An evaluation of a public health nutrition workforce development intervention for the nutrition and dietetics workforce

Background: Workforce development is a key element for building the capacity to effectively address priority population nutrition issues. On‐the‐job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition; however, there is limited evidence for their effectiveness. Methods: An evaluation of a mentoring circle workforce development intervention was undertaken. Thirty‐two novice public health nutritionists participated in one of three mentoring circles for 2 h, every 6 weeks, over a 7‐month period. Pre‐ and post‐intervention qualitative (questionnaire, interview, mentor diary) and quantitative (competence, time working in public health nutrition) data were collected. Results: The novice public health nutritionists explained the intervention facilitated sharing of ideas and strategies and promoted reflective practice. They articulated the important attributes of the mentor in the intervention as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback. Participants reported a gain in competency and had an overall mean increase in self‐reported competence of 15% (range 3–48% change; P < 0.05) across a broad range of competency elements. Many participants described re‐orienting their practice towards population prevention, with quantifiable increases in work time allocated to preventive work post‐intervention. Conclusions: Mentoring supported service re‐orientation and competency development in public health nutrition. The nature of the group learning environment and the role and qualities of the mentor were important elements contributing to the interventions effects. Mentoring circles offer a potentially effective strategy for workforce development in nutrition and dietetics.     

Going rural but not staying long: Recruitment and retention issues for the rural dietetic workforce in Australia

Aim: To determine the recruitment and retention issues for rural based dietetic services. Methods: A sequential explanatory mixed methods approach was used to examine six case study sites of dietetic practice, in a geographical area covering 30 000 km² in rural New South Wales, Australia. Quantitative data were obtained from document searches of human resource records between 1991 and 2006. Data were tabulated and counts and proportions used. Qualitative data were obtained from in-depth semistructured individual interviews conducted with 40 key informants including past and present dietitians (n = 28), dietetic managers (n = 3), health service managers (n = 6) and other key influencers (n = 3). The interviews were thematically analysed using the NVivo 7 program. Themes were coded into common categories, using a constant comparison inductive approach. Results: Ninety individual dietitians (94% female) were employed across the six sites over 15 years. The majority were new graduates with less than 1 year of experience. Approximately one-third remained in their position for less than 6 months while 32% remained for 2 years or longer. Key themes emerged from the qualitative data around the characteristics of a rural role, line management of dietitians in a rural site and establishing and maintaining rural staff. Conclusion: Recruitment and retention in rural areas may be improved in the future through strategies to reduce perceived professional isolation, improve management support, access to continuing education and the development of career pathways.     

Update on Medicare‐funded allied health chronic disease management consultations in dietetics and the five most referred professions in 2010

Aim: Uptake of Medicare‐funded chronic disease management items has increased exponentially since the programme commenced in 2004. We aim to report on national utilisation of the five most referred of 13 allied health services and to examine patient uptake rates. Methods: Annual statistics generated from national Medicare billing data from January 2010 to December 2010 were extracted from the Medicare public database and compared by profession, state and per capita population. Results: The five most utilised individual services were: (in decreasing order) podiatry, physiotherapy, dietetics, chiropractic and speech pathology. They provided 94% of all allied health consultations nationally, on referral from general practitioners. Per capita utilisation revealed wide variation in uptake by state and territory; some states had far less services than the national average. Patterns of referral instanced by age range and gender of clientele differed between professions. Most dietetics clients were middle aged (45–74 years) and this fits with expectations of chronic disease incidence. There was inequity of access to group services for the management of type 2 diabetes, with most services (85%) provided in South Australia and New South Wales. Conclusion: Dietetics providers have maintained and improved their referral rate and continue to be the third most utilised Medicare chronic disease management allied health service. Six years into the programme, further exploration is warranted to understand the reasons for wide variation in rates of patient uptake for the service provider professions.     

