“I don't eat when I'm sick”: Older people's food and mealtime experiences in hospital

Background Inadequate dietary intake is a common problem amongst older acute-care patients and has been identified as an independent risk factor for in-hospital mortality. This study aimed to explore whether food and mealtime experiences contribute to inadequate dietary intake in older people during hospitalisation. Methods This was a qualitative phenomenological study, data for which were collected using semi-structured interviews over a three-week period. During this time, 26 patients aged 65 years or more, admitted to medical and surgical wards in a tertiary acute-care hospital, were asked to participate if they were observed to eat less than half of the meal offered at lunch. Participants provided their perspectives on food and mealtimes in hospital. Responses were recorded as hand-written notes, which were agreed with the interviewee, and analysed thematically using the framework method. Results Twenty-five older people were interviewed across six wards. Two main themes, ‘validating circumstances’ and ‘hospital systems’, were identified. Each theme had several sub-themes. The sub-themes within validating circumstances included ‘expectations in hospital’, ‘prioritising medical treatment’, ‘being inactive’, and ‘feeling down’. Those within ‘hospital systems’ were ‘accommodating inconvenience’, ‘inflexible systems’, and ‘motivating encouragement’. Conclusion Inadequate dietary intake by older hospital patients is complex and influenced by a range of barriers. Multilevel and multidisciplinary interventions based on a shared understanding of food and nutrition as an important component of hospital care are essential to improve dietary intake and reduce the risk of adverse clinical outcomes. Improving awareness of the importance of food for recovery amongst hospitalised older people and healthcare staff is a priority

Physicians' perspectives on the treatment of patients with eating disorders in the acute setting

Abstract Background Hospitalisation for an eating disorder is rare, however treatment in the acute medical setting can be a life-saving admission. While the multidisciplinary team delivers overall patient care, medical decisions are the responsibility of the treating physicians. Treatment decisions directly impact on patient care and outcomes. This study aimed to explore the considerations that influence the medical decisions of physicians when treating patients with eating disorders in the acute setting. Method Semi-structured interviews were conducted with ten medical physicians who had previously treated eating disorders on a general medical unit in two Australian tertiary hospitals. An interview schedule, based on the literature and four relevant domains from the Consolidated Framework for Implementation Research, was developed. Interviews were audio recorded, transcribed verbatim and analyzed thematically. Coding and interim themes and sub-themes were developed by two dietitian researchers; these were further refined through researcher discussion and triangulation with two additional dietitian researchers. Results Ten doctors were interviewed (3 consultants (1 adult general medical and 2 paediatricians: 13–16 years medical experience), 2 registrars (4–7 years experience), 1 resident (1 year experience), and 4 interns (< 1 year experience). Doctors described memorable patient cases, related to hospital stays over several weeks. Interviews ranged in length from 58 min to 91 min. Four themes (with five sub-themes) were developed: 1) navigating uncertainty (focusing on processes and goals and seeking information), 2) being “the good doctor” (doing the right thing), 3) seeing the big picture (depending on key players and considering short and long-term), and 4) involving family and patient. Conclusions Non-specialist physicians described challenges in the treatment of eating disorders in the inpatient setting. They take a holistic approach that considers both short and longer-term goals, relying on specialist colleagues, the wider multidisciplinary team and sometimes family members to guide treatment decisions during admissions on general medical wards. Additional support, education and training centered on the key themes may increase physicians’ confidence and ability to make effective treatment decisions for this patient group. The results are relevant to all health professionals working in this field to better understand the priorities of medical physicians and to support them to achieve positive outcomes in the inpatient treatment of patients with eating disorders

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce

AIM: The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care. METHODS: A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce. RESULTS: A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs. CONCLUSIONS: The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team

Telehealth methods to deliver multifactorial dietary interventions in adults with chronic disease: A systematic review protocol

Background: The long-term management of chronic diseases requires adoption of complex dietary recommendations, which can be facilitated by regular coaching to support sustained behaviour change. Telehealth interventions can overcome patient-centred barriers to accessing face-to-face programs and provide feasible delivery methods, ubiquitous and accessible regardless of geographic location. The protocol for this systematic review explains the methods that will be utilised to answer the review question of whether telehealth interventions are effective at promoting change in dietary intake and improving diet quality in people with chronic disease. Methods/design: A structured search of Medline, EMBASE, CINAHL, and PsychINFO, from their inception, will be conducted. We will consider randomised controlled trials which evaluate complex dietary interventions in adults with chronic disease. Studies must provide diet education in an intervention longer than 4 weeks in duration, and at least half of the intervention contact must be delivered via telehealth. Comparisons will be made against usual care or a non-telehealth intervention. The primary outcome of interest is dietary change with secondary outcomes relating to clinical markers pre-specified in the methodology. The process for selecting studies, extracting data, and resolving conflicts will follow a set protocol. Two authors will independently appraise the studies and extract the data, using specified methods. Meta-analyses will be conducted where appropriate, with parameters for determining statistical heterogeneity pre-specified. The GRADE tool will be used for determining the quality of evidence for analysed outcomes. Discussion: To date, there has been a considerable variability in the strategies used to deliver dietary education, and the overall effectiveness of telehealth dietary interventions for facilitating dietary change has not been reviewed systematically in adults with chronic disease. A systematic synthesis of telehealth strategies will inform the development of evidence-based telehealth programs that can be tailored to deliver dietary interventions specific to chronic disease conditions. Systematic review registration: PROSPERO CRD42015026398

