Exploring dietitians’ views on digital nutrition educational tools in Malaysia: a qualitative study

Manaf Zahara Abdul,Rosli Mohd Hafiz Mohd,Noor Norhayati Mohd,Jamil Nor Aini,Mazri Fatin Hanani,Shahar Suzana 한국영양학회 2024 Nutrition Research and Practice Vol.18 No.2

BACKGROUND/OBJECTIVES Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians’ perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues. BACKGROUND/OBJECTIVES Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians’ perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.

Perceived Leadership Style of Korean Dietitians : Focusing on the Transformational and Transactional Leadership Styles

Yoon Ji-Young,Joo Nami Korean Society of Community Nutrition 2005 Journal of community nutrition Vol.7 No.4

The purpose of this study is to identify the transformational or transactional leadership styles of Korean dietitians. The study was completed with Korean dietitians (n = 268, $67\%$ response) using mail survey. The leadership styles were divided into transformational (including charisma, intellectual stimulation, individualized consideration) and transactional (contingent reward, management by exception) leadership found in the several literature. Overall, the score of Korean dietitians' transactional leadership was higher than that of the transformational leadership (p < .05). Among three sub-dimensions of the transformational leadership styles, the score of 'individualized consideration' was higher than 'charisma' and 'intellectual stimulation'. Between two sub-dimensions of the transactional leadership styles, Korean dietitians used more 'management-by-exception' than 'contingent reward'. ANOVA results suggested that the transformational leadership was more likely to be used by the younger dietitians, while the transactional leadership was more likely to be used by the older dietitians (p < .05). Data showed that dietitians having 3-6 year dietetic experience used more transformational leadership than other experienced dietitians (p < .05). It was also found that the Korean dietitians' leadership styles were influenced by the type of dietetic practice area. Data showed that 'charisma', 'intellectual stimulation', 'individualized consideration' and 'contingent reward' were more likely to be used by Korean dietitians from school than by dietitians from health. care and industry (p < .05). This study will be useful for dietitians to guide the application of appropriate leadership style in order to increase employees' job satisfaction as well as organizational performance. (J Community Nutrition 7(4) : $207\∼214$, 2005)

대구·경북지역 단체급식소 유형별 영양사의 개인특성과 직무특성이 조직몰입과 직무만족에 미치는 영향

신은경,이연경 한국식생활문화학회 2003 韓國食生活文化學會誌 Vol.18 No.2

The objective of this study was to investigate the effects of personal and job characteristics on the organizational commitment and job satisfaction of dietitians employed in different foodservice settings. The subjects were dietitians(n=830) employed by schools, hospitals, and industries in Daegu · Gyeongbuk area. A questionnaire as used to determine personal and job characteristics, commitment and satisfaction. Organizational commitment scores were the highest for hospital dietitians, and the lowest for industry dietitians (p<0.05). Industry dietitians felt significantly less loyal to their organizations than did the other dietitians(p<0.05). School and hospital dietitians were significantly more likely to say they cared about the fate of their organizations and thought their organizations were the best to work for. Age, education, length of employment, and wages were positively associated with hospital dietitians' commitment(p<0.05). For all dietitians, the fewer the work hours, the higher the commitment(p<0.05). When asked to rate their satisfaction with various aspects of their jobs, dietitians expressed the most satisfaction with co-workers, and the least satisfaction with promotion opportunities. School dietitians were significantly less satisfied with pay and promotion than were the other dietitians. Organizational commitment was associated with wages(p<0.05), autonomy(0.08), feedback(0.16), dealings with others(0.07), and task identity(0.09). Job satisfaction was affected by educational level(-0.13), wages(-0.10), autonomy(0.18), friendship opportunities(0.14), feedback(0.16), task identity(-0.11) and organizational commitment(0.40) (Lisrel program).

