Dietitian’s perspectives of systematically reviewed interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults: a Delphi study

Article type
Authors
Desroches S1, Bissonnette-Maheux V2, Lapointe A2, Deschênes S2, Légaré F3, Gravel K2, Thirsk J4
1Institute of Nutrition and Functional Foods, Laval University, Quebec City, Quebec, Canada; CHU Research Center, Quebec University Hospital Center–Hospital St-François d’Assise, Quebec City, Quebec, Canada
2Institute of Nutrition and Functional Foods, Laval University, Quebec City, Quebec, Canada
3Department of Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada; CHU Research Center, Quebec University Hospital Center–Hospital St-François d’Assise, Quebec City, Quebec, Canada
4Practice Based Evidence in Nutrition, Dietitians of Canada, Canada
Abstract
Background: Adoption of a healthy diet has been identified as the cornerstone for preventing and managing several chronic diseases. However, adherence to dietary advice is suboptimal, thus potentially hampering the effectiveness of dietary interventions.

Objectives: To assess dietitians’ perspectives on the importance and applicability of interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults in the Canadian context.

Methods: By conducting a Cochrane systematic review, we identified eight promising interventions for enhancing adherence to dietary advice: telephone follow-up, feedback based on self-monitoring, portion sizes, exchange lists, individualized menu suggestions, behavioural contract, watching a video, and multiple interventions. Expert dietitians were recruited to participate to a Delphi study through an invitation email sent to various chronic diseases-related networks from Dietitians of Canada. They were invited to participate by completing an electronic questionnaire asking them to rate the importance and applicability on a seven-point Likert scale of each of these eight specific interventions in their practice.

Results: Among the 32 dietitians who completed the three-round Delphi study, four interventions showed a strong consensus using a ≥ 75% level of agreement. Among those, feedback based on self-monitoring (6.97 ± 0.18 and 6.72 ± 0.46; means ± SD for importance and applicability respectively), multiple interventions (6.94 ± 0.25 and 6.81 ± 0.40), and portion sizes (6.69 ± 0.54 and 6.75 ± 0.51) were found important and applicable, while video (4.75 ± 0.67 and 4.84 ± 0.72) was found neither important nor unimportant and neither applicable nor inapplicable.

Conclusions: These findings could guide the development of educational training sessions for dietitians to help them provide interventions that are likely to be adhered to by their patients but also that are applicable to their practice. Further studies should validate these findings with patients to assess whether these interventions are also relevant to their reality. (Supported by a Knowledge synthesis grant from the Canadian Institutes of Health Research.)