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Article

Quality of Dietetic Patient Education Materials for Diabetes and Gastrointestinal Disorders: Where Can We Do Better?

by
Kelly Lambert
*,
Olivia Hodgson
and
Claudia Goodman
School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
*
Author to whom correspondence should be addressed.
Dietetics 2024, 3(3), 346-356; https://doi.org/10.3390/dietetics3030026
Submission received: 12 May 2024 / Revised: 24 August 2024 / Accepted: 3 September 2024 / Published: 6 September 2024
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Abstract

:
(1) Background: Patient education materials are frequently used by dietitians to support counselling and reinforce key concepts. No studies have examined the quality of dietetic patient education materials for diabetes and common gastrointestinal conditions. (2) Methods: Materials relating to the dietary management of diabetes and gastrointestinal conditions (IBD, IBS, lactose intolerance, coeliac disease and low-FODMAP diets) were evaluated by three dietitian raters. Readability was assessed, and materials with a reading grade level ≤ 7 were considered readable. The PEMAT was used to assess understandability and actionability. Clarity was determined using the CDCCCI. (3) Results: Overall readability scores were satisfactory with a median grade level of 6 (IQR: 5–8). Readability scores did not differ between material types (p = 0.09). The health literacy demand of materials was suboptimal, with a mean understandability score of 65.9 ± 15.1% and an actionability score 49.6% ± 20.8%. Both scores fell below the benchmark of ≥70%. These did not differ between material types (p = 0.06 and p = 0.15, respectively). Clarity scores were below the benchmark of ≥90% (mean score 64.2 ± 14.8%). Only 6.6% of materials achieved a score of ≥90. (4) Conclusions: Improvements to the health literacy demand and clarity of dietetic patient education materials are required. Areas for future improvement have been identified.

1. Introduction

Eight in ten Australians live with at least one long-term chronic health condition [1]. This includes conditions such as diabetes, kidney disease, and cardiovascular disease. Other conditions such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), lactose intolerance, and coeliac disease are extremely common, and a global survey recently estimated the prevalence of functional gastrointestinal conditions such as these at 40% [2]. Medical nutrition therapy and dietary manipulation are a key part of the self-management of these conditions.
Many individuals turn online for medical and dietary information when they are unable or unwilling to access health professionals such as dietitians [3,4,5]. However, there are significant challenges with the quality of these resources. Previous work evaluating the quality of online dietary resources for those with kidney disease found that only three quarters contained-evidence based information, and showed extensive shortcomings regarding the understandability and actionability (health literacy demand) [6]. Other publications for kidney disease designed by dietitians but not freely available were also similarly poor [7].
Studies examining the quality of patient education materials for diabetes are very limited in number. Previous work examining general diabetes patient education materials found that they were of poor quality [8]. Another study evaluating the readability of Australian multilingual diabetes materials found readability levels exceeding grade ten [9]. While none of these studies specifically targeted dietetic materials, these small studies suggest that patient education materials for people with diabetes may not be of adequate quality and may not reach their intended population, with their high readability grade listed as a significant barrier [10].
Previous studies of the quality of patient education materials for those with gastrointestinal disorders are also concerning. One study that investigated the readability of non-dietary IBS materials online found that the information was significantly beyond the reading age of the average person [11]. Another study assessing dietary education resources for coeliac disease found that only 1% of the materials evaluated met the recommended reading level [12]. These studies suggest that the quality of patient education materials for many conditions is suboptimal [8,11,13,14], and there are few comprehensive examinations of dietetic patient education materials.
Understanding the quality and health literacy demand of dietary education materials is critical to patient understanding and subsequent behaviour change. Therefore, the aim of this study was to quantify the quality of written dietary patient education materials. In particular, we wished to explore the readability, understandability, actionability, and overall clarity of resources, and identify areas for improvement.

