Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians’ Competence: A Delphi Consensus from the United States

Abstract

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs’ NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach’s alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and >0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings.

Inter-Rater and Intra-Rater Reliability of the INSPECT (Interactive Nutrition Specific Physical Exam Competency Tool) Measured in Multi-Site Acute Care Settings

“…Through a systematic, rigorous process that included both quantitative and qualitative methods with expert RDNs’ input, the INSPECT was developed and examined for reliability and validity. The preliminary validity studies utilizing the expert RDN panel had shown excellent content validation and acceptable face validation for the INSPECT [ 26 ]. This current reliability study shows equally promising results.…”

“…Based on the expert consensus and open feedback from the experts, a total of 41 items and 11 subsets were identified and included in the final version of the INSPECT. A detailed account of the second phase of the Delphi consensus study with evidence of face and content validation is given in a previous publication [ 26 ].…”

Item-Level Analysis of a Newly Developed Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) Using the Rasch Measurement Model

“…The INSPECT is a competency tool specifically designed to meet this need. The INSPECT was developed and examined over multiple phases that included item generation via focus groups with experts [ 17 ], content, and face validation of the preliminary version of the INSPECT utilizing the Delphi methodology [ 18 ], and evaluation of the tool as a whole using classical test theory methodologies [ 19 ]. The current study examined the item-level psychometric properties of the INSPECT using the Rasch model IRT methodologies.…”

“…Rating scale analysis indicated that the lower rating measures were associated with lower person ability and higher ratings with higher person ability. The mid-rating of ‘3’ did not emerge as a category of its own, however, this rating was introduced in the INSPECT based on the expert input during content validation [ 18 ]. As this study only contained RDN performers with a mean clinical experience of 5.8 years, all other ability levels were not examined, which possibly excluded the rating of ‘3’ from emerging as a category.…”

“…Utilizing the expert consensus and their open feedback, a new version of the INSPECT was designed with 41 items. The details of the second phase of the study are outlined in a prior publication [ 18 ].…”