention development approach 5,15,49,53 . Although evidence has been synthesised and confirms effectiveness and feasibility of nutrition interventions to improve diet‐related CVD risk, the limited and/or poor reporting of design elements makes replicability and translation of these interventions into practice difficult 5,15,49,53 .…”

Section: Discussionmentioning

confidence: 99%

“…5,15,49,53 Although evidence has been synthesised and confirms effectiveness and feasibility of nutrition interventions to improve dietrelated CVD risk, the limited and/or poor reporting of design elements makes replicability and translation of these interventions into practice difficult. 5,15,49,53 Given that knowledge translation of nutrition intervention to lower CVD risk is limited, improving both the design and reporting of these interventions is a priority. 49 Previous research has identified that telehealth is not always well accepted amongst health providers, including those working in rural locations.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Developing a telehealth medical nutrition therapy (MNT) service for adults living in rural Australia at risk of cardiovascular disease: An intervention development study

Herbert

Schumacher

Brown

et al. 2023

J Human Nutrition Diet

Self Cite

View full text Add to dashboard Cite

BackgroundReceiving medical nutrition therapy (MNT) from an accredited practising dietitian (APD) can reduce diet‐related cardiovascular disease (CVD) risk factors. However, people living in rural areas of Australia experience barriers to accessing dietitians because of their remote location. Telehealth has the potential to improve dietetic access in rural areas; however, there is limited research into the development and delivery of telehealth MNT interventions specific to these areas. The present study describes the development of the Healthy Rural Hearts (HealthyRHearts) telehealth MNT intervention, which was developed as a part of the HealthyRHearts randomised control trial, set in primary care practices in rural areas of the Hunter New England and Central Coast Primary Health Network. The aim of HealthyRHearts is to improve diet‐related risk factors for CVD in rural adults at moderate to high CVD risk using a telehealth MNT intervention delivered by an APD.MethodsThe study describes the development of the HealthyRHearts telehealth MNT intervention, using the 14‐item GUIDance for rEporting of intervention Development (GUIDED) checklist and the Template for Intervention Description and Replication (TIDieR) framework to guide description.ResultsHealthyRHearts is a complex intervention that aims to translate a telehealth MNT intervention for CVD prevention into rural and remote primary care settings. The intervention is designed to be implemented across multiple sites of varying characteristics and needs, with the ability to accommodate individual complexities within the rural context and target population. Participants are adults aged 45–75 years who are assessed as moderate to high risk of CVD by their general practitioner (GP). Consenting participants are referred to the intervention by their GPs and receive five telehealth MNT consultations with an APD over 6‐months. APDs are trained in the intervention protocol including intervention materials, resources and behaviour change counselling strategies.ConclusionUsing the GUIDED and TIDieR frameworks to guide description of the HealthyRHearts intervention development process facilitates detailed description of decision‐making pathways for each element of the intervention design. The comprehensive description of the intervention development process for HealthyRHearts is intended to facilitate replication, iteration and optimisation of the intervention for rural contexts.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Developing a telehealth medical nutrition therapy (MNT) service for adults living in rural Australia at risk of cardiovascular disease: An intervention development study

Herbert

Schumacher

Brown

et al. 2023

J Human Nutrition Diet

Self Cite

View full text Add to dashboard Cite

show abstract

“…These reviews published between 2020 and 2023 (including 94 unique studies) together, highlight significant gaps in rural nutrition and dietetics research to date in Australia and generate extensive data to inform considerations for future research. 4,6,[10][11][12][13] Specifically, there has been a lack of dietary intervention research in rural Australian communities 11 or in rural communities globally, 14 incomplete dietary intake data collected in these populations, a lack of exploration on how environmental sustainability could impact rural nutrition, as well as an under-utilisation of rural dieticians in this research. 11,12 Further, minimal food environment interventions specific to rural areas have been conducted either in Australia or globally 15 despite the evidence that rural food environments are less healthy and have minimal promotion of healthy foods.…”

Section: Rural Nutrition Researchmentioning

confidence: 99%

Rural nutrition and dietetics research—Future directions

Alston,

Heaney,

Kent

et al. 2023

Australian J Rural Health

Self Cite

View full text Add to dashboard Cite

AimThe aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities.ContextClear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade.ApproachA review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts.ConclusionEstablishing strong, collaborative place‐based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition‐related disease disparity between rural and metropolitan Australia.

show abstract

“…Whilst there is a need to privilege preventative medicine addressing CVD risk factors [ 10 ], there is little published research specific to rural communities to guide practice [ 11 ]. Specifically, there is limited evidence of improvement in dietary intake patterns secondary to nutrition interventions in the context of CVD prevention and management within rural communities [ 12 – 14 ]. In addition, only a small proportion of research funding is dedicated to rural research [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

Schumacher¹,

Herbert²,

May³

et al. 2023

BMC Cardiovasc Disord

Self Cite

View full text Add to dashboard Cite

Background Few randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings. Methods/design A cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey – Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies. Discussion Research outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia. Trial registration This trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

show abstract

The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review

Cited by 7 publications

References 68 publications

Developing a telehealth medical nutrition therapy (MNT) service for adults living in rural Australia at risk of cardiovascular disease: An intervention development study

Developing a telehealth medical nutrition therapy (MNT) service for adults living in rural Australia at risk of cardiovascular disease: An intervention development study

Rural nutrition and dietetics research—Future directions

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

Contact Info

Product

Resources

About