Research is the basis for successful practice in any profession.

Research and the dietetics profession: Making a bigger impact MELINDA M. MANORE, PhD, RD; ESTHER F. MYERS, PhD, RD, FADA Research is the basis for successful practice in any profession. Because of the stakes involved, research is especially important in the healthcare field. In the dietetics profession, we recognize that it is incumbent upon us to use research as the foundation for decisions and recommendations we make in practice, education, and public policy. M. M. Manore is professor and chair in the Department of Nutrition and Food Management, Oregon State University, Corvallis; E. F. Myers is Director, Scientific Affairs and Research at ADA headquarters in Chicago, IL. The Research Philosophy and Diagram were developed by the Research Committee with input from House of Delegates dialogue Research Committee Members: Melinda Manore, PhD, RD, Chair; Constance Geiger, PhD, RD; Charlette Gallagher-Allred, PhD, RD; Carol Shanklin PhD, RD; Rachel Johnson, PhD, MPH, RD; Peter Beyer, MS, RD; Elvira Johnson, MS, RD; Linda Snetselaar, PhD, RD; Marianne Smith-Edge, MS, RD, FADA. Research Backgrounder developed by Karri Looby, MS, RD, Manager, Membership/Governance. Copyright 2003 by the American Dietetic Association. 0002-8223/03/10301-0013$35.00/0 doi: 10.1053/jada.2003.50021 NEED FOR EVIDENCE-BASED PRACTICE First, research is important in dietetics practice because it is the foundation of our profession. Stakeholders purchasing dietetics services or employing dietetics professionals are increasingly demanding that healthcare services, including dietetics, be supported by high-caliber research and evidencebased practice guidelines. Research is also the basis for education, since it drives the core knowledge and competencies we expect dietitians to understand and practice. Second, research is necessary to strengthen and sustain the knowledge base of our profession. Third, research is important in setting public policy. As the leading source of food and nutrition information, the American Dietetic Association (ADA) is increasingly being asked to testify before Congress or submit comments on proposed regulations and public policy related to nutrition, health, and food issues. The ADA is also being asked to provide input to the research agendas of other organizations (corporate, federal, professional). It is critical that any testimony, information, or recommendations coming from the ADA be based on the most current research. The Nutrition Policy Task Force (2001) proposed seven principles to guide public policy efforts in food, nutrition, and health. Two of the seven principles reflect an emphasis on research: Principle 5: Sound science and its application in technology contribute to effective food, nutrition, and health policy. Principle 7: Evidence-based medical nutrition therapy is an integral part of disease treatment, management, and rehabilitation. Each year, the ADA provides members with a research summary supporting the Association s initiatives to give to their legislators during the Public Policy Workshop (1). ADA MEMBER KNOWLEDGE, SKILLS, AND COMPETENCIES The Commission on Accreditation for Dietetics Education (CADE) establishes the accreditation standards for education programs preparing entry-level dietetics practitioners. The knowledge and competency areas within the standards are: communications, physical and biological sciences, social sciences, research, food, nutrition, management, and healthcare systems. Within a didactic education program, research knowl- 108 / January 2003 Volume 103 Number 1

edge and competencies can be enhanced through participation in research activities, such as a clinical research project (2). Specific research-related competencies for entry-level graduates are listed below: basic knowledge about research methodologies, needs assessment, and outcomes-based research; working knowledge of the scientific method and quality improvement method; and demonstrated ability to interpret current research and basic statistics (3). The ADA and its credentialing agency, the Commission on Dietetic Registration (CDR), have the Code of Ethics, which provides guidance to dietetics practitioners in their professional practice and conduct. By accepting membership in the ADA and/or accepting and maintaining the CDR s credentials, individuals agree to abide by the Code. Specific principles in the Code related to research are as follows: The dietetics practitioner practices dietetics based on scientific principles and current information. The dietetics practitioner presents substantiated information and interprets controversial information without personal bias, recognizing that legitimate differences of opinion exist. The dietetics practitioner assumes responsibility and accountability for personal competence in practice, continually striving to increase professional knowledge and skills and to apply them in practice (4). The ADA has helped dietetics professionals provide quality services through the development of uniform standards called the Standards of Professional Practice for Dietetics Professionals (5). These standards are not requirements, but are broad statements describing the minimum expectations of dietetics professionals in providing nutrition services to the public. The Standards state that a dietetics professional can effectively apply, participate in, or generate research to enhance practice. The Standards list the following indicators as measures of success related to research: locates and reviews research findings for their application to dietetics practice; bases practice on sound scientific principles, research and theory; promotes research through alliances and collaboration with dietetics and other professionals and organizations; contributes to the development of knowledge and research in dietetics; collects measurable data and documents outcomes within the practice setting; and shares research data and activities through various media. The Standards also list the following expected outcomes when research is applied in practice: The client receives appropriate services based on the effective application of research. A foundation for performance measurement and improvement is provided. Outcomes data support reimbursement for the services of dietetics professionals. Research findings are used for the development and revision of policies, procedures, practice guidelines, protocols, and clinical pathways. Professionals use benchmarking and knowledge of best practices to improve performance. While the ADA is made up of individual members with a myriad of skills, the collective capability of ADA members to contribute to research is critical to the continued growth of the dietetics profession. RESEARCH CAPABILITY OF ADA Although dietetics is an applied science, with 50% of practitioners holding advanced degrees (1,495 with PhDs) (6), there are few dietitians involved in research projects. A 1999 member survey showed that 2% report serving as principal investigators, 3% report participating in designing research studies or writing research reports, and 2% report implementing research studies designed by others (7). Of the 550 ADA members with PhDs who responded to a 2001 research survey, 70% reported submitting at least one research proposal in the last five years (8). Only 36% of members who have completed the Portfolio Development Process selected research and grant writing as a future learning need. These results indicate that only a small percentage of members are seeking research skills for the future (9). The Spring 2001 House of Delegates (HOD) passed a motion recognizing the following research related needs: critical evaluation of the research in preparation of evidencebased practice guides; integration of research findings into daily practice; and dietitians participating in research in the practice setting. To support research within the profession, the American Dietetic Association Foundation (ADAF) has started the Research Endowment Fund, which will provide seed grant monies to explore research questions important to the profession. To better assist members in integrating research into the profession, the ADA Research Committee developed a research philosophy, a diagram reflecting the role of research in the dietetics profession, and a list of research-related roles for the ADA. These items were presented to the HOD for dialogue, modified based on HOD input, and then approved by the House Leadership Team. RESEARCH IN THE DIETETICS PROFESSION The definition of dietetics, reaffirmed by the Board of Directors in 2000, was the starting point for the development of the research philosophy statement and the accompanying diagram. Both are intended to reflect how various areas of research are necessary for the dietetics profession. Philosophy and ADA Roles The research philosophy statement and accompanying ADA roles are given in Figure 1 and will be used to guide decisions regarding ADA research activities. Each of the research roles is followed by a brief description and appropriate applications. Although ADA is not a major research funding agency, many other roles related to research are appropriate, such as facilitating a multidisciplinary research proposal for submission to a federal funding agency or convening a group of expert scientists and practitioners to develop specific research questions related to the dietetics profession (eg, nutritional genomics). Research Diagram The research diagram (Figure 2) shows how dietetics professionals integrate research from a variety of areas into their daily practice. Although the diagram does not include every type of research used by dietitians, it does represent the major sources of research knowledge. Each area of research has a brief description to explain the types of knowledge that the dietetics professional might use. Types of research designs, such as epidemiological or clinical trials, are Journal of THE AMERICAN DIETETIC ASSOCIATION / 109

