Public Health Nutrition Workforce Research Articles

Towards healthy food retail: An assessment of public health nutrition workforce capacity to work with stores

ObjectiveThis article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. MethodsConvergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data. ResultsA gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work. ConclusionsProvision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail. Implications for Public HealthBuilding capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools.

Nutritionists as policy advocates: the case of obesity prevention in Quebec, Canada.

A core function of the public health nutrition workforce is advocacy. Little is known of the nutritionists' role in policymaking from a policy process theory perspective. The current study analyses the nutritionists' role in advocating for a six-year governmental plan on obesity prevention in Quebec, Canada. We conducted qualitative research using Quebec's obesity policy as a case study to understand the role of nutritionists in advocating for obesity prevention policies. A conceptual framework combining the Advocacy Coalition Framework with a political analysis model based on the Theory of the Strategic Actor was developed to analyse the beliefs, interests and strategies of policy actors including nutritionists. Data sources comprised semi-structured open-ended interviews with key policy actors (n 25), including eight nutritionists (32 %) and policy-related documents (n 267). Data analysis involved thematic coding and analysis using NVivo 11 Pro. Quebec, Canada. Key policy actors including nutritionists. Nutritionists formed the core of the dominant public health coalition. They advocated for an inter-sectoral governmental plan to prevent obesity through enabling environments. Their advocacy, developed through an iterative process, comprised creating a think tank and reinforcing partnerships with key policy actors, conducting research and developing evidence, communicating policy positions and advocacy materials, participating in deliberative forums and negotiating an agreement with other coalitions in the policy subsystem. Nutritionists' advocacy influenced agenda setting and policy formulation. This research may contribute to empowering the public health nutrition workforce and strengthening its advocacy practices. It informs practitioners and researchers concerned with obesity policy and workforce development.

Dietetic Workforce Capacity Assessment for Public Health Nutrition and Community Nutrition

Worldwide, there is a continued rise in malnutrition and noncommunicable disease, along with rapidly changing dietary patterns, demographics, and climate and persistent economic inequality and instability. These trends have led to a national and global focus on nutrition-specific and nutrition-sensitive interventions to improve population health. A well-trained public health and community nutrition workforce is critical to manage and contribute to these efforts. The study describes the current public health and community nutrition workforce and factors influencing registered dietitian nutritionists (RDNs) to work in these settings and characterizes RDN preparedness, training, and competency in public health and community nutrition. The study was comprised of a cross-sectional, online survey of mostly US RDNs working in public health/community nutrition and semistructured telephone interviews with US-based and global public health and community nutrition experts. RStudio version 1.1.442 was used to manage and descriptively analyze survey data. Thematic analysis was conducted to evaluate expert interviews. Survey participants (n = 316) were primarily women (98%) and White (84%) with the RDN credential (91%) and advanced degrees (65%). Most reported that non-RDNs are performing nutrition-related duties at their organizations. Respondents generally rated themselves as better prepared to perform community nutrition vs public health functions. Interviews were conducted with 7 US-based experts and 5 international experts. Experts reported that non-RDNs often fill nutrition-related positions in public health, and RDNs should more actively pursue emerging public health opportunities. Experts suggested that RDNs are more desirable job candidates if they have advanced public health degrees or prior experience in public health or community nutrition and that dietetic training programs need to more rigorously incorporate public health training and experience. Significant opportunity exists to improve the preparedness and training of the current dietetic workforce to increase capacity and meet emerging needs in public health and community nutrition.

Using unfolding case studies to better prepare the public health nutrition workforce to address the social determinants of health.

The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food. Two unfolding case studies were trialled with undergraduate students in two-hour workshops to enhance their capability to address access to nutritious food as a social determinant of health. The approach provided information about the case using a staged approach that supported learners to review and reply to information and then continue this process as the case became increasingly complex. Melbourne, Australia.ParticipantsThirty-eight undergraduate nutrition and dietetics students. The analysis revealed that the unfolding case study approach provided a place to challenge and deepen knowledge and think about the application of theory. As the cases developed and became more challenging, students were supported to consider appropriate approaches and recognised the constant evolution and dynamic nature of practice. This learning activity challenged students and supported deep learning about possible solutions. It may also be useful at a graduate level and for continuous education of nutritionists and/or dietitians to empower the workforce to address the social determinants of health, rather than just acknowledging them as a set of barriers that prevent people and communities from achieving optimal health. Further work is required to investigate how unfolding case studies in curricula shape preparedness for practice of public health nutrition.

Capacity-building for a strong public health nutrition workforce in low-resource countries.

