Teaching and assessment of communication skills in dietetics: a scoping review.

BACKGROUND: Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics. METHODS: The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised. RESULTS: The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools. CONCLUSIONS: The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.

Communication Skills: A Scoping Review of Experiences, Perceptions, and Use in Dietetics Practice.

BACKGROUND: Communication skills are a cornerstone of practice for dietitians. The field of dietetics is evolving and there is a need to synthesize the available literature on communication skills to improve the effectiveness of patient consultations and inform practitioner development. OBJECTIVE: This scoping review aimed to identify the research literature relating to communication skills used in dietetics practice and perceptions and experiences of dietetics students, dietitians, and patients regarding communication skills. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and best practice guidance. Five databases (Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, and PsycInfo), two theses databases, and conference proceedings for 8 dietetics and health professions education associations were systematically searched for research on dietitians' communication skills. This included skills used in dietitian-patient communication, in communication interactions in different employment contexts, and diverse forms of communication (verbal, written, technological) and the views of dietetics students, dietitians, and patients, regarding communication skills. The search had no geographical or time limits. Studies were independently screened by two authors. RESULTS: The 70 included studies spanned 45 years and were organized into four thematic categories: importance of communication skills in dietetics practice, development of communication skills, communication skills for dietitian-patient communication, and communication skills for wider dietetics practice. Sixty-five (92.9%) of the studies specifically explored the communication skills used for dietitian-patient consultations, including rapport building, questioning, listening, paraphrasing, and clarifying, whereas skills such as intercultural communication were less researched. CONCLUSIONS: There is consensus between patients and dietitians regarding the skills that contribute to effective dietitian-patient communication. Areas less explored in the literature include the skills needed for intercultural communication and those needed for science communication. Greater understanding of the communication skills needed for contemporary nutrition and dietetics practice will guide education strategies for the development of dietitians.

Evaluating digital competencies for allied health professionals in the United Kingdom.

The Covid-19 pandemic accelerated the move to virtual and remote consultations in clinical practice with digital technologies widely implemented. eHealth interventions and use of applications in a variety of conditions means that patients and their families, as well as healthcare professionals, can access and interpret data in real-time, as well as providing trends in various clinical parameters including blood pressure for instance. Despite the aim of digital transformation in the National Health Service in the United Kingdom, this has not been fully realised and there is no consensus on the skills and competencies required for allied health professionals (AHPs). This qualitative study undertook two focus groups with twelve AHPs to evaluate the AHP Digital Competency Framework in the UK. The participants recognised the importance of a digital technology in their clinical practice and perceived digital literacy as essential for AHPs. In relation to the AHP framework, participants agreed that competencies in digital technology were clinically relevant, and assessment of these competencies should be performed regularly in practice. However, the majority were unaware of the AHP digital competency framework and suggested improvements to optimise its use in practice and identified areas for improvement. Overall, the AHP Digital Competency Framework has the potential, with better dissemination and further refinement of the wording, to become a useful tool to support the enhancement of digital competency in AHPs and improve the delivery of patient care.

Communication skills in dietetic practice: a scoping review protocol.

OBJECTIVE: This scoping review aims to examine and map the evidence regarding communication skills in dietetic practice and the education strategies used to develop them. Specifically, the review will address usage in practice, perceptions, and experiences, as well as the teaching and assessment of communication skills in student dietitians and dietitians. INTRODUCTION: Communication skills are a key element of practice for dietitians. Dietetic practice is evolving, and there is a need to explore the breadth of literature on communication skills for contemporary practice and how these skills are taught. INCLUSION CRITERIA: This scoping review will consider empirical research on dietitians' or nutritionists' communication skills. This will include skills used in dietitian-patient communication, in communication interactions in different employment contexts, and diverse forms of communication (verbal, written, technological). We will consider the views of student dietitians, dietitians, and patients, as well as evidence regarding how communication skills are taught and assessed in dietetics. Sources may include experimental, quasi-experimental, observational, and qualitative studies. METHODS: The following electronic databases will be searched: MEDLINE, Embase, CINAHL, ERIC, and PsycINFO. There will be no date limits. Reference lists of eligible studies will be back-searched. Google Scholar will be used for forward citation tracking. Conference proceedings from the previous five years will be searched for eight conferences of the professional associations of dietetics and health care education. ProQuest Dissertations and Theses, and WorldCat Dissertations and Theses will be searched for unpublished literature. The findings will be summarized in tabular format and a narrative synthesis.

Working-age adults using food banks in England have significantly poorer health and higher rates of mental health conditions than adults in the general population: A cross-sectional quantitative study.

