A Delphi consensus study to determine the workload components and activity standards of dietitians in South Africa's central and tertiary public hospitals.

BACKGROUND: The global Human Resources for Health (HRH) strategy emphasizes the need to invest in HRH to meet population needs and improve the provision of quality health care services. In South Africa, dietitians are recognized as registered professionals who provide nutrition services. In this paper, we used 2 key steps (3 and 4) of the eight step World Health Organization (WHO) Workload Indicators of Staffing Need (WISN) methodology to determine the workload components and activity standards for dietitians at South African central and tertiary public hospitals. METHODS: All (9) provincial nutrition managers (phase one) and 21 out of a total 22 head dietitians at central and tertiary public hospitals (phase two) participated in an online survey. In phase one, the provincial managers provided the job descriptions (JDs) of dietitians in their provinces, and the JDs were analyzed to determine the baseline workload components. In phase two, dietitians participated in a multi-stage Delphi process to reach consensus on workload components and activity standards. Consensus was deemed to be agreement of 70% or more, while the median of participants' responses was used to obtain consensus on the activity standards. RESULTS: The JDs of dietitians were a useful baseline for the consensus exercise as there were no other suitable source documents. The response rate was 100% for all three rounds of the Delphi survey. Dietitians reached agreement (consensus ≥ 70%) on 92% of proposed workload components and activity standards. Following the removal of duplicate and certain administrative activities, a total of 15 health, 15 support and 15 additional service activities with aligned activity standards resulted from the consensus exercise. CONCLUSION: The Delphi technique was a suitable method for reaching agreement on workload components and activity standards for dietitians at South African central and tertiary public hospitals. The findings from this study can now be used to compile a standardized list of workload components and activity standards and ultimately to determine dietetic staffing needs for the central and tertiary public hospital level of care.

Predictors of Tri-council Funding Among Nutrition Researchers in Canada.

Purpose: Barriers in research for women and dietitians have been documented. We sought to describe tri-council funding awarded within the nutrition discipline according to institution type, academic rank, gender, dietitian status, and primary research methods used.Methods: Using an online search methodology, faculty members with research appointments were identified from nutrition departments offering accredited dietetic programs and/or at Canada's collective of research-intensive universities known as U15. All data regarding faculty members, their institutions, and funding were collected through publicly available websites and Scopus. Tri-council funding associated with the nominated principal investigator, from a 5-year period, 2013-2014 to 2017-2018, was extracted. Binary logistic regression was used to test for predictors of receiving any tri-council operating funds within the 5-year period.Results: Faculty members (n = 237) from 21 institutions were identified for inclusion. Those from U15 institutions, at the full professor rank, nondietitians, men, and those who engaged in primarily quantitative research methods (vs. qualitative or mixed-methods) were significantly more likely to hold any tri-council funding during the eligible period. Dietitians (n = 76) were significantly less likely to hold tri-council funding, independent of institution, rank, gender, and primary research methods utilized.Conclusions: The apparent under-funding of academic dietitians from federal tri-council sources requires exploration.

Mapping the Roles of Nutrition and Dietetics Professionals in Sustainable Food Systems and Exploring Opportunities for Strategic Collaboration.

Current food systems drive environmental damage, social injustices, and undermine health, and these challenges are complex and seemingly intractable. Collaboration is required to transition to more sustainable food systems (SFS). Registered Dietitians and Nutritionists (RDs) are an under-leveraged and well-positioned group to contribute to addressing food systems challenges because of their locations in the system and their existing skillsets. Drawing on research with dietitians, this perspective paper presents both a theoretical proposal as well as collective expertise in supporting sustainable development of the global food system. It highlights where RDs work in food systems with the aim to reveal multiple points of entry where RDs can and do contribute to SFS across food systems, approaches to apply, as well as opportunities for collaboration within and beyond the profession. Educational and societal barriers exist that prevent systematic RD engagement; however, examples of established work provide models to follow.

Using Voice Assistant Systems to Improve Dietary Recall among Older Adults: Perspectives of Registered Dietitians.