2. Materials and Methods

This cross-sectional desk-based study involved analysis of online written dietetic patient education materials from February 2021 to March 2022. No ethics approval was required as no participants were involved and all materials were freely available. A purposive sample of dietary education materials from reputable government or patient advocacy organisations was obtained using an incognito window on the search engine Google. In addition, one resource for each condition was also obtained from local dietitians at the major public hospital to represent materials provided in clinical practice. Only five common gastrointestinal disorders were chosen for examination and were based on clinical judgement. These included Inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), the low-FODMAP diet, lactose intolerance, and coeliac disease. Eligibility criteria included materials that were freely accessible to dietitians in Australia, written in English, were more than 100 words in length, focused on dietary advice, and were available for download.
To determine the quality and health literacy demand of resources, three assessments were conducted. First, readability of the materials was assessed using the Hemingway editor [15]. This online tool uses the Flesch Kincaid readability formula to calculate the reading grade level. Australian government guidance suggests a reading level ≤ grade 7 is preferred [16] as 44% of Australians have reading skills at middle-high school level or lower [17]. In addition, no more than 5% of sentences should be long, and at least 96% of sentences should use the active voice [17]. The text of the included materials was copied and pasted into the editor. All formatting was corrected and tables removed. The text of each material was then computed to determine the readability grade score, as well as counts of passive voice and the number of phrases with simpler alternatives. Sentences that were hard to read and very hard to read were also calculated and converted to a percentage for analysis. Materials that scored ≤ grade 8 were classified as readable.
Next, the understandability and actionability (referred to as the health literacy demand) of each material were evaluated using the Patient Education Material Assessment Tool for printable materials (PEMAT-P) [18]. Understandability refers to whether or not the information can be understood by consumers from diverse backgrounds and different levels of health literacy [19]. Actionability refers to whether or not the information is written in a way that allows consumers to simply identify what they need to do after reading the material [19]. The PEMAT-P includes 17 items that measure understandability and 7 items that measure actionability. Items were scored as agree or disagree and then converted into a percentage score. Items were also able to be scored as not applicable. Scores of ≥70% indicated the material is understandable or actionable [19].
Finally, the clarity of the materials were evaluated using the Centres for Disease Control and Prevention Clear Communication Index Score Sheet (CDC CCISS) [20]. This tool contains 20 questions with yes or no responses. Questions were scored as yes received one point and questions that scored no received zero points except for question 17 (‘Does the audience have to conduct mathematical calculations?’) where this scoring was reversed as per instructions from the authors [21]. Question 11 was not scored (‘Does the material explain what authoritative sources, such as subject matter experts and agency spokespersons, know and do not know about the topic?), and questions 18–20 were not scored as this level of detail is typically not included in patient handouts for diet. Scores for each material were converted into a percentage. When materials scored ≥ 90%, they were considered to have high clarity [21].
All data were analysed using IBM SPSS version 28 (IBM Corp, Armonk, NY, USA). Normality was assed using the Shapiro–Wilk test. Normally distributed data are reported as the mean and standard deviation or median and interquartile range. Chi square tests were used to determine differences in the proportion of materials of adequate quality between diabetes and those with gastrointestinal disease. Independent t tests or Mann–Whitney tests were used to compare continuous variables between groups. Materials for each condition (diabetes, gastrointestinal disease) were scored by one final year student dietitian reviewer, with a 20% sample of each evaluated independently by a second reviewer (KL, an experienced clinical dietitian and researcher). Inter-rater reliability was determined between reviewers using Cohen’s kappa statistic. Guidelines for the interpretation of Cohen’s kappa were as follows: Cohen’s kappa of 0.0–0.2 is poor agreement; 0.21–0.4 is fair agreement; 0.41–0.60 is moderate agreement; 0.61–0.80 is good agreement; and 0.81–1.0 is very good agreement [22]. A p value < 0.05 was considered statistically significant.

3. Results

A total of 76 resources were eligible for analysis from 22 platforms (Table 1). Of these, 30 were diabetes-related and 46 related to gastrointestinal disorders. Further details on the source of individual materials are contained in Supplementary Materials Table S1. Agreement between raters for understandability was 0.43 (moderate agreement), that for actionability was 0.89 (very good agreement), and that for clarity was considered very good [22], with a Cohen kappa of 0.84.
The median material length was five pages (Interquartile range IQR: 3–6.25). Less than half of the materials (n = 34, 44.7%) were considered short (≤4 pages). Diabetes materials were shorter in length (Table 2, median 3 pages (IQR: 2–5) compared to gastrointestinal disease materials (median length 5.5 pages (IQR: 4–7). This difference was not statistically significant (p = 0.87).

