Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes: a national survey of health professionals

Globally, at least 10% of adults are living with diabetes and half of these cases are not treated with glycaemic control medication. Assessment of dietary adequacy and foot health are integral components of diabetes mellitus management recommended in clinical guidelines, yet these assessments are frequently not performed. Australian allied health services including dietetics and podiatry are not widely used by adults with diabetes. This study aimed to identify facilitators and barriers for delivering medical nutrition therapy (MNT) and podiatry care for adults with diabetes mellitus by health professionals. A cross-sectional study was conducted in which Australian health professionals reported facilitators and barriers for providing MNT and podiatry care in an online survey. Quantitative data collected from the survey were analysed using descriptive statistics and qualitative survey responses were categorised into posteriori themes using inductive content analysis. The survey was completed by 208 health professional participants including the following disciplines dietitians (48%), diabetes educators (34%), GPs (11%) and practice nurses (7%). The most frequently (> 70% in each discipline) reported facilitator were related to their nutrition knowledge for diabetes management. A barrier theme reported by dietitians was that adults with diabetes mellitus were receiving conflicting nutrition advice from other health professionals related to diabetes management which impacted on their uptake of MNT. Barrier themes reported by other health professionals were patient reluctance to consult with a dietitian, a lack of understanding of the importance of nutrition by health professionals and limited availability of dietetic services. A facilitator for delivery of podiatry care was that a patient foot assessment was performed by many (> 65% in each discipline) health professionals as part of an annual cycle of care. Barriers were appointment cost (range: 48–53% for each discipline) and adult’s lack of understanding of the importance of a podiatry foot assessment (range: 48–93%) for diabetes management. Increasing health professionals’ knowledge of general nutrition advice as well as the role and value of dietetic and podiatry services will be important for diabetes care. Not applicable.