Jane McClinchy

Practitioner and lay perspectives of the service provision of nutrition information leaflets in primary care.

BACKGROUND In primary care, leaflets are often used to communicate health information. Increasingly, primary healthcare practitioners need to provide dietary advice. There is limited research exploring how nutrition information leaflets are used in primary care. The present study explored practitioner and lay experiences with respect to providing and receiving nutrition information in primary care, focusing in particular on the use of leaflets for nutrition information. METHODS A qualitative design was used incorporating focus groups with 57 practitioners based at seven general practitioner practices and a purposive sample of 30 lay participants attending six Consumer Health Organisations within one primary care trust. Focus groups were taped and transcribed verbatim and data were analysed thematically, assisted by computer software n6® (QSR International Pty Ltd, Melbourne, Australia). RESULTS Practitioners discussed barriers to giving nutritional advice, access to leaflets, lay receptiveness to advice and their perceptions about the value of leaflets to lay people. Food was not considered in terms of its nutritional components by lay participants and the need for nutritional information was not perceived to be relevant until they had received a medical diagnosis. Lay participants discussed the importance of receiving nutritional advice relating to their medical diagnosis and the altered status of written information that was delivered personally. Practitioner and lay groups suggested improvements to ensure that nutritional advice be supported by relevant and appropriate written information. CONCLUSIONS This research has underlined the continuing importance of nutrition information leaflets and concludes that there is particular value in involving lay participants in the development of nutrition information leaflets.

Dietary Advice and Collaborative Working: Do Pharmacists and Allied Health Professionals Other Than Dietitians Have a Role?

Long term health conditions either wholly or partly diet-related continue to increase. Although pharmacists and allied health professionals (AHPs) have a role in the management of patients with long term conditions, there is limited research exploring whether pharmacists and AHPs other than dietitians have a role in the delivery of dietary advice. This research aimed to explore their views regarding the provision of dietary advice to patients. The research involved a qualitative methodology utilising five uni-professional focus groups with a total of 23 participants. All groups considered the provision of dietary advice in the context of their own professional roles, discussed issues relating to referral to the dietitian for specialist advice and most discussed the need for written information. Interprofessional and collaborative working is needed to maximise the role in the delivery of dietary advice, access to evidence based nutritional information and utlisation of referral pathways across pharmacists and AHPs to ensure the timely provision of nutritional advice to patients. There is a potential role for dietitians to take the lead and further research should focus on this area.

A multidisciplinary approach to providing nutritional advice : the views and experiences of allied health professionals and dietitians