Food bank use has risen rapidly in the UK since 2010. The negative health impacts of food insecurity are well-documented, but there is a lack of quantitative research exploring the health of people using food banks, who are most often severely food insecure. To address this gap, this study compares health outcomes between working-age adults using food banks and those in the general population in England, investigating whether adults using food banks are disproportionately affected by poor health, even after accounting for socioeconomic differences. Data from a survey of 598 adults using Trussell Trust food banks in 2016-2017 were merged with data from the Health Survey for England (HSE) from 2016. Outcome variables of interest were: self-rated health, life-limiting health conditions (disability) and self-reported metabolic, cardiovascular, musculoskeletal and mental health conditions. Logistic regression models were used to examine the odds of adults using food banks having health conditions, disability and poor self-rated health compared to the general population. The prevalence rates of poor self-rated health, disability, mental health disorders and musculoskeletal conditions were significantly higher among adults using food banks than the general population (p < .05 for all outcomes). These associations remained after accounting for gender, age, marital status, employment and education. This comparative study highlights the many health disadvantages among adults using food bank compared to the general population. The higher risk of poor self-rated health, disability and mental health conditions was not fully explained by measures of low socioeconomic status. Possible explanations for these findings include: first, that poor health may increase vulnerability to food insecurity, and, in turn, use of food banks; second, that experiences of food insecurity and food bank use may cause declines in health; and third, that food bank use and poor health may be joint outcomes arising from the last decade of austerity in the UK.

Comparing dietary macronutrient composition and food sources between native and diasporic Ghanaian adults.

BACKGROUND: Dietary acculturation may contribute to the increased burden of non-communicable diseases (NCDs) in diasporic populations of African ancestry. OBJECTIVE: To assess nutritional composition and the contribution that traditional foods make to the diets of native and UK-dwelling Ghanaian adults. DESIGN: An observational study of Ghanaian adults living in Accra (n=26) and London (n=57) was undertaken. Three-day food records were translated to nutrient data using culturally sensitive methods and comparisons were made for energy, macronutrients, and dietary fibre between cohorts. The contribution of traditional foods to dietary intake was measured and the foods contributing to each nutrient were identified. RESULTS: Compared to native Ghanaians, UK-Ghanaians derived a significantly higher proportion of energy from protein (16.9±3.9 vs. 14.1±2.8%, p=0.001), fat (29.9±7.9 vs. 24.4±8.5%, p=0.005), and saturated fat (8.5±3.4 vs. 5.8±3.7%, p<0.001) and a significantly lower energy from carbohydrate (52.2±7.7 vs. 61.5±9.3%, p<0.001). Dietary fibre intake was significantly higher in the UK-Ghanaian diet compared to the native Ghanaian diet (8.3±3.1 vs. 6.7±2.2 g/1,000 kcal, p=0.007). There was significantly less energy, macronutrients, and fibre derived from traditional foods post-migration. Non-traditional foods including breakfast cereals, wholemeal bread, and processed meats made a greater contribution to nutrient intake post-migration. CONCLUSIONS: Our findings show the migrant Ghanaian diet is characterised by significantly higher intakes of fat, saturated fat, and protein and significantly lower intakes of carbohydrate; a macronutrient profile which may promote increased risk of NCDs amongst UK-Ghanaians. These differences in the nutrient profile are likely to be modulated by the consumption of 'Western' foods observed in migrant communities.

Dietary intake in Black British adults; an observational assessment of nutritional composition and the role of traditional foods in UK Caribbean and West African diets.

OBJECTIVE: Acculturation to the UK diet may contribute to the increased burden of non-communicable diseases in Black British communities. The present study aimed to assess nutritional composition and the contribution that traditional foods make to dietary intake in a group of UK-residing Caribbean and West African adults and to explore differences according to ethnicity and duration of residence. DESIGN: Observational study. Dietary intake was assessed using multiple, standardised triple-pass 24 h recalls and analysed using a nutritional composition database. Associations between sociodemographic variables and duration of residence with dietary intake were assessed using ANCOVA. SETTING: London, UK, October 2011-December 2012. SUBJECTS: UK adults of Caribbean (n 50) or West African (n 83) ancestry, aged 18-75 years. RESULTS: The Caribbean participants were older and more likely to be born in the UK. After adjusting for age, sex and ethnicity, those who had been resident in the UK for the longest duration had significantly higher intakes of energy (P<0·001), fat (P=0·002) and Na (P=0·03). The West African participants sourced significantly more energy (P=0·04), fat (P=0·02), saturated fat (P=0·02) and Na (P=0·001) from traditional cultural foods compared with the Caribbean diet, which was more reliant on 'Westernised' foods such as sugar-sweetened beverages. CONCLUSIONS: These results are novel in demonstrating dietary acculturation in UK adults of Caribbean and West African ancestry. We have provided detailed data regarding the role of traditional foods, presenting dietary information that may guide in individualising care for patients from these communities and improve the cultural sensitivity of public health strategies.

Designing a national clinical audit of nutritional care in health and social care settings: consideration and future directions.

The aim of this review paper is to consider how the principles of clinical audit could be applied to the development of an audit of nutritional care in hospitals and care homes, based on criteria derived from the Essence of Care: Food and Drink. A literature review identified fifteen key papers that included guidance or standards for nutritional care in hospitals or care homes. These were used to supplement the ten factors suggested by the Essence of Care to develop a set of potential audit criteria covering all aspects of the nutritional care pathway including the identification of risk of malnutrition, implementation of nutritional care plans, referral to healthcare professionals for further nutritional assessment and nutritional support strategies. A series of audit tools have been developed, including an organisational level audit tool, a staff questionnaire, a patients' and residents' records audit tool and a patients' and residents' experiences questionnaire. Further issues to consider in designing a national nutritional audit include the potential role of direct observation of care, the use of trained auditors and the scope for including the results of pre-existing local audits. In conclusion, a national audit would need to encompass a very large number of health and care organisations of widely varying sizes and types and a diverse range of people.