Summary of findings of studies reviewed (n=46)
| Author(s) and year | Intervention type | Study location | Participants | Study design | Focus of intervention/topics covered | Outcomes |
|---|---|---|---|---|---|---|
| Levy et al, 201133 | Workshop | USA | Primary healthcare professionals (doctors, nurses, physician assistants) | Pre-test and post-test without control group | Training programme to provide information, tools and technical assistance to primary care practices to improve delivery of preventive services and the management of chronic diseases | Training well received by all participants Self-reported improvement in knowledge between pre-test and post-test Self-reported satisfaction with intervention |
| Carson, 200334 | Part of an ambulatory clerkship | USA | Fourth year medical students | Cross-sectional | Training medical students on assessment of body composition using tape measure Facilitating the identification and treatment of metabolic syndrome | Increased self-reported knowledge Probable changes in practice behaviour |
| Taren et al, 200335 | Required course | USA | Preclinical medical students | Pre-test and post-test with control group | Evaluation of an integrated nutrition education programme Nutrition intervention for disease prevention and therapy | Significant increase in nutrition OSCE scores between pre-test and post-test Increased self-reported satisfaction in nutrition content of the curriculum |
| Buckley, 200336 | Varied formats (web-based, web-enhanced and traditional lectures) | USA | Fourth year nursing students | Cross-sectional | Evaluating the effect of various formats of training on the nutrition knowledge of participants | No significant changes in knowledge between the three formats More positive perception of web-enhanced than the web-based and traditional |
| Ray et al, 201237 | Lectures, demonstrations and interactive practical sessions | UK | Third and fourth year clinical students | Pre-test and post-test without control group | Evaluating the effectiveness of a nutrition education intervention in a cohort of tomorrow's doctors using knowledge, attitude and practice scores related to clinical nutrition Covering topics relating to hospital malnutrition | Significant improvement in knowledge scores between pre-test and post-test Significant changes in attitude scores Students reported satisfaction with the course Applied acquired knowledge to patients |
| Ke et al, 200838 | Workshop | Taiwan | Nurses in ICU, GI and GS | RCT | The effects of educational intervention on nurses’ knowledge, attitudes and behavioural intentions regarding supplying artificial nutrition and hydration Coverage of topics such as normal nutrient metabolism, nutrient metabolism for terminal patients with cancer and appropriateness of supplying ANH to terminal patients with cancer | Significant improvement in knowledge between pre-test and post-test Significant changes in mean attitude scores Significant changes in behaviour intentions |
| Buchowski et al, 200239 | A computer-based and a required course | USA | First year medical students | Pre-test and post-test without control group | The efficacy of two modules (nutrition anaemias and diabetes and weight management) used by first year medical students Coverage of topics such as nutritional anaemias, diabetes and weight management | Increase in knowledge scores between pre-test and post-test Developed positive attitudes towards nutrition after intervention Mixed results with regard to confidence to counsel patients on nutrition |
| Puoane et al, 200640 | Workshop | South Africa | Nurses | Pre-test and post-test without control group | Assessing the attitudes and perceptions towards severely malnourished children and their mothers/caregivers pre-test and post-intervention Coverage of topics such as principles of care set out by the WHO for managing severe malnutrition | Positive change in attitudes towards malnourished children after intervention Change in perceptions about malnourished children after training Reduction in case fatalities |
| Hillenbrand and Larsen, 200241 | Workshop | USA | Paediatric residents | Pre-test and post-test without control group | The effect of an educational intervention on paediatric residents’ knowledge about breastfeeding, their confidence in addressing lactation issues and their management skills during clinical encounters with breastfeeding mothers | Intervention improved the knowledge of paediatric residents about breastfeeding Confidence increased after the intervention Limited changes in participants’ practice behaviour after intervention |
| Maiburg et al, 200342 | Computer-based instruction | The Netherlands | GP trainees | Pre-test and post-test with control group | The impact of a computer-based instruction on nutrition knowledge and practice behaviour of GP trainees Covered a wide range of nutrition including food pyramid, obesity, diabetes mellitus, hypercholesterolaemia, hypertension and irritable bowel syndrome | Improvement in knowledge scores after intervention Changes in practice behaviour |
