Nutrition & Dietetics最新文献

Aim: To develop evidence-informed propositions for implementing whole-of-program assessment across dietetic education settings, in response to emerging education theory, technological advances such as generative artificial intelligence, and the need for meaningful learning and trustworthy progression decisions.

Methods: A four-stage multiple methods study, grounded in pragmatism, was conducted. Initial propositions were developed through a systematic scoping review of programmatic assessment literature. Thematic analysis was used to identify patterns, which were iteratively refined into themes and then preliminary propositions. These were further refined through workshops with dietetic educators, who provided feedback based on their expertise. A repeated systematic scoping review incorporated recent research to ensure currency, with findings integrated into the propositions. In the final stage, feedback from external reviewers was used to enhance clarity and practical relevance.

Results: Nine propositions for evidence-informed practice in dietetic student assessment were developed. These propositions focus on aligning assessment with program learning outcomes, using varied learning tasks to generate trustworthy learning evidence, developing feedback literacy among education partners, involving expert assessors in progression decisions, and providing intermediate reviews to monitor student progress. The propositions emphasise the importance of student agency and recognise the influence of institutional structures and culture on assessment.

Conclusions: The propositions provide a practical, whole-of-program approach to assessment that promotes learning and trustworthy progression decisions. The approach is recommended as the common assessment process across the dietetics profession. By aligning assessment practices across the curriculum and profession, these propositions seek to enhance educational outcomes and address the evolving challenges in dietetic student education.

Aim: Evaluate assessment practices and outcomes for dietetic students and compare findings with those from a previous systematic review.

Methods: A systematic review was conducted whereby four databases (MEDLINE, Embase, Cumulative Index in Nursing and Allied Health Literature, and Education Resources Information Centre) were searched on 11 October 2023 with terms related to dietetics, students, and assessment. The search was repeated on 8 January 2025 to identify new publications. Eligibility criteria were primary research published after 1 June 2017 reporting at least one assessment method for dietetic students with an assessment-related outcome. Assessment practices and outcomes were evaluated using Miller's Pyramid, the New World Kirkpatrick's Hierarchy, and the principles of programmatic assessment.

Results: From 5701 search results, 22 were identified, revealing new assessment practices, including entrustable professional activities, e-portfolios, and programmatic assessment, localised to Australia and Singapore. Compared to publications prior to 2017, a greater proportion conceptualised assessment as part of a system (46% compared to 28%) with a sustained higher prevalence of does and shows levels of Miller's Pyramid. Evaluation continued to focus on reaction, learning, and behaviour.

Conclusions: Findings indicate a transition towards programmatic approaches to systems of assessment within dietetics, though this shift was not observed globally. Such a shift is crucial for ensuring the profession's agility in responding to modern disruptors and maintaining the delivery of high-quality education.

Aims: Unpaid mandatory student placements are common among allied health disciplines. This qualitative study aimed to specifically explore the student dietitian experiences of and perspective on financial stress and food insecurity during unpaid mandatory student placements as well as describe any related impacts on their health and wellbeing.

Methods: Semi-structured interviews were undertaken with student dietitians living in Australia and New Zealand. Participants had self-nominated for interviews from a larger interprofessional mixed method study on student placement poverty. Inductive thematic analysis involving coding, categorisation, theme development and refinement was used to generate themes.

Results: A total of 11 interviews were undertaken. Most students were female, studying full-time and living in Queensland, New South Wales and New Zealand. All students had undertaken at least one unpaid placement. Thematic analysis of the student experience of placement generated five key themes and 18 subthemes. The key themes were (1) Overall Wellbeing on Placement, (2) Financial Security, (3) Social Support, (4) Income Sources and (5) Course Structure. Overall, unpaid placements had a significant impact on the ability of students to maintain their overall wellbeing whilst on placement. This included impacts on financial security. There was noted to be substantial cognitive dissonance between high levels of nutrition knowledge and the inability to maintain their own food security.

