General Practice and Primary Care - Theses
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ItemNo Preview AvailableExploring the use of technology to address barriers Indigenous peoples experience when help-seeking for family violence( 2020)Australia’s Indigenous populations experience high rates of family violence but are less likely to access support than non-Indigenous peoples. Mainstream family violence responses have rarely been informed by Indigenous perspectives, and as a result are often not embraced. Although online family violence resources have been well received by non-Indigenous communities, their acceptability to Indigenous peoples has yet to be determined. This thesis engaged with an Indigenous Australian community to understand their perceptions of help-seeking behaviours for family violence and respond to the barriers experienced when pursuing support. Further, this thesis explored the potential for technology as an acceptable resource for those impacted by Indigenous family violence, and what elements an online resource would need have for it to be engaging and usable. To address these aims, a series of methods were used. Firstly, a scoping review was undertaken to identify the help-seeking barriers experienced by Indigenous peoples globally. Then, Community-Based Participatory Research (CBPR) methods were used for addressing the localised help-seeking barriers and exploring the acceptability and elements of online resources for Indigenous family violence. Following a Canadian framework for collaborative research developed with Indigenous peoples, the CBPR methods began by working closely with an Indigenous population on a community-identified need. After establishing trust and seeking approval for the research, an Aboriginal Community Advisory Group was formed and guiding principles for the collaborative research were established. Then, working with the Aboriginal Community Advisory Group, appropriate CBPR methods for addressing the aims of the research were identified. To understand the local perspectives on help-seeking behaviours for Indigenous family violence, interviews took place with fourteen Indigenous women and nine men. These interviews also explored the potential for online family violence resources for Indigenous peoples. Findings from the interviews were then complemented with a round of focus groups where the use of technology for responding to family violence was discussed. Finally, to enhance the likelihood of developing an online resource that was engaging and acceptable to Indigenous peoples, a further round of focus groups and Aboriginal Community Advisory Group deliberations informed the understanding of the elements needed in an appropriate resource. These methods also led to the co-design of an online resource for the Indigenous community involved in the research. This thesis presents the findings in three peer-reviewed articles and a model of suggested elements for online Indigenous family violence resources that can be adapted for other communities. The findings suggest that Indigenous peoples avoid accessing formalised services for family violence because of the substantial barriers they experience such as shame, racism, and fear. One key original contribution to knowledge is that Indigenous peoples perceived online responses for family violence to be acceptable and anticipate that many barriers to support can be addressed through the use of technology. Other significant and new understandings include that Indigenous peoples want co-designed family violence resources that facilitate healing through connection to culture, community and country. This thesis provides evidence that systematic change is required to prioritise the respectful treatment of Indigenous peoples accessing support for family violence. Implications at the practice level include that service providers need cultural training – informed by Indigenous knowledge – to provide culturally safe care so Indigenous peoples can overcome fear and access support. Technology has a role to play in providing accessible support for Indigenous family violence survivors in the practice space. Finally, research implications include opportunities to expand knowledge on the link between culture and healing. Using CBPR methods, non-Indigenous research teams can work respectfully with Indigenous knowledge holders to highlight their voices and create appropriate and useful solutions for community-driven needs.
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ItemThe gender-sensitive care project: Exploring sexual violence in psychiatric inpatient units( 2020)Sexual violence is a major global public health issue. There are strong associations between sexual violence victimisation and mental illness, with one in three women presenting at mental health services have experienced domestic violence, including sexual violence. Women often report feeling disempowered and re-victimised while in psychiatric inpatient units, especially in mixed-gender wards. The biomedical model has been the dominant model of care in psychiatric inpatient units. Recent years have seen a global movement towards gender-sensitive and trauma-informed models of care for those with mental illness. To date, there is limited extant research focused on understanding health professionals' experiences and practices of these care models. This research aimed to understand how trauma-informed care or gender-sensitive care is experienced and enacted by health professionals’ for women victim-survivors of sexual violence across acute psychiatric inpatient units. To address this aim, the research was divided into two phases and four research questions. The first phase answered research questions one and two through a scoping review of the literature. The first research question explored health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient settings. The second research question explored health professionals' awareness of the gendered impacts of trauma and how this impacts the care provided. The second phase included a qualitative case study, including stakeholder interviews, observations, and document analysis. The second phase answered research questions three and four. The third research question explored health professionals' perceptions of providing care for women who are victim-survivors of sexual violence in psychiatric inpatient units. The fourth research question explored health professionals' experiences in providing care for women who are victim-survivors of sexual violence in psychiatric inpatient units. The researcher also conducted a policy review of current mental health and violence against women policy and procedures to understand the context of health professionals' experiences and practices. The findings of these studies are presented in three peer-reviewed published articles. The findings suggest that trauma-informed and gender-sensitive care are inconsistently understood and enacted in practice. A more comprehensive care model, which is gender-trauma and-violence informed, is suggested to address the identified barriers in acute psychiatric inpatient units. This research contributes to improving care provision for women who are victim-survivors of sexual violence during their admissions to psychiatric inpatient units.
