Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics

IF 2.9 3区医学 Q3 NUTRITION & DIETETICS

Journal of Human Nutrition and Dietetics Pub Date : 2024-09-25 DOI:10.1111/jhn.13373

Kelly Lambert, Nicola Tulissio, Denelle Cosier

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引用次数: 0

Abstract

Background

Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics.

Methods

This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect.

Results

Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0–1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92).

Conclusions

This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.

Abstract Image

查看原文本刊更多论文

对健康素养有敏感认识的护理模式对肾病饮食门诊的影响。

背景：慢性肾脏病患者的健康知识不足与较差的疾病管理和较多的并发症有关。众所周知，肾脏饮食的依从性并不理想，而患者对肾脏饮食的反馈表明，患者在离开肾科门诊时会感到困惑。本研究旨在评估对健康素养敏感的护理模式（MOC）对肾脏病饮食门诊的影响：这项准实验性非随机前后研究招募了在三家肾脏营养师诊所就诊的成年人。修订后的 MOC 包括肾脏饮食问题提示单、教学回放以及通俗易懂的材料和说明。评估结果包括临床、饮食、患者报告的满意度和生活质量。组间和组内差异采用配对 t 检验、独立样本 t 检验（或非参数等效检验）、卡方检验和 McNemar 检验进行分析。线性混合模型评估了饮食质量总分、水果、蔬菜、蛋白质和乳制品摄入量的变化，时间为固定效应，随机受试者为特定效应：结果：修订后的 MOC 初次预约失败率较低（21.5% 对 9.1%）。修订后的膳食管理手册与水果（p = 0.03）和蔬菜（p = 0.003）摄入量的显著提高以及适当饮食质量比例的提高（p = 0.03）有关。这些影响的效应大小适中（d = 0.5，95% 置信区间 = 0.0-1.0）。修订后的 MOC 还与基线满意度提高（p = 0.04）和复查预约时所有问题的可接受性得分提高有关。修订后的 MOC 在临床上改善了生活质量，但改善不明显（p = 0.92）：这种对健康知识敏感的低成本干预是改善肾脏营养师门诊成人水果和蔬菜摄入量的有效策略。进一步的研究将有助于确定教学回放使用的忠实性和成本效用分析。进行更大规模的试验，以检测生活质量的变化，也将具有参考价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Human Nutrition and Dietetics 医学-营养学

CiteScore

5.30

自引率

15.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Human Nutrition and Dietetics is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. Papers are therefore welcomed on: - Clinical nutrition and the practice of therapeutic dietetics - Clinical and professional guidelines - Public health nutrition and nutritional epidemiology - Dietary surveys and dietary assessment methodology - Health promotion and intervention studies and their effectiveness - Obesity, weight control and body composition - Research on psychological determinants of healthy and unhealthy eating behaviour. Focus can for example be on attitudes, brain correlates of food reward processing, social influences, impulsivity, cognitive control, cognitive processes, dieting, psychological treatments. - Appetite, Food intake and nutritional status - Nutrigenomics and molecular nutrition - The journal does not publish animal research The journal is published in an online-only format. No printed issue of this title will be produced but authors will still be able to order offprints of their own articles.