The experience of dietitians working on interventions in the takeaway food sector: lessons for workforce development. (Original Research).Abstract Objective: To review the experiences and views of dietitians who had participated in interventions in the takeaway food sector to determine competencies relevant to the development of the public health nutrition workforce in this setting. Design: Semi-structured interviews A semi-structured interview is a method of research used in the social sciences. While a structured interview has a formalized, limited set questions, a semi-structured interview is flexible, allowing new questions to be brought up during the interview as a result of what the were conducted by telephone among a purposive pur·po·sive adj. 1. Having or serving a purpose. 2. Purposeful: purposive behavior. pur sample of dietitians currently or previously involved in interventions in the takeaway food sector. Interviews were guided by five questions relating to relating to relate prep → concernant relating to relate prep → bezüglich +gen, mit Bezug auf +acc work performed, competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like. 2. requirements, competency deficits, training requirements and personal competency gains as a result of involvement in this public health nutrition work. Responses were recorded, transcribed and thematically the·mat·ic adj. 1. Of, relating to, or being a theme: a scene of thematic importance. 2. analysed. Subjects and setting: Ten dietitians working on interventions conducted in Australia during 1990-99. Results: The main tasks undertaken related to general public health practices such as communication, training, research and project management. The most commonly required competencies (and reported deficits) related to project management including skills and knowledge of needs assessment, planning, strategy development, implementation and evaluation. This was followed closely by communication skills specific to the work context of the takeaway food sector. A common observation by practitioners was the need for a greater knowledge of the corporate operation of the food service industry and the need for more training in marketing, project management, research and business administration. Main outcome measures: Subjective views about needs for workforce development based on past work experience. Conclusions: The competency and training themes identified in this qualitative study reflect many of those previously reported in the literature concerning the development of the public health workforce and can inform scholarship in the development of public health nutrition. Key words: workforce development, competencies, public health nutrition, dietitians, experiential ex·pe·ri·en·tial adj. Relating to or derived from experience. ex·pe  ri·en learning
Introduction There are numerous definitions for public health nutrition that have been proposed around the world (1-4) that consistently identify the features of public health nutrition practice as being population based, preventive preventive /pre·ven·tive/ (pre-vent´iv) prophylactic. pre·ven·tive or pre·ven·ta·tive adj. Preventing or slowing the course of an illness or disease; prophylactic. n. in focus, multidisciplinary mul·ti·dis·ci·pli·nar·y adj. Of, relating to, or making use of several disciplines at once: a multidisciplinary approach to teaching. and intersectoral, using a mix of strategies including behavioural Adj. 1. behavioural - of or relating to behavior; "behavioral sciences" behavioral , legislative, environmental and socio-cultural approaches to the resolution of nutrition problems. The public health nutrition workforce is difficult to define and is potentially diverse. However, public health nutrition workforce enumeration 1. (mathematics) enumeration - A bijection with the natural numbers; a counted set. Compare well-ordered. 2. (programming) enumeration - enumerated type. and profiling in Australia (5,6) has identified that practitioners with dietetic dietetic /di·e·tet·ic/ (di?ah-tet´ik) pertaining to diet or proper food. di·e·tet·ic adj. 1. Of or relating to diet. 2. qualifications make up the majority of the designated public health nutrition workforce, and that the majority have entry-level dietetics dietetics /di·e·tet·ics/ (-iks) the science of diet and nutrition. di·e·tet·ics n. The branch of therapeutics concerned with the practical application of diet in relation to health and disease. qualifications as their highest qualification. Considerations about the adequacy of the preparation of the public health nutrition workforce therefore, should logically include a focus on the training and practice of dietitians and how well it pre pares PARES. A man's equals; his peers. (q.v.) 3 Bl. Com. 349. dietitians to effectively undertake public health nutrition work. Strategy planning for workforce development can also benefit from investigation into how dietitians develop competencies on the job. There has been considerable debate in Australia about the definition of public health nutrition (3,7-13). Some of the argument in this debate focused on the adequacy of existing entry-level competencies for dietitians (7) working in public health nutrition. Two papers have been published recently from work commissioned by the Dietitians Association of Australia (DAA DAA - Distributed Application Architecture: under design by Hewlett-Packard and Sun. A distributed object management environment that will allow applications to be developed independent of operating system, network or windowing system. ) (14,15). Both of these studies, while limited by their lack of specific reference to public health nutrition practice, have produced evidence that the existing competencies for entry-level dietitians inadequately represent the work performed by dietitians working in public health nutrition. Interventions that aim to improve the nutritional quality and safety of the food supply are an accepted component of national public health nutrition strategies in Australia (16). The work involved in developing, implementing and evaluating interventions in the takeaway food sector can be considered as typical activity for public health nutrition i.e. population based, intersectoral, multidisciplinary and involving a mix of strategies requiring diverse competencies, consistent with previously cited definitions (1-4). An audit of interventions that have been developed in various states and sectors targeting the takeaway food sector in Australia during the last decade has been conducted recently (17). Assessment of these interventions using a standardised Adj. 1. standardised - brought into conformity with a standard; "standardized education" standardized standard - conforming to or constituting a standard of measurement or value; or of the usual or regularized or accepted kind; "windows of standard width"; audit procedure identified characteristics of practice in this field that included limited strategy utilisation, unsophisticated evaluation, limited dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there of findings through peer-reviewed literature and clear evidence of interventions constrained con·strain tr.v. con·strained, con·strain·ing, con·strains 1. To compel by physical, moral, or circumstantial force; oblige: felt constrained to object. See Synonyms at force. 