Identifying Physicians’ and Nurses’ Nutrition Knowledge Using Validated Instruments: A Systematic Narrative Review
Physicians and nurses, who are knowledgeable in nutrition, improve patients’ health outcomes. However, limited information is provided about the areas of nutrition they are knowledgeable in. This review sought to identify physicians’ and nurses’ nutrition knowledge through validated instruments. A systematic narrative review of the literature was conducted. Three databases - PubMed Central, Science Direct and Embase databases were searched from 1990 until December 2019. Retrieved studies were screened through a predetermined inclusion criterion and data extraction of included studies occurred. Quality assessment and risk of bias of included articles was completed. Thirty-three articles met the inclusion criteria. Instruments to identify nutrition knowledge varied among each study. Mean percentages of nutrition knowledge were between 32.5% correct to 72% correct. Nutrition knowledge was highest in the areas of nutrients’ roles, and food sources/macronutrients, whereas knowledge was lowest in the area of providing medical nutrition therapy. In general, physicians and nurses who were older, considered a specialist, held an advanced degree and/or had more years of practice had higher nutrition knowledge scores. Overall, literature about physicians’ and nurses’ nutrition knowledge is heterogeneous and scant as well as the instruments used to measure this knowledge. Within these limits, nutrition knowledge may be improved in certain areas.
Jeanette Mary Andrade,
Identifying Physicians’ and Nurses’ Nutrition Knowledge Using Validated Instruments: A Systematic Narrative Review, International Journal of Nutrition and Food Sciences.
Vol. 9, No. 2,
2020, pp. 43-53.
World Health Organization. NCD mortality and morbidity. Global Health Observatory Data. http://apps.who.int/gho/data/node.main.A860. Published 2018. Retrieved December 15 2019.
Global Action Plan: For the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva, Switzerland; 2020.
Khandelwal S, Kurpad A, Narayan KMV. Global non-communicable diseases - The nutrition conundrum. Front Public Heal. 2018; 6 (9): 1-3.
Branca F, Lartey A, Oenema S, et al. Transforming the food system to fight non-communicable diseases. BMJ. 2019; 364. doi: 10.1136/bmj.l296.
Nowson CA, O’Connell SL. Nutrition knowledge, attitudes, and confidence of Australian general practice registrars. J Biomed Educ. 2015; 2015: 1-6. doi: 10.1155/2015/219198.
Wang X, Ouyang Y, Liu J, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014; 349 (July): 1-14. doi: 10.1136/bmj.g4490.
Bélanger M, Poirier M, Jbilou J, Scarborough P. Modelling the impact of compliance with dietary recommendations on cancer and cardiovascular disease mortality in Canada. Public Health. 2014; 128 (3): 222-230. doi: 10.1016/j.puhe.2013.11.003.
Adams KM, Lindell KC, Kohlmeier M, Zeisel SH. Status of nutrition education in medical schools. Am J Clin Nutr. 2006; 83 (4).
Kardakis T, Jerdén L, Nyström ME, Weinehall L, Johansson H. Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare - a two-year follow up. BMC Health Serv Res. 2018; 18 (1): 1-13. doi: 10.1186/s12913-018-3023-z.
Ball L, Desbrow B, Leveritt M. An exploration of individuals’ preferences for nutrition care from Australi. Aust J Prim Health. 2014; 20: 113-120.
Potter MB, Vu JD, Croughan-Minihane M. Weight management: What patients want from their primary care physicians. J Fam Pract. 2001; 50 (6): 513-518. http://www.ncbi.nlm.nih.gov/pubmed/11401737.
Mowe M, Bosaeus I, Rasmussen H, Kondrup J, Unosson M. Nutritional routines and attitudes among doctors and nurses in Scandinavia: A questionnaire based survey. J Clin Nutr. 2006; 25: 524-532.
Wechsler H, Levine S, Idelson RK, Schor EL, Coakley E. The physician’s role in health promotion revisited - A survey of primary care practitioners. N Engl J Med. 1996; 334 (15): 996-998.
Smith S, Seeholzer EL, Gullett H, et al. Primary care residents’ knowledge, attitudes, self-efficacy, and perceived professional norms regarding obesity, nutrition, and physical activity counseling. J Grad Med Educ. 2015; 7 (3): 388-394. doi: 10.4300/JGME-D-14-00710.1.
