Hearty Eating
1. Introduction
Hearty Eating is a series of healthy eating group sessions to support people with heart disease in the Greater Glasgow Health Board area.
High rates of coronary heart disease (CHD) are known to affect Scotland, particularly the Glasgow area. The ‘Hearty Eating’ Project is part of the Chronic Disease Management Strategy lead by the Health Board and has its roots in secondary prevention of CHD mobilised through primary. ‘Hearty Eating’ has evolved from the Glasgow Primary Care initiative that supported the Glasgow Response Angina.
Secondary Prevention Programme (GRASPP) and patients are offered:
- Smoking cessation support
- Live Active Programme (exercise referral) based in local leisure centres
- Hearty eating support (group sessions facilitated by a Dietician).
2. Partners
Local Healthcare Co-operatives
Greater Glasgow Primary Care Trust (PCT)
Glasgow City Council
East and West Dunbartonshire Councils
3. Purpose & Objectives
The overall aim of the ‘Hearty Eating’ Project is to:
"Provide diet and lifestyle change education to patients with new and established CHD. The courses may be variable in length but will be patient focussed and locally accessible".
- The original objectives developed to set up the project have evolved into the following:
- To evaluate the effectiveness of the referral pathway from Primary Care onto the project on an ongoing basis
- Continue to identify suitable venues to deliver courses
- Evaluate links between the project with primary and secondary health care and other partners.
- Evaluate and update any of the topics referring to recent clinical evidence in prevention and diet related treatment of coronary heart disease
- Monitor and evaluate any changes to diet and lifestyle that patients achieve after each course.
4. Methodology
‘Hearty Eating’ is targeted at people with heart disease or related cardiac risk factors within the Greater Glasgow population. There is no conscious targeting of areas of high deprivation, however the dieticians felt there is some degree of self-selection because these areas were the ones with higher rates of heart disease. Originally the project was targeted at patients with unstable angina. However, this was widened to include those with any cardiac risk factors.
The ‘Hearty Eating’ project consists of 6-week group sessions on healthy eating, facilitated by dietitians and held in the Glasgow area. A framework of topics has been developed. The specific content of individual sessions is tailored to meet the needs of specific groups.
Topics include:
- an introductory week
- healthy eating/motivation/target setting
- shopping tours/food labelling
- salt, sugar, fat, fibre
- eating out and alcohol
- exercise by referral
- cooking skills
- food and a limited budget.
The process of entry onto the scheme involves several steps: the Practice Nurse uses a ‘Stages of Change’ assessment tool with patients identified at risk of CHD or with confirmed CHD to evaluate their suitability for referral to the scheme.
The ‘Hearty Eating’ scheme is offered to patients identified as ‘Ready to change’. Patients are then contacted by the administrator and invited to attend a group in their area. They are asked to confirm attendance. Patients attend the 6-week course built on active learning principles.
5. Funding
Dr Caroline Morrison, a public health consultant and manager of the Managed Clinical Networks for Glasgow, negotiated funding for the project which was awarded in 2000 from the Greater Glasgow Health Board.
Funding supports 2 full time dietetic posts, half time administrative support and additional overhead and research and development costs.
6. Barriers
The Chronic Disease Management Programme which includes a diabetes service as well as coronary heart disease programme (of which ‘Hearty Eating’ is now part) has created extra demand on community dieticians time across Glasgow. The long term plan to integrate the ‘Hearty Eating’ programme into more mainstream dietetic activity has been resisted by them because of conflicting priorities. This is being overcome by the ‘Hearty Eating’ Dietician by demonstrating the cost effectiveness of group work and helping dieticians understand that this model can be used instead of routine 1:1 consultation with CHD patients.
Generally there has been a dilution of emphasis and priority for ‘Hearty Eating’ priorities amidst NHS reforms.
Patients in one particular locality are reticent to travel outside their immediate vicinity to attend sessions. This has been overcome by providing travel assistance and arranging sessions for groups drawn from well defined locations.
Initial negativity of Practice Nurses to the ‘Hearty Eating’ scheme because:
- they had not been involved in the development of the ‘Hearty Eating’ project
- they perceived the scheme as overly bureaucratic resulting in more work for them
- they perceived waiting times between referral and placement as too long.
7. Evaluation
There are three different elements of evaluation.
- Glasgow GP Live Active Report
- ‘Hearty Eating’ Pilot Project
- GRASPP Evaluation Report (this is the wider CHD programme of which ‘Hearty Eating’ is a part).
- process and outcome evaluation was carried out during the programme
- quantitative measurements recorded included weights, heights and waist measurements and cholesterol (measured prior to the first visit)
- a questionnaire was developed to measure qualitative data such as eating patterns at the start and after the 6 week course
- the results of the pilot showed a 40% non attendance rate of total referrals
- baseline measurements showed little change overall in the 6 week period
- the healthy eating questionnaire showed some change in reported eating behaviours, although the high DNA rate made this difficult to interpret
8. Sustainability
To integrate the ‘Hearty Eating’ and Exercise Referral Schemes into new GP contracts to encourage GPs to refer patients on to community based initiatives. Embed Hearty Eating into the local Health Board Strategy to make this group work model the preferred approach for dieticians working in secondary prevention.
Develop a service level agreement between the Health Board and the local authority for ongoing resourcing of the exercise referral programme. Develop a process of cross-reference between smoking cessation, exercise and ‘Hearty Eating’ groups, so that, for example, dieticians could refer patients for exercise.
9. Lessons Learnt
The project needs a ‘champion’ to lead and drive the project and gain commitment at strategic Health Board level to win funding. The project requires dedicated staff to facilitate planning, implementation and evaluation.
Communication with key referral agents (Practice Nurses and GPs) and their support is important in keeping the momentum of the project going. Effective planning and organisational skills are important to ensure the smooth and efficient administration of the scheme. A strong local rationale for the project that is objective, and not subjective, is required.
Lead contact:
Contact: Marianne Hayward,
Job Title: Hearty Eating Co-ordinator
Address:
Hearty Eating Project
Pollok Health Centre
21 Cowglen Road
Pollok
Glasgow
G53 6EQ
Tel: 0141 531 6821.
Email: marianne.hayward@glacomen.scot.nhs.uk