1Research Center for Psychology,School of Psychology,University of Minho,Campus de Gualtar,4710-057 Porto,Portugal.
2Faculty of Psychology and Science Education,University of Porto,Porto,Portugal.
Public Health Nutr. 2018 Feb;21(2):435-446. doi: 10.1017/S1368980017002543. Epub 2017 Oct 30.
With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians' beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps.
Semi-structured interviews analysed according to thematic analysis procedures.
Public primary-care and private settings.
Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7).
Regardless of work context, 'persistence of efforts' emerged as the main characteristic of dietitians' action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice.
Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians' work in private settings should be addressed.
肥胖是一个主要的公共卫生问题，营养师的任务是协助客户改变行为，这是一项艰巨的任务。由于营养师对肥胖的信念、态度和实践存在不一致的数据，而且对于公共和私人实践之间的差异知之甚少，因此我们进行了本研究以解决这些差距。
根据主题分析程序对半结构化访谈进行分析。
公共初级保健和私人环境。
17 名在公共初级保健（n=10）和私人环境（n=7）工作的葡萄牙注册营养师。
无论工作背景如何，“坚持不懈”都是营养师行动的主要特征。除了对肥胖患者持有负面态度外，他们的实践并没有受到负面影响。他们认为自己是促进生活方式改变的积极推动者，为患者提供尽可能多的管理策略，赋予患者权力，对成功减轻体重感到满意，相信自己有能力帮助患者。然而，根据营养师工作的环境，报销、工作环境、感知障碍、患者特征和资源可用性的差异似乎导致了坚持度的差异，这体现在私人实践中努力和参与度的增加，以及公共初级保健实践的减少。
葡萄牙营养师对肥胖治疗结果表现出积极的心态和行动；然而，应该改进行为改变策略的教育。公共卫生系统需要进行重组，以加强有效的肥胖管理实施。应该解决推动营养师在私人环境中工作的动机问题。
