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.

Abstract available in the Journal of the Academy of Nutrition and Dietetics.

Increasing demographic diversity, persistent health disparities, and ongoing efforts to reduce health care costs have made cultural and linguistic competence in the United States health care system a premier concern. Integral to improving cultural competence in health care is providing health professionals with adequate education and training in cultural competence. For this reason, there has been increasing attention paid by academia across health-related disciplines and by national organizations and governmental health agencies to delineating what cultural competence in education and training entails. Though a multidisciplinary body of literature on developing curricula related to cultural competence for health professionals exists, still lacking from this literature is sufficient input from the dietetic profession. The purpose of this cross-sectional internet-based research was to create a curricular model of core curricular competencies related to cultural competence for the education and training of registered dietitians. A random sample of registered dietitians rated 73 proposed curricular competencies for essentiality on a 7-point Likert-like scale (1 = Not a priority; 7 = Essential). Exploratory principal components analysis (PCA) with Varimax rotation condensed the proposed competencies with similar variances of responses into factors (model domains) and eliminated competencies which accounted for too little or ambiguous variance. Factors were assigned unique labels based on the prevailing themes of their respective competencies and further interpreted in terms of respondent characteristics via multivariate general analysis of variance (MANOVA). Results based on a 17.9% (n=1,090) rate of response produced a model with 69 competencies and 7 domains: Communication and Relationships; Community Collaboration; Disparities and Diversity in Health Care; Information Access, Analysis, and Use; Bias Management; Food Environments; and Models and Definitions. Significant differences in mean factor ratings were detected between respondents who differed by race and by experience working with diverse individuals and groups. This model is representative of existing research on cultural competence, but it is the first unique to dietetics. It may be used by dietetic education and training programs to systematically plan, implement, and evaluate curricula for cultural competence.

