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Objective:BRAC, an international development organization based in Bangladesh, engages community health workers called Shasthya Shebikas (SS) to implement home fortification of foods with micronutrient powders (MNP). We identified factors associated with home visits by SS, at different levels of the BRAC programme-delivery hierarchy, to implement home-fortification interventions.Design:We conducted a cross-sectional survey, semi-structured interviews, and collected programme-related data from sub-districts included in the caregiver survey of BRAC’s home-fortification programme and performed multilevel logistic regression modelling to investigate factors associated with home visits by SS.Settings:Sixty-eight sub-districts in Bangladesh.Participants:Caregivers of children aged 6–59 months (n 1408) and BRAC’s SS (n 201).Results:Households with older children (0·55; 0·42, 0·72; P < 0·001) and located >300 m from the SS’s house (0·67; 0·50, 0·89; P = 0·006) were less likely to have been visited by the SS, whereas those with caregivers who had ≥5 years of schooling (1·53; 1·10, 2·12; P = 0·011) were more likely to have been visited by the SS (adjusted OR; 95 % CI). Households in the catchment area of older SS aged >50 years (0·44; 0·21, 0·90; P = 0·025) were less likely to have been visited by the SS, whereas those with SS who received incentives of >800 BDT (3·00; 1·58, 5·58; P = 0·001) were more likely to have been visited by the SS (adjusted OR; 95 % CI).Conclusions:The number of home visits is a function of the characteristics of SS, factors that characterize the households they serve and characteristics of their organizational context, particularly to implement home fortification of foods with MNP.

Objective:To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support.Design:A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey.Setting:Public health units.Participants:Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling.Results:Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals.Conclusions:Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health.

Objectives: Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries. Design: A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data. Setting: The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK. Subjects: Sixty key informants participated in the study. Results: There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents. Conclusions: There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes., funded by DG Education and Culture - JOBNUT project

ObjectiveThe present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development.DesignThe bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices.SettingEducation and practice settings.SubjectsThis model will have applications for educators and practitioners.ResultsModifications to existing models have been informed by the authors’ observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice.ConclusionsPublic health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

ObjectivePublic health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students.DesignThe programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback.ResultsResource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme.ConclusionsThe THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.

ObjectiveTo evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices.DesignThe mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness.SettingVictoria, Australia.SubjectsThirty-two novice public health nutrition practitioners employed in the state public health system.ResultsKey evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness.ConclusionsThis qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

ObjectiveTo explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists.DesignQualitative study using in-depth interviews.Subjects and settingEighteen advanced-level public health nutritionists working in academic and practice settings in Australia.ResultsThe attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition.ConclusionsThe present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.

Objectives:To assess factors affecting competency development of the Australian public health nutrition workforce and investigate competency development intentions, barriers and self-reported training needs.Design:Cross-sectional study using self-administered mail- or email-delivered questionnaire.Setting and subjects:Two hundred and forty practitioners working in designated community and public health nutrition positions in the Australian health system.Results:An 87% questionnaire response rate was achieved. The profile of the sample included female practitioners (95%) within the age range of 26–45 years (67%), from dietetic backgrounds (75%) and employed in state health departments as community dietitians/nutritionists (52%) or public health nutritionists (32%). Only 14% had completed higher degree qualifications but most (80%) reported an intention to do so in the future. Entry-level dietetic education was considered by most respondents (57%) to be inadequate preparation for public health nutrition practice but considered it had utility as a precursor for public health nutrition competency development because of its strong grounding in nutrition knowledge, basic research skills and problem-solving. On-the-job learning was the most prominent competency development influence reported by this workforce. Flexibility in teaching and learning approaches is needed to facilitate workforce participation in further competency development. The main competency development needs focused on analytical and policy process competencies; however, there was a general need expressed for competency development across many competency areas.Conclusions:These data provide intelligence to inform public health nutrition workforce development, particularly that relating to continued professional development amongst the existing workforce.

