Introduction
Pets are affected by numerous nutrition-sensitive conditions (eg, developmental orthopedic disease, diabetes mellitus, food allergy dermatitis, chronic enteropathies, kidney disease, and obesity), which negatively influence quality of life.1 Furthermore, there are numerous reports of health risks when feeding commercial pet food with inadequate quality control2–4 or unbalanced homemade recipes.5,6 These nutrition-sensitive conditions increase both financial and emotional burden of pet owners (ie, caregivers, parents, and clients) when inadequately managed or prevented. Pet owners recognize the importance of nutrition on health and often consider veterinarians to be a trusted source of nutrition information.7–9 However, the frequency of pet nutrition communication during small animal veterinary appointments is limited.10–14
Barriers to pet nutrition communication must be addressed to best prevent and manage nutrition-sensitive conditions.7,13 In a quantitative survey study, Alvarez et al10 reported (1) anticipated client resistance to diet change, (2) time limitations, (3) navigating nutrition misinformation, (4) plethora of pet foods, and (5) anticipated client cost concerns to be the primary barriers reported by small animal veterinarians. In the present study, we conducted a qualitative exploration through veterinary focus groups to broaden the investigation of barriers to nutrition communication that small animal veterinarians face in practice and capture data that investigators would otherwise not consider or investigate, to minimize investigator bias. The objectives of the study were as follows: to identify barriers that veterinarians experience in communicating pet nutrition with pet owners, potential solutions to breaking down barriers, and unanticipated findings (ie, to capture aspects of nutrition communication that have not been considered by investigators previously).
Methods
Veterinarians in small animal general practice were recruited to participate in a focus group, with the help of the Virginia Maryland College of Veterinary Medicine alumni coordinator and local veterinary medical associations. The Virginia Tech Human Research Protection Program determined that the study protocol (IRB-19-505) met the criteria for exemption from Virginia Tech’s Institutional Review Board review.
Five virtual focus groups were conducted from February 3, 2021, to April 2, 2021, using the Zoom platform. Focus groups were designed to capture the variety of veterinary experiences in communicating about veterinary nutrition. Participants were recruited through email and social media and included whether they were veterinarians actively practicing canine/feline medicine and able to participate in 1 virtual focus group session. Focus groups were conducted until the moderator determined that no further unique themes emerged and data saturation had been reached.15 Participation in a certain focus group was based on individual preferences for time and day of the week.
A moderator and assistant were present during each focus group. The moderator led the discussion using a predetermined set of questions, while the assistant took notes in response to those questions. The moderator and assistant were not immersed in nutrition to limit bias during focus group discussions. Furthermore, the moderator was formally trained in facilitating focus groups. Questions were divided into 3 sections: (1) confidence in discussing pet nutrition with pet owners during small animal veterinary appointments, (2) barriers to discussing nutrition with pet owners during small animal appointments, and (3) an open-ended inquiry as to other aspects of discussing nutrition with pet owners during small animal veterinary appointments that focus group participants wish to share.
Each focus group was audio recorded, and transcripts were created using Otter.ai software. Transcripts were then proofread and anonymized in preparation for qualitative analysis. Transcripts were analyzed in Atlas.ti qualitative data analysis software (ATLAS.ti Scientific Software Development GmbH), using a hybrid of inductive and deductive thematic analysis to find common themes among the 5 focus groups.16 Two coders analyzed the data separately, and disparities between the 2 coders were addressed.
Participation incentives included a single $100 Visa gift card and 1 hour of virtual live veterinary nutrition–related continuing education. All participants were mailed the gift card and received a copy of the continuing education slides and a recording of the continuing education events by email after participation in the focus group.
Results
A total of 18 veterinarians from Maryland, Michigan, Virginia, Washington DC, and West Virginia participated in the study. The majority of participants (n = 10; 56%) graduated from the Virginia-Maryland College of Veterinary Medicine. The number of years since graduation from veterinary school was a median of 14 years (range, 2 to 40 years). Further demographic information on participants was not collected. Two to 5 veterinarians participated in each focus group. Analysis of focus group data revealed a total of 19 codes, organized under 4 themes. The following 4 themes represent distinct barriers that veterinarians face when discussing nutrition with pet owners and potential solutions to overcoming these identified barriers: (1) time, (2) misinformation and information overload, (3) pet owners’ apprehension toward new information, and (4) veterinarians’ confidence in nutrition knowledge and communication skills.
