Employers' expectations of core functions, credentials and competencies of the community and public health nutrition workforce in Australia.

Abstract

(Nutr Diet 2004;61:105-11)

Objectives: To review position descriptions of the community and public health nutrition workforce in order to assess employers' expectations of workforce functions and competency requirements.

Design: Qualitative content analysis of job descriptions obtained from a sample of the known community and public health nutrition workforce in Australia and collation of position descriptions advertised in the February 2002 to August 2002 period.

Subjects: Community and public health nutritionists in the Australian health system.

Main outcome measures: Descriptive qualitative data about employers' expectations of the core functions, competencies and credentials of community and public health nutritionists, as expressed by position descriptions.

Results: From a total of 64 position descriptions obtained, 46 were included in the analysis. This sample consisted of 35 existing (occupied) positions and 11 new (advertised) positions. These were distributed across 29 entry-level and 17 advanced-level positions. The most consistent core function domains, as represented by duty statements, were community-based nutrition intervention management (planning, strategy development, implementation and evaluation), capacity building and nutrition-related research and evaluation. Entry-level positions were more likely to have direct-care or clinical dietetics functions and there was a stronger emphasis on coordination, capacity building and research in the advanced-level positions. Competency expectations, as represented by key selection criteria, focused on experience of intervention management, knowledge of public health nutrition issues and strategies, interpersonal communication skills and the ability to adopt a multidisciplinary working style. Almost all of the entry-level positions required mandatory dietetic qualifications.

Conclusions: As a proxy of employers' expectations, analysis of workforce position descriptions by duties (functions) and selection criteria (credentials and competencies), provide an alternative and complementary method to inform workforce development. Position description development may be an important organisational response to facilitate progressive workforce development and re-orientation.

Key words: employers' expectations, workforce development, core functions, competencies, public health nutrition, position descriptions

**********

Introduction

Dietitians have been identified as the dominant professional group, at least numerically, through the limited workforce information available that enumerates and profiles the designated public health nutrition workforce in Australia (1,2). This has implications for the development of the public health nutrition workforce because it appears that dietetic training programs provide the entry-level (and in most cases highest) qualifications upon which much of the public health nutrition workforce is built (3,4). There are no existing specific competency standards for public health nutrition in Australia to guide workforce development, although some have argued in the past that existing entry-level dietetic competency standards serve this function (5). Recent consultations however, support a view that specialst-level competencies for public health nutrition are required (2,3,6).

The methodologies used in developing dietetic competencies in Australia have focussed on functional analysis, critical incident debriefing and professional consultations (7). The perspectives of the employing organisation (hereafter referred to as the employer) appear not to have been specifically canvassed in the context of competency standards and workforce development, which raises questions about whether the competency standards provide the architecture for workforce development that matches employers' needs and expectations. Most of the recent Australian literature (6,8) relating to dietetic competencies reflects practitioner or academics' views rather than employer or organisational expectations.

There have been few published studies of employers' expectations of the nutrition and dietetic workforce's functions or competency requirements. One American study surveyed employers to rate graduate dietitians' competencies against entry-level graduate competency standards, but did not specifically investigate what employers expect in terms of roles or competencies (9).

Position descriptions are an instrument of human resource management used by employers to define the roles and responsibilities, credentials and competency requirements of a defined position within the workforce (10). As such they have potentially important roles in public health nutrition workforce development and practice. They define a position and represent a proxy of the organisational expectations of the position, and are the standard against which employers recruit and assess the performance of the majority of the workforce (11). They also provide an organisational mandate for a particular type of practice. The importance of this codified mandate has recently been demonstrated in a study of the public health nutrition workforce in Victoria where community-based dietitians reported being limited in their capacity to perform public health nutrition roles because position descriptions and organisational expectations did not provide support for services that were not clinical in nature (12). Position descriptions that are out of touch with the realities of practice and the problem resolution required in this field may therefore limit workforce effectiveness.

