Symposium I
Religion and Spirituality in Nutrition and Dietetics (RSND)
Friday, May 13, 2016, 10:30 - 12:00
Chair: Deborah Lycett
Introduction to the Field – What has Religion and Spirituality got to do with Nutrition and Dietetics?
Dr. Deborah Lycett
PowerPoint slides of the presentation (PDF)
1. Religion and Spirituality in Nutrition and Dietetics. A Mixed Methods Study Exploring Changes in Health Care Students’ Development, Learning Experience and Perceived Professional Competency of Spirituality, Religion and Health whilst Attending ECRSH 2014
Riya Patel Stephen Garvey, Dr. Deborah Lycett, Fazilah Twining, Nicola Cooper, Bernice Tighe, Annie Pettifer, Carla Phillips
Background: Spiritual health impacts the outcome of many physical and psychological conditions. In the UK most spiritual care is provided by the chaplaincy, but evidence suggests quality of care provided by health professionals is enhanced by them addressing spiritual needs of patients. Therefore healthcare students need to develop greater competency in spiritual care, and can benefit from exposure to expertise that lies outside of the UK through attending conferences like ECRSH 2014. To explore:
- Students’ reflective experience of ECRSH; what it meant to them and how it will impact their patient care.
- Change in student perception of the importance of religion/spirituality (R/S) in healthcare, their confidence to address it and their level of comfort to do so.
Methods: 31 undergraduate healthcare students (mostly student dietitians) volunteered to attend the 7 day field trip which included ECRSH 2014. Participants completed semi-structured reflective diaries and rated themselves on a likert scales from 1 – 10, before and after the trip, on the importance they placed on religion and spirituality in healthcare, their confidence to address it and their level of comfort to do so. Qualitative data was analysed using thematic analysis and Nvivo 10 software was used. Quantitative data was analysed using SPSS software Ethical approval was provided by Coventry University Ethics.
Results
- Perceived importance of R/S significantly increased by 11%.
- Confidence to deliver R/S care increased by 18%.
- Personal level of comfort to address R/S increased by 17%.
- These changes were also not associated with students own religiosity or spirituality.
Five qualitative themes emerged (1) What is spirituality and religion? (2) From interference to intergration in clinical practice, (3) Filling the hole in holistic care (4) Finding the balance between personal, professional and patient beliefs, (5) The conflict between science and religion: the challenges that lie ahead.
Conclusions: Attendance at an international academic conference significantly increased how important health care students perceived religion and spirituality to be in healthcare. It also identified some of the perceived challenges related to defining religion and spirituality in policy, training needs and translation to practice.
Reference: Yontef, G.M. (1993): Awareness, Dialogue and process: Essays on Gestalt therapy. NY: The Gestalt Journal Press, Inc.
PowerPoint slides of the presentation (PDF)
2. Towards a Protocol for Developing Spiritual Competencies in Dietetics
Stephen Garvey, Dr. Deborah Lycett, Anne Coufopoulos, Deanne Clouder
Background: The increasing burden of long term conditions, many that involve dietetic care, is increasing in the UK, causing strain and pressure on the National Health Service (NHS). In order to ensure that patients are treated with dignity, compassion and respect, a whole person centred approach, taking into consideration social, emotional, religious and spiritual needs, is required.
Most of the evidence surrounding religious and spiritual (R/S) care in the training and practice of healthcare professionals (HCPs) comes from nursing and psychiatry. The aim of this intervention is to see whether the competencies developed for these disciplines can be applied to dietetics.
The use of educational games to develop HCP competencies in several areas is becoming popular. It provides a non-threatening environment in which a learner can engage in an experientially to critically assess their understanding, gain insight and reflect on this.
Objective: To develop, implement and evaluate an educational board game to increase knowledge and confidence of student dietitians to engage with religious and spiritual aspects of holistic dietetic care.
Methods
- Student dietitians who have completed 14 weeks of clinical placement would be invited to take part. Ethical approval will be sought from Coventry University Ethics Committee.
- A board game designed to develop awareness and use of self, spiritual process (assessment, planning, implementation and evaluation of care), assurance and quality expertise. To provide opportunity for reflection and analysis of case studies and an awareness of and overcoming of the barriers to providing R/S care. Focus is on the ‘whole person’ allowing players to address and discuss issues surrounding holistic care; the game incorporates all aspects of holistic care (nutritional emotional, social, religious and spiritual) and uses a variety of activities, role play, and online interactive digital stories of patients experiences and beliefs.