3.1. Readability

Overall readability scores were satisfactory with a median grade level of 6 (IQR: 5–8). Readability scores did not differ between material type (p = 0.09), with a diabetes material median grade level of 6.0 (IQR: 5–7.75) compared to a gastrointestinal disease material median grade level of 7 (IQR: 6–8). Materials relating to IBS and coeliac disease had the highest median readability scores (Table 2). The overall proportion of diabetes materials considered readable was 73.3% (n = 22) compared to 63% (n = 29) of gastrointestinal disease materials (p = 0.35).
The complexity of sentences from the included materials is shown in Table 2. Overall, materials had a relatively low proportion of sentences in the passive voice and that were considered hard to read (median number of sentences per material of 6.7% (IQR: 3.6–12.3). The use of the passive voice was significantly more prominent in gastrointestinal materials, with a higher median number of sentences per material written in the passive voice (9.5 IQR: 6–14.8) compared to a median of 3 (IQR 1–5.8, p ≤ 0.001) in the diabetes materials. Gastrointestinal materials contained a higher proportion of sentences considered hard to read (8.4% IQR: 4.4–13.7%) compared to diabetes materials (median 4.55% IQR: 2.3–9.3%; p = 0.03). Of these gastrointestinal materials, materials on IBD appeared to have the highest number of sentences that were considered very hard to read (18.1 ± 13.9%), and lactose intolerance had the lowest (8.2 ± 5.4%). Detailed information on the readability metrics of each material are contained in Supplementary Table S1.

3.2. Health Literacy Demand

The health literacy demand of materials was highly variable. Overall, the materials had a mean understandability score of 65.9 ± 15.1% and an actionability score of 49.6 ± 20.8% (Table 3). Both of these scores are below the cut off of ≥70%, suggesting a high health literacy demand. The overall proportion of materials considered understandable was 43.4.%. The proportion of materials considered understandable did not differ between diabetes (22.4%) and gastrointestinal materials, at 21.1% (p = 0.06)
Actionability scores for all groups of materials were below the cut off of ≥70%. The mean score overall was 49.6 ± 20.8%. The proportion of materials that exceeded the cut off for actionability was 13.2%. Actionability scores did not differ between diabetes (7.9%) and gastrointestinal materials 5.3% (p = 0.15). The lowest scores for actionability were for materials on low-FODMAP diets (mean score 36.8% ± 21.8) and the highest scores were for lactose intolerance materials (mean score 56.1% ± 19.6). Detailed information on the health literacy demand of each material is contained in Supplementary Table S2.
There were numerous areas for improvement regarding the health literacy demand of written dietary patient education materials. These are shown in Figure 1. The poorest-performing elements of understandability were ‘including visual cues with captions’, ‘using visual cues to draw attention’, ‘using visual cues to enhance understanding’ and ‘including a summary statement’. The poorest-performing items on the actionability scale included ‘visual aids help act on instructions’, ‘including simple instructions for doing calculations’, ‘provides tangible tools’ and ‘breaks instructions into manageable, explicit steps’. The item on ‘explaining graphs/tables’ also scored poorly.

3.3. Clarity

Overall, the clarity of the written materials was inadequate, with a mean score 64.2 ± 14.8%. Only 6.6% of materials achieved a score of ≥90%. These are shown in Table 2. Areas that were suboptimal are shown in Figure 2, and these include a lack of or poor use of visuals, lack of the active voice in the main message, or calls to action and use of unfamiliar words.

3.4. Overall Quality

Of the 76 materials reviewed, only 3.9% (n = 3 materials) passed all benchmarks, that is, exceeded benchmarks for readability, understandability, actionability, and clarity. These materials were Healthy Eating: A guide for older people living with diabetes [23]; Diabetes and Healthy Food Choices (Diabetes New Zealand) [24]; and The gluten free diet (Coeliac UK) [25].