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ItemGPimED: General Practice: improving management of Eating Disorders: Can a one hour online educational intervention improve the detection and management of patients with Eating Disorders by General Practice Trainees?( 2020)GPimED: Can a one- hour on-line learning module improve early diagnosis and management of Eating Disorders by General Practice Trainees? PROBLEM STATEMENT Eating disorders are a serious and potentially life-threatening group of illnesses within the community. The literature shows that diagnosis and management of these illnesses are inadequately covered during medical school and subsequent General Practice training. This can result in a delay in diagnosis and appropriate referral thus significantly contributing to patient morbidity and mortality plus increased financial burden on the community. The literature demonstrates that patients with ED present repeatedly to General Practice (GP) with a myriad of signs and symptoms There is often delay in diagnosis due to varied reasons. The literature also finds that this delay coupled with lack of appropriate management can greatly exacerbate the morbidity and potential mortality. For example, within this group of disorders, Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric illness with suicide rates 32 times higher than the general population and a mortality rate of 10%. General Practitioners (GPs) are often time poor and lack the knowledge to adequately manage patients with ED Online education for GPs is becoming more popular as it is cost effective, convenient and allows rural and remote GPs access to educational material they might not otherwise be able to access if it is available only via face to face delivery AIM The aim of this study is to determine whether a one-hour online learning module developed to upskill General Practitioners in the recognition and management of Eating Disorders improves the performance of GP trainees. SIGNFICANCE This study will shed light on the effectiveness of online education in upskilling GP trainees and if the ED module is successful, it may lead to improved treatment of patients with evolving or established eating disorders in the General Practice setting. It will potentially reduce the rates of delayed diagnosis resulting in improved outcomes. The literature indicates that patients with an ED present up to 5 times more frequently to primary care than demographically matched peers. General Practice is thus ideally placed to recognize these patients, to make a timely diagnosis and initiate appropriate investigation, management and referrals. The literature also indicates when diagnosis and appropriate intervention occurs within the first three years of the disorder developing, there is a greater than 40% chance of complete recovery. On November 1st 2019, the Federal Government initiated $110 million in extra funding for increased support for patients with a serious ED. This support can only be accessed if the patient as an Eating Disorder Plan completed is be done by the GP who has performed appropriate screening and provided the requisite history, examination and investigations. METHODS The trial design was a randomized, parallel-group study. Participants were recruited from the Victorian General Practice Training Consortia MCCC and EVGPT. The comparator was a general Youth Mental health module. Baseline surveys including demographic details plus a clinical case designed to assess baseline competence in recognising a probable eating disorder case and management thereafter. Following randomisation to either the ED module arm (intervention) or control arm, follow up surveys were completed after 6 weeks, quantitative evaluation was conducted using clinical scenarios presented as case studies in the format of Key Feature Problems (KFPs) which are a component of the FRACGP examination. RESULTS Despite our best efforts, there were only small number of recruits- 15 respondents with 8 completing all components of the study. Despite the small sample, there was measurable improvement in many parameters assessed cross both arms of the trial. In particular, an increase in the identification of ED as a differential diagnosis and improved referrals to health professionals considered integral to the evidence based best practice multidisciplinary team approach to ED management.