- An evaluation provides exposure to simulated situations in which assessment can take place. Using the media laboratory at Coventry University, students will be provided with a simulated consultation with subtle references to the patient’s R/S health. These consultations will be video recorded and assessed to determine how well students address these needs before and after the board game intervention.
- Pre and post intervention the students own R/S well-being will be measured using validated tools. How important they rate R/S in patient care and their level of comfort and confidence in addressing R/S will be measured using Likert scales.
- Qualitative data will be obtained from the student about their experience of these sessions either by way of semi-structured interviews.
We are presenting the idea and protocol for discussion and so results are not available at this stage. We anticipate that the results of this study will inform the further development of education tools for managing R/S with holistic dietetic care.
PowerPoint slides of the presentation (PDF)
3. A Feasibility Study Investigating the Ppracticalities and Experiences of Implementing a Healthy Diet Skills Programme in a Faith-Placed, Foodbank Setting
Alexandra Harper, Dr. Deborah Lycett, Anne Coufopoulos
Background: In 2008/09 25,899 people received 3 days emergency food from UK foodbanks, this rose to 1,084,604 people by 2014/15. The leading UK foodbank charity, The Trussell Trust, is a Christian organisation distributing food out of local churches. To address the foodbank clients’ broader needs, a ‘more than food’ approach has emerged aiming to reduce reliance on external support & improve social circumstances, health & well-being. Usual diets of foodbank clients fall short of healthy eating recommendations, so as part of this approach; a dietitian worked with the foodbank & developed, delivered & evaluated a healthy diet skills programme in collaboration with Coventry Foodbank & Coventry University.These programmes have never been formally evaluated. Although evidence suggests delivering health interventions in faith-placed settings enables holistic needs to be addressed more easily, builds on community infrastructure & relies less on external services.
Aim: To explore the role of a dietitian in a UK foodbank. To test the feasibility of delivering & evaluating an intervention for foodbank clients to improve knowledge, skills, behaviour & confidence related to healthy eating & cooking, using the items received in a foodbank parcel.
Methods: A 2-week nutrition education & cooking intervention delivered in the foodbank. Pre & post intervention measures assessed change in nutritional knowledge, dietary choice & confidence in healthy food preparation. Feasibility was measured through client’s uptake & attendance rates at the programme. Dietitan’s reflections on their role in a UK foodbank were recorded.
Preliminary Results: Recruitment was difficult as motivation in this client group was poor. Understanding client’s circumstances was an important aspect of helping clients to engage. Attendees were more likely to be female & unemployed. There was high attrition for those who signed up, 75%, but once clients attended week one only 5% did not attend week two. Baseline knowledge was low therefore course content was simplified. Approximately 80% clients improved in food preparation confidence. The foodbank dietitian’s role was about more than nutrition: to act as an advocate & support clients with all aspects of health & well-being; to refer/signpost clients to different services internal & external to the faith-based organisation; to recognise spiritual needs. Reliance on volunteer support to help deliver the intervention was challenging.
Conclusions: A foodbank dietitian makes an important contribution empowering clients to improve their diet & supports them holistically. A church setting provides a non-judgemental & supportive environment for this client group to feel safe. It serves as a hub of resources where multiple levels of support were accessed to improve holistic health.
PowerPoint slides of the presentation (PDF)
4. Taste and See: A Feasibility Study of a Church- Based, Healthy, Intuitive Eating Programme – Positive Preliminary Results
Dr. Deborah Lycett, Riya Patel, Anne Coufopoulos, Andy Turner
Introduction: Obesity treatment remains a high priority globally. Evidence suggests holistic approaches, which include a religious element, are promising. Much is US research, but recent evidence suggests UK need among Christians.
Objective: To conduct a mixed-methods pre-post feasibility study of a 12week faith-based, healthy, intuitive-eating programme, within a UK church.
Methods: 18 participants with BMI>25kg/m2 took part. Ethical approval was granted by Coventry University Ethics committee. Physical, psychological and spiritual outcomes were measured at baseline, 12weeks and will also be measured at 6months. Results were analysed using intention to treat (ITT) analysis; baseline observation carried forward (BOCF) was used to input missing data. Qualitative data was collected with semi-structured interviews.
