South African dietitians’ practices and perceptions regarding food exchange lists, as part of the food exchange system, in the nutrition care process
Brand, Desire Michelle
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The nutrition care process (NCP) is a standardised method to apply nutritional therapy, followed by dietitians to promote evidence-based practice. While various tools can be used by dietitians as part of the NCP, the decision to use a certain tool is based on relevance, convenience, and trustworthiness. As food exchange lists (FELs) can be used in multiple phases of the NCP, and in light of the significance of targeted nutrition therapy and the appropriate use of tools on the nutritional outcome, it is essential to describe dietitians’ practices and perceptions regarding the use of FELs as part of the NCP. Particularly, as limited literature is available on the use of FELs by dietitians in practice, especially in South Africa, where population specific FELs are lacking. This cross-sectional survey aimed to determine South African dietitians’ practices and perceptions regarding the use of FELs as part of the NCP. All dietitians and community service dietitians residing in South Africa who were registered at the Health Professions Council of South Africa (HPCSA), were eligible to participate in this study. Dietitians’ socio-demographic information and practices and perceptions regarding the use of FELs within the NCP were determined using an online survey, created with Evasys Software®. The link to the survey was shared through e-mail newsletters to Association for Dietitians in South Africa (ADSA) members and on Dietetics-Nutrition is a Profession (DIP) and Dietetic Services Facebook pages. The survey was open for completion for a duration of two months, from February to April 2020. Dietitians in the current study were mainly female (96.2%; n = 126), with the greater proportion of dietitians being between 25-30 years of age (42.8%; n = 56), speaking Afrikaans (53.4%; n = 70) or English (50.4%; n = 66) as a home language, practising for one to four years post community service (34.4%; n = 43), based in Gauteng (29.8%; n = 39), and employed in private settings (53.4%; n = 70). Dietitians in South Africa are using FELs for different purposes in the nutritional management of various population groups, throughout all phases of the NCP, although 67.7% of dietitians applied FELs in dietary counselling and 92.1% in meal planning as part of the NCP. More dietitians employed in private settings used FELs (86.3%) compared to government (55.3%) or tertiary education/ research/ pharmaceutical sectors (64.7%). This significant association may partly be ascribed to a greater proportion of dietitians who self-designed FELs in private settings (42.5%), which appeared to have been associated with dietitians’ perceived knowledge of FELs. Also, a significantly larger proportion of dietitians employed in government settings compared to private practices considered patients’ language (25.0%; 5.8%) and literacy level (92.9%; 67.3%) in the decision to provide patients with FELs. Overall, 78.7% of dietitians obtained FELs from universities and most FELs currently in use have been updated in the past five years. Even so, the greater proportion of dietitians (46.6%) reported the lack of South African specific foods as the main reason why FELs are due for an update. Dietitians acknowledged the importance of population-specific FELs with the majority (85.3%) advocating for FELs that are specific to various ethnic groups, mainly cultural (61.9%) and language groups, as well as different literacy levels (65.4%), mostly grade 8-9 level. While a smaller percentage (39.7%) indicated that FELs should be adapted for different religions, the majority (68.3%) reported that vegetarianism / veganism should be considered. Adapting FELs according to socio-economic status was not perceived as essential to most dietitians. Majority of dietitians recommended FELs should be adapted for different stages of the life cycle, especially given the lack of resources on portion sizes in paediatric patients. Given the convenience of use, dietitians reported using alternative tools to the FELs, but also supported the idea of an electronic FEL. Main concerns affecting the use of health applications, comprised dietitians’ doubts about accessibility, ease of use, trustworthiness and costs involved. The use of a comprehensive FEL that is relevant and evidence-based, which dietitians find convenient to use, may improve nutritional outcomes in dietetic practices and promote the dietetics profession.