Dietary assessments are important clinical tools used by Registered Dietitians (RDs). Current methods pose barriers to accurately assess the nutritional intake of older adults due to age-related increases in risk for cognitive decline and more complex health histories. Our qualitative study explored whether implementing Voice assistant systems (VAS) could improve current dietary recall from the perspective of 20 RDs. RDs believed the implementing VAS in dietary assessments of older adults could potentially improve patient accuracy in reporting food intake, recalling portion sizes, and increasing patient-provider efficiency during clinic visits. RDs reported that low technology literacy in older adults could be a barrier to implementation. Our study provides a better understanding of how VAS can better meet the needs of both older adults and RDs in managing and assessing dietary intake.

Physician Nutrition Advice and Referrals to Registered Dietitians.

PURPOSE: This study aims to examine the frequency and content of healthcare providers' nutrition recommendations and referrals Registered Dietitian Nutritionists (RDN). METHODS: Physicians, physician assistants, nurses, and other providers (> 18 years of age) currently practicing primarily in the United States received an email survey that assessed dietary recommendations for diabetes, hypertension, dyslipidemia, overweight/obesity, and general wellbeing, frequency and comfort level of providing nutrition advice, and RDN referrals. Chi-square and Student's t-tests were used for analysis. RESULTS: 154 physicians (61%), registered nurses/nurse practitioners/physician assistants (19.5%), and other providers (19.5%) were included. Those with nutrition education gave nutrition advice more than those without for some, but not all, conditions (P = .01). The Mediterranean diet was most frequently recommended, except for hypertension. The DASH diet was recommended to 47.7% of patients with hypertension. More providers gave dietary advice than referred to RDNs. Dietary advice was associated with RDN referrals for diabetes (P = .01) and wellbeing (P = .05). Providers with an RDN in their practice provided advice for diabetes more than those without (P = .01). CONCLUSION: Healthcare providers gave nutrition recommendations consistent with evidence-based guidance. RDN referrals occur in conjunction with dietary recommendations, not as replacement.

Dietitians' perspectives on the role of dietetics practice in 'gut health'.

AIMS: This study aimed to explore dietitians' perspectives on the evidence surrounding the relationship between diet and 'gut health' and the current and emerging role of dietetics practice in this area. METHODS: A qualitative descriptive methodology was used. Online semi-structured interviews were conducted with Australian dietitians, focused on the perspectives related to gut health management in dietetics practice. Inductive thematic analysis was employed, commencing with initial coding by two researchers, and further coding leading to development of emergent themes. Divergent data were discussed and considered in analysis. RESULTS: Fourteen interviews were conducted (2 males, 12 females). An overarching theme identified that current evidence is insufficient to direct dietetics practice change regarding gut health. Six subthemes on dietetics practice in 'gut health' emerged including (a) practice is multifaceted, (b) current practice aligns with dietary guidelines, (c) symptom management remains the primary concern, (d) evidence-based information is sought, (e) translational evidence is required for practice change and (f) there is a role for dietetics in gut health research and translation. CONCLUSIONS: Dietitians do not appear confident in their practice regarding gut microbiome-related management and recognise there is currently limited translatable research to inform practice. Evidence to date suggests that recommendations for positive gut health do not differ substantially from Australian Dietary Guidelines. Dietitians will need additional education if further evidence emerges, however they demonstrated a strong commitment to evidence-based practice.

Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives.

Introduction: Children with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children. Participants: Interdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22). Methods: The study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method. Results: Thematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources. Discussion: Health professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children.

Sports Nutrition in Japan: from the Past to the Future.

The Tokyo 2020 Olympics and Paralympics finished on 5 November 2021. A total of 870,000 meals were provided in the main dining facility during the events. Sports nutrition research in Japan began before the previous Tokyo Olympics, which was held in 1964. A book about sports nutrition in Japan had already been published, in 1949. A number of previous studies have examined nutrition among Olympic athletes, and influential research on sports nutrition in Japan includes a series of studies on sports anemia. This series covered basic research into the mechanisms of sports anemia through to the prevention of sports anemia. However, anemia among athletes remains an important issue. In Japan, an accreditation system for sports dietitians was established in 2007, and a scientific association for sports nutrition was established in 2004. However, the connection between basic research and practice remains a substantial problem.

Dietitians' Attitudes and Understanding of the Promotion of Grains, Whole Grains, and Ultra-Processed Foods.

