EAL

DLM: Self-Management and Individualized Counseling (2001)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The purpose of this study was to investigate the nutrition knowledge and attitudes of cardiac patients in various regions of the US.

Inclusion Criteria:

Inclusion criteria included the following:

Patient was visiting cardiologists in one of the following regions: New England, Southern California or the Midwest
Patient was willing to complete surveys.

Exclusion Criteria:

Did not meet inclusion criteria.

Description of Study Protocol:

N=606 patients attending cardiology clinics (New England, N=194; Southern California, N=116; and the Midwest, N=296) completed the survey designed to measure nutrition knowledge and attitude toward dietary change.

Recruitment

Patients attending cardiology clinics in New England, Southern california and the Midwest

Design

Cross-sectional study (survey)

Intervention: n/a

Statistical Analysis

frequency tests examined by X² tests
mean values examined by t-tests
tests of association by Pearson correlation coefficients
all tests two-tailed with α=0.01

Data Collection Summary:

Timing of Measurements

Data collected when questionnaire was given to subjects at time of clinic visit

Study Variables

Medical history
Attitudes toward importance of nutrition
Knowledge of "heart-healthy" diet information.

Description of Actual Data Sample:

Initial N: 606 surveys completed

Attrition (final N): not applicable

Location: Cardiology clinics in New England, southern California, midwest

The New England site was a medium-sized practice with six cardiologists and a patient population that was roughly 90% white, 5% black and 5% Latino or other. Approximately 50% of these patients were covered by Medicare, 45% were privately insured and 5% were covered by Medicaid.
The Southern California site was a hospital-based practice with five cardiologists and a patient population that was roughly 50% black, 30% white, 10% Asian, 5% Latino and 5% other. Approximately 60% of patients were covered by Medicare, and the remainder were evenly split between private insurance and Medi-Cal (for low-income patients).
The Midwest site was a hospital-based practice with 15 to 20 cardiologists and a university affiliation. Roughly 75% of these patients were white, 10% were black, 10% were Latino and 5% were other. Approximately, 65% of these patients were covered by Medicare, 25% were privately insured and 10% were covered by Medicaid.

Summary of Results:

Response Rate

data collected February through May 1993
606 surveys completed (74% response rate)
Subjects were 51% female, 49% male

Medical History

36% had MI 29.2% had heart surgery 33.5% had a heart defect.

Attitudes

On a scale of one to nine, the mean ranking for importance of nutrition for CVD was 7.7 52.2% of patients ranked nutrition as nine in importance.

Dietary Information

92.4% of patients reported receiving dietary literature but only 30.5% reported complete understanding. Differences in complete understanding by region:
- California, 68%
- New England, 50.0%
- Midwest, 43.9%.
Nutrition counseling should receive higher priority for physicians in both medical training and patient care. Cardiology patients should be referred to an RD on a more routine basis.

Author Conclusion:

Survey results indicate that cardiac patients view diet as an important component in preventing and treating cardiovascular disease, but patient knowledge is marginal. The patients do not fully understand educational materials given them.

Funding Source:

University/Hospital:

Wesleyan University

Reviewer Comments:

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	Yes
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		N/A
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	No
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	N/A
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes