Abstract
Background: Regular nut consumption is inversely associated with all-cause mortality, and in particular cardiovascular disease. Despite these findings, nut consumption in New Zealand, Europe, and the USA is far lower than recommended. Gaining an understanding of the barriers to and facilitators of regular nut consumption is likely to be useful to develop initiatives to increase nut consumption. Two small studies suggest that individuals would eat more nuts if advised so by their doctor. How health professionals perceive nuts may influence their recommendations to patients. Therefore, collecting information on nut perceptions and current nut recommendation practices of health professionals are also of importance.
Objectives: This study aimed to assess the knowledge, beliefs, and perceived benefits and barriers regarding nut consumption among the general adult population in New Zealand. This study also aimed to examine the beliefs and knowledge of nuts among New Zealand dietitians, general practitioners, and general practice nurses, as well as their current nut recommendation practices.
Methods: A cross-sectional survey with a mixed-mode design consisting of self-administered web and paper questionnaires was used in the present study. Using the New Zealand electoral rolls, 1600 individuals were randomly selected from the general populace, with oversampling for Māori ethnicity. A total of 1440 health professionals were selected based on their occupation. The survey followed Dillman’s Tailored Design Method, and involved four mailing occasions. Participants received, in order, a letter invitation to the online questionnaire, a reminder postcard, a paper questionnaire with postage-paid return envelope, and a final thank-you/reminder postcard.
Results: A response rate of 44% (n=710) and 53% (n=759) was achieved for the general public and health professionals, respectively. In total, 94% of the general population reported consuming nuts in the past 12 months, with cashews, almonds, peanuts, walnuts, and Brazil nuts being the five most commonly consumed nuts. Predictors of nut consumption included being female, having a higher education level, and a higher household income. Nut consumers reported that the main reasons for consumption were because they liked the taste of nuts, nuts were nutritious, and a good source of protein. Non-consumers cited reasons of disliking the taste and texture of nuts, and because nuts were high in fat. More than 60% of the general public respondents agreed that nuts are healthy, high in protein, and filling, but more than 40% did not know about the effects of nut consumption on total blood cholesterol, risk of cardiovascular disease, and diabetes. Approximately 50% of respondents said that they would eat more nuts if advised to by a doctor or dietitian. One of the strongest facilitators for nut consumption was a positive recommendation from a health professional, and the most prevalent barrier was the cost of nuts. The majority of dietitians agreed that eating nuts would not increase total blood cholesterol or risk of cardiovascular disease, while half of the general practitioners and general practice nurses indicated no knowledge of this effect. More dietitians advised patients to eat more nuts, compared to general practitioners and general practice nurses, while more general practitioners advised patients to eat fewer nuts, compared to the other two professions.
Conclusion: This study is the first to assess beliefs, attitudes, and perceptions of nut consumption among the general public and health professionals. The results of this study provide us with useful information on which to base public health initiatives to improve regular nut consumption among the general population. Further research is required to develop and assess such initiatives. The results can also be used to address concerns health professionals have in regards to nut consumption, which prevents them from recommending nuts to their patients.