Table 5.
The effectiveness of nutrition training to improve nutrition knowledge of health care workers.
| Author | Study design | Health cadre | Nutrition training intervention | Comparison | Outcome: nutrition knowledge |
|---|---|---|---|---|---|
| Bassichetto and Réa (13), Brazil | RCT: 31 professionals received intervention and 28 were the control | Pediatricians and nutritionists | WHO’s “infant and young child feeding counseling: an integrated course.” The training includes 8 h of practical sessions. Out of 34 sessions, 8 were dedicated to breastfeeding, 6 to HIV and infant and young child feeding, 7 to complementary feeding, 10 to counseling, and 4 to general themes | Doctors and nutritionists in control group did not receive the training intervention. | Proportion of knowledge increase was more among HCWs in IG [e.g., Breastfeeding – IG-79.3%, CG-37% (P = 0.004); HIV and IYCF – IG-48.3%, CG-18.5% (P = 0.049); Complementary feeding – IG-69.0%, CG-37.0% (P = 0.012)] |
| Moore et al. (14), UK | Cluster RCT-paired cluster randomized trial with pre- and post-intervention assessment | 12 General practitioners | A training program was delivered to six intervention practices. Emphasis was on increasing motivation to improve quality of dietary consultations and providing practical skills adapted from behavior models. A 7.5-h training included patients’ assessment, education, and goal setting in issues of public health importance including drinking | Six control practices did not receive nutrition training | IG-trained practitioners were 30% (95% CI 12–50, P = 0.001) more likely to believe that their knowledge was up-to-date than practitioners in IG. There was no statistical significance difference in actual knowledge between IG and CG |
| Santos et al. (15), Brazil | RCT of 28 government health centers | 28 Medical doctors | A total of 14 doctors in the intervention group received a 20-h nutrition-counseling training and practice using IMCI’s “counsel the mother” and “management of the sick young infant” modules. The key recommendations identified were as follows: increase breast and complementary feeding frequency, provide animal protein and micronutrient-rich foods, add oil to the food, and increase dietary diversity | 14 Doctors recruited for CG did not receive training | Doctors from IG correctly answered 83% (95% CI 65–100) of 77 questions on practical situations in the IMCI guidelines compared to 68% (95% CI 48–88) in the CG (P = 0.02) |
| Cattaneo and Buzzetti (16), Italy | Controlled non-randomized study | Nurses, midwives, obstetricians, and physicians | An 18-h UNICEF “breastfeeding, management, and health proportion in baby-friendly hospitals” course along with a 2-h counseling session from the WHO breast-feeding counseling course were implemented | Post-training evaluation | In Group 1, nutrition knowledge went up from a mean score of 0.41 to 0.66 to 0.72. In Group 2, nutrition knowledge went from 0.53 to 0.53 to 0.75 |
| Palermo et al. (37), Australia | Pre–post-intervention study | Nutritionists and dieticians | A total of 32 dieticians were allocated to three IGs: two face-to-face groups and one rural video-linked group. The intervention involved a mentoring circle of experienced nutritionists and community-based dieticians. Each participant attended six 2-h sessions every 6 weeks for a 7-month intervention period | Pre–post-intervention comparison (qualitative and quantitative) | Reported competency score increased post-training/mentoring. An increase in post-intervention measures was also reported: [69.1(13.8) to 79.3(12.1), P < 0.001] |
| Lindorff-Larsen et al. (17), Denmark | Pre–post-intervention study | Doctors and nurses | A follow-up study was conducted in 2004 and compared to a baseline study in 1997. Nutrition training and guidelines were being introduced and used between the two study intervals. Details of such training were not further elaborated | A cross-sectional study, post-trainings and post-guideline application | About two-thirds of doctors and nurses expressed that their education nutrition was sufficient at post-intervention. Significantly fewer health workers lacked methods to identify undernutrition (P < 0.001) and difficult-to-identify patients in need of nutrition support (P < 0.001) at post-intervention |
| Hamer et al. (39), Gambia | Pre–post-intervention study | Registered nurses and auxiliary nurses | Nutrition training for nurses was conducted using the IMCI training manual, “assess and classify sick children aged 2 months to 5 years.” It included both theoretical and practical components of assessing children with and without wasting and edema | Post-training evaluation | Nurses showed good knowledge and performance after the completion of training |
| Edwards and Wyles (40), UK | Pre–post-intervention study | Midwives, physicians, dieticians, and nurses | A total of 24 1-h training sessions were held for 189 staff. Each session consisted of factual and brainstorming sessions about what a pregnant woman eats, and a nutrition calculation of daily requirement for folic acid | Post-training evaluation | Health workers’ nutrition knowledge improved post-training |
| O’Mahony et al. (41), UK | Pre–post-intervention study | Nursing staff | Nutrition training was delivered to nurse participants on the use of the Malnutrition Universal Screening Tool (MUST) | Post-training evaluation | A non-significant difference in post-training nutrition knowledge was observed [Mean (SD) knowledge score 21(6.7) vs. 23(6.2)]. A significant difference was observed in sub-analyses by bands. Nurses were more aware that malnutrition was a significant problem for the National Health Service post-training (P < 0.027) |