2. by a lack of public health nutrition intelligence about the takeaway food industry (18). There is no published literature that explores whether competency deficits of the workforce can be an explanation for the limited evidence of intervention effectiveness in public health nutrition. Research and development in the area of competency in public health nutrition is therefore important for the development of the workforce. This study was undertaken to explore requirements for the development of the workforce in relation to workforce functions, competencies, preparation and training by investigating the experiences of dietitians working on interventions in public health nutrition in the takeaway food sector. Consideration of practitioners' observations and reflections on practice and experiental learning in this field provide a basis for comparison with existing literature on competencies for public health nutrition, and provide insights into continuing development of the dietetics profession in this field of practice. Methods As part of a national review of public health nutrition interventions in the takeaway food sector (17), a contact list was developed of public health nutritionists who had taken a leading role in the design, implementation and evaluation of interventions during 1990 to 1999. This list was compiled using known contacts, existing public health nutrition networks, listserv memberships (Nutnet and PubNut) and 'snowball' sampling techniques (19). Data were obtained using a semi-structured interview instrument administered by telephone, that included five questions relating to work performed (functions), competency needs, adequacy of previous training, continuing competency development needs and personal competency gains as a result of intervention involvement. The questions in this instrument are shown in Table 1 and the line of inquiry follows in brackets brackets: see punctuation. . The interview was semi-structured in that the questions provided a basis for discussion but did not constrain con·strain tr.v. con·strained, con·strain·ing, con·strains 1. To compel by physical, moral, or circumstantial force; oblige: felt constrained to object. See Synonyms at force. 2. the breadth of issues discussed. Responses were transcribed verbatim ver·ba·tim adj. Using exactly the same words; corresponding word for word: a verbatim report of the conversation. adv. and manually sorted using word processing word processing, use of a computer program or a dedicated hardware and software package to write, edit, format, and print a document. Text is most commonly entered using a keyboard similar to a typewriter's, although handwritten input (see pen-based computer) and software into key response themes. Narrative from transcripts has been included in the results to illustrate findings from the thematic the·mat·ic adj. 1. Of, relating to, or being a theme: a scene of thematic importance. 2. analysis (19-21). Quasi-statistical content analysis (19) of key response themes was performed by tabulating them, in descending descending /des·cend·ing/ (de-send´ing) extending inferiorly. order of frequency, to illustrate the hierarchy of common responses. Results A total of ten interviews was conducted with public health nutritionists (all graduates of dietetic training) from 11 different interventions conducted during 1990 to 1999. Each of the interviewees considered themselves most appropriate to comment on the implementation of the project and its progress because they had primary responsibility for management of the project. Work functions The most common work tasks reported focused on communication and networking with project partners, project management, research and evaluation, training, resource development and conducting assessments against accreditation accreditation, n a process of formal recognition of a school or institution attesting to the required ability and performance in an area of education, training, or practice. criteria. Competency needs When asked to reflect on their experiences and identify the competencies (knowledge, attributes and skills) required to achieve good outcomes for interventions in the takeaway food sector, a number of consistent themes was identified (see Table 2). The most common competency requirement related to project management and included skills and knowledge of needs assessment, planning, strategy development, implementation and evaluation. ...one of the difficulties is knowing what to do and how...we know there's a problem but not necessarily how to practically go about addressing it...like how do you start, what strategies can be used?...I don't think we have been very innovative with strategies because there is not much out there that can guide planning... This theme was followed closely by communication skills that included interpersonal skills "Interpersonal skills" refers to mental and communicative algorithms applied during social communications and interactions in order to reach certain effects or results. The term "interpersonal skills" is used often in business contexts to refer to the measure of a person's ability , negotiation skills, written communication skills and the ability to engage stakeholders Stakeholders All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. . Establishing rapport The former name of device management software from Wyse Technology, San Jose, CA (www.wyse.com) that is designed to centrally control up to 100,000+ devices, including Wyse thin clients (see Winterm), Palm, PocketPC and other mobile devices. with industry stakeholders is crucial to develop some trust and facilitate shared involvement in projects... An awareness of and knowledge of the food service industry in terms of its operations, the nature of markets and corporate agendas was considered important. Knowledge of product lines was also regarded as important. You need to have an awareness of the needs of retailers and the competing pressures involved.., this means understanding the realities of business, profit and the fact that it's a tough business... Competency in coalition building, partnership development and intersectoral collaboration were reported as important. Its