Dietitians' Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults.

PURPOSE: To assess dietitians' perspectives on the importance and applicability of interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults in the Canadian context. METHODS: Based on a Cochrane systematic review, we identified 8 promising interventions for enhancing adherence to dietary advice: behavioural contracts, exchange lists, feedback based on self-monitoring, individualized menu suggestions, multiple interventions, portion size awareness, telephone follow-up, and videos. Thirty-two dietitians then completed a 3-round Delphi study by responding to an electronic questionnaire asking them to rate the importance and applicability in their practice of the 8 interventions on a 7-point Likert scale. RESULTS: Using a ≥75% level of agreement, 4 interventions showed strong consensus: multiple interventions, feedback based on self-monitoring, portion size awareness, and videos. Among these, the most significant were (means ± SD for importance and applicability, respectively) feedback based on self-monitoring (6.97 ± 0.18 and 6.72 ± 0.46), portion size awareness (6.69 ± 0.54 and 6.75 ± 0.51), and multiple interventions (6.94 ± 0.25 and 6.81 ± 0.40). CONCLUSIONS: These findings can guide the development of educational training sessions for dietitians to help them provide practice-relevant interventions that will increase the likelihood that patients adhere to their advice regarding prevention and management of chronic diseases.

Phase II Practice-based Evidence in Nutrition (PEN) evaluation: interviews with key informants.

PURPOSE: Dietitians of Canada has collaborated with experts in knowledge translation and transfer, technology, and dietetic practice to develop and implement an innovative online decision-support system called Practice-based Evidence in Nutrition (PEN). A study was conducted to evaluate the perceived facilitators and barriers that enable dietitians to use or prevent them from using PEN. METHODS: As part of the overall evaluation framework of PEN, a qualitative descriptive research design was used to address the research purpose. Individual, semi-structured telephone interviews with 17 key informants were completed, and the interview transcripts underwent qualitative content analysis. RESULTS: Respondents identified several facilitators of and barriers to PEN use. Facilitators included specificity to dietetics, rigorous/expert review, easy accessibility, current content, credible/secure material, well-organized/easy-to-use material, material that is valuable to practice, and good value for money. Barriers included perceived high cost, fee structuring/cost to students, certain organizational aspects, and a perceived lack of training for pathway contributors. CONCLUSIONS: This formative evaluation has indicated areas in which PEN could be improved and strategies to make PEN the standard for dietetic education and practice. Ensuring that PEN is meeting users' knowledge needs is of the utmost importance if dietitians are to remain on the cutting edge of scientific inquiry.

Developing an interview guide to evaluate practice-based evidence in nutrition: use of the delphi technique.

An interview guide was created for qualitative evaluation of the impact of Practice-based Evidence in Nutrition (PEN) on dietetic practice, and its success as a medium for knowledge translation and transfer (KTT). The Delphi technique was used to bring together a diverse group of experts (n=7) with extensive knowledge in KTT and evidence-based practice (EBP); these experts developed the interview guide content. The technique is an effective means of gathering expert input to inform evaluation tool development, particularly in the absence of accepted evaluation guidelines or pre-existing evaluation tools. Although challenges exist with the Delphi technique, it is an adaptable method that can be modified to meet a variety of needs. During this project, the technique was modified to meet specific needs, including participants' partial anonymity and starting material to reduce the number of required rounds. The resulting interview guide contained open-ended questions focused on respondents' understanding of EBP and PEN, use of PEN by dietitians in other disciplines, perceptions of the quality/usefulness of PEN, and barriers to and facilitators of PEN use.

Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults: a study protocol.

BACKGROUND: Adoption of a healthy diet has been identified as the cornerstone in the prevention and management of chronic diseases. However, non-adherence to lifestyle changes raises an important issue since adherence level to dietary advice is a key determinant of the effectiveness of dietary treatment. Therefore, based on the results of a Cochrane systematic review on interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults, the aim of this study is to assess the importance and applicability of interventions enhancing adherence to dietary advice in the Canadian context. METHODS/DESIGN: In phase 1, dietitians' opinion will be assessed through a Delphi study regarding the importance and the applicability in the Canadian context of the interventions found the most effective to enhance adherence to dietary advice through a Cochrane systematic review. In phase 2, findings of the Cochrane systematic review assessing the effects of interventions for enhancing adherence to dietary advice will be reported in a practical format on an online knowledge translation tool for dietitians and other health professionals. DISCUSSION: In recent years, there has been an increasing recognition of the failure to translate research findings into clinical practice. Therefore, knowledge translation efforts need to prioritize effective interventions that will be the most relevant for practice and end-users by adapting them to the local context. Our study will provide decision makers in the field of dietetic practice with essential knowledge on adherence for elaborating educational activities for academic or professional settings that will respond to dietitians' priorities in terms of importance and applicability to day-to-day practice.