................. .............. ....... R S RCH ....... ..............................................SSIONAL RESEARCH AND PROFESSIONAL BRIEFS

Professional image of British andAmerican dietitiansB. L. WARDLEY, MS, RD, SRD; SHARRONDALTON, PhD, RD

rofessional image is important for di-etitians in the United States (US) andUnited Kingdom (UK). The ideal im-

age is described as highly professional andvisible (1). It includes external recognitionof professional expertise, professional ac-tivities and publications, and peer respect.Professional image has been studied morein the US (2-8) than in the UK (9,10).

Traditionally, the professional image ofdietitians has been strongly related to jobfunction in the US (2,3) and UK (9,11)rather than to external characteristics. In1988, however, US dietitians reported (5,6)that recognition by other health profes-sionals is important to their professionalimage. And although clinical managers inNew York City reported mainly positiveimages in a 1991 survey, includingincreasedstatus and greater recognition within theprevious 5 years, 27% thought they hadimage problems within their institutions(8). Likewise, a 1989 study by the BritishDietetic Association (BDA) (9) found thatUK dietitians perceived their role as impor-tant, but they thought other professionalsconsidered it less important, particularlyin hospital settings, because the job func-tions of dietitians were perceived as re-lated mainly to foodservice.

The practice of and education for dietet-ics are similar in the US and UK (Table 1).One difference is that the UK NationalHealth Service provides a structured ca-reer ladder for specialists (Table 1). Doesthis difference affect professional image?We conducted a survey of UK dietitians toevaluate perceived professional image andchanges during the previous 5 years. Find-ings were compared with results from asimilar US survey (5).

MATERIALS AND METHODSThe study group consisted of 33 UK stateregistered dietitians who served as precep-tors to American graduate students in a1989 Nutrition and Dietetic Study Abroadprogram in London and northern England.Analysis was based on 31 complete sur-veys. The state registered dietitians wereinterviewed at their worksites by 15 US

B. L. Wardley (corresponding author)is program coordinator/adjunctinstructor and S. Dalton is anassociate professor in the Departmentof Nutrition, Food and HotelManagement, New York University,New York, NY 10003.

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graduate students participating in the 2-week program. US student interviewershad a minimum of a baccalaureate degreein nutrition and some practical experi-ence; halfwere registered dietitians (RDs).

Interview questions were adapted froma 1988 US image study (5). Questionsfocused on perceived value of educationaland professional preparation, degree ofinvolvement in various job-related activi-ties, and opinions about whatjob functionsshould and should not be performed bydietitians. Open-ended questions eliciteddescriptions of the professional dietitian'simage. Responses were grouped accord-ing to patient interaction, attitude, medi-cal staff interaction, and general negativecomments.

Responses were then compared (Table2) with those reported by US dietitians inthe 1988 US image study (5) of 96 RDsrepresenting 76 hospital settings. In the US

study, half of the respondents (n = 49)were specialist dietitians in nutrition sup-port; 47were general clinical dietitians. USdata were derived from telephone inter-views with respondents chosen from ran-domly distributed hospitals. The UK dieti-tians participating in direct interviews werenot randomly selected. Data were ana-lyzed by comparing responses about imagebetween general and specialist UK dieti-tians (x2) and then between UK responsesand 1988 US data (Student's t test).

RESULTS AND DISCUSSIONHalf (n = 16) of the UK respondents had abaccalaureate degree in nutrition and di-etetics; 15 had a diploma in dietetics (nowdiscontinued) or a baccalaureate degree inscience with a postgraduate diploma indietetics. Two thirds (n = 22) of the UKdietitians were specialist dietitians regis-tered for 1 to 29 years (mean = 7.7 years);one third (n = 9) were general dietitiansregistered for 1 to 15 years (mean = 5.3years). In comparison, general and spe-cialist US dietitians both averaged 7 yearsas RDs and had baccalaureate degrees.More than half of the US specialist dieti-tians had earned master's degrees, as had32% of US general clinical dietitians.

