Patient and Professional Perspectives on Nutrition in Chronic Respiratory Disease Self-Management: Reflections on Nutrition and Food Literacies

Abstract

Background:Nutrition literacy (NL) and food literacy (FL) have emerged as distinct forms of the multifaceted concept of health literacy (HL). Despite convincing evidence that changes in dietary behavior can improve health, the role of nutrition in supporting self-management in patients with chronic respiratory disease tends to be overlooked.Objective:This study examined patient and key informant (health care professionals, researchers, and policymakers) perspectives on nutrition in the context of self-management practices in asthma and chronic obstructive pulmonary disease with implications for NL and FL.Methods:Data were collected during 16 focus groups with 93 English- and French-speaking patients in the Canadian Provinces of British Columbia, Ontario, and Quebec, and in-depth interviews with 45 key informants mainly from Canada. Participants' comments, including dietary perception keywords, were extracted and classified using NVivo software. Thematic analysis was applied.Key Results:Patients' perspectives on nutrition reflected three broad themes: (1) importance of nutrition knowledge in self-management, (2) applying nutrition knowledge in self-management, and (3) challenges in applying nutrition knowledge in self-management. Embedded within the third theme were six sub-themes: Limitations in “accessing nutrition information,” “understanding nutrition information,” “basic literacy skills,” and “ability to act on nutrition information,” along with “lack of supports to act on nutrition information,” and “competing daily demands in mealtime and medication management.” Although less than 10% of key informants provided nutrition-relevant comments, their comments reinforced patients' concerns about barriers to accessing, understanding, and using nutrition information in self-management.Conclusions:Our findings suggest that more attention be directed to nutrition in the self-management of chronic respiratory disease and warrant further research on the roles of NL and FL in this health practice context. Such research could also contribute to the broader agenda of understanding NL and FL and applying them as subconcepts of HL in chronic disease self-management interventions. [HLRP: Health Literacy Research and Practice. 2018;2(3):e166–e174.]Plain Language Summary:Growing evidence supporting the role of diet in chronic disease calls for more attention to nutrition literacy. This study explored patient and key informant viewpoints on engaging with nutrition information in self-management of chronic lung disease. Findings suggest patients encounter many challenges in accessing, understanding, and acting on relevant nutrition information.