Use of the nutrition care process and nutrition care process terminology in an international cohort reported by an online survey tool

Document Type

Journal Article

Publication Title

Journal of the Academy of Nutrition and Dietetics







First Page


Last Page


PubMed ID



Academy of Nutrition and Dietetics


School of Medical and Health Sciences




Lövestam, E., Steiber, A., Vivanti, A., Boström, A. M., Devine, A., Haughey, O., ... Orrevall, Y. (2019). Use of the nutrition care process and nutrition care process terminology in an international cohort reported by an online survey tool. Journal of the Academy of Nutrition and Dietetics, 119(2), 225-241. Available here


BACKGROUND: Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed.

OBJECTIVE: The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries.

METHODS: A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels.

MAIN OUTCOME MEASURES AND STATISTICAL ANALYSIS: The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information.

RESULTS: Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest.

CONCLUSIONS: Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.



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