Thesis (MNutr)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Introduction: Nutritional genomics is a new and emerging field aimed at investigating the complex interactions between genetics and diet and the joint influence this has on disease prevention and health promotion. Research is accelerating at a rapid pace and although still in its infancy, it is important for registered dietitians (RDs) to be knowledgeable and keep abreast of these developments as it promises to revolutionize dietetic practice. International studies have demonstrated low confidence and involvement as well as poor knowledge of both genetics and nutritional genomics amongst RDs. To date no similar studies have been conducted amongst South African (SA) RDs. Methods: A cross-sectional descriptive study was conducted using a national survey of 1881 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using an existing and validated questionnaire as developed for use in a similar study amongst RDs in the United Kingdom (UK). The self-administered questionnaire consisted of 4 sections to assess the following aspects: i) involvement and confidence in activities relating to genetics and nutritional genomics ii) knowledge of genetics and nutritional genomics iii) factors associated with knowledge and iv) demographic information. The main method of questionnaire distribution was via email (70%) using the Association of Dietetics in South Africa (ADSA) distribution service and questionnaires were posted to those RDs not registered with ADSA (30%). Results: The response rate was 15.2% (n = 279). Results showed low involvement in activities relating to genetics (n = 47, 17%) and nutritional genomics (n = 72, 25.8%). The majority of respondents indicated low confidence in performing activities relating to genetics (n = 161, 58.7%) and nutritional genomics (n = 148, 53.8%). However, a significant positive association was found between involvement and confidence for all activities (p < 0.001). The mean total knowledge score was 48.5 (±19%) and considered as low, with the mean genetics score of 58.5 (± 24%) being significantly higher than the nutritional genomics score of 31.9 (±23%), p < 0.001. Those respondents who reported involvement in discussing the genetic basis of a disease (p = 0.02); providing guidance to patients with genetic disorders (p = 0.01); providing training or education on human genetics (p = 0.01) and discussing with patients how diet may interact with genes to influence risk (p = 0.03) also had higher total knowledge scores. Factors associated with knowledge were greater genetics content in university studies (p < 0.001); higher qualification (p = 0.01); participating in related continuous professional development (CPD) activities (p <0.001) and considering genetics of greater importance to dietetic practice (p = 0.03). Conclusions: The results of this study indicate that there is overall low involvement, confidence and knowledge of genetics and nutritional genomics amongst SA RDs and this compares well with international studies. Recommendations therefore include the development of a competency framework for genetics and nutritional genomics for undergraduate dietetic education as well as CPD activities in order to provide the driving force for the development of this field in SA. / AFRIKAANSE OPSOMMING: Inleiding: Voeding genomika is 'n nuwe en ontwikkelende veld wat die komplekse interaksies tussen dieet en genetika bestudeer, asook die gesamentlike invloed wat dit op gesondheids- bevordering en siekte voorkoming het. Navorsing is vinnig besig om uit te brei en alhoewel dit nog in die begin fase is, is dit belangrik vir geregistreerde dieetkundiges (GDs) om op hoogte te bly van die nuutste ontwikkelinge, aangesien dit die potensiaal het om 'n merkwaardige invloed op die dieetkunde praktyk te hê. Internasionale studies het lae selfvertroue en betrokkenheid, asook lae kennis van genetika en voeding genomika onder GDs bevind. Daar is tans geen studies beskikbaar onder Suid Afrikaanse (SA) GDs nie. Methodes: 'n Dwarssit studie is onderneem deur gebruik te maak van 'n nasionale opname van al 1881 dieetkundiges wat by die Health Professions Council of South Africa (HPCSA) geregistreer is. Data is ingesamel deur 'n gevalideerde self-geadministreerde vraelys wat ook begruik is vir 'n eenderse studie onder dieetkundiges in die Vereenigde Koninkryk (VK). Dit het bestaan uit vier afdelings om die volgende aspekte te evalueer: i) betrokkenheid en selfvertroue in aktiwiteite te make met genetika en voeding genomika ii) kennis van genetika en voeding genomika iii) faktore wat met kennis geassosieer word asook iv) demografiese inligting. Die hoof metode van data insameling was deur middel van epos (70%) met behulp van die Association for Dietetics in South Africa (ADSA) se epos databasis. Vraelyste is aan diegene gepos wat nie geregistreer was by ADSA nie (30%). Resultate: Vyftien persent (n = 279, 15.2%) van GDs het op die vraellys gereaggeer. Resultate het lae betrokkenheid in aktiwitiete met betrekking tot genetika (n = 47, 17%) en voeding genomika (n = 72, 25.8%) gewys. Die meerderheid van die deelnemers het lae selfvertroue gerapporteer in die uitvoering van aktiwiteite wat genetika (n = 161, 58.7%), asook voeding genomika (n = 148, 53.8%) behels. Daar was 'n statistiese beduidende positiewe assosiasie tussen betrokkenheid en selfvertroue vir alle aktiwiteite (p < 0.001). Die gemiddelde kennis telling was 48.5 (±19%) wat as laag beskou kan word. Die gemiddelde kennis vir genetika van 58.5 (± 24%) was statisties beduidend meer as die vir voeding genomika 31.9 (±23%), p < 0.001. Deelnemers wat betrokkenheid aangedui het in die bespreking van die genetiese basis van 'n siekte (p = 0.02); raadgewing aan pasiënte met genetiese siektes (p = 0.01); lewering van opleiding met betrekking tot genetika (p = 0.01) asook die bespreking van die interaksie van dieet en genetika met pasiënte en die invloed hiervan op risiko (p = 0.03), het ook beduidende hoër totale kennis gehad. Faktore wat met kennis geassosieer word is die genetika inhoud in voorgraadse studies (p < 0.001), hoër kwalifikasies (p = 0.01), voorgesette professionele onderrig (VPO) (p <0.001) asook diegene wat genetika as belangrik beskou vir dieetkunde praktyk (p = 0.03). Gevolgtrekking: Die resultate van hierdie studie wys dat daar oor die algemeen lae betrokkenheid, selfvertroue en kennis is van genetika en voeding genomika onder SA GDs. Dit vergelyk goed met international bevindinge. Aanbevelings is dat 'n raamwerk vir die kennis van genetika asook voeding genomika ontwikkel word vir voorgraadse dieetkunde studies, asook die ontwikkeling van VPO aktiwiteite wat die dryfkrag sal voorsien vir die ontwikkeling van hierdie veld in SA.

