Positioning nutrition care within community-based health services in India: availability, demand, perceived impact and the role of medical doctors

Vollständiger Abstract

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Background Nutrition care at the community level can support the prevention and management of nutrition-related chronic diseases. However, the lack of nutrition professionals, healthcare professionals’ limited understanding of their role in nutrition care and/or limited training in nutrition may affect nutrition care in India. This study explored the perspective of Indian medical doctors as well as nutritionists/dietitians on the demand, availability and impact of nutrition interventions and their attitudes and training towards nutrition care. Methods A self-administered cross-sectional online survey was conducted with medical doctors, nutritionists and dietitians in February, 2021. The questions covered five domains: (1) participants’ characteristics, (2) perceived availability and demand for nutrition services, (3) perceived impact of nutrition services on dietary choices, hospitalisations and deaths, (4) perception of medical doctors’ role in nutrition care and (5) education and training in nutrition. Results A total of 74 participants completed the survey with most being from West Bengal. Almost 60% of participants perceived a moderate demand for nutrition services (n=44) with many reporting unsatisfactory services (n=34; 45.9%). Nutritionists/dietitians ranked the impact of nutrition interventions (ie, food taxes/subsidies (median; IQR 3–0/3–2), food distribution (median; IQR 3–0.75/4–1.5) and food labels (median; IQR 3–2/4–1.25) on promoting healthier dietary choices higher than medical doctors. Similar findings were observed regarding the prevention of hospitalisations and deaths. Significant differences existed in the perceived role of medical doctors in encouraging patients/clients to eat healthy foods (median; IQR 4–2.75/4–0.5) and to seek support from other health professionals (median; IQR 5–1/4–2). About 30% of medical doctors did not receive any nutrition content as part of their training (n=12). Conclusion Nutrition education and counselling services in primary healthcare are perceived as promising actions to support healthier dietary choices and to contribute to the management of malnutrition and chronic disease in India. Medical doctors and nutritionists/dietitians were generally aligned regarding the role of medical doctors in nutrition care, with more nutrition training warranted to further support their roles.