Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States.

Sunitha Zechariah,Jennifer L Waller,Gianluca De Leo,Judith Stallings,Leigh Lehman,Ashley J Gess

doi:10.3390/healthcare9091225

Sunitha Zechariah, Jennifer L Waller + Show 4 more

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https://doi.org/10.3390/healthcare9091225

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Abstract

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs’ NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach’s alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and >0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings.

Highlights

Nutrition-focused physical examination (NFPE) is a systematic head-to-toe assessment of the physical and functional abilities of patients to determine their nutritional status and to verify the presence of any nutrient deficiencies or excesses [1]
Items generated in the first phase of the study were used to design the Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT), and this Delphi study explored the expert consensus resulting in excellent inter-rater reliability and internal consistency for content validation and an acceptable level of face validation
The final version of the INSPECT is currently being evaluated in real-life, multi-site clinical settings among practicing Registered dietitian nutritionists (RDNs) to establish additional evidence supporting the INSPECT’s construct validity, reliability, acceptability, and feasibility

Summary

Introduction

Nutrition-focused physical examination (NFPE) is a systematic head-to-toe assessment of the physical and functional abilities of patients to determine their nutritional status and to verify the presence of any nutrient deficiencies or excesses [1]. The first step in the MNT is a comprehensive nutrition assessment conducted by the RDNs. A nutrition assessment involves collecting, examining and inferring a variety of patient information including anthropometrics, biochemical parameters, clinical evaluation and diet history to determine the cause and extent of the patients’ nutrition problems [2,3]. An integral component of the clinical evaluation part of the nutrition assessment is a handson head-to-toe physical examination that enables the RDNs to gather accurate information to identify nutritionally relevant signs and deficiencies. Attempts are being made to train RDNs to employ NFPE in their routine practice, wide variation in skill and comfort level in performing NFPE has been reported among RDNs [4,6]

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