The Effects of Dietitian Weight and Self-Disclosure About Weight on Women\u27s Evaluations of Registered Dietitians

This study investigated the effects of dietitian weight status, dietitian self-disclosure about personal weight issues, and participant weight status on participants\u27 initial perceptions and evaluations of registered dietitians. The research design was a randomized 2x2x2 factorial design consisting of 2 dietitian weight status conditions (normal weight and obese), 2 dietitian self-disclosure conditions (absence or presence of self-disclosure about personal weight issues), and 2 participant weight status conditions (normal weight and obese). A simulated nutrition counseling situation was developed in which participants were shown a photograph of a dietitian and then listened to an audio recording of an overview of nutrition counseling supposedly prepared by the dietitian. Participants were subsequently asked to evaluate the dietitian on a variety of dimensions related to nutrition counseling. Results of this study were divided into 3 parts. In the first part, the outcome measures were participants\u27 ratings of the dietitian\u27s expertness, trustworthiness, and attractiveness, as measured by the Counselor Rating Form. Statistical analyses included multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) as appropriate. Results indicated that an obese dietitian who self-disclosed about (i.e., verbally acknowledged) her current overweight status was rated as less expert (p = .0003) and attractive (p = .02) by normal weight participants than an obese dietitian who did not self-disclose. These effects were not observed with obese participants. In the second part, the outcome measures were participants\u27 ratings of their willingness to begin nutrition counseling with the dietitian, perception of the dietitian\u27s knowledgeability, perception of the dietitian\u27s effectiveness (both general effectiveness and effectiveness within a variety of specific nutrition counseling contexts), perception of the dietitian\u27s status as a role model, comfort in discussing personal concerns with the dietitian, and perception of the dietitian\u27s ability to relate to their concerns. Analyses again consisted of MANOVA and ANOVA as appropriate. Results indicated that participants were less willing to begin nutrition counseling with the obese dietitian compared with the normal weight dietitian (p = .01). No effects were observed for participants\u27 ratings of the dietitian\u27s knowledgeability or overall effectiveness as a nutrition counselor. However, the obese dietitian was generally perceived as less effective than the normal weight dietitian in weight-related nutrition counseling contexts (p ≤ .05). The normal weight dietitian who disclosed a past history of overweight was seen as a better role model than the normal weight dietitian who did not self-disclose (p = .02). The obese dietitian who acknowledged her current overweight status was seen as a poorer role model than one who did not self-disclose (p = .0007). Normal weight participants were more comfortable with the normal weight dietitian than with the obese dietitian (p = .01) and also thought that the normal weight dietitian would be better able to relate to their concerns (p = .005). Obese participants were equally comfortable with the normal weight or obese dietitian, but thought that the obese dietitian would be better able to relate to their concerns (p = .009). In the third part, the outcome measures were again participants\u27 ratings of the dietitian\u27s expertness, trustworthiness, and attractiveness, as measured by the Counselor Rating Form. For this part, predictive models were developed for each of these dependent variables using multiple regression procedures with stepwise selection method. Potential predictors in each model were participants\u27 internal, powerful others, and chance health locus of control beliefs, as assessed with the Multidimensional Health Locus of Control (MHLC) Scale. Results indicated that participants\u27 powerful others health locus of control scores were positively related to their evaluations of the dietitian\u27s expertness, trustworthiness, and attractiveness (p ≤ .05 in each model), while their chance health locus of control scores were negatively related to their evaluations (p ≤ .05 in each model), These health locus of control dimensions accounted for small, but significant amounts of variability in each dependent variable (model R2 values of .05 - .07). Some overall conclusions may be drawn from the results of this study. First, in no instance was it beneficial for the obese dietitian to verbally acknowledge her current overweight status; acknowledgement of personal overweight consistently resulted in more negative perceptions of the dietitian by participants. Negative effects of dietitian obesity were observed for some of the outcome variables; most notable was that participants were less willing to begin nutrition counseling with the obese dietitian. Otherwise, when dietitian weight status was important in participants\u27 perceptions, the effects appeared to be context-specific and/or dependent upon the weight status of the participants. Thus, in some situations, obese dietitians may face an additional barrier with clients that normal weight dietitians do not face. Finally, a characteristic of the participants, health locus of control orientation, also played an important role in their perceptions of the dietitian. In conclusion, characteristics and behaviors of the dietitians, as well as characteristics of the participants, were important factors in participants\u27 perceptions and evaluations of registered dietitians

Barnes Hospital Record Dietary Newsletter

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Patient adherence to smartphone weight loss applications: A dietitian perception study

Background: Dietitians play an important role in weight management. Self-monitoring of food intake is an effective tool for weight management. As smartphones gain popularity, many individuals are using smartphone apps for diet tracking to lose weight. Objective: To determine the dietitians’ perception on whether their involvement with the use of smartphone weight loss apps results in increased patient/client adherence and increased weight loss. Methods: An online survey was completed by 2,532 weight management dietitians. Paired t-tests were used to determine dietitians’ perceptions on patient/client adherence and weight loss using smartphone apps with dietitian intervention compared to without dietitian intervention (p\u3c.05). Results/Conclusion: Eighty-three percent of weight management dietitians recommended smartphone weight loss apps. Dietitians’ perceive adherence with smartphone apps to be significantly greater with dietitian feedback than without dietitian feedback (p=.000). Dietitians also perceive weight loss with smartphone apps to be significantly greater with dietitian feedback than without dietitian feedback (p=.000)

Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework

This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM).The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed.The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition.Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis

Foodservice in hospital: development of a theoretical model for patient experience and satisfaction using one hospital in the UK National Health Service as a case study

Hospital foodservice does not operate in isolation but requires the cooperation and integration of several disciplines to provide the ultimate patient experience. The objective of this research was to explore the antecedents to patient satisfaction and experience, including the service element. Accordingly, focus groups were conducted with doctors (n = 4), nurses (n = 5), ward hostesses (n = 3) and patients together with their visitors (n = 10), while open-ended interviews were conducted with the foodservice manager, facilities manager, chief dietitian, orthopaedic ward dietitian and chief pharmacist. Themes centred on ‘patients’, ‘foodservice’ and ‘mealtimes’, and results show that food qualities, particularly temperature and texture, are important factors impinging on patient satisfaction, and the trolley system of delivery is an acceptable style of service. Service predisposition demonstrates little relevance to patient satisfaction towards overall meal enjoyment. A theoretical model has been developed that identifies hospital foodservice in a cyclic relationship with the community primary healthcare team

Barnes Hospital Record Dietary Newsletter

https://digitalcommons.wustl.edu/bjc_barnes_record/1082/thumbnail.jp