| Hillenbrand and Larsen (20), US | Pre–post-intervention study | Pediatric residents | A total of 49 pediatric residents participated in a four-part education series about breastfeeding over 4 consecutive days. It included lectures, discussions, role-playing, and group exercises. The education intervention was internally designed by the authors using inputs from lactation experts and fellow pediatricians | Post-training evaluation | Mean composite knowledge score was 80% post intervention compared to 69% pre-intervention, representing an 11% increase (P < 0.01) |
| Olsson et al. (42), Sweden | Pre–post-intervention study | Nurses | Nutrition education for nurses was conducted for 3 months. It was based on the use of nutrition assessment including energy intake, clinical complications of inadequate energy intake, hospital food energy, patients’ energy requirements, weighing patients and its necessity, reasons for weight loss during illness, and fluid management | Post-training evaluation | 69% Of nurses could calculate a patient’s energy requirement post-training compared to 24% pre-training (P < 0.01). Compared to pre-training, more nurses knew the energy content of hospital food (61 vs. 45%, P < 0.05), knew how to handle enteral infusion equipment (55 vs. 6%, P < 0.01), and found it easy to assess patients’ energy needs (56 vs. 24%, P < 0.01) |
| Gance-Cleverland et al. (21), US | Pre–post-intervention study | Nurse practitioners | A total of 35 nurse practitioners received an intensive 4-h Healthy Eating and Activity Together Clinical Practice Guideline (HEAT CPG) training session | Post-training evaluation | Nutrition knowledge post training improved, including on assessment of growth (P < 0.001), assessment of family history (P < 0.001), and assessment of physical activity (P < 0.001). Practitioners’ nutrition recommendation knowledge also improved post-training compared to pre-training |
| Bjerrum et al. (18), Denmark | Pre–post-intervention study | Nurses | A total of 16 nurses participated in a special training program on nutrition. It was based on experimental theories. A total of five modules lasting 3–4 days were included. They combined theories of planned change and nutrition issues | Post-training evaluation | A short-duration training program enhanced nurses’ awareness of nutrition care, management through assessment and monitoring, their management roles, and approach to clinical nutrition |
| Kennelly et al. (44), Ireland | Pre–post-intervention study | General practitioners (GPs) and nurse practitioners | An educational program incorporating Malnutrition Universal Screening Tool (MUST) training was implemented in 8 of 10 eligible primary practices, seven private nursing homes, and two health centers. The training program was designed based on consultations with health professional groups, clinical guidelines from expert bodies, and current evidence for oral nutrition supplementation (ONS) use in community settings | Post-training evaluation | Nutrition knowledge improved across three evaluation points (P < 0.05). For specific groups, a significant improvement in knowledge score was also observed among general practitioners (P < 0.001) and nurses (P < 0.001) |
| Simoes et al. (46), Ethiopia | Pre–post-intervention study | Clinic nurses | Six clinic nurses received a 9-day course using the pre-tested version of the IMCI course. The training modules included assessment and classification of a sick child, treatment of the child, counseling the mother, and follow-up. Other modules included practical sessions in the clinic | Post-training evaluation | After training, nurses could recognize visible severe wasting with a 67% sensitivity and 99% specify; conjunctiva pallor for anemia at 45% sensitivity and 94% specificity; and bipedal edema with 69% sensitivity and 98% specificity |
| Davies-Adetugbo and Adebawa (47), Nigeria | Pre–post-intervention study | Community health extension workers | A 6-h training on breastfeeding and child survival was conducted for health workers and mothers. The training included the importance of breast-feeding, exclusive breastfeeding, lactation maintenance, expressed breast milk, practical demonstration of attachment, suckling, expression of milk, and cup feeding. An intensive 2-day training was then conducted for health workers using a WHO/UNICEF 18-h breastfeeding course manual. Training included practical, role-playing, and theory sessions | Post-training evaluation | Trained health workers had a significantly higher aggregate knowledge score compared to their untrained counterparts [9.4(9.1–9.7) vs. 7.6(6.6–8.6), P < 0.001] |
| Stark et al. (49), US | Quasi-experimental design using intervention and delayed intervention comparison group | Nutrition and health professionals | An online professional development program for nutrition and health practitioners course was given to the intervention group for 6 weeks. It was based on the PRECEDE-PROCEED health program planning framework involving assessment of underlying factors for a health problem and strategizing the intervention | Delayed intervention control group | Compared to the control group, the intervention group reported significant positive changes (P < 0.01) on knowledge and skills scores |
| Charlton et al. (24), Zambia | Pre–post-intervention study | Health workers for growth monitoring and promotion | Eight out of 16 HCWs received the growth monitoring and promotion training | Post-training evaluation | Compared to untrained HCWs, trained HCWs could correctly define growth monitoring and promotion (P < 0.001) |
IG, intervention group; CG, control group; HCWs, health care workers.