Curriculum design for professional development in public health nutrition in Britain

Roles and competencies in the nutritional domain for the management of the metabolic diseases and in the hospital setting: A position paper of the Italian College of Academic Nutritionists, MED-49 (ICAN-49)

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.

An Integrative Approach to Needs Assessment and Curriculum Development of the First Public Health Major in Singapore

Although public health undergraduate education is increasingly popular in the West, studies describing the needs assessment and curriculum development of public health undergraduate education programs are lacking in the Asia Pacific. The objective of this study was to describe the needs assessment and curriculum development of a second major in public health for undergraduates in the National University of Singapore, the first in Singapore. We used the integrated framework for curriculum development in higher education, which consisted of five stages. In Stage 1, the environment was assessed on the need for a new curriculum. Externally, there was a demand for public health workforce in Singapore based on a review of reports from the Ministry of Health and the job portals. Internally, there was a demand from existing students of the university, along with support from the faculty to offer a new curriculum. There was no university in Singapore offering an undergraduate major program in public health. In Stage 2, competencies to be developed were identified from public health job descriptions using job portals, the needs of public health stakeholders, and competencies listed in the public health curriculum accreditation frameworks such as the Council on Education for Public Health. In Stage 3, based on data triangulation, the curriculum was designed as a second major that is offered to all students of the university from year 2 onward. Students have to complete a total of 12 modules, of which 6 are core and 6 are elective. The capstone module is a 320-h internship module where students will be attached to public health–related agencies, organizations, or non-governmental organizations. Our curriculum is generally aligned with undergraduate public health programs in other established universities in the United States of America, United Kingdom, Australia, and Hong Kong. In Stage 4, various pedagogical strategies were identified for the core modules. We are currently at Stage 5 where implementation, monitoring, and evaluation are still being carried out. We hope that the lessons learnt will serve to inform other universities in the Asia Pacific that are considering implementing such programs and broadening their offerings in public health education.

Capacity building in public health nutrition

The aim of the present paper is to review capacity building in public health nutrition (PHN), the need for which has been stressed for many years by a range of academics, national and international organisations. Although great strides have been made worldwide in the science of nutrition, there remain many problems of undernutrition and increasingly of obesity and related chronic diseases. The main emphasis in capacity building has been on the nutrition and health workforce, but the causes of these health problems are multifactorial and require collaboration across sectors in their solution. This means that PHN capacity building has to go beyond basic nutrition and beyond the immediate health workforce to policy makers in other sectors. The present paper provides examples of capacity building activities by various organisations, including universities, industry and international agencies. Examples of web-based courses are given including an introduction to the e-Nutrition Academy. The scope is international but with a special focus on Africa. In conclusion, there remains a great need for capacity building in PHN but the advent of the internet has revolutionised the possibilities.

Public health nutrition workforce development in seven European countries: constraining and enabling factors

OBJECTIVES

Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries.

DESIGN

A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data.

SETTING

The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK.

SUBJECTS

Sixty key informants participated in the study.

RESULTS

There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents.

CONCLUSIONS

There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes.

Core functions for the public health nutrition workforce in Europe: a consensus study

OBJECTIVE

To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice.

DESIGN

A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders.

SETTING

Europe.

SUBJECTS

A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries.

RESULTS

Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups.

CONCLUSIONS

This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.

The making of a nutrition professional: the Association for Nutrition register

OBJECTIVE

Nutritionists in the UK are at the start of an exciting time of professional development. The establishment of the Association for Nutrition in 2010 has presented an opportunity to review, revitalize and expand the UK Voluntary Register of Nutritionists. In the UK and elsewhere, there is a need for a specialist register of nutritionists with title protection as a public safeguard.

DESIGN

The new structure will base professional registration on demonstration of knowledge and application in five core competencies. Initially, there will be five specialist areas: animal; public health; nutritional scientist; food; sports and exercise. The wording and requirements linking the specialist areas to the competencies have been carefully defined by leading individuals currently on the existing register in these specialist areas. These have been evaluated by a random sample of existing registrants to check for accuracy of definitions and examples. Other work aims to establish a clear quality assurance framework in nutrition for workers in the health and social care sectors (UK Public Health Skills and Career Framework Levels 1-4) who contribute to nutrition activity, such as community food workers, nutrition assistants and pharmacists. Students, co-professional affiliates and senior fellows will also find a place in the new Association. The title 'nutritionist' is not currently legally protected in the UK and it is used freely to cover a range of unregulated practice.

CONCLUSIONS

The establishment of a professional register to protect the public and to provide a clear identity for nutritionists is a vital step forward.

