Dr. Katherine Ford is a Registered Dietitian and a Canadian Institutes of Health Research (CIHR) Health System Impact Postdoctoral Fellow at University of Waterloo. She also holds a Mitacs Elevate Fellowship in conjunction with the Canadian Nutrition Society. During her fellowship, Katherine is supporting the Canadian Malnutrition Taskforce with integrating a malnutrition care standard in Canadian hospitals. Katherine’s PhD work at the University of Alberta investigated the determinants of protein intake and the role of a high protein diet in maintaining muscle mass during chemotherapy treatment for colorectal cancer. Katherine utilizes her experience as Dietitian to bring a clinical perspective to her research and is interested in better understanding the impact of nutritional assessment and interventions on patient-oriented outcomes and how to spread and scale effective interventions.
Up to half of Canadians admitted to hospital are malnourished. There is a need to implement, sustain, and scale-up best practices for malnutrition care in Canada. The More-2-Eat project focused on implementing (Phase 1) and sustaining (Phase 2) an evidenced-based nutrition care pathway. Advancing Malnutrition Care (AMC) aims to scale this success across Canada through a mentor-champion program.
More-2-Eat Phase 1 included implementing a nutrition care pathway in 5 hospital units for 12 months. Phase 2 aimed to sustain the improvements in 4 original hospitals and spread to 6 new hospitals over 18 months. The Capability, Opportunity, and Motivation for Behaviour (COM-B) model guided implementation. To scale across Canada, AMC uses a mentor-champion model with Phase 1 and 2 champions becoming AMC mentors that guide new champions. Baseline audits are underway along with COM-B-based experience questionnaires for mentors and champions. Likert scales were used to assess champions’ preliminary confidence and commitment (1:not; 10:very), and understanding (1:low; 10:high) of changing practice.
Champions were key to implementation and sustainability of the nutrition care pathway in Phases 1 and 2, and the AMC mentor-champion model shows promise in continuing this impact. To date, AMC has recruited n=8 mentors (n=6 from Phase 1 and/or 2), and n=8 new champions, from 3 provinces across Canada. Preliminary results found that champions felt confident (mean±SD: 7±1) in their role and committed (9±1) to applying learnings. Understanding of practice change strategies was highest for data collection to track change (8±1) and lowest for changing behaviour (6±2). All champions had experience working with teams to make unit improvements.
Champions are confident and committed to changing practice. AMC shows promise in continuing to support sustainable implementation of a nutrition care pathway in Canadian hospitals using a mentor-champion model. Audits and experience surveys will monitor impact.