Time
According to participants, time is a significant barrier to having nutrition discussions with pet owners. Among the 5 focus groups, the struggle with time was discussed at length in 4 of the groups. Lack of time during appointments was of most concern. Furthermore, several participants also suggested that they struggled to make time for outside research and education in regard to nutrition: “You’ve got a limited amount of time with each owner. You’re trying to typically solve a problem for the pet in that kind of short period of time.”
While participants offered a range of respective appointment times specific to their individual practices, participants overwhelmingly agreed that the time they do have is not enough to allow for in-depth nutrition discussions. As 1 participant explained, “In a 30-minute appointment, or even a 60-minute appointment, you have so many things to cover.” Through further discussion, it was discovered that most focus group participants have come to handle limited appointment times in 1 of 2 ways: (1) overlooking the topic of nutrition altogether or (2) tailoring the time they allot for discussion to the type of exam they are performing. Multiple participants disclosed that they are more likely to bring up nutrition “when there’s an obvious issue or obvious need for nutritional intervention,” such as when an animal arrives with obesity-related orthopedic issues, diabetes, or gastrointestinal concerns. Subsequently, if an animal presents with different medical needs or an emergency or the animal is not clearly showing signs of malnutrition, participants explained they were less likely to broach the subject of nutrition to focus on more relevant concerns. One participant shared that they gloss over nutrition during wellness visits in particular because owners are often in a rush to leave and unwilling to listen to preventive recommendations for an animal that is deemed healthy. Alternatively, multiple participants across the 5 groups said that they addressed nutrition in nearly all of their appointments, at minimum asking what and how much an owner is feeding their pet or discussing the animal’s body condition score. Even if they are unable to have lengthy discussions about nutrition, these participants argued that by logging this information they can refer to their notes at a later time, creating an opportunity to compare the animal’s physique to previous visits and address any problematic changes. A few participants proposed (and some have implemented in their own clinics) offering nutrition-specific appointments to clients.
In addition to a perceived lack of time during appointments, participants expressed that they struggled with finding time to improve their own nutritional knowledge outside of the clinic: “I just don’t have enough time to go through and keep up with all the latest in nutrition.”
Despite nutrition education being available and many of the focus group participants indicating an interest in attending them, it was expressed that the ever-changing climate of nutritional information makes keeping up seem like an uphill battle. One participant felt that they couldn’t possibly stay up to date on current recommendations, “unless I spent all my [continuing education] time doing just nutrition.” Additionally, when clients come in with preconceived notions about their pet’s food, many participants agree that they “don’t have that time to delve into research and dispute those things.” Furthermore, participants in 2 out of the 5 focus groups agreed that food labels and ingredients are presented by food companies in an intentionally “confusing and tricky” way, making it all the more difficult for veterinarians to know whether certain foods are nutritionally sound without conducting some level of research.
Misinformation and information overload
The internet and access to infinite sources of information were identified as a unique challenge for participants. Participants felt that irreputable sites and resources were easier to find and can be more appealing to clients than those with actual scientific data and veterinary backing. Any search on pet nutrition yielded pages of blogs, websites, and other platforms where participants expressed that nonprofessionals could offer their opinions and advice. The struggle to overcome misinformation from their clients was repeatedly mentioned by participants in all focus groups: “I think that’s probably the biggest barrier is there’s more misinformation than there is good information on the internet.”
Participants said that biased, incorrect, and sometimes harmful information was widely available. With access to this misinformation, all focus groups felt their clients entered appointments with concrete opinions on nutrition and pet health. Multiple participants shared they found it difficult to dispel this misinformation and change the minds of their clients. One participant reiterated the difficulties many others felt: “it’s hard to compete with the internet.” The focus groups found that the internet is not the only source of their clients’ misinformation. Pet owners may seek advice from breeders and pet store employees.
