Evaluation processes used by Iowa dietitians to determine adequacy of nutrition education materials

A challenge which plagues dietitians is limited time to spend with clients; consequently, a greater reliability is placed on the distribution of written nutrition materials. To be effective, materials need to contain nutrition messages that are clear, concise, and address clients' nutritional and educational needs. The process of determining clients' needs should be coupled with selecting the most appropriate nutrition education materials. Such procedures are derived from the application of nutrition communication principles which serve as guides for dietitians in helping their clients establish healthy dietary behaviors. The purpose of this study was to determine evaluation techniques utilized by dietitians to determine the adequacy of nutrition education materials. A content grid was formed for evaluation criteria identified in the literature. An instrument based on these compiled criteria was developed, reviewed by nutrition education experts, and pilot-tested to support construct- and content-related evidence of validity. The instrument was mailed to a random sample of 350 dietitians who were licensed in Iowa. A total of 223 (63.7%) instruments were returned; 142 (63.7%) respondents reported that they do select and use nutrition education materials with clients; thus, they were able to complete the survey. The dietitians provided information on the frequency with which they evaluate specific characteristics of printed nutrition education materials; the potential barriers they encounter when selecting, evaluating and developing materials; and their perceptions of the adequacy of materials for client use. It was found that dietitians in Iowa do tend to conduct thorough client need assessments; however, they generally do not couple this practice with a formal evaluation of the nutrition education materials provided to clients. Dietitians most frequently evaluate the content characteristics of nutrition education materials in relation to readability and format characteristics. Barriers most frequently encountered by dietitians are limited budgets to purchase materials and inadequate time to evaluate and develop them. Many dietitians perceive that the nutrition education materials they provide do meet clients' needs, encourage healthy dietary behaviors, and are understandable. The results of this study can guide professional development opportunities for dietitians, enhance nutrition services, and potentially lighten the substantial economic burden of chronic diet-related diseases.The research done for this thesis received the Iowa State University 1997 Research Excellence Award and the 1997 Family & Consumer Sciences Education & Studies Research Excellence Award

Strategies for Systems Thinking and Sustainable Food Systems Integration in Dietetics Education

In a time where food and nutrition challenges are increasingly interconnected, nutrition and dietetics education must evolve to prepare students for the complexities of promoting sustainable food systems. The Academy of Nutrition and Dietetics emphasizes nutrition and health, social, cultural, and ethical values, environmental stewardship, and economic vitality as principles of sustainable food systems. In addition, the Accreditation Council on Education in Nutrition and Dietetics and the Commission on Dietetics Registration point to a need to prepare nutrition and dietetics students for sustainable food systems aspects related to equity and access and to employ socially and culturally appropriate interventions.This article is published as Bergquist, E.E., Tagtow, Angela M., Strategies for Systems Thinking and Sustainable Food Systems Integration in Dietetics Education. Journal of the Academy of Nutrition and Dietetics. August 2025, In Press. https://doi.org/10.1016/j.jand.2025.08.00

Implementation of an Individual + Policy, System, and Environmental (I + PSE) Technical Assistance Initiative to Increase Capacity of MCH Nutrition Strategic Planning

IntroductionChildhood obesity disproportionately affects low-income women, children, racial/ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living initiatives should apply individual plus policy, systems, and environmental (I + PSE) approaches.MethodsFour public health maternal and child nutrition teams selected through an application process participated in 12 months of technical assistance (TA) to develop action plans incorporating I + PSE in nutrition programming. TA included: (1) online modules; (2) community of practice (CoP) meetings; and (3) individual coaching sessions. Teams completed midpoint and endpoint surveys to assess TA knowledge and process outcomes. Semi-structured, in-depth interviews conducted post TA were transcribed and content analysis used to characterize themes and sub-themes.ResultsFacilitators to implementing I + PSE approaches included TA delivery through online modules, participation in the CoP, and individual coaching to address barriers to implementation and leadership support. Barriers were time and funding limitations, working in isolation, and lack of infrastructure and self-efficacy. Co-learning helped TA teams overcome stagnancy and promote development of creative solutions. Teams recognized relationship-building as integral to systems development.DiscussionLessons learned occurred across three main areas: relationships, capacity-building, and barriers encountered. Relationship formation takes time and is often not recognized as an asset impacting public health programing. Relationship direction - upstream, downstream, and lateral - affects ability to build organizational and systems capacity. While this study includes a small number of public health nutrition teams, this practice-based research highlights the value of I + PSE TA to tackle complex problems, with reciprocal, multisectoral support to enhance public health nutrition program impact

Implementation of an Individual + Policy, System, and Environmental (I + PSE) Technical Assistance Initiative to Increase Capacity of MCH Nutrition Strategic Planning

