Population based nutrition intervention terminology is a set of terms and definitions that outline core aspects of public health nutrition interventions. The terms are used to describe and differentiate programs and interventions designed to “improve the nutritional well-being of a population;” which are distinctly different from interventions directed toward individual change. The terms for population based nutrition action include:
These terms and their definitions, plus more specific descriptors and examples of use in a nutrition and dietetics practitioners work are elaborated on in eNCPT reference sheets (reference sheets are separate documents accessible with an eNCPT subscription). The new terminology is part of the eNCPT and was developed to accompany and facilitate documentation of the Nutrition Care Process(NCP).
The Nutrition Care Process (NCP) is a systematic method that nutrition and dietetics practitioners use to plan, provide, and evaluate nutrition care for individuals and populations. It involves four steps: 1) assessment, 2) diagnosis, 3) intervention, and 4) monitoring and evaluation. The NCP is supported with the standardized terminology of the eNCPT, which facilitates documentation and communication of the four steps of the NCP. The new terminology is specific to the Nutrition Intervention step, defined as purposefully planned actions intended to positively change a nutrition-related behavior, environmental condition, or aspect of health status for an individual or population.
The steps of the NCP are very similar to the steps used in program development and implementation in public health, namely: 1) assessment, 2) diagnosis of the problem and it underlying causes or determinants, 3) intervention design and implementation, and 4) monitoring and evaluation of the program and its outcomes. Thus, the process of public health work can be aligned with the NCP. The NCP also aligns with other commonly used program planning cycles such as the CDC Program planning cycle, the Bi-cycle Model, and the Precede/Proceed model.
Up until now, the standardized terminology of the eNCPT has focused on clinical dietetics and interventions directed to achieving outcomes at the individual level. However, the public health practice paradigm is distinctly different from direct patient care. Drawn from language commonly used in the public health program planning, the new terms provide a language for characterizing and describing interventions designed to have impact on populations. Having terminology that more accurately portrays public health nutrition practice can help foster understanding of public health and how it is different from, but complementary to, other areas of nutrition and dietetics practice.
This terminology is for dietitians and nutritionists involved in work that is directed toward changes that impact populations as a whole rather than specific individuals. This includes nutrition and dietetics practitioners working in community settings and public health, as well as nutrition and dietetics practitioners in health care systems, businesses, and organizations that plan and implement interventions or programs to bring about changes that impact a defined population.
The terms were developed by a subgroup of the Nutrition Care Process and Research Outcomes (NCPRO) Advisory Workgroup of the Academy of Nutrition and Dietetics (Academy), and were reviewed by U.S. and international dietitians with expertise in public health nutrition. The terms were then submitted to the Academy’s NCPRO Committee and approved for addition to the eNCPT—the Academy’s standard terminology that supports the steps of the NCP.
These new terms are complementary to the existing terminology for nutrition care that has been in existence since 2008 and is widely used in clinical dietetics by nutrition and dietetics practitioners in the United States and many countries around the world. The addition of these terms recognizes that nutrition and dietetics practitioners work across the continuum of practice in a wide range of settings, and that public health practice is different from, but complementary to, traditional clinical dietetics. Adding relevant public health terms to the existing terminology provides language to more accurately represent public health nutrition practice.
Additionally, in its strategic planning, the Academy has identified public health as a focus area and is directing greater efforts toward public health initiatives. Thus, articulation and clarification of standardized terminology for public health nutrition interventions is very timely.
Detailing population level intervention is especially relevant as more and more groups recognize and adopt the Social Ecological Model (SEM) of multiple levels of influence to attack complex problems and bring about change. The SEM includes individual, interpersonal, organizational, community and policy levels of change. Interventions directed to the individual and their supporting relationships (interpersonal level) are the primary focus of clinical dietetics; while interventions directed to the broader environment to influence organizational, community, and policy change are customarily targets of public health work. The new terminology provides a way to characterize and communicate interventions at the higher levels of the SEM. Using the terminology fosters shared understanding that can support collaborative intervention activities designed to impact complex and challenging nutrition problems of a population, using all levels of the SEM.
The developers of the terminology recognize that SEM is the predominant underlying framework used by many organizations and programs, but it does not preclude the use of other theoretical frameworks or approaches. In fact, six other population level change theoretical models or approaches are included in the specific descriptors of the “theoretical frameworks” term.
While the terms are new additions to the eNCPT, the population level nutrition intervention terms “strategies”, “settings” and “sectors” reflect and incorporate terms that are widely used by many programs and disciplines and are advocated by agencies such as the Institute of Medicine and the Centers for Disease Control and Prevention. “Theoretical framework” is identified as an essential component underpinning effective health promotion and community intervention programs.
Public health nutrition and dietetics practitioners commonly engage in cross-sector, multidisciplinary collaborations to plan, implement and evaluate programs or interventions. In this collaborative work, approaches and jargon from many disciplines and sectors are blended together; however, a uniting framework for many interventions is the SEM. Thus, many collaborators should recognize and be receptive to terminology used by public health nutrition and dietetics practitioners that is structured around the SEM.
Voluntary adoption by nutrition and dietetics practitioners and programs over time is expected; but it is not the intent to require universal adoption. The terminology is a tool to foster planning, communication and evaluation of interventions that address nutrition problems of populations and lead to the effective accomplishment of goals. Its use should foster greater attention to theoretical frameworks and the strategic selection and naming of targets for change. Settings and sectors for collaboration may be more systematically identified and described. The terminology should be applicable and helpful in many situations. In many cases, it will mean simply applying somewhat different language in routine work. In other cases, it could lead to rethinking how interventions are designed and described. This could result in practice changes related to program planning and reporting.
The new terminology offers a structure for envisioning different approaches for tackling complex nutrition-related problems. Its application requires critical thinking, analysis and synthesis to determine the defining characteristics of a program or intervention that can best lead to positive outcomes. This is useful when planning interventions, writing grant proposals, and communicating program details with funders, collaborators and other stakeholders. This benefit is also important for evaluation and research, where having clearly described and differentiated interventions is important for comparing and contrasting alternative approaches to problems, defining appropriate outcomes for measurement, and determining effectiveness.
A challenge of adopting new terminology is that public health and community nutrition programs are funded through various government agencies and organizations subject to regulations, operating procedures, documentation, and reporting requirements with language and indicators that may or may not be compatible with the new nutrition intervention terminology. Dissemination and adoption of the terminology will involve identifying where the new terminology may be compatible and useful. Early in the dissemination and implementation process, it will be necessary to identify related terminology for programs and applications. Implementation is an ongoing process that involves innovating programmatic and organizational culture while engaging teams in practice and making adjustments.
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