New Zealand GPs and nutrition care: Perceptions, perceived competence, and barriers to provision.

Abstract

Aim The aim of this thesis was to investigate New Zealand (NZ) General Practitioners’ (GPs) attitudes towards, and barriers to, providing nutrition care to their patients. Methods Six studies were designed using principles of programmatic research. Study 1, a literature review, explored different approaches to providing nutrition care in general practice. Study 2, focus groups, were conducted with NZ GPs to explore their attitudes and barriers regarding provision of nutrition care. Study 3, the development of nutrition competence was investigated through a review of undergraduate nutrition education requirements in NZ and five other countries. Study 4, a validated 65-itemquestionnaire was used to determine medical students’ attitudes and confidence in providing nutrition care. Study 5, a validated 65-item questionnaire was used to determine and compare medical students, GP registrars and GPs attitudes and confidence in providing nutrition care. Study 6, a previously used questionnaire from the United States of America, was adapted to investigate the impact of an undergraduate course for medical students on their dietary intake and confidence in providing nutrition care. Results Study 1, demonstrated that a variety of approaches exist to enhance GPs’ capacity to provide nutrition care. In study 2, 48 GPs indicated routinely providing basic nutrition care to patients but perceived that they had limited capacity to provide extensive nutrition care due to limited time, and lack of nutrition competence. In study 3, all 6 countries except one, have curriculum guidelines to inform undergraduate nutrition education, however, implementation of guidelines is not widespread, nor mandatory. In study 4, 183 students believed that incorporating nutrition care into practice was important; were confident in general nutrition skills; but less confident in skills related to general food knowledge. In study 5, 183 students, 51 GP registrars and 57 GPs displayed positive attitudes and moderate confidence towards incorporating nutrition care into practice. GPs’ greater experience in providing nutrition care may contribute to confidence. In study 6, at the completion of the course 61 medical students reported a higher frequency of wholegrain food intake (p=0.0229) compared to the start of semester, yet were less comfortable making nutrition recommendations (p=0.008). Most medical students (63.9%) had an increased awareness of dietary choices, and some (15.3%) reported an increased likelihood to counsel patients on lifestyle behaviour. Conclusions There is a need to improve the nutrition education provided to medical students and GPs in NZ to enhance their knowledge and skills in providing nutrition care.