Top

Published in:

01-10-2020 | Nutrition | Original Paper

Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension

Authors: Sarah Dash, Victoria Delibasic, Sadeem Alsaeed, Michael Ward, Katherine Jefferson, Donna P. Manca, JoAnne Arcand

Published in: Journal of Community Health | Issue 5/2020

Abstract

Dietary modifications are key health behaviour recommendations for the prevention and management of hypertension, a leading contributor of global disease burden. Despite this, few primary care physicians discuss nutrition with their patients. This study describes the barriers and facilitators to the provision of dietary advice for hypertension prevention and management among Canadian physicians. A validated 62-item cross-sectional survey was distributed online to 103 Canadian primary care physicians between 2017 and 2019. Eighty participants were included in the analyses. The majority of participants were based in Ontario (68.7%) and saw 10–24 patients per week (53.5%). Fewer than half (47.5%) of participants were knowledgeable about the recommended sodium level by Hypertension Canada (< 2000 mg/day) and 38.8% felt it was difficult to know which foods are high or low in sodium. Approximately one quarter felt the findings about sodium and hypertension and cardiovascular disease are controversial. Other significant barriers were: not enough time to talk to patients about diet (76.3%), belief that patients are not truthful about their diet (76.3%), patients would not follow their advice (46.8%), and that it was difficult to keep up with so many guidelines (50.0%). Many identified that electronic medical record tools (80.8%), access to dietitians (84.9%), or more nutrition education in medical training (65.8%) would help facilitate advice. Given the importance of diet and the central role of physicians in motivating dietary change among patients, approaches are required to address identified barriers and facilitators to providing dietary advice to reduce the burden of hypertension.

Forouhi, N. G., & Unwin, N. (2019). Global diet and health: Old questions, fresh evidence, and new horizons. The Lancet, 393(10184), 1916–1918. https://doi.org/10.1016/S0140-6736(19)30500-8CrossRef

Nerenberg, K. A., Zarnke, K. B., Leung, A. A., et al. (2018). Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Canadian Journal of Cardiology, 34(5), 506–525. https://doi.org/10.1016/j.cjca.2018.02.022CrossRefPubMed

Weaver, C. G., Clement, F. M., Campbell, N. R. C., et al. (2015). Healthcare costs attributable to hypertension. Hypertension, 66(3), 502–508. https://doi.org/10.1161/HYPERTENSIONAHA.115.05702CrossRefPubMed

Newberry, S. J., Chung, M., Anderson, C. A. M., et al. (2018). Sodium and potassium intake: Effects on chronic disease outcomes and risks. Rockville, MD: Agency for Healthcare Research and Quality.CrossRef

Stewart, M., & Ryan, B. (2015). Ecology of health care in Canada. Canadian Family Physician, 61(5), 449–453.PubMedPubMedCentral

Mellen, P. B., Palla, S. L., Goff, D. C., Jr., & Bonds, D. E. (2004). Prevalence of nutrition and exercise counseling for patients with hypertension, United States, 1999 to 2000. Journal of General Internal Medicine, 19(9), 917–924. https://doi.org/10.1111/j.1525-1497.2004.30355.xCrossRefPubMedPubMedCentral

Wynn, K., Trudeau, J. D., Taunton, K., Gowans, M., & Scott, I. (2010). Nutrition in primary care: Current practices, attitudes, and barriers. Canadian Family Physician, 56(3), e109-116.PubMedPubMedCentral

Al-Muammar, M. N. (2012). Predictors of physicians’ practices related to nutritional counseling and management in Riyadh City. Alexandria Journal of Medicine, 48(1), 67–74. doi:https://doi.org/10.1016/j.ajme.2011.09.002.CrossRef

Cranney, M., Warren, E., Barton, S., Gardner, K., & Walley, T. (2001). Why do GPs not implement evidence-based guidelines? A descriptive study. Family Practice, 18(4), 359–363. doi:https://doi.org/10.1093/fampra/18.4.359.CrossRefPubMed

10.

Kolasa, K. M., & Rickett, K. (2010). Barriers to providing nutrition counseling cited by physicians. Nutrition in Clinical Practice, 25(5), 502–509. https://doi.org/10.1177/0884533610380057CrossRefPubMed

11.

Visser, F., Hiddink, G., Koelen, M., van Binsbergen, J., Tobi, H., & van Woerkum, C. (2008). Longitudinal changes in GPs’ task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight. Family Practice, 25(suppl_1), i105–i111. doi:https://doi.org/10.1093/fampra/cmn078.CrossRefPubMed

12.

Cabana, M. D., Rand, C. S., Powe, N. R., et al. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA, 282(15), 1458–1465.CrossRef

13.

Arcand, J., Mendoza, J., Qi, Y., Henson, S., Lou, W., & L’Abbe, M. R. (2013). Results of a national survey examining Canadians’ concern, actions, barriers, and support for dietary sodium reduction interventions. Canadian Journal of Cardiology, 29(5), 628–631. https://doi.org/10.1016/j.cjca.2013.01.018CrossRefPubMed

14.

Sinclair, J., Lawson, B., & Burge, F. (2008). Which patients receive on diet and exercise? Canadian Family Physician, 54(3), 404.PubMedPubMedCentral

15.

Eaton, C. B., Goodwin, M. A., & Stange, K. C. (2002). Direct observation of nutrition counseling in community family practice. American Journal of Preventive Medicine, 23(3), 174–179. https://doi.org/10.1016/S0749-3797(02)00494-4CrossRefPubMed

16.

