Evidence-Based Practice in the Field of Nutrition: A Systematic Review of Knowledge, Skills, Attitudes, Behaviors and Teaching Strategies

Abstract

Objectives Evidence-based practice (EBP) has been embraced and supported in medicine and several allied health professions for over a decade. We conducted a comprehensive review of the literature to explore EBP competencies and teaching strategies within the nutrition field. Methods Five databases (MEDLINE, EMBASE, ERIC, Cochrane, CINAHL) were systematically searched for observational and experimental studies from inception to August 2021. Eligible studies had to document EBP competencies or teaching strategies to improve EBP competencies among nutrition students and professionals. Competencies were categorized as: i) framing answerable questions, ii) searching literature for best evidence, iii) assessing study quality and/or risk of bias (RoB), iv) interpreting the importance of results, v) interpreting certainty of evidence, vi) applying results based on client values and preferences, vii) evaluating clinical performance. Currently, two reviewers are independently screening, abstracting data, and assessing RoB. Results We screened 1006 initial articles to find 9 eligible studies. Six cross-sectional surveys discussed EBP competencies among registered dietitians (RD) and dietetic interns, while 1 randomized trial and 2 before and after studies evaluated the effectiveness of teaching strategies among RDs and undergraduate students. Studies assessed 2 to 5 EBP competencies using heterogeneous methods that were often unclear. Participants generally scored low with respect to knowledge and skills across the competencies assessed. For instance, the largest study, a survey of RDs from the American Dietetic Association reported that among 258 participants, 64% never attended an EBP lecture, 45% never received formal training in RoB, and 31% did not understand 95% Confidence Intervals. Among teaching strategies, journal clubs improved EBP competencies the most, including framing answerable questions, searching literature, assessing RoB, and applying study results. Full results forthcoming. Conclusions Preliminary results indicate that few nutrition students or professionals have adequate EBP competencies, including skills in RoB assessment and interpreting the importance of study results. Regular journal clubs are an effective way to teach most competencies in EBP. Funding Sources Texas A&M Presidential Transformational Teaching Grant.

Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review

“…Full search strategies are available on request. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [18] and Synthesis without meta-analysis (SWiM) [19] to report our review and the protocol was registered in PROSPERO (CRD42022311916) [20].…”

“…In addition to medicine[3], these competencies have generally been embraced in many contemporary evidence-based programs including nursing [5], pharmacy [8], physiotherapy [6], occupational therapy [9], and psychology [7]. We worked with an experienced librarian to conduct a comprehensive search across five databases and four grey literature sources with no language restrictions, and we registered our study protocol on an open-access, publicly accessible website [20]. We performed screening, data extraction, and quality assessment independently and in pairs, including the assessment of our 12 studies using CROSS [40] and COREQ [41] reporting instruments.…”

“…Our study protocol, published a priori [20], underwent several revisions that were necessary once we better understood the available data. The first revision was the exclusion of the seventh competency, which involved self-evaluation of EBP competencies.…”