This study was undertaken to review the roles, responsibilities and key selection criteria of a sample of the Australian public health nutrition workforce in order to assess employers' expectations of the functions and competency requirements of this workforce.

Method

Sampling

Respondents to a national survey of the community and public health nutrition workforce (4,13) (n = 240), conducted in early 2002, were contacted via email with a request to forward a copy of existing position descriptions for inclusion in the review. Position descriptions for positions advertised in the February 2002 to August 2002 period were also obtained. Nomenclature-based inclusion criteria were applied. Position descriptions included in the analysis had position titles of Community Nutritionist/Dietitian, Public Health Nutritionists, Dietitian/Nutritionists in community-based settings and Nutrition Project Worker. All positions with Clinical Dietetic titles based in hospital settings were excluded. Positions that were replicas of others were excluded so that like position descriptions were included in the analysis only once.

Analysis

Job descriptions were categorised into entry-level and advanced-level nutrition positions, following a review of the position level, reporting arrangements and title. Advanced-level positions were differentiated from entry-level positions by use of senior or specialist classifications or titles. This categorisation allowed comparisons to be made between employer expectations of entry- and advanced-level public health and community nutrition positions. For each job description, a number of components were examined, including title nomenclature, reporting arrangements, employing organisation/sector, duties (roles and responsibilities) and key selection criteria (competency and credential expectations).

Qualitative content analysis was conducted on duty statements and key selection criteria using a three-stage process including category development (coding), sorting and tallying. Common categories of duty and selection criteria statements were developed following an initial reading of each of the documents with reference to existing literature (2,14,15). Duty statements and selection criteria were then sorted into these categories using a constant comparison technique that involved initial sorting of statements into categories, followed by ongoing consideration of categories during the sorting process (16,17). Using a 20% cut-off point (selection criteria listed in more than 20% or one in five of position descriptions), the most commonly listed key selection criteria for both junior and senior positions were determined and ranked in descending order of commonality. The purpose of this analytical method was to identify patterns, commonalities and relationships in an inductive manner, consistent with qualitative research paradigms. Ethics approval for this study (as part of a broader study) was obtained from the Griffith University Human Research Ethics Committee.

Results

A total of 64 position descriptions were obtained, including four position descriptions with clinical dietetic titles and 14 replicate position descriptions, which were excluded from the analysis. This left a total of 46 position descriptions for analysis, including 17 advanced-level and 29 entry-level positions. Table 1 summarises the characteristics of the 46 different position descriptions included in this analysis.

Position nomenclature

Position titles generally included some combination of community, nutrition, dietetics and public health descriptors. Advanced-level positions tended to be more likely to be labelled public health nutritionists with entry-level positions most likely to be labelled a combination of community nutritionist or dietitian. Queensland employers were the most consistent users of the title public health nutritionist.

Reporting and organisational level

Most of the positions reported to a health service manager (without nutrition specialisation) in the public or community health sector. Advanced-level positions were most likely in public health units whereas entry-level positions were mostly located in community health services. Most of the position descriptions from the non-government health sector (e.g. Heart Foundation, Cancer Councils, Nutrition Foundation) were classified as advanced-level or senior positions.

Core functions

Core functions as reflected by duty and role statements are summarised in Table 2 in seven function categories. The most common functions relate to intervention management (such as 'oversee the planning, implementation and evaluation of nutrition projects ...') and capacity building (such as 'develop effective training and support programs for professional groups') for both entry- and advanced-level positions. Advanced-level positions tended to have more research and analysis type functions in common (such as 'conduct community-based needs assessments' whereas entry-level positions had more clinical dietetic service functions (such as 'provide outpatient dietetic education').

Comparison between position levels shows that entry-level positions were more likely than advanced-level positions to have clinical dietetic role statements. Not one of the advanced-level position descriptions listed an expectation of direct-care dietetic functions. Advanced-level positions were more likely to have coordinating functions rather than implementing interventions and more often have capacity building, management and research functions. Capacity building and intervention management were consistent function domains of both levels of the public health nutrition workforce.