Objectives:To investigate the attitudes, experiences and beliefs of advanced-level public health nutritionists with respect to public health nutrition workforce composition, core functions, competency requirements and existing workforce capacity.Design:Qualitative study using structured interviews.Setting:Australia.Subjects:Forty-one advanced-level public health nutritionists employed in academic and senior technocratic positions in state health systems.Results:Advanced-level public health nutritionists recognise the diversity of the public health nutrition workforce but clearly identify the need for a specialist public health nutrition workforce tier to provide workforce leadership. Nominated core functions for public health nutrition reflect broader public health core functions but, in the context of nutrition, specific problem resolution. Opinions about competency needs were similar to many of the cross-cutting competencies identified in the public health field but with specific application to nutrition problems. Competency in the scientific underpinning of nutrition was considered particularly important and delineated this public health nutrition workforce from the broader public health workforce. Public health nutrition was identified as a specialisation within public health and dietetics. Workforce capacity assessments by this group indicate a need for workforce development.Conclusions:Qualitative data from a large proportion of the Australian public health nutrition leadership group have identified core functions, competencies and workforce development priorities that can be a basis for further systematic research and workforce strategy development.

ObjectiveTo assess and develop consensus among experienced public health nutrition practitioners from high-income countries regarding conceptualisation of capacity building in practice, and to test the content validity of a previously published conceptual framework for capacity building in public health nutrition practice.DesignA Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50 % of panellists ranking items as ‘very important’ on a five-point Likert scale across three survey rounds.SettingPublic health nutrition practice in Australia, the UK, Canada and the USA.SubjectsPublic health nutrition practitioners and academics.ResultA total of thirty expert panellists (68 % of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management.ConclusionsThe findings from the study suggest there is broad agreement among public health nutritionists from high-income countries about how they conceptualise capacity building in public health nutrition practice. This agreement suggests considerable content validity for a capacity building conceptual framework proposed by Baillieet al. (Public Health Nutr12, 1031–1038). More research is needed to apply the conceptual framework to the implementation and evaluation of strategies that enhance the practice of capacity building approaches by public health nutrition professionals.

ObjectiveTo outline a framework and a process for assessing the needs for capacity development to achieve nutrition objectives, particularly those targeting maternal and child undernutrition.DesignCommentary and conceptual framework.SettingLow- and middle-income countries.ResultA global movement to invest in a package of essential nutrition interventions to reduce maternal and child undernutrition in low- and middle-income countries is building momentum. Capacity to act in nutrition is known to be minimal in most low- and middle-income countries, and there is a need for conceptual clarity about capacity development as a strategic construct and the processes required to realise the ability to achieve population nutrition and health objectives. The framework for nutrition capacity development proposed recognises capacity to be determined by a range of factors across at least four levels, including system, organisational, workforce and community levels. This framework provides a scaffolding to guide systematic assessment of capacity development needs which serves to inform strategic planning for capacity development.ConclusionsCapacity development is a critical prerequisite for achieving nutrition and health objectives, but is currently constrained by ambiguous and superficial conceptualisations of what capacity development involves and how it can be realised. The current paper provides a framework to assist this conceptualisation, encourage debate and ongoing refinement, and progress capacity development efforts.

Objective: To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice. Design: A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders. Setting: Europe. Subjects: A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries. Results: Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups. Conclusions: This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe., EU DG Education and Culture - project JOBNUT

ObjectiveTo test the feasibility of a pan-European professional recognition system for public health nutrition.DesignA multistage consultation process was used to test the feasibility of a model system for public health nutritionist certification. A review of existing national-level systems for professional quality assurance was conducted via literature review and a web-based search, followed by direct inquiries among stakeholders. This information was used to construct a consultation document circulated to key stakeholders summarising the rationale of the proposed system and inviting feedback about the feasibility of the system. Two consultation workshops were also held. The qualitative data gathered through the consultation were collated and thematically analysed.SettingEurope.SubjectsPublic health nutrition workforce stakeholders across twenty-nine countries in the European Union.ResultsOne hundred and forty-five contacts/experts representing twenty-nine countries were contacted with responses received from a total of twenty-eight countries. The system proposed involved a certification system of professional peer review of an applicant's professional practice portfolio, utilising systems supported by information technology for document management and distribution similar to peer-review journals. Through the consultation process it was clear that there was overall agreement with the model proposed although some points of caution and concern were raised, including the need for a robust quality assurance framework that ensures transparency and is open to scrutiny.ConclusionsThe consultation process suggested that the added value of such a system goes beyond workforce development to enhancing recognition of the important role of public health nutrition as a professional discipline in the European public health workforce.

