Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries.

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians' perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians' reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p < 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition's clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media.

Dietitians Working in Continuing Care Facilities in Nova Scotia: Pre- and Post-COVID-19 First Wave.

Continuing care (CC) facilities have been impacted by a growing demand for services, insufficient resources for the provision of quality food and nutrition care, and, most recently, the COVID-19 pandemic. This study explored the roles and responsibilities of dietitians working in CC facilities in Nova Scotia (NS) before and after the COVID-19 first wave. Using ethics-approved questionnaires, the estimated 75 dietitians working in CC facilities in NS were surveyed in Fall 2019 and Fall 2020 about their roles and responsibilities. Twenty responded to the first questionnaire and 15 to the second. Analysis of data included simple statistical and qualitative description methods. The findings highlighted the complexities and challenges faced by these dietitians in the provision of resident nutrition care, overseeing foodservices, training staff and dietetic interns, and contributing to facility specific care committees before and after the COVID-19 first wave. There is a need to advocate for minimum standards for dietetic and foodservice funding in CC facilities based on higher acuity and complex care needs of residents and considering the multifaceted roles of dietitians in CC. Efforts to improve awareness about the roles of dietitians working in CC among resident families, other dietitians, and dietetic interns are also needed.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study.

COVID-19's intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians' practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

The Information Sharing Behaviors of Dietitians and Twitter Users in the Nutrition and COVID-19 Infodemic: Content Analysis Study of Tweets.

Background: The COVID-19 pandemic has generated an infodemic, an overabundance of online and offline information. In this context, accurate information as well as misinformation and disinformation about the links between nutrition and COVID-19 have circulated on Twitter since the onset of the pandemic. Objective: The purpose of this study was to compare tweets on nutrition in times of COVID-19 published by 2 groups, namely, a preidentified group of dietitians and a group of general users of Twitter, in terms of themes, content accuracy, use of behavior change factors, and user engagement, in order to contrast their information sharing behaviors during the pandemic. Methods: Public English-language tweets published between December 31, 2019, and December 31, 2020, by 625 dietitians from Canada and the United States, and Twitter users were collected using hashtags and keywords related to nutrition and COVID-19. After filtration, tweets were coded against an original codebook of themes and the Theoretical Domains Framework (TDF) for identifying behavior change factors, and were compared to reliable nutritional recommendations pertaining to COVID-19. The numbers of likes, replies, and retweets per tweet were also collected to determine user engagement. Results: In total, 2886 tweets (dietitians, n=1417; public, n=1469) were included in the analyses. Differences in frequency between groups were found in 11 out of 15 themes. Grocery (271/1417, 19.1%), and diets and dietary patterns (n=507, 34.5%) were the most frequently addressed themes by dietitians and the public, respectively. For 9 out of 14 TDF domains, there were differences in the frequency of usage between groups. "Skills" was the most used domain by both groups, although they used it in different proportions (dietitians: 612/1417, 43.2% vs public: 529/1469, 36.0%; P<.001). A higher proportion of dietitians' tweets were accurate compared with the public's tweets (532/575, 92.5% vs 250/382, 65.5%; P<.001). The results for user engagement were mixed. While engagement by likes varied between groups according to the theme, engagement by replies and retweets was similar across themes but varied according to the group. Conclusions: Differences in tweets between groups, notably ones related to content accuracy, themes, and engagement in the form of likes, shed light on potentially useful and relevant elements to include in timely social media interventions aiming at fighting the COVID-19-related infodemic or future infodemics.

Telenutrition: Changes in Professional Practice and in the Nutritional Assessments of Italian Dietitian Nutritionists in the COVID-19 Era.

The COVID-19 pandemic has brought about various restrictions around the world, and its impact on healthcare has been enormous: RDNs have had to shift from in-person interactions with clients to telenutrition consultations, encountering obstacles. We designed the first survey to investigate the changes in RDN practices related to telenutrition provision after the onset of the pandemic through an online survey in Italy. Four hundred and thirty-six responses were analyzed. Before the pandemic, only 16% of Italian RDNs provided telenutrition; this percentage increased significantly up to 63% (p < 0.001). Among patients, the lack of interest in accessing telenutrition (30.9%) and the Internet (16.7%) were the most frequently reported barriers. Among RDNs, one of the main obstacles was their inability to conduct nutritional evaluation or monitoring activities (24.4%). Our survey indicated that increased adoption of telenutrition can be a valid, safe alternative to face-to-face visits. Telenutrition was mainly used by young RDNs (20-39 years) with fewer years of professional experience (0-20 years) and master's degrees. Remote nutrition can enable RDNs to maintain normal workloads and provide patients with uninterrupted access to nutritional healthcare. It is important that RDNs using telemedicine resources possess the ability to provide high-quality, efficient, and secure services using evidence-based guidance.