“There are so many websites out there that have so much misinformation, and then there’s not really a good consolidated website for veterinarians to read.” This misinformation was identified by participants as being difficult for veterinary professionals to weed through, too. Each of the focus groups indicated there are few reputable and unbiased sources to help inform their discussions or to direct pet owners to. Participants indicated that fact-checking diets and pet food nutrition profiles requires a significant amount of time. Fad diets and keeping up with the constantly changing landscape of pet nutrition proves difficult and time-consuming. Participants understood that most fad diets are harmful, or at the very least unnecessary, but convincing pet owners this is the case is difficult given the limited time and resources. Many expressed the need for a single source of consolidated information, produced independent from a pet food company, which would allow them to stay in the know without dedicating too much time doing research. And, as indicated repeatedly in all focus groups, without up-to-date nutrition training or access to trustworthy resources, participants felt they were unable to provide take-home information to their clients.
Pet owner apprehension
Even with the best efforts to discuss nutrition, focus group participants often felt their clients were apprehensive and unwilling to receive recommendations from veterinarians. Participants proposed that clients’ apprehension may stem from a variety of factors. Widely available misinformation from sources pet owners are inclined to trust more, like breeders or online resources, make it difficult for veterinarians to get their point across. This uphill battle is made more difficult when veterinary professionals feel their training does not provide them the resources or skills to have these conversations.
Barriers to communication with owners was identified to be multifaceted: participants described how pet owners often come in with preconceived notions about nutrition (mainly from misinformation found online and from outside sources like breeders and pet store employees), a mindset that the owner is the expert on their pet’s health, or a belief that their pet’s weight is not a health issue. These ideas and mindsets were identified by participants to cause disinterest in pet owners when discussing nutrition with their veterinarian. “I think the perception of clients is that they think we don’t know anything about nutrition, they’re gonna take the recommendation of the pet store over us.”
With information from seemingly credible sources so widely available, participants expressed that owners form their own opinions and often believe they have trustworthy and factual information at their fingertips. Participants felt a general sense of unwillingness from pet owners to accept the veterinarian’s recommendation. One participant noted that many of the pet owners that visit their practice are generally highly educated, making it even more difficult to change their mind after they have made their decision. Participants also noted pet owners’ apprehension when they do not see immediate results in their pet. If follow-up appointments on a pet’s weight do not show immediate desired results, veterinarians find that pet owners are less likely to follow through with their recommendations. As 1 participant noted, “I think if they don’t see the initial success, then I’m losing them on the follow-up if they’re not getting any satisfaction from it.”
An additional limitation was that participants perceived that pet owners felt such discussions were not suited for veterinarians: “They think that we don’t receive much education on nutrition and that we’re not able to look at a pet holistically as far as nutrition is concerned.” Some participants shared that technicians were more often asked for food recommendations, which may stem from beliefs that the veterinarian was only qualified to discuss medical issues. Realizing this, many participants advocate for nutrition education for veterinary technicians, allowing for repetition across the clinic and thus imparting onto owners that nutrition is an important aspect of animal health.
“I’ve had clients that have told me that I recommend some of the big name companies, Purina, Royal Canin, Hills, because they pay back my student loans. A lot of our clients think we’re getting some kind of kickback from it.” A few participants felt that pet owners had an apprehension toward “big name” food companies. Participants had a hard time navigating these complexities, especially when they felt a certain brand was best for that pet. Navigating the owner’s misconceptions that veterinarians receive incentives to recommend specific brands not only made conversation difficult, but multiple participants indicated their frustration with these sentiments. One veterinarian disclosed, “This hurts to the core [...] Because none of us did this for the money.” In addition, participants expressed that food brands that are generally approved or recommended by veterinarians can carry a hefty price tag compared to lower quality foods, resulting in nonadherence with recommendations. Lack of alternatives to name-brand foods can further this divide between veterinarian and pet owner. Multiple participants in the focus groups noted that when the client was open to their nutrition recommendations, cost became the most important barrier.
Veterinarian confidence in nutrition knowledge and communication skills
Focus group participants were asked whether they felt they received adequate information on nutrition in their respective university programs. Some participants said that they were well educated on the science of nutrition but communication strategies were scarce, while others thought that their education was lacking in all areas. Regardless of instruction levels, participants overall agreed that they possessed low confidence when speaking with clients about nutrition. Practitioners said they struggled with convincing owners that veterinarian-recommended foods are valuable because there is a lack of reputable resources that support their recommendations. Participants indicated this is especially true when clinicians are attempting to propose a change of diet for animals that are healthy. Interestingly, participants across all 5 focus groups expressed confidence in their ability to discuss obesity and body condition scores, despite an overwhelming agreement that owners can be sensitive to such conversations.
