Multiple factors affect dietitians' counseling practices for high blood cholesterol

Objective. To examine the association of factors from social cognitive theory with dietitians' counseling practices for high blood cholesterol. Design. A cross-sectional mail survey of 1,500 dietitians that included a 67-item, specially designed questionnaire to collect data. Subjects. The sample comprised clinical dietitians and dietitians in consulting and private practice who were members of The American Dietetic Association and were practicing in Pennsylvania; Delaware; Washington, DC; Maryland, North Carolina; and Virginia (N=1,500). Questionnaires were returned by 1,011 (67%) respondents; the 508 respondents (50%) who counseled adults for high blood cholesterol completed the entire questionnaire. Statistical analyses performed. Statistical analyses proceeded in three steps: descriptive statistics on questionnaire items, calculation of composite index scores, and bivariate and multivariate analyses. Results. Of the key hypothesized factors, greater self-efficacy, higher levels of outcome efficacy, and greater adherence expectations significantly correlated with compliance-enhancing counseling practices. Outpatient dietitians used more compliance-enhancing counseling practices than did inpatient dietitians. Stepwise multiple regression analysis showed that the outpatient setting, a greater number of counseling sessions, follow-up counseling, and a charge to patients for counseling positively correlated with compliance-enhancing counseling practices. Applications. Recommendations suggested by the findings include structuring professional training and continuing education programs for dietitians to strengthen self-efficacy, providing more feedback to improve perceived outcome efficacy, and changing the organization of the delivery of nutrition counseling services for prevention to allow more outpatient counseling.