|ISSN No. 1606-7754 Vol.15 No.3 December 2007|
Improving best practices through nutrition education among Caribbean healthcare professionals
Godfrey Xuereb,1 Pauline Samuda,1 Dalip Ragoobirsingh,2 Errol Y Morrison2
Caribbean Food and Nutrition Institute, University of the West Indies Mona Campus, PO Box 140, Kingston 7, Jamaica1, Biochemistry Section Faculty of Medical Sciences, University of the West Indies Mona Campus, Kingston 7, Jamaica2
Diabetes and hypertension are among the leading causes of mortality and morbidity in the Caribbean with obesity being the major underlying factor. The Caribbean Food and Nutrition Institute (CFNI) developed a “Protocol for the Nutritional Management of Obesity, Diabetes and Hypertension in the Caribbean” whose main goal is to improve the standards of care in the region. A short training programme was developed on how to implement the Protocol. The successful implementation of the Protocol depended on the effectiveness of this training, thus an evaluation of the training was conducted. Two hundred and seventy nine (279) healthcare workers were trained in Jamaica, Guyana, Belize, St. Vincent and the Grenadines, and Suriname through a three-day workshop. Participants were given a short pre and post-knowledge test and completed an end of workshop evaluation. The results showed that in all the countries there was a positive shift in the knowledge and that most of the participants rated the content and quality of the training highly. Participants stated that the overall aim, structure and scope of the workshop were met and that they appreciated greatly the overall usefulness of the training. The improved knowledge of healthcare professionals is key to the successful implementation of the protocol and improved quality of care.
Keywords: Chronic Diseases, Interprofessional Education, Nutrition, Guidelines, Programme Evaluation, Best Practices
The four leading causes of death in the Caribbean are heart disease, cancer, stroke and diabetes and in 2000 they accounted for over 51% of all mortality.1 All of these health conditions share a common underlying factor, obesity, which has increased to epidemic proportions across the region. A rising trend has been observed in both the prevalence and mortality rates of diabetes in the Caribbean. It was estimated that over the five-year period 1995-2000 the number of cases of type 2 diabetes would increase from 1.3 million to almost 1.5 million.2
The observed increase in diabetes rates can largely be attributed to an increase in overweight and obesity among the Caribbean population. The report of the Caribbean Commission on Health and Development 1 shows overweight levels (BMI >25 kgm-2) of over 50% among the female populations in St. Kitts and Nevis, Belize, Jamaica, Dominica, Guyana, Trinidad and Tobago and Barbados. A cross cultural study found a high waist circumference (>0.8, males; >0.7 females), in 34% of females in Jamaica, 41% in Saint Lucia and 45% in Barbados.3 High waist circumference is indicative of increased risk for the development of diabetes.4
Diabetes is accompanied by a significantly increased prevalence of hypertension and dyslipidaemia. Cooper et al5 reported hypertension rates of 27.2%, 24% and 25.9% for Barbados, Jamaica and Saint Lucia, respectively. The data for Jamaica was confirmed by Mendez et al,6 who reported that the prevalence of hypertension is 20% in men and 28% in women. These findings were similar to those found by Ragoobirsingh et al,7 who reported a point prevalence of hypertension of 30.8% in the 15-and-over age group.
Practice guidelines for nutrition care have been developed for patients with type 2 diabetes in various countries. Evaluation studies done on medical nutrition therapy that follows these guidelines have shown that the management is more cost effective when the guidelines are adhered to.8 Studies have also found that management using guidelines achieved a greater magnitude of change in fasting plasma glucose and HbA1C levels.9 Since medical nutrition therapy for chronic diseases is not a “one size fits all”, a protocol needs to be used to guide health professionals in providing nutrition therapy that is individualized and aimed at improving outcomes.
For healthcare providers to contribute fully to the implementation of a chronic disease management programme, they will need the following:
One major barrier in the Caribbean is a lack of human resources where there is not only a shortage of people with appropriate basic training in nutrition but an overall shortage of health workers. Those in the post lack the skills of specialist care, counselling, education and evaluation. In a survey that CFNI carried out in five countries it found that the nutritional management of obesity, diabetes and hypertension was inconsistent with the global consensus. Additionally the quality of anthropometric evaluation was not only inconsistent between countries but also within countries.
The Caribbean Food and Nutrition Institute (CFNI) developed a “Protocol for the Nutritional Management of Obesity, Diabetes and Hypertension in the Caribbean”. The main goal of the Protocol is to improve the standards of care for all people with diabetes in the Caribbean region, and thus to enhance their quality of life. To this end, the Protocol provides some necessary tools for carrying out effective nutrition management including tools for assessment, planning, implementation, co-ordination and evaluation.
Training is seen as the key to success for any implementation programme. Thus the success of the Protocol depended on the effectiveness of the training, which accompanied the implementation in a given country. A short training programme was developed for the training of non-nutrition health professionals on how to implement the Protocol for the nutritional management of diabetes, hypertension and obesity.
This paper presents the results of an evaluation of the effectiveness of the training programme used in the implementation of the use of the nutrition protocol and the knowledge changes in healthcare workers after the training.