Abstract
Background: General practitioners (GPs) are in an ideal position to provide nutrition care to their patients, but there may be barriers to them delivering optimal care. Internet-delivered computer-tailored communications provide an opportunity for GPs to offer their patients optimal nutrition care that is low cost and convenient. The 5+YourWay® Coach is an Internet-delivered, personalised coaching service, which has previously been shown to significantly increase fruit and vegetable intakes in low fruit and vegetable consumers. This research aimed to identify Southland and Otago GP nutrition care practices and their barriers to providing adequate care, and GP and patient perceptions of and experience with using the 5+YourWay® Coach service.
Methods: The study was undertaken in two parts: part I was a needs analysis of GPs and patients, and part II was a pilot of the 5+YourWay® Coach service.
Part I: A cross-sectional Internet-administered survey was conducted amongst Otago and Southland GPs to investigate their current nutrition care practices and their perceptions of the 5+YourWay® Coach service; 51 GPs participated (29% response rate, 63% female). A convenience sample of 30 adult patients at a large general practice medical centre in Dunedin, Otago, participated in a 5-10 minute structured interview to explore their nutrition care experiences, their Internet access and their perceptions of the 5+YourWay® Coach service.
Part II: A four-month pilot of the 5+YourWay® Coach service was conducted in the medical centre describe above. GP and practice nurse referrals over a four-week period and patients’ completion of the first online session by week eight of the pilot study were monitored. Immediately following the referral period, 16 GPs and nine practice nurses completed a self-administered questionnaire (73% and 60% response rates, respectively), which evaluated their experience with the service, including referral barriers. A 10-minute telephone interview was held with 20 referred patients who did not complete the first online session (67% response rate) to identify their barriers to accessing it.
Results: The majority of patients interviewed believed that their GP or practice nurse should advise them to eat fruit and vegetables. Over half of GP respondents (58%) reported that they “often” recommended fruits and vegetables to their patients, but the mode (43%) “seldom” followed-up their patients to monitor improvements. Most GPs (74%) had a positive initial impression of the service, but believed that their referral rates to the service would be challenged by patients not being interested (27%) or lack of Internet access (17%). However, most patients (21 of 30) were interested in using the service, and Internet access was high. During the four-week referral period, 15 GPs and six practice nurses referred 58 patients to the service. The major barrier to referring more patients was “lack of time”. The first online session was completed by 28 patients (48%). Referred patients reported not accessing the website due to “lack of time”.
Conclusion: This research suggests that patients are not currently receiving optimal nutrition care from primary healthcare providers, and GPs and patients support implementing the 5+YourWay® Coach service in the general practice setting. Recommendations for refinements to the 5+YourWay® Coach service should be considered in any future research investigating its long-term effectiveness in the primary healthcare setting.