In response to whether participants felt they received adequate education regarding nutrition, at least 1 veterinarian from each focus group responded they were well educated in the science of nutrition but felt they lacked training on how to effectively discuss nutrition with their clients. “I feel like I did have a decent background in nutrition, but we didn’t really talk about how to talk to clients about it.”
Likewise, participants across the 5 focus groups agreed that their main concern when discussing nutrition is their “ability to deliver the message to the client.” As 1 participant explained, “The core nutrition knowledge is there, but it’s the miscellaneous questions that make me nervous having those discussions.” Further worsening this struggle is a lack of reputable resources from which veterinarians can make informed decisions about food, and/or resources to which veterinary professionals can direct pet owners for reliable information.
A significant number of participants across the 5 groups indicated that they had to obtain much of their nutritional knowledge on their own. Regarding their university curriculum specifically, many shared that they received very little to no nutrition education. And, according to those who did receive some instruction, training focused more on large animal nutrition, which was not conducive to participants’ small animal–focused careers: “I don’t think we got much nutrition [education]. I remember a lot of large animal nutrition but not small animal.”
Another veterinarian said, “I don’t think we had the best nutrition course… I think we really only talked about it for a week.” Similarly, another veterinarian explained that their university did not have a nutrition department at all and instead had a professor from a nearby veterinary program come and give short lectures. Without a proper basis of knowledge from which to build, these participants expressed that understanding, let alone communicating, nutritional information is all the more difficult for them.
Regardless of participants’ perceived levels of nutrition education, participants across the focus groups agreed that their confidence in discussing nutrition is highest when there are concerns that can be treated with veterinary therapeutic diets. “I’m more confident [speaking about nutrition] when it’s a discussion [where] there’s a medical condition that we need to use a food to change.”
Another participant said, “I’d probably have a better handle on things when it comes to nutrition for management of medical diseases so […] I can explain why these prescription diets are beneficial.” As participants explained, a significant amount of money and research has already been put into veterinary therapeutic diets meant to treat specific medical conditions; therefore, many participants felt comfortable recommending these commercial brands. They indicated that their confidence wanes when pet owners refuse to switch to a veterinary therapeutic diet because they are “anti-kibble or anti–processed food” or the owner simply cannot afford the new diet. Stemming from frequent situations such as these, some participants have come to fear that they rely too heavily on veterinary therapeutic diets without having a strong understanding of the nutrients that make the food useful for medical treatment, therefore making it more difficult for veterinarians to recommend alternative food options to their clients. Voicing this concern, a participant shared that “I feel like I’m just kind of going with some of the diets that are already on the market rather than […] having a deep understanding about what [a] pet truly needs.”
It was frequently discussed among all focus groups that tact is a vital aspect of nutrition communication with clients. “You’ve got to be very careful about how you approach the topic [of nutrition], because [clients] will get offended very easily, because they love their pet.”
According to participants, using words like “fat” or “obese” can often have serious consequences with owners because they seem to “take it as an affront,” as if clients perceive this wording to mean that they are being irresponsible pet owners. Participants expressed that care has to be taken when approaching the topic of nutrition, whether it is related to malnutrition or the type of food an owner has been feeding, like “raw diets, home cooked diets, [or] grain-free diets.” Multiple participants across the focus groups shared their approaches to handling such situations, including “broaching the subject without making the clients feel like they’re bad people,” like using lighthearted language or humor. Some examples of this include terms like “chunky monkey,” “rotund,” “chubbies,” or commenting on animals’ “swimsuit bodies.”
Overcoming barriers
Participants discussed the need for robust education on small-animal nutrition and communication and resources for practitioners to share with their clients and use to inform their decisions.
As noted above, participants felt there is a lack of credible sources for nutritional information to aid in their discussions and refer pet owners to. Materials in easy-to-read and understandable language can supplement nutrition discussions, especially when there is limited time during appointments. To overcome this barrier, many participants shared that they have found and collected some resources to share and send home with clients with hopes of bolstering owner understanding of foods and nutritional recommendations provided during appointments. As 1 practitioner explained, “I find [it] helps if you give them something in their hand to take home that they can read later.” While these participants found these resources to be valuable in communicating with their clients, they continue to call for updated information with clear verbiage from reputable professionals.
