Nutrition Counseling Training Changes Physician Behavior and Improves Caregiver Knowledge Acquisition

Physician behavior and caregiver retention of nutrition advice were examined as potential mediating factors in the success of a nutrition counseling efficacy trial in Pelotas, Brazil, which reduced growth faltering in children 12-24 mo old. After pair-matching on socioeconomic status and nutrition indicators, municipal health centers were randomly assigned to an intervention group, in which physicians were trained with an IMCI-derived (Integrated Management of Childhood Illness) nutrition counseling protocol, or to a control group, without continuing education in nutrition. In a substudy of the larger trial, direct observation of consultations, followed by home interviews with mothers, provided data on physician counseling behavior and mothers' retention of nutrition advice. Trained providers were more likely to engage in nutrition counseling (P < 0.013) and to deliver more extensive advice (P < 0.02). They also used communication skills designed to improve rapport and ensure that mothers understood the advice (P < 0.01). Mothers who received advice from trained providers had high rates of recalling the messages on specific foods (95 vs.27%; P < 0.01) and feeding practice and food preparation recommendations (90 vs. 20%; P < 0.01), whereas the proportions of the messages recalled on breast-feeding (60% vs. 30%) did not differ significantly (P < 0.20). The training course contained several elements that may explain why intervention group mothers were better able to recall nutrition advice. These include locally appropriate messages, tools for assessing individual problems, and counseling skills.