Joost Test Engels

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The need to reorient health services from curative care towards preventive care is emphasised in both global and national reports (1,2). Similarly, a focus shift from disease and care towards health and behaviour is implied by the concept of ‘positive health’ (3,4). Preventive care involves health promotion, addressing risk factors for chronic diseases, such as an unhealthy diet, physical inactivity, smoking, and excessive alcohol consumption (5). Diet is an essential element of basic nursing care (6) and competency profiles of nurses include a health promotor role (7–9). Thus, dietary behaviour change support entails a role for nurses. This involves not only detection of dietary problems but also addressing diet in conversations with patients, motivating patients to change dietary behaviour, and supporting patients in goal setting and action planning to change dietary behaviour (8,10). Nevertheless, most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential (11–14).

Research investigated which factors affect dietary behaviour change support by nurses. Studies point out that nurses’ knowledge and attitude, role perception, nurse-patient encounter, and cooperation and organizational context had influence. A lack of dietary knowledge was a prominent nurse-related barrier (11,15,16). Besides, limited undernutrition awareness could impede nurses from monitoring undernutrition (14). Another barrier for providing dietary care was confusion and insecurity regarding dietary care responsibilities (11,14,15), while perceiving dietary care provision or dietary behaviour change support as their responsibility was enabling (14–18). Since diet might be a sensitive topic, nurses struggled with dealing with patient autonomy, while tailoring the approach and having a relationship with a patient were helpful (15,19,20). Besides, having communication skills was considered a necessary condition for dietary behaviour change support (15,16,18). Influence of cooperation and organizational context was also studied. Supportive was the expectation throughout the organisation that nutritional screening was undertaken (11,21). Unsupportive was a lack of time (11,14–17,19–21). A cooperation-related barrier was limited referral options to dieticians (21) or a lack of awareness of dietetic service provision and the referral process (17).

So far, only few studies focused on dietary behaviour change support by nurses. Many studies we found on dietary care concentrated on undernutrition monitoring and treatment (11,14,21). Overall, current understanding remains incomplete regarding factors influencing dietary behaviour change support by Dutch nurses. Thus, further investigation of nurse-perceived factors is warranted. Factors influencing dietary behaviour change support might be categorised using behavioural models such as the COM-B model (22) or the more elaborate Theoretical Domains Framework (23). Furthermore, strategies to reduce nurse-perceived barriers and fulfil nurses’ needs should be developed. Education could be one of the strategies, as a call to action posed that dietary competencies should be incorporated into nursing education and follow-up education (24). Diet and behaviour change receive limited attention in current nursing curricula (24). For example, dietary education constituted only 0.4% of the Bachelor of Nursing programmes in the Netherlands in 2019 (25,26). Accordingly, education targeted at current and future nurses is needed on the following topics relevant for the professional practice: a) diet and health, b) dietary behaviour change, c) professional dilemmas in dietary care, and d) interprofessional collaboration.

Project description

To contribute to preventive care, nurse-perceived factors influencing dietary behaviour change support among patients will be identified. Subsequently, diet and related topics relevant for the nursing practice will be integrated in nursing education. Thus, training materials will be developed and evaluated to train (future) nurses in supporting dietary behaviour change of patients. The themes of interest are a) diet and health, b) dietary behaviour change, c) professional dilemmas in dietary care, and d) interprofessional collaboration. The project aims:


1. Ministerie van Volksgezondheid Welzijn en Sport (VWS). Nationaal Preventieakkoord. 2018. 2. World Health Organization (WHO). WHO global strategy on people-centred and integrated health services. Interim Report [Internet]. 2015. Available from: 3. Huber M, André Knottnerus J, Green L, Van Der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ. 2011 Jul 30;343. 4. Dierx J, De Bot C, Steuns A, Mares M. Gedragsverandering vanuit positieve gezondheid. Samenspel tussen zorg en welzijn. Bussum: Uitgeverij Coutinho; 2022. 5. World Health Organization (WHO). Noncommunicable diseases [Internet]. 2021 [cited 2021 Apr 13]. Available from: 6. Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. Defining the fundamentals of care. Int J Nurs Pract. 2010;16:423–34. 7. College of Nurses of Ontario (CNO). Competencies for Registered Nurses [Internet]. Ontario; 2018 Dec. Available from: 8. Landelijk Overleg Opleidingen Verpleegkunde (LOOV). Bachelor Nursing 2020. Een toekomstbestendig opleidingsprofiel 4.0. the Netherlands; 2015 Jan. 9. Nursing and Midwifery Council (NMC). Standards for competence for registered nurses. 2010. 10. Rosendal H, Bleijenberg N, de Bont M, Zilverentant M, van Merwijk C. Expertisegebied wijkverpleegkundige. V&VN, Beroepsvereniging van zorgprofessionals; 2019 Jun. 11. Håkonsen SJ, Pedersen PU, Bygholm A, Thisted CN, Bjerrum M. Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: The self-perceived views of the primary care workforce. BMC Health Serv Res [Internet]. 2019 Sep 6 [cited 2021 Mar 29];19(1):642. Available from: 12. Håkonsen SJ, Bjerrum M, Bygholm A, Kjelgaard HH, Pedersen PU. The Routines, Knowledge and Attitudes towards Nutrition and Documentation of Nursing Staff in Primary Healthcare: A Cross-Sectional Study. J Community Public Heal Nurs. 2018;4(3):1–8. 13. van Hell-Cromwijk M, van der Veen Y, Groenendijk T, Algra H, Kroeze W. Aandacht voor eten en drinken in de wijkzorg. TvZ. 2020;44–7. 14. Ziylan C, Haveman-Nies A, Van Dongen EJI, Kremer S, De Groot LCPGM. Dutch nutrition and care professionals’ experiences with undernutrition awareness, monitoring, and treatment among community-dwelling older adults: A qualitative study. BMC Nutr. 2015 Jul 30;1(1). 15. Groenendijk-van Woudenbergh GJ, van Hell-Cromwijk MC, van der Veen YJJ, Algra HF, Kroeze W. Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses. Fam Pract [Internet]. 2021 Sep 5 [cited 2021 Sep 14]; Available from: 16. Cass S, Ball L, Leveritt M. Australian practice nurses’ perceptions of their role and competency to provide nutrition care to patients living with chronic disease. Aust J Prim Health. 2014;20:203–8. 17. Gianfrancesco C, Johnson M. Exploring the provision of diabetes nutrition education by practice nurses in primary care settings. J Hum Nutr Diet [Internet]. 2020 Apr 1 [cited 2021 Dec 8];33:263–73. Available from: 18. Martin L, Leveritt MD, Desbrow B, Ball LE. The self-perceived knowledge, skills and attitudes of australian practice nurses in providing nutrition care to patients with chronic disease. Fam Pract. 2014 Apr;31(2):201–8. 19. Hestevik CH, Molin M, Debesay J, Bergland A, Bye & A. Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study. J Hum Nutr Diet [Internet]. 2019;33:198–206. Available from: 20. Bright D, Gray BJ, Kyle RG, Bolton S, Davies AR. Factors influencing initiation of health behaviour conversations with patients: Cross-sectional study of nurses, midwives, and healthcare support workers in Wales. J Adv Nurs. 2021;77:4427–38. 21. Green SM, James EP, Latter S, Sutcliffe M, Fader MJ. Barriers and facilitators to screening for malnutrition by community nurses: A qualitative study. J Hum Nutr Diet. 2014 Feb;27:88–95. 22. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci [Internet]. 2011 Apr 23 [cited 2021 Mar 29];6(42):42. Available from: 23. Michie S, Johnston M, Abraham C, Lawton R, Parker D. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Heal Care [Internet]. 2005;14:26–33. Available from: 24. DiMaria-Ghalili RA, Mirtallo JM, Tobin BW, Hark L, Van Horn L, Palmer CA. Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action 1-4. Am J Clin Nutr [Internet]. 2014;99:1184S-1193S. Available from: 25. Stuurgroep Ondervoeding. Ondervoedingsonderwijs in de verpleegkunde [Internet]. 2019 [cited 2021 May 7]. Available from: 26. Groenendijk-van Woudenbergh T, ten Cate D, van der Veen Y, Ettema R. Krijgt voeding in het verpleegkundig onderwijs meer vaste grond onder de voeten? Onderwijs en Gezondheidszorg. 2019;4.

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