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Background A global shift towards sustainable food habits is imperative to mitigate climate change. Registered Dietitians (RDs)s work in positions where they have the opportunity to influence decisions affecting food consumption. Objective To survey Swedish RDs’ attitudes and interest towards integrating a sustainability perspective into practice, and elucidate what determinants affect their choice and possibilities to promote sustainable food habits. Methods A mixed methods approach was taken consisting of a digital questionnaire including question of qualitative and quantitative character, namely: 1) an initial section regarding the respondents’ background 2) Likert scale questions to measure level of agreement in various statements 3) open-ended questions where the respondents were asked to describe their experiences, opinions and thoughts regarding the subject. Results The RDs (n=102) were interested in learning more about sustainable food habits, but unsure regarding whether RDs should have a leading role in promoting sustainable food habits. The integration of a sustainability perspective in nutrition practice was a matter of prioritizations. Dietitians were concerned that sustainable food habits would stand in conflict with other aspects of nutrition therapy. Organizational policies and work descriptions were reported to rarely mention sustainable food habits and this affected the RDs work. The dietetic programs at the Swedish Universities were described to lack a sustainability perspective. The RDs were unsure about how to approach sustainability in their practice. Conclusion Policies and work descriptions need to comprise a sustainability perspective to enable RDs to use and develop their knowledge and skills in sustainable food habits. Educational departments need to consider sustainability in their educational plans to meet the RDs’ need for more education and training in this area. The profession should come together to discuss the its’ role in promoting sustainable food habits / Bakgrund En utveckling mot hållbara matvanor är av största vikt för att dämpa klimatförändringarna. Dietister är experter på kost och nutrition och arbetar på positioner där de har möjlighet att påverka beslut som rör matkonsumtion. Syfte Att kartlägga svenska dietisters attityder och intresse för att integrera ett hållbarhetsperspektiv i sitt arbetssätt och utröna vilka faktorer som påverkar deras val och möjlighet att främja hållbara matvanor. Metod Undersökningen omfattade både kvalitativ och kvantitativ metod i en digital enkät. Enkätens första sektion innehöll frågor rörande deltagarens bakgrund. Övriga delar av enkäten bestod i huvudsak av frågor av typen Likertskalor, samt öppna frågor där deltagarna fick beskriva sina upplevelser, åsikter och tankar kring olika delar av forskningsämnet. Resultat Dietisterna (n=102) var intresserade av att lära sig mer om hållbara matvanor, men det rådde delade meningar huruvida dietister borde ha en ledande roll i arbetet för att främja hållbara matvanor. Integration av ett hållbarhetsperspektiv i dietistens arbetssätt var en fråga om prioriteringar. Dietisterna var oroliga att hållbara matvanor skulle stå i konflikt med andra viktiga aspekter av nutritionsbehandlingen. Policydokument och arbetsbeskrivningar nämnde sällan hållbara matvanor och detta verkade försvåra för dietisterna. Deltagarna uttryckte att dietistprogrammen vid universiteten saknar ett hållbarhetsperspektiv. Dietisterna kände sig osäkra på hur de skulle förhålla sig till hållbarhet i deras arbete. Slutsats Policydokument och arbetsbeskrivningar behöver innefatta ett hållbarhetsperspektiv för att möjliggöra för dietister att använda och utveckla deras kunskap och färdighet gällande hållbara matvanor. Utbildningsinstitutionerna behöver ta hänsyn till hållbarhet i sina utbildningsplaner för att möta dietisternas behov och önskemål om utökad utbildning och praktik i detta område. Professionen behöver komma samman för att diskutera vilken roll dietisten bör ha I arbetet för att främja hållbara matvanor.

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