The role of professional placements in the development of dietetic competencies is widely accepted. There is a surprising lack of scholarship to assess what extent and how practice-based learning exposures contribute to competency accumulation across the different domains of practice. This qualitative study explored the experience of recent dietetic graduates whilst on placements across three domains of nutrition and dietetic practice, including clinical, food service and public health nutrition practice. This investigation focused particularly on the various factors infl uencing competency development in the placement environment. Qualitative interviews (n = 30) were conducted with recent graduates from 3 Universities in Australia, from 2 under-graduate and 1 post-graduate program. A semi structured interview technique was used to explore the experience of students whilst on each placement. These interviews were administered, recorded, and transcribed by a trained interviewer. All members of the research team reviewed the transcripts and compared, clarifi ed and interpreted the key response themes (research triangulation). Students consistently reported that professional placements forced accelerated competency development. Physical (the work environment) and interpersonal factors (such as attributes of the supervisor) were identifi ed as major infl uences on competency development. The following factors were also thematically identified as major contributors to the students learning experience: work space, organisation within departments, orientation to placement, organisational climate, supervisor communication, personality, interpersonal skills and teaching ability. Personal attributes of the student were also found to impact on competency development. These themes were consistent across practice domains. This study provides valuable evidence for academics and practitioners when developing placement programs.Abstract of poster presented at Dietitians Association of Australia 16th International Congress of Dietetics, 5-8 September 2012, Sydney Convention & Exhibition Centre, Sydney, Australia. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baker, J., Fish, J., Walton, K. L., McMahon, A., Brewer, C. J., Manning, F., Grafenauer, S., Kennedy, M. A. & Probst, Y. (2012). If a picture tells a thousand words, how useful are they as a teaching tool? Evaluating a digital food photo resource within a first year tertiary nutrition subject. Nutrition and Dietetics, 69 (Suppl. S1), 158-158. Authors Joanna Baker, Janaye Fish, Karen L. Walton, Anne Therese McMahon, Christine J. Brewer, Fiona Manning, Sara Grafenauer, Meredith A. Kennedy, and Yasmine Probst This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3193The role of Australian general practitioners (GPs) in providing nutrition care to patients for chronic disease management is currently receiving increased attention. However, limited literature explores the experiences of patients receiving nutrition care in this setting, as well as the nutrition-related expectations placed upon GPs by patients. This study explored the nutrition-related experiences, expectations and satisfaction of individuals diagnosed with Type II Diabetes under the care of an Australian GP. A cross-sectional retrospective online survey was developed using a review of relevant literature and practice guidelines for management of Type II diabetes in general practice to guide specifi c lines of enquiry. The survey was sent to all members of Diabetes Australia, Queensland with a registered author-address. Sixty-three survey items were clustered into fi ve groups, including general and diabetesrelated demographics; nutrition-related self effi cacy; perspectives on ideal GP nutrition care; and refl ections of previous GP nutrition care. Nine hundred and seventeen participants completed the survey (RR = 11%). Despite 81% of participants claiming that receiving nutrition care will be benefi cial to their diabetes management, only 49% of participants state that their GP has provided some nutrition care in relation to their diabetes. Of these participants, 86% are satisfi ed with the nutrition care received; however only 27% of participants believe that the nutrition care they have received from their GP has positively infl uenced their diabetes management. Patients report high levels of satisfaction with nutrition care received by GPs however varied perceptions regarding the effectiveness of this care.

Dietary management of older people with diabetes

Diabetes UKs revised nutrition guidelines for the prevention and management of diabetes, published recently, encourage education in self-management and include additional guidance for older people with diabetes. The incidence of diabetes in older people is increasing. Many older people with diabetes are healthy and mobile, and live in the community, but a number are frail and living in care homes. Those who are frail are at increased risk of malnutrition from a range of causes. Older people with diabetes should be assessed for malnutrition risk and referred to a dietitian if required. Management of these patients focuses on foods that are high in protein and energy foods. A case study gives an example of how a community nurse may be involved.

A qualitative exploration of the value of volunteering to the employability of nutrition and dietetic graduates amongst employers

