Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: Results of a randomized, controlled study

OBJECTIVE: The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual's recommendations by pri mary care practices was evaluated by examining two strategies: physician tr aining on how to implement the manual's recommendations versus simple maili ng of the manual. This article reports on the results of a randomized contr olled trial to evaluate the effectiveness of these two strategies. DESIGN:A three-arm, randomized, controlled study. SETTING: Free-standing primary care physician practices in Pennsylvania and New Jersey. INTERVENTION: Each study practice was randomly assigned to one of three gro ups. The training group practices were invited to send one member from thei r practice of their choosing to a 3-hour "train-a-trainer" workshop, the ma nual-only-group practices were mailed the nutrition manual, and the control group practices received no intervention, For training group practices, tr aining was provided in the four major components of the nutrition manual: h ow to organize the office environment to support cancer prevention nutritio n-related activities; how to screen patient adherence to the NCI dietary gu idelines; how to provide dietary advice/referral; and how to implement a pa tient follow-up system to support patients in making changes in their nutri tion-related behaviors. MEASUREMENTS: The primary outcomes of the study were derived from two evalu ation instruments. The observation instrument documented the tools and proc edures recommended by the nutrition manual and adopted in patient charts an d the office environment. The in-person structured interview evaluated the physician and staffs self-reported nutrition-related activities reflecting the nutrition manual's recommendations. Data from these two instruments wer e used to construct four adherence scores corresponding to the areas: offic e organization, nutrition screening, nutrition advice/referral, and patient follow-up. MAIN RESULTS: The adoption of the manual's recommendations was highest amon g the practices in the training group as reflected by their higher adherenc e scores. They organized their office (P = .005) and screened their patient s regarding their eating habits (P = .046) significantly more closely to th e recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training grou p practices were only 54.9% adherent to the manual's recommendations regard ing nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition sc reening, and 14.6% adherent to its patient follow-up recommendations. CONCLUSIONS: Primary care practices exposed to the nutrition manual in a tr aining session adopted more of the manual's recommendations. Specifically, practices invited to training were more likely to perform nutrition screeni ng and to structure their office environment to be conducive to providing n utrition-related services for cancer prevention. The impact of the training was moderate and not statistically significant for nutrition advice/referr al or patient follow-up, which are important in achieving long-term dietary changes in patients. The overall low adherence scores to nutrition-related activities demonstrates that there is plenty of room for improvement among the practices in the training group.