Participants found that information repetition across the clinic helps develop trust and dispel misinformation from outside sources. Additionally, participants expressed that when veterinary technicians and support staff are able to lead conversations on nutrition with pet owners, it reduces pressure on veterinarians to discuss nutrition during their limited contact time.
Discussion
This study identified several barriers to veterinary nutrition communication: (1) time, (2) misinformation and information overload, (3) pet owners’ apprehension to receive recommendations, and (4) veterinarians’ confidence in nutrition knowledge and communication skills. Similar to findings from this study, Alvarez et al10 reported that veterinarians are more confident and more likely to discuss nutrition during sick pet visits versus wellness visits or to discuss veterinary therapeutic diets versus over-the-counter diets. Making time for nutrition is important for all patients because nutrition is critical for maintaining health. Furthermore, many nutrition deficiencies take a while to present and do so with vague clinical signs. However, time has consistently been identified as a barrier, by veterinarians and pet owners, in prior studies.10,17,18 The barrier of time may be the most challenging, as practices are increasingly busy. Furthermore, as identified in the current study, not all clinical contexts (eg, emergency visits) may be conducive to a nutrition conversation. Given the current time structure and delivery models of veterinary care, simply expecting veterinarians to incorporate nutrition in with the plethora of other topics is likely not realistic nor likely to be effective, especially where other topics may be triaged as being more important during a particular appointment.19 Veterinarians’ time limitations are also linked to other nutrition communication barriers. Not only do veterinarians have limited time to discuss nutrition with pet owners, the present study also identified veterinarians’ time limitation to participate in nutrition continuing education and time to research or navigate nutrition resources to develop their own knowledge base and address nutrition misinformation.
Three themes regarding overcoming barriers and managing time limitations emerged from the participants: (1) improving communication and nutrition education, (2) improving and increasing access to client-friendly resources, and (3) empowering veterinary technicians and support staff to discuss nutrition.
Improving nutrition and communication education may help enhance veterinarians’ confidence in discussing nutrition and reduce perceptions of pet owner apprehension toward veterinarians’ knowledge of pet nutrition. Furthermore, the more confidence a practitioner has in their nutrition knowledge and nutrition communication, the more efficient veterinarians are likely to be in discussing nutrition. A number of veterinarians in the present study identified receiving little to no education on veterinary nutrition in veterinary school, leaving a large void in their nutrition knowledge that needed to be filled independently upon entering veterinary practice. Although the time needed with owners in the clinic was expected to be a barrier to nutrition communication, surprisingly, participants also identified the time commitment for nutrition continuing education to be a barrier. Enhancing nutrition and communication training in veterinary curricula is an important first step for building a strong nutrition foundation for practitioners to rely upon, which is likely to help minimize the time needed for nutrition continuing education in practice. Unfortunately, not all veterinary schools have nutrition faculty and there is a need to further develop nutrition in many veterinary curricula.20 In 1 study,21 92% of first-year veterinary students surveyed considered nutrition to be an important component of the veterinary curricula and 64% anticipated it would not be emphasized in their curricula. Nutrition has been recognized to be critical for veterinary patient health.22,23 To further support this recognition, veterinary medicine needs to look at how the teaching of nutrition can be enhanced in veterinary schools to ensure that veterinarians enter the profession with a solid nutrition foundation, which then can more efficiently be built upon through continuing education opportunities once in practice.
In addition to improving access to nutrition education in veterinary schools, improving access to a Board Certified Veterinary Nutritionist may also help with improving veterinary professionals’ nutrition education. An increasing number of platforms offering specialist consults are available to veterinarians, though very few of these platforms offer access to a Board Certified Veterinary Nutritionist. Therefore, enhancing veterinarian and veterinary technician access to a Board Certified Veterinary Nutritionist through consulting platforms provides another opportunity for greater nutrition education within veterinary practice.
To the authors’ knowledge, this was the first study in which veterinarians identified the need for more nutrition-specific communication training. Effective communication in veterinary medicine improves information gathering and adherence and likely positively impacts pet health.13,24–26 For example, how veterinary questions are phrased, such as when asking a pet owner about their goals or during diet history collection, influences the depth of information retrieved.27 While communication is included in veterinary medicine curricula, it needs further development,24 especially specific to veterinary nutrition. Communication training should promote a relationship-centered style, encompass cultural competence, and avoid a judgmental tone.28–30 While relationship-centered communication may seem more time-consuming, Shaw28 reported that appointments with a relationship-centered communication style (ie, biolifestyle-social, collaboration between the veterinarian and pet owner) take less time than appointments with a veterinary authoritarian communication style (ie, biomedical).
