Table 6.

Effectiveness of nutrition training to improve nutrition counseling and counseling skills of caregivers.

Author	Study design	Health cadre	Intervention	Comparison	Outcome: nutrition counseling
Zaman et al. (22), Pakistan	Cluster RCT: 18 health centers were assigned to IG and a similar number to CG	Lady health visitors (MLVs)	Nutrition-counseling training using IMCI’s “counsel the mother” module for five and a half days. It included infant feeding knowledge and practice sessions to develop communication and counseling skills	Health centers of the control group without counseling training for health workers	Counseling: asking about feeding practices and paying attention to answers: IG-50%, CG-25%, P = 0.056; praising mothers for positive action: IG-37%, CG-8%, P = 0.006. Appropriate recommendations to specific changes with explanation: IG-29%, CG-4%, P = 0.01
					Communication skills: IG-82%, CG-51%, P = 0.015
Bassichetto and Réa (13), Brazil	RCT: 31 professionals received intervention and 28 were recruited as a control group	Pediatricians and nutritionists	WHO’s “Infant and young child feeding counseling: an integrated course” was administered. 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	Participants recruited for the control group did not receive the training intervention	Counseling: IG-51.7%, CG-22.2% (P = 0.004)
Moore et al. (14), UK	Cluster RCT-paired cluster randomized trial with pre- and post-intervention evaluation	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	A total of six control practices did not receive nutrition training	Counseling: trained practitioners were 30% (95% CI 7–53, P = 0.01) more likely to provide dietary advise that was completely appropriate
Pelto et al. (19), Brazil	Cluster RCT of 28 municipal health centers	Doctors	Physicians from the intervention group received a 20-h training in a program derived from the IMCI nutrition-counseling module. After training, they provided care to caregiver/child pairs attending their centers	Physicians in the control group received a clinical refresher course but not on nutrition counseling	Counseling: trained providers engaged more in nutrition counseling [only 9(24%) consultations of IG participants did not include advice compared to 14 (43%) among CG participants: P < 0.013]; gave 81 messages compared to 20 of untrained ones (P < 0.002); gave more message specific to foods, preparations, and feeding practices compared to untrained ones (P < 0.01)
					Communication skills: mean communication skills score of trained physicians was 3.94 (SD 1.68) vs. 1.38 (SD 1.02) for untrained ones (P < 0.01)
Santos et al. (15), Brazil	RCT of 28 government health centers	28 Medical doctors	A total of 14 doctors of the IG 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, give animal protein and micronutrient-rich foods, add oil to the food, and increase dietary diversity	14 doctors recruited for the control group did not receive the training	Counseling: 83% of mothers in IG compared to 49% of mothers in CG received nutrition counseling (P < 0.001)
Penny et al. (23), Peru	Cluster RCT of 12 health facilities serving periurban areas	Health workers in selected health facilities	The intervention included training for HCWs to improve anthropometry skills. An accreditation system was also introduced for institutional change. Also it included demonstration of preparation of complementary foods and child’s age-specific group sessions for caregivers	HCWs and caregivers of CG did not receive the training intervention	Counseling: twice as many mothers in IG received nutrition advice after birth compared to those in CG (52 vs. 24%, P = 0.02). Greater impacts on counseling were observed at 4 and 18 months post-intervention (P < 0.002)
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 four consecutive days. The training included lectures, discussions, role-playing, and group exercises. The education intervention was designed using additional inputs from lactation experts and fellow pediatricians	Post-training evaluation	Counseling: residents showed an increased knowledge in advising mothers concerning low milk supply (P = 0.045), infections including mastitis (P = 0.002), or abscess (P < 0.001)
					Counseling and practice: residents showed significant increases in counseling on signs of breast-feeding adequacy (P = 0.012) and managing lactation problems correctly (P = 0.004)
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	Counseling: participants reported a significant improvement in behavior modification techniques (P < 0.001) and practitioners’ counseling (P < 0.001)
Kennelly et al. (45), Ireland	Pre–post-intervention study	General practitioners-doctors	Seven GPs participated in the nutrition education program. The content of training included causes of malnutrition, effects of malnutrition, the use of the Malnutrition Universal Screening Tool (MUST), practical dietary advice for patients with poor appetite, and evidence supporting the use of oral nutrition supplements (ONS)	Post-training evaluation	Counseling: basic dietary advice provided by a health professional increased significantly post-training (90 vs. 26%, P < 0.001)
Kennelly et al. (44), Ireland	Pre–post-intervention study	General practitioners (GP) and nurse practitioners	An educational program incorporating the 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 ONS use	Post-training evaluation	Counseling: about 80% of HCWs reported always providing nutrition advice to patients
Simoes et al. (46), Ethiopia	Pre–post-intervention study	Clinic nurses	A 9-day course using the pre-tested version of the IMCI course was provided to six clinic nurses. The training modules included assessment and classification of sick child, treatment of the child, counseling the mother, and follow-up. Other modules included practical sessions in the clinic	Post-training evaluation	Counseling: trained health workers provided feeding advice rated as “good” by 78%, “fair” at 18% and “poor” at 4%
Newes-Adeyi et al. (48), US	Pre–post-intervention study	Health workers of a special nutrition program	A total of 35 health workers underwent a 1-day intensive training program to improve their growth monitoring counseling and management of nutrition-related problems. The training included lectures, case studies, discussions, small group work, and role-plays	Post-training evaluation	Counseling: compared to pre-training, there was a significant change in elicitation (P < 0.001) and negotiation proficiency (P = 0.07). The level of engagement in discussing provider suggestions for follow-up strategies increased from 1.8 to 2.3 (P < 0.01) and the overall responsiveness level increased from a mean of 2.4–2.8 (P < 0.07)

IG, intervention group; CG, control group; HCWs, health care workers.