4. Discussion

The World Health Organisation has called for a greater focus on health literacy and considers it central to improved outcomes for non-communicable diseases globally [26]. This is in part because health literacy is an important mediator of health outcomes, and strategies to make health information more accessible to people may be a mechanism to achieve greater equity in health [27]. This study therefore examined the quality and health literacy demand of dietetic patient education materials for people with diabetes and gastrointestinal conditions. We found that overall readability was acceptable and at least two thirds of materials could be read by people with a grade 7 reading ability or lower. However, the health literacy demand of these materials was suboptimal, especially the actionability of materials.
Readability is one component that influences the comprehension of information. A meta-synthesis of more than 7800 websites established that online health information continues to be problematic and that most is written at too high a reading level [28]. We found that a median grade reading level of 6 was consistent with recommendations from the Australian government recommendations [17]. While pleasing, closer examination of the structure of sentences suggests that improvements can still be made to improve the quality of dietetic patient education materials. A starting place would be to include a plain language summary statement at the start of the document signposting the purpose of the document and its intended audience. Similarly, a summary statement at the end of the document emphasising key points would improve overall quality. This is also a critical feature as poor readability can lead to misinformation and a detrimental impact on health [28].
No frameworks presently exist for dietitians to use when designing dietetic patient education materials. The PEMAT provides a useful starting point for evaluating materials. Consistent with a number of previous studies [6,7,8,13], the areas requiring most attention include the use of visuals to support key messages. Selection of images that represent the target audience or the concept discussed are important but so too are the use of titles or legends to explain how the visuals support the key message. The noticeable use of high-quality food-based images in the resources evaluated are to be applauded, but consideration should be given to the common practice of printing resources in black and white due to resource limitations. Resources that are potentially to be printed or used in black and white format should also be designed in this manner. Colour should also be used carefully, with universal design principles for accessibility [29] in mind. Colour can be used to convey information, indicating an action is needed, or they can be used to distinguish a visual element. Blue/orange is considered a common colourblind-friendly palette. In addition, placement of images on materials should avoid using text and background colours that have low contrast or text on a patterned background as this makes the materials harder to read [30]. An example is shown in Figure 3.
Actionability of information contained within dietetic patient education materials continues to be an area for ongoing improvement. Previous studies of dietetic materials have documented actionability statistics between 37% [7] and 66.83% [31]. The results of the present study are situated in the middle of this range (49%) but remain under the benchmark for actionable material [18]. Of the single study that has examined some multilingual dietary materials, actionability also remained a challenge and translation did not appear to influence on the meaning [9].
It is known that tailored education materials have been shown to be more effective than generic materials for facilitating behaviour change [32]. To complement this feature and improve the overall quality of resources, several areas for improvement regarding actionability are shown in Table 4. These have been adapted for dietetic materials from the PEMAT user manual [18] and in order of priority based on the findings of the present study.
The strengths of this study include the comprehensive examination of health literacy demand using validated tools, and analysis beyond just readability. The relatively large number of materials examined and the inclusion of materials used presently in clinical practice are also strengths. Limitations include the changing availability of online materials and the inability to exactly replicate the selection of materials examined. There are also inherent limitations to the PEMAT, with the agreement between raters considered moderate for the element of understandability. The involvement of raters with limited exposure to the conditions examined may more closely represent the perspectives of consumers with naïve exposure to the conditions. This would need confirmation via the involvement of consumers to formally assess and examine materials. This is an important element for future research. Examination of materials developed for consumers from diverse backgrounds by consumers themselves should also be an area for future research.

5. Conclusions

This examination of the quality and health literacy demand of dietetic patient education materials suggests that more work is required to assist dietitians to construct materials of high quality and improved health literacy demand and clarity. Given that patient education materials are often used to support the delivery of advice during dietetic sessions and to reinforce the key points discussed, the development of practical frameworks for the optimal design of materials would be useful. In the interim, we present suggestions that may be a useful starting point.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/dietetics3030026/s1: Supplementary Table S1: Readability metrics of included materials (n = 76); Supplementary Table S2: Assessment of quality of eligible written dietary patient education materials (n = 76).