Specialties represented byUK dietitians

Table 1Comparison of preparation for and practice of dietetics in the United States and the UnitedKingdom

Educational components United States United Kingdom

BS degree; topicscovered: Natural sciences; social sciences; Natural sciences; social

food, nutrition, and dietetics; sciences; food, nutrition, andcommunications; education; dietetics; food subjects;financial and human resource catering management;management medicine; data analysis;

computing; communications;research methods

Hours = 1,920 Hours = 1,895128 US credits Equivalent to 127 US credits

Supervised practice: ADA a approved supervised practice BDAb approved practicalprograms: approved, training, catering practice,preprofessional practice internship, industrial trainingcoordinated programsHours= 900 minimum Hours= 1,720

Registration: Registered dietitian State registered dietitianCredential monitoring: Commission on Dietetic Registration Council for Professions

Supplementary to Medicine

Areas of practice: Grading structure according to National Health Service gradinginstitution; ADA dietetic practice structure: Basic grade-groups general; Senior II-general/

specialty; Senior I-specialty:renal, pediatric, community;Chief Ill-management:specialty/general; District-management

Continuing education: 75 hours every 5 years Voluntary study days/workshops; specialty coursesvalidated by BDA;recommended for positions inspecialty practice

aADA = American Dietetic Association, bBDA = British Dietetic Association.

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Table 2Professional image of dietitians in the United Kingdom compared with dietitians in the UnitedStates (US)

Category US UKSpecialist General Specialist Generaldietitian dietitian dietitian dietitian(n =49) (n =47) (n = 22) (n=9)

% response Patient Interaction 27 26 18' 11involved in patient care/nutrition

education 14 13 18 11Work with home care patients 0 2 0 0Work with other specialized patients 14 9 0 0Miscellaneous 0 2 0 0Attitude 84 84 73 44Caring toward patients 0 2 0 0Competent/knowledgeable 33 19 0 )Valuable asset/important 4 2 0 0Professional/well respected 47 38 32 1 Well educated 12 11 0 0Positive/good image 12 6 27 1 1More assertive 10 8 0 oImage of specialist is better .. ... 27 33Miscellaneous 10 8 1 4 oMedical staff interaction 55 28 18 11Important part of team 20 6 14 11Resource for medical staff 30 13 0 0Work directly with physician/nurse 4 0 0 0Involved in research 4 0 0 0Miscellaneous 0 6 4 0Negative comments 10' 45* 64' 67*Cook/prepare food 2 21 18 11Less important member of team 6 6 11 0Lack public awareness/physician

recognition .. .. 32 22Miscellaneous 5 17 18 44

aUnderlined figures indicate net percentage of responses in that category 'P<.01.

were predominantly community (32%),pediatrics (14%), and renal (14%) dietet-ics. (Note: percentages rather than fre-quencies have been used to aid compari-son with US data [5,61.) Community dieti-tians are considered specialty or Senior I inthe National Health Service five-tieredgrad-ing structure (see Table 1). Of this group,77% had specialized education such aspostgraduate courses and managementtraining programs approved by the BDA.

The UK general dietitians rated theirtraining significantly (P .05) more rel-evant to practice than did the specialistgroup. This agrees with the views reportedby tIS general dietitians (5) and should beexpected because dietetics education is anentry-level discipline in both countries.

The self-evaluations of professional im-age by ("K dietitians were generally posi-tive and similar to those reported by USdietitians. Specialist dietitians perceivedthemselves more positively than did gen-eralists in both countries. The generalistsalso thought that specialists have a morepositive image. Table 2 shows that 33% ofthe UK general dietitians and 27% of thespecialists think the specialist image ismore positive and respected than that ofthe generalist. Reasons given were special-ists are an important part of the health careteam ani specialists are significantly

(P <.05) more involved in research thangeneralists. The latter reason was con-firmed by responses to another questionabout tasks: participation in research wasreported by 19% as a major task theythought they should be, but were not,doing. The US dietitians had a similar re-sponse about research involvement.

UK dietitians had a higher percentage ofnegative comments than did those in theUS study (P <.01) (Table 2). The differ-ence in negative comments within groupswas less marked between the UK general-ist and the UK specialist (67% and 64%)than between the US generalist and the USspecialist (45% and 10%). The image ofthe dietitian as a cook was reported by 29%of UK and 23% of US respondents, eventhough related foodservice activities rankedlow among their reported job functions.

The UK and US dietitians appear to havesimilar level of involvement in most jobfunctions, such as consulting with medicalstaff, developing nutrition care plans, andparticipating in medical rounds. However:more UