Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review

Abstract

ABSTRACTBackgroundEvidence-based practice (EBP) promotes shared decision-making between clinicians and patients and has been widely adopted by various health professions including nutrition & dietetics, medicine and nursing.ObjectiveTo determine evidence-based practice (EBP) competencies among nutrition professionals and students reported in the literature.DesignSystematic review.Data sourcesMedline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, andClinicalTrials.govup to March 2023.Eligibility criteria for study selectionEligible primary studies had to objectively or subjectively document the assessment of at least one of six predefined core EBP competencies, including formulating structured clinical questions, searching the literature for best evidence, and assessing studies for methodological quality, magnitude (size) of effects, certainty of evidence for effects, and determining the clinical applicability of study results based on patient values and preferences.Data extraction and synthesisTwo reviewers independently screened articles and extracted data, including the reporting quality for eligible studies. Results were not amenable to meta-analysis and were thus summarized for each EBP competency.ResultsWe identified 12 eligible cross-sectional survey studies, comprised of 1065 participants, primarily registered dietitians, across six countries, with the majority assessed in the United States (n=470). The reporting quality of the survey studies was poor overall, with 43% of items not reported and 22% of items partially reported. Only one study (8%) explicitly used an objective questionnaire to assess EBP competencies. The proportion of studies reporting on each competency were: 17% on the formulation of clinical questions, 83% on searching the literature, 75% on methodological quality or critical appraisal, 58% on interpreting statistical results, and 75% on applying study results. In general, the six competencies were incompletely defined or reported (e.g., it was unclear what ‘applicability’ and ‘critical appraisal’ referred to, and what study designs were appraised by the participants). Two core competencies, the magnitude (size) of effects and the certainty of evidence for effects, were not assessed.ConclusionsAmong 12 included articles the overall quality of study reports was poor, and when EBP competencies were reported they were predominantly self-perceived assessments as opposed to objective assessments. No studies reported on competencies in assessing magnitude of effect or certainty of evidence, skills that are essential for optimizing clinical nutrition decision-making.Systematic review registrationPROSPERO CRD42022311916.