Abstract
Background: Primary care practice nurses are frequently required to provide dietary advice to patients at risk of heart disease. However, they are usually not trained in nutrition and have limited time available to provide dietary counselling. The purpose of this project was to develop a brief heart healthy eating assessment tool and counselling guide to be used by practice nurses to help support in providing individualised dietary advice to patients at risk of cardiovascular disease.
Objective: The development was done in two stages; the first stage of the project was a needs analysis with primary care practice nurses that identified key dietary habits in relation to heart disease. The current project aims to pre-test the tool and develop individualised dietary advice that is based on key behaviour change principles and health literacy. The objectives include: refine the brief heart healthy eating assessment (questions) to suit low health literacy; develop heart healthy eating advice (counselling guide) using key behaviour change principles and health literacy; conduct focus groups to pre-test the brief heart healthy eating assessment tool with members of the general public including Pacific people.
Design: The plain language approach was used when developing the tool. Key strategies obtained from the Social Cognitive Theory and the Health Belief Model were used to develop the counselling guide. The tool was then pre-tested using two focus groups, consisting of six Pacific people and seven with mixed ethnicity, with a total of 13 participants. The focus groups were used to gather information on relevance, usability and comprehension of the draft tool and to find out areas for improvement. A general inductive approach was applied to identify common themes. Feedback from the focus groups was used to modify the resource accordingly. The final draft version was then tested for readability using five common readability tools.
Result: The key findings of this study were the identification of barriers to implementing change, including cost, lack of familial support and difficulties in changing habits. Furthermore, it was found that the dietary advice needed to be briefer, simpler and practical, and incorporate visual images. Appropriate changes to the tool were made. The readability test revealed the tool was easy to read, with a reading age of 10-11 years old.
Conclusion: Several alterations were made to the tool after pre-testing to improve relevance, usability and comprehension. However, the results are limited to two focus groups. Further research is recommended to continue the process of pre-testing and refinement until there is little or no room for improvement