Implementation of the cardioprotective diet manual in primary health care: Study protocol

Authors

DOI:

https://doi.org/10.21527/2176-7114.2024.48.14630

Keywords:

Nutrition, Heart Disease Risk Factors, Primary Healthcare, Patient Care Team, Implementation Science

Abstract

The Cardioprotective Feeding Manual for Primary Healthcare Professionals (MAC) aims to translate the dietary recommendations from guidelines of prevention and treatment of cardiovascular risk factors into a single playful and comprehensive strategy. However, it is not known the best method to implement it in Primary Healthcare (PHC). The aim of this article is to present the protocol for the MAC implementation study in PHC in two cities in brazilian’s southeastern region. This is a type II hybrid implementation study with cluster randomized clinical trial design. All PHC services in the cities (n=59) will be randomized (1:1) to the group that will receive a multifaceted strategy for implementation for the MAC, which includes not only the distribution of the material, but training and Audit and Feedback (intervention) or for the group that includes only the distribution of the material, mimicking the current scenario (control). The primary outcome of implementation will be assessed from the Cardioprotective Feeding guidance rate and the primary outcome of effectiveness will be assessed by the consumption of vegetables by users, in six months of follow-up. Secondary outcomes are: understanding of guidance by users and professionals, rate of additional guidance to MAC, perception of incorporation of guidance in clinical practice of professionals, identification of barriers and facilitators for the implementation of MAC and still weight of users. If positive, the expansion of training to other Brazilian cities will be discussed.

References

World Health Organization (WHO). Cardiovascular diseases (CVDs) [Internet]. Fact sheet no 317, update in Jun 2021. 2021 [citado 17 de agosto de 2022]. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

Siqueira ASE, Siqueira-Filho AG, Land MGP. Analysis of the Economic Impact of Cardiovascular Diseases in the Last Five Years in Brazil. Arq Bras Cardiol 2017;109(1):39–46. https:// doi.org/ 10.5935/abc.20170068.

Nilson EAF, Andrade RCS, Brito DA, Michele LO. Custos atribuíveis a obesidade, hipertensão e diabetes no Sistema Único de Saúde, Brasil, 2018. Rev Panam Salud Públican 2020;44. https:// doi.org/ 10.26633/RPSP.2020.32.

Brasil. Ministério da Saúde. Hospital do Coração. Alimentação Cardioprotetora: manual de orientações para os profissionais de saúde da Atenção Básica [Internet]. Brasília: Ministério da Saúde; 2018. 138 p. Available at: http://189.28.128.100/dab/docs/portaldab/publicacoes/alimentacao_cardioprotetora_orien_pro_saude_ab.pdf

Weber B, Bersch-Ferreira ÂC, Torreglosa CR, Marcadenti A, Lara ES, da Silva JT, et al. Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial. Am Heart J 2019;215:187–97. https:// doi.org/ 10.1016/j.ahj.2019.06.010.

Weber B, Galante AP, Bersch-Ferreira AC, Torreglosa CR, Carvalho VO, da Silva VE, et al. Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial. Clinics 2012; 67(12):1407–14. https:// doi.org/ 10.6061/clinics/2012(12)10.

Brasil. Ministério da Saúde. Secretaria de atenção à saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira [Internet]. 2 ed. Brasília: Ministério da Saúde; 2014. 156 p. Available at: http://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf

Brasil. Ministério da Saúde. Política Nacional de Alimentação e Nutrição [Internet]. Brasília: Ministério da Saúde; 2013. 84 p. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_alimentacao_nutricao.pdf

Brasil. Ministério da Saúde. Hospital do Coração. Alimentação Cardioprotetora [Internet]. Brasília: Ministério da Saúde; 2018. 16 p. Available at: http://189.28.128.100/dab/docs/portaldab/publicacoes/alimentacao_cardioprotetora.pdf

Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies - a synthesis of systematic review findings. J Eval Clin Pract 2008; 14(5):888–97. https:// doi.org/ 10.1111/j.1365-2753.2008.01014.x.

Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev 29; 2015(4):CD005470. https:// doi.org/ 10.1002/14651858.CD005470.pub3.

Colquhoun HL, Brehaut JC, Sales A, Ivers N, Grimshaw J, Michie S, et al. A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci 2013; 8(66). https:// doi.org/ 10.1186/1748-5908-8-66.

Brasil. Ministério da Saúde. VIGITEL Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados [Internet]. Brasília: Ministério da Saúde; 2022. 128 p. Available at: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4(50). https:// doi.org/ 10.1186/1748-5908-4-50.

Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci 2017;12(77). https:// doi.org/ 10.1186/s13012-017-0605-9.

Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14ª ed. São Paulo: Hucitec; 2014. 407 p.

Minayo MCS, Assis SG, Souza ER. Avaliação por triangulação de métodos: abordagem de programas sociais [Internet]. 1ª ed. Rio de Janeiro: Editora FIOCRUZ; 2005. 244 p. Available at: http://books.scielo.org/id/cywyh

Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. 1ª ed. London: Wiley; 2010. 194 p.

