A qualitative study of adherence to nutritional treatment: perspectives of patients and dietitians

BACKGROUND: Effective interaction between care providers and patients is crucial for the success of most medical treatments; in nutritional medical treatment, it is of paramount importance. The aim of the present study was to ascertain the role of the dietitian–patient relationship and the counseling approach in influencing individual patient decisions to adhere to counseling by persisting with nutritional treatment. METHODS: We conducted focus groups with two types of patients, namely, those who had consulted dietitians only once and those who had attended at least three appointments. We divided these two groups into 12 focus groups. In addition, in-depth interviews were held with 17 clinical dietitians. Our qualitative research was based on the perceptions of patients and dietitians. RESULTS: When the encounter between the dietitian and the patient followed the standard educational and informative approach, both the short-term nature of the interaction and the absence of an individualized therapeutic program discouraged patients from persisting with treatment. In contrast, the counseling and therapeutic nutritional approach promoted nutritional guidance through broader behavioral and lifestyle therapies. This approach appears more appropriate for chronically ill patients. The dietitians and some of the patients understand that the profession is changing from the informative and educational approach to a therapeutic counseling approach, but it is difficult for them to adapt to the new model. CONCLUSION: Most patients appear to want individualized, not standardized, treatment. In order to change patients’ eating patterns, dietitians must adopt a more therapeutic approach and relate to patients’ cultural needs and desires to achieve sustainable results.