Validation of a dietary advice protocol for adults with obesity in primary health care according to the Brazilian Dietary Guidelines

Fam Pract. 2022 Nov 23:cmac132. doi: 10.1093/fampra/cmac132. Online ahead of print.

Abstract

Background: Obesity is a non-communicable chronic disease which carries a high cost for the Brazilian Unified Health System. Standardized protocols can help primary health care (PHC) professionals manage the disease.

Objectives: To describe the validation process of a protocol concerning dietary guidelines for adults with obesity in PHC by non-nutrition professionals.

Methods: A validation study of a dietary advice protocol consisting of 6 recommendations was conducted according to Brazilian Dietary Guidelines. The topics incorporated into the recommendations were submitted to a panel of judges for content validity and achieved a Scale Content Validity Index (S-CVI) score >0.80. Subsequently, an online workshop was held and consisted of guiding questions to adequately improve current protocols. Face validity was assessed in a mediation workshop conducted with PHC non-nutrition professionals. Following the validation process, necessary adjustments were made to the eating protocol.

Results: The validation process was conducted by a panel of 20 judges and 10 PHC professionals. The content was validated using a 0.98 S-CVI. The online workshop expert panel agreed the instrument provides a trustworthy foundation for appropriate dietary guidelines. Moreover, the judges suggested changes to the flowchart designed to support the professionals' decisions, discussed the absence of quantitative prescription guidelines, and offered additional suggestions to strengthen equity and encourage autonomy in non-nutrition healthcare professionals in PHC.

Conclusion: This study describes the validation process of a dietary advice protocol for people with obesity, as well as the importance of its integration into PHC.

Keywords: clinical protocols; dietary guideline; obesity; primary health care; validation study.

Plain language summary

Obesity is a public health problem that generates high costs for the Brazilian Unified Health System. Dietary guidelines are essential for the care of people suffering from obesity in primary health care (PHC) and should be implemented by all health professionals. However, the absence of protocols based on the Brazilian Dietary Guidelines to support dietary advice constitutes a gap that can prevent the active participation of professionals without training in the field of nutrition. Thus, the objective of this study is to describe the validation process of a protocol for dietary advice for adults with obesity for non-nutrition professionals working in PHC. Researchers and practitioners participated in panels as judges and evaluated the initial text of the protocol, suggesting changes when necessary. Notes on the clarity of the text were also provided. After the requested adjustments, the protocol was validated and made available by the Brazilian Ministry of Health to PHC professionals.