Profile of the rural allied health workforce in northern New South Wales and comparison with previous studies

Objective: To survey allied health professionals in one region of New South Wales. Design: A questionnaire designed to give a profile of the allied health workforce was mailed to 451 practitioners from 12 health professions between July and September 2005. Setting: The region included the upper Hunter Valley, Liverpool Plains, New England Tablelands and North-west Slopes and Plains of New South Wales. Main outcome measures: The overall response was 49.8%, although the response rates varied between disciplines. Data were collected for a wide range of dependent variables. Results: Pharmacists were the most numerous respondents (21.8%), followed by physiotherapists (17.3%), psychologists (12.4%), radiographers (11.1%) and occupational therapists (10.6%). These five professions made up 73.3% of respondents. Approximately 75% of the sample worked in Rural, Remote and Metropolitan Areas (RRMA) 3 and 4 sized towns. The female to male ratio was 3:1. The mean age was 43 years, the average time since qualification was 20 years and the mean time in the current position was 10 years. Half of the respondents said they intended leaving within 5 years. Some 65% were of rural origin. The ratio of private to public sector employment was 0.75:1, with 64.0% working full-time. Conclusions: Comparison is made between this and previous studies. The results highlight the need for further regional allied health workforce profiling and for a recruitment and retention strategy that targets new graduates of rural origin and encourages them to stay.     

Comparison of the results of two rural allied health workforce surveys in the Hunter New England region of New South Wales: 2005 versus 2008

Objective: To compare the results of the 2005 and 2008 surveys of the rural allied health workforce in the study region. Design: Comparative analysis of two cross‐sectional surveys. Setting: The rural, northern sector of the Hunter New England region of NSW, Australia. Participants: Both surveys targeted 12 different allied health professions. There were 225 respondents in 2005 and 205 in 2008. Main outcome measures: Comparison is made for 15 dependent variables. Results: There was no significant difference for most variables between 2005 and 2008. Mean age and mean years qualified decreased slightly, from 43 to 41 years and from 20 to 17 years, respectively. The proportion of respondents of rural origin was about two‐thirds in both studies and about half had a rural placement during training. While more than half supervised students, only about one‐third had received training for that role. In both 2005 and 2008, the proportion working 35 or more hours each week was about 66% but the proportion working more than 40 hours had doubled to about 36%. In both surveys about half intended leaving their job within 10 years, while the proportion satisfied with continuing professional development access had halved, from 70% to 35%. Conclusions: Most results of the 2005 Hunter New England survey were verified. It was confirmed that a large proportion of the allied health workforce in the region intend leaving their job in the next 5 to 10 years. This is a concern for the development of new service delivery models.     

Future Dietitian 2025: informing the development of a workforce strategy for dietetics

Background

Healthcare is changing and the professions that deliver it need to adapt and change too. The aim of this research was to inform the development of a workforce strategy for Dietetics for 2020–2030. This included an understanding of the drivers for change, the views of stakeholders and recommendations to prepare the profession for the future.

Methods

The research included three phases: (i) establishing the context which included a literature and document review (environmental scan); (ii) discovering the profession and professional issues using crowd‐sourcing technology; and (iii) articulating the vision for the future using appreciative inquiry.

Results

The environmental scan described the current status of the dietetic profession, the changing healthcare environment, the context in which dietitians work and what future opportunities exist for the profession. The online conversation facilitated by crowd‐sourcing technology asked the question: ‘How can dietitians strengthen their future role, influence and impact?’ Dietitians and interested stakeholders (726 and 109, respectively) made 6130 contributions. Seven priorities were identified and fed into the appreciative inquiry event. The event bought together 54 dietitians and analysis of the discussions generated five themes: (i) professional identity; (ii) strong foundations‐creating structure and direction for the profession; (iii) amplifying visibility and influence; (iv) embracing advances in science and technology; and (v) career advancement and emerging opportunities.

Conclusions

A series of recommendations were made for the next steps in moving the workforce to a new future. The future for dietetics looks bright, embracing technology, as well as exploring different ways of working and new opportunities, as this dynamic profession continues to evolve.

