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Clinician Perspectives of Barriers and Enablers to Implementing the Mediterranean Dietary Pattern in Routine Care for Coronary Heart Disease and Type 2 Diabetes: A Qualitative Interview Study

  • Author Footnotes
    ∗ Certified in Australia.
    Hannah L. Mayr
    Correspondence
    Address correspondence to: Hannah L. Mayr, PhD, APD, Department of Nutrition and Dietetics, Building 15, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, 4102 Queensland, Australia.
    Footnotes
    ∗ Certified in Australia.
    Affiliations
    Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Centre for Functioning and Health Research, Metro South Health, Queensland, Australia

    Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia

    Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ Certified in Australia.
    Jaimon T. Kelly
    Footnotes
    ∗ Certified in Australia.
    Affiliations
    Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia

    Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
    Search for articles by this author
  • Graeme A. Macdonald
    Affiliations
    Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

    Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
    Search for articles by this author
  • Anthony W. Russell
    Affiliations
    Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

    Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ Certified in Australia.
    Ingrid J. Hickman
    Footnotes
    ∗ Certified in Australia.
    Affiliations
    Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ Certified in Australia.
Published:January 28, 2022DOI:https://doi.org/10.1016/j.jand.2022.01.012

      Abstract

      Background

      Practice guidelines for coronary heart disease and type 2 diabetes recommend promoting the Mediterranean dietary pattern (MDP), which improves cardiometabolic risk markers and may prevent disease progression and complications. It is unknown to what extent the MDP is recommended in routine care for patients with these conditions, particularly in multiethnic settings.

      Objective

      The study aim was to explore multidisciplinary health care professionals’ perspectives on recommending the MDP in routine care for patients with coronary heart disease or type 2 diabetes and barriers and enablers to its implementation.

      Design

      A qualitative description design was employed, utilizing semistructured individual interviews to collect data.

      Participants and setting

      Fifty-seven clinicians (21 nurses, 19 doctors, 13 dietitians, and 4 physiotherapists) routinely managing relevant patients across hospital and community settings in a metropolitan health service in Australia participated in interviews between November 2019 and March 2020.

      Statistical analysis performed

      Interviews were audiorecorded, transcribed verbatim, and analyzed using thematic analysis.

      Results

      Four overarching themes were identified highlighting that the MDP was not routinely recommended: current dietary practices (all clinicians perceived they had a role in dietary care but prioritization varied. There was a legacy of single nutrient-based strategies and disease silos); clinician-centered barriers to recommending MDP (limited MDP knowledge and practice skills and variable understanding and acceptance of evidence supporting its use. This was related to lack of education and training about the diet and personal interest/experience); organizational culture and resources influence dietary care (MDP not embedded in service culture or current clinic tools and resources, with limited dietary knowledge exchange within and across multidisciplinary teams); and perceived patient-centered barriers to implementation of MDP (socioeconomic challenges in a multicultural setting, and a lack of belief in patient capabilities to improve diet adherence).

      Conclusions

      Clinician and organizational factors, compounded by perceptions about patient acceptance, influence recommendations of the MDP for patients with coronary heart disease or type 2 diabetes. These factors should be addressed to improve translation of MDP evidence into practice.

      Keywords

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      Biography

      H. L. Mayr is an accredited practising dietitian, Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia; a health practitioner research fellow, Centre for Functioning and Health Research, Metro South Health, Queensland, Australia; an assistant professor, Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; and a lecturer, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

      Biography

      J. T. Kelly is an accredited practising dietitian and senior research fellow, Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia; and Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.

      Biography

      G. A. Macdonald is a senior staff specialist, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; and an associate professor, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

      Biography

      A. W. Russell is an endocrinologist and director, Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; and an associate professor, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

      Biography

      I. J. Hickman is an advanced accredited practising dietitian and a principal research fellow, Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia; and an associate professor, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia