Lifestyle Behavior Change in Patients With Nonalcoholic Fatty Liver Disease: A Qualitative Study of Clinical Practice

Avery, Leah; Exley, Catherine; McPherson, Stuart; Trenell, Michael I.; Anstee, Quentin M.; Hallsworth, Kate

doi:10.1016/j.cgh.2017.06.011

Cited by 42 publications

(70 citation statements)

References 7 publications

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“…[102][103][104][105] Barriers and facilitators to implementing lifestyle change Although the evidence demonstrates lifestyle interventions can be effective tools for managing NAFLD and clinical guidelines recommend lifestyle changes, there is a substantial disconnect between these ideals and how care is delivered in routine clinical practice. 106,107 Many clinicians feel they lack the training, tools and time to effectively deliver lifestyle interventions, 106 and report the need for a multidisciplinary team to adequately manage NAFLD including a range of lifestyle intervention options to support maintenance of long-term behaviour change. 106 ,108 ,109 This is a luxury not afforded in most clinical setups.…”

Section: Evidence For Nash and Cirrhosismentioning

confidence: 99%

“…A lack of understanding and acknowledgement of the link between current lifestyle habits and their NAFLD/NASH will hinder any meaningful change -patients need to understand that NAFLD/ NASH is potentially reversible if they make and sustain these changes. 106,[109][110][111] There are multiple behaviour change techniques (BCTs) that have been shown to be effective in the management of patients with chronic diseases. [112][113][114] These BCTs aid clinicians to support patients in making informed decisions about their behaviour(s) and encourage patients to take a level of responsibility for their own health.…”

Section: Evidence For Nash and Cirrhosismentioning

confidence: 99%

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Lifestyle modification in NAFLD/NASH: Facts and figures

2019

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The development of non-alcoholic fatty liver disease is closely linked to lifestyle factors, namely excessive caloric intake coupled with reduced physical activity and exercise. This review aims to examine the evidence behind lifestyle change as a tool to improve hepatic steatosis and liver histology in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. Furthermore, potential barriers to adopting lifestyle changes and strategies to overcome these barriers in the clinical setting are discussed.

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Section: Evidence For Nash and Cirrhosismentioning

confidence: 99%

Section: Evidence For Nash and Cirrhosismentioning

confidence: 99%

Lifestyle modification in NAFLD/NASH: Facts and figures

2019

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“…IP address: 44.224.250.200, on 15 Apr 2021 at 19:01:09, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0007114521001100 with NAFLD and treating clinicians have highlighted the need for a multidisciplinary team to support lifestyle management of this condition (19) . Therefore, the aim of this qualitative study was to explore multidisciplinary clinicians' perspectives on whether the MDP is recommended in routine care for patients with NAFLD and the barriers and facilitators to its implementation through semistructured interviews.…”

Section: Introductionmentioning

confidence: 99%

‘Focus on diet quality’: a qualitative study of clinicians’ perspectives of use of the Mediterranean dietary pattern for non-alcoholic fatty liver disease

et al. 2021

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Practice guidelines for nonalcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians’ perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multiethnic setting. Semistructured individual interviews were conducted with 14 clinicians (7 doctors, 3 nurses, 3 dietitians and 1 exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinician’s described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone’s role, whereby doctors and nurses raise awareness and dietitians provide individualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss; in-depth knowledge of the dietary pattern; access to patient education and monitoring resources; service culture, including an interdisciplinary clinic goal; and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from diverse cultural and socioeconomic backgrounds; and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.

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“…All highlight the importance of lifestyle behavior change in all patients with NAFLD regardless of disease severity. However, despite the publication of these guidelines, a gap remains between recommended clinical care behaviors and actual care delivery [ 21 ]. Specifically, there are inconsistencies in the way in which patients are diagnosed.…”

Section: Introductionmentioning

confidence: 99%

Using the theoretical domains framework to identify barriers and enabling factors to implementation of guidance for the diagnosis and management of nonalcoholic fatty liver disease: a qualitative study

Hallsworth

Dombrowski

McPherson

et al. 2019

Translational Behavioral Medicine

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Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide and is steadily on the increase. In response, national and international guidance have been developed to standardize diagnosis and guide management of the condition. However, research has highlighted a discordance between published guidance and clinical practice. The purpose of this study is to identify barriers and enabling factors to implementation of guidance to inform the development of an intervention. We interviewed 21 health care professionals and 12 patients with NAFLD. Topic guides were developed with reference to national and international guidance. Data were content analyzed using the Theoretical Domains Framework. Beliefs about consequences and professional role and identity were the most prominent domains identified from health care professionals in the context of diagnosis and management of NAFLD. Environmental context and resources, memory, attention and decision processes, goals, behavioral regulation, knowledge, and skills emerged as important barriers/facilitators to implementation of guidance targeting management of NAFLD. Knowledge and beliefs about consequences were the most prominent domains from the perspective of patients. Social influences, environmental context and resources and behavioral regulation were most prominent in the context of NAFLD management. Guideline implementation can be improved by use of interventions that target standardized use of diagnostic criteria by health care professionals. Training of health care professionals was identified as important to improve care delivered to patients in order to effectively manage NAFLD. Interventions that target knowledge of patients, in particular, raising awareness that NAFLD can be progressive when not actively managed would facilitate implementation of guidance.

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Lifestyle Behavior Change in Patients With Nonalcoholic Fatty Liver Disease: A Qualitative Study of Clinical Practice

Cited by 42 publications

References 7 publications

Lifestyle modification in NAFLD/NASH: Facts and figures

Lifestyle modification in NAFLD/NASH: Facts and figures

‘Focus on diet quality’: a qualitative study of clinicians’ perspectives of use of the Mediterranean dietary pattern for non-alcoholic fatty liver disease

Using the theoretical domains framework to identify barriers and enabling factors to implementation of guidance for the diagnosis and management of nonalcoholic fatty liver disease: a qualitative study

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