위탁급식 전문업체 영양사의 인력관리 실태조사

엄영람,류은순 대한영양사협회 2003 대한영양사협회 학술지 Vol.9 No.3

The study was conducted to identify dietitians' position and role by assessing the present condition on management of human resources in contract-managed foodservice companies. Questionnaires were distributed to 79 contracted companies(eight large-size, 48 mid-size, 23 small-size companies) from March to May in 2002. About eighty-five percent of contracted foodservice companies employed the new dietitians as full time employees, and seventy-five percent of them were promoted the dietitians by evaluation after a given period of time. As a starting payment for university graduates, large-size companies payed an average of 16,260,000 won/year, which was significantly higher(p<0.01) than those of mid-sized(11,320,000 won/year) and small-sized companies(11,620,000 won/year). The mean lengths of dietitians' service were 33.5 months in large-size companies, 26.5 months in mid-sized companies, 26.0 months in small-sized companies. It was less than 3 years in all companies(avg. 26.9 months). Fifty-four companies(68.4%) employed dietitians in each foodservice contract, whereas 25 companies didn't employ dietitians. The ratios of dietitians out of employees in each department of the companies were 42.6% in the department of contracted foodservice management, 19.9% in the department of menu development, 18.1% in the department of food safety, 8.7% in the department of distribution and purchase, 4.2% in the department of business, and 3.9% in the department of customer satisfaction. The dietitians' positions were directors in two companies(2.5%), general managers in two companies(2.5%), deputy managers in seven companies(8.9%), managers in twenty-nine companies(36.7%), assistant managers/chief clerks in twenty-four companies(30.4%), and chiefs in twenty-five companies(31.6%). The frequencies of training for dietitians were 6.2 times/year for the food safety training, 5.8 times/year for the cooking training, 4.8 times/year for nutrition-related training, and 4.7 times/year for service training.

부산지역 학교급식에서 세시음식에 대한 영양사의 인식 및 적용에 관한 조사

류은순 한국식생활문화학회 2003 韓國食生活文化學會誌 Vol.18 No.2

We surveyed dietitians' perception on application of festival foods in the school foodservice in Busan area. The questionnaires were distributed to 244 dietitians working in elementary(143 individuals), middle(50 ind.), and high schools(51 ind.). The mean scores of dietitians' perception for the succession of the festival foods are 4.57/5.00 at Seolanl, 4.28/5.00 at Jeongwoldaeboreum, 4.12/5.00 at Dongji, 4.02/5.00 at Chuseok, 3.91/5.00 at Sambok, 3.27/5.00 at Dano, 3.00/5.00 at Chopail, 2.67/5.00 at Samjitnal, and 2.65/5.00 at YuDu. The dietitians have frequently practice the Sambok foods to the school two third of dietitians(72.2%) answered that it is needed to provide festival foods as the school foodservice menu for festive days. However, the survey indicate that putting festival foods on the school foodservice is hampered by the facts that foods do not appeal to the students' taste and it is difficult to cook the foods by school foodservice facilities. Mean scores of dietitians' acquaintance with about the origins and contents of festive days are Dongji(3,67/5.00), Seolnal(3.63/5.00), Sambok(3.60/5.00), Jeongwaldaeboreum(3.58/5.00), Chuseok(3.39/5.09) and Dano(3.23/5.00). When the dietitians provided lunch for the students, 80.1% of them occasional give the information on the festival foods to the students. Therefore, it is recommended to hand down festival foods that the dietitians develope the recipe for foods applicable in school foodservice and government adopt a policy and education programs.

