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(Effects of a Nutrition Education Program on Physicians/Residents--continued)


Chapter 4.    RESULTS AND DISCUSSION


Nutrition Knowledge of Family Practice Residents

The summary of the pre-test and post-test scores obtained from the nutrition test for the residents participating in the 11-session nutrition education program can be found in Table 1.

Table 1. Nutrition Knowledge Scores for Family Practice Residents

Residents

 

Pre-Test

Post-Test

Difference

N=15

n

Mean

SD

Mean

SD

Mean

SD

1st Year

5

32.2

3.83

37.6

3.85

5.4

2.80

2nd Year

5

35.6

2.19

38.6

1.95

3.0

0.84*

3rd Year

5

36.2

3.63

38.2

4.21

2.0

1.00

All Years

15

34.7

3.6

38.1

3.25

3.4

1.03**

* Statistically significant p<0.05 using paired t tests.
** Statistically significant p<0.01 using paired t tests.

 

The analysis of the data indicated a significant increase in nutrition knowledge for all family practice residents from a pre-test mean score of 34.7 to a post-test mean score of 38.1 (p< 0.05). Additionally, the data also indicates a significant increase in the nutrition knowledge of the second-year residents from a pre-test mean score of 35.5 to a post-test mean score of 38.6 (p < 0.05). While the data show that there was an increase in the pre-test to post-test mean scores of the first and third-year residents, because of the larger standard deviations, the results were not significant.

The data also indicate that the pre-test scores for the residents tended to increase for each succeeding year, although not significantly. Third-year residents scored higher than second-year residents, who scored higher than first-year residents. The original assumption was that the residents would receive no other nutrition training during the study period. While there was no other formal didactic nutrition training at the Family Practice Center during their residency period, the data indicate residents were probably receiving some nutrition information informally during their daily interactions with other health care professionals, including other physicians, dietitians, pharmacists, and nurses.

Descriptions of Medical Concerns of Patients Surveyed

The second part of the investigation was to see if the 11-session nutrition education program would influence the nutrition-related professional behaviors of the family practice residents. The results of the responses by the patients can be found in Tables 2 through 5 (below).

As can be seen from the percentages summarized in Table 2, the pre-test and post-test groups appear to be well matched on reasons for visiting their physician and for the duration of their current medical concern(s). The chi-square analysis failed to indicate any significant differences at the 0.05 level of confidence. Therefore, the reasons why the pre- and post-test groups visited their physicians should not have influenced the residents’ nutrition behaviors.

Table 2. Description of Medical Concerns of Patients Surveyed1

N=610 (Total)

Pre-Test Visits

Post-Test Visits


Number

%

Number

%

N=

304


306


Reasons for current medical visit


Prenatal Visit

23

7.6

18

5.9


Well-child Visit

14

4.6

14

4.6


Physical/ Check-up

92

30.3

96

31.4


Other

175

57.6

178

58.1

Duration of current medical concern


New

107

35.2

114

37.2

 

Ongoing

197

64.8

192

62.7

1 Reasons for visits were not significantly different for pre-test and post-test groups.

Nutrition-Related Professional Behaviors of Residents

The summary of the pre-test and post-test frequency of patient nutrition education behaviors of residents documented by the patient survey can be found in Table 3.

The analysis of the data indicated a significant increase in the frequencies of several patient nutrition education behaviors. In relation to the frequency of nutrition handouts given, frequencies of use for all the handouts showed a trend to increase from pre- to post-education. There was an increase in total handouts and handouts on general nutrition, special nutrition needs and special diet plans. However, there was no significant increase (p<0.05) in the frequency of total handouts given between pre- and post-education periods.

In relation to the discussion of nutrition, again there was a consistent trend toward an increase in frequency for all categories. The overall frequency of nutrition discussions increased, as did the frequency of discussion for special health needs. Although neither increase was statistically significant, there was a significant difference (p<0.05) between the pre-test and post-test scores for the frequency of discussions about nutrition for health maintenance.

Table 3. Patient Nutrition Education Behaviors Used by Residents1

N=610 (Total)

Pre-Test Visits

Post-Test Visits


Number

%

Number

%

N=

304


306


Patient Education Behaviors2

Handouts Given:

42

13.8

49

16.0


General Nutrition

16

5.3

25

8.2


Special Nutrition Topics

9

3.0

15

4.9


Special Diet Plans

26

8.6

31

10.2

Discussion of Nutrition:

92

30.3

114

37.2


For Health Maintenance

52

17.1

72

23.5*


For Special Health Needs

46

15.1

52

17.0

Referrals/Recommendations:

24

7.9

46

15.0**


Dietitians

4

1.3

18

5.9**


Outpatient Class

4

1.3

8

2.6


Community Group

6

2.0

7

2.3

 

Supplements

14

4.6

20

6.5

1 Data may have included some visits to residency faculty rather than residents themselves
since many patients were not able to give the name of the physician they had seen.
2 Category totals might not equal sum of subcategories due to some patients receiving
multiple educational interactions.
* Values were significantly different p<0.05 using chi-square statistics.
** Values were significantly different p<0.01 using chi-square statistics.