Mogre V, Stevens FCJ, Aryee PA, Matorwmasen-Akkermans FL, Abubakari B, Scherpbier AJJA. Nutrition care practices, barriers, competencies and education in nutrition: A survey among Ghanaian medical doctors. Med Sci Educ. 2018; 28 (4): 815-824. doi: 10.1007/s40670-018-0591-9.
Kris-etherton PM, Akabas SR, Bales CW, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation. Am J Clin Nutr. 2018; 99 (August). doi: 10.3945/ajcn.113.073502.
Association of American Medical Colleges. Medical School Graduation Questionnaire: 2018 All Schools Summary Report. 2018; 2019 (March): 47. https://www.aamc.org/download/490454/data/2018gqallschoolssummaryreport.pdf.
Abdollahi M, Houshiarrad A, Abtahi M, et al. The nutrition knowledge level of physicians, nurses and nutritionists in some educational hospitals. J Paramed Sci. 2013; 4 (Supplement): 106-114. doi: 10.22037/jps.v4i0.4151.
Stotts NA, Englert DA, Crocker KS. Nutrient education in schools of nursing in the United States. Part 2: The status of nutrition education in schools of nursing. J Parenter Enter Nutr. 1987; 11 (4): 406-411. doi: 10.1177/0148607187011004406.
Dumic A, Miskulin M, Pavlovic N, Orkic Z, Bilic-Kirin V, Miskulin I. The nutrition knowledge of Croatian general practitioners. J Clin Med. 2018; 7 (7): 178. doi: 10.3390/jcm7070178.
Parmenter K, Wardle J. Evaluation and design of nutrition knowledge measures. J Nutr Educ. 2000; 32: 269-277.
Axelson ML, Bringburn D. The measurement and conceptualization of nutrition knowledge. J Nutr Educ. 1992; 24 (5): 239-246.
Sapp SG, Jensen HH. Reliability and validity of nutrition knowledge and diet-health awareness tests developed from the 1989-1991 Diet and health knowledge surveys. J Nutr Educ. 1997; 29: 63-72.
Feren A, Torheim LE, Lillegaard ITL. Development of a nutrition knowledge questionnaire for obese adults. Food Nutr Res. 2011; 55.
Devries S, Willett WC, Bonow RO. Nutrition education in medical school, residency training, and practice. J Am Med Assoc. 2019; 321 (14): 1351-1352. doi: 10.1155/2015/357627.
Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015; 1-7. doi: 10.1155/2015/357627.
DiMaria-Ghalili RA, Mirtallo JM, Tobin BW, Hark L, Van Horn L, Palmer CA. Challenges and opportunities for nutrition education and training in the health care professions: Intraprofessional and interprofessional call to action. Am J Clin Nutr. 2014; 99 (5): 1184-1193. doi: 10.3945/ajcn.113.073536.
Aspry KE, Van Horn L, Carson JAS, et al. Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: A science advisory from the American Heart Association. Circulation. 2018; 137 (23): 821-841. doi: 10.1161/cir.0000000000000563.
Crogan NL, Shultz JA. Comparing nutrition knowledge exam scores with reported nutrition topics of. J Nurses Staff Dev - JNSD. 2000; 16 (6): 277-281.
Mogre V, Yakubu A, Fuseini M, Amalba A, Aguree S. Nurses’ knowledge and attitudes regarding malnutrition in children and its management in Ghana. Curationis. 2017; 40 (1): 1-8. doi: 10.4102/curationis.v40i1.1618.
Ilmonen J, Isolauri E, Laitinen K. Nutrition education and counselling practices in mother and child health clinics: Study amongst nurses. J Clin Nurs. 2012; 21 (19-20): 2985-2994. doi: 10.1111/j.1365-2702.2012.04232.x.
Kgaphola MS, Wodarski LA, Garrison MEB. Nutrition knowledge of clinic nurses in Lebowa, South Africa: Implications for nutrition services delivery. J Hum Nutr Diet. 1997; 10 (5): 295-303. doi: 10.1046/j.1365-277X.1997.00063.x.
Kazi AM, Khalid W. Questionnaire designing and validation. J Pak Med Assoc. 2012; 62 (5): 514-516.
Lai PSM. Validating instruments of measure: Is it really necessary? Malaysian Fam Physician. 2013; 8 (1): 2-4.
Garcia de Yebenes Prous M, Rodriguez SF, Carmona OL. Validation of questionnaires. Reumatol Clin. 2009; 5: 171-177.
Moher D, Liberati A, Tetzlaff J, Altman D. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009; 6 (7). doi: 10.1371/journal.pmed1000097.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ WV, ed. Cochrane Handbook for Systematic Reviews of Interventions. 6th ed. Cochrane; 2019. www.training.cochrane.org/handbook.
