1. RENAL DIET PRESCRIPTION Looking for the missing link….. Olwyn Talbot-Titley Renal Dietitian NDHB

2. My Journey  Clinical excellence- evidenced based  Nutrition up to ½ treatment  Nutrition education highest form of learning as usually involves behaviour change

3. Assessing my effectiveness as an educator Survey: Measure if there was an increase in patient knowledge level after 12 months dietitian education.

4. Assessing my effectiveness as an educator Outcome: No change in knowledge level

5. Why?

6. Dietary advice to reduce phosphorus intake Sullivan JAMA 2009

7. Why? Looking for the missing link…..

8. Why? Looking for the missing link….. 2012 research by Vidgen & Gallegos ‘Young people need good food literacy so they can provide for their nutritional needs’

9. What is food literacy ?

10. Research By Vidgen and Gallegos Food literacy Nutrition plan, select, cook, eat diet quality, food groups, serves -

13. What is food literacy ? Definitions 1.‘Set of knowledge, skills and behaviour to plan, manage, select, prepare and eat foods to meet and determine intake’

14. What is food literacy ? Definitions 1.‘Set of knowledge, skills and behaviour to plan manage select prepare and eat foods to meet and determine intake’ 2. ‘Scaffolding that empowers individuals, households, communities or nations to protect diet quality through change, and support dietary resilience over time.’

15. NZ Survey  2006 Health Literacy survey 56.2% of population has a poor literacy score.  Rural Maori statistics are worse. (Assumption that food literacy is part of health literacy) This translates >1/2 renal patients do not understand…..

16. Is poor food literacy the missing link ?

17. If yes, this could explain why our attempts at increasing nutrition knowledge and concordance have failed some patients.

18. Is poor food literacy the missing link ? Setting out to test this hypothesis.

19. About the ‘How To’ project  Focus on people with poor food literacy  Food literacy Framework  Food skills & knowledge to be the result

20. ‘How to’ considerations  Team approach  Committee with a patient representative, renal expertise and community links

21. ‘How to’ considerations Part 1 ‘How to’ Framework- plan, select, (cook) and eat Part 2 ‘How to’ Cookbook compilation

22. What improvements can we measure? 1. Knowledge by repeating the same ‘screening’ questionnaire 2. Behaviour change Can this be reflected by tracking blood levels ?

23. Future Changes may include 1.Dietitians building literacy then undertake nutrition education(complex diet prescription) 2. Renal team supporting the building of food literacy 3. Medication literacy project 4. Always involve patients families

24. Super heroes- the summary  H. is for health literacy- food literacy  E. is for education to help make choices  R. is for repetition  O. is for ownership of knowledge and skills  E. is for everyone-team & patients/families  S. is for support. Renal team and families support the opportunity for a good quality and extended life.

25. References  Defining Food Literacy, its components, development and relationship to food intake: A case study of young people and Disadvantage, Helen Vidgen and Danielle Gallegos, Queensland University 2012  Effect of Food additives on Hyperphosphatemia Amongst Patients With End-Stage Renal Disease A randomised controlled trial ( Presentation slide attributed to Lyn Lloyd, Dietitian, Auckland ) Sullivan et al. JAMA Feb 11, 2009 Vol. 31 no 6  Ministry of Health ( 2010) Korero Marama: Health Literacy and Maori: Results from the 2006 adult literacy and life skills survey. Wellington: Ministry of Health