| Ockene et al, 199543 | Workshop | USA | Internists | RCT | Impact of a training programme on physicians’ lipid intervention knowledge, attitudes and skills Improved skills on brief dietary risk assessment and patient-centred counselling | No significant changes in self-reported knowledge scores Limited changes in attitudes Counselling scores increased between pre-test and post-test |
| Zaman et al, 200844 | Workshop | Pakistan | Healthcare workers | RCT | Impact of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices and reducing growth faltering in children aged 6–24 months | Improved communication skills Improved consultation performance Mothers able to recall recommendations of health workers |
| Eisenberg et al, 201345 | Workshop | USA | Doctors and other healthcare professionals | Pre-test and post-test without control group | Improving healthcare professionals nutrition behaviour, personal habits and their perceived ability to advise overweight or obese patients through the inclusion of ‘culinary education’ in the form of cooking demonstrations and participatory hands-on cooking workshops, combined with more traditional didactic and nutrition-related presentations | Self-reported significant positive changes in ability to counsel obese patients Changes in participants’ nutrition behaviours |
| Roche et al, 200746 | Computer-based instruction | USA | Paediatric residents | RCT | A computer-based compact disc instructional programme covering the nutrition topics of oral rehydration therapy, calcium and vitamins | Modest improvement in self-reported knowledge scores after intervention Positive attitudes towards computer instruction after intervention Participants believed intervention enhanced their knowledge in nutrition |
| Gance-Cleveland et al, 200947 | Workshop | USA | Nurse practitioners | Pre-test and post-test without control group | Four-hour training session on HEAT CPG to improve provider behaviour and efficacy Topics covered included obesity prevention, behaviour modifications and family counselling, family collaboration and advising | Post-training results revealed significant improvement in practitioner knowledge Post-training results revealed significant improvement in practitioners’ intent to improve behaviour Post-training results revealed significant improvements in practitioners’ report of increased confidence in ability to address barriers |
| Ray et al, 201448 | Workshop | UK | Junior doctors | Pre-test and post-test without control group | Nutrition assessment in hospitalised patients | Significant improvement in knowledge, attitudes and practice scores |
| Bassichetto and Réa, 200849 | Workshop | Brazil | Paediatricians and nutritionists | RCT | Training intervention to equip junior doctors to run a hospital nutrition awareness week to contribute to the improvement in nutrition care Topics covered included clinical and public health nutrition, organisational management and leadership strategies | Significant improvement in knowledge scores after intervention Improvement in dietary counselling after intervention |
| Dacey et al, 201350 | Workshop | USA | Doctors and other healthcare professionals | Pre-test and post-test without control group | The impact of two types of live face-to-face CME programmes aiming to alter participants’ thinking and behaviour and comfort with the use of lifestyle medicine Topics included the history and rationale for lifestyle medicine, exercise medicine initiative and lifestyle medicine competencies | Improvement in the perception of barriers to lifestyle medicine Improvement in self-reported knowledge Increased confidence to counsel |
| Ritenbaugh et al, 199651 | 4-year integrated nutrition curriculum | USA | All levels of medical students | Cross-sectional | Evaluation of an integrated nutrition curriculum | Changes in knowledge Students satisfied with curriculum |
| Tziraki et al, 200014 | Workshop | USA | Primary care doctors | RCT | Training to improve the adoption of a manual to guide primary care practices in structuring their office environment and routine visits to improve nutrition screening, advice/referral and follow-up for cancer prevention Compared the effect of training on the manual with mailing the manual to practices | Greater adoption of manual recommendations among practices in the training group Training group adhered closer to diet screening recommendations in the manual Changes in office environment were conducive to nutrition screening and dietary advice |
| Edwards and Wyles, 199952 | Workshop | UK | Healthcare professionals | Pre-test and post-test without control group | Effectiveness of training sessions for health professionals concerning folic acid in pregnancy | Improvement in knowledge after training Participants enjoyed most parts of the training |
| Castro et al, 201353 | Workshop | Brazil | Doctors in the ICU | Pre-test and post-test with control group | A multifaceted nutritional educational intervention on the quality of nutritional therapy and clinical outcomes of critically ill patients | Significant improvement in participants’ knowledge after the intervention Reduction in patients’ length of stay of in the ICU Adequacy of nutritional therapy improved significantly Initiating enteral nutrition earlier than 48 hours more commonly |