Covidence Systematic Review Software. Melbourne, Australia: Veritas Health Health Innovation; 2018.
Microsoft Excel. Version 1902. Redmond, WA: Microsoft Corp; 2018.
Academy of Nutrition and Dietetics. Evidence Analysis Manual: Steps in the Academy Evidence Analysis Process. 2016.
Mumby S, Leineweber M, Andrade J. The impact the smarter lunchroom movement strategies have on school children’s healthy food selection and consumption: A systematic review. J Child Nutr Manag. 2018; 42 (2).
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33 (1): 159-174. doi: 10.2307/2529310.
IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N. Y., USA).
Flynn M, Sciamanna C, Vigilante K. Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins. Nutr J. 2003; 2 (April 1998): 1-4. doi: 10.1186/1475-2891-2-19.
Perry L. Fishing for understanding: Nurses knowledge and attitudes in relation to nutritional care. Int J Nurs Stud. 1997; 34 (6): 395-404.
Stanek KL, Powell M, Betts N. Nutritional knowledge of nurses in long-term health care facilities. J Nutr Elder. 1991; 10 (3): 35-48. doi: 10.1300/J052v10n03.
Lindseth G. Nutriton preparation and the geriatric nurse. West J Nurs Res. 1994; 16 (6): 692-703.
Lindseth G. Evaluating rural nurses for preparation in implementing nutrition interventions. J Rural Heal. 1990; 6 (3): 231-245. doi: 10.1111/j.1748-0361.1990.tb00664.x.
Harkin N, Johnston E, Mathews T, et al. Physicians’ dietary knowledge, attitudes, and counseling practices: The experience of a single health care center at changing the landscape for dietary education. Am J Lifestyle Med. 2019; 13 (3): 292-300. doi: 10.1177/1559827618809934.
Al-Zahrani AM, Al-Raddadi RM. Nutritional knowledge of primary health care physicians in Jeddah, Saudi Arabia. Saudi Med J. 2009; 30 (2): 284-287.
Al-Numair KS. Nutrition knowledge of primary care physicians in Saudi Arabia. Pakistan J Nutr. 2004; 3 (6): 344-347. doi: 10.3923/pjn.2004.344.347.
Al-Shwaiyat NM. Assessment of therapeutic nutritional knowledge of Jordanian nurses. Int J Nutr Food Sci. 2013; 2 (3): 142. doi: 10.11648/j.ijnfs.20130203.18.
Alkhaldy AA. Nutritional knowledge and self-reported nutritional practice against malnutrition among physicians in Jeddah, Saudi Arabia. Healthcare. 2019; 7 (4): 149. doi: 10.3390/healthcare7040149.
Kable A, James C, Snodgrass S, et al. Nurse provision of healthy lifestyle advice to people who are overweight or obese. Nurs Heal Sci. 2015; 17 (4): 451-459. doi: 10.1111/nhs.12214.
Martin L, Leveritt MD, Desbrow B, Ball LE. The self-perceived knowledge, skills and attitudes of australian practice nurses in providing nutrition care to patients with chronic disease. Fam Pract. 2014; 31 (2): 201-208. doi: 10.1093/fampra/cmt070.
Schaller C, James EL. The nutritional knowledge of Australian nurses. Nurse Educ Today. 2005; 25 (5): 405-412. doi: 10.1016/j.nedt.2005.04.002.
Duerksen DR, Keller HH, Vesnaver E, et al. Nurses’ perceptions regarding the prevalence, detection, and causes of malnutrition in Canadian hospitals: Results of a Canadian malnutrition task force survey. J Parenter Enter Nutr. 2016; 40 (1): 100-106. doi: 10.1177/0148607114548227.
Duerksen DR, Keller HH, Vesnaver E, et al. Physicians’ perceptions regarding the detection and management of malnutrition in Canadian hospitals: Results of a Canadian malnutrition task force survey. J Parenter Enter Nutr. 2015; 39 (4): 410-417. doi: 10.1177/0148607114534731.
Temple NJ. Survey of nutrition knowledge of Canadian physicians. J Am Coll Nutr. 1999; 18 (1): 26-29. doi: 10.1080/07315724.1999.10718823.
Boaz M, Rychani L, Barami K, et al. Nurses and nutrition: A survey of knowledge and attitudes regarding nutrition assessment and care of hospitalized elderly patients. J Contin Educ Nurs. 2013; 44 (8): 357-364. doi: 10.3928/00220124-20130603-89.