Building global alliances for public health nutrition training

The purpose of this paper is to present a review of opportunities and challenges for future progress in building intercountry, regional, and global alliances for public health nutrition training. Drawing on experiences from developing, implementing, and evaluating public health nutrition training in Australasia, Europe, and the Middle East, suggestions are provided for building a network of global training activities. Opportunities are described in areas such as standardization of course competencies and registration schemes, resource sharing, student and trainer exchange programs, and professional development. Challenges are identified and options presented for building global alliances in public health nutrition training into the future.

A survey among potential employers for developing a curriculum in public health nutrition

Objectives

To describe which functions potential employers of public health nutritionists in Norway find important for a person trained in public health nutrition to be able to carry out. Further, to illustrate how the findings were used in the development of a curriculum for a bachelor in public health nutrition at Akershus University College.

Design

A non-random, cross-sectional survey using a questionnaire with both pre-coded and open-ended questions.

Subjects

Ninety-one establishments working in various fields more or less related to nutrition responded (response rate of 45 %).

Results

Local offices of the Norwegian Food Safety Authority were over-represented among respondents. Functions related to communication and food and nutrition laws and regulations were most frequently rated as important by the respondents. Functions in nutrition research, project work and policy and planning were also regarded important by more than half of the respondents. The priorities of the potential employers together with the additional comments and suggestions were taken into account when a new curriculum on public health nutrition was developed.

Conclusions

The assessment of functions prioritised by employers of public health nutritionists gave a valuable input for developing a new curriculum in public health nutrition. It reflected the challenges of the real world that public health nutritionists will work in and therefore helped making the curriculum potentially more relevant.

Definitions for public health nutrition: a developing consensus

Objectives:

To assess the level of agreement amongst a panel of public health nutrition leaders regarding the key descriptors used to define the field of public health nutrition.

Design:

Cross-sectional survey requiring quantitative and qualitative responses representing the first round of a consensus development Delphi technique.

Setting:

International.

Subjects:

Expert panel of 24 public health nutrition leaders from nine countries in the European Union, the USA and Australia.

Results:

All but one of the panel agreed it was important to have a consensus definition for public health nutrition to describe the field consistently. Opinion about the length and complexity of this definition tended to vary depending on the intended use of the definition. The large majority (18/24) supported the inclusion of specific reference to physical activity in a definition of public health nutrition, although there was not consensus (>83% agreement as criterion) on this point. Consensus descriptors regarded as important in a definition of public health nutrition included: population-based, focus on health promotion, food and nutrition systems focus, wellness maintenance, primary prevention, applies public health principles, education, environmental and political descriptors. Treatment as a descriptor was rated as unimportant by a majority (14/24) of panellists, delineating public health nutrition from clinical practice.

Conclusions:

There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of descriptors that can be used to define public health nutrition. The limitations of using word-for-word definitions between and within countries may be overcome by explicit use of the consensus descriptors identified in this process.

A conceptual framework for intelligence-based public health nutrition workforce development

Objective:

This paper describes a conceptual framework and associated intelligence requirements for problem-based workforce development for public health nutrition.

Methods:

A conceptual framework for public health nutrition workforce development was constructed based on a review of the literature and consideration of the intelligence needs to inform workforce development planning.

Results:

A cyclical conceptual framework including five intelligence-linked components including public health nutrition problems and priorities, solutions and best buys, work needed, capacity to do the work and workforce development needs. This framework applied to the Australian situation illustrates its applications in workforce development research and planning. Although the existing availability of workforce development intelligence in each of these components varies, the framework does provide a systematic approach for workforce development research and planning directly related to public health nutrition problem resolution.

Conclusions:

This framework highlights deficiencies in the existing public health nutrition workforce development intelligence and the need for further research to inform workforce development strategy planning.

Public health nutrition workforce composition, core functions, competencies and capacity: perspectives of advanced-level practitioners in Australia

Objectives:

To investigate the attitudes, experiences and beliefs of advanced-level public health nutritionists with respect to public health nutrition workforce composition, core functions, competency requirements and existing workforce capacity.

Design:

Qualitative study using structured interviews.

Setting:

Australia.

Subjects:

Forty-one advanced-level public health nutritionists employed in academic and senior technocratic positions in state health systems.

Results:

Advanced-level public health nutritionists recognise the diversity of the public health nutrition workforce but clearly identify the need for a specialist public health nutrition workforce tier to provide workforce leadership. Nominated core functions for public health nutrition reflect broader public health core functions but, in the context of nutrition, specific problem resolution. Opinions about competency needs were similar to many of the cross-cutting competencies identified in the public health field but with specific application to nutrition problems. Competency in the scientific underpinning of nutrition was considered particularly important and delineated this public health nutrition workforce from the broader public health workforce. Public health nutrition was identified as a specialisation within public health and dietetics. Workforce capacity assessments by this group indicate a need for workforce development.

