Year

2021

Season

Fall

Paper Type

Doctoral Dissertation

College

Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)

Department

Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Dr. Lauri Wright

Second Advisor

Dr. Andrea Y. Arikawa

Third Advisor

Dr. Jenifer Ross

Department Chair

Dr. Lauri Wright

College Dean

Dr. Curt Lox

Abstract

Background

Obesity is a disease with many associated comorbidities and its prevalence in the U.S. continues to increase despite the majority of people with obesity attempting weight loss. Dietitians are responsible for using evidence-based practice to mitigate the effects of obesity, however, differences in practice philosophies, opinion leaders, misinformation, a sense of competence, and the complexity of nutrition research have been identified as barriers to implementing practice guidelines into daily practice. It is unclear how dietitians strike a balance between empirical evidence, anecdotal evidence, and patient-centered practice.

Aims

The primary aim of this mixed-methods study was to identify the barriers and facilitators of research utilization and evidence-based practice in adult weight management. The secondary aim was to identify how dietitians gather information about obesity and/or adult weight management as well as to understand what factors influence how they discern whether to adopt a new practice strategy.

Theory

A combination of Social Cognitive Theory and Diffusion of Innovations Theory provided a framework to understanding the barriers and facilitators to the adoption of various practice innovations in the field of obesity management.

Methods

The validated BARRIERS survey was disseminated to dietitians working at least part-time with people with obesity. Survey also contained additional miscellaneous questions regarding information gathering preferences and use of best practices. Semi-structured interviews were conducted to understand current obesity practices utilizing thematic analysis of the interviews.

Results

Survey data identified that Setting items (M = 23.89, SD = 6.83) were the greatest perceived barrier within the BARRIERS survey items. Years of experience were found to decrease the perception of Setting items with 0-5 years (M = 25.01, SD = 6.39) and 6-11 years for Setting was (M = 25.00, SD = 6.29) compared to 32 or more years (M = 20.60, SD = 6.38) indicating that years of experience help decrease the perception of Setting barriers. Qualitative results identified that time, degree of training, and reliance on opinion leaders are the greatest barrier to research utilization, implementation of best practices, and gathering information from refereed sources.

Conclusion

Dietitians report limited time resources derived from a number of factors and are compounded by limited training in statistical analysis and a sense of competence which leads to a reliance on opinion leaders to place research findings into context on their behalf. Dietitians should be cautious of reliance upon others in gathering information as misinformation may be a significant factor. Continuing education requirements and the use of podcasts are a significant contributor of increasing reliance on opinion leaders for daily practice guidance.

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