ObjectiveTo assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts.DesignA modified Delphi study involving three rounds of questionnaires.SettingEuropean Union.SubjectsPublic health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries.ResultsA total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within theNutrition science,Professional,AnalyticalandPublic health servicescompetency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study.ConclusionsCompetencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

ObjectivesThe present paper aims to review and report on the current and predicted future public health nutrition workforce in South Africa. Additionally, it examines ways in which the Department of Health (DOH) is striving to meet the increasing burden of nutrition-related diseases in South Africa.MethodsThe primary sources of data used for the review were reports from the Census office, South African health reviews, mortality and morbidity statistics, and documents from the Health Professions Council of South Africa.ResultsThere are fewer than 2000 registered dietitians in South Africa and fewer than 600 of them work in the public health sector. Furthermore, professional nurses – who are the backbone of the primary health-care system and deliver the rudiments of basic nutritional care – are not being trained in sufficient numbers to meet population growth; in 2004 there was only one nurse per 4000 persons. This situation is aggravated by the growing burden of conditions associated with both overnutrition and undernutrition, as well as the enormous demands of the HIV/AIDS epidemic. The DOH is striving to meet these increasing needs by means of the Integrated Nutrition Programme as well as a National Human Resources Plan which includes numerous strategies to improve the quantity and quality of health professionals’ training, including dietitians and nutritionists. This plan includes the objective of increasing the public health nutrition workforce to more than 250 newly trained dietitians and nutritionists per annum by 2010.

ObjectiveRenewed focus on public health has brought about considerable interest in workforce development among public health nutrition professionals in Canada. The present article describes a situational assessment of public health nutrition practice in Canada that will be used to guide future workforce development efforts.MethodsA situational assessment is a planning approach that considers strengths and opportunities as well as needs and challenges, and emphasizes stakeholder participation. This situational assessment consisted of four components: a systematic review of literature on public health nutrition workforce issues; key informant interviews; a PEEST (political, economic, environmental, social, technological) factor analysis; and a consensus meeting.FindingsInformation gathered from these sources identified key nutrition and health concerns of the population; the need to define public health nutrition practice, roles and functions; demand for increased training, education and leadership opportunities; inconsistent qualification requirements across the country; and the desire for a common vision among practitioners.ConclusionsFindings of the situational assessment were used to create a three-year public health nutrition workforce development strategy. Specific objectives of the strategy are to define public health nutrition practice in Canada, develop competencies, collaborate with other disciplines, and begin to establish a new professional group or leadership structure to promote and enhance public health nutrition practice. The process of conducting the situational assessment not only provided valuable information for planning purposes, but also served as an effective mechanism for engaging stakeholders and building consensus.

Objective:This paper describes a conceptual framework and associated intelligence requirements for problem-based workforce development for public health nutrition.Methods:A conceptual framework for public health nutrition workforce development was constructed based on a review of the literature and consideration of the intelligence needs to inform workforce development planning.Results:A cyclical conceptual framework including five intelligence-linked components including public health nutrition problems and priorities, solutions and best buys, work needed, capacity to do the work and workforce development needs. This framework applied to the Australian situation illustrates its applications in workforce development research and planning. Although the existing availability of workforce development intelligence in each of these components varies, the framework does provide a systematic approach for workforce development research and planning directly related to public health nutrition problem resolution.Conclusions:This framework highlights deficiencies in the existing public health nutrition workforce development intelligence and the need for further research to inform workforce development strategy planning.