all about developing win-win relationships...retailers won't be interested if there's nothing in it for them... The reported value of being a dietitian dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease. di·e·ti·tian or di·e·ti·cian n. A person specializing in dietetics. , and having skills specific to dietitians varied, with some noting it was a barrier and others reporting it as a definite advantage. I think that because they knew I was a dietitian they think I'm a 'health nazi'...and this created some initial barriers... Some of the really cooperative retailers valued my dietetic knowledge because it gave some credibility to their claims of selling healthier food... Competency deficits When asked to reflect on and identify their deficits in competencies a number of deficits was consistently identified and these were similar to reported competency needs (see Table 2). Competencies related to project management and knowledge and awareness of the food service industry were the most common deficits reported. Limited skills in market research and limited knowledge of strategies available for the development of interventions in the takeaway food sector were also common responses. Continuing competency development needs Interviewees almost unanimously identified a need for more training in business, marketing and consumer research and project management (see Table 3). The diversity of learning from experience in these projects is shown by the main themes in Table 3. All interviewees reported that they had gained personally from their experience in interventions in the takeaway food sector and had further developed a range of competencies as a result (Table 3). I have learnt that we really need to reconsider re·con·sid·er v. re·con·sid·ered, re·con·sid·er·ing, re·con·sid·ers v.tr. 1. To consider again, especially with intent to alter or modify a previous decision. 2. what we think success of interventions is...our expectations are out of touch with market realities... Many of the assumptions we used when selecting strategies were wrong...partly because we were ignorant of how the industry operates...a bit naive naive - Untutored in the perversities of some particular program or system; one who still tries to do things in an intuitive way, rather than the right way (in really good designs these coincide, but most designs aren't "really good" in the appropriate sense). ... Discussion The use of semi-structured interviewing of information-rich cases (dietitians with work experience in public health nutrition interventions in the takeaway food sector) to specifically explore issues is consistent with qualitative methodology (19-21). Although it must be recognised that work experience in interventions in the takeaway food sector does not represent the totality TOTALITY. The whole sum or quantity. 2. In making a tender, it is requisite that the totality of the sum due should be offered, together with the interest and costs. Vide Tender. of work functions in public health nutrition, it does represent work that overlaps with many intervention-based activities in this field. Analysis of the core functions of the workforce is an accepted component of scholarship in the development of the workplace and recently has led to the production of a code of core functions for public health (22). The use of purposive sampling in the current study means that the consultation with the public health nutrition workforce is more representative than that achieved in the two studies of Phillips et al. (14,15). Collection of details about the educational and career attributes of interviewees may have been useful to explore differences in responses to the questions asked but was not included in this study. The main work functions reported by this group (project management, research, partnership development) reflected the strategies used in interventions in the takeaway food sector that involved collaboration with retailers, development of accreditation programs and stakeholder stakeholder n. a person having in his/her possession (holding) money or property in which he/she has no interest, right or title, awaiting the outcome of a dispute between two or more claimants to the money or property. research (17). They also reflect core public health functions (22,23), reinforcing a view that public health nutrition is a field of public health practice (13). Many of the competencies reported to be needed were also reflected in nominated nom·i·nate tr.v. nom·i·nat·ed, nom·i·nat·ing, nom·i·nates 1. To propose by name as a candidate, especially for election. 2. To designate or appoint to an office, responsibility, or honor. competency deficits. These were consistent with many of the competency needs identified in the studies on dietetic competency by Phillips et al. (14,15) and in fields such as health promotion (24,25) and from US studies of competencies for public health nutrition (1,26,27). These findings partially reflect the existing DAA competency standards (14). Although it can be argued that the DAA competency standards are designed specifically for entry-level practice, the reality of workforce development in Australia is that dietitians constitute the majority of the designated public health nutrition workforce and many commence work in public health nutrition positions with no further qualifications than entry-level dietetic qualifications (5,6). The similarities between reported deficits in competencies, competency needs and needs for further development of competencies, suggest that dietetic training has provided inadequate preparation for the public health nutrition workforce. This supports a need, identified by Phillips et al. (15), for development of post-basic competencies and training that supports competency development in public health nutrition above and beyond entry-level standard. Conclusions This study provides qualitative data suggesting a need for research into the development of the workforce and debate that addresses the questions of the type of competencies required. Issues such as how best to prepare dietitians for work in public health nutrition and what strategies most effectively and efficiently enhance the capacity of the workforce to deal with public health nutrition issues such as the takeaway food supply need to be addressed. The dietetics profession should not assume that the existing training and competency frameworks employed for preparation of the entry-level workforce are adequate for effective practice in public health nutrition. As the predominant pre·dom·i·nant adj. 1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant. 2. professional group in the public health nutrition workforce, dietitians should also take a lead role in progressing work and debate in this area.
