Application of the current dietary guidelines for people with diabetes mellitus by dieticians and nurses

[摘要] English: Intensive diabetes management resulting in control of blood glucose concentrations will delay the onset and significantly impede the progression of complications from diabetes. Healthcare professionals such as dieticians and nurses are increasingly challenged to help patients with diabetes achieve a desirable body weight, and maintain good metabolic control. Therefore, a clear understanding of current dietary goals and skills to implement these goals when counselling patients with diabetes, is needed. A Position Statement was compiled by an expert group of dieticians in South Africa in 1997 to encourage a uniform approach to the nutritional management of diabetes mellitus. However, application of these dietary recommendations by health professionals has not been established.The main aim of this study was to assess the current practice trends of dieticians and nurses regarding application of the goals of the Position Statement in the Free State province (FS) and the North West province (NW). To accomplish this aim, dieticians and nurses were asked open-ended questions regarding the dietary goals.The study was a comparative, multi-centre study. A total of 18 dieticians (n=8 from the FS and n=10 from the NW), registered as Private Practicing Dieticians (PPDs), as well as a randomized, stratified sample of 150 registered nurses (n=100 from the FS and n=50 from the NW) working in all primary health care clinics, were included in the study. The researcher obtained informed consent from each participant.After the researcher telephonically scheduled appointments with all participants who gave permission to take part in the study, structured personal and telephonic interviews were conducted with dieticians and nurses, respectively. A standardized questionnaire was used to gather the necessary information. Answers were evaluated by scores preset to each answer, classifying them from the most to the least acceptable answer. High scores (from 75% to 100%) gave an indication of good application of the dietary goals, while lower scores (from 65%-74%) indicated that the dietary goals were not properly applied. The lowest scores (below 65%) indicated poor application of the dietary goals.All dieticians that were included in the study, as well as 64 and 31 nurses in the FS and NW, respectively, received formal letters from the researcher, requesting a copy of nutrition education material (NEM). Total scores were also determined for each NEM. High scores (from 75%-100%) indicated that the information was comparable to the dietary goals, while lower scores (from 65%-74%) gave an indication that part of the information was outdated. The lowest scores (below 65%) indicated that the information was unacceptable or completely outdated.Eighty-eight percent of the FS PPDs and 70% of the NW PPDs, as well as 87% and 96% of the FS and NW nurses, respectively, gave permission to take part in the study. Although dieticians obtained higher scores than nurses in both the FS and NW, total scores obtained by all health professionals were below 65%. No statistically significant differences were found between the scores obtained by nurses in the FS (mean 28%) and nurses in the NW (mean 29%). Dieticians in the FS and NW obtained mean scores of 64% and 61%, respectively. Although scores obtained by the FS dieticians were 3% higher, no statistically significant differences were found between the scores of dieticians in the two provinces. Mean scores obtained by NEMs from all health professionals were below 65%. No statistically significant differences were found between the scores for NEM from dieticians (mean 35%) and scores for NEM from nurses (mean 33%).It can be concluded that dieticians and nurses in the FS and NW poorly apply the current dietary recommendations for people with diabetes. Furthermore, most of the NEMs used by both dieticians and nurses in their respective practice settings do not correlate with the 1997 dietary goals. These results indicate that there is a dire need to focus on better education of health professionals who counsel patients with diabetes. More research is needed to identify the possible barriers to effective application of current dietary recommendations by health professionals.

[发布机构] University of the Free State