Date of Award


Document Type

Thesis - ECU Access Only


Edith Cowan University

Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Supervisor

Professor Amanda Devine

Second Supervisor

Dr Therese O’Sullivan

Third Supervisor

Dr Leesa Costello

Fourth Supervisor

Dr Angela Vivanti


BACKGROUND: A consistent care process, clear and concise medical documentation, and standardised nutrition terminology is beneficial for dietetic practice. The Nutrition Care Process (NCP), a contemporary framework to promote critical thinking and systematically address nutrition problems, and its terminology (NCPT, formerly known as IDNT) was developed to suit these purposes. However, this framework has not yet been adopted globally. The basis for this lack of adoption relates to difficulties in traditional face-to-face implementation, including a lack of local NCP experts, time constraints, financial limitations and geographical isolation.

OBJECTIVE: To develop, implement and evaluate an online education portal for NCP implementation, tailored to dietitians in clinical settings internationally. This portal also seeks to develop an online community of practice to enhance the NCP learning experience.

METHOD: The study consisted of three stages and used a number of quantitative and qualitative methods. In Stage one, qualitative focus groups with clinical dietitians were conducted to identify gaps in NCP education and assess needs in relation to an online education portal. This formative research was used to inform the second stage of website development, which was set within the framework of Spiral Technology Action Research (STAR). This approach engaged participants to further inform website development and refine the site prior to launch and implementation of the NCP online education. In the third and final stage, the resulting ‘Dietitians Online Nutrition Care Process (DoNCP)’, was launched nationally and internationally. The effectiveness of the online education was evaluated and measured by change in knowledge and attitude of dietitians pre- and post-website intervention using the Attitudes, Support, Knowledge of Nutrition Care Process (ASK NCP) questionnaire. Data on country of practice, learning style preferences, work status (full-time vs part-time), years of dietetic experience, and sense of community were also investigated. Qualitative exit interviews were conducted with participants and were triangulated with quantitative outcomes.

RESULTS: A total of 444 dietitians from 35 countries attempted to register on the DoNCP website, with 372 registering successfully and completing the pre-ASK NCP questionnaire. Of these 372 dietitians, 68 (18.3%) completed both pre- and post-ASK NCP questionnaires, and were called ‘Questionnaire Completers (Q completers)’. The 304 dietitians (81.7%) who completed the pre- but not post-ASK NCP questionnaire were called ‘Questionnaire Non-Completers (Q non-completers)’. Q completers (n=68) were similar to Q non-completers (n=304) in aspects of gender, age, country of practice, highest education level, learning style preference, work position, work status, and geographical location of workplace (p>0.05 for all), with the exception of years of dietetic experience (p0.05 for all). After DoNCP website intervention, Q completers (n=68) reported significant improvements in their knowledge of NCP (p0.05 for all). Post intervention, the sense of community for Q completers (n=68) was not significantly associated with the change in NCP knowledge and attitudes scores (p>0.05 for all). The DoNCP website provided a sense of community for dietitians to a certain extent, however, a community of practice did not fully emerge during the finite data collection period.

CONCLUSIONS: The DoNCP website was confirmed as an effective portal to support NCP learning for dietitians at the national and international level, regardless of the sense of community. The knowledge and attitudes scores (value, confidence, support, and training) towards NCP model framework improved following the utilisation of the DoNCP website. The fact that learning style preference was not associated with differences in knowledge and attitude change suggested that the DoNCP website provided a wide range of educational resources to accommodate a range of different learning styles. Participants perceived the DoNCP website as a professional resource that met their needs and enhanced their learning of NCP.