NOVA is a food-classification system based on four levels of processing, from minimally processed to ultra-processed foods (UPFs). Whole-grain-containing commercial breads and ready-to-eat breakfast cereals are considered ultra-processed within NOVA, despite being considered core foods in the Australian Dietary Guidelines. These food categories contribute the greatest quantities of whole grain in the Australian diet, although consumption is less than half of the 48 g/day daily target intake. Dietitians are key to disseminating messages about nutrition and health; therefore, an accurate understanding of whole grains and the effects of processing is critical to avoid the unnecessary exclusion of nutritionally beneficial foods. The aim was to utilise an online structured questionnaire to investigate dietitians' attitudes to the promotion of grains and whole grains and understand their level of knowledge about and attitudes towards NOVA and the classification of specific whole-grain foods. Whole-grain foods were perceived positively and are regularly promoted in dietetic practice (n = 150). The dietitians tended not to consider whole-grain breads and ready-to-eat breakfast cereals as excessively processed, although most generally agreed with the classification system based on the extent of processing. If dietitians intend to incorporate NOVA and concepts of UPFs in their counselling advice, the anomalies regarding the categorisation of whole-grain choices and optimum intakes should be addressed.

Individual-Level Factors are Significantly More Predictive of Employee Innovativeness Than Job-Specific or Organization-Level Factors: Results From a Quantitative Study of Health Professionals.

Individual innovativeness is particularly indispensable among health professionals. The healthcare environment is complex and its knowledge workers must continually adapt to change and be comfortable with ambiguity. The objective of this study was to determine the relative importance of individual, job-specific, and organizational factors on innovative output of health professionals. Employed Canadian Registered Dietitians (n = 237) completed an online survey incorporating relevant validated tools, including the 10-item Big Five Inventory and the Alberta Context Tool. Factors were classified by level and introduced in blocks to a multivariate linear regression model, with the outcome of self-reported innovative output. Factors included in the model explained 44% of variation in self-reported innovative output. Although all blocks contributed significantly to the model, minimal variation was explained by factors at the job-specific (4%) and organizational levels (4%). Factors at the individual level most predictive of innovative output were role innovation, the personality trait of conscientiousness and voluntary membership in a professional association. To encourage employee innovativeness, health administrators, and managers of health professionals should consider how best to incorporate screens for individual-level indicators of innovative output (eg, personality tests) in their institutional hiring and selection processes.

Knowledge and attitudes of lower Michigan primary care physicians towards dietary interventions: A cross-sectional survey.

Background: Dietary interventions are first-line therapies for the prevention and management of many chronic diseases, yet primary care physicians prescribe these interventions infrequently. Objectives: This study investigates primary care physicians' current knowledge and opinions regarding the delivery of dietary interventions. This work aims to identify modifiable barriers to prescribing dietary interventions to prevent and treat diet-related diseases. Methods: We designed and fielded an anonymous, cross-sectional survey of faculty and resident physicians across the Internal Medicine, Family Medicine, and Pediatrics departments in three academic and community hospitals in lower Michigan. Data were collected between January 15 and April 15, 2019. Self-rated knowledge and attitudes were measured on a 5-point Likert scale. Objective scores were calculated for each question as percentage answered correctly among all respondents. Objective knowledge scores were compared based on participants' years in practice. Results: Response rate was 23% (356 responses). The sample was 62.3% female and 75.3% non-Hispanic White, and 56.7% were age 40 or younger. Average objective knowledge score was 70.3% (±17.2) correct. Mean self-rated knowledge score was 2.51 (±0.96) on a scale of 1(Poor) - 5(Excellent). Overall agreement with a statement of importance of dietary interventions was 3.99 (±0.40) on a scale of 1 (strongly disagree) to 5 (strongly agree). A majority (91.7%) of respondents indicated they would like more opportunities to learn about the evidence supporting dietary interventions. Conclusions: Physicians desire to incorporate dietary interventions into their practice. Findings encourage the development of educational strategies to support dietary intervention use among primary care physicians.

Outcomes of a nutrition service provided by dietitians at a major multi-cultural competition event: An observational study.