Background: The latest available data for England show that childhood obesity continues to be a major public health concern with 9.3% of 4–5 years old and 18.9% of 10–11 years old children found to be obese (1). The aim of the study was to explore attitudes towards a community based childhood obesity prevention project among parents participating in the programme. Methods: The ‘Fit Together’ programme was provided in socio-economically deprived areas of Leeds which, at the time of the research study, was in its final year of running. The programme was delivered for 2 hours each week over a six week period by community health educators, and involved health education and cooking sessions. A convenience sample of parents who had attended at least one session of the Fit Together programme, delivered between November-December 2014, were recruited from a children’s centre (where families access health advice and related activities with their children aged 0– 5yr) and a primary school. Semi-structured interviews were conducted using a topic schedule with prompts, and were digitally recorded. A short screening questionnaire was completed to obtain demographic information. Three parents were present in each of the two Fit Together sessions allocated for recruitment. These six parents were recruited to the study and were interviewed. Interviews were transcribed verbatim, transcripts manually coded and thematic analysis conducted using a framework approach. Ethical approval for the study was obtained from the Faculty of Health & Social Sciences Local Research Ethics Coordinator, Leeds Beckett University. Results: Participants were all mothers with 1–3 children, and mean age was 27 years. Four participants self-defined their ethnicity as White British and the remaining two as Pakistani. Themes emerging from the interview data suggested that participants’ appraisal of the programme was positive and they reported benefits in behaviour change relevant to addressing childhood obesity. Parents felt the programme was logistically suitable, and had appropriate content and leaders. All participants would recommend the programme and highlighted the development of their cooking skills, which related to an increase in home cooking and in fruit and vegetable consumption. The opportunity to involve their children and spend time with them learning skills was a strongly held view among respondents. Parents felt the programme had also increased their awareness of nutrition content and children’s dietary habits. However, the view that an extended programme and subsequent follow-up were needed was commonly held. Additional benefits beyond behaviour change were also expressed. For example, the importance of social interaction was clear, with respondents reporting the alleviation of boredom and isolation while attending the programme, as this participant states: “Something to do ain’t it? Gets you out. There’s nothing else to go to” (White British, 23yr, 2 children). Participants also reported exchanging cultural beliefs and learning new styles of cooking from people from different backgrounds. Discussion: The findings of this first exploration of parents’ attitudes to Fit Together supports existing literature on the value of community educators in delivering health interventions (2). Beneficial behaviour change such as increased homecooking was consistent with previous programmes (3). Conclusion: Attitudes towards Fit Together were positive, with mothers viewing the programme as acceptable and bene- ficial. References 1. Stevens. L., & Nelson, M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population. Journal of Human Nutrition and Dietetics, 24; 223–232. 2011. 2. Evans, C., & Harper, C. A History and Review of school meals standards in the UK. Journal of Human Nutrition and Dietetics, 89–99. 2009. 3. Lop ez Nomdedeu, C. Agencia Espanola de Seguridad Alimentaria y Nutricion. Ministerio de Sanidad y Consum. La alimentacion de tus ni nos. Nutrici ~ on Saludable de la Infan- cia a la Adolescencia. Madrid: Fiselgraf, S.L. 2002.Background: The latest available data for England show that childhood obesity continues to be a major public health concern with 9.3% of 4–5 years old and 18.9% of 10–11 years old children found to be obese (1). The aim of the study was to explore attitudes towards a community based childhood obesity prevention project among parents participating in the programme. Methods: The ‘Fit Together’ programme was provided in socio-economically deprived areas of Leeds which, at the time of the research study, was in its final year of running. The programme was delivered for 2 hours each week over a six week period by community health educators, and involved health education and cooking sessions. A convenience sample of parents who had attended at least one session of the Fit Together programme, delivered between November-December 2014, were recruited from a children’s centre (where families access health advice and related activities with their children aged 0– 5yr) and a primary school. Semi-structured interviews were conducted using a topic schedule with prompts, and were digitally recorded. A short screening questionnaire was completed to obtain demographic information. Three parents were present in each of the two Fit Together sessions allocated for recruitment. These six parents were recruited to the study and were interviewed. Interviews were transcribed verbatim, transcripts manually coded and thematic analysis conducted using a framework approach. Ethical approval for the study was obtained from the Faculty of Health & Social Sciences Local Research Ethics Coordinator, Leeds Beckett University. Results: Participants were all mothers with 1–3 children, and mean age was 27 years. Four participants self-defined their ethnicity as White British and the remaining two as Pakistani. Themes emerging from the interview data suggested that participants’ appraisal of the programme was positive and they reported benefits in behaviour change relevant to addressing childhood obesity. Parents felt the programme was logistically suitable, and had appropriate content and leaders. All participants would recommend the programme and highlighted the development of their cooking skills, which related to an increase in home cooking and in fruit and vegetable consumption. The opportunity to involve their children and spend time with them learning skills was a strongly held view among respondents. Parents felt the programme had also increased their awareness of nutrition content and children’s dietary habits. However, the view that an extended programme and subsequent follow-up were needed was commonly held. Additional benefits beyond behaviour change were also expressed. For example, the importance of social interaction was clear, with respondents reporting the alleviation of boredom and isolation while attending the programme, as this participant states: “Something to do ain’t it? Gets you out. There’s nothing else to go to” (White British, 23yr, 2 children). Participants also reported exchanging cultural beliefs and learning new styles of cooking from people from different backgrounds. Discussion: The findings of this first exploration of parents’ attitudes to Fit Together supports existing literature on the value of community educators in delivering health interventions (2). Beneficial behaviour change such as increased homecooking was consistent with previous programmes (3). Conclusion: Attitudes towards Fit Together were positive, with mothers viewing the programme as acceptable and bene- ficial. References 1. Stevens. L., & Nelson, M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population. Journal of Human Nutrition and Dietetics, 24; 223–232. 2011. 2. Evans, C., & Harper, C. A History and Review of school meals standards in the UK. Journal of Human Nutrition and Dietetics, 89–99. 2009. 3. Lop ez Nomdedeu, C. Agencia Espanola de Seguridad Alimentaria y Nutricion. Ministerio de Sanidad y Consum. La alimentacion de tus ni nos. Nutrici ~ on Saludable de la Infan- cia a la Adolescencia. Madrid: Fiselgraf, S.L. 2002.