A Study of United States Registered Dietitian Nutritionists during COVID-19: From Impact to Adaptation.

The COVID-19 pandemic introduced an unprecedented health crisis, requiring many Registered Dietitian Nutritionists (RDNs) to expand their duties and services, while other RDNs faced unemployment, reduced hours, and changes to their work environment. This study evaluated whether the pandemic impacted RDNs' weight, eating behaviors, and psychological factors, and whether professional training as an RDN was perceived as a protective factor in maintaining healthy habits. A 57-item, cross-sectional, online questionnaire including open-ended questions was distributed to RDNs residing in the United States. Over two months (January 2021 to February 2021), 477 RDNs completed the questionnaire. Among RDNs, 68.5% reported no weight change, 21.4% reported weight gain greater than 5 pounds, and 10.3% reported weight loss greater than 5 pounds. Approximately 75% (n = 360) reported their RDN professional training equipped them with the skills needed to maintain healthy eating behaviors. Reduced physical activity and mental health were the top qualitative themes that emerged regarding reasons for weight change. These findings suggest that RDN professional practice skills may have conferred some personal health benefits, as evidenced by smaller weight gains, the maintenance of healthy habits, and fewer reporting psychological effects relative to the general population and other health professionals, thereby limiting the impact of pandemic-induced work and life disruptions.

Patient/Carer experience of dietetic care following move to remote working during pandemic

Background/AimsPatient reported outcome measures (PROMs) are essential in gaining valuable feedback. Due to outbreak of COVID-19, dietitians at Great Ormond Street Hospital (GOSH) were moved off site to work remotely resulting in change of practice, where patients who were previously seen face-to-face, were reviewed by telephone. The blood, cells, cancer (BCC) dietitians undertook a PROMs questionnaire to understand patient/carer experience of dietetic service and was compared to experience pre-pandemic.MethodsParents/carers with a child under care of BCC dietitians from mid-June to September 2020 were eligible to complete online Nutrition and Dietetic Patient Outcomes Questionnaires (validated PROM tool). Children >8 years were eligible to complete young-person version of questionnaire. After review with dietitian, parents/carers were given website URL to allow optional and anonymous completion of questionnaire on own electronic devices. Responses allocated numerical values and analysed using Microsoft Excel.ResultsThirty-five parent/carers and two young persons completed questionnaire. No difference in dietetic experience observed overall (score=26.1) since pre-pandemic (score=26.1). Those who had met a dietitian once scored more favourably (score=23.7) than those who had seen dietitian twice or more (score =27.5, 26.7 respectively);in 2019, those who had seen dietitian >5 times had more positive experience (score=23.6). Reported improvement in parents/carers feeling a dietitian helped them better understand how to manage child’s condition (+7%), but worse experience around managing anxiety (-9%) and increasing socialisation/interaction (-22%).ConclusionsChange to remote working during pandemic well-received by parents/carers under BCC dietitians at GOSH. Data collected during national lockdown likely impacted results around anxiety and socialisation;however, impact of face-to-face reviews in reducing anxiety must be considered. A combination of face-to-face reviews and remote working is likely to become new model of care. Repeat questionnaire is needed once new ways of working implemented. Methods of gathering data from young children needs further consideration.

A UK survey of nutritional care pathways for patients with COVID-19 prior to and post-hospital stay.

BACKGROUND: During the global COVID-19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID-19 infection prior to and after discharge. METHODS: Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. RESULTS: Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID-19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first-line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were 'very or reasonably confident' in their team's nutritional management of COVID-19. Less than half (42%) reported on training needs. CONCLUSIONS: Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID-19 infection. Further work is needed to develop strategies for evaluation of their impact.

Virtual nutrition consultation: what can we learn from the COVID-19 pandemic?