Many pet owners want to be involved in the nutrition decisions and not simply told what to do.18 While historically veterinarians are often cited as a trusted source of nutrition information,7,8,31 some clients view veterinarian nutrition recommendations with skepticism.7,31–34 Pet owners may feel as though nutrition recommendations are based on a financial incentive.18 Listening to a pet owner’s goals and concerns for their pet provides an important context for nutrition communication and future recommendations. Alvarez et al10 identified perceived client cost concerns as a barrier to nutrition communication. In the present study, cost was only reported as a barrier when clients were open to diet change. Clarifying the role of cost in a client’s decision-making is important to clarify upfront. Furthermore, when making recommendations, details are important (eg, exactly what food and how much) as ambiguity can negatively influence client adherence.35
Consistent with previous research,18 veterinarians participating in the present study reported nonveterinary sources, like the internet, to be a barrier to relaying valid information to pet owners. Navigating nutrition misinformation has also been identified by small animal veterinarians as a barrier to nutrition communication in a prior study.10 Navigating pet nutrition is complex and time-consuming due to the plethora of food formats (eg, kibble, canned, fresh, raw, or homemade), food characteristics (eg, grain-free, organic, human grade, vegetarian, wholistic, or natural), and non–evidence-based nutrition information available to pet owners. Pet owners often focus on the ingredient list of pet food7,8,31; however, there is a lot more to pet food beyond what is stated on the label, such as nutrient bioavailability and food safety.36–38
There are several resources currently available that were developed by veterinarians for veterinarians to help improve nutrition communication between veterinary professionals and pet owners. However, the awareness of current nutrition resources is likely low, as Blees et al11 reported that only 21% of veterinarians surveyed were aware of the World Small Animal Veterinary Association Global Nutrition Guidelines.39 The World Small Animal Veterinary Association publishes Global Nutrition Guidelines39 where veterinarians can find several accompanying resources for in-clinic use (eg, Diet History Form), including resources to send home with clients (eg, Guidelines on Selecting Pet Food). In addition, the American Animal Hospital Association also publishes several Nutrition Resources40 to help implement nutrition in practice. The Pet Nutrition Alliance41 provides calorie calculators for dogs and cats and published their Dare to Ask research on pet food. The FDA Center of Veterinary Medicine42 regulates pet food in the US and publishes related information. The Association of American Feed Control Officials43 publishes guidelines for pet food; note, it is up to the FDA, along with feed control officials within each state, to enforce these guidelines as the Association of American Feed Control Officials itself is not a regulatory organization. Veterinary Nutritionists at Tufts’ Petfoodology Blog44 provides a wide range of client-friendly topics about pet food. Guelph’s Worms & Germs Blog45 is a client-friendly resource that covers food safety topics, like raw pet food. The American Academy of Veterinary Nutrition46 holds an annual Research Symposium with a large focus on small animal nutrition, open to veterinarians, veterinary technicians, and students.
To improve access to the benefits of evidence-based nutritional advice, it would behoove the veterinary profession to consider how best to provide access and distribute credible, client-friendly resources to pet owners. Janke et al18 explored methods for providing information suitable for clients in a veterinarian-based focus group study. They reported visual aids paired with verbal explanation to be helpful. Collaborating with public health colleagues on the best means for disseminating credible client-friendly nutrition information at a population level may also be helpful. Focus group studies of veterinarians, veterinary technicians, and pet owners regarding their awareness and perceptions of current nutrition resources available may help further frame what nutrition resources should be disseminated and what else is needed.