Author Contributions

Conceptualisation, K.L. and C.G.; methodology, K.L.; validation, K.L.; formal analysis, K.L., O.H. and C.G.; investigation, K.L., O.H. and C.G.; data curation, K.L., O.H. and C.G.; writing—original draft preparation, K.L., O.H. and C.G.; writing—review and editing, K.L., O.H. and C.G.; supervision, K.L.; project administration, K.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable for studies not involving humans or animals.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data are available on reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Dietetics 03 00026 g001
Figure 1. Scores for the PEMAT-P for understandability and actionability. Legend: The dotted line represents the benchmark of ≥70% that materials should reach to be considered to have a low health literacy demand.
Figure 1. Scores for the PEMAT-P for understandability and actionability. Legend: The dotted line represents the benchmark of ≥70% that materials should reach to be considered to have a low health literacy demand.
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Figure 2. Scores for the CDCCCI for clarity. Legend: The dotted line represents the benchmark of ≥ 90% that materials should reach to be considered to have high clarity.
Figure 2. Scores for the CDCCCI for clarity. Legend: The dotted line represents the benchmark of ≥ 90% that materials should reach to be considered to have high clarity.
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Figure 3. Recommendations for good contrast between text and background adapted from [30].
Figure 3. Recommendations for good contrast between text and background adapted from [30].
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Table 1. Source and number of written dietary patient education materials.
Table 1. Source and number of written dietary patient education materials.
Diabetes
Materials
n = 30		Gastrointestinal Disease
Materials
n = 46
NEMO (8)NEMO (5)
PEN (3)PEN (7)
Dietitians Australia (1)GESA (5)
NDSS (10)Better Health (5)
NZDA (3)Health Direct (3)
BDA (1)BDA (1)
DUK (2)Dietitians Australia (1)
ADA (1)American College Gastroenterology (1)
ISLHD (1)ISLHD (5)
Crohn’s and Colitis Foundation (1)
Crohn’s and Colitis Australia (1)
Crohn’s and Colitis UK (1)
Monash University (1)
Coeliac Australia (1)
NIDDK (1)
Coeliac Disease Foundation (1)
Coeliac UK (1)
Mayo Clinic (15)
Legend: NEMO: Nutrition Education Materials Online; PEN: Practice Based Evidence in Nutrition; NDSS: National Diabetes Service Scheme; NZDA: New Zealand Dietetic Association; BDA: British Dietetic Association; DUK: Diabetes UK; ADA: American Diabetes Association; ISLHD: Illawarra Shoalhaven Local Health District; GESA: Gastroenterological Society of Australia; NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases.
Table 2. Readability metrics of included materials (n = 76).
Table 2. Readability metrics of included materials (n = 76).
Number of Sentences Complexity
Type of Diet-Related
Materials		Readability
Grade Score 		Using a
Passive Voice		Sentences Have a
Simpler
Alternative 		Classified as
Hard to Read (%)		Classified as Very Hard to Read (%)
Diabetes sheets6 (IQR: 5–7.75)3 (IQR: 1–5.75)2 (IQR: 9–3.75)9.1 (IQR: 6.1–12.4)4.6 (IQR: 2.3–9.3)
IBD sheets6 (IQR: 6–9.5)12.4 ± 9.64.9 ± 3.415.7 ± 1018.1 ± 13.9
IBS sheets7 (IQR: 4.5–9)9 ± 5.02.6 ± 2.88.5 ± 3.510.8 ± 14.2
Low-FODMAP sheets6 (IQR: 5–7)10.7 ± 8.34.6 ± 3.48.2 ± 3.610.5 ± 7.5
Lactose intolerance sheets6 (IQR: 5.8–7.5)11 ± 8.71.5 ± 1.58.6 ± 4.98.2 ± 5.4
Coeliac disease sheets7 (IQR: 7–8)11.7 ± 54.9 ± 3.111.4 ± 7.68.9 ± 4.7
All gastrointestinal sheets7.0 (IQR: 6–8)9.5 (IQR: 6–14.8)3 (IQR: 1.25–5)10.6 (IQR: 6.2–13.3)8.4 (IQR: 4.4–13.7)
All sheets (n = 76)6 (IQR: 5–8)7 (IQR: 3–12)3 (IQR: 1–4.3)9.5 (IQR: 6.2–12.6)6.7 (IQR: 3.5–12.3)
Legend: IQR: interquartile range; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome.
Table 3. Assessment of quality for eligible written dietary patient education materials (n = 76).
Table 3. Assessment of quality for eligible written dietary patient education materials (n = 76).
Type of Diet-Related
Material		Length (Pages)Understandability (%)Actionability
(%)		Clarity
(%)
Diabetes 3 (IQR: 2–5)72.1 ± 11.255.9 ± 21.063.7 ± 15.1
IBD5 (IQR: 4.5–8)62.8 ± 14.044 ± 17.364.7 ± 13.7
IBS5 (IQR: 2.5–5)66.1 ± 20.140.0 ± 23.173.6 ± 18.1
Low FODMAP6 (IQR: 4–7)59.9 ± 21.136.8 ± 21.861.4 ± 18.8
Lactose Intolerance6.5 (IQR: 5.75–9)61.5 ± 16.356.1 ± 19.655.6 ± 8.09
Coeliac Disease6 (IQR: 4–8)60.3 ± 12.249.7 ± 17.167.7 ± 11.2
Summary (n = 76)5 (IQR: 3–6.25)65.9 ± 15.149.6 ± 20.864.2 ± 14.8
Legend: IBD: inflammatory bowel disease; IQR: interquartile range.
Table 4. Suggestions to improve the actionability of dietetic patient education materials.
Table 4. Suggestions to improve the actionability of dietetic patient education materials.
Actionability ItemExemplar ResponseExample of Poor Actionability
Use visual aids to help act on instructionsThis picture shows a range of snacks divided into those you can eat every day, some you can eat in the suggested portions, and some that should be eaten in small amounts as a an occasional treat.Choose healthy snacks
Includes simple instructions for doing calculationsCheck the nutrition information panel on the food package to work out how much fibre is in the serving size of the product. In this case, the food contains 2 g of fibre for each serving (3 pretzels or 28 g).
 