Credentials required

All of the position descriptions had tertiary qualifications as a requirement of employment. The entry-level positions that operated mostly in a community health setting tended to require dietetic qualifications (25 out of 29 as essential). Other nutrition qualifications or related tertiary qualifications were listed as alternatives in only two position descriptions. Eligibility for Dietititians Association of Australia (DAA) membership was an essential requirement for many entry-level positions (21 out of 29). Only nine positions stipulated accredited practicing dietitian (APD) status as essential. Dietetic credentials were less common essential requirements for advanced-level positions, requiring dietetic qualifications (six out of 17 cases), eligibility for DAA membership (six out of 17 cases) and APD status (one out of 17). Almost all (16 out of 17) of the advanced-level position descriptions listed as essential or desirable qualifications in nutrition and dietetics and/or public health or a related field. The most commonly listed desirable or essential credential for advanced-level positions was tertiary qualifications in public health, health promotion or public health nutrition (10 out of 17, five cases as essential) followed by dietetic qualifications (seven out of 17, five as essential). Having a drivers licence was a common essential credential among this sample of positions (25 out of 46 positions).

Competency expectations

Table 3 compares the most common credentials and competency expectations of employers (those listed by more than 20% of position descriptions) by different workforce levels ranked in descending order of commonality. Experience and knowledge of intervention management in public health nutrition was the most common competency in this sample. Other consistent competencies reflected employers' expectations of practice, such as multidisciplinary action and application of nutrition knowledge to public health issues. High-level interpersonal skills were required in 37 of 46 position descriptions with 33 listing this competency as essential.

Discussion

Position descriptions represent a codification of the employers' expectations about functions, competencies and credentials and as such are important instruments to guide workforce development through recruitment, role and function articulation and performance review. Given this role, job description analysis offers an alternative and complementary methodology for supporting or validating existing methods of competency development and review.

While position description re-organisation may be an important organisational response to facilitate workforce development and re-orientation, direct consultation or feedback from employers and other stakeholders would further validate this methodology. There are a number of research quality issues that relate to the use of job description analysis as a methodology for assessing functions and competencies required for effective public health nutrition practice. There are a number of quality criteria that can be applied to the qualitative document analysis method used in this study, including: authenticity, credibility, representation (18). Given that all the position descriptions analysed in this study were official documents from health organisations used to recruit nutrition professionals, there appears to be no issues relating to document authenticity.

The first limitation of this method relating to credibility is an assumption that whoever drafts the position description has appropriate knowledge of the practice and competency needs of a community- and population-based nutritionist. Given that most of the positions reviewed reported to managers who were not nutrition specialists, it is probable that position descriptions may be generalised towards public/community health functions or modelled on existing dietetic positions, rather than being specific to public health nutrition.

The credibility of this method would be low if it was used to try to assess actual or needed worker functions. If the purpose of reviewing organisational expectations in terms of duty statements and selection criteria is to assess how these expressed expectations reflect the current organisational environment of the workplace and effect workforce development, limitations relating to credibility would be less significant. The expectation expressed that over a quarter of entry-level positions in this sample provide direct-care clinical services reinforces earlier studies among the public health nutrition workforce in Victoria that identified this requirement as a major barrier to extending the capacity of the workforce to develop public health nutrition services (12).

The second credibility limitation is that position descriptions may be out of date. The reported rapid turnover of the designated community and public health nutrition workforce in Australia (1,13) (and the associated position description review), probably reduces the impact of this. The collation of newly advertised positions in the six-month study period also reduces this effect.

Given that the number of position descriptions sourced from the known public health nutrition workforce represents less than 25% of all positions, caution should be applied to generalising results to the total workforce. The over-representation of Queensland-based health department position descriptions, for example, may bias the analysis in favour of employers' expectations in that state. The lack of position descriptions from nutritionists employed in the food industry also limits the extent to which results can be generalised in this workforce sector, although opinion is currently divided about whether this workforce is considered part of the public health nutrition workforce (2). Nonetheless, the transferability of the findings (how qualitative findings can be applied to other situations or populations) to workforce development considerations at a national or state level (such as workforce function review, recruitment and continuing professional development) is likely to be possible.

