ABSTRACT
BACKGROUND: Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education. OBJECTIVE: This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director. DESIGN: Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale (STS) and a researcher-designed survey with 1-5 Likert-type scales. PARTICIPANTS/SETTING: The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors, with a 27% (n=163) response. STATISTICAL ANALYSIS: Descriptive statistics (frequency, mean, standard deviation) were calculated using Excel. Inferential statistics were examined using R. ANOVA was used to compare experience as RDN and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total STS score and demographic and programmatic variables. RESULTS: Seventy-seven percent of program directors scored high on the STS (mean score 65.2, on a 0-80 scale, SD 8.4), and more than 85% of directors agreed including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed systems thinking was adequately addressed in ACEND standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate ACEND standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low. CONCLUSIONS: Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators' perceived importance and program coverage. Enhancing program directors' awareness and utilization of Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.
