Skip to main content

Advertisement

Log in

Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: Results of a randomized, controlled study

Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual’s recommendations by primary care practices was evaluated by examining two strategies: physician training on how to implement the manual’s recommendations versus simple mailing of the manual. This article reports on the results of a randomized controlled trial to evaluate the effectiveness of these two strategies.

DESIGN: A three-arm, randomized, controlled study.

SETTING: Free-standing primary care physician practices in Pennsylvania and New Jersey.

INTERVENTION: Each study practice was randomly assigned to one of three groups. The training group practices were invited to send one member from their practice of their choosing to a 3-hour “train-a-trainer” workshop, the manual-only-group practices were mailed the nutrition manual, and the control group practices received no intervention. For training group practices, training was provided in the four major components of the nutrition manual: how to organize the office environment to support cancer prevention nutrition-related activities; how to screen patient adherence to the NCI dietary guidelines; how to provide dietary advice/referral; and how to implement a patient follow-up system to support patients in making changes in their nutrition-related behaviors.

MEASUREMENTS: The primary outcomes of the study were derived from two evaluation instruments. The observation instrument documented the tools and procedures recommended by the nutrition manual and adopted in patient charts and the office environment. The in-person structured interview evaluated the physician and staff’s self-reported nutrition-related activities reflecting the nutrition manual’s recommendations. Data from these two instruments were used to construct four adherence scores corresponding to the areas: office organization, nutrition screening, nutrition advice/referral, and patient follow-up.

MAIN RESULTS: The adoption of the manual’s recommendations was highest among the practices in the training group as reflected by their higher adherence scores. They organized their office (P=.005) and screened their patients regarding their eating habits (P=.046) significantly more closely to the recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training group practices were only 54.9% adherent to the manual’s recommendations regarding nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition screening, and 14.6% adherent to its patient follow-up recommendations.

CONCLUSIONS: Primary care practices exposed to the nutrition manual in a training session adopted more of the manual’s recommendations. Specifically, practices invited to training were more likely to perform nutrition screening and to structure their office environment to be conducive to providing nutrition-related services for cancer prevention. The impact of the training was moderate and not statistically significant for nutrition advice/referral or patient follow-up, which are important in achieving long-term dietary changes in patients. The overall low adherence scores to nutrition-related activities demonstrates that there is plenty of room for improvement among the practices in the training group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. US Dept of Health and Human Services. Surgeon General’s Report on Nutrition and Health. Washington, DC: US GPO; 1988. DHHS publication (FOES) 88-50210.

    Google Scholar 

  2. National Research Council, National Academy of Sciences. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Press; 1989.

    Google Scholar 

  3. US Dept of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Public Health Service, US DHHS; 1990.

    Google Scholar 

  4. US Preventive Services Task Force. Guide to Clinical Preventive Services. Baltimore, Md: Williams & Wilkins; 1989.

    Google Scholar 

  5. Thomas P, ed. Improving America’s Diet and Health: From Recommendations to Action. Washington, DC: National Press; 1991.

    Google Scholar 

  6. US Food and Drug Administration. Health and Diety Survey. Washington, DC: Food and Drug Administration, Division of Consumer Studies, Center for Food Safety and Applied Nutrition; 1990.

    Google Scholar 

  7. American Dietetic Association and International Food Information Council. How Are Americans Making Food Choices? Chicago, Ill: The American Dietetic Association; 1989.

    Google Scholar 

  8. Hiddink GJ, Hautvast JGAJ, van Woerkum CMJ, Fieren CJ, van’t Hof MA. Consumers’ expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr. 1997;65(suppl):S1974-S1979.

    Google Scholar 

  9. Glanz K, Gilboy MB. Physicians, preventive care and applied nutrition: selected literature. Acad Med. 1992;67:776–81.

    Article  PubMed  CAS  Google Scholar 

  10. Krause TO, Fox HM. Nutrition knowledge and attitudes of physicians. J Am Diet Assoc. 1977;70:607–9.

    PubMed  CAS  Google Scholar 

  11. Soltesz KS, Price JH, Johnson LW, Telljohann SK. Perceptions and practices of family physicians regarding diet and cancer. Am J Prev Med. 1995;11:197–204.

    PubMed  CAS  Google Scholar 

  12. Glanz K, Tziraki C, Albright C, Fernandes J. Nutrition assessment and counseling practices—attitudes and interests of primary care physicians. J Gen Intern Med. 1995;10:89–92.

    Article  PubMed  CAS  Google Scholar 

  13. Weinsier RL, Boker JR, Brooks CM, et al. Nutrition training in graduate medical (residency) education: a survey of selected training programs. Am J Clin Nutr. 1991;54:957–62.

    PubMed  CAS  Google Scholar 

  14. Winick M. Report on nutrition education in the United States medical schools. Bull N Y Acad Med. 1989;65:910–5.

    PubMed  CAS  Google Scholar 

  15. American Society for Clinical Nutrition Committee on Medical/Dental School and Residency Nutrition Education. Priorities for nutrition content within a medical school curriculum: a national consensus of medical educators. Acad Med. 1990;65:538–40.