AIM: The nutrition service available for athletes competing at major events varies significantly and is dependent on advocacy for dietetic inclusion. The aim of this study was to describe the outcomes of a nutrition service designed and led by dietitians at a major international competition: the 2017 Taipei Universiade. METHODS: Athletes (university students aged 17-25 years) and officials that used the service were invited to participate. Occasions of service were recorded using standard pro formas and dietary analysis of consultations was conducted using Foodworks. RESULTS: The scope of the service included 242 enquiries, 884 weight checks, 25 skinfold measures and 37 consultations. A significantly higher proportion of females asked about food allergy/intolerance (26.2% vs 12.5%, P = .039) than males. Most athletes who sought a nutrition consultation had not received previous nutrition support (86.5%) and wanted performance-related meal plans and advice (81.1%). On average, their diets were adequate in micronutrients with the exception of calcium, and low in serves of vegetables and dairy products. The majority of athletes (72.9%) seeking a consultation reported that they did not follow a specific diet for their sport. Sports supplements, performance enhancers and vitamin-mineral supplements use was 45.9% (n = 17), 13.5% (n = 5) and 13.5% (n = 5), respectively. Most athletes were of a high international calibre, however, reported low confidence in their nutrition knowledge and did not consistently apply knowledge to practice. CONCLUSION: This demonstrates a need for nutrition services by dietitians at this and similar events to improve the dietary intake of young adult athletes.

The history and development of registered dietitian accreditation systems in China and other comparable countries.

A dietitian has qualifications in nutrition and dietetics and applies the science of food and nutrition to improve the health of individuals, groups, and communities. The Registered Dietitian (RD) credential has gained recognition over the years for its expertise. The accreditation systems were developed and have been used to ensure quality of this profession. Accreditation systems set standards for academic and professional training in nutrition and dietetics and reflect current research-based information. The purpose of this paper is to review a few countries that have a RD accreditation system including China and several other countries, e.g. the United States, Japan, and the United Kingdom. The aims are to introduce the newly established RD system in China and to compare the differences among the countries' systems.

Lifestyle Intervention Framework for Obese Patients with Non-alcoholic Fatty Liver Disease - a Tool for Health Professionals in Resource Constraint Settings.

Purpose Non-alcoholic fatty liver disease (NAFLD), is recognized as a health care burden worldwide. Lifestyle modification remains the first line of treatment. However, the real challenge is ensuring the patient's adherence to lifestyle modification measures, especially in hospitals with resource-limited settings. Methods We developed a six-month-long, dietitian-led, hospital-based, lifestyle intervention framework for obese NAFLD patients and evaluated its content. Literature review, interviews, and discussions with 10 health experts (general physicians, dietitians/nutritionists, gastroenterologists, and a clinical psychologist) and 45 NAFLD patients (35 in Phase I and 10 in Phase II) in a tertiary hospital of India were carried out. Results The lifestyle intervention framework has unique features, such as an intensive nature to ensure adherence, a comprehensive educational format with clear guidelines, the customization of a prescription as per individual patient requirements, and a holistic approach to inculcate self-monitoring and behavioral change in NAFLD patients. Conclusion Health professionals worldwide can use this lifestyle intervention framework to develop counseling interventions for better adherence among obese NAFLD patients.

Ascertainment and critical assessment of the views of the general public and healthcare professionals on nutrigenomics in Greece.

AIM: The aim of this study was to understand the general public's and healthcare professionals' views on nutrigenomics. PATIENTS & METHODS: We designed a cross-sectional survey of healthcare professionals (n = 87) and the general public (n = 1504) in the three largest cities in Greece (Athens, Thessaloniki and Patras). RESULTS: Our data revealed that only 11.5% of respondents from the general public had been advised to take a genetic test in order to explore the relationship between their genes and their nutritional status. Although 80.5% of healthcare professionals would have been willing to recommend their patients/clients to undergo nutrigenomic analysis to correlate their genetic profile with their diet, only 17.2% of respondents had actually done so. In general, the general public was opposed to direct-access nutrigenomics testing. CONCLUSION: The application of genomic information in the context of nutritional choice requires the continuing education of healthcare professionals and the dissemination of accurate and reliable information to the general public.