Endevelt R, Werner P, Goldman D, Karpati T. Nurses’ knowledge and attitudes regarding nutrition in the elderly. J Nutr Heal Aging. 2009; 13 (6): 485-489.
Park KA, Cho WI, Song KJ, Lee YS, Sung IS, Choi-Kwon SM. Assessment of nurses’ nutritional knowledge regarding therapeutic diet regimens. Nurse Educ Today. 2011; 31 (2): 192-197. doi: 10.1016/j.nedt.2010.05.017.
Kim H, Choue R. Nurses’ positive attitudes to nutritional management but limited knowledge of nutritional assessment in Korea. Int Nurs Rev. 2009; 56 (3): 333-339. doi: 10.1111/j.1466-7657.2009.00717.x.
Ozcelik AO, Surucuoglu MS, Akan LS. Survey on the nutrition knowledge level of turkish physicians: Ankara as a sample. Pakistan J Nutr. 2007; 6 (6): 538-542.
Yalcin N, Cihan A, Gundogdu H, Ocakci A. Nutrition knowledge of nurses. Heal Sci J. 2013; 7 (1): 99-108.
Bauer S, Halfens RJG, Lohrmann C. Knowledge and attitudes of nursing staff towards malnutrition care in nursing homes: A multicentre cross-sectional study. J Nutr Heal Aging. 2015; 19 (7): 734-740. doi: 10.1007/s12603-015-0535-7.
Mowe M, Bosaeus I, Rasmussen HH, et al. Insufficient nutritional knowledge among health care workers? Clin Nutr. 2008; 27 (2): 196-202. doi: 10.1016/j.clnu.2007.10.014.
Tafese Z, Shele A. Knowledge, attitude and practice towards malnutrition among health care workers in Hawassa City, Southern Ethiopia. Glob Acad Res Journals. 2015; 1 (1): 1-8.
Grammatikopoulou MG, Katsouda A, Lekka K, et al. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition. 2019; 57: 69-73. doi: 10.1016/j.nut.2018.05.013.
Daradkeh GA, Al Bader K, Singh R. The nutrition knowledge of primary care physicians in the state of Qatar. Pakistan J Nutr. 2012; 11 (8): 781-785.
Ameh PO, Yakubu K, Miima M, Popoola O, Mohamoud G, von Pressentin KB. Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees. African J Prim Heal Care Fam Med. 2019; 11 (1): 1-15. doi: 10.4102/phcfm.v11i1.1701.
Hu SP, Wu MY, Liu JF. Nutrition knowledge, attitude and practice among primary care physicians in Taiwan. J Am Coll Nutr. 1997; 16 (5): 439-442. doi: 10.1080/07315724.1997.10718711.
Hu S, Wu M, Liu J. Nutrition knowledge, attitude and practice among primary care physicians in Taiwan. J Am Coll Nutr. 1997; 16 (5): 439-442.
Trakman GL, Forsyth A, Hoye R, Belski R. Developing and validating a nutrition knowledge questionnaire: Key methods and considerations. Public Health Nutr. 2017; 20 (15): 2670-2679. doi: 10.1017/S1368980017001471.
Fincham JE. Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ. 2008; 72 (2): 43. doi: 10.5688/aj720243.
Morton SMB, Bandara DK, Robinson EM, Atatoa Carr PE. In the 21st Century, what is an acceptable response rate? Aust N Z J Public Health. 2012; 36 (2): 106-108. doi: 10.1111/j.1753-6405.2012.00854.x.
Mogre V, Stevens FCJ, Aryee PA, Amalba A, Scherpbier AJJA. Why nutrition education is inadequate in the medical curriculum: A qualitative study of students’ perspectives on barriers and strategies. BMC Med Educ. 2018; 18 (1): 1-11. doi: 10.1186/s12909-018-1130-5.
Matsumoto M, Tanaka R, Ikemoto S. Validity and reliability of a general nutrition knowledge questionnaire for Japanese adults. J Nutr Sci Vitaminol (Tokyo). 2017; 63 (5): 298-305. doi: 10.3177/jnsv.63.298.
National Research Council (US) Committee on nutrition in medical education. Nutrition Education in U.S. Medical Schools. Washington (DC); 1985.
Blunt SB, Kafatos A. Clinical nutrition education of doctors and medical students: Solving the Catch 22. Adv Nutr. 2019; 10 (2): 345-350. doi: 10.1093/advances/nmy082.