An exploration of the language used alongside the Process for Nutrition and Dietetic Practice (PNDP) to describe nutrition-related problems

Jane McClinchy, Rebekah Lindhop, ‘An exploration of the language used alongside the Process for Nutrition and Dietetic Practice (PNDP) to describe nutrition-related problems’, poster presented at the British Dietetic Association Research Symposium, Birmingham, UK, 2 December, 2015.

Lay and practitioner perspectives and experiences of obesity

The role of professional placements in the development of dietetic competencies is widely accepted. There is a surprising lack of scholarship to assess what extent and how practice-based learning exposures contribute to competency accumulation across the different domains of practice. This qualitative study explored the experience of recent dietetic graduates whilst on placements across three domains of nutrition and dietetic practice, including clinical, food service and public health nutrition practice. This investigation focused particularly on the various factors infl uencing competency development in the placement environment. Qualitative interviews (n = 30) were conducted with recent graduates from 3 Universities in Australia, from 2 under-graduate and 1 post-graduate program. A semi structured interview technique was used to explore the experience of students whilst on each placement. These interviews were administered, recorded, and transcribed by a trained interviewer. All members of the research team reviewed the transcripts and compared, clarifi ed and interpreted the key response themes (research triangulation). Students consistently reported that professional placements forced accelerated competency development. Physical (the work environment) and interpersonal factors (such as attributes of the supervisor) were identifi ed as major infl uences on competency development. The following factors were also thematically identified as major contributors to the students learning experience: work space, organisation within departments, orientation to placement, organisational climate, supervisor communication, personality, interpersonal skills and teaching ability. Personal attributes of the student were also found to impact on competency development. These themes were consistent across practice domains. This study provides valuable evidence for academics and practitioners when developing placement programs.Abstract of poster presented at Dietitians Association of Australia 16th International Congress of Dietetics, 5-8 September 2012, Sydney Convention & Exhibition Centre, Sydney, Australia. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baker, J., Fish, J., Walton, K. L., McMahon, A., Brewer, C. J., Manning, F., Grafenauer, S., Kennedy, M. A. & Probst, Y. (2012). If a picture tells a thousand words, how useful are they as a teaching tool? Evaluating a digital food photo resource within a first year tertiary nutrition subject. Nutrition and Dietetics, 69 (Suppl. S1), 158-158. Authors Joanna Baker, Janaye Fish, Karen L. Walton, Anne Therese McMahon, Christine J. Brewer, Fiona Manning, Sara Grafenauer, Meredith A. Kennedy, and Yasmine Probst This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3193The role of Australian general practitioners (GPs) in providing nutrition care to patients for chronic disease management is currently receiving increased attention. However, limited literature explores the experiences of patients receiving nutrition care in this setting, as well as the nutrition-related expectations placed upon GPs by patients. This study explored the nutrition-related experiences, expectations and satisfaction of individuals diagnosed with Type II Diabetes under the care of an Australian GP. A cross-sectional retrospective online survey was developed using a review of relevant literature and practice guidelines for management of Type II diabetes in general practice to guide specifi c lines of enquiry. The survey was sent to all members of Diabetes Australia, Queensland with a registered author-address. Sixty-three survey items were clustered into fi ve groups, including general and diabetesrelated demographics; nutrition-related self effi cacy; perspectives on ideal GP nutrition care; and refl ections of previous GP nutrition care. Nine hundred and seventeen participants completed the survey (RR = 11%). Despite 81% of participants claiming that receiving nutrition care will be benefi cial to their diabetes management, only 49% of participants state that their GP has provided some nutrition care in relation to their diabetes. Of these participants, 86% are satisfi ed with the nutrition care received; however only 27% of participants believe that the nutrition care they have received from their GP has positively infl uenced their diabetes management. Patients report high levels of satisfaction with nutrition care received by GPs however varied perceptions regarding the effectiveness of this care.