The underlying premise of this study has been that position descriptions reflect a codification of the employing organisations' expectations about work functions, competencies and credentials and these expectations are significant in workforce development. The meaning of findings in this study based on this premise is considerable. The review of position descriptions to codify roles, competencies and credential expectations of population-based nutrition professionals so that those in these positions can make progress with developing population-based services with organisational support, has been a recent recommendation of strategic development for the public health nutrition workforce in Victoria (19).

The inconsistent use of a common nomenclature for population-based and preventive nutrition practitioners (such as public health nutritionist), evidenced from titles in this sample of position descriptions, poses a number of issues for workforce development. The most important relates to the need to consistently market public health nutrition as a field of practice and to develop an awareness and appreciation of preventive service delivery that is distinct from clinical practice. Use of the title, public health nutritionist, to specify a practitioner with a mandate and competency profile for population-based and preventive practice is now used increasingly internationally (20-24). Use of the title is also increasing in Australia. Queensland Health, for example, has recently made a commitment to public health nutrition by investing in the development of a new, designated public health nutrition workforce (25).

Many of the functions listed in position descriptions in this sample reflect the core functions for public health that were developed by the National Public Health Partnership (26), particularly among advanced level positions. This supports a previously expressed view that public health nutrition practice is a sub-set of public health practice (2). The mix of public health and clinical dietetic functions evident in over one-quarter of entry-level position descriptions reflects the varied service and practice mix of many community health-based nutrition positions found in earlier workforce surveys (1,27). This expectation of employers for a service variety that requires a variety of competencies, including public health and clinical competency, has been identified as a barrier to workforce development in the community health setting (12). The literature supporting the advanced or specialist nature of public health nutrition competencies (14,15) also makes this expectation unrealistic.

The almost universal requirement for dietetic qualifications for entry-level community and public health nutrition positions by employers effectively limits access of non-dietitians to paid work experience in community nutrition. This may be an undesirable side effect of employers' expectations that community-based nutritionists perform a mix of clinical roles and public health roles. Undesirable in the sense that public health nutrition specialisation and advance competency attainment is limited for nutritionists and other related practitioners who have interests in public health nutrition, but have not followed a dietetic training route. With this requirement, a focus on the adequacy of dietetic training is even more important in the context of public health nutrition workforce development. Employers clearly value postgraduate qualifications in public health, giving indications to desirable continuing professional development paths for dietitians. This also supports a common view among advanced-level practitioners about the value of building on nutrition competencies with public health competencies via public health training programs (3).

The common expectation of intervention management competency and experience, multidisciplinary interaction, communication skills and public health nutrition specific knowledge, expressed in position descriptions, is consistent with the international scholarship in public health nutrition competency (14,15,28,29).

The regular requirement for practitioners with high-level interpersonal skills is of interest. It suggests that public health nutrition practice requires these skills to productively apply leadership, mobilise and build community capacity, and manage and build the networks and teams required for effective public health action.

Conclusions

This analysis provides a description of employer expectations of functions and competencies and provides a basis for further scholarship relevant to public health nutrition practice and workforce development. It suggests a need for debate about the appropriateness of employer stipulations for dietetic qualifications as an essential selection criteria rather than public health nutrition competencies, for community- and public health-based nutrition positions. Position description re-organisation may be an important organisational response to facilitate workforce development and re-orientation in this field.