Preliminary Results at 12 weeks: 17 out of 18 participants completed the intervention. Significant improvements were found in weight ((mean difference [95% confidence interval (CI)] -1.57kg [-2.85, -0.28]), Quality of Life Visual Analogue Scale (11.72 [3.89, 19.55], mental well-being (6.72 [4.08, 9.36]), depression (-3.06 [-4.89, -1.22]), anxiety (-4.11 [-6.06, -2.16]) and intuitive-eating scores (13.06 [6.96, 19.15]). Some scores on The Three Factors Eating Questionnaire (TFEQ) were significantly worse (restrained-eating (19.14[9.99, 28.28]); emotional eating (11.42 [1.01, 21.82])). Measures of spiritual well-being (4.78 [-1.08, 10.63]) and religious love (0.39 [-0.64, 1.41]) showed a non-significant improvement.
Preliminary themes about spirituality from participant interviews: At the start of the course, the idea of spirituality in relation to eating was puzzling to the participants, and bringing God into their eating was not something they had previously considered despite experiencing considerable struggles with their weight. However as time went on the spiritual component took the participants on a journey. This journey led participants to love themselves the way God loves them, which formed an important foundation for changing motives to manage their weight post intervention.
Conclusion: Results support a mainly positive association with outcomes of the intervention. However uncertainty exists due to the small sample size and wide confidence intervals. A larger cluster-randomised controlled trial is planned. If weight can be reduced by a small amount and mental health improve in the obese population, the public health impact could be substantial. Emerging themes of spirituality that came out of the programme were: ‘I can take my food issues to God’ and ‘God’s love is a catalyst for self-love’. Using churches enables religious and spiritual health to be addressed and also uses existing social structures and a voluntary workforce that are potentially sustainable and cost effective.
PowerPoint slides of the presentation (PDF)
5. A Qualitative Study Exploring the Role of Religion on Diet Choices in Seventh-Day Adventist University Students
Chantal Tomlinson, Dr. Deborah Lycett
Positive health outcomes associated with dietary choices of Seventh-day Adventist’s (SDA’s) is well known. However there is little exploration regarding how individuals feel about the role religion plays in their food choices and how this impacts their dietary behaviour. The aim of this study is to develop an understanding of the way religion and spirituality influences diet and food choices in SDA students.
A qualitative phenomenological study to capture the lived experience of SDA’s beliefs on their dietary choices. 4 participants were recruited from the Adventist Society using purposive sampling on the Coventry University campus. Semi-structured interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to categorise data into emerging themes. Member checking and peer review were included to maintain participant views. Ethical approval was granted from Coventry University.
5 themes were identified: ‘dietary choices’, ‘religious and social influence’, ‘motivation through impact on the ‘whole-person’’ and ‘spiritual journey’. Participants mentioned food and dietary choices to: refrain from consuming meat, dairy products, drinking plenty of water and refrain from caffeinated drinks. Participants were motivated by the impact these choices had on their ‘whole being’. They believed that their diet impacted them physically: ‘when I’m vegetarian I’m lighter as in I’m not bloated.’ It also has an impact on them spiritually: ‘So if I don’t eat meat for like a certain amount of time, then it becomes easier for God to have a greater influence in my life.’ This was also then demonstrated through responses that suggested progression of a spiritual journey: ‘And I think as I grow in my spiritual relationship with God... then I will kinda draw away from meat products.’
Religious teachings from The Bible and Ellen White, influence participants to make a conscious effort towards a plant-based diet (the original diet). There is also a notable impact of culture these choices e.g. upbringing and immediate peer influence. Participants felt their diet had an impact on their spirituality as well as their physical and mental health. Despite the small sample size (restricted due to time constraints), validity in qualitative research is gained from meaningful, information rich data rather than from a large number of participants. Nevertheless, in order to obtain transferable results, data saturation within the greater population of SDA students would be advantageous. Although the researcher was also an SDA, an inside view enhanced the interpretation of themes. Nonetheless, the researcher reflected critically on their influence throughout the research to prevent any unfair bias and enhance reflexivity.
Religious teachings, culture, physical and spiritual benefit are instrumental in influencing the dietary choices of SDA university students. This impact of diet on spiritual well-being and the spiritual drive to change dietary behaviours are important aspects to consider in dietetic consultations. This may then lead to more effective behaviour change with this patient group.