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In response to growing evidence that student healthcare professionals find professional practicum stressful and that it negatively affects their mental health, a six-session psychoeducation Resilience and Wellbeing Program was implemented by a professional counselor in Year 3 of the Bachelor of Nutrition and Dietetics at Griffith University, Australia. The aim of this study was to evaluate student dietitians' perceptions of whether the program improved their ability to cope with practicum stressors. The study used a longitudinal cohort design, with students completing surveys at three time points: before and after the program and after the final practicum. The study was completed with two cohorts of students between 2018 and 2020 (n = 111). Most respondents (95%) found their professional practicum to be stressful or challenging on at least some occasions, mostly due to constantly being assessed (56%), finances (40%), and being away from usual supports (38%). Almost all students rated the program as having some value (99%), with the content about stress and self-care the most highly rated. Qualitative comments revealed the program helped students to manage stress by prioritizing their personal needs. Students used stress management skills during the practicum to achieve balance in their lives, despite pandemic conditions.

Background: Health is influenced by many determinants, including the social and physical environment, economic factors, and individual characteristics. Diet and nutrition play a critical role in health, both in the prevention and treatment of non-communicable diseases, with dietary risk factors alone causing 5.3% of the total disease burden in Australia. Dietetic care has been shown to improve consumer outcomes, demonstrating its role in addressing the burden caused by poor diet. While quality has been extensively explored in tertiary and, to a lesser degree, in primary healthcare settings, there is limited research exploring quality in primary care dietetics. The overarching aim of this doctoral research program was to explore quality management in primary care dietetics through the lens of complexity science. Five aims were addressed in four sequential stages of research using a qualitatively driven mixed methods design. The five aims were: i) to describe and evaluate the literature on quality improvement strategies used to enhance health outcomes achieved by dietetic care that is delivered in the primary care setting (Stage 1); ii) to explore primary care dietetics through the lens of complexity science (Stage 2); iii) to explore how healthcare consumers describe nutrition care (Stage 3); iv) to explore how healthcare consumers and professionals describe dietetic care (Stage 3); and v) to develop a theoretical approach to quality management for primary care dietetic services (Stage 4). The research was designed and executed from a pragmatic philosophical positioning and, consequently, focused on exploring quality with a solution- and action-orientated purpose., Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Health Sci & Soc Wrk, Griffith Health, Full Text

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Health Sci & Soc Wrk, Griffith Health, Background: Chronic diseases are a global issue with high human and economic costs and consequences. Chronic disease treatment requires people to change their health related behaviours with support from health care professionals. Behaviour change science is a component of health psychology and behavioural science that can help explain and predict behaviours to guide and inform intervention design. Dietitians in primary care are well-positioned to support adults with chronic disease to change their diet through nutrition education and counselling that incorporates behaviour change science. The way in which this knowledge is applied within dietary interventions, how it can be addressed in practice and whether behaviour change science is adequately taught within dietetics education programs in Australia is unclear, warranting further investigation. The overall aim of this doctoral research program was to explore the application of behaviour change science in the dietetics profession. This exploration was achieved through the following three aims: i) to investigate how behaviour change science is used in dietetics interventions and determine its effectiveness; ii) to explore how behaviour change science can be applied on an individual level for chronic disease management; iii) to investigate and explore how behaviour change science has been taught within dietetics education programs. These three aims were addressed throughout four phases of research which aligned with the Joanna Briggs Institute (JBI) Model of Evidence Based Healthcare. The JBI Model contextualises five ‘inner segments’ that conceptualises evidence based health care and includes Global Health, Evidence Generation, Evidence Synthesis, Evidence Transfer, and Evidence Implementation. The methodological approach for the body of research drew on both qualitative and quantitative approaches, guided by a pragmatic paradigm with relational epistemology using sequential explanatory mixed methods. This thesis is

Background. Healthcare placements in dietetics education contribute significantly to student learning. Exploring students’ self-conceptualisation of placement experiences may provide insights to better support learning. Self-determination theory (SDT) has been used to seek insight into clinical and educational settings but has not yet been applied to dietetic placement learning. This study investigated dietetics students’ reflections of key influences on placement learning experiences and their alignment with an SDT framework. Methodology. A post-placement two-stage critical incident debrief was conducted with seven successive cohorts (168 students) of dietetic undergraduate students on final placement. In debriefs, students’ anonymous themes were collected and discussed, inductively analysed, and then mapped against an SDT framework of psychological and motivational constructs. Results. Nine key themes were identified that impacted upon placement experiences. Four themes related to framework constructs: 1. Supervisor (and peer) autonomy support: 2. Perceived competence; 3. Relatedness; and, 4. Autonomy and intrinsic motivation. Non-SDT themes were also present including: 5. Learning environment and experience; and, themes about professional behaviours and identity: 6. Teamwork and interactions, 7. Managing emotions and self-care, 8. Dietetic professional communications and behaviours and, 9. Developing a professional identity. Conclusions. Embedding a structured debrief in the curriculum and using a psychological motivational SDT framework to analyse themes arising can provide valuable information about the learning needs of students on placement with potential for wider application in dietetic learning and teaching and workforce employability. The current findings may have application in university curricula before and after professional placement.

Background: Clinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community. Methods: An exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements (n = 14) or blended placements (n = 9). Individual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses. Results: The overarching theme across all blended model placements was ‘enhanced work-readiness’, including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme ‘enhanced work-readiness’: students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blend

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medicine, Griffith Health, Childhood malnutrition is a growing public health challenge for low- and middle-income countries. Globalization and urbanization have led to a significant shift in dietary habits and physical activity patterns over the past few decades, resulting in the coexistence of undernutrition and overnutrition within populations. The negative health, development, and social impacts of childhood malnutrition are serious and ongoing for individuals and their families, while also contributing an economic burden to these countries. Early childhood is a crucial period in the formation of dietary habits, which tend to track throughout life. Worldwide, current evidence suggests that the dietary habits of preschool-aged children, namely, low intake of fruit and vegetables, and higher intake of foods rich in sugar, fat, and salt, do not align with dietary recommendations. Therefore, early interventions are important to establish healthy dietary habits in preschool children to combat childhood malnutrition. Sri Lanka is a middle-income country that is currently experiencing a simultaneous rise in overweight and obesity along with continued undernutrition in children aged five years or younger. This is more pronounced in urban locations of Sri Lanka, which comprises approximately one third of all children aged five years or younger. To date, multiple strategies have been implemented to improve the nutritional status of Sri Lankan children; however, none have specifically targeted preschool-age children. Therefore, population-specific effective eating interventions are urgently warranted for urban Sri Lankan preschool children. Development of food choices is multifactorial; hence, using an ecological approach to understand the interplay of these factors in the formation of food choices in early childhood is necessary. Addressing multi-level factors that influence children’s food choices has improved the effectiveness of intervention strategies. However, such an understanding and subseque