Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
Nutr Diet. 2019 Apr;76(2):166-173. doi: 10.1111/1747-0080.12538.
This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis.
A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses).
Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants.
While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.
本研究旨在确定对饮食服务的满意度，确定参与饮食服务的障碍和促进因素，以及接受血液透析患者可接受的营养护理方法。
根据现有的满意度调查和理论领域框架中的关键结构，开发了一份问卷，以了解患者在获取饮食服务方面的行为。根据行为改变车轮的 COM-B 模型（能力、机会和动机）对结构进行分组，以告知未来的干预措施。来自布里斯班三个血液透析单位的 66 名患者参与了研究，通过笔记本电脑（由营养师助理）或纸质问卷（由护士）完成问卷。
66 名患者完成了问卷（应答率为 40%，年龄 62±14 岁，58%为男性）。大多数受访者（n=63，95%）报告自开始血液透析以来曾看过营养师。四分之一的受访者报告拒绝或不想见营养师。尽管如此，与服务满意度相关的问题大多是积极的。与参与营养师的障碍和促进因素相关的问题揭示了动机领域是主要障碍，有 41%（n=26）的参与者不想改变饮食。能力和机会领域不是障碍。当患者有问题或疑虑时，他们更喜欢从营养师那里获得营养信息，而不是在预定义的间隔时间内。大多数参与者不接受远程医疗。
虽然患者对饮食护理感到满意，但他们对饮食服务提供的偏好与当前循证指南不一致，这突显了需要替代的护理模式。饮食干预措施需要以解决动机的方式提供。
