Validation of an evidence-based dietetic practice instrument and the association between level of education and use of evidence-based dietetic practices among registered dietitian nutritionists

Abstract

Evidence-based practice (EBP) is associated with improved and consistent patient care and reduced healthcare costs. While dietetic didactic and practice requirements emphasize EBP, there is a lack of a valid and reliable instrument that measures both objective and subjective knowledge of EBP among registered dietitian nutritionists (RDNs). Content validity was conducted with 11 experts and resulted in a 38-item survey that included ten items assessing objective knowledge of EBP. Items were deemed clear and appropriate for the survey goals and intended audience based on a face validity review among 16 RDNs with varying backgrounds. A pilot evaluation (n = 12) pre- and post-research methods course found responsiveness to the objective knowledge subscale; however, this was only statistically significant with the pre-validation instrument (p = .05, r = .57). Internal consistency reliability (n = 482) was acceptable for the survey (Cronbach’s alpha = .91) and its subscales. However, the objective knowledge subscale was low (Cronbach’s alpha = .41), likely due to too few items and variation in EBP exposure and training among participants. Test-retest (n = 335) found a good degree of reliability within the objective knowledge subscale at both timepoints (ICC = .71). Secondarily, this instrument was used to assess associations between level of education (i.e., bachelor’s, master’s, doctoral) and objective knowledge of EBP (n = 482). This research suggests that each increasing degree type further supports the knowledge of EBP concepts (all comparisons p \u3c .001). Other predictors of EBP include recency of degree completion, peer-reviewed publications, and specialty certifications. Moderate positive associations (r = .41, p \u3c .001) were found between subjective and objective knowledge measures, suggesting RDNs may be relatively accurate in their self-assessed knowledge of EBP. Future research should evaluate the efficacy of EBP training, particularly among practitioners further from degree completion