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The major purpose of this study was to analyze the productivity of the clinical dietitian in order to develop appropriate models for measurement of productivity of the clinical dietitian. Due to the lack of research on productivity in the service sector, a modified Delphi Technique was used to identify appropriate measures of input and output for the clinical dietitian. The information gathered from the Delphi Technique was used to develop a survey designed to measure the productivity of the clinical dietitian. Two hundred eighty-three participants responded to the survey. Five measures of productivity were developed. They were: (1) hours in direct patient care/total hours worked (2) hours in indirect patient care/ total hours worked (3) hours in nonpatient care/ total hours worked (4) hours spent in direct plus indiiect patient care/total hours worked and (5) the activity level in nonproductive activities. The independent variables used in this study were: (1) patient load of the clinical dietitian (2) years of experience of the clinical dietitian (3) the allocation of time to tasks performed by the clinical dietitian (4) consultation methods used by the clinical dietitian (5) size of the hospital (6) employment status of the clinical dietitian (7) mission of the hospital (8) percent occupancy of the hospital and <9> percent of the budget generated by Medicare patients. Results of the analyses showed that dietitians were spending a variety of time in the thirty-three identified activities. They had a high activity level in performing diet histories, individual diet instructions, performing nutritional assessments, and reviewing and recording in medical records. Tasks involving low levels of activity were taking anthopometric measurements, reading professional literature and attending professional conferences. To fully investigate the relationship between the measures of productivity (dependent variables) and the independent variables stepwise multiple linear regression in the SAS statistical program was used. Analyses revealed two models appropriate for measuring the productivity. These models involved nonpatient care and nonproductive activities. The development of these models overcame the difficulty discussed in the service literature of developing direct measures of productivity of employees in the service sector. / Ph. D.

Yes / Personalized nutrition has the potential to improve health, prevent disease and reduce healthcare expenditure. Whilst research hints at positive consumer attitudes towards personalized nutrition that draws upon lifestyle, phenotypic and genotypic data, little is known about the degree to which registered dietitians (RD) are engaged in the delivery of such services. This review sought to determine possible factors associated with the integration of the emerging science of Nutritional Genomics (NGx) into the clinical practice setting by practicing registered dietitians. Scope Search of online databases (Pubmed; National Library of Medicine; Cochrane Library; Ovid Medline) was conducted on material published from January 2000 to December 2014. Studies that sampled practicing dietitians and investigated integration or application of NGx and genetics knowledge into practice were eligible. Articles were assessed according to the American Dietetic Association Quality Criteria Checklist. Key findings Application of nutritional genomics in practice has been limited. Reluctance to integrate NGx into practice is associated with low awareness of NGx, a lack of confidence in the science surrounding NGx and skepticism toward Direct to consumer (DTC) products. Successful application to practice was associated with knowledge about NGx, having confidence in the science, a positive attitude toward NGx, access to DTC products, a supportive working environment, working in the clinical setting rather than the public health domain and being in private rather than public practice. Conclusions There is a need to provide RGs with a supportive working environment that provides ongoing training in NGx and which is integrated with clinical practice.

