The HERALD study. A pragmatic pre-post implementation study on the effects of a HEalth liteRAcy sensitive modeL of Dietetic care on diet quality in nephrology outpatient clinics.

The intervention consists of an alternative model of dietetic care that has been adapted to be health literacy sensitive. Four components of care will be modified compared to usual care: patient appointment letters; use of a question prompt sheet; use of teachback; and use of health literacy adapted patient education materials. - appointment letters in the intervention will differ from usual care by having revised wording in line with health literacy principles ie increased readability, simplified jargon, chunking of information and reduced linguistic demand. - Dietitians employed by the local health district allocated to the nephrology clinic will deliver the intervention. The mode of delivery will be individual face to face advice delivered by dietitians. The number of times the intervention will be delivered is 2 minimum as per evidence based practice over the period of 3-6 months. If additional sessions are required these will be determined by the dietitian based on the need to modify care due to change in clinical outcomes, patient knowledge, or the need to modify the dietary prescription. The first contact will be a one hour individual face to face consultation followed by at least one review appointment of 30 minutes length as per usual standard practice. Each session will involve education and counselling by the dietitian and review of understanding with the patient using teachback. The location where the intervention occur will be the outpatient clinic in the Dept. of Renal Medicine at one of three sites in the Illawarra Shoalhaven Local Health District. Once informed consent is received, patients will receive dietary advice from the dietitian. The dietitian may choose to use the modified patient education materials, question prompt sheet or teachback during the session with the patient. After the appointment a series of patient experience measures will be completed with the chief investigator. These tools include the EQ-5D-5L quality of life tool; the Australian hospital Patient Experience Set and the Nutrition and Dietetic Patient Outcomes Questionnaire Adult. Semi structured interview questions with patients and carers will be completed after the first appointment. Interviews with dietitians regarding the feasibility of the new model of care will occur prior to the intervention; 2 weeks after commencement and after all patients have been recruited. All advice will be individualised as per usual routine practice except that in the intervention period, participants will receive a question prompt sheet prior to the appointment and receive health literacy modified versions of the relevant patient education materials during the session. These patient education materials will be modified prior to the intervention by the Chief Investigator using the protocols for development of patient educational materials the health district. Intervention fidelity will be assessed by the research team by listening to audio recordings of the session to record the number of questions asked by patients, the materials used by the dietitian with the patient, and the number of rounds of teachback utilised in the session. Post intervention semi structured interviews will be conducted with dietitians to ascertain feasibility of the intervention long term.