Modified Policy-Delphi study for exploring obesity prevention priorities

INTRODUCTION: Until now, industry and government stakeholders have dominated public discourse about policy options for obesity. While consumer involvement in health service delivery and research has been embraced, methods which engage consumers in health policy development are lacking. Conflicting priorities have generated ethical concern around obesity policy. The concept of ‘intrusiveness’ has been applied to policy decisions in the UK, whereby ethical implications are considered through level of intrusiveness to choice; however, the concept has also been used to avert government regulation to address obesity. The concept of intrusiveness has not been explored from a stakeholder's perspective. The aim is to investigate the relevance of intrusiveness and autonomy to health policy development, and to explore consensus on obesity policy priorities of under-represented stakeholders. METHODS AND ANALYSIS: The Policy-Delphi technique will be modified using the James Lind Alliance approach to collaborative priority setting. A total of 60 participants will be recruited to represent three stakeholder groups in the Australian context: consumers, public health practitioners and policymakers. A three-round online Policy-Delphi survey will be undertaken. Participants will prioritise options informed by submissions to the 2009 Australian Government Inquiry into Obesity, and rate the intrusiveness of those proposed. An additional round will use qualitative methods in a face-to-face discussion group to explore stakeholder perceptions of the intrusiveness of options. The novelty of this methodology will redress the balance by bringing the consumer voice forward to identify ethically acceptable obesity policy options. ETHICS AND DISSEMINATION: Ethical approval was granted by the Bond University Health Research Ethics Committee. The findings will inform development of a conceptual framework for analysing and prioritising obesity policy options, which will be relevant internationally and to ethical considerations of wider public health issues. The findings will be disseminated through peer-reviewed publications, conference presentations and collaborative platforms of policy and science

The role of communication, building relationships, and adaptability in non-profit organisational capacity for health promotion

While the non-profit sector has an integral role in health promotion, it is unclear whether these organisations have the capacity for health promotion activities. This study aims to explore and describe capacity changes of a non-profit organisation during a 3-year community-based nutrition intervention. The non-profit organisation, with 3800 members throughout the state of Queensland, Australia, implemented a 3-year food literacy community-based intervention. A team of qualified nutritionists delivered the program in partnership with community-based volunteers. A separate aim of the intervention was to build capacity of the non-profit organisation for health promotion. A qualitative study was undertaken, using a social constructivist approach to explore organisational capacity changes longitudinally. All relevant participants including non-profit executive managers and nutritionists were included in the study (100% response rate). Data collection included semi-structured interviews (n = 17) at multiple intervention time points and document analysis of program newsletters (n = 21). Interview transcripts and documents were analysed separately using thematic and content analysis. Codes and categories between the two data sources were then compared and contrasted to build themes. Organisational capacity was predominantly influenced by four themes; ‘communicating’, ‘changing relationships’, ‘limited organisational learning’ and ‘adaptability and resistance to change’. Developing non-profit organisational health promotion capacity appears to require focusing on fostering communication processes and building positive relationships over time. Capacity changes of the non-profit organisation were not linear, fluctuating across various levels over time. Assessing non-profit organisational capacity to implement community interventions by describing adaptive capacity, may help researchers focus on the processes that influence capacity development

Patient Experiences of Dietary Management in Chronic Kidney Disease: A Focus Group Study

Objective: People with chronic kidney disease (CKD) contend with complex dietary recommendations. The challenge in practice is for clinicians to provide individualized support with the frequency and consistency required to sustain dietary changes. This study aimed to describe the experiences of patients with managing dietary recommendations, including their perspectives on the potential to use telehealth to support dietary management in CKD. Design: Focus group study. Subjects: Twenty-one adult patients with CKD (nondialysis) and 3 caregivers (total N = 24) purposively sampled to achieve diverse demographic and clinical characteristics, from two nephrology units in Queensland, Australia. Methods: Five focus groups were conducted, audio recorded, and transcribed. Transcripts were analyzed using thematic analysis drawing on the principles of grounded theory. Main Outcome Measure: Themes aligned with the research question. Results: We identified five themes: exasperating stagnancy (patronized by redundant advice, confused and unprepared for dietary change, inevitability of failure, and barriers to accessing dietetic services); supporting and sustaining change (receiving regular feedback, incremental and comprehendible modification, practical guidance on food, flexibility in monitoring schedule, and valuing peer advice); fostering ownership (seeking kidney diet information, enacting behavior change, making reminders, and tracking progress against targets); motivators and positive learning instruction (relying on reassurance, positive reinforcement, focusing on allowable foods, and involving family); threats and ambiguities of risk (sugar as the culprit, ubiquity of salt, illegible food labeling, avoiding processed foods, and questioning credibility of sources). Conclusions: Patients with CKD desire a preventative approach to CKD progression and maintaining their health, however, are stymied by dietary restrictions and a lack of reliable dietetic advice. Easy-to-use telehealth options have the potential to overcome the shortcomings in current health service delivery which may be limiting factors to providing these approaches. They provide patients with pragmatic tools, comprehensible and consistent information which fosters ownership and self-monitoring