Should the UK define separate BMI categories for older people

The role of professional placements in the development of dietetic competencies is widely accepted. There is a surprising lack of scholarship to assess what extent and how practice-based learning exposures contribute to competency accumulation across the different domains of practice. This qualitative study explored the experience of recent dietetic graduates whilst on placements across three domains of nutrition and dietetic practice, including clinical, food service and public health nutrition practice. This investigation focused particularly on the various factors infl uencing competency development in the placement environment. Qualitative interviews (n = 30) were conducted with recent graduates from 3 Universities in Australia, from 2 under-graduate and 1 post-graduate program. A semi structured interview technique was used to explore the experience of students whilst on each placement. These interviews were administered, recorded, and transcribed by a trained interviewer. All members of the research team reviewed the transcripts and compared, clarifi ed and interpreted the key response themes (research triangulation). Students consistently reported that professional placements forced accelerated competency development. Physical (the work environment) and interpersonal factors (such as attributes of the supervisor) were identifi ed as major infl uences on competency development. The following factors were also thematically identified as major contributors to the students learning experience: work space, organisation within departments, orientation to placement, organisational climate, supervisor communication, personality, interpersonal skills and teaching ability. Personal attributes of the student were also found to impact on competency development. These themes were consistent across practice domains. This study provides valuable evidence for academics and practitioners when developing placement programs.Abstract of poster presented at Dietitians Association of Australia 16th International Congress of Dietetics, 5-8 September 2012, Sydney Convention & Exhibition Centre, Sydney, Australia. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baker, J., Fish, J., Walton, K. L., McMahon, A., Brewer, C. J., Manning, F., Grafenauer, S., Kennedy, M. A. & Probst, Y. (2012). If a picture tells a thousand words, how useful are they as a teaching tool? Evaluating a digital food photo resource within a first year tertiary nutrition subject. Nutrition and Dietetics, 69 (Suppl. S1), 158-158. Authors Joanna Baker, Janaye Fish, Karen L. Walton, Anne Therese McMahon, Christine J. Brewer, Fiona Manning, Sara Grafenauer, Meredith A. Kennedy, and Yasmine Probst This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3193The role of Australian general practitioners (GPs) in providing nutrition care to patients for chronic disease management is currently receiving increased attention. However, limited literature explores the experiences of patients receiving nutrition care in this setting, as well as the nutrition-related expectations placed upon GPs by patients. This study explored the nutrition-related experiences, expectations and satisfaction of individuals diagnosed with Type II Diabetes under the care of an Australian GP. A cross-sectional retrospective online survey was developed using a review of relevant literature and practice guidelines for management of Type II diabetes in general practice to guide specifi c lines of enquiry. The survey was sent to all members of Diabetes Australia, Queensland with a registered author-address. Sixty-three survey items were clustered into fi ve groups, including general and diabetesrelated demographics; nutrition-related self effi cacy; perspectives on ideal GP nutrition care; and refl ections of previous GP nutrition care. Nine hundred and seventeen participants completed the survey (RR = 11%). Despite 81% of participants claiming that receiving nutrition care will be benefi cial to their diabetes management, only 49% of participants state that their GP has provided some nutrition care in relation to their diabetes. Of these participants, 86% are satisfi ed with the nutrition care received; however only 27% of participants believe that the nutrition care they have received from their GP has positively infl uenced their diabetes management. Patients report high levels of satisfaction with nutrition care received by GPs however varied perceptions regarding the effectiveness of this care.