Conclusion: These findings highlight that unpaid mandatory student placements (especially those requiring full-time attendance) represent a major challenge for student dietitians, with implications for student physical and mental wellbeing and future diversity within the profession of dietetics.

Aims: This study aimed to identify and synthesise the evidence on factors influencing the incorporation of Entrustable Professional Activities into assessment in nutrition and dietetics education.

Methods: A systematic review was conducted with a narrative synthesis and was undertaken and reported in accordance with the PRISMA guidelines. Six electronic databases were searched (MEDLINE, CINAHL, SCOPUS, PsycINFO, Web of Science, and EMBASE) on 9 September 2024. Methodological quality was assessed using the Critical Appraisal Skills Program checklists. Key patterns identified from the narrative synthesis of the included manuscripts were labelled as themes and represented in a figure.

Results: Across the international literature, six articles were identified revealing six main and interconnected themes related to factors influencing the incorporation of Entrustable Professional Activities in nutrition and dietetics. In summary, development and review processes for Entrustable Professional Activities require key stakeholder engagement in addition to ensuring they are linked to assessment structures and existing frameworks. Furthermore, technology platforms and applications appeared to support Entrustable Professional Activity incorporation, and training is an important part of integration.

Conclusions: Further research on factors influencing incorporation is occurring and is suggested to continue, especially given Entrustable Professional Activities seemingly offer a tangible option to simplify the intricacy of competency-based assessment in work-based practice. However, further research to enhance understanding of whether Entrustable Professional Activities support nutrition and dietetics learners and assessors in undertaking high-quality assessment with utility is warranted.

Aims: This study explored dietary trends and urban-rural disparities in food consumption among older adults in China.

Methods: A repeated cross-sectional study of adults aged 65+ years using data from four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey. Multiple logistic regression models assessed daily vs. non-daily consumption of fresh fruit, vegetables, meat, eggs, and milk products.

Results: Among 20 945 older adults, over half were female (51.44%) and 54.22% resided in rural communities. Most participants did not consume fresh fruit (83.23%), meat (67.21%), eggs (65.13%), or dairy products (79.89%) daily, although 64.84% consumed vegetables daily. Urban adults had significantly higher odds of daily consumption of fruit (OR = 2.06), meat (OR = 1.56), eggs (OR = 1.20), and dairy (OR = 2.01).

Conclusion: The study highlights urban-rural disparities in dietary behaviours, emphasising the need for public health initiatives to improve healthier diets and expand dietary options, especially in rural populations.

Aim: To investigate enablers and barriers to providing home enteral nutrition care and the use of blended tube feeding for adult clients.

Methods: An explanatory sequential mixed-methods study mapped to the Theoretical Domains Framework, comprising a national cross-sectional web-based survey, descriptive qualitative analysis of focus groups, and triangulation of quantitative and qualitative data. The target population was dietitians operating in all work environments with adult clients in patient-facing roles.

Results: 23 enablers and 24 barriers were identified for the provision of home enteral nutrition and blended tube feeding. Home enteral nutrition enablers: clinical guideline familiarity, confidence in troubleshooting, capacity for home visits, and access to peer support. Barriers centered on time constraints, complex funding arrangements, and an unclear scope of practice, particularly in relation to advanced procedures and community-based roles. Blended tube feeding enablers: patient and caregiver enthusiasm, alignment with person-centred care, peer encouragement, and the availability of written resources. Barriers included limited clinician training, inconsistent messaging between hospital and community sectors, and restrictive or absent organizational policy. Awareness of best practice guidelines emerged as a shared enabler between home enteral nutrition care and blended tube feeding use, while the lack of targeted university education and post-graduate clinical support was the only common barrier across both.

Conclusions: This novel study offers insights into dietitians' experiences in home enteral nutrition care and blended tube feeding use. Tailored strategies must address the unique barriers in home enteral nutrition and blended tube feeding to improve the quality and consistency of care for tube-fed adults.