    Article  Google Scholar 

  16. Lazarus K, Weinsier RL, Boker JR. Nutrition knowledge and practices of physicians in a family-practice residency program: the effect of an education program provided by a physician nutrition specialist. Am J Clin Nutr. 1993;58:319–25.

    PubMed  CAS  Google Scholar 

  17. Gray DS, Harvison S, Wilson JL. Evaluation of a nutrition education program for family practice residents. J Med Educ. 1988;63:569–71.

    PubMed  CAS  Google Scholar 

  18. Jack BW, Gans KM, McQuade W, et al. A successful physician training program in cholesterol screening and management. Prev Med. 1991;20:364–77.

    Article  PubMed  CAS  Google Scholar 

  19. Patterson J, Fried RA, Nagle JP. Impact of a comprehensive health promotion curriculum on physician behavior and attitudes. Am J Prev Med. 1989;5:44–9.

    PubMed  CAS  Google Scholar 

  20. Vinicor F, Cohen SJ, Mazzuca SA, et al. DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. J Chronic Dis. 1987;40:345–56.

    Article  PubMed  CAS  Google Scholar 

  21. Glanz K, Brekke M, Harper D, Bache-Wiig M, Hunninghake DB. Evaluation of implementation of a cholesterol management program in physicians’ offices. Health Educ Res. 1992;7:151–63.

    Article  PubMed  CAS  Google Scholar 

  22. McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH. Promoting cancer prevention activities by primary care physicians: results of a randomized, controlled trial. JAMA. 1991;266:538–44.

    Article  PubMed  CAS  Google Scholar 

  23. Dietrich AJ, Barrett J, Levy D, Carney-Gersten P. Impact of an educational program on physician cancer control knowledge and activities. Am J Prev Med. 1990;6:346–52.

    PubMed  CAS  Google Scholar 

  24. Shea S, Gemson DH, Mossel P. Management of high blood cholesterol by primary care physicians: diffusion of the National Cholesterol Education Program Adult Treatment Panel Guidelines. J Gen Intern Med. 1990;5:327–34.

    Article  PubMed  CAS  Google Scholar 

  25. Ammerman AS, DeVellis BM, Haines PS, et al. Nutrition education for cardiovascular disease prevention among low income populations—description and evaluation of a physician-based model. Patient Educ Couns. 1992;19:5–18.

    Article  PubMed  CAS  Google Scholar 

  26. Tziraki C. Nutrition in Primary Care: How to Help Patients Improve Their Eating Habits. Bethesda, Md: National Cancer Institute; 1994. DHHS publication NIH-94-3855.

    Google Scholar 

  27. Glynn T, Manley M. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for Physicians. Bethesda, Md: National Cancer Institute; 1989. DHHS publication NIH 89-3064.

    Google Scholar 

  28. Albright CL, Farquhar JW. Principles of behavioral changes. In: Greene HL, ed. Introduction to Clinical Medicine. Philadelphia, Pa: B.C. Decker, Inc., 1991.

    Google Scholar 

  29. Lee YJ, Ellenberg JH, Hirtz DG, Nelson KB. Analysis of clinical trials by treatment actually received: is it really an option? Stat Med. 1991;10:1595–605.

    Article  PubMed  CAS  Google Scholar 

  30. Pocock SJ. Clinical Trials: A Practical Approach. New York, NY: Wiley; 1983.

    Google Scholar 

  31. Ockene IS, Herbert JR, Ockene JK, Merriam PA, Hurley TG, Saperia GM. Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). Am J Prev Med. 1996;12(4):252–58.

    PubMed  CAS  Google Scholar 

  32. Ockene IS, Herbert JR, Ockene JK, et al. Effect of physician-delivered nutrition counseling and office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemia population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). Arch Intern Med. 1999;159:725–31.

    Article  PubMed  CAS  Google Scholar 

  33. Nestle M. The politics of dietary guidance—a new opportunity. Am J Public Health. 1994;84:713–5.

    Article  PubMed  CAS  Google Scholar 

  34. Mant D. Effectiveness of dietary intervention in general practice. Am J Clin Nutr. 1997;65:S1933-S1938.

    Google Scholar 

  35. Hiddink GJ, Hautvast JGAJ, Van Woerkum CMJ, Fieren CJ, van’t Hof MA. Information sources and strategies of nutrition guidance used by primary care physicians. Am J Clin Nutr. 1997;65:S1996-S2003.

    Google Scholar 

  36. Glanz, K. Review of nutritional attitudes and counseling practices of primary care physicians. Am J Clin Nutr. 1997;65:S2016-S2019.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tziraki, C., Graubard, B.I., Manley, M. et al. Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: Results of a randomized, controlled study. J GEN INTERN MED 15, 155–162 (2000). https://doi.org/10.1046/j.1525-1497.2000.03409.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2000.03409.x

Key words

Navigation