Evaluating Hospital food Service : Nutritional Standards and Staff Views

The role of professional placements in the development of dietetic competencies is widely accepted. There is a surprising lack of scholarship to assess what extent and how practice-based learning exposures contribute to competency accumulation across the different domains of practice. This qualitative study explored the experience of recent dietetic graduates whilst on placements across three domains of nutrition and dietetic practice, including clinical, food service and public health nutrition practice. This investigation focused particularly on the various factors infl uencing competency development in the placement environment. Qualitative interviews (n = 30) were conducted with recent graduates from 3 Universities in Australia, from 2 under-graduate and 1 post-graduate program. A semi structured interview technique was used to explore the experience of students whilst on each placement. These interviews were administered, recorded, and transcribed by a trained interviewer. All members of the research team reviewed the transcripts and compared, clarifi ed and interpreted the key response themes (research triangulation). Students consistently reported that professional placements forced accelerated competency development. Physical (the work environment) and interpersonal factors (such as attributes of the supervisor) were identifi ed as major infl uences on competency development. The following factors were also thematically identified as major contributors to the students learning experience: work space, organisation within departments, orientation to placement, organisational climate, supervisor communication, personality, interpersonal skills and teaching ability. Personal attributes of the student were also found to impact on competency development. These themes were consistent across practice domains. This study provides valuable evidence for academics and practitioners when developing placement programs.Abstract of poster presented at Dietitians Association of Australia 16th International Congress of Dietetics, 5-8 September 2012, Sydney Convention & Exhibition Centre, Sydney, Australia. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baker, J., Fish, J., Walton, K. L., McMahon, A., Brewer, C. J., Manning, F., Grafenauer, S., Kennedy, M. A. & Probst, Y. (2012). If a picture tells a thousand words, how useful are they as a teaching tool? Evaluating a digital food photo resource within a first year tertiary nutrition subject. Nutrition and Dietetics, 69 (Suppl. S1), 158-158. Authors Joanna Baker, Janaye Fish, Karen L. Walton, Anne Therese McMahon, Christine J. Brewer, Fiona Manning, Sara Grafenauer, Meredith A. Kennedy, and Yasmine Probst This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3193The role of Australian general practitioners (GPs) in providing nutrition care to patients for chronic disease management is currently receiving increased attention. However, limited literature explores the experiences of patients receiving nutrition care in this setting, as well as the nutrition-related expectations placed upon GPs by patients. This study explored the nutrition-related experiences, expectations and satisfaction of individuals diagnosed with Type II Diabetes under the care of an Australian GP. A cross-sectional retrospective online survey was developed using a review of relevant literature and practice guidelines for management of Type II diabetes in general practice to guide specifi c lines of enquiry. The survey was sent to all members of Diabetes Australia, Queensland with a registered author-address. Sixty-three survey items were clustered into fi ve groups, including general and diabetesrelated demographics; nutrition-related self effi cacy; perspectives on ideal GP nutrition care; and refl ections of previous GP nutrition care. Nine hundred and seventeen participants completed the survey (RR = 11%). Despite 81% of participants claiming that receiving nutrition care will be benefi cial to their diabetes management, only 49% of participants state that their GP has provided some nutrition care in relation to their diabetes. Of these participants, 86% are satisfi ed with the nutrition care received; however only 27% of participants believe that the nutrition care they have received from their GP has positively infl uenced their diabetes management. Patients report high levels of satisfaction with nutrition care received by GPs however varied perceptions regarding the effectiveness of this care.

An exploration into dietitians’ knowledge about, attitudes towards and experiences of the nutrition and dietetic care process (NDCP).

Research Symposium Abstract from the British Dietetic Association Annual Conference: 30th Nov 2012