학교급식 음료 선호도에 대한 초등학생과 영양사의 인식 비교

배문희,서선희,Bae, Moon-Hee,Seo, Sun-Hee 한국식품영양과학회 2007 한국식품영양과학회지 Vol.36 No.8

본 연구는 서울 지역 초등학생 705명과 초등학교 영양사 100명을 대상으로 설문지를 이용하여 학교급식에서의 음료 선호도에 대한 인식과 제공 실태를 파악하고 영양사와 초등학생간의 음료 선호도 인식의 차이를 비교 분석하였다. 이에 대한 결과는 다음과 같다. 학교급식에서 나오는 우유 선호도에 대한 초등학생의 의견은 보통이다(35.2%), 좋다(22.0%), 싫다(18.3%), 매우 좋다(12.2%), 매우 싫다(12.2%) 순이었다. 남학생과 여학생의 학교급식 우유 선호도에 유의적인 차이가 나타났으며 여학생(평균=2.79)보다 남학생(평균=3.24)의 학교급식 우유 선호도가 높았다. 학교급식에서 나오는 요구르트 선호도에 대한 의견은 매우 좋다(39.9%), 좋다(35.1%), 보통이다(20.1%), 싫다(2.9%), 매우 싫다(1.9%) 순으로 우유 선호도와 달리 요구르트 선호도는 높은 것으로 나타났다. 남학생과 여학생의 학교급식 요구르트 선호도에 유의적인 차이가 나타났으며 여학생(평균=3.88)보다 남학생(평균=4.26)의 요구르트 선호도가 높았다. 학교급식에서 나오는 과일주스 선호도에 대한 의견은 매우 좋다(53.5%), 좋 다(30.4%), 보통이다(13.9%), 싫다(1.3%), 매우 싫다(0.9%) 순이었다. 학교급식에 나오는 과일주스 선호도는 우유나 요구르트보다 비교적 높게 나다났으며 남학생(평균=4.37)과 여학생(평균=4.32)의 과일주스 선호도의 유의적인 차이는 나타나지 않았다. 초등학생의 과일주스 섭취빈도 조사 결과 설문 응답자의 41.8%가 과일주스를 일주일에 2-3번 섭취하고 설문 응답자의 21.5%가 한 달에 2-3번 섭취하는 것으로 나타났다. 과일주스를 마시는 동기로는 과일주스 맛을 느끼고 싶을 때(30.1%), 간식(27.3%), 갈증해소(24.2%) 순으로 나타났다. 초등학생이 가장 좋아하는 과일주스는 오렌지주스(34.1%), 사과주스(20.77%), 포도주스(17.5%) 순이었으며 가장 자주 마시는 과일주스로는 오렌지주스(57.3%), 포도주스(13.8%), 사과주스(8.1%) 순으로 조사되었다. 초등학생이 선호하는 과일주스와 가장 자주 마시는 과일주스 1순위로 모두 오렌지주스를 선택하였으며 사과주스와 포도주스는 선호도에 비해 섭취 빈도가 낮은 것으로 나타났다. 영양사를 대상으로 학교급식에서 과일주스 제공 실태 조사 결과 응답자의 과반수 이상이 한 학기에 1회 미만(61.0%)으로 과일주스를 제공한다는 것으로 나타나 학교급식에서 과일주스 제공빈도가 매우 낮음을 알 수 있었다. 감귤주스와 사과주스가 학교급식에서 자주 제공되는 과일주스로 꼽혔으며 영양사들은 학교급식에서 1인용 과일주스의 포장용기로 종이팩이 가장 적당하다고 대답하였다. 현재 57.8%의 학교 급식에서 1인당 125 mL의 사과주스를 제공하고 있고 14.7%의 학교급식에서 1인당 100 mL 의 사과주스를 제공하고 있는 것으로 나타났으며 영양사들이 인식하는 적당한 1회용 과일주스 양은 125 mL(58.1%). 100 mL(31.4%) 순이었다. 학교급식 메뉴로서 과일주스보다 요구르트를 더 선호하는 이유로 유산균 및 칼슘 보충가능, 저렴한 가격, 선호도 등이 대부분을 차지하였다. 영양사들은 초등학생들이 과일주스보다 요구르트를 더 좋아한다고 생각하고 있으며 실제 초등학생들의 과일주스에 대한 선호도는 우유와 요구르트의 선호도보다 매우 높았다. 초등학생의 우유 선호도에 대해 영양사들은 초등학생들의 실제 우유 선호도보다 초등학생들이 우유를 좋아하지 않는다고 인식하고 있는 것으로 나타났으며 영양사가 인식하고 있는 초등학생의 요구르 The purpose of this study was to investigate the difference between students' beverage preference and dietitians' perception in elementary school lunch program. This study was conducted in three phases: (1) questionnaire development and survey administration to elementary school students (2) survey administration to dietitians who were in charge of the elementary school food service, and (3) comparison of beverage preferences between elementary school students and dietitians. In phase I, 703 elementary school students in Seoul were surveyed from July 11 to July 19. In Phase II, 100 school food service dietitians in Seoul participated by mail survey from September 15 to October 30, 2006. Based on the results, elementary school students tended to show a neutral milk preference (mean=3.04), whereas dietitians perceived that elementary school students had lower milk preference (mean=2.67). Also dietitians perceived higher yogurt preference (mean=4.27) than the real elementary school students' preference (mean=4.02). T-test results showed the gender difference on milk and yogurt preference. Male students had higher milk preference (t=4.912, p<0.001) and yogurt preference (t=3.621, p<0.001) than female students. Elementary school students showed high fruit juice preference (mean=4.34); however, dietitians perceived lower fruit juice preference of students (mean=3.92). There was no gender difference on fruit juice preference. Though elementary school students had higher fruit juice preference, the frequency of fruit juice served in school lunch was quite low. Over half of the dietitians reported that they served fruit juice less than once a semester. The results of this study indicated the existence of distinctive difference between students' fruit juice preference and school lunch menu offerings.