The serving size can be useful if you are going to eat one serving. Sometimes the serving size is very small and you may eat more than one serving.		Eat 30 g fibre per day
Provides tangible tools to help the user take action Use Table 1 with a list of low-FODMAP foods to help you plan your meals while following the elimination phase of the low-FODMAP diet.Table 1 has a list of low-FODMAP foods
Breaks instructions into manageable, explicit stepsChoose packaged foods with less than 120 mg of sodium per 100 g of food. Some packaged foods may have this information listed as a percentage of the daily value (%DV). Choose foods with a daily value of 5% or less, or those labelled ‘low sodium’ or ‘no added salt’.
 
Do not add salt to foods when cooking or at the table and if eating out, ask for low salt options.		Eat less salt and limit to 2300 mg per day
Explains how to use graphs/tables to take actionsWhen reading a nutrition information panel, look first at the per 100 g serve column. Choose foods with less than 3 g of fat per 100 g.
 
Some packaged foods may have this information listed as a percentage of the daily value (%DV). If you needed to be careful of how much fat you eat, then choose foods with a daily value of 5% or less, or those labelled ‘low fat’.		Figure 1 has an example of the nutrition information panel
Clearly identifies one action the user can takeBe active for 30 min every day to help manage your blood glucose levels.Exercise can help control your blood glucose levels
Addresses the user directly when describing actionsYou can find the amount of sodium in a food on the nutrition information panel on the back of packaged foods.Sodium is found on the nutrition information panel on the back of packaged foods
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Lambert, K.; Hodgson, O.; Goodman, C. Quality of Dietetic Patient Education Materials for Diabetes and Gastrointestinal Disorders: Where Can We Do Better? Dietetics 2024, 3, 346-356. https://doi.org/10.3390/dietetics3030026

AMA Style

Lambert K, Hodgson O, Goodman C. Quality of Dietetic Patient Education Materials for Diabetes and Gastrointestinal Disorders: Where Can We Do Better? Dietetics. 2024; 3(3):346-356. https://doi.org/10.3390/dietetics3030026

Chicago/Turabian Style

Lambert, Kelly, Olivia Hodgson, and Claudia Goodman. 2024. "Quality of Dietetic Patient Education Materials for Diabetes and Gastrointestinal Disorders: Where Can We Do Better?" Dietetics 3, no. 3: 346-356. https://doi.org/10.3390/dietetics3030026

APA Style

Lambert, K., Hodgson, O., & Goodman, C. (2024). Quality of Dietetic Patient Education Materials for Diabetes and Gastrointestinal Disorders: Where Can We Do Better? Dietetics, 3(3), 346-356. https://doi.org/10.3390/dietetics3030026

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