ABSTRACT

1. Evaluation of a Group Nutrition Education Session Provided to Hospitalized Patients with Respect to Change in Heart Healthy Dietary Behaviours Post Hospital Discharge L. Luu, BSc, RD; M. Shergill, BSc, RD; F. Russell, BASc, RD; Tova Nathanson, BASc, RD; S. Schamehorn, BA, BASc, RD; J. Song, MSc, CNSD, RD; A. Graham, CM, MD, FRCPC; P. Darling, PhD, RD. Heart and Vascular Program, Nutrition Department, Li Ka Shing Knowledge Institute of St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada RESULTS ABSTRACT Figure 1: Profile of subject recruitment and study completion. Background: Adopting “heart healthy dietary behaviours” (HHDB) is an integral component of cardiovascular disease treatment. There is limited research supporting the effectiveness of in-patient, group nutrition education, to promote healthy dietary behaviour change. The objectives of this study are to evaluate specific HHDB before, 1 month following and 6 months following a group nutrition education session, using the stage of change (SOC) construct as a measure of dietary behaviour change. Methods: “Eat Well, Live Well” (EWLW) is a 60-minute, registered dietitian facilitated, group nutrition education session, aimed at educating in-patients on HHDB at St. Michael’s Hospital, Toronto. Inclusion criteria encompassed patients admitted to the Heart &Vascular Program, >= 18years, fluent in English, and with no renal disease. Participants completed questionnaires measuring SOC for 10 HHDB before, 1 month following and 6 month following EWLW. The HHDB that were measured included; high intake of fruits & vegetables, choosing whole grains, limiting saturated fat by choosing lean meat and poultry, reducing portion sizes of meat, choosing low fat milk products, avoiding butter, shortening and hard margarines, avoiding trans fats, reducing sugar and sweets, having fish at least twice a week, and reducing sodium. Results: A total of 43 and 34 participants completed the study 1 and 6 months following EWLW, respectively. Significant progression along the SOC construct for participants adopting the recommended behaviours was observed for 9 HHDB at 1-month and 6-months following EWLW; indicating positive dietary behaviour change occurred and was sustained. Conclusion: The EWLW group nutrition education session appears to have supported positive dietary behaviour change related to “heart healthy dietary behaviours” (HHDB) 1 month following attendance. Engagement in heart healthy eating behaviours was sustained six months following the EWLW group nutrition education session. 62 patients recruited and consented to participate in study 7 patients did not Attend EWLW session 55 patients eligible for one and six month follow-up 3 patients withdrew 9 patients did not complete follow-up questionnaire (mail/telephone) 4 patients withdrew 2 patients deceased 15 patients did not complete follow-up questionnaire (mail/telephone) BACKGROUND 43 patients completed one-month follow up questionnaires 34 patients completed six-month follow up questionnaires • Diet therapy is the first recommended treatment option to modify the risk factors for cardiovascular disease. • The National Cholesterol Education Program (NCEP) has established dietary education as the cornerstone of therapeutic activities to facilitate lifestyle change. • There is limited research supporting the effectiveness of in-patient, group nutrition education, to promote healthy dietary behaviour change thus far. • The Stage of Change (SOC) construct of the Transtheoretical Modelis a recognized tool for measuring behaviour change. It explains or predicts a person's success or failure in achieving a proposed behavior change. Progression from a lower level SOC to a higher level SOC would predict successful behaviour change. OBJECTIVE Evaluate specific HHDB before, 1-month following and 6-months following a group nutrition education session, using the stage of change (SOC) construct as a measure of dietary behaviour change. METHODS Study Design: Prospective, before and after design Inclusion Criteria: • > 18 years of age • Admitted to the Heart & Vascular Program at St. Michael’s Hospital under cardiology, coronary care, & cardiovascular surgery between February 23rd – April 24th, 2009. • Comprehension of the English language Exclusion Criteria: Renal disease • Intervention – EWLW Group Education Class • At St. Michael’s hospital, an interactive, one-hour, group nutrition education session facilitated by a Registered Dietitian (RD), is delivered twice weekly to in-patients. • The session reviews and encourages adoption of HHDB such as: utilizing Canada’s Food Guide; portion sizes; how to read labels; limiting saturated and trans fats; choosing healthier fats; increasing fiber intake; increasing Omega-3 intake; limiting sugar and sweets; and reducing sodium intake. • Data:Collected February 2009-November 2009 • SOC questionnaire administered before, 1-month & 6-months after attending EWLW via mail or telephone. Figures 2-12: Stage of change (SOC) scores for total behaviours and 10 individual heart healthy eating behaviours at baseline, one month and six months following the intervention. * Indicates statistical significance at p-value of <0.05 by linear mixed model. CONCLUSIONS • Subjects who attended EWLW group nutrition education session self reported engagement in eight out of ten heart healthy behaviours at one month following EWLW education session and these behaviours were sustained six months following EWLW group nutrition education session. Fruit and vegetable consumption remained low at one month; however there was observed improvement at six months. Fish consumption was the only behaviour that did not positively progress through the stage of change construct. • The data support the effectiveness of a single, RD lead, group nutrition education session, conducted in an in-patient/hospital setting, in promoting the adoption of heart healthy eating behaviours.