Conclusions:

Qualitative data from a large proportion of the Australian public health nutrition leadership group have identified core functions, competencies and workforce development priorities that can be a basis for further systematic research and workforce strategy development.

Professional regulation of nutritionists: where are we now?

Waterlow's (1981) Sixth Boyd Orr Lecture on a 'crisis of identity for nutrition' stimulated the Nutrition Society's drive to professionalisation. Twenty-five years on, the Society begins a new stage; first, towards an independent voluntary regulator, and then towards statutory regulation. It is timely to reflect on progress and identify the remaining challenges. The Society has made impressive progress as a voluntary regulator since 1991 when the Institute of Biology opened a register in cooperation with the Institute of Food Science and Technology and the Nutrition Society; the present register is 2.75-fold larger. The Society has specialist standards for course accreditation that enable graduates to apply for direct entry to the register, having met standards of competency in nutrition or public health nutrition. A code of ethics and a statement of professional conduct underpin a functioning system for oversight and governance that protects the public, the hallmark of all professions. Registered nutritionists lay easy claim to a unique science basis for their profession. A scheme for continuing professional development (CPD) started in July 2006, 1 year before a sample audit starts to show the link between CPD and re-registration. The scheme will be piloted in the first year. The critical challenge is the issue of identity. Waterlow (1981) stated that professional registration must lead explicitly and formally to a specific vocation, an occupation that provides services that society requires and one that contributes to the well-being and health of all. The present time may be the last and best chance for nutritionists, as nutrition has a higher priority for government in the UK than ever before. The Society has begun to help in strategic public health workforce planning and development; new and still plastic, it is the ideal locus from which a discipline and a profession can emerge. The CPD scheme will work if it helps nutritionists meet their own needs; more mutual cooperation and consensus about real world standards of performance are needed. Nutritionists need to show how they actually contribute to national health and/or wealth. Then, sustained resources can be advocated for and the support of the voting public and legislators secured, without which it will not be possible to get the legal protection that is desirable for the profession.

Competency development needs of the Australian public health nutrition workforce

Objectives:

To assess factors affecting competency development of the Australian public health nutrition workforce and investigate competency development intentions, barriers and self-reported training needs.

Design:

Cross-sectional study using self-administered mail- or email-delivered questionnaire.

Setting and subjects:

Two hundred and forty practitioners working in designated community and public health nutrition positions in the Australian health system.

Results:

An 87% questionnaire response rate was achieved. The profile of the sample included female practitioners (95%) within the age range of 26–45 years (67%), from dietetic backgrounds (75%) and employed in state health departments as community dietitians/nutritionists (52%) or public health nutritionists (32%). Only 14% had completed higher degree qualifications but most (80%) reported an intention to do so in the future. Entry-level dietetic education was considered by most respondents (57%) to be inadequate preparation for public health nutrition practice but considered it had utility as a precursor for public health nutrition competency development because of its strong grounding in nutrition knowledge, basic research skills and problem-solving. On-the-job learning was the most prominent competency development influence reported by this workforce. Flexibility in teaching and learning approaches is needed to facilitate workforce participation in further competency development. The main competency development needs focused on analytical and policy process competencies; however, there was a general need expressed for competency development across many competency areas.

Conclusions:

These data provide intelligence to inform public health nutrition workforce development, particularly that relating to continued professional development amongst the existing workforce.

Competencies for effective public health nutrition practice: a developing consensus

OBJECTIVES

To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice.

DESIGN

A modified Delphi study involving three rounds of questionnaires.

SUBJECTS

A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia.

RESULTS

Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies.

CONCLUSIONS

There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.

Food aid in emergencies: a case for wheat?

As disasters and conflict increase, a higher proportion of total food aid is given as humanitarian aid. Most food aid is in the form of cereals, primarily wheat. The main donors are the USA and the EU, but there is an increase in the numbers of donors, including non-governmental organizations, buying food rather than using surpluses. Alongside the greater diversity and complexity of food aid, there is more controversy about policy and practice. If disasters are development failures, emergency food aid must be a step in the continuum from relief to rehabilitation. Comparisons of the seventeen countries that were major recipients of food aid (> 10,000 t) in 1997, show diversity in social development, dietary pattern, number of refugees, relative food inadequacy and wasting (i.e. % standard weight-for-height > 2 SD). In the absence of information of consistent quality, what influences the scale of emergency aid is unclear and susceptible to politicization, so that need and supply may not be matched. Local considerations seem to be as important as external food aid for the nutrition of the recipients. Challenges for the future include assuring the nutritional quality of rations to solve deficiency problems. The implications for the professional public health nutritionist working on emergency food provision include continuing professional development to enhance the technical expertise necessary to design appropriate feeds or rations. These public health nutritionists, more than others, require a grounding in social science theories that underpin management, ethics of professionalism and the politics of food aid.