Table 1. Position description characteristics summary, total number
(number of advanced-level position descriptions)

                                     ACT     NSW    NT     QLD    SA

Number of respondents to national    13 (g)  49     11     25     26
workforce survey (4,13)
Number of position descriptions       1(1)   21(5)   5(1)  13(6)   6(1)
obtained (a)
Number of position descriptions
analysed                              1(1)   17(5)   4(1)  10(6)   6(1)

Nomenclature
Public Health Nutritionists                   2             7(6)
Community Nutritionists                       2      1
Community Dietitian/Nutritionist              4(1)   2      1      1
Dietitian/Nutritionist                1(1)    3                    3
Other (b)                                     6(4)   1      2      2(1)

Level
Junior                                1      12      3      4      5
Senior                                1       5      1      6      1

Responsible to
Manager Nutrition type services (c)           1      1      3(1)   1
Manager Public health type
  services (d)                                7(3)   2       (5)
Management Committee                          1
Other manager (e)                     1(1)    2(2)   1(1)   2      6(1)

Employer
Public Health Units/Teams                      (2)   3(1)   8(6)
Community Health                      1(1)     (1)   1      2      5
Non-Government Organisations                   (2)                 1(1)
Hospital (f)                                  1

                                     Tas    Vic    WA     Total

Number of respondents to national    6     71     39      240
workforce survey (4,13)
Number of position descriptions      4(1)   3(0)   7(2)    60(17)
obtained (a)
Number of position descriptions      2(1)   3(0)   3(2)    46(17)
analysed

Nomenclature
Public Health Nutritionists                        1       10(6)
Community Nutritionists                                     3(0)
Community Dietitian/Nutritionist     1      2              11(1)
Dietitian/Nutritionist                      1               8(1)
Other (b)                             (1)           (2)    14(9)

Level
Junior                               1      3       1      29
Senior                               1      0       2      17

Responsible to
Manager Nutrition type services (c)  1               (1)    8(2)
Manager Public health type services
  (d)                                       2        (1)   17(9)
Management Committee                                        1(1)
Other manager (e)                     (1)   1       1      15(5)

Employer
Public Health Units/Teams            1              3(2)   17(11)
Community Health                            3              13(2)
Non-Government Organisations          (1)                   5(4)
Hospital (f)                                                1(0)

(a) Excluding position descriptions with clinical dietetics title.
(b) Other position description name includes consultant nutritionist,
program specialist, nutrition manager, program manager nutrition, senior
purchasing officer nutrition, project officer, manager.
(c) Manager nutrition type services includes PHN directors, community
nutrition coordinators (have nutrition credentials).
(d) Manager public health type services includes public health, health
promotion, health developent, community health (not nutrition
credential).
(e) Other manager includes allied health manager, project officers.
(f) Employed by hospital but working in designated community position
with similar title.
(g) Includes Food Standards Australia New Zealand (FSANZ) workforce.

Table 2. Summary of position functions (duty statements) by function
domain and level

Function domain         Functions                  Entry-     Advanced-
                                                   level      level
                                                   positions  positions
                                                   n = 29     n = 17
Research and
  analytical
                   Needs assessment                   9       10
                   Conduct local research             6       11
                   Service evaluation                11        3
                   Monitoring and surveillance        8        5
                   Evaluation of policy               1        4

Intervention
  management
                   Program planning                  19       15
                   Program evaluation                19       14
                   Program implementation            20        4
                   Strategy design                    8       11
                   Nutrition program coordination     0       10

Capacity building
                   Team meetings/Team building       24       13
                   Provide intelligence advice       19        9
                   Training other professionals       8       10
                   Continuing professional           15        3
                   development
                   Community development             10        7
                   Grants, applications and           6       10
                   submission writing
                   Consult communities                5        8
                   Supervising students               7        6
                   Training health professionals     12       10
                   Training community members         3        9

Policy process
                   Advocacy                           3        5
                   Developing policy                  3        2
                   Advising on policy                 3        2

Management
                   Human resource management         14        7
                   Quality management                13        3
                   Meetings                          11        4
                   Report writing                     6        8
                   Administrative tasks               7        4
                   Strategic planning                 5        5
                   Financial management               2        6

Clinical services
                   Dietary education individuals     15        2
                   Clinical assessment               13        2
                   Clinical dietetics service        12        2
                   management                                  2
                   Treatment planning                13        2
                   Reviewing patients                11        1