CITATION: Delisle, H. et al. 2017. Capacity-building for a strong public health nutrition workforce in low-resource countries. Bulletin of the World Health Organization, 95:385-388. doi:10.2471/BLT.16.174912

Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

Objective:To explore and describe methods of communication, education practices, perceived challenges and the potential role of nutritionists working in remote Australian Aboriginal communities in order to inform future public health efforts. Methods:Nutritionists who work or have worked in remote Aboriginal communities in Australia's Northern Territory within the past decade were identified via purposive and snowball sampling, and responded to a semi‐structured survey in 2012. Content and interpretive thematic analysis was used to generate themes. Results:Working approaches of 33 nutritionists are presented, representing 110 years of working experience in the Northern Territory. Emerging themes included: ‘Community consultation is challenging’, ‘Partnering with local people is vital’, ‘Information is not behaviour’, ‘Localisation of nutrition education is important’ and ‘Evaluation is tricky’. Available time, training background and workforce structure were said to constrain practice and those nutritionists with longer experience described a more culturally competent practice. Conclusions:Modifications in structure, training and support of the public health nutrition workforce, facilitation of professional and cultural partnerships, outcome evaluation and localisation and evaluation of health messages may promote more meaningful nutrition communication in remote communities. Implications:Findings can inform further investigation into the structures needed to improve public health skills for nutritionists transitioning from mainstream practice into the challenging cross‐cultural context of Aboriginal health settings.

Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes.

To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC). Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training. The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes. The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions. Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition. Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.

Can a community of practice equip public health nutritionists to work with remote retail to improve the food supply?

This study aimed to determine the influence on practice of a community of practice designed for public health nutritionists who work with retail stores in remote Indigenous communities in Australia. A descriptive evaluation of the community of practice participants' perspectives using the most significant change technique and individual in-depth interviews was conducted. Data were analysed using thematic and content analysis with a focus on answering the evaluation questions. Twelve public health nutritionists employed to work with remote Indigenous community stores were involved. The community of practice was reported to develop competence through problem solving, knowledge sharing and building confidence for innovative work. Building competence was achieved through accessible and timely professional support. Sharing stories and being encouraged to reflect on practice was valued and supported the participant's practice. Working to improve the food supply is challenging but there is value in being supported by like-minded colleagues to stay focused on this work. Most participants perceived the community of practice intervention to be an effective strategy to improve their work. These findings provide evidence of a promising intervention for building the public health nutrition workforce in remote Indigenous community store retail settings.

Postsecondary Public Health Nutrition Programs in Egypt

Background. Escalating obesity rates have become a major public health problem in Egypt. To address this concern, the education and training of a competent and culturally relevant public health nutrition (PHN) workforce is necessary. The aim of this study is to list and identify current PHN education and training programs offered in Egyptian colleges and universities. Method. An electronic review of websites, departmental homepages, and academic program web links of selected colleges and universities in Egypt ( N = 63) was conducted to identify available training and education in PHN and nutrition-affiliated academic programs. Results. Of the 63 identified Egyptian colleges and universities, two universities, both located in Alexandria, offered education and training degrees in PHN, and 16 were identified as offering non-PHN degree programs, predominantly in home economics. Conclusions. The relative scarcity of PHN training programs in colleges and universities in Egypt coupled with the lack of nationally recognized professional nutrition associations as well as a regulatory standard by which to define the nutrition profession appears to be a gap within the allied health profession in Egypt. Greater cooperation between colleges and universities in Egypt and international collaboration with other colleges and universities outside Egypt may help facilitate the development of academic PHN programs in Egyptian higher education. This would serve the dual purpose of addressing the obesity prevalence and developing a sustainable congruent allied health workforce capacity that includes culturally relevant and competent public health dietitians/nutritionists for effective PHN action operating in Egypt.

Consensus on the core functions of the public health nutrition workforce in Australia

AbstractAimTo assess consensus among public health nutrition workforce development stakeholders on public health nutrition workforce core functions, and the level of competency attainment required to perform each function in different practice jurisdictions.MethodsA modified Delphi study involving three iterative survey rounds among a purposively sampled expert panel of 33 public health nutrition workforce development stakeholders. Surveys tested panellist ratings of a listing of 50 function statements derived from the literature, across two survey rounds (rounds 1 and 2), with feedback between rounds. Rounds 2 and 3 assessed panellist ratings of the level of competency attainment required to perform functions across pre‐defined district, provincial and national practice jurisdictions. An arbitrary consensus cut‐off of >50% was applied with <10% change between rounds interpreted as agreement stability.ResultsEighteen of a total list of 50 functions were rated as ‘core’ by a majority (>50%) of panellists, with six categorised as analytical, five as capacity building and eight as intervention management functions. The level of competency attainment required to effectively perform these 19 core functions increased consistently as the jurisdiction of practice increased in population coverage (district < provincial < national).ConclusionsPublic health nutrition workforce development stakeholders in Australia agree that there are a number of consistent core functions of the public health nutrition workforce that help define the work of public health nutritionists. They also recognise that the competency expectations for practice vary in different practice jurisdictions. The results provide an empirical basis for prioritising and designing future workforce development targeting specific practice jurisdictions.

