Variation in dietetic documentation is reported in the literature, but standardised documentation is described as supporting consistent practice in both manual and electronic formats. In Cyprus, nutrition and dietetic professionals (NDPs) work across private and institutional settings, including services within and outside the General Health System (GHS/ΓΕΣΥ). This study examined NDPs’ knowledge, perceptions, and implementation of documentation processes and standardised languages, and includes expert validation of a new electronic tool based on the Process for Nutrition and Dietetic Practice (PNDP) (e-ΔΔΔΦ). A pragmatic multiphase research philosophy was used to support a mixed-methods design. Two online questionnaires were administered. Phase 1 included a questionnaire that was self-developed by the research team and was informed by the conceptual structure of the Nutrition Care Process (NCP) as defined by the Academy of Nutrition and Dietetics, including its four-step model (Assessment, Diagnosis, Intervention, Monitoring and Evaluation) and structured diagnostic reasoning principles (Academy of Nutrition and Dietetics, 2013; Swan et al., 2017). Additional guidance was drawn from the PNDP framework issued by the British Dietetic Association (BDA), which operationalises NCP logic within European practice contexts. European professional documentation harmonisation principles disseminated by the European Federation of the Associations of Dietitians (EFAD) were also considered. It collected demographics and information on awareness and use of documentation processes (DPs) and standardised languages (SLs), perceived benefits and drawbacks, and implementation challenges. Questionnaire 2 assessed expert views on the electronic PNDP tool, rating relevance, clarity, and simplicity on a 1–5 scale 3 and collecting open comments. Recruitment was conducted through the Cyprus Nutrition and Dietetic Association (CyDNA) and social media (email, Facebook, Instagram) using a survey link and QR code. Participants self-selected after confirming eligibility and providing informed consent. Quantitative data were prepared from Google Forms exports and analysed in SPSS (v27). Descriptive statistics were reported. Associations between categorical variables were tested using Fisher’s Exact test. For larger contingency tables, Fisher–Freeman–Halton exact tests were used, with Monte Carlo estimation (10,000 samples; 99% confidence interval) when exact computation was not feasible. Effect sizes were assessed using Cramer’s V. Multiple-comparison control used Bonferroni (in SPSS) or Benjamini–Hochberg adjustment (in Excel), with a monotonicity step applied. Open-ended responses were coded into themes, converted to numerical variables where appropriate, and analysed descriptively as multiple-response sets. Phase 1 questionnaire was completed by 63 NDPs, below the planned sample size (n=218). Results were interpreted cautiously where inferential testing was used. Respondents were mostly early-career (mean age 27.4 years; mean practice experience 9.6 months). Most reported practising in Nicosia or Limassol and working in independent private practice. Awareness of at least one DP was reported by 98.4% of participants. PNDP was the most commonly reported DP used in practice (68.3%). Most PNDP users reported implementing all stages. When difficulty was reported, nutrition diagnosis and intervention were the steps most often identified as challenging. Qualitative findings indicated that the main perceived benefits of SL use were improved communication and clearer documentation, followed by structure and consistency and perceived improvements in care. The main reported drawbacks were time required to complete documentation and the need for training, with additional concerns about workflow disruption. Expert validation (n=7) rated the electronic PNDP tool positively for relevance, clarity, and simplicity. Expert comments focused on improving visual readability, making minor wording changes, and adding clinical fields (e.g., current weight and date fields). Overall, the findings indicate high awareness and reported use of standardised documentation among this sample, with reported barriers linked mainly to time and training requirements. Expert feedback supported the usability of an electronic PNDP format with targeted interface and content refinements.
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Full text Περιγραφή: PhD_Thesis_Elina_Polydorou.pdf (pdf)
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Digital Transformation of Nutrition in Cyprus: Development and Cross-sectional evaluation of a PNDP Electronic Tool with the Nutrition Care Process - Identifier: 6793
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