임상영양팀의 업무생산성 및 효과분석

김영혜,신은수,강은희,김주현,김미경,김계진,홍희선 대한영양사협회 1996 대한영양사협회 학술지 Vol.2 No.2

In Korea, the majority of hospital dietitians expend most of their time performing food management related activities, and only a few carry out nutrition care activities in full-time. This study was designed to measure productivity of the clinical nutrition team and assess the role of clinical dietitians in the only 2200-bed teaching hospital in Korea. Six full-time clinical dietitians collected time data for four weeks according to the nutrition care activities outlined. Three clinical dietitians assigned to 7 units recorded how often physicians implemented their recommendations for two months. Two kinds of survey questionaire were developed and sent to the patients and the health care team. The followings are a summary of the results. 1. The clinical nutrition team of 6 full-time dietitians expended 75% of their time performing patient care activities, 20% in non-patient care activities and 5% in delay and transit. 2. Each clinical dietitian assigned to the units carried out 56 patient care activities on daily basis. 3. The average time required for the clinical nutrition services was 60.2 minutes for outpatient counseling, 89 minutes for inpatient counseling, 72.5 minutes for nutrition management, 95 minutes for malnutrition consult and 121 minutes for dysphagia diet management. 4. Physicians' implementation of clinical dietitians' recommendations was 98.5%. 5. Most physicians and nurses viewed the clinical dietitians on the units assertive, contributing to the quality improvement of medical services, and helpful to the patients as well as the health care team. 6. Most patients viewed the clinical dietitians on the units considerate, attentive and helpful. Based on these results, it is suggested that : ① daily meal round and nutrition care monitoring are effective tools for nutrition intervention in the hospital setting. ② unit assignment of clinical dietitians enhances the patients' satisfaction in the nutrition services provided as well as the perceptions of health care team on clinical dietitian's expertise.

서울․경기 지역 의료기관 영양사의 연하곤란 입원환자 영양관리 업무에 대한 중요도와 수행도 인식

이경은,김다솜 동아시아식생활학회 2019 동아시아식생활학회지 Vol.29 No.5

This study examined the importance and performance of nutrition management for in-patients with dysphagia, as perceived by dietitians and investigated the perceived barriers in performing nutrition management at clinical settings. A mail survey was conducted with 554 dietitians in hospitals located in Seoul and Gyeonggi-do. The responses from 147 dietitians was finally used for data analysis. The average scores for performance and importance of nutrition management for patients with dysphagia were 2.99 points and 4.23 points respectively, based on a 5-point scale. In terms of performance, ‘inspecting and adjusting meal settings and menus for patients (3.55 points)’ was rated the highest and ‘providing nutrition education for patients and caregivers (2.65 points)’ was rated the lowest. Perceived importance was rated the highest for ‘performing nutrition counseling for patients and caregivers (4.45 points).’ According to the nutrition care process (NCP) stage, the perceived performance scores of nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation were 3.06, 2.84, 3.05, and 2.88 points, respectively. The importance of the four stages of NCP was rated over 4.0 points. The performance levels of nutrition management for patients with dysphagia differed significantly by dietitians’ prior educational experience on dysphagia (p<0.001), educational background (p<0.001), and the types of hospitals (p<0.01). However, the perceived importance did not significantly differ by the general characteristics of dietitians. An importanceperformance analysis revealed that dietitians need to focus on improving performance for nutrition screening, collecting and evaluating food and nutrition related data, conducting nutrition diagnosis, performing nutrition counseling, and providing nutrition education for patients and their caregivers. The lack of time and opportunities for nutrition education and counseling, difficulty for controlling the foods brought to hospitals from home, and the lack of time for collecting data and information on patients were identified as barriers for nutrition management. Considering an increased prevalence of dysphagia, standardized diet and nutrition management guidelines for dealing with dysphagia and proper staffing of dietitians are needed to improve nutrition management for patients with dysphagia at clinical settings. Dietitians also should participate in continued education programs to develop their expertise.