Aspirational competency expectations for public health nutritionists in Australia: A consensus study

AbstractAimTo assess consensus among public health nutrition (PHN) workforce development stakeholders on the competencies required for effective PHN practice in the Australian workforce context.MethodsA modified Delphi study involving two iterative survey rounds among an expert panel of 33 Australian PHN workforce development stakeholders. Surveys tested panellist ratings (essential, useful, irrelevant) of a listing of 143 competency elements derived from the literature and existing competency standards, across two survey rounds, with feedback between rounds. An arbitrary consensus cut‐off of 67% was applied with <10% change between rounds or 100% agreement interpreted as agreement stability.ResultsA total of 109 competency elements from the total list of 143 were rated as essential above the consensus cut‐off, representing 76% of the original list. Thirty‐three (33) elements were rated as essential by 100% of panellists. Approximately 90% or more of the competency elements tested were retained using the 67% cut‐off across nutrition science, nutrition communication, professional communication, capacity building and intervention management competency units. Competency elements rated as essential beyond the consensus cut‐off concentrated in the practice competency units of nutrition assessment, monitoring and surveillance, capacity building, and intervention management.ConclusionsThe results provide an empirical basis for future nutrition curriculum renewal and workforce development innovations and challenge the assumption that existing dietetic workforce preparation based on meeting entry‐level competencies is adequate for community and PHN practice.

Public health nutrition workforce development in seven European countries: constraining and enabling factors.

Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries. A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data. The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK. Sixty key informants participated in the study. There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents. There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes.

Core functions for the public health nutrition workforce in Europe: a consensus study.

To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice. A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders. Europe. A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries. Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups. This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.

Employers’ Perspectives of Students: In a Master of Public Health (Nutrition) Program

Efforts to support workforce development led to the launch of a new master of public health program aimed at improving access to graduate studies for practising nutrition professionals. The first cohort of students identified employer support as a key determinant of their success. In order to identify ways of addressing both student and employer needs, we explored the perspectives of students' employers. Seventeen in-depth, semi-structured, open-ended interviews were conducted with employers. Interviews were audiotaped and transcribed. Transcripts were organized using NVivo software and coded thematically. All employers indicated support for employee education and development in principle, but most faced practical challenges related to limited staffing during education leaves. Organizational policies varied considerably across employer groups. Collective agreements that guided education policy were seen to ensure consistent support for employees, but also to limit creative approaches to education support in some situations. Employers highly valued graduate student projects that were directly related to the workplace; these projects presented opportunities for collaboration among the university, students, and employers. Universities need to work with employers and other stakeholders to identify ways of overcoming barriers to public health nutrition graduate education and workforce development.

Planning a graduate programme in public health nutrition for experienced nutrition professionals

Public health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students. The programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback. Resource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme. The THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.

A qualitative evaluation of an Australian public health nutrition workforce development intervention involving mentoring circles

To evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices. The mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness. Victoria, Australia. Thirty-two novice public health nutrition practitioners employed in the state public health system. Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness. This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

Health nutrition practice in Italy

The increasing need for nutrition professionals is driven by growing public interest in nutrition and the potential of nutrition to prevent and treat a variety of diet-related conditions. Health promotion units and health services face great challenges in trying to address current and future population health issues. This review describes the present state of health nutrition practice in Italy, exploring the nature, role, and utility of training for nutrition professionals to meet the increasing burden of nutrition-related diseases. Evidence suggests that the public health nutrition workforce and infrastructures lack the necessary capacity to respond to national population needs regarding food and nutrition at many levels. This situation is aggravated by the growing prevalence of nutrition-related diseases as well as by the lack of adequate academic nutrition training. The public health nutrition infrastructures need to be enhanced, as do the education and training systems. Roles and functions in health nutrition practice need to be defined and discipline-specific competencies should be integrated.

An evaluation of a public health nutrition workforce development intervention for the nutrition and dietetics workforce

Workforce development is a key element for building the capacity to effectively address priority population nutrition issues. On-the-job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition; however, there is limited evidence for their effectiveness. An evaluation of a mentoring circle workforce development intervention was undertaken. Thirty-two novice public health nutritionists participated in one of three mentoring circles for 2 h, every 6 weeks, over a 7-month period. Pre- and post-intervention qualitative (questionnaire, interview, mentor diary) and quantitative (competence, time working in public health nutrition) data were collected. The novice public health nutritionists explained the intervention facilitated sharing of ideas and strategies and promoted reflective practice. They articulated the important attributes of the mentor in the intervention as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback. Participants reported a gain in competency and had an overall mean increase in self-reported competence of 15% (range 3-48% change; P < 0.05) across a broad range of competency elements. Many participants described re-orienting their practice towards population prevention, with quantifiable increases in work time allocated to preventive work post-intervention. Mentoring supported service re-orientation and competency development in public health nutrition. The nature of the group learning environment and the role and qualities of the mentor were important elements contributing to the interventions effects. Mentoring circles offer a potentially effective strategy for workforce development in nutrition and dietetics.

Consensus on the competencies required for public health nutrition workforce development in Europe – the JobNut project

To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts. A modified Delphi study involving three rounds of questionnaires. European Union. Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries. A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study. Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

Time for leadership development interventions in the public health nutrition workforce

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