The experiences and perceptions of registered dietitians delivering dietetic services in New Zealand primary health care

Abstract

Background: Supporting the increasing number of patients with chronic disease, particularly Māori, Pacific peoples and those from deprived neighbourhoods, is a growing burden for New Zealand primary health care. Food and nutrition play an integral role in the prevention and management of many chronic diseases. Dietitians, with their expertise in nutrition and specific skills in counselling for eliciting behaviour change, should therefore play an important role in this setting. Current national health policy supports the development of multidisciplinary teams integrated into primary health care. However, there are currently few dietitians working in this sector and little is known about their roles or the services they deliver.

Aim: To explore the experiences and perceptions of dietitians delivering dietetic services in New Zealand primary health care. Method: Qualitative, semi-structured, face-to-face, interviews were conducted with twelve primary health care dietitians from a range of ages, ethnicities and professional backgrounds. Audio-recorded interviews were transcribed verbatim and analysed using an inductive thematic analysis approach. Results: Participants were delivering a range of dietetic services in primary health care including: providing nutrition care directly to patients, delivering health promotion initiatives to patients, and upskilling primary health care professionals in nutrition through the provision of patient nutrition education resources and nutrition education sessions. A number of factors that dietitians perceived to impact on their ability to deliver these services emerged: (1) being part of a multidisciplinary, culturally diverse team; (2) being physically located within the primary health care practice; (3) having access to patients’ electronic health records; (4) collaborating with other primary health care professionals to deliver nutrition care and health promotion initiatives; (5) workforce capacity, funding, specifications in service delivery contracts and management support; (6) the dietitian’s personal background and experience, and (7) the presence of professional support. Conclusion: It is evident from this study that New Zealand dietitians are doing their best to deliver a relevant and culturally appropriate service for primary health care and their priority populations. By addressing a number of service delivery constraints, dietitians will be able to provide an even more effective and wider reaching service. In addition, supporting the integration of dietitians into the primary health care practice should allow them to deliver more collaborative and co-ordinated services. Furthermore, ensuring dietitians have strong professional support networks, both from within the dietetic profession and from other primary health care professionals, will enable them to develop the confidence and competence to work more effectively in this setting. This should ultimately help to improve the health of communities in New Zealand who are disproportionally affected by chronic disease.