Evaluating clinician sustainment of a Mediterranean‐style dietary pattern approach in routine care for coronary heart disease and type 2 diabetes utilizing Normalization MeAsure Development (NoMAD) instrument

Résumé fourni par la source

BACKGROUND: A broader project translated evidence for a Mediterranean-style dietary pattern (MDP) into clinicians' routine dietary care for type 2 diabetes and coronary heart disease in a public health service in Australia. This study aimed to determine sustainment of practice and what predicts clinicians' routine use of an MDP approach 2 years after facilitated implementation. METHODS: May 2021-October 2022 implementation strategies targeted multidisciplinary clinicians involved with dietary care. In October 2024 clinicians were surveyed using an adapted 14-item Normalization Measure Development (NoMAD) questionnaire. Sustainment was defined as self-rating ≥7 on a scale from 0 (not at all) to 10 (always) that recommending MDP is a "normal part of your work." Exploratory analyses, including logistic regression, identified whether clinician characteristics, NoMAD items, and theoretical constructs predicted sustainment. RESULTS: Six dietitians and 61 other clinicians completed surveys, of which 100% and 52% self-reported MDP practice sustainment, respectively. Multivariable models in the total cohort found that the odds of sustainment increased with higher scores in NoMAD items related to the perception that using an MDP approach was legitimately within the clinicians' role (odds ratio [OR], 15.7; 95% CI, 3.23-224), shared understanding of supporting evidence (OR, 3.79; 95% CI, 1.35-15.8), and the constructs cognitive participation (OR, 6.12; 95% CI, 1.78-27.9) and collective action (OR, 5.7; 95% CI, 1.48-30.1). Twenty-seven clinicians commenced in the setting ≤2 years prior; within this group, MDP practice sustainment was significantly higher if MDP handover/orientation was received (71% vs 29%, P = 0.012). CONCLUSION: These data provide novel insights into impacts on sustainment of implemented evidence-based dietary practice in the context of a multidisciplinary workforce with high turnover.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.