OBJECTIVE: To investigate the extent, quality and challenges of dietetic counselling during the pandemic. DESIGN: A cross-sectional online thirty-six-item Google Survey. The survey queried demographics and information on usage and perceived telemedicine quality. SETTING: The survey was distributed to Israeli Dietetic Association (ATID) mailing list between 31 March and 5 May 2020. PARTICIPANTS: Clinical dietitians, members of ATID, who consented to participated in the survey. RESULTS: Three hundred dietitians (12 % of ATID members; 95 % women; mean age 4·41 (sd 10·2) years) replied to the survey. Most dietitians reported a significant ∼30 % decrease in work hours due to the pandemic. The most prevalent form of alternative nutrition counselling (ANC) was over the phone (72 %); 53·5 % used online platforms. Nearly 45 % had no former ANC experience. Both ANC formats were reported inferior to face-to-face nutritional consultation (consultation quality median scores 8 and 7, on a 1-10 scale, for online and phone, respectively). ANC difficulties on either phone or online platforms were technical (56 and 47 %, respectively), lack of anthropometric measurements (28 and 25 %, respectively) and interpersonal communication (19 and 14·6 %, respectively). Older age and former phone counselling experience were associated with higher quality scores, respectively (OR = 1·046, 95 % CI 1·01, 1·08, P = 0·005), (95 % CI 1·38, 4·52, P = 0·02). Those who continued to work full time had five-time greater odds for a higher quality score using online platforms (OR = 5·33, 95 % CI 1·091, 14·89, P = 0·001). CONCLUSIONS: Our findings suggest telemedicine holds considerable promise for dietary consultation; however, additional tools and training are needed to optimise remote ANC, especially in light of potential crisis-induced lockdown.

Evaluation of dietary supplement, functional food and herbal medicine use by dietitians during the COVID-19 pandemic.

OBJECTIVE: The current study was conducted to evaluate the dietary habits of the dietitians who had a leading role in this regard during the pandemic and their use of dietary supplements, functional food and herbal medicines. DESIGN: A cross-sectional study. An online questionnaire was used as a data collection tool to identify the participants' socio-demographic characteristics, health statuses and dietary habits and their use of dietary supplements, functional foods and herbal medicines. SETTING: Turkey. PARTICIPANTS: The study population was 550 dietitians. RESULTS: In the current study, the participants' average age was 30·6 ± 9·1 years, and most of them (88·2 %) were women. More than half of the participants (88·9 %) thought that adequate and balanced nutrition would positively affect the course of COVID-19. To avoid COVID-19, 94·5 % of the dietitians used dietary supplements, 46·1 % herbal medicines and 34·9 % functional foods during the pandemic. The most commonly used dietary supplement was fish oil (81·9 %), functional food was vegetables and fruits (80·5 %) and the herbal medicine was cinnamon (63·5 %). Women's consumption of functional foods was approximately twice higher compared with men (95 % Cl: 1·048, 4·165; P < 0·05). The findings showed that the longer the dietitians were in their careers, the more functional foods and herbal medicines they used. CONCLUSION: During the pandemic, dietitians' use of foods with protective effects against diseases increased depending on their academic knowledge and experience in nutrition. The findings obtained in the current study suggest that an expert's opinion should be obtained before using dietary supplements and herbal medicines.

Wellbeing at Work before and during the SARS-COV-2 Pandemic: A Brazilian Nationwide Study among Dietitians.

This study aimed to evaluate the perceptions of dietitians' wellbeing at work before and during the SARS-COV-2 pandemic in Brazil. This cross-sectional study was performed using a previously validated instrument to investigate the wellbeing of dietitians at work in Brazil. The questionnaire on the wellbeing of dietitians was composed of 25 items (with a 5-point scale), characteristics, and questions about the SARS-COV-2 period. The application was carried out with GoogleForms® tool from 26 May to 7 June 2020. The weblink to access the research was sent via email, messaging apps, and social networks. Volunteers were recruited nationwide with the help of the Brazilian Dietitians Councils, support groups, as well as media outreach to reach as many dietitians as possible. Volunteers received, along with the research link, the invitation to participate, as well as the consent form. A representative sample of 1359 dietitians from all the Brazilian regions answered the questionnaire-mostly female (92.5%), Catholic (52.9%), from 25 to 39 years old (58.4%), with a partner (63.8%), and with no children (58%). Most of the participants continue working during the pandemic period (83.8%), but they did not have SARS-COV-2 (96%), nor did their family members (80.7%). The wellbeing at work before SARS-COV-2 was 3.88 ± 0.71, statistically different (p < 0.05) from during the pandemic, with the wellbeing of 3.71 ± 0.78. Wellbeing at work was higher before the pandemic for all the analyzed variables. Analyzing variables separately before and during the pandemic, dietitians with partners, children and a Ph.D. presented higher scores for wellbeing at work. Professionals receiving more than five times the minimum wage have higher scores. During the pandemic, better wellbeing was observed for dietitians working remotely.