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Table 3 Number of data units allocated to each category, summary of themes and revisions completed

From: Design and pilot evaluation of an evidence-based worksheet and clinician guide to facilitate nutrition counselling for patients with severe mental illness

  Number of data points (n positive, n constructive) Positive themes (frequency) Constructive themes (frequency) Revisions based on data
Worksheet
 Content/ Information 28 (14 positive, 14 constructive) -appreciated the worksheet (3), the first page of recommendations (6), table on cost (1), healthy dessert ideas (1), complex carb recommendations (1), sample plate (1)
-appreciated inclusion of motivational interviewing components (1)
-more sample meals (3)
-more transparency on the cost of food (1)
-link to other resources about minimizing cost (1)
-increase relative content of motivational enhancement material (1)
-remove scoping review reference (1)
-more guidance on portion sizes (5)
-include plant-based options (1)
-consider adding a shopping list (1)
-second day of meal examples added
-scoping review reference removed
-additional resources related to cost and portion size added to clinician guide
-suggestions such as the addition of portion size information to the worksheet were not acted on as the authors felt they would increase the complexity and length of the worksheet substantially
 Complexity 9 (4 positive, 5 constructive) -complexity was appropriate (4) -recommendations must be specific and easy to implement (2)
-6th grade reading level (1)
-fewer words to read (1)
-more pictures to assist individuals with language barriers or cognitive deficits (1)
- removed vague or theoretical recommendations, improved congruence with 5th grade reading levels and minimize text
 Structure 6 (2 positive, 4 /constructive) -interactive nature of the worksheet was appreciated (2) -move motivational enhancement material earlier in the worksheet (3)
-consider flier format (1)
-Question about personal importance of healthy eating moved to the top of first page
 Design 16 (3 positive, 13 constructive) - overall design (1) and plate image (2) was appreciated -improve plate recognizability (2)
-consider adding colour (3)
-more distinction between educational material and action items (1)
-more pictures of example foods (2)
-include pictures of foods to avoid (5)
-cutlery added to plate image to increase recognizability
-boxes placed around the activities for participants to complete in order to increase recognition
-colour was not added as printing a colour version in black and white would result in lower quality images
-foods to avoid were not added as the worksheet attempted to maintain s focus on positive messaging
 Patient Centeredness 10 (1 positive, 9 constructive) -recommendations are accessible and feasible (1) -importance of cultural sensitivity (5)
-importance of financial considerations (2)
-accessibility in different languages (2)
-included food recommendations from a larger number of cultures as well as low-cost options
-future plan to translate into French and other languages
Clinician Guide
 Content/ Information 14 (2 positive, 12 constructive) -appreciated having the guidance document -increase clarity about the level of evidence supporting the statements in the clinician guide (6)
-remove material that is redundant with the worksheet (1)
-clarify mechanism of action information in chart (1)
-remove reference to patient contract to reduce ambiguity (1)
-increase the number of sample MI questions (1)
-consider adding more references to support the recommendations (3)
-The “rationale” column was split into two columns: “supporting evidence” and “mechanism of action”
-Levels of evidence were added
-The level of detail for the mechanisms of action were reviewed to ensure that it was appropriate
-recommendations that were also found in the worksheet were removed from the clinician guide
-reference to contracting was removed
-additional references were not added in order to avoid lengthening the guide; clinicians are directed to the scoping review to access more information about the research used to create the recommendations
 Complexity 0  
 Structure 1 (constructive)   -consider lengthening guide beyond 1 page (double sided) to allow for additional detail to be included -guide lengthened to 3 pages to allow for additional detail to be included and to increase visual appeal
 Design 0  
 Patient Centeredness 21 (2 positive, 19 constructive) -participants appreciated cultural sensitivity (1) and efforts to include an interdisciplinary team in the patient’s care -lack of guidance on next steps if a patient declines to discuss their diet (1)
-lack of clear statement related to the gradual nature of diet behaviour change and expectations for the initial session (5)
-suggestion to include assessment of patient diet and tailored recommendations (3)
-many patients have limited food budgets (5)
-making dietary changes is difficult (4)
-untreated psychosis may interfere with patients’ ability to engage in dietary counselling (1)
-recommendation for how to approach patient refusal was added
-statement added about the gradual nature of diet change
-while comprehensive diet assessment was deemed beyond the scope of the worksheet, optional instructions were added to the guide for interested clinicians
-revisions were made to the clinician guide to emphasize the healthy foods that could be purchased for $10 and recommendations were made for approaching food insecurity if identified
-more specific guidance about motivational enhancement was added
-included instruction to use the worksheet during periods of relative clinical stability