Yes / Background: Commercial technology-enabled personalised nutrition is undergoing 19 rapid growth, yet uptake in dietetics practice remains low. This survey sought the opinions 20 of dietetics practitioners on personalised nutrition and related technologies to understand 21 facilitators and barriers to its application in practice. 22 Method: A cross-section of Registered Dietitians were recruited in the US, UK, 23 Australia, Canada, Israel, Mexico, Portugal, Spain and South Africa. The questionnaire 24 sought views on risk of genetic technology, ethics of genetic testing, usefulness of new 25 personalised nutrition technologies, entrepreneurism and the perceived importance of 26 new technologies to dietetics. Validated scales were included to assess personality (Big 27 5) and self-efficacy (NGSEI). The survey was available in English, Spanish and 28 Portuguese. Regression analyses were performed to identify factors associated with 29 integration of nutrigenetic testing into practice, and to identify factors associated with the 30 perceived importance of bio, information and mobile technologies to dietetic practice. 31 Results: A total of 323 responses (response rate 19.7%) were analysed. Dietetic 32 practitioners who had integrated personalised nutrition technology into practice perceived 33 technologies to be less risky (P=0.02), biotechnology to be more important (P<0.01), and 34 professional skills to be less important (P=0.04) than those who had not. They were also 35 more likely to see themselves as entrepreneurs (P<0.01) and to perceive lower risks to be 36 associated with technology (P<0.01). Practitioners of nutrigenetics were lower on 37 neuroticism (P<0.01) and higher on self-efficacy (P<0.01), extraversion (P<0.01) and 38 agreeableness (P<0.01). Higher perceived importance of biotechnology to dietetic 39 practice was associated with higher perceived usefulness of omics tests (P<0.01). 40 Perceived importance of information technology was associated with perceived 41 importance of biotechnology (P<0.01). Mobile technologies were perceived as important 42 by dietitians with the highest level of education (P=0.02). 43 Conclusions: For dietitians to practice technology-enabled personalised nutrition, 44 training will be required to enhance self-efficacy, address risk perceived to be associated 45 with new technologies and to instil an entrepreneurial mindset.

The payment for nutritional services is one of the most critical issues facing the dietetic profession today. Several of the recent studies have focused on the fee assessment for nutritional services by hospitals but there has been only one published study that investigated the pricing structure of services in the context of the dietetic profession. However, what research that has been done clearly show that there is an important relationship between the concept of service and the role of the dietitian in the service sector, the pricing strategy in the service sector, the variables affecting the pricing structure and the pricing strategies for nutritional services. Therefore, the major purpose of this research was to determine those variables which have been identified as most influential in establishing fees charged by consulting dietitians and to establish guidelines on the price structuring of services offered in a private independent practice by a consulting dietitian. The major independent variables in this research postulated to affect the dependent variables, charge per hour to private and contract clients, charge per hour to private clients and charge per hour to contract clients. The dietetic profession will see increased competition for reimbursement for nutritional counseling services. This research provides questions in regard to specific pricing policies for nutritional consulting private practices. / Master of Science

Yes / Purpose - This research explores the perceptions and experiences of early adopters of the technology. Design/Method/Approach - Registered Dietitians (RD´s) (N=14) were recruited from the UK, Canada, South-Africa, Australia, Mexico and Israel. Six qualitative interviews and two focus groups were conducted online using a conference calling platform. Data were recorded, transcribed and thematically analysed. Findings - Early adopters of Nutrigenomics (NGx) were experienced, self-efficacious RD’s who actively sought knowledge of NGx through communication with one another and the broader scientific community. They considered NGx an extension of current practice and believed RD’s had the skills to deliver it. Perceived barriers to widening the application of NGx were linked to skepticism among the wider dietetics community. Proliferation of unregulated websites offering tests and diets was considered ‘pseudoscience’ and detrimental to dietetics fully embracing NGx. The lack of a sustainable public health model for the delivery of NGx was also perceived to hinder progress. Results are discussed with reference to ‘diffusion of innovation theory’. Originality/Value - The views of RD’s who practice NGx have not been previously studied. These data highlight requirements for future dietetic training provision and more inclusive service delivery models. Regulation of NGx services and formal recognition by professional bodies is needed to address the research/practice translation gap.

Professional Development 2001 has been proposed by the Commission on Dietetic Registration as a new system for recredentialing dietetic practitioners to better ensure professional development. Changes include self-directed learning and reflective inquiry, new, unfamiliar concepts to this profession. To date, neither the Commission on Dietetic Registration nor the American Dietetic Association have offered a systematic review of these concepts and their implications for practice. As practitioners begin to consider this proposal in relation to their practice, the broader perspective of adult education research and theory can provide insight, depth and context to enlighten its use. A critical analysis was undertaken to demonstrate how Professional Development 2001 embodies the concepts of self-directed learning, reflective inquiry, and lifelong-learning and why these concepts are important as a means of assuring professional competence. Implications for practice are discussed. / Master of Science

