Use of the Nutrition Care Process and Nutrition Care Process Terminology in an International Cohort Reported by an Online Survey Tool

Published:December 13, 2018DOI:



      Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed.


      The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries.


      A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels.

      Main outcome measures and statistical analysis

      The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information.


      Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest.


      Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.


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      E. Lövestam is an assistant lecturer, Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.


      A. Steiber is chief science officer, Nutrition and Dietetics Data Science Center, Academy of Nutrition and Dietetics, Chicago, IL.


      C. Papoutsakis is a senior director, Nutrition and Dietetics Data Science Center, Academy of Nutrition and Dietetics, Chicago, IL.


      A. Vivanti is a research and development dietitian, Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia, and senior lecturer, School of Human Movement and Nutrition Studies, University of Queensland, Queensland, Australia.


      A.-M. Boström is a registered nurse, an associate professor, and a senior lecturer, Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden; a university nurse, Theme Aging, Karolinska University Hospital, Stockholm, Sweden; and a professor II, Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway.


      A. Devine is a registered public health nutritionist and a professor of public health and nutrition, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.


      O. Haughey is a senior dietitian and project manager, Irish Nutrition and Dietetic Institute, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.


      C. M. Kiss is a team leader, Clinical Nutrition and Dietetics, University Hospital Basel, Basel, Switzerland.


      N. R. Lang is a senior lecturer, Department of Nutrition and Health, VIA University College, Aarhus, Denmark.


      C. Peersen is a senior lecturer, Department of Nutrition and Health, VIA University College, Aarhus, Denmark.


      J. Lieffers is an assistant professor, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.


      L. Lloyd is a senior renal dietitian, Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.


      T. A. O’Sullivan is a senior lecturer, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.


      L. Thoresen is a clinical dietitian, Cancer Clinic, Trondheim University Hospital, Trondheim, Norway, and a clinical dietitian, National Advisory Unit on Disease-Related Malnutrition, Oslo University Hospital, Oslo, Norway.


      Y. Orrevall is head of research and development, Education and Innovation, Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden, and an associated researcher, Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Stockholm, Sweden.