 

There was a trend toward an increase in frequency for all categories of nutrition recommendations. The frequency of recommendations to outpatient classes, community groups, and for the use of supplements all increased, although not significantly. There was a significant increase (p <0.01) between the pre-test and post-test frequency of overall recommendations and for recommendations to see a dietitian.

Nutrition Education Behaviors Used by Residents for Health Maintenance Patients
(Well Child, Prenatal, Physical/Check-Up)

Similarly, the analysis of the data for patient visits for health maintenance indicated a significant increase in the frequencies of several patient nutrition education behaviors as found in Table 4.

Table 4. Nutrition Education Behaviors Used by Residents1
for Health Maintenance Patients
(Well Child, Prenatal, Physical/Check-Up)

N=257

Pre-Test Visits

Post-Test Visits


Number

%

Number

%

N=

129


128


Patient Education Behaviors2

Handouts Given:

20

15.5

29

22.7


General Nutrition

9

6.9

15

11.7


Special Nutrition Topics

4

3.1

12

9.5*


Special Diet Plans

9

6.9

17

13.4

Discussion of Nutrition:

53

41.1

64

50.0


For Health Maintenance

31

24.0

43

33.6


For Special Health Needs

25

19.4

30

23.4

Referrals/Recommendations:

12

9.3

30

23.4**


Dietitians

1

0.8

13

10.2**


Outpatient Class

1

0.8

5

3.9


Community Group

4

3.1

6

4.7

 

Supplements

8

6.2

10

7.8

1 Data may have included some visits to residency faculty rather than residents themselves
since many patients were not able to give the name of the physician they had seen.
2 Category totals might not equal sum of subcategories due to some patients receiving
multiple educational interactions.
* Values were significantly different p<0.05 using chi-square statistics.
** Values were significantly different p<0.01 using chi-square statistics.

The frequency of discussion of special nutrition topics (sodium, cholesterol, fiber, and osteoporosis) increased significantly (p<0.05) from pre-education to post-education. Again, there was a trend toward an increase in frequency for all categories of nutrition recommendations. The frequency of recommendations to outpatient classes, community groups, and for the use of supplements all increased, although not significantly. There was a significant increase (p <0.01) between the pre-test and post-test frequency of overall recommendations and for recommendations to see a dietitian. These data would indicate that many of the differences shown for the entire group in Table 3, could be explained by the residents’ nutrition-related professional behaviors with their health maintenance patient visits.

Patient Requests for Nutrition Information and Evaluation of Residents’ Responses

On the patient survey, the patients were allowed to rate the adequacy of the residents’ responses by indicating one of three choices, "Very complete," "Adequate," or "Not what I needed." The summary of the data from the patient survey on how many patients requested nutrition information and the adequacy of the residents’ responses to these requests can be found in Table 5.

The analysis of the data indicated a significant increase (p<0.05) between the pre-test and post-test frequency in the number of patient requests for nutrition information. One of the possible reasons for the increase in the amount of patient requests for information may have been due to the other identified increases in the nutrition-related behaviors of the physicians. These requests for information may be in response to the increase in frequency of nutrition handouts, nutrition discussions, and nutrition recommendations initiated by their resident physician.

 

Table 5. Patient Requests for Nutrition Information and Evaluation of
Residents‚ Responses

N=610 (Total)

Pre-Test Visits

Post-Test Visits


Number

%

Number

%

N=

304


306


Requests for Nutrition Information

40

13.2

63

20.6*

Evaluation of Resident Responses


Very Complete

30

75.0

52

82.5**


Adequate

10

25.0

9

14.2


Not What I Needed

0

0.0

2

3.2

* Values were significantly different p<0.05 using chi-square statistics.
** Values were significantly different p<0.05 using the normal approximation
test for equality of proportions.

 

Additionally, while not significantly different using chi-square statistics, there was a significant increase (p <0.05) in the resident responses evaluated by patients as "Very complete" when data were analyzed using the normal approximation test for equality of proportions. While the survey did not explore this issue in more detail, it is possible that this increase was a result of the nutrition education program. As the residents increased their nutrition knowledge, they would have been better prepared to adequately answer patient questions.

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(Chapter 5. Summary and Conclusions)




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