Abstract
The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n=110) reported that 5.7±10.6 out of every 10 appointments were completed in person; compared to paediatricians (n=182) who reported 7.5±7.0 out of every 10 appointments to be in person (p<0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n=89/104) of statements reached consensus, whereas in round-two 12.5% (n=13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised. The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.
Highlights
Remote consultations fall under the umbrella term telemedicine, defined by the World Health Organisation (WHO) as ‘the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies’ [1]
Using a focused literature search, the draft Pedi-Remote Malnutrition Application (R-MAPP) nutrition awareness tool was based on existing evidence in addition to the nutrition focused approached described in the WHO-IMCI guidelines using a traffic light system of green, amber, red and purple [11,15]
We report on the Pedi-R-MAPP tool, developed using a modified Delphi consensus
Summary
Remote consultations fall under the umbrella term telemedicine, defined by the World Health Organisation (WHO) as ‘the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies’ [1]. Individuals who are hard to reach due to geographical barriers and vulnerable groups, e.g. children, through the widespread implementation of technology enabled care services (TECS) [5,6] Implementation of these types of services would usually be completed over time with robust process framework for use in place, with associated training and evaluative report of the efficacy of processes used with these consultations and associated health care outcomes [2]. Shriqui- Kaufman et al reported that 45% of dietitians had no formal training in alternative nutrition counselling via TECS and that the majority of TECS was delivered by telephone and half delivered through an online platform Those with less experience were more likely to report lower satisfaction scores; suggesting that experience, knowledge acquisition and training were key drivers for confidence around the completion of a remote nutrition focused assessment [3,9]. When HCPs were asked to look back over the last 12 months, dietitians (n 1⁄4 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n 1⁄4 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations.
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