Implementing a dietary intervention in primary care practice: A process evaluation

Objectives. Physicians acknowledge the need to advise their patients about dietary habits, but they may not have the training or tools to do this effi ciently. In the context of a randomized trial, we investigated the feasibil ity of enlisting physicians to implement a dietary intervention in the prim ary care setting. Methods. Physicians from 14 primary care practices were assigned via random ization to introduce a self-help booklet to promote dietary change at routi ne appointments. Delivery of the booklet was recorded by these intervention physicians at the clinic appointment; intervention participants were asked 3 months later in a telephone interview about whether they received and us ed the booklet. Results. According to physician documentation, 95% of intervention particip ants who kept an appointment (n = 935) received the booklet; among particip ants completing a 3-month interview (n = 890), 96% reported the same. Howev er; only about 50% of participants reported receiving the booklet from thei r physician; the remainder received the booklet from other clinic staff. Ov erall, 93% reported reading at least part of the booklet. Use of the bookle t varied little whether it was delivered by a physician or staff person, bu t it was more likely to be read as time spent discussing the booklet increa sed. Conclusions. Physician cooperation and evidence of intervention effectivene ss support the use of primary care for the delivery of interventions to cha nge diet; training the entire health team and repeating dietary advice at s ubsequent visits may improve the success of such interventions.