Starting the Conversation: Performance of a brief dietary assessment and intervention tool for health professionals

Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 27599-7426, USA.
American journal of preventive medicine (Impact Factor: 4.53). 01/2011; 40(1):67-71. DOI: 10.1016/j.amepre.2010.10.009
Source: PubMed


For chronic disease prevention and management, brief but valid dietary assessment tools are needed to determine risk, guide counseling, and monitor progress in a variety of settings. Starting The Conversation (STC) is an eight-item simplified food frequency instrument designed for use in primary care and health-promotion settings.
This report investigates the feasibility, validity, and sensitivity to change of the STC tool, a simplified screener instrument for assessment and counseling.
Data from an ongoing practical efficacy study of type 2 diabetes patients in a diverse population (N=463) were used to document STC validity, robustness, stability, and sensitivity to change from baseline to 4 months. Data were collected from 2008 to 2010, and they were analyzed for this report in 2010.
The eight STC items and summary score performed well. STC items and the summary score were moderately intercorrelated (r =0.39-0.59, p<0.05). The STC summary score was significantly correlated with the NCI fat screener at baseline (r =0.39, p<0.05), and change in the STC summary score correlated with reduction in percentage of calories from fat (r =0.22, p<0.05) from baseline to 4 months. The STC was sensitive to the intervention, with intervention participants improving significantly more than controls on the summary score (M=1.16 vs 0.46, p<0.05).
The brief STC is a relatively simple, valid, and efficient tool for dietary assessment and intervention in the clinical setting. It is available in English and Spanish and is in the public domain. Researchers and practitioners are encouraged to assess its utility in other settings and with other dietary interventions.

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Available from: Deborah J Toobert, Jul 30, 2014
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    • "Some tools have been developed for PC (Gans et al., 2003). The majority of these tools have focused on specific nutrients (e.g., fat, salt), foods (e.g., fruit and vegetables), or meal patterns (e.g., regular meals) (Hark &amp; Deen, 1999;Paxton, Strycker, Toobert, Ammerman, &amp; Glasgow, 2011); however, some of these questionnaires take 10–15 minutes to complete, which is not realistic given that physicians conduct most DA in a couple of minutes (Eaton et al., 2002). Given the complexity of diet, different tools may make more sense in screening for different diet problems, followed by more in-depth assessment by a relevant member of the team. "
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    ABSTRACT: Patients in primary care (PC) are often counselled on diet, and assessment of current food intake is a necessary prerequisite for individualized nutrition care. This sequential mixed-methods study explored current diet assessment (DA) practices in team-based PC in Ontario, Canada, with interdisciplinary focus groups (FGs) followed by a web-based survey. Eleven FGs (n = 50) discussed key patient groups and health conditions requiring DA, as well as facilitators and barriers to accurate DA. Interpretative analysis revealed three themes: DA as a common activity that differed by health profession, communication of DA results within the team, and nutrition care as a collaborative team activity. A total of 191 providers from 73 Family Health Teams completed the web-based survey, and confirmed that many providers are frequently doing DA and that methods vary by discipline. Most providers conducted DAs every day or almost every day. As expected, dietitians used more formal and detailed methods to assess diet than other disciplines, who were more likely to ask a few pointed questions. These baseline data provide information on the range of current DA practices in team-based PC that can inform development of new, more accurate approaches that may improve counselling effectiveness.
    Full-text · Article · Jan 2016 · Journal of Interprofessional Care
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    • "To encourage responses, initial mailings included a $10 gift card and nonrespondents received 2 follow-up reminders. The questionnaire included measures on patient experiences with clinicians, exercise behavior, patient activation measures (using the Patient Activation Measure-13) (Hibbard et al., 2005), general health (using the Medical Outcomes Study 12-item Short Form Version 2) (Frosch et al., 2010), diet using questions from the " Starting the Conversation " measure (Paxton et al., 2011), self-reported chronic conditions, and demographics. "
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    ABSTRACT: Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in 3 safety net clinics. Key stakeholder interviews (n = 21) were conducted both during early implementation of practice change and 6 months later. Patient surveys (n = 393) examined obese patient activation and health status. Insufficient program resources and limited patient engagement due to external factors were implementation barriers despite fairly high patient activation. Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Because of high turnover, multiple supporters may improve sustainability.
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    • "The presence and severity of depressive symptoms at baseline is measured using the Patient Health Questionnaire (PHQ-8), [47] which is re-administered during the 30-day follow up interview, as both prevalent and incident depression are common in this setting and impact multiple outcomes [48]. Other health behaviors, such as tobacco/alcohol use, diet, and exercise are measured using the Centers for Disease Control (CDC) Behavioral Risk Factor Surveillance System (BRFSS), [49] the Starting the Conversation (STC) scale, [50] and the Exercise Vital sign, [51] respectively. Post-discharge stress is assessed as well (Table 1). "
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    ABSTRACT: The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes. The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort. This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes.
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