Empowering credentialed veterinary technicians and support staff in nutrition education would likely help address some of the time pressures veterinarians face in preventing them from discussing nutrition. Veterinary technicians are an essential member of the veterinary team and play a tremendous role communicating with clients. Janke et al47 found that client engagement in veterinary care decision-making was enhanced by collaboration between client, veterinarians, and veterinary technicians versus between client and veterinarian alone. While clinics are challenged with hiring and retaining veterinary technicians, empowering veterinary technicians to lead nutrition efforts could enhance job satisfaction and support greater clinic revenue, thus facilitating proper compensation of technician time and providing another avenue for veterinary technician professional development.48 Veterinary technicians could lead patient nutrition assessment, communicate with clients around navigating pet food and nutrition plan adherence, as well as lead certain nutrition-related rechecks (eg, weigh-ins during a prescribed weight loss plan).49,50 Veterinary technician–led nutrition-specific appointments should be considered by veterinary practices to help address the time barriers identified by participating veterinarians. In addition, increasing the time of appointments for certain situations (first appointment with a specific veterinarian, puppy/kitten, or pets with multiple health issues) may be helpful in achieving important nutrition touch points by allowing time for a team-based approach in which veterinarian and veterinary technician collaborate to address nutrition with clients.17
Veterinary technicians and support staff could also support keeping the entire veterinary team up to date with nutrition continuing education by attending nutrition continuing education and bringing the information back to other members of the team. While veterinary technicians will have similar time constraints for continuing education, perhaps clinics could identify members of the veterinary team with a passion for nutrition and task them with helping to keep the veterinary team up to date on nutrition continuing education.
Although the findings of the present study may not be generalizable to all veterinarians, this was not the intention of the qualitative focus group methodology employed. Rather, the purpose of the focus groups was to develop a deeper understanding of barriers veterinary professionals experience in communicating about pet nutrition that were not limited to the researchers own ideas, which is common to survey-based research. The benefit of this approach is reflected in the unanticipated findings of the present study. This study identified several barriers to veterinary nutrition communication, several of which had been identified in prior studies (eg, time, nutrition misinformation, and client resistance)10,17,18 and 2 unanticipated findings, including the barrier of time for nutrition education and the need for communication training. In addition, these findings offer the opportunity to refine future quantitative survey efforts intended to investigate barriers and solutions for nutrition communication.
Moving forward, addressing these barriers is likely not going to be accomplished by individual veterinarians. Rather, the veterinary profession as a whole needs to look for new opportunities to improve nutrition education of veterinary professionals and their communication with pet owners. Findings of the present study support that further efforts to increase nutrition and communication education in veterinary curricula is important to ensure new graduates leave veterinary school with a solid nutrition foundation and the confidence to communicate with clients about nutrition. Further, pet owners and the veterinary profession are likely to benefit from increasing access to credible nutrition information that is not perceived by pet owners as biased. Finally, veterinary nutrition provides an excellent opportunity to embrace a team-based approach to care delivery, thereby warranting further exploration of opportunities to empower veterinary technicians and support staff. It is likely technician-supported or -led nutrition-specific appointments could assist in overcoming many of the current barriers that exist at a practice level.
Investigating and developing best practices for how nutrition can be effectively incorporated into the day-to-day realities of a busy veterinary practice are likely needed to further support the veterinary profession’s efforts to incorporate nutrition within most consultations. Further research with veterinarians, veterinary technicians, veterinary support staff, and pet owners is needed to create effective solutions to help break down barriers to nutrition communication in veterinary medicine. Supporting veterinary teams in the navigation of pet nutrition communication is important to help prevent and manage nutrition-sensitive conditions (eg, obesity and kidney disease, respectively) that can impact quality of life for both pets and their owners.
Acknowledgments
The authors would like to thank Dr. Cassie Wagner, for assistance with recruitment, and Dr. Charlotte Baker, for assistance with overall study design.
Disclosures
Dr. Wenzel, Tara Long, Sydney Koerner, and Dr. Harvey, have nothing to disclose. Dr. Coe regularly receives research funding, consults for, and receives honoraria from various veterinary organizations and commercial companies, including Royal Canin, Nestle Purina, the Purina Institute, and Hill’s. Dr. Coe currently holds the VCA Canada Chair in Relationship-Centred Veterinary Medicine at the Ontario Veterinary College, University of Guelph. Dr. Shepherd has received research funding and honoraria from Hill’s Pet Nutrition and Nestle Purina.She is currently the Scientific Communications Nutritionist at Royal Canin U.S. No AI-assisted technologies were used in the generation of this manuscript.
Funding
This study was funded by the Virginia Maryland Regional College of Veterinary Medicine (VMCVM) Veterinary Memorial Fund (VMF).
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