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Item"It happens to clinicians too”: The prevalence, impact and implications of domestic and family violence against health professional women( 2020)Domestic and family violence (DFV) is a major health and social issue in Australia and across the globe. It affects people of all ages and walks of life, predominantly women and children. DFV is associated with a range of harms and impacts, and more frequent utilisation of health services is one. Consequently, health professionals find themselves at the frontline of responding to the health sequelae of violence and trauma in the family. However, healthcare is a gendered profession, where the majority of employees are women. How commonly DFV affects Australian women working in healthcare, and what, if any, association there is between a health professional’s personal experience of DFV and their clinical care of patients accessing healthcare for DFV, is not known. An additional gap in the evidence-base is understanding the needs and perspectives of both survivor health professionals and key stakeholders about the role of the healthcare workplace in supporting survivor staff, not just patients. To address these research gaps, the aim of this PhD study was to investigate the prevalence, clinical care impacts and workplace implications of DFV against an Australian population of women nurses, doctors and allied health professionals. This study utilised a combined methodological approach to collect both quantitative and qualitative data. The first phase of the project was a descriptive, cross-sectional survey of health professionals at a large Australian tertiary maternity hospital, in which 471 health professional women participated (45.0% response rate). Phase two followed, and individual and group interviews were conducted with 18 hospital managers and other key stakeholders. The original contributions of this thesis to new knowledge was the finding that DFV was common in the lives of the health professional women in this study: intimate partner violence (IPV) had affected one in ten (11.5%, 43) women during the last 12-months, and one third (33.6%, 146) of women since the age of sixteen. Sexual violence by an intimate partner was reported by 12.1% (51) of health professional women. Overall, just under half (45.2%, 212) of the participating health professional women had experienced IPV or violence from another family member (including childhood witnessing of DFV) across the life course. The second original finding of this study was that a health professional’s experience of DFV appeared to facilitate clinical care of survivor patients. Specifically, exposure to DFV was positively associated with preparedness to care for survivor patients through greater uptake of professional DFV training, more sensitive attitudes about survivors and more frequent access of information with which to resource survivor patients. The final original knowledge contribution was how hospital workplaces can best support their survivor staff, drawing on the perspectives and experiences of both survivor health professional women (n=93) and hospital managers (n=18). Survivors wanted their workplace to understand that DFV had affected them and to support both their individual needs and recovery as well as their professional capacity to respond to survivor patients. Managers recognised the imperative of a hospital workplace to ensure the availability of multifaceted support for survivor staff, and suggested mechanisms for this. Safety emerged as a key barrier to a more supportive workplace for survivor staff; participants were clear that occupational violence could render a workplace physically unsafe, and fear or uncertainty about how a disclosure of DFV would be responded to affected feelings of emotional safety. The findings of this thesis are presented across three publications. The results indicate that the cumulative trauma burden in Australian health professional women’s lives is high. That burden is added to by the risk of vicarious trauma that all health professionals face in a role where listening to patient histories of trauma and violence is routine. However, the survivors in this study did not present as enduringly vulnerable; on the contrary, they self-reported an informed and sensitive readiness to respond to patients with whom they have DFV in common. This research indicates the efficacy of a trauma and violence-informed framework to underscore and strengthen a recovery-orientated hospital response towards both survivor staff and patients.
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ItemMultimorbidity in People with Type 2 Diabetes: Exploration of Associations with Mortality and Glycaemia( 2020)Background Type 2 diabetes is a leading health priority of the 21st century. Type 2 diabetes management is complex for both practitioners and patients, made more so because diabetes rarely occurs on its own. Indeed, multimorbidity (the co-occurrence of two or more chronic conditions in an individual) is the norm in diabetes. Multimorbidity, brings about many challenges including difficulties in managing the competing demands of multiple conditions. This can result in reduced adherence to complicated therapeutic regimens. This in turn could lead to suboptimal glycaemia which has been shown to be associated with poorer health outcomes such as the development of downstream complications and increased mortality. Currently, there is no universally accepted measure of multimorbidity. The literature has suggested that the type as well as number of conditions are both important when considering multimorbidity. It has been suggested that multiple conditions in those with type 2 diabetes should be categorised as concordant (diabetes-related) or discordant (unrelated). While the associations between multimorbidity, glycaemia (HbA1c) and all-cause mortality in people with type 2 diabetes has been studied to some extent, significant gaps remain in the existing literature. In particular, the effects of different patterns of multimorbidity including concordant and discordant conditions have not been studied extensively. Similarly, little is known about the relationships between multimorbidity and emerging novel glycaemic measures, such as glycaemic variability and