The International Nutrition Care Process and Terminology Implementation Survey: Towards a Global Evaluation Tool to Assess Individual Practitioner Implementation in Multiple Countries and Languages

Published:December 12, 2018DOI:



      The Nutrition Care Process (NCP) and NCP Terminology (NCPT) is a systematic framework for critical thinking, decision making, and communication for dietetics practitioners worldwide, aiming to improve quality and patient safety in nutrition care. Although dietetics practitioners in several countries have implemented the NCP/NCPT during recent years, to date there is no globally validated instrument for the evaluation of NCP/NCPT implementation that is available in different languages and applicable across cultures and countries.


      The aim of this study was to develop and test a survey instrument in several languages to capture information at different stages of NCP/NCPT implementation across countries and cultures.


      In this collaboration between dietetics practitioners and researchers from 10 countries, an International NCP/NCPT Implementation Survey tool was developed and tested in a multistep process, building on the experiences from previous surveys. The tool was translated from English into six other languages. It includes four modules and describes demographic information, NCP/NCPT implementation, and related attitudes and knowledge.


      The survey was reviewed by 42 experts across 10 countries to assess content validity and clarity. After this, 30 dietetics practitioners participated in cognitive interviews while completing the survey. A pilot study was performed with 210 participants, of whom 40 completed the survey twice within a 2- to 3-week interval.


      Scale content validity index average was 0.98 and question clarity index was 0.8 to 1.0. Cognitive interviews and comments from experts led to further clarifications of the survey. The repeated pilot test resulted in Krippendorff’s α=.75. Subsequently, refinements of the survey were made based on comments submitted by the pilot survey participants.


      The International NCP/NCPT Implementation Survey tool demonstrated excellent content validity and high test–retest reliability in seven different languages and across an international context. This tool will be valuable in future research and evaluation of implementation strategies.


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


      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. 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.-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.


      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.