Presented as “An Ounce of Prevention: Weighing the Role of the Registered Dietitian in Population Health.” 2019 The North American Primary Care Research Group (NAPCRG) Practice Based Research Network (PBRN) Conference in Bethesda, MD. Click here
Copyrights reserved© 2019. Original research is in print by 2020.
Kathryn Kelley, MPH; Tatyana El-Kour, MA, MS, RDN, FAND; Elizabeth Yakes Jimenez, PhD, RDN, LD
Integrating registered dietitian nutritionists (RDNs) into primary healthcare and prevention efforts is effective in improving heath and economic outcomes globally. With an aging population, rapidly increasing prevalence of preventable chronic diseases, and a coinciding shortage in healthcare workers in the United States (U.S.) and globally, a well-trained public health workforce is needed. RDNs have unique expertise that is paramount to addressing chronic disease and prevention, but the capacity and preparedness of RDNs working in public health nutrition and community nutrition is not well understood. The objectives of this study are to identify factors influencing dietitians to work in public health and community nutrition and driving their preparedness to work in these fields, and to obtain expert RDN practitioner opinions on capacity of the public health/community nutrition dietetic workforce.
A mixed-methods design was used, comprised of a 22-question online survey of US-based RDNs working in positions in public health nutrition and/or community nutrition, and semi-structured 10-question phone interview with experts in these fields. The survey was distributed to approximately 11,600 participants. Survey data were analyzed using descriptive statistics and chi-square tests of independence to identify relationships between variables. An expert panel identified a variety of eligible interview participants. Transcripts were independently and collaboratively coded by two study team members and aggregated into themes.
Settings & Participants:
Online survey participants (n=316) were primarily female (97%), white (84%), had advanced degrees (65%), and had six or more years of experience in the public health nutrition and/or community nutrition (56%). Respondents were most commonly employed by local or state departments of public health (22%). Phone interviews were conducted with seven US and five international experts (n=12). Eleven out of 12 participants were female, and all participants had advanced degrees. U.S.-based experts had an average of 30 years of experience in the field and global experts had an average of 16 years of experience. Most commonly, they worked in college/university or nonprofit settings. Global experts had experience in the Middle East, Africa, and South America.
Most survey participants reported that they are required to be RDNs in their current positions (62%); however, 64% also reported that non-RDNs perform nutrition-related duties at their organizations. Many participants reported that an interest in prevention and population-based health influenced them to work in the field, and on-the-job training and graduate education best prepared them to perform work-related functions. In general, participants were better-prepared to perform community nutrition functions (e.g., culturally and linguistically appropriate program development) than public health nutrition functions (e.g., identifying fiscal resources available through grants and contracts). Among RDNs in the workforce, public health nutrition skills, especially financial planning and management, were self-rated as generally needing further development. Significant associations were found between RDNs’ self-rated ability to apply public health nutrition skills and their “usual” application of several public health nutrition functions (p < 0.05).
Expert interviewees stated that their employers don’t specifically seek out RDNs. They said that RDNs are more desirable job candidates if they have advanced degrees or prior experience related to public health or community nutrition. Experts suggested that dietetic programs need to incorporate public health training to increase competency and better prepare RDNs to fill positions in the field. Global workforce capacity and preparedness varied significantly by country, though several experts commented that dietetics training needs an increased emphasis on global nutrition issues and continuing education may be beneficial.
RDNs, especially those with advanced degrees or field/work experience in public health, can bring valuable expertise to prevention efforts, but employers often don’t specifically seek out RDNs. Significant opportunity exists to increase emphasis on public health in dietetics training, and thus increase dietetic workforce capacity in this area, improve RDN preparedness to work in public health settings, and meet future demands in public health nutrition and community nutrition.
Healthy diets are a critical component of disease prevention and management, and the dietetic workforce needs to increase capacity in public health nutrition and community nutrition to join interdisciplinary efforts to prevent disease at the population and community level.