Rotondi MA. CRTSize: Sample Size Estimation Functions for Cluster Randomized Trials [Internet]. 2022. Available at: https://cran.r-project.org/web/packages/CRTSize/index.html

R Core Team. R: A language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 2021. Available at: https://www.r-project.org/

Waitzberg DL. Indicadores de qualidade em terapia nutricional: 10 anos de IQTN no Brasil : resultados, desafios e propostas [Internet]. 3 ed. São Paulo: ILSI Brasil; 2018. 264 p. Available at: https://ilsibrasil.org/wp-content/uploads/sites/9/2018/06/Fascículo-10-anos-de-IQTN-no-Brasil2-Final.pdf

Weschenfelder C, Sapp P, Riley T, Petersen K, da Silva JT, Bersch-Ferreira AC, et al. Absolute and Relative Agreement between the Current and Modified Brazilian Cardioprotective Nutritional Program Dietary Index (BALANCE DI) and the American Heart Association Healthy Diet Score (AHA-DS) in Post Myocardial Infarction Patients. Nutrients 2022; 14(7):1378. https://doi.org/2072-6643/14/7/1378.

Bersch-Ferreira AC, Hall WL, Santos RHN, Torreglosa CR, Sampaio G, Tereza da Silva J, et al. The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial. Clin Nutr 2021; 40(6):3828–35. https://doi.org/S0261561421002272.

Torreglosa CR, Sarti FM, Bersch-Ferreira ÂC, Weber B, Santos RHN, Chiavegatto Filho ADP. Qualidade da dieta e despesa diária com alimentação em adultos com doença cardiovascular no Brasil. Cad Saude Publica 2020; 36(10). https://doi.org/10.1590/0102-311X00225019.

Plienis AJ, Romanczyk RG. Analyses of performance, behavior, and predictors for severely disturbed children: A comparison of adult vs. computer instruction. Anal Interv Dev Disabil 1985; 5(4):345–56. https://doi.org//0270468485900047.

Edwards A, Baldwin N, Findlay M, Brown T, Bauer J. Evaluation of the agreement, adoption, and adherence to the evidence‐based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians. Nutr Diet 2022; 79(2):197–205. https://doi.org/10.1111/1747-0080.12702.

Baumgartner A, Bargetzi M, Bargetzi A, Zueger N, Medinger M, Passweg J, et al. Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison. Nutrition 2017; 35:43–50. https://doi.org/S0899900716302295.

Fasting A, Hetlevik I, Mjølstad BP. Palliative care in general practice; a questionnaire study on the GPs role and guideline implementation in Norway. BMC Fam Pract 2021; 22(1):64. https://doi.org/10.1186/s12875-021-01426-8.

Smith T, McNeil K, Mitchell R, Boyle B, Ries N. A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nurs 2019; 18(1):14. https://doi.org/10.1186/s12912-019-0337-z.

Kilsdonk E, Peute LW, Jaspers MWM. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis. Int J Med Inform 2017; 98:56–64. https://doi.org/S1386505616302702.

Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review. BMC Med Inform Decis Mak 2008; 8(1):38. https://doi.org/10.1186/1472-6947-8-38.

Balas E, Boren S. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics. Yearb Med Inform. 2000; 65–70.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J 2003; 348(26):2635–45. https://doi.org//abs/10.1056/NEJMsa022615.

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol 2015; 3(1):32. https://doi.org/10.1186/s40359-015-0089-9.

Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. Prev Sci 2020; 21, 319–331. https://doi.org/10.1007/s11121-020-01087-6.

Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012; (6):CD000259. https://doi.org/10.1002/14651858.CD000259.pub3.

Funck E. Audit as leviathan: constructing quality registers in Swedish healthcare. Financ Account Manag. 2015;31(4):415–38. https://doi.org/10.1111/faam.12063.

Siverbo S, Cäker M, Åkesson J. Conceptualizing dysfunctional consequences of performance measurement in the public sector. Public Manag Rev. 2019; 21(12):1801–23. https://doi.org/ 10.1080/14719037.2019.1577906.

Lourencetti ALS, Saidel MGB, Treichel CAS, Presotto RF, Silva MC, Santos DS, et al. Uso de Audit and Feedback: lições de uma pesquisa de implementação. Acta paul enferm [Internet]. 2023; 36:eAPESPE02627. https://doi.org/10.37689/acta-ape/2023AOSPE02627.

Published

2024-07-04

How to Cite

da Silva, J. G. S. T., Pagano, R., da Silva, L. R., El Khouri, F. J., Tokunaga, S. M., Torreglosa, C. R., Barreto, J. O. M., Lara, E. M. de S., Santos, R. H. N., Marcadenti, A., & Ferreira, Ângela C. B. (2024). Implementation of the cardioprotective diet manual in primary health care: Study protocol. Context and Health Journal, 24(48), e14630. https://doi.org/10.21527/2176-7114.2024.48.14630

Issue

Section

ORIGINAL ARTICLE