Nancy M. Tolman

Recommendations of Dietitians for Overcoming Barriers to Dietary Adherence in Individuals With Diabetes

PURPOSE The purposes of this research were to (1) identify factors that contribute to the barriers to dietary adherence in individuals with diabetes identified in a 1998 study and (2) obtain recommendations from registered dietitians for strategies to overcome these barriers. METHODS A 10-item, open-ended telephone questionnaire was used to obtain information. The sample included 75 registered dietitians who participated in a previous survey to identify barriers and agreed to a follow-up telephone interview. RESULTS Of the 75 participants, 28% reported spending 5 hours or less per week counseling individuals with diabetes, 64% spent between 6 and 30 hours, and 8% spent more than 31 hours per week. Almost half of the participants (47%) were certified diabetes educators. Factors identified as the greatest contributors to the barriers being evaluated included lack of time, lack of symptoms, lack of education (including follow-up), poor self-esteem/lack of empowerment, and misinformation from family/peers/others with diabetes. The primary recommendations for overcoming each of these barriers included individualizing meal plans and planning ahead, teaching about complications, and setting obtainable goals. CONCLUSIONS The registered dietitians who were surveyed emphasized the importance of individualizing dietary counseling.

Primary Follow-up Care in a Multidisciplinary Setting Enhances Catch-up Growth of Very-low-birth-weight Infants

OBJECTIVE To determine the impact of multidisciplinary primary care follow-up, which included the services of a registered dietitian, on growth outcomes of very-low-birth-weight (VLBW) infants. DESIGN Data were obtained retrospectively from medical records. Forty-two infants receiving follow-up care on an as needed basis from the general pediatric clinic were compared with 33 infants receiving multidisciplinary follow-up care that included routine nutrition intervention from the comprehensive care clinic. Comparisons were made in weight, length, and head circumference measurements; growth rates; and catch-up growth (defined as > or = 5th percentile on growth charts of the National Center for Health Statistics attained by 12 months growth-corrected age). SUBJECTS VLBW infants (< or = 1,500 g at birth) were selected from both follow-up groups. STATISTICAL ANALYSIS Chi 2 Analysis compared the proportions of infants in each group who achieved catch-up growth. Unpaired t tests compared group means in weight, length, and head circumference measurements and growth rates. RESULTS The two groups differed significantly in the number of infants exhibiting catch-up growth for length and head circumference. At 8 months growth-corrected age, 7 (28%) of the general pediatric clinic infants were at the 5th percentile or greater for length compared with 21 (64%) of the comprehensive care clinic infants (P < .01); 15 (60%) of the general pediatric clinic group and 30 (91%) of the comprehensive care clinic group were at the 5th percentile or greater for head circumference (P < .05). At 12 months growth-corrected age, 12 (57%) of the general pediatric clinic infants and 26 (87%) of the comprehensive care clinic infants were at the 5th percentile or greater for length (P < .05); 11 (52%) of the general pediatric clinic infants and 27 (90%) of the comprehensive care clinic infants were at the 5th percentile or greater for head circumference (P < .05). APPLICATIONS Multidisciplinary primary care follow-up that includes the services of a registered dietitian for nutrition intervention can enhance the catch-up growth of VLBW infants through 12 months growth-corrected age.

Motivational Strategies Used By Dietitians Counseling Individuals With Diabetes Mellitus

Abstract LEARNING OUTCOME: Learner will identify motivational strategies used most often and those perceived most effective by dietitians counseling individuals with diabetes. The purpose of this study was to determine use and perceived effectiveness of motivational strategies used by dietitians counseling individuals with diabetes. A total of 862 members of ADAs Diabetes Care and Education Practice Group were surveyed. A 3-part questionnaire (motivational strategies, barriers to compliance, and demographic information) was designed by the research team. Data were analyzed using NCSS. Demographics and use of motivational strategies were described using frequencies. Chi-squared analysis was used to determine differences based on demographic variables. 430 subjects responded (50% response rate) and 398 questionnaires were usable. Almost half of the respondents were certified diabetes educators and about half worked in hospital settings. Only 13 of the 32 (41%) motivational strategies were used frequently by 50% or more of the dietitians. The top 2 strategies based on perceived effectiveness were tailoring the diet to clients lifestyle and involving client in decision making. These strategies were also used frequently by a majority of the dietitians. There were differences in use of motivational strategies based on setting of practice and certification as a diabetes educator. For example, CDEs used sequencing of instructional steps, promotion of blood glucose monitoring and exercise and group classes significantly (p