Table 1
Semi-structured interview questions [logic]
1. What have been the main tasks involved in this
program? [functions]
2. Based on your experience with takeaway programs,
what competencies do you think are required to
achieve good outcomes? Prompt: What skills/
knowledge/attributes would you look for in
a project officer to do this project?
[competency needs]
3. What are the main competency deficits you
think you had in the project? [adequacy of
workforce preparation]
4. If you could do further training in a particular
field to be better prepared for a project
like this--what field would it be in?
[continuing competency development needs]
5. What lessons/skills have you gained through your
work in this project? [competency gains]
Table 2
Common competencies identified by dietitians who had experience with
working on public health nutrition interventions in the takeaway food
sector
Competency needs
* Project management [needs assessment, planning,
implementation and evaluation].
* Communication [interpersonal, negotiation,
writing and stakeholder engagement skills]
* Knowledge of the corporate food service industry
and its products
* Coalition building, partnership development and
intersectoral collaboration
* Strategy portfolio development and design
[ability to be innovative and lateral
thinking]
Main competency deficits identified
* Project management
* Food industry knowledge
* Market research skills, including consumer
behaviour research and sales knowledge
* Takeaway sector intervention strategy awareness
Listed in descending order of frequency
Table 3
Competency development needs and gains commonly identified by dietitians
who had experience with working on public health nutrition interventions
in the takeaway food sector
Competency development need areas
* Marketing and consumer research
* Strategy portfolio development
* Project management
* Business administration/economics
* Communications
* Research
Competency gains through experience with
interventions in the takeaway food sector
* The nature and value of true intersectoral
collaboration
* An awareness and knowledge of the food industry
(public health intelligence gain)
* Greater awareness of the limitations of
strategies used
* Research skills
* Marketing skills
Listed in descending order of frequency
Acknowledgments The contributions in terms of time, ideas and attitudes of the ten public health nutritionists participating in interviews is appreciated. Editorial advice from Agneta Yngve while visiting public health nutrition fellow at Griffith University Griffith University is an Australian public university with five campuses in Queensland between Brisbane and the Gold Coast. In 2007 there were more than 33,000 enrolled students and 3,000 staff. is acknowledged, as is the constructive comments and suggestions provided by the anonymous reviewers. References (1.) Rogers B, Schlossman N. 'Public nutrition': the need for cross-disciplinary breadth in the education of applied nutrition professionals. Food and Nutrition Food and Nutrition See also cheese; dining; milk. accubation Rare. the act or habit of reclining at meals. alimentology Medicine. thescience of nutrition. allotriophagy Pathology. Bulletin 1997;18:120-33. (2.) Landman J, Buttriss J, Margetts B. Curriculum design for professional development in public health nutrition in Britain. Public Health Nutr 1998;1:69-74. (3.) Hughes R, Somerset S. Definitions and conceptual frameworks For the concept in aesthetics and art criticism, see . A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to a system analysis project. for public health and community nutrition: a discussion paper. Aust J Nutr Diet 1997;54:40-5. (4.) Johnson D, Eaton D, Wahl P, Gleason C. Public health nutrition practice in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . J Am Diet Assoc 2001;101:529-34. (5.) Steele J. Towards a public health nutrition human resource infrastructure in Queensland [Master of Public Health thesis]. Brisbane: University of Queensland The University of Queensland (UQ) is the longest-established university in the state of Queensland, Australia, a member of Australia's Group of Eight, and the Sandstone Universities. It is also a founding member of the international Universitas 21 organisation. ; 1995. (6.) Hughes R. Enumeration and profiling of the designated Australian public health nutrition workforce. Aust N Z J Public Health. In press 2003. (7.) Ash S, Capra S, Cumming F, Gibbons Famous people named Gibbons include:
(8.) Niall M. O'Dea K. Viewpoint article: definitions and conceptual framework for public health and community nutrition [letter]. Aust J Nutr Diet 1997;54:208. (9.) Yeatman H. Viewpoint article: definitions and conceptual framework for public health and community nutrition [letter]. Aust J Nutr Diet 1997;54:155-6. (10.) Tapsell L. Viewpoint article: definitions and conceptual framework for public health and community nutrition [letter]. Aust J Nutr Diet 1997;54:153-4. (11.) Hughes R, Somerset S. Viewpoint article: definitions and conceptual framework for public health and community nutrition [in reply to Mackerras D]. Aust J Nutr Diet 1998;55:39. (12.) Hughes R, Somerset S. Viewpoint article: definitions and conceptual framework for public health and community nutrition [in reply to Ash Set al. and Tapsell L]. Aust J Nutr Diet 1997;54:154-5. (13.) Mackerras D. Viewpoint article: definitions and conceptual framework for public health and community nutrition [letter]. Aust J Nutr Diet 1998;55:37-8. (14.) Phillips S, Ash S, Tapsell L. Relevance of the competency standards to entry-level dietetic practice. Aust J Nutr Diet 2000;57:198-207. (15.) Phillips S, Ash S, Tapsell L. Dietitians' views on the current competency standards for entry-level dietitians. Aust J Nutr Diet 2000;57:190-7. (16.) Strategic Intergovernmental in·ter·gov·ern·men·tal adj. Being or occurring between two or more governments or divisions of a government. in Nutrition Alliance. Eat Well Australia: An agenda for action for public health nutrition 2000-2010. Canberra: Department Health and Aged Care; 2001. (17.) Hughes R. An audit of public health nutrition interventions in the takeaway food sector in Australia, 1990-1999. Southport: Griffith University; 2000. (18.) Ashton B, Hughes R. A review of public health intelligence of the takeaway food sector. Southport: Griffith University; 2000. (19.) Grbich C. Qualitative research Qualitative research Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. in health: An introduction. Sydney: Unwin & Allen; 1999. (20.) Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 2000;320:50-2. (21.) Pope C. Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ 2000;320:114-6. (22.) US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS . The public health workforce: An agenda for the 21st Century. Washington DC: Government Printing Office; 1997. (23.) National Public Health Partnership. Public health practice in Australia today-Core functions. Melbourne: National Public Health Partnership; 2001. (24.) Precision Consultancy. Draft health promotion competency standards. Melbourne: Precision Consultancy; 2000. (25.) Swerrissen H, Tilgner L. A workforce survey of health promotion education and training needs in the state of Victoria, Aust N Z J Public Health 2000;24:407-12. (26.) Dodds J, Polhamus B. Self-perceived competence in advanced public health nutritionists in the United States. J Am Diet Assoc 1999;99:808-12. (27.) Pelletier D. Advanced training in food and nutrition: Disciplinary, interdisciplinary in·ter·dis·ci·pli·nar·y adj. Of, relating to, or involving two or more academic disciplines that are usually considered distinct. interdisciplinary Adjective , and problem orientated o·ri·en·tate v. o·ri·en·tat·ed, o·ri·en·tat·ing, o·ri·en·tates v.tr. To orient: "He . . . approaches, Food and Nutrition Bulletin 1997;18:134-45. Nutrition Unit, School of Health Science, Griffith University, Queensland Roger Hughes, BSc, GradDipNutrDiet, PGradDipHlthPromo, MPH, APD APD atrial premature depolarization (see atrial premature complex, under complex ); pamidronate. , RPHN, Director Correspondence: R. Hughes, Nutrition Unit, School of Health Science, Griffith University, PMB PMB Private Message Board PMB Print Measurement Bureau PMB Performance Measurement Baseline PMB Private Mail Box (non-USPS) PMB Plant and Microbial Biology PMB Private Mailbox PMB Physics in Medicine and Biology 50, Gold Coast, Queensland “Gold Coast” redirects here. For other uses, see Gold Coast (disambiguation). Gold Coast is a city and local government area in the southeast corner of Queensland, Australia. , 4217. Email: R.Hughes@mailbox A simulated mailbox in the computer that holds e-mail messages. Mailboxes are stored on disk as a file of messages, a database of messages or as an individual file for each message. The standard mailboxes are usually In, Out, Trash and Junk (Spam). .gu.edu.au |
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