Different settings, different approaches: a qualitative comparison of Portuguese dietitians’ beliefs, attitudes and practices about obesity in public and private settings

• Published in: Public health nutrition 2018-02, Vol.21 (2), p.435-446
• Main Authors: Teixeira, Filipa V, Pais-Ribeiro, José Luis, Maia, Ângela
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Attitudes; Body Mass Index; Body weight loss; Diet; Diet - psychology; Dietetics - education; Dietitians; Epidemics; Evaluation Studies as Topic; Exercise; Family physicians; Female; Health Behavior; Health care policy; Health Knowledge, Attitudes, Practice; Humans; Interviews; Life Style; Male; Medical personnel; Middle Aged; Motivation; Nutrition research; Nutritionists - education; Nutritionists - psychology; Obesity; Obesity - therapy; Patients; Perceptions; Portugal; Primary care; Private practice; Professionals; Psychology; Public Health; Public health education; Reorganization; Research Papers; Resource availability; Stigma; Studies; Surveys and Questionnaires; Treatment Outcome; Weight control; Weight Loss; Workforce Development; Working conditions; Young Adult
• ISSN: 1368-9800; 1475-2727
• DOI: 10.1017/S1368980017002543

With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians' beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps. Semi-structured interviews analysed according to thematic analysis procedures. Public primary-care and private settings. Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7). Regardless of work context, 'persistence of efforts' emerged as the main characteristic of dietitians' action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice. Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians' work in private settings should be addressed.