Faculty of Health Sciences, Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada.
Department of Family Medicine, Queens University, Kingston, ON, Canada.
J Community Health. 2020 Oct;45(5):1067-1072. doi: 10.1007/s10900-020-00831-x.
Dietary modifications are key health behaviour recommendations for the prevention and management of hypertension, a leading contributor of global disease burden. Despite this, few primary care physicians discuss nutrition with their patients. This study describes the barriers and facilitators to the provision of dietary advice for hypertension prevention and management among Canadian physicians. A validated 62-item cross-sectional survey was distributed online to 103 Canadian primary care physicians between 2017 and 2019. Eighty participants were included in the analyses. The majority of participants were based in Ontario (68.7%) and saw 10-24 patients per week (53.5%). Fewer than half (47.5%) of participants were knowledgeable about the recommended sodium level by Hypertension Canada (< 2000 mg/day) and 38.8% felt it was difficult to know which foods are high or low in sodium. Approximately one quarter felt the findings about sodium and hypertension and cardiovascular disease are controversial. Other significant barriers were: not enough time to talk to patients about diet (76.3%), belief that patients are not truthful about their diet (76.3%), patients would not follow their advice (46.8%), and that it was difficult to keep up with so many guidelines (50.0%). Many identified that electronic medical record tools (80.8%), access to dietitians (84.9%), or more nutrition education in medical training (65.8%) would help facilitate advice. Given the importance of diet and the central role of physicians in motivating dietary change among patients, approaches are required to address identified barriers and facilitators to providing dietary advice to reduce the burden of hypertension.
饮食调整是预防和治疗高血压的主要健康行为建议，高血压是全球疾病负担的主要原因之一。尽管如此，很少有初级保健医生与患者讨论营养问题。本研究描述了加拿大医生在预防和管理高血压方面提供饮食建议的障碍和促进因素。2017 年至 2019 年期间，通过在线向 103 名加拿大初级保健医生分发了一份经过验证的 62 项横断面调查。80 名参与者被纳入分析。大多数参与者来自安大略省（68.7%），每周看 10-24 名患者（53.5%）。不到一半（47.5%）的参与者了解加拿大高血压协会推荐的钠含量（<2000 毫克/天），38.8%的人认为很难知道哪些食物富含或低钠。大约四分之一的人认为钠与高血压和心血管疾病之间的关系存在争议。其他重要障碍包括：没有足够的时间与患者讨论饮食问题（76.3%）、认为患者对饮食不诚实（76.3%）、患者不会听从他们的建议（46.8%），以及很难跟上这么多指南（50.0%）。许多人认为电子病历工具（80.8%）、营养师的访问（84.9%）或更多的医学培训中的营养教育（65.8%）将有助于提供建议。鉴于饮食的重要性以及医生在激励患者改变饮食方面的核心作用，需要采取措施解决提供饮食建议以减轻高血压负担的障碍和促进因素。
