Evidence-based practice competencies among nutrition professionals and students: a systematic review.
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BACKGROUND: Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE: The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS: We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index and ClinicalTrials.gov up to March 2023. Eligible primary studies had to assess one of six predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data and results were summarized for each EBP competency. RESULTS: We identified 12 eligible cross-sectional survey studies, comprised of 1,065 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. Only one study (8%) explicitly used an objective questionnaire to assess EBP competencies. 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, understanding of effect size and the certainty of evidence for effects, were not assessed. CONCLUSIONS: The overall quality of study reports was poor and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in assessing effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Further, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation and application among dietetics practitioners. PROSPERO REGISTRATION: CRD42022311916.