Nutrition
  communication
                   Communication strategy             7        4
                   development
                   Group nutrition education          9        1
                   Media use for nutrition            4        3
                   education

Function domain        Functions                   Total
                                                   n = 46
Research and
  analytical
                   Needs assessment                  19
                   Conduct local research            17
                   Service evaluation                14
                   Monitoring and surveillance       13
                   Evaluation of policy               5

Intervention
  management
                   Program planning                  34
                   Program evaluation                33
                   Program implementation            24
                   Strategy design                   19
                   Nutrition program coordination    10

Capacity building
                   Team meetings/Team building       37
                   Provide intelligence advice       28
                   Training other professionals      18
                   Continuing professional           18
                   development
                   Community development             17
                   Grants, applications and          16
                   submission writing
                   Consult communities               13
                   Supervising students              13
                   Training health professionals     12
                   Training community members        12

Policy process
                   Advocacy                           8
                   Developing policy                  5
                   Advising on policy                 5

Management
                   Human resource management         21
                   Quality management                16
                   Meetings                          15
                   Report writing                    14
                   Administrative tasks              11
                   Strategic planning                10
                   Financial management               8

Clinical services
                   Dietary education individuals     17
                   Clinical assessment               15
                   Clinical dietetics service        14
                   management
                   Treatment planning                15
                   Reviewing patients                12

Nutrition
  communication
                   Communication strategy            11
                   development
                   Group nutrition education         10
                   Media use for nutrition            7
                   education

(a) Junior position statements had a mean of 12.7 duty statements (range
4-36).
(b) Senior position statements had a mean of 11.2 statements (range
5-23).

Table 3. Most common essential credential and competency expectations
listed by more than 20% of position descriptions, by position level (a)

Entry level (n = 29)         % (n)    Advanced level (n = 17)    % (n)

Dietetic qualifications (b)  86 (25)  Experience and knowledge   94 (16)
                                      of public health
                                      nutrition intervention
                                      management (planning,
                                      implementation and
                                      evaluation)
Experience and knowledge of  79 (23)  Consultation and           71 (12)
public health nutrition               negotiation skills
intervention management
(planning, implementation
and evaluation)
Able to work in a            76 (22)  Interpersonal              65 (11)
multidisciplinary manner              communication skills
Interpersonal communication  76 (22)  Able to work in a          41 (7)
skills                                multidisciplinary manner
Eligible for DAA membership  72 (21)  Knowledge of public        41 (7)
(b)                                   health nutrition issues
                                      and strategies
Current drivers licence (b)  69 (20)  Dietetic qualifications    35 (6)
                                      (b)
Independent and              59 (17)  Eligible for DAA           35 (6)
self-directed worker                  membership (b)
Knowledge of public health   34 (10)  Cultural competency        35 (6)
nutrition issues and
strategies
Computer literacy            34 (10)  Collaboration with other   29 (5)
                                      sectors and organisations
Public health and primary    28 (8)   Tertiary qualifications    29 (5)
health care principles                in public health, health
                                      promotion or related
                                      field (b)
Clinical dietetics           28 (8)   Current drivers licence    29 (5)
competencies
                                      Research and evaluation    23 (4)
                                      competencies

(a) Descending order of commonality.
(b) Credentials in bold italics.

Acknowledgments 

Appreciation is extended to the practitioners who responded to requests for position descriptions. Kelly Paterson's early contributions to this research project, while a student in the Master of Nutrition and Dietetic Program at Griffith University, is greatly appreciated. The anonymous reviewers of this paper should also be acknowledged for the constructive suggestions.

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Nutrition Unit, School of Health Science, Griffith University, Queensland

R. Hughes, BSc, GradDipNutrDiet. PGradDipHlthPromo, MPH, PhD, APD, RPHN, Director

Correspondence: R. Hughes, Nutrition Unit, School of Health Science, Griffith University. PMB 50, Gold Coast. Queensland, 4217.

Email: [e-mail]