time-in-range. These new ways of understanding glycaemia may be important independent risk factors for developing complications in people with type 2 diabetes. Aim To explore associations between multimorbidity, all-cause mortality and glycaemic outcomes, including HbA1c and novel measures of glycaemic variability and time-in-range in people with type 2 diabetes. Methods My PhD includes a systematic review and three quantitative studies of more than 150,000 people with type 2 diabetes utilising UK, Taiwan and Australian datasets. This provides a clearer picture of the implications of multimorbidity for people with type 2 diabetes in different populations from different countries, health settings, healthcare systems and of different ethnicities. Results The findings of my studies identified that multimorbidity was highly prevalent among people with type 2 diabetes. More than 80% of the 150,000 people included in my studies were found to have at least one other chronic condition in addition to type 2 diabetes. I found the associations between multimorbidity, mortality and glycaemia were mostly consistent across my studies. Increasing multimorbidity was significantly associated with increased all-cause mortality. This was the case for total count of multimorbidity, as well as counts of concordant and discordant conditions. Increasing concordant counts had the greatest effect on mortality. However, when examining the effects of individual conditions and combinations of two conditions on mortality in the UK and Taiwan cohorts, the results differed between Caucasian and ethnic Chinese populations. I also found that across my studies, all measures of multimorbidity were not associated with higher HbA1c, glycaemic variability and time-in-range. Conclusion This PhD has contributed a novel and deeper understanding of the significance of multimorbidity in people with type 2 diabetes. It has provided an insight into the effects of different patterns of multimorbidity, including concordant and discordant conditions, on important health outcomes in different cohorts of people with type 2 diabetes. My findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with type 2 diabetes and multimorbidity, accounting for the various conditions they be may be living with. While managing glycaemia in people with diabetes is important, it should not overshadow efforts to address multimorbidity, both concordant and discordant. It is important to consider the overall multimorbidity disease burden as a way of recalibrating and personalising our clinical focus in supporting people with diabetes. By taking a holistic approach and caring for the whole person, this could potentially reduce their annual mortality risk by reducing the overall burden of multimorbidity.
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ItemThe ethical principles which guide the allocation of healthcare resources to rural children( 2020)This thesis describes research into the way Australian government officials decide to allocate healthcare resources for children who live in rural and remote areas of the country. It is known that infant mortality and health outcomes are worse for these children than for urban children. Moreover, there is evidence that rural families are more likely to experience difficulties gaining access to healthcare for their children than urban families. Documents and guidelines published by federal and state health departments suggest that the allocation of healthcare resources should be guided by the principles of equity and of obtaining the greatest possible improvement of the health of the whole population for the money spent. Prima facie, these principles are mutually incompatible. Aim: This investigation was designed to answer the following questions: 1. What healthcare resources are currently available for children in rural and remote areas in Australia? 2. How do the parents of children living in rural and remote areas of NSW experience the provision of healthcare resources for their children and the consequences for their child and family of that pattern of resource provision? 3. How are healthcare resources allocated to children living in rural and remote areas and what factors are taken into consideration in making this allocation? 4. What ethical framework underpins the allocation of healthcare resources for children now? 5. What ethical framework could guide healthcare resource allocation for children in a way that best fits the needs of rural children, of their families and of government health officials? Methodology: To gain a picture of the healthcare resources available to rural children in NSW, the decision-making process which led to the current distribution of those resources and the experience of rural families in gaining access to those resources, I employed complementary qualitative and quantitative approaches. In early 2018, information on the geographic location of healthcare resources relevant to the needs of children in the Western New South Wales (NSW) Local Health District was obtained from the National Health Services Directory and compared with the location of child populations of various sizes in geographical units known as State Suburbs. To compare family experiences in gaining healthcare for their children, raw data were obtained from the NSW Health Child Population Health Survey, and the experiences of rural families in their interactions with several kinds of healthcare resource were compared with those of urban families. Elected and non-elected officials of the Australian Government Department of Health and Ageing and the NSW Ministry of Health were interviewed, and themes identified from the transcripts. From this analysis, descriptions of the aims and process of healthcare resource allocation decision-making emerged, including description of the constraints on decision-making and the role of ethical considerations. The analysis also revealed the views of decision-makers on the nature of the ethical principles which guide resource allocations. Findings: Comparison of geographical locations of healthcare resources with those of child populations revealed that healthcare resources needed by rural children were lacking in many localities containing substantial child populations. This evidence partly explains the findings that rural