Perspectives of staff and clients regarding the delivery of nutrition information in Green Prescription: a qualitative inquiry

Abstract

In New Zealand, the community-based service, Green Prescription (GRx), has a preventative health focus, supporting clients to make lifestyle changes including improving nutrition literacy, which is known to improve health and reduce chronic disease risk and outcomes ^(1,2). Fourteen GRx services operate in New Zealand, each with staff who have backgrounds in health and/or exercise. Some staff are degree-qualified nutritionists and/or dietitians. Responsibilities of staff may include providing clients with information about nutrition. We aimed to identify the extent of nutrition information delivery in GRx including successes, challenges, and perspectives of staff and clients. An invitation was extended to all 14 GRx services inviting participation from both staff and clients. Semi-structured interviews were conducted with a convenience sample of 15 GRx staff and 18 clients, representing nine and five GRx services respectively. Interviews were completed in-person, over video call, and by phone. Responses from clients and staff revealed both positive and challenging aspects of nutrition information delivery from GRx services. Thematic analysis identified factors that enhance or diminish the delivery of nutrition information including capacity of staff and appropriateness of information. One theme highlighted was expectations from both clients and staff about what is needed, beneficial and feasible. An expectation identified was for GRx staff to provide meal plans and tailored nutrition advice. Provision of this is dependent on the capacity of nutrition-qualified staff as well as confidence of non-nutrition-qualified staff delivering information beyond basic nutrition guidelines. Client respondents reported they benefit from nutrition information but are challenged when their dietary needs require more specific input, which may be beyond the capacity of GRx. From a staff perspective, there is an expectation that clients possess a certain level of basic nutrition literacy and the effect of nutrition on health. However, staff responses identified there is a vast range of nutrition knowledge among clients; limited foundational knowledge, while simultaneously having in-depth understanding of certain nutrition topics. Provision of information is further complicated by misconceptions about nutrition and limited knowledge about specific health conditions where nutrition plays a significant role. Factors that impact the practical implementation of eating more healthfully were identified by both clients and staff, demonstrating there needs to be both sensitivity and adaptability about what is feasible for clients and achievable in GRx service delivery. Greater focus on determining the nutrition literacy a person has and communicating what is practical in both service delivery and clients’ circumstances would aid in aligning the expectations of supporting clients well with nutrition education and enhance available resources within Green Prescription services.