Clinical dietitians' perceptions of their use of theory to guide practice

The purpose of this study was to examine clinical dietitians' perceptions about their use of theory and the values, beliefs and views that influenced clinical practice. A patient education and counseling survey instrument was developed to measure the construct of theory perception called the Theory Perception Scale, and was pretested for face validity with a convenience sample of clinical dietitians. Ten statements with Likert scale answers measured the construct of theory perception and three open-ended questions explored the influences to practice and how clinical dietitians conceptualized theory. Registered dietitians working in the area of clinical nutrition were selected through the Commission on Dietetic Registration database using systematic random sampling. Three hundred and four clinical dietitians participated in the study. Descriptive and nonparametric statistics were use to analyze the Theory Perception Scale median score for the variables of clinical setting, years in profession, academic degree, and advanced-level certification. Internal consistency of the survey instrument was tested using Cronbach's alpha. Qualitative data were analyzed by constant comparison, coding of themes and patterns, and triangulation by comparing open-ended answers to one another and to the quantitative data. Results: Clinical dietitians with graduate degrees and those working in the outpatient setting perceived their use of theory to be significantly greater than inpatient dietitians and dietitians without graduate degrees. Major influences to patient education and counseling were dietitian beliefs about respecting patient autonomy, providing individualized care and patient involvement in the educational process. Clinical dietitians in the study in general did not understand theory as a construct as reported in the literature, but instead identify theory as a method or technique. Dietitians who used theory typically report using parts of counseling theory combined with their own ideas to inform practice, thus often breach theory fidelity. The knowledge and use of education theory among clinical dietitians was minimal. Dietitians who do not support the use of theory rely on their experience and intuitive knowing to direct education and counseling. The results suggest a dietetic research theory-practice gap and the need for counseling and education theory that can be applied in clinical settings.