Stages of change in dietetics practice.


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Registered dietitian nutritionists (RDNs) have provided nutrition counseling to patients and clients across practice settings for over 60 years. A major component of a RDNs work includes conducting nutrition assessments and providing nutrition interventions. RDNs must assess the “readiness” or stages of change for all patients and clients to provide appropriate interventions. The Transtheoretical Model (TTM), an integrative model of behavior change, uses stages of change to integrate the processes and principles of change across major theories of psychotherapy. At the core of the TTM is the stages of change construct, which suggests individuals change behaviors over time through a series of stages. While assessing stages of change and the provision of a stage-matched intervention in nutrition counseling is important, there is limited research surrounding the stages of change construct in dietetics practice. Thus, the purpose of this project is to first determine the extent to which RDNs are assessing stages of change in dietetics practice and how this assessment is being conducted, and then develop and validate a staging algorithm for healthy eating in the general population. Chapter Three is a descriptive study of nutrition professionals’ knowledge and use of the stages of change construct in dietetics practice. Chapter Four is a criterion validity study for the dietary stages of change algorithm. Results from the descriptive study revealed most nutrition professionals are familiar with the stages of change construct and are assessing stages of change. However, the methods differed, with the majority using open-ended questions during the patient interview. Assessing stages of change is appropriate and feasible in most practice settings, with low utility in acute care settings and pediatric populations. Results of the criterion validity study revealed a non-linear relationship between stages of change and total healthy eating index (HEI) scores. Mean total HEI-2015 scores were highest among those in precontemplation, suggesting the algorithm misclassified some individuals. However, mean total HEI-2015 scores increased linearly from contemplation to maintenance. These findings are promising and warrant further validity testing to refine this tool for clinical practice.



Nutrition counseling. Dietetics practice. Transtheoretical model. Stages of change. Healthy eating index. Criterion validity evidence.