Table 2. Illustrative quotes by participants relevant to meta themes and subthemes
  1.1     Prioritisation of nutrition (n = 4 articles)
  ‘The ideal role is that if you’re not taking the opportunity to talk to patients about their diet and exercise, you are just missing every opportunity to save the nation’s health in every way possible’.8
  ‘Diet and exercise are part of the consultation. It’s routine’.15
  ‘General practitioners have a very important role in providing this [nutrition] advice’.24
  ‘[I]t is our role as general practitioners to enquire about [exercise and nutrition] and provide support as needed’.27
  1.2      Inter-Professional collaboration (n = 4 articles)
  ‘Currently unable to refer women to [the] dietician, [due to] (funding)…therefore midwives, especially those involved in continuity of care models are at the coal face to make changes given they have the right information and tools to do so’.12
  ‘Obviously it needs to be a joint effort between the doctors and the nursing staff and the dietician’.13
  ‘It would be helpful to have dietician provide in-service with select critical care scenarios to gain understanding for how she approaches a patient case and chooses dietary formula based on patient’s past history, multiorgan failure, type of surgery done, allergies, etc’.23
  ‘I haven’t referred to exercise physiologists because there aren’t that many around and the referral pathways are not well developed in our region. I’ve certainly referred to physios but usually on an EPC [enhanced primary care] type thing and that’s not enough. They need more’.27
  1.3      The value of nutritional interventions (n = 3 articles)
  ‘I preferred not to answer the Q [question] about how many serves of dairy to give adequate calcium – because I don’t believe dairy is healthy for anyone’.11
  ‘I’m not aware of any studies…which have actually made a difference to the outcome of these patients’.13
  ‘Probably better than any medication that we can give you’.27
  1.4       Prioritisation of nutrition (n = 2 articles)
  ‘It’s [nutrition] an important thing, but it’s not an essential…like the airway, breathing, circulation…those things will always come first’.13
  ‘…dealing with acute, immediate issues that the patient has come in with…then not getting the chance to talk about things like exercise and nutrition’.27
  2.1     Knowledge (n = 4 articles)
  ‘I’m sure there’s research in that area [nutrition interventions], but I don’t know anything about it’.13
  ‘Lack of knowledge, which stems from lack of training. You learn from what you read in the patient information sheets’.15
  ‘I know very little about the management of weight in pregnancy and the implication of obesity…’.18
  ‘I do a lot of background readings in this idea [nutrition counselling] so I feel like I have a lot of knowledge on how to work through that but I don’t think this is a common thing at all in general practice’.27
  2.2      Confidence (n = 3 articles)
  ‘To be honest I wouldn’t feel 100% confident. I mean I have certain knowledge towards it [nutrition] but I don’t feel very confident’.19
  ‘I would like to build on knowledge to gain confidence’.25
  ‘[It’s] as important as all the pharmacological treatment but probably as [general practitioners] we don’t do it enough and don’t have enough confidence in giving recommendations regarding exercise and nutrition’.27
  2.3     Interest in training and education in nutrition (n = 6 articles)
  ‘Midwives are often the first point of contact a mother has with a health professional during her pregnancy and should be given every opportunity to expand knowledge and give the best advice to mothers and their families’.12
‘I think we [practitioner nurses] should all do a nutritional course, solely on nutrition…’.8
‘As health professionals we can help with the guidelines… we are not trained. Going on a course of or having a CE session does not make you an expert. Basic stuff is ok, but then flick on’.15
  ‘Would like further education re re-feeding syndrome’.23
  ‘I need to have more education and training on this [nutrition] to do [counsel] it properly’.25
  ‘I think having resources that are simple and easy to use that are fairly generic so that [they] can be used for most cancers and a handout for patients would be incredibly useful’.27
  2.4      Education (n = 3 articles)
  ‘…and you know we don’t really have enough staff education before people come in or when they come in. Its fly by the seat of your pants for a lot of it…’.19
‘Postgraduate education provides limited education regarding nutritional therapy…’.23
‘I think most medical school training needs to increase the emphasis on nutrition and addressing lifestyle risk factors’.24
  2.5     Policy and Guidelines (n = 3 articles)
  ‘Things work so much better when we eliminate some of the shades of grey…a consistent guideline would be terrific in many areas of maternity care, not just nutrition advice’.12
  ‘My knowledge [of enteral nutrition] was gained mostly by self-education…When I came to this ICU, the feeding policy was non-existent and feeding practices were poor’.23
  ‘And ongoing support, continuous professional development in nutrition, I have never, I don’t think, been to one; I don’t think they’re around’.27
  2.6     Resources (n = 2 articles)
‘Very little education or resources are directed towards midwives in this area and we are the health professionals who spend most time with the women’.12
  ‘I think that’s the real issue; I don’t think I have a real resource, I’m just using my brain, my common sense. I don’t think I’ve ever had any tuition about diet and cancer’.27
3          CHALLENGES
  3.1     Time (n = 5 articles)
  ‘We [practitioner nurses] are just so busy and just so overworked that we don’t get time to do that sort of thing [provision of nutrition care]’.8
  ‘It is good to talk about nutrition, but how do you fit that in when people come in with an agenda for a 15-minute consult?’.15
  ‘15 minutes appointment for first pregnancy (the only one I see) is barely enough time to discuss folic acid + iodine, midwife referral, listeria… so [I] don’t often also discuss weight’.19
  ‘…I feel time is a large impediment in the general practitioners’ ability to provide complex nutritional advice to patient’.24
  ‘Ten-minute consultations are simply spinning the wheels in the mud. You can’t do anything, because you don’t have the time to do anything’.27
  3.2      Patient factors (n = 5 articles)
  ‘We are seeing more obese women and it is difficult to give then advice on weight management during pregnancy’.12
  ‘Patients have their own agenda. They come with their own list. They don’t want the general practitioner talking about subjects not relevant to the list’.15
‘Well they don’t really ask us anything, they try not to because they don’t want to be told not to do things they want to do. They try to get away with stuff’.19
  ‘Someone who lacks motivation and has no other support outside their general practitioner is unlikely to succeed in a lifestyle change’.24
  ‘Patients have their own agenda when they come to the doctor…the top of their priority list is not always to hear about nutrition, exercise and lifestyle…but you still try to weave it in’.27
  3.3     Funding (n = 2 articles)
  ‘Under the current unsatisfactory system, including the paucity of remuneration for general practice in obstetric care, involvement [of gestational weight management] in obstetric care is impossible’.18
  ‘Yeah, the fact that [general practitioners] don’t get funded for spending a lot of time with patients [to discuss exercise and nutrition]’.27
    3.4      Communication (n = 1 articles)
  ‘Communication skills. To be able to talk to the patients and gather information you need. Much the same as what we’re doing now’.8
Int J Med Educ. 2022; 13:124-137; doi: 10.5116/ijme.6271.3aa2