FIG 1. ADA research philosophy statement and accompanying roles.

FIG 2. ADA Research Philosophy and Diagram. not listed specifically and may be present in several research areas. The diagram also has a separate area designated as dietetics research, which represents research unique to dietetics. The outside circle of the diagram reflects the context and environment that surrounds both the research and the dietetics professional. The words practice, education, and policy reflect the major environments in which the dietetics professional will apply research. Journal of THE AMERICAN DIETETIC ASSOCIATION / 111

Applications and use The research diagram (Figure 2) can be used as an educational tool to assist dietetics professionals in identifying research needed in practice and for professional development. Educators can incorporate the research philosophy and diagram into the curriculum to explain how the dietetics professional integrates knowledge from various areas of research. The dietetics professional can use the diagram to identify specific research learning needs related to their professional development portfolio. The diagram can also be useful to help others outside the profession understand the broad research and knowledge areas that the dietetics profession encompasses. Finally, ADA leaders and staff will use the research roles listed in the diagram to determine how the organization can promote research. For example, in some roles the ADA may act as an advocate, while in other situations it may be appropriate for the ADA to facilitate the actual writing of a research grant. The ADA has always played a major role in disseminating research through the Journal of the American Dietetic Association and a multitude of other avenues, including e-mail/listserv communication, the ADA Web site, public relations documents, position papers, and official testimony. SUMMARY Research strengthens the credibility of the profession and keeps the ADA on par with other health professions who use evidence-based guidelines. The ADA understands the importance of research to our profession and the need for dietitians to be instrumental in making advances in the science of all aspects of nutrition, health, and food issues. The development and publication of the ADA s research philosophy and the active role the Association is now taking in establishing evidencebased guidelines and promoting research will continue to position the ADA as the leading source of food and nutrition information. References 1. Discussion Paper on Food, Nutrition and Health Policy. Available at: http:// www.eatright.com/images/leadership/nptf.pdf. Accessed October 31, 2002. 2. Brehm BJ, Rourke KM. Enhancing didactic education through participation in a clinical research project. J Am Diet Assoc. 1999;99:1090-1093. 3. CADE Accreditation Handbook. Available at: http://www.eatright.com/ cade/standards.html. Accessed October 31, 2002. 4. ADA Code of Ethics. Available at: http://www.eatright.com/adacode.html. Accessed October 31, 2002. 5. ADA Standards of Professional Practice for Dietetics Professionals. Available at: http://www.eatright.com/qm/standardslist.html. Accessed October 31, 2002. 6. Bryk JA. Report on the 1999 Membership Database of the ADA. J Am Diet Assoc. 2001;121:947-953. 7. Rogers D, Leonberg BL, Broadhurst CB. 2000 Commission on Dietetic Registration Dietetics Practice Audit. J Am Diet Assoc. 2002;102:270-292. 8. Survey of Researchers. Unpublished report. Conducted by the Research Committee of The American Dietetic Association. October 2002. 9. Keim KS, Johnson CA, Gates GE. Learning needs and continuing professional education activities of Professional Development Portfolio. J Am Diet Assoc. 2001;101:697-702. 112 / January 2003 Volume 103 Number 1