Year
2025
Season
Spring
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
Committee Chairperson
Andrea Arikawa, PhD, MPH, RDN, LD/N, FAND
Second Advisor
Jen Ross, DCN, RD, LDN, FAND
Third Advisor
Carly Leon MS, RDN, CD
Department Chair
Andrea Arikawa, PhD, MPH, RDN, LD/N, FAND
College Dean
Dr. Mei Zhao
Abstract
This study examined health insurance leaders' knowledge and attitudes regarding Registered Dietitian Nutritionists (RDNs) and their integration into healthcare delivery. An anonymous cross-sectional survey collected data from 65 insurance leaders representing national (70.8%) and regional (29.2%) providers, with 80% working for organizations covering over 800,000 members. The study achieved a 71.4% response rate through professional networks.
Kruskal-Wallis analysis revealed significant differences in policy knowledge across job roles (p=.026), with pairwise comparisons showing Food is Medicine professionals scored lower than reimbursement specialists. Gender significantly impacted overall survey scores (p=.031), attitudes toward RDNs (p=.038), and future framework perspectives (p=.002), with females demonstrating more positive attitudes than males in future frameworks (p=.027). Education level significantly influenced knowledge of RDN skills (p=.010), with advanced degrees correlating with greater understanding. Frequency analysis showed strong support for expanding RDN scope of practice (70.8% strongly agreeing) despite substantial knowledge gaps regarding health coach education (66.2% uncertainty). Mann-Whitney U tests confirmed no significant differences in knowledge or attitudes based on provider type (national vs. regional), membership size, or ethnicity (all p>.05).
The results demonstrate widespread support for RDN integration despite notable knowledge gaps in policy understanding. Current coding structures present significant challenges, as time-based Medical Nutrition Therapy codes fail to reflect service complexity, and payer policies often restrict billable units regardless of patient needs. This disconnect between clinical complexity and reimbursement mechanisms creates barriers to effective RDN utilization. The findings suggest meaningful opportunities to enhance coding frameworks to better align with the complexity of RDN services, potentially improving both healthcare outcomes and cost-effectiveness in chronic disease management.
Suggested Citation
Sheaffer, Amanda, "Demographic influences on knowledge and attitudes of health insurance leaders on the role of registered dietitian nutritionist: Implications and future directions" (2025). UNF Graduate Theses and Dissertations. 1324.
https://digitalcommons.unf.edu/etd/1324