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Job satisfaction of registered dietitians (RDs) is a very poorly researched subject on a global scale. Apart from a handful of studies conducted in the United States of America (USA) from the 1980’s through to the early 1990’s and only one recently published in 2006, there is no other published information relating to this topic. As a result a crosssectional descriptive study was conducted using a national survey of all 1509 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using a 2 part self-administered questionnaire, the first part collected demographic data and the second part collected data pertaining to job satisfaction attitude. The job satisfaction questionnaire was based on the Job Satisfaction Survey (JSS), measuring nine themes of: salary, promotion, knowledge and skills, professional colleagues, members of the multi-disciplinary team, communication, the work environment, rewards of the job and nature of work. Based on the registration contact details of RDs, the questionnaires were distributed by either e-mail or post, giving a final response rate of 22,5% (n=340), representing over a fifth of the dietetic workforce registered with the HPCSA. Overall the data indicated that South African RDs were only slightly satisfied (65,7%) with their current employment, with no significant ifference in overall job satisfaction between those working and living overseas (68,4%)(n=23) and those in South Africa (65,7%)(n=317). Despite there being a positive attitude towards the nature of work (tending towards confirmation of career satisfaction), lower levels of satisfaction were primarily found to be due to poor salaries, lack of promotional opportunities and a perception of low professional image. No extreme levels of satisfaction were found. In regard to associations between demographic variables and job satisfaction, a significant positive correlation was found to occur between age (Spearman’s p=0,036), professional experience (Mann-Whitney U p=0,035), area of expertise (Mann-Whitney U p=0,001), hours of work (Kruskal-Wallis p=0,021) and the location of work (rural versus urban based work) (Mann-Whitney U p=0,00001). Therefore it is predicted that over the next five years, there will be poor staff retention of RDs in dietetic posts, where the greatest loss will be in the Department of Health (DOH), where approximately 83% of current DOH staff (n=113) will be searching for alternative employment. Recommendations therefore include that there should be a re-evaluation of RD pay scales, career-pathing with promotional opportunities, boosting the RD professional image and enhancing dietetic undergraduates programs by including the teaching of nondietetic skills such a business skills and entrepreneurship, required to support dietetic practice on a broader scale.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of this study was to explore the barriers that doctors experience to referring patients to dietitians. The study sample (n = 700) included a selection of all practicing medical doctors and specialists in the Gauteng province of South Africa. Registration with the Health Professions Council of South Africa (HPCSA) was a prerequisite. METHOD: This was a quantitative study using a validated questionnaire e-mailed to participating doctors in order to determine factors affecting their referral practices. The first part of the questionnaire consisted of demographic and general information about the respondent and the second and third parts consisted of a series of closed-ended questions that related to specific issues of nutrition information and dietitian referral practices respectively. The questionnaire comprised a total of 21 questions. Subjects were sent the questionnaire by e-mail and given four weeks to respond. Three reminder e-mails were sent to encourage participation. Statistical analysis methods included: Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linear associations, as well as Goodman and Kruskal tau tests. RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finally useable. Doctors who had a nutrition component in their training referred patients to dietitians more often than those who did not and older doctors referred to a dietitian less often (Chi-square tests, p < 0.05). A correlation was observed between the duration of medical practice and frequency of referral (p = 0.03) while gender had no influence on referral practice. A correlation (p < 0.001) was also found between frequency of referral and university of study with symmetric measures. Hyperlipidaemia, diabetes mellitus and obesity were identified as the conditions doctors would most likely refer to a dietitian. For 45% of the doctors insufficient time during consultation was the strongest barrier to providing nutrition councelling to their patients. The barrier identified most commonly was that doctors were unaware of dietitians in the vicinity of their practices (49%). Sixty four percent of doctors believed that better marketing by dietitians would increase their referrals, and 21.4% believed that the title ‘nutritionist’ or ‘nutrition specialist’ would be more suitable for the profession of dietetics. CONCLUSION: The findings of the study indicate that a number of factors contribute to the barriers that doctors experience to referring patients to dietitians. Although the study was limited by a small sample, it nevertheless draws attention to the responsibility of both dietitians and doctors to work together toward providing patients with a more efficient team approach treatment and care system. More qualitative studies are needed to explore the identified barriers further, especially within the South African context, as well as to establish appropriate recommendations to overcome the barriers to referral.