A Study on Food Allergy Practices of Dietitians at Schools in Korea

Yeonsoo Kim(김연수),Eunji Park(박은지),Yunsook Lim(임윤숙) 한국웰니스학회 2014 한국웰니스학회지 Vol.9 No.4

최근들어 성장기 아동과 청소년의 건강과 웰빙이 성인기까지 영향을 미치는 중요한 요인으로 대두되고 있다. 치명적인 위험을 동반한 국내 식품 알러지 발생 빈도가 증가하면서 학교 급식에서 식품 알러지 교육 및 실행 프로그램의 필요성이 증대되고 있다. 본 연구는 학교 급식을 담당하는 영양사들의 식품 알러지와 알러지 발생시 위험에 대처하는 방법들에 대한 지식과 태도를 평 가하고 학교내 식품 알러지 발생시 이에 대처하는 방법 등을 알아보기 위해 실시하였다. 본 연구에서는 서울 시내의 144개교 학 교 급식 영양사를 대상으로 식품 알러지에 대한 지식과 식품 알러지 관련 실태에 관하여 조사하였다. 결과로는 급식 영양사들의 식품 알러지에 대한 지식과 태도는 각각 15점 만점에 10.1, 30 점 만점에 22.6으로 나타났다. 또한, 연구 대상자의 45%만이 학생들 이 가지는 식품 알러지에 대한 조사를 실시하는 것으로 나타났고, 단지 21% 만이 대상 학생이나 학부모들에게 식품 알러지에 대 한 교육을 실시하는 것으로 나타났다. 특히, 연구 대상자들이 근무하는 학교의 10% 만이 식품 알러지를 가지는 학생들에게 대체 식단을 제공하고 있었으며, 학생들 사이에서 식품을 공유하지 못하도록 하거나, 조리 종사자들의 라텍스 장갑 사용을 금지 하는 등에 대한 식품 알러지 예방 규칙은 전혀 없는 것으로 나타났다. 본 연구 결과를 종합해보면, 현재 국내 학교 급식에서 식품 알러지에 대한 관리가 부족한 실정이며, 이를 향상시키기 위한 정 부와 학교의 노력이 더욱 필요한 것으로 사료된다. The prevalence of food allergies has been increasing and food allergy management programs were implemented at schools in Korea to increase public awareness of food allergies and to educate students on the topic of food allergies for their healthy lives and wellness. The objectives of the present study were to identify and to evaluate dietitians' knowledge and attitudes toward food allergies, risk-taking behaviors, and coping strategies with the ultimate goal of protecting against and managing food allergies at school. The study participants included 144 dietitians at schools located in Seoul, Korea. A survey was used to measure dietitians' knowledge and practices with respect to food allergies. Dietitians' knowledge and attitude scores with regard to food allergies were 10.1 out of 15 and 22.6 out of 30, respectively. The results of the study indicate that only 45% of dietitians conducted a survey to identify students with food allergies, and only 21% provided education concerning food allergies, mainly to students with food allergies and their parents. Moreover, only 10% of dietitians offered food substitutions as a strategy to avoid food allergies and did not implement a policy of no sharing foods among students and no use of latex gloves for food service workers when they prepared food substitutions. It seems that the current management of food allergies in school meal service is not sufficient. The findings of the current study could be used to improve prevention and management of food allergies at school.

강원지역 초등학교와 고등학교 영양사의 직무만족도에 관한 연구

장미라,김명희 대한영양사협회 2003 대한영양사협회 학술지 Vol.9 No.1

Dietitians' satisfaction between elementary school and high school in KangWon Do region were surveyed with questionnaires. 61 elementary school dietitians and 30 high school dietitians participated. The dietitians in elementary schools had higher scores in age, marital status, years at work, types of employment, average annual income and had lesser hours of work. In overall, elementary schools had higher percentage on self operation and on the period of their food distribution to students. High schools had higher percentage on conventional systems, freedom in the amount of food distribution, number of meals per day and the meal charge. It was clear that dietitians in high schools showed more interests in changing their careers due to the poor working environment and salary. The highest score was on the relationship with other coworkers and the lowest score was on the poor working environment and salary. In general, dietitians in both types of schools were not satisfied with their career, especially with the working environment and salary.