families were more likely than urban families to experience difficulty in accessing healthcare for their children, especially due to lack of resources, long delays in waiting time for scarce resources or transport difficulties in accessing them. Interviewed officials indicated that elected officials (health ministers) and members of the National and NSW Cabinets held the ultimate power to make allocation decisions, and that those decisions had budgetary and political constraints. Ethical principles appeared to play only a minor role in allocation of healthcare resources, and while equity was the principle most often mentioned, there was no agreement on whether equity of resource allocation, equity of access to resources or equity of health was the aim. Discussion and Implications: The investigation canvassed a range of metaethical principles which could inform resource allocation decision-making. It concluded that equity (and especially vertical equity) in access to healthcare resources for equal need was the principle most likely to be acceptable in Australian society and to Australian resource allocation decision-makers. At the same time, it appeared to be the most likely to improve the health and wellbeing of rural children, both absolutely and in relation to that of urban children. Despite the investigation’s identification of the value of equity of healthcare access, there is a discrepancy between the published intentions of the Australian Government Department of Health and NSW Health to allocate healthcare resources according to this principle, and the minor role which ethical principles, including equity, play in actual decision-making. Further, there is lack of certainty among officials about the goal of achieving equity (that is, whether equity in resource allocation, equity in healthcare access or equity in health should be the aim). The investigation suggests two principal reasons why the avowed aim of allocating resources to achieve equity was not, in fact, achieving equity of health or of healthcare access. One was the apparent uncertainty among officials about the aspect of health or healthcare in which equity was to be achieved. The other reason was deficiency in motivation to act on an acknowledged moral reason (to act to achieve equity). The data suggest that adoption of the motivating principles of communitarianism or compassion would be more likely to supply the motivation to act to achieve equity than the assumption that the interests of the individual should underlie all ethical principles.
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ItemUrinary tract infections in young children: optimising diagnosis with effective and cost-effective urine sample collection( 2020)BACKGROUND Urinary tract infections (UTIs) are very common in young children, but hard to diagnose, and easily missed. Diagnosis is important: if untreated UTI can cause sepsis and permanent kidney scarring. Many young children with unexplained fever must have a urine sample tested to check for potential UTI. The problem is that collecting urine samples from young pre-continent children is extremely difficult. Existing collection methods all have limitations. Standard care in Australia of waiting for a clean catch is time-consuming and often unsuccessful. Urine bags have unacceptably high contamination. Catheter and needle procedures are painful and distressing, and require expertise and equipment to perform. Suboptimal practice compromises patient care and wastes healthcare resources. AIMS & METHODS The doctoral research had the overall objective to improve non-invasive urine sample collection for young pre-continent children. Specific aims were to discover: 1. A quick, simple and effective non-invasive collection method 2. Cost-effectiveness of current and new collection methods 3. Which collection methods are practical in the primary care setting 4. Knowledge translation of findings into practice These aims were examined with the following research methodologies: 1. Two clinical trials of a novel voiding stimulation method 2. Economic evaluation of existing and new collection methods 3. Qualitative study in Australian general practice 4. Local guideline update and development of consumer resources RESULTS The novel Quick-Wee voiding stimulation method was conceptualised, using cold wet gauze to gently rub the suprapubic region. This triggers cutaneous bladder reflexes for faster and more successful urine sample collection. A pilot study (n=40) demonstrated the method was feasible. A randomised trial (n=354) demonstrated significantly higher success in collecting a urine sample within 5 minutes, and significantly higher parental and clinician satisfaction, compared to standard clean catch practice. An economic evaluation comprehensively modelled the costs and cost-effectiveness to collect a definitive sample for all common urine sample collection methods. Overall, catheterisation was the favoured collection method, Quick-Wee the favoured non-invasive method, and urine bags were the most expensive method. This is the first cost-effectiveness analysis of its kind, filling a significant evidence gap, and identifying potential cost savings. A qualitative study explored the barriers and enablers to collecting urine samples from young children in Australian general practice. Non-invasive methods were strongly favoured and invasive methods were rarely used. Key barriers included time and space constraints in clinics. Key enablers included parental motivation, education handouts and voiding stimulation methods. These important insights can inform policy, education and future research. Knowledge translation activities were undertaken including updating statewide guidelines and creating consumer resources. The Quick-Wee method is now recommended in guidelines across a range of settings internationally. CONCLUSION This body of work developed the new Quick-Wee voiding stimulation method and has shown it is more effective, more cost-effective, and more acceptable than standard care. It is gentle for children and simple for clinicians. This research has addressed key evidence gaps, contributing new knowledge to optimise investigation of UTI in young children. Findings have changed practice and been implemented in policies and guidelines internationally.