| Pelto et al, 200454 | Workshop | Brazil | Doctors | RCT | Training to improve the nutrition counselling behaviour of physicians and caregiver retention of nutrition advice using the nutrition component of the WHO/UNICEF strategy of IMCI Reducing growth faltering in children by means of the nutrition training programme | Modest changes in physician behaviour in practice Mother's uptake of physician advice improved Reduction in malnutrition cases |
| Kohlmeier et al, 200055 | Computer-based instruction | USA | First year medical students | Pre-test and post-test without control group | Evaluating students’ attitudes and self-efficacy in nutrition and cancer and acceptability of a computer-based instruction | Significant improvement in attitudes and self-efficacy after intervention Students generally accepted computer-based instruction |
| Bjerrum et al, 201256 | Workshop | Denmark | Nurses | Pre-test and post-test without control group | Improving nurses knowledge in nutrition and their attitudes towards their responsibility to providing nutrition care in relation to assessment and management Coverage of basic nutrition education, malnutrition in the hospital setting | Changes in knowledge and attitudes Participants felt more secure in their ability to provide nutrition care Participants were satisfied with the intervention |
| Pedersen et al, 201257 | Workshop | Denmark | Nurses | Pre-test and post-test without control group | Training programme to implement nutritional guidelines to change nurses’ nutrition practice behaviour relating to the identification of patients’ eating habits, improving patients’ knowledge about appropriate food choices and number of snacks eaten between meals to risk of undernutrition in hospitalised patients | Modest changes in nutrition practice behaviour Improvement in the eating difficulties of patients Patients’ knowledge of appropriate food choices improved |
| Conroy et al, 200458 | Required course | USA | Second year medical students | Pre-test and post-test without control group | Impact of an innovative preventive medicine and nutrition curriculum on students’ confidence about addressing patients’ diet and exercise patterns and on their own health habits | Personal dietary, exercise patterns of participants improved Confidence in their ability to address diet and exercise in patients increased |
| Endevelt et al, 200659 | Workshop | Israel | Second year medical students | Cross-sectional | Identification of time slots for nutrition training for medical students Impact of a nutrition education programme on students’ knowledge Topics covered included nutrition and dietary recommendations for healthy people. Health risks of obesity | Changes in knowledge Students considered nutrition curriculum to be effective |
| de Fine Olivarius et al, 200560 | Seminar | USA | Primary care doctors | Pre-test and post-test with control group | Improving the quality of diet recording and instruction in primary care Diet counselling for diabetes patients using one's own diet | Improvement in personal dietary behaviours of participants Changes in attitudes towards dietary counselling |
| Schlair et al, 201261 | Workshop | USA | First year medical students | Pre-test and post-test without control group | The feasibility and impact of a brief nutrition counselling curriculum on medical students’ nutrition knowledge, confidence, attitudes and practices and their own affect the students’ own nutrition behaviour and attitudes Topics covered were nutrition-related counselling confidence for patients with obesity and chronic disease and understanding of simple nutrition messages | Significant changes in self-efficacy scores Significant changes in attitudes Improvement in nutrition counselling competence Improvement in personal dietary habits |
| Scolapio et al, 200862 | Workshop | USA | Doctors, dieticians and pharmacist | Pre-test and post-test with control group | Impact of a live continuing medical education nutrition course on participants’ nutrition knowledge and practice behaviour Coverage of a variety of topics including identifying methods to feed patients with acute pancreatitis, parenteral nutrition, management of obesity and others | Significant changes in knowledge Confidence in counselling patients on nutrition improved Modest changes in practice behaviours |
| Kennelly et al, 201063 | Workshop | Ireland | GPs and nurses | Pre-test and post-test without control group | The impact of a dietetics intervention on healthcare professionals’ knowledge in nutrition and practice behaviour related to the management of malnutrition in hospitalised patients and the acceptability of the educational intervention | Significant changes in knowledge Modest changes in practice behaviours Level of acceptance for the intervention increased |
| Lewis et al, 201464 | Internet-based instruction | USA | Paediatric residents | Cross-sectional | Evaluating paediatric trainees’ engagement, knowledge acquisition and satisfaction with nutrition modules delivered in interactive and non-interactive format Coverage of breastfeeding practices | Significant change in knowledge Engagement with course content increased Level of satisfaction with intervention increased |