Abstract Introduction Childhood obesity disproportionately affects low-income women, children, racial/ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living initiatives should apply individual plus policy, systems, and environmental (I + PSE) approaches. Methods Four public health maternal and child nutrition teams selected through an application process participated in 12 months of technical assistance (TA) to develop action plans incorporating I + PSE in nutrition programming. TA included: (1) online modules; (2) community of practice (CoP) meetings; and (3) individual coaching sessions. Teams completed midpoint and endpoint surveys to assess TA knowledge and process outcomes. Semi-structured, in-depth interviews conducted post TA were transcribed and content analysis used to characterize themes and sub-themes. Results Facilitators to implementing I + PSE approaches included TA delivery through online modules, participation in the CoP, and individual coaching to address barriers to implementation and leadership support. Barriers were time and funding limitations, working in isolation, and lack of infrastructure and self-efficacy. Co-learning helped TA teams overcome stagnancy and promote development of creative solutions. Teams recognized relationship-building as integral to systems development. Discussion Lessons learned occurred across three main areas: relationships, capacity-building, and barriers encountered. Relationship formation takes time and is often not recognized as an asset impacting public health programing. Relationship direction – upstream, downstream, and lateral - affects ability to build organizational and systems capacity. While this study includes a small number of public health nutrition teams, this practice-based research highlights the value of I + PSE TA to tackle complex problems, with reciprocal, multisectoral support to enhance public health nutrition program impact. </jats:sec

Systems Thinking and Sustainable Food Systems in Dietetics Education: A Survey of Directors

Background Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education. Objective This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director. Design Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale (STS) and a researcher-designed survey with 1-5 Likert-type scales. Participants/Setting The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors, with a 27% (n=163) response. Statistical Analysis Descriptive statistics (frequency, mean, standard deviation) were calculated using Excel. Inferential statistics were examined using R. ANOVA was used to compare experience as RDN and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total STS score and demographic and programmatic variables. Results Seventy-seven percent of program directors scored high on the STS (mean score 65.2, on a 0-80 scale, SD 8.4), and more than 85% of directors agreed including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed systems thinking was adequately addressed in ACEND standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate ACEND standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low. Conclusions Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators' perceived importance and program coverage. Enhancing program directors' awareness and utilization of Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.This is a manuscript of an article published as Bergquist, Erin E., Lyndi Buckingham-Schutt, Christina Gayer Campbell, Awoke Dollisso, Shuyang Qu, Angela M. Tagtow, and Scott Smalley. "Systems Thinking and Sustainable Food Systems in Dietetics Education: A Survey of Directors." Journal of the Academy of Nutrition and Dietetics (2024). doi:/10.1016/j.jand.2024.06.233. Copyright 2024 by the Academy of Nutrition and Dietetics. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License

A pathway to personal, population and planetary health for dietitians and nutrition professionals

Abstract Background Earth and all its inhabitants are threatened by a planetary crisis; including climate change, deforestation, biodiversity loss and pollution. Dietitians and nutrition professionals have a responsibility to lead transformational change in contemporary food and health systems to help mitigate this crisis. The study aims to develop a conceptual framework to support dietitians towards personal, population and planetary health. Methods Non‐empirical methods were used by the co‐researchers to explore and explain the application of an international framework ‘Next‐Generation Solutions to Address Adaptive Challenges in Dietetics Practice: The I + PSE Conceptual Framework for Action’. Results A non‐sequential pathway guide to personal, population and planetary health for nutrition professionals was developed including several key guiding principles of Agency, Action, Ascension, Alignment, Alliance and Allyship, and Advocacy and Activism. Each guiding principle features descriptors and descriptions to enhance dietitian and nutrition professional Agency (i.e. vision, self‐belief, confidence, strength and responsibility), Action (i.e. start, shift, translate, achieve and commit), Ascension (i.e. build, overcome, manage, challenge and progress), Alignment (i.e. leadership, transparency, diplomacy, values and systems), Alliance and Allyship (i.e. support, collaborate, represent, community and citizenship) and Advocacy and Activism (i.e. disrupt, co‐design, transform, empower and urgency). The framework and its descriptors support enhanced understanding and are modifiable and flexible in their application to guide the participation of dietitians and nutrition professionals in transformational change in personal, population and planetary health. This guide acknowledges that First Nations knowledge and customs are important to current and future work within this field. Conclusions Alongside the international body of work progressing in this field, this framework and visual guide will support dietitians and nutrition professionals to achieve urgent, transformational change in personal, population and planetary health

A pathway to population, personal and planetary health for dietitians

A non-sequential pathway guide to population, personal and planetary health for dietitians was developed including several key guiding principles of Agency, Action, Ascension, Alignment, Alliance and Allyship, and Advocacy and Activism.  </p

A Pathway to Planetary Health for Dietitians and Nutrition Professionals

A non-sequential pathway guide to Population, Personal and Planetary Health for Dietitians and Nutrition Professionals was developed including several key guiding principles of Agency, Action, Ascension, Alignment, Advocacy and Activism and Alliance and Allyship. Acknowledgements: The co-authorship team are grateful for the contributed knowledge and cultural experience of First Nations Consultant, Quandamooka woman Noell Burgess, to the framework. We recognise that further collaboration and future work relating to planetary health and sustainability with First Nations and, in Australia, Aboriginal and Torres Strait Islander people is vital, and we propose to advance this body of work by supporting and collaborating with First Nations people in the work they are leading to support our planetary health and ensuring sustainable food sources.   We acknowledge Brenna Quinlan of Illustrations with a Purpose for her consultancy to develop Figure 1; the Pathway figure which features a sweet pea vine.  This version supercedes the previous FigShare published version but either can be used.</p