Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses.

AIM: To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. BACKGROUND: Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. DESIGN: A qualitative descriptive study. METHODS: Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. RESULTS: Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. CONCLUSION: It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. IMPACT: The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. PATIENT OR PUBLIC CONTRIBUTION: A nurse provided feedback on the interview guide.

Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses.

BACKGROUND: Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases. OBJECTIVE: To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients. METHODS: Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis. RESULTS: Two main themes were determined: professional characteristics and professional-patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional-patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients' own choices and underuse of existing educational materials. CONCLUSIONS: Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.

Hepatitis B in Moroccan-Dutch: a qualitative study into determinants of screening participation.

Background: Chronic hepatitis B (HBV) leads to an increased risk for liver cirrhosis and liver cancer. In the Netherlands, chronic HBV prevalence in the general population is 0.20%, but 3.77% in first generation immigrants. Our aim was to identify determinants associated with the intention to participate in HBV testing among first generation Moroccan immigrants, one of the two largest immigrant groups targeted for screening. Methods: Semi-structured interviews were held with first (n = 9) and second generation (n = 10) Moroccan-Dutch immigrants, since second generation immigrants frequently act as their parents' brokers in healthcare. Results: Most participants had little knowledge about hepatitis B, but had a positive attitude towards screening. Facilitators for screening intention were perceived susceptibility to and severity of disease, positive attitude regarding prevention, wishing to know their hepatitis B status and to prevent potential hepatitis B transmission to others. Additional cultural facilitators included fear (of developing cancer), and existing high health care utilization; a religious facilitator was the responsibility for one's own health and that of others. Barriers included lack of awareness and knowledge, practical issues, not having symptoms, negative attitude regarding prevention, fear about the test result and low-risk perception. A cultural barrier was shame and stigma, and a religious barrier was fatalism. Conclusion: We identified important facilitators and barriers, which we found, can be interpreted differently. Specific and accurate information should be provided, accompanied by strategies to address shame and stigma, in which Islamic religious leaders could play a role in bringing information across.

Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study.

UNLABELLED: Hepatitis B virus (HBV) infections are an important health problem in Turkish migrants in the Netherlands. This study describes the effectiveness of a culturally tailored internet intervention promoting HBV screening in Turkish migrants. METHODS: Turkish migrants, aged 16-40 years old, could participate in an online intervention offering either: (i) behaviourally plus culturally tailored (BCT) information; (ii) behaviourally tailored (BT) information or (iii) generic information (GI). Subsequently, free HBV screening was offered. RESULTS: Out of 10.069 invited persons, 1512 (15%) logged in on the website and 623 people were tested. Screening uptake was 44% in the BCT group, 46% in the GI group and 44% in group BT. The BCT group showed favourable intervention effects for scores on determinants of screening when compared with baseline scores and BT. CONCLUSION: Although BCT did show favourable intervention effects for several determinants addressed in the intervention, we were not able to demonstrate the added value of BCT on screening uptake. TRIAL REGISTRATION: The Netherlands National Trial Register NTR 2394.

Development of a culturally tailored Internet intervention promoting hepatitis B screening in the Turkish community in the Netherlands.

Hepatitis B virus infections are an important health problem in the Turkish community in the Netherlands. Screening for hepatitis B should be promoted through public health interventions, which take into account the socio-cultural and behavioural determinants that influence screening. The Intervention Mapping protocol was used to develop a culturally tailored Internet intervention for first-generation Turkish immigrants in Rotterdam, aged 16-40 year. Behavioural factors and cultural motivators and barriers, identified in the first steps of the protocol, were incorporated in the intervention. To ensure participation, members of the target population were involved in all steps of programme development. A theory- and evidence-based culturally tailored intervention was developed. Both surface structure and deep structure elements were used; surface structure tailoring resulting in different Internet skins and peer-stories for subgroups, such as young women. Deep structure elements comprised cultural motivators such as the religiously inspired feelings of responsibility and strong family values, and perceived community rules regarding health and disease. Cultural barriers that were addressed were the satisfaction and trust in Dutch health care, and the association of hepatitis B screening with sexual behaviour. Intervention Mapping provided a useful framework for the systematic development of our theory- and evidence-based intervention to promote hepatitis B screening in the Turkish community in the Netherlands.

Cultural tailoring for the promotion of hepatitis B screening in Turkish Dutch: a protocol for a randomized controlled trial.

BACKGROUND: Chronic hepatitis B virus infection (HBV) is an important health problem in the Turkish community in the Netherlands, and promotion of screening for HBV in this risk group is necessary. An individually tailored intervention and a culturally tailored intervention have been developed to promote screening in first generation 16-40 year old Turkish immigrants. This paper describes the design of the randomized controlled trial, which will be used to evaluate the effectiveness of the two tailored internet interventions as compared to generic online information on HBV, and to assess the added value of tailoring on socio-cultural factors. METHODS/DESIGN: A cluster randomized controlled trial design, in which we invite all Rotterdam registered inhabitants born in Turkey, aged 16-40 (n = 10,000), to visit the intervention website is used. A cluster includes all persons living at one house address. The clusters are randomly assigned to either group A, B or C. On the website, persons eligible for testing will be selected through a series of exclusion questions and will then continue in the randomly assigned intervention group. Group A will receive generic information on HBV. Group B will receive individually tailored information related to social-cognitive determinants of screening. Group C will receive culturally tailored information which, next to social-cognitive factors, addresses cultural factors related to screening. Subsequently, participants may obtain a laboratory form, with which they can be tested free of charge at local health centres. The main outcome of the study is the percentage of eligible persons tested for HBV through to participation in one of the three groups. Measurements of the outcome behaviour and its determinants will be at baseline and five weeks post-intervention. DISCUSSION: This trial will provide information on the effectiveness of a culturally tailored internet intervention promoting HBV-screening in first generation Turkish immigrants in the Netherlands, aged 16-40. The results will contribute to the evidence base for culturally tailored (internet) interventions in ethnic minority populations. An effective intervention will lead to a reduction of the morbidity and mortality due to HBV in this population. This may not only benefit patients, but also help reduce health inequalities in western countries. TRIAL REGISTRATION: The Netherlands National Trial Register NTR 2394.