Formação do nutricionista atuante no Programa Nacional de Alimentação Escolar / Dietitians' training in the National School Feeding Program

The purpose of this research was to investigate the educational demands of dietitians engaged in the National School Feeding Program (NSFP) and to characterize the profile, career trajectory and improvement demands of these professionals, as well as the daily facilities and difficulties of the program. Data collection was carried out through a semi-structured questionnaire. Descriptive statistics and analysis of open questions were performed. The research comprised 246 dietitians - 98.4% of whom were female. Most participants (76.3%) concluded the course 10 years ago, that is, subsequent to the National Curriculum Guidelines (NCG). Contents related to NSFP were part of the undergraduate program of these dietitians, but insufficient for most of them. Thus, 31% of the nutritionists surveyed underwent further training courses to work in the NSFP. The most cited characteristics required to engage the program were technical knowledge, creativity, teamwork and dynamism. The facilities to work in the program were related to administrative aspects, while the difficulties included technical aspects. Training demands included the elaboration of nutritionally adequate menus and costs, greater participation in the nutrition educational processes, bidding, and improvement for all the professionals involved in school feeding, promoting exchanges of experiences, professional value, and raising managers' awareness regarding the importance of the Program. The divergence of content and pedagogical models during training may limit the expansion of the professional integration desired for dietitians, requiring curricular re-equalization concerning the current policies.

Este trabajo tuvo por objetivos investigar las demandas de formación profesional del nutricionista que actúa en el Programa de Alimentación Escolar (PAE), caracterizar su perfil profesional, su trayectoria y las facilidades y dificultades del Programa. La recolección de datos se realizó por medio de cuestionario semi-estructurado. Se realizó tratamiento estadístico descriptivo de los datos y análisis de las preguntas abiertas. La investigación contó con la participación de 246 nutricionistas, siendo 98,4% de sexo femenino. La mayoría (76,3%) había terminado su carrera hacía 10 años, es decir, posteriormente a las Directrices Curriculares Nacionales (DCN). Para la mayoría de los nutricionistas, los contenidos relacionados al PAE constaron en el currículo de grado de forma insuficiente. Por lo tanto, 31% tuvieron que realizar cursos específicos en esa área. Las características más citadas como necesarias para actuación en el programa fueron: conocimiento técnico, creatividad, trabajo en equipo y dinamismo. Las facilidades de los nutricionistas para actuar en el Programa se refirieron a aspectos administrativos, mientras que las dificultades incluyeron aspectos técnicos. Las demandas de formación contemplaron la elaboración de menús adecuados tanto nutricionalmente como en costo, una mayor participación en los procesos de educación nutricional y licitatorios, y la capacitación de todos los profesionales involucrados en el proceso de alimentación escolar, promoviendo intercambio de experiencias, valorización del nutricionista y sensibilización de los gestores con relación a la importancia del Programa. La brecha entre los contenidos y los modelos pedagógicos durante la formación puede limitar la ampliación de la inserción profesional deseada por el nutricionista requiriendo readecuaciones curriculares en función de las actuales políticas.

Este trabalho objetivou investigar as demandas de formação do nutricionista atuante no Programa de Alimentação Escolar (PNAE), caracterizar seu perfil profissional, trajetória de formação, demandas de aprimoramento e facilidades e dificuldades do cotidiano do Programa. Realizou-se a coleta de dados por meio de questionário semiestruturado. Utilizou-se tratamento estatístico descritivo dos dados e análise das questões abertas. A pesquisa contou com a participação de 246 nutricionistas, sendo 98,4% do sexo feminino. A maioria (76,3%) concluiu o curso há 10 anos, ou seja, posteriormente às Diretrizes Curriculares Nacionais (DCN). Conteúdos referentes ao PNAE fizeram parte da graduação dos nutricionistas, porém, de forma insuficiente para a maioria deles. Com isso, 31% deles realizaram cursos de aperfeiçoamento para atuar no PNAE. As características necessárias, mais citadas, para atuação no programa foram: conhecimento técnico, criatividade, trabalho em equipe e dinamicidade. As facilidades dos nutricionistas para atuar no Programa referiam-se a aspectos administrativos, enquanto as dificuldades incluíam aspectos técnicos. As demandas de formação abrangeram a elaboração de cardápios adequados nutricionalmente e ao custo, maior participação nos processos de educação nutricional, licitatórios e em aprimoramentos com todos os profissionais envolvidos no processo da alimentação escolar, promovendo trocas de experiências, valorização do nutricionista e sensibilização dos gestores para a importância do Programa. O descompasso dos conteúdos e modelos pedagógicos durante a formação pode limitar a ampliação da inserção profissional almejada para o nutricionista, requerendo readequações curriculares em função das atuais políticas.