     

Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians

Aim: To examine current Australian dietetic practice in the management of gestational diabetes, to identify models of dietetic care and to determine the need for national evidence‐based dietetic practice guidelines for gestational diabetes. Methods: A 55‐item cross‐sectional survey of Australian dietitians practicing in the area of gestational diabetes was undertaken. Participants were recruited via Dietitians Association of Australia interest group membership, public and private hospital maternity and diabetes services across Australia. The survey examined dietetic service provision, interventions, management recommendations, postnatal care, current guideline use and the perceived need for Australian evidence‐based dietetic management guidelines. Results: A total of 220 eligible dietitians participated in the survey. The majority (77%) reported that all women with gestational diabetes attending their service were referred to a dietitian. Group (33%) and individual consults (93%) were provided and 67% provided one to two dietetic consults per client. Fifty‐four per cent (54%) believed that their service currently offered adequate antenatal dietetic interventions and 8% adequate postnatal follow up for women with gestational diabetes. There were differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. However, consistency was seen in key components of nutrition education. Dietitians perceived that there was a need for evidence‐based gestational diabetes dietetic practice guidelines (86%) and nutrition recommendations (87%). Conclusion: The survey results strongly indicate there is a need for evidence‐based gestational diabetes practice guidelines and nutritional recommendations and provide baseline data for future practice of Australian dietitians working in gestational diabetes.     

Small-area estimates of general practice workforce shortage in rural and remote Western Australia

OBJECTIVE: To trial a measure of rural and remote GP access for small areas. Design: A cross-sectional study using geographical information systems software to calculate GP to population rates with a floating catchment of 100 km radius around census collection districts (CCDs). SETTING: Non-metropolitan Western Australia. PARTICIPANTS: The locations and full-time equivalents of GPs and other primary-care doctors were identified through a GP workforce survey. MAIN OUTCOME MEASURES: GP to population ratios for each CCD were classified as being above or below a benchmark of adequate GP access. CCDs with no GP sessions reported within 100 km were identified separately. These categories were investigated by divisions of general practice and by indigenous status, age and employment characteristics of the population. RESULTS: Small-area estimates detected greater variation in access than depicted by conventional methods. Sixty-four per cent of the non-metropolitan population live in CCDs with adequate GP access. Forty-five per cent of indigenous people and 52% of people working in rural industries live in CCDs with access below the benchmark. CONCLUSIONS: The floating catchment method is a powerful tool to identify small areas of inadequate service. It can be applied to measure access to other professionals, medical equipment or facilities.     

Mapping the public health workforce I: a tool for classifying the public health workforce

We aimed to develop a tool to identify members of the public health workforce and classify them using categories developed for the Chief Medical Officer's project to strengthen the public health function. The tool was developed to gain a picture of London's public health workforce, and needed to be reliable and easy to use in many settings inside and outside the health service. We needed to be able to classify posts from brief information without interrogation of postholders, so that the entire workforces of large organisations could be classified from information provided by only a few key informants. Key questions and decision rules were defined by presenting interviewees in public health with brief information on nine jobs and discussing with them the process by which they determined whether each post was in the public health workforce, and if so, in which category. The questions and decision rules were refined into a classification tool which was presented as a flow diagram and a questionnaire. Application of the tool revealed that it was understood by key informants and resulted in classifications which were accepted by the researchers. The tool has now been applied extensively in London and yielded useful results. Many other applications in public health workforce planning and development are anticipated.     

Building sustainable rural research capacity: the experiences of a brain injury rehabilitation service

There is an emerging recognition of the need for health research that is conducted by and for rural people. Rural research promotes excellence in clinical practice and can improve staff recruitment and retention. A group of clinicians from a regional brain injury service collaborated with academics at their local university to form the Rural Rehabilitation Research on Brain Injury initiative. This initiative has funded four peer-reviewed research projects, secured an Australian Research Council grant and established the beginnings of a state-wide rural research collective involving all Brain Injury Rehabilitation Programs in New South Wales. Sustainable research enterprises such as this have significant potential as a 'prototype' for building research capacity in other rural health sectors. Governments and funding bodies should support these initiatives.