| Acuña et al, 200865 | Workshop | Brazil | Medical and nursing students | Pre-test and post-test without control group | Evaluating the effect of an intensive education course given to healthcare professionals and students Topics covered related to hospital malnutrition | Ability to diagnose malnutrition improved |
| Powell-Tuck et al, 199766 | Required course | USA | Second year medical students | Pre-test and post-test without control group | Development and inception of a 7-day curriculum on diet and health | Students’ feedback was positive Significant changes in knowledge |
| Afaghi et al, 201267 | Workshop | Iran | Clinical year 4 and 5 students | Pre-test and post-test without control group | Clinical-based case study teaching to enhance clinical skills regarding the role of nutrition in chronic disease Topics covered included the role of nutrition in chronic diseases, assessment of dietary intake and weight management | Student perceptions of the adequacy of the instruction were positive Significant changes in knowledge |
| Carson et al, 200268 | Required course | USA | Fourth year medical students | Pre-test post-test with control group | The outcomes of an integrated cardiovascular nutrition in the fourth year of medical school at the University of Texas | Significant changes in knowledge Significant changes in attitude Self-efficacy in addressing nutrition issues improved |
| Vanderpool et al, 201469 | Continuous medical education | USA | Paediatric gastroenterology residents and paediatric gastroenterologists | Pre-test and post-test without control group | Improving nutrition knowledge acquisition and dissemination Topics covered included paediatric nutrition and paediatric nutrition assessment | Changes in knowledge Changes in behaviour Changes in patient outcomes |
| Duerksen, 200270 | Clinical rotation | Canada | Second year medical students | Pre-test and post-test without control group | Assessment of hospitalised patients’ nutrition using the SGA | Students correctly identified malnourished patients Increased confidence in nutritional assessment |
| Engel et al, 199771 | Computer-based training as part of family practice clerkship rotation | USA | Third year medical students | Pre-test and post-test without control group | Knowledge and self-efficacy in prescribing diets for patients with diabetes | Improved changes in knowledge Improved changes in self-efficacy |
| Richards and Mitchell, 200172 | Presentation by a dietitian to individual participants | Australia | GPs | Pre-test and post-test without control group | Presentation of a nutrition manual and behaviour modification strategies | Improved confidence to provide specific nutrition information and dietary recommendations Increase in the use of the nutrition manual Nutrition counselling of patients improved |
| Kipp, 199773 | Computer-based instruction | USA | First year medical students | Pre-test and post-test without control group | Evaluation of a CAI module on food guide pyramid and dietary guidelines | Students considered CAI as appropriate learning tool for nutrition concepts Students satisfied with format Changes in knowledge |
| Cooksey et al, 200074 | Computer-based instruction | USA | Preclinical medical students | Cross-sectional | Evaluation of series of interactive, multimedia educational programmes (nutrition in medicine) that teach the basic principles of nutritional science and application to cases | Advantages of accessibility, self-paced study, interactivity, immediate feedback and tracking students’ performance were noted |
| Cheatham et al, 200275 | Computer-based tutorial | USA | Nursing, physician assistant and physical therapy students | Pre-test and post-test without control group | Development and use of a computer-based tutorial on nutritional assessment | Significant changes in knowledge scores Students felt amount of content was adequate |
| Kolasa et al, 199676 | Workshop | USA | Dietetic students, family medicine residents and third year medical students | Cross-sectional | Encouraging effective communication with media and consumer through article preparation | Participants found the intervention to be an interesting way to learn about current food and nutrition issues |
| Fox, 200977 | Required course | Canada | Community nutrition graduate students | Pre-test and post-test without control group | Incorporation of arts as strategies for understanding and addressing community health issues | Students recognised the incorporation of arts as a mechanism of conducting health research, advocacy, education, healing and capacity-building initiatives |
ANH, artificial nutrition and hydration; CME, continuous medical education; CPG, clinical practice guideline; GI, gastroenterology; GP, general practitioner; computer-assisted instruction; GS, general surgery; HEAT, healthy eating and activity together; ICU, intensive care unit; IMCI, integrated management of childhood illness; OSCE, objectively structured clinical examination; RCT, randomised controlled trial; SGA, subjective global assessment; UNICEF, United Nations Children's Fund.