Aim: To explore how behavioural, normative, and control beliefs shape early dietary implementation after bariatric surgery by exploring patient and dietitian perspectives using the theory of planned behaviour framework.

Methods: Semi-structured interviews were conducted with 16 patients who had bariatric surgery within the past 12 months and 24 dietitians involved in postoperative care to explore beliefs about dietary recommendations. Interviews explored five key dietary recommendations with questions guided by the theory of planned behaviour framework. Data were analysed using a deductive and inductive approach.

Results: Behavioural beliefs indicated a complex relationship between perceived benefits and cognitive demands, with protein intake and symptom management emerging as key motivators. Normative beliefs highlighted the dual influence of supportive family environments and challenging workplace contexts, particularly regarding modified eating behaviours. Control beliefs demonstrated an integrated pattern where physical constraints, psychological factors, and environmental demands seemed to intersect to influence dietary implementation. Of the five key dietary recommendations, patients faced unique challenges with vitamin supplementation due to the interaction between physical limitations and delayed reward perception. The cognitive burden of managing new dietary behaviours appeared to be a determinant of adoption across belief domains.

Conclusion: Early dietary changes after bariatric surgery seem to be influenced by psychological, social, and physical factors beyond education. Future interventions should aim to incorporate strategies to reduce cognitive load, address competing social pressures, and account for the temporal aspects of health-protective behaviours. Theory-based interventions that integrate implementation intention techniques, social support optimisation, and temporal self-regulation strategies may enhance dietary adherence during this critical adaptation phase.

Aim: Investigate changes in diet quality scores in adults who repeated a brief online dietary assessment tool, the Healthy Eating Quiz, and whether changes in diet quality varied by sociodemographic variables, dietary characteristics, or motivations for completing the tool.

Methods: This is a secondary analysis of longitudinal data collected July 2019-May 2022. Data from respondents aged 16-100 years who repeated the dietary assessment tool were analysed, including diet quality, measured using the validated Australian Recommended Food Score (range 0-73), sociodemographic and dietary characteristics (gender, age, socioeconomic status, vegetarian status, and meal sharing), and the main motivation for completing the tool. Paired t-tests assessed change in score between first and second tool completion (reported as mean (SD)). One-way ANOVA was used to test whether mean change in score differed by respondent sociodemographic, dietary, or motivation variables.

Results: Across 5189 respondents (73.6% female, 42.0 (17.4) years), mean score improved by 2.28 points during a mean 231 (11) days (p <0.001). Non-vegetarians reported a significantly greater improvement in score than vegetarians (2.39 (6.78) versus 1.56 (6.97) points, p = 0.003). Similarly, those who ate main meals alone improved more (2.70 (7.05) points) compared to those who ate with one (2.15 (6.67) points) or ≥two others (2.14 (6.72) points, p = 0.035).

Conclusion: Using the Healthy Eating Quiz, a diet quality assessment tool, on repeated occasions may contribute to improvements in diet quality in adults.

Aims: Pressuring children to eat can override hunger and satiety cues, which may lead to over- or under-eating and food refusal. This study aims to describe the manifestations of pressure-to-eat in child care from early childhood educators.

Methods: A secondary data analysis was conducted using qualitative content analysis. Observations of educators from child care centres in Nova Scotia and Prince Edward Island (n = 9) occurred over 2 days. Observation data were coded and counted to determine the most and least prevalent forms of pressure. The count results were then assessed quantitatively by educator demographic characteristics to explore potential associations using nonparametric tests (Mann-Whitney U test, Spearman's correlations).

Results: Offering food and encouraging eating without referencing hunger or satiety was found to be the most common type of pressure; serving children without asking if they were hungry made up the majority of this type of pressure. This was less common with both increasing educator age (r = -0.692, p = 0.039), as well as years of experience (r = 0.878, p = 0.002). Pressuring children to eat by referring to health benefits and consequences was the least common type of pressure.

Conclusion: This study provides insight into the types and frequency of pressure-to-eat strategies implemented in child care centres, which can inform interventions to create more responsive feeding environments.