Credentialing Exam Hesitancy in Dietary Management Certificate Program Graduates: A First Look at Perceived Barriers

Certified dietary managers (CDMs) lead their food services team by ensuring food quality, safety, and palatability while applying nutrition principles to food purchasing, storage, preparation, and service. Despite labor shortages and forecasted growth in both healthcare and food services management jobs, approximately 30% of credentialing exam candidates forego their exam within the first year after completing a didactic career technical education program approved by the Association of Nutrition and Foodservice Professionals. Moreover, very few return to pursue their exam after the first year. This study explored, through the lens of the theory of planned behavior, the perceived obstacles contributing to CDM program graduates' reluctance to sit for the national board certification. Semi-structured interviews were conducted with a purposive and convenience sample of eight participants from various regions of the United States to gain insight into internal and external factors contributing to their exam hesitancy. Thematic analysis yielded several themes, including a lack of control over internal and external barriers to taking the exam. Participants reported facing family and work constraints exacerbated by the pandemic and the lack of financial resources to meet exam preparation and registration costs. They expressed feelings of exam-related anxiety, being ill-prepared, unsupported by their programs and employers and discouraged by the observed stressful working conditions of current CDMs. This study helps establish a foundation for remedial action by stakeholders, educational program leaders, and CDM employers in support of certification candidates. Findings raise questions about the prevalence of credentialing exam barriers in other disciplines and pave the way for future investigations about exam hesitancy.