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ItemThe role of physiotherapists in providing nutrition care to improve dietary behaviours( 2020)Background: Non-communicable chronic diseases are the foremost cause of death, illness, and disability in Australia. Poor dietary behaviours contribute significantly to the burden of chronic disease and health care costs. Promoting healthy eating is a crucial step to prevent and manage lifestyle-related chronic diseases. Although extensive evidence-based dietary guidelines are available in Australia, poor dietary habits are common. Nutrition care is nutrition or dietary related advice given by health professionals to improve dietary behaviour of patients. Previous studies among healthcare professionals highlighted a 'lack of time' as a barrier to deliver nutrition care in primary care. Physiotherapists are well positioned for such health promotion in comparison to other primary care practitioners as they often have prolonged and repeated consultations with patients. However, to date, there have been no studies in Australia to explore whether physiotherapists could provide nutrition care to their patients. Aim: This study aims to investigate practices, knowledge, and barriers to providing nutrition care of Australian physiotherapists. Method: Mixed methods were used. A qualitative study was conducted with physiotherapists practicing in Victoria, exploring their practices, knowledge, barriers, and personal behaviours in relation to nutrition. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. For further exploration, results were used to inform the development of a national survey of physiotherapists working in the primary care setting. Survey results were analysed using STATA software and reported using descriptive statistics. Results: 20 physiotherapists were interviewed, and 344 practicing physiotherapists participated in the online survey. Three main themes supported by nine sub-themes emerged from the interview data. Participants were strongly motivated to provide nutrition care given the relevance of nutrition to their patients' conditions. However, they suggested the complexity of nutrition care and a lack of training and knowledge often stopped them from promoting healthy eating in their clinical settings. All interview participants engaged in some level of nutrition care in their physiotherapy settings. The results of the national quantitative study suggest physiotherapists in Australia are engaging in nutrition care commonly by providing a referral to a dietitian (71% of survey participants) and verbal advice (65% of survey participants) to encourage patients to eat healthily. Thirty-eight percent of participants reported encouraging healthy eating with patients regularly. The preferred content for 'basic healthy eating advice' includes drinking water (89%), minimizing intakes of processed (89%) and sugary food (89%) and alcohol (75%), and increasing consumption of fruits and vegetables (68-73%). Eighty percent of survey participants were confident with their knowledge of the Australian Guide to Healthy Eating (AGHE), but only 58% were confident to use AGHE to assist them in evaluating patients' dietary intake. Based on a validated questionnaire, participants' self-perceived competence scores (mean score 63%; very confident) in providing nutrition care, showed they were confident with their nutrition knowledge, skills, communication and counselling practices with favourable attitudes towards providing nutrition care for their patients. Barriers identified by the participants to providing nutrition care included lack of clarity in the scope of practice (60%), lack of nutrition-training (52%), lack of time (48%), patient perception (43%) and lack of resources or materials (41%). They have also identified professional development training in nutrition (78%), encouragement or policy statement from the Australian Physiotherapy Association (APA) (76%), and printed or online materials as resources (70%) as facilitators to providing nutrition care to patients. The majority of participants (83-86%) recognized the impact of diet on NCDs and health, besides being aware of evidence-based information. Ninety-three percent of survey participants agreed that physiotherapists serve as role models for their patients, and 85% agreed that they should assist in improving patients' dietary behaviour. More than half (57%) of the participants were eating according to the Australian Dietary Guidelines (ADG). Conclusion: The findings of this study indicated that almost all participating physiotherapists were currently providing nutrition care, with the majority referring patients to a dietitian and encouraging patients to eat healthily. Nearly forty percent of participants reported encouraging healthy eating with patients regularly. Participants preferred offering basic healthy eating advice focussing on drinking water, minimizing the intake of less healthy food, and less commonly on increasing the consumption of healthy foods. The majority of participants were confident with their knowledge of AGHE, but fewer of them were confident to use the guidelines to assess patients' food consumption. The study also indicated that more than half of the participants were eating healthily in alignment with national dietary guidelines. The study showed that the participants were confident with their nutrition-related knowledge, skills, communication, and expressed favourable attitudes towards providing nutrition care in physiotherapy settings. However, they have highlighted that training and approval of a broader scope of practice as facilitators to further development of this role. Their practice and motivation in providing nutrition care suggest that they are parallel with the international health promotion advocacy towards eradicating NCDs.