Kolasa, K. M., & Rickett, K. (2010). Barriers to providing nutrition counseling cited by physicians: a survey of primary care practitioners. Nutrition in Clinical Practice, 25(5), 502–509. https://doi.org/10.1177/0884533610380057CrossRefPubMed

17.

Mente, A., O’Donnell, M., Rangarajan, S., et al. (2016). Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: A pooled analysis of data from four studies. The Lancet, 388(10043), 465–475. https://doi.org/10.1016/S0140-6736(16)30467-6CrossRef

18.

Webster, J., Waqanivalu, T., Arcand, J., et al. (2017). Understanding the science that supports population-wide salt reduction programs. The Journal of Clinical Hypertension, 19(6), 569–576. https://doi.org/10.1111/jch.12994CrossRefPubMed

19.

Oria, M., Harrison, M., Stallings, V. A., & National Academies of Sciences, Engineering, and Medicine. (2019). Sodium: Dietary reference intakes based on chronic disease. Washington, DC: National Academies Press.

20.

Arcand, J., Webster, J., Johnson, C., et al. (2016). Announcing “up to date in the science of sodium.” The Journal of Clinical Hypertension, 18(2), 85–88. https://doi.org/10.1111/jch.12732CrossRefPubMed

21.

Gramlich, L. M., Olstad, D. L., Nasser, R., et al. (2010). Medical students’ perceptions of nutrition education in Canadian universities. Applied Physiology, Nutrition, and Metabolism, 35(3), 336–343. https://doi.org/10.1139/H10-016CrossRefPubMed

22.

Ampt, A. J., Amoroso, C., Harris, M. F., McKenzie, S. H., Rose, V. K., & Taggart, J. R. (2009). Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice, 10(1), 59. doi:https://doi.org/10.1186/1471-2296-10-59.CrossRefPubMedPubMedCentral

23.

Coleman, T. (2010). Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework. BMC Public Health, 10(1), 167. https://doi.org/10.1186/1471-2458-10-167CrossRefPubMedPubMedCentral

24.

Lin, J. S., O’Connor, E., Evans, C. V., Senger, C. A., Rowland, M. G., & Groom, H. C. (2014). Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: A systematic review for the U.S. preventive services task forcehealthy lifestyle counseling in persons with cardiovascular risk factors. Annals of Internal Medicine, 161(8), 568–578. https://doi.org/10.7326/M14-0130CrossRefPubMed

25.

Broekhuizen, K., Kroeze, W., van Poppel, M. N. M., Oenema, A., & Brug, J. (2012). A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: An update. Annals of Behavioral Medicine, 44(2), 259–286. https://doi.org/10.1007/s12160-012-9384-3CrossRefPubMedPubMedCentral

26.

Eysenbach, G. (2001). What is e-health? Journal of Medical Internet Research, 3(2), E20. https://doi.org/10.2196/jmir.3.2.e20CrossRefPubMedPubMedCentral

27.

Elbert, N. J., van Os-Medendorp, H., van Renselaar, W., et al. (2014). Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: A systematic review of systematic reviews and meta-analyses. Journal of Medical Internet Research, 16(4), e110. https://doi.org/10.2196/jmir.2790CrossRefPubMedPubMedCentral

28.

Clarke, M., Shah, A., & Sharma, U. (2011). Systematic review of studies on telemonitoring of patients with congestive heart failure: A meta-analysis. Journal of Telemedicine and Telecare, 17(1), 7–14. https://doi.org/10.1258/jtt.2010.100113CrossRefPubMed

29.

McLean, G., Band, R., Saunderson, K., et al. (2016). Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis. Journal of Hypertension, 34(4), 600–612. https://doi.org/10.1097/HJH.0000000000000859CrossRefPubMedPubMedCentral

30.

Arcand, J., Abdulaziz, K., Bennett, C., L’Abbé, M. R., & Manuel, D. G. (2013). Developing a Web-based dietary sodium screening tool for personalized assessment and feedback. Applied Physiology, Nutrition, and Metabolism, 39(3), 413–414. doi:https://doi.org/10.1139/apnm-2013-0322.CrossRefPubMedPubMedCentral

31.

Neuhauser, L., & Kreps, G. L. (2010). eHealth communication and behavior change: promise and performance. Social Semiotics, 20(1), 9–27. doi:https://doi.org/10.1080/10350330903438386.CrossRef

Title: Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension
Authors: Sarah Dash
Victoria Delibasic
Sadeem Alsaeed
Michael Ward
Katherine Jefferson
Donna P. Manca
JoAnne Arcand
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Nutrition
Care
Hypertension
Hypertension
Published in: Journal of Community Health / Issue 5/2020
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-020-00831-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2020

Material Hardship and Indoor Allergen Exposure among Low-Income, Urban, Minority Children with Persistent Asthma

Sexual Dating Violence, School-Based Violence, and Risky Behaviors Among U.S. High School Students

Identifying Factors Associated with Cancer Screening in Immigrant Populations Living in New York City

Isolation of Gram-Positive, Antibiotic-Resistant Bacteria from Tactile Mobile Phones in a Northwestern Mexican City

Prevent and Protect: A Vaccination Initiative for Uninsured Patients at a Student-Run Free Clinic

The National Grange: A Rural Community Resource to Increase the Reach of Health Promotion and Disease Prevention in the United States