Elsevier

Journal of Nutrition Education and Behavior

Volume 38, Issue 5, September–October 2006, Pages 286-292
Journal of Nutrition Education and Behavior

Research brief
Development and Evaluation of the Nutrition Component of the Rapid Eating and Activity Assessment for Patients (REAP): A New Tool for Primary Care Providers

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Abstract

Objectives

1. To describe the development of a dietary assessment tool (Rapid Eating and Activity Assessment for Patients [REAP]) that quickly assesses a patient’s diet and physical activity and facilitates brief counselling by a primary care provider, and 2. To describe the evaluation of the REAP in terms of its reliability, validity, and ease of use by primary care providers.

Design, Setting and Participants

The evaluation of REAP included: 1) an implementation feasibility study conducted with 61 medical students and practicing physicians in practice settings at various medical schools; 2) a calibration study with 44 Brown University Medical School students; 3) cognitive assessment testing with 31 consumers in Rhode Island; and 4) a reliability and calibration study of the revised tool with 94 consumers in Rhode Island and Massachusetts.

Results

The feasibility study revealed moderately high rankings on usefulness, ease, practicality, and helpfulness. The calibration studies demonstrated that REAP has excellent test-retest reliability (r = 0.86, P < .0001), is correlated with the Healthy Eating Index score (r = 0.49, P = .0007), and is significantly associated with intake of most nutrients studied.

Conclusions and Implications

REAP has adequate reliability and validity to be used in primary care practices for nutrition assessment and counselling, and is also user-friendly for providers.

Introduction

Diet plays an important role in the prevention and treatment of many diseases and health problems.1, 2, 3, 4, 5, 6 Nutrition counseling is effective in changing dietary habits, and it has been shown to reduce medication costs.7, 8, 9, 10, 11 National guidelines stress the importance of physician involvement in nutrition counseling.5, 12, 13

Physicians can help patients make positive dietary changes,14, 15, 16, 17 and patients want physicians to provide nutrition counseling.18, 19 However, many physicians do little nutrition counseling themselves, nor do they refer patients to dietitians.5, 20, 21, 22, 23 When counseling does occur, it is often too general, vague, and/or extreme to facilitate successful implementation.21, 22 Barriers to nutrition counseling in the physician’s office include not enough time, inadequate nutrition training, and perceived lack of counseling skills.23, 24, 25, 26 Thus, tools enabling physicians to rapidly and accurately assess patients’ diets and exercise habits in a way that immediately facilitates discussion and goal-setting could be instrumental for more effective patient counseling. Existing brief diet assessment questionnaires27, 28, 29, 30 focus only on a specific health problem or nutrient and/or do not address nutritional issues in a brief, user-friendly format for immediate use to aid in counseling.

The purposes of this paper are (1) to describe a new tool to help physicians and other health care providers conduct nutrition and physical activity assessment and counseling with their patients in a practical and effective manner; and (2) to discuss how the nutrition component of the tool was developed and evaluated.

Section snippets

Description and development of the REAP tool

Investigators involved in the Nutrition Academic Award, an initiative to improve nutrition training across a network of US medical schools31 developed the Rapid Eating and Activity Assessment for Patients (REAP) tool to help health care providers integrate a brief dietary assessment into standard medical history and physical examination. The objectives of the REAP tool are: (1) to address dietary issues that are national nutrition priorities for adults4, 5; (2) to provide a tool that can be

Evaluation methods and results

The REAP tool underwent a series of evaluations, including: (1) an implementation feasibility study with medical students and practicing physicians, (2) a validation study with medical students, and (3) cognitive assessment testing with consumers. The tool was then revised based on the results from these evaluations and (4) underwent reliability testing and an additional validation study of the revised tool with consumers. Evaluation substudies were approved by the Brown University and/or

Discussion and implications for practice

Because of limited resources and the need for the REAP tool to get into the field quickly, convenience samples were predominately used for evaluating the tool, which may limit the generalizability of our findings. This is a common fault of dietary assessment validation studies, which have involved mainly higher-educated, non-Hispanic white participants. In the REAP evaluation, the majority of subjects in the consumer validation study had lower education levels, and the cognitive assessment

Acknowledgments

This article was supported in part by Grant No. NIH-HL-03948 Linking Resources for Brown Medical Nutrition Education. The authors wish to acknowledge Dr. Patricia Stewart, Nicholas Everage, Dorothy Delessio, Alison Armstrong, Jeffrey Stumpff, Doreen Salgueiro, Leanne Fournier, and Cynthia Davis for their help in conducting the research and/or preparing this manuscript.

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    Continuing Education Questionnaire available at www.sne.org/Meets Learning Need Codes for RDs and DTRs 3010, 5090, and 6020.

    This study was supported in part by Grant No. NIH-HL-03948 Linking Resources for Brown Medical Nutrition Education.

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