Davison Karen
Department of Community Health Sciences, University of Calgary, Calgary, AB.
Can J Diet Pract Res. 2006 Autumn;Suppl:S47-53. doi: 10.3148/67.0.2006.s47.
Individuals with mental illness are at nutritional risk because of health, social, and economic factors. To address this problem, the Canadian Collaborative Mental Health Initiative (CCMHI) and Dietitians of Canada (DC) commissioned the development of a toolkit that outlines the role of the registered dietitian (RD) and advocates for RDs in primary health care (PHC) mental health programs.
The development of the toolkit followed a four-stage process: a comprehensive literature review, a focus group discussion with a national working group, interviews with consumers about RD services, and evaluation of the toolkit.
The costs of mental illness in Canada are at least US dollars 6.85 billion per year. Currently, little evidence exists on how RD services can reduce these expenses. The focus group identified accessibility as the predominant issue facing individuals with mental illness. To explain consumer experiences with RD services, a three-tier theory based on in-depth interviews was developed. Consumer experiences with RDs occur in five categories: financial concerns, perception of service, status of mental illness, engagement, and self-esteem (tier 1). These are further influenced by five individual and contextual factors, e.g., social environment, the mental illness (tier 2), which are weighed as benefits and barriers instrumental in determining actions (tier 3).
The evaluation of the final draft of the RD toolkit confirmed that it reflected the visions of PHC. The toolkit is intended to act as a blueprint for action. Dietitians are encouraged to use its contents to advocate for positions in mental health PHC settings.
由于健康、社会和经济因素，患有精神疾病的个体存在营养风险。为解决这一问题，加拿大心理健康合作倡议组织（CCMHI）和加拿大营养师协会（DC）委托编写了一份工具包，概述注册营养师（RD）的作用，并在初级卫生保健（PHC）心理健康项目中为注册营养师提供支持。
工具包的编写遵循四个阶段的流程：全面的文献综述、与全国工作组进行焦点小组讨论、就注册营养师服务对消费者进行访谈以及对工具包进行评估。
加拿大每年精神疾病的花费至少为68.5亿美元。目前，关于注册营养师服务如何降低这些费用的证据很少。焦点小组确定可及性是患有精神疾病的个体面临的主要问题。为解释消费者在注册营养师服务方面的经历，基于深入访谈开发了一个三层理论。消费者与注册营养师的经历分为五类：经济担忧、服务认知、精神疾病状况、参与度和自尊（第一层）。这些又进一步受到五个个人和背景因素的影响，例如社会环境、精神疾病（第二层），这些因素被权衡为决定行动的有利因素和障碍（第三层）。
对注册营养师工具包最终草案的评估证实，它反映了初级卫生保健的愿景。该工具包旨在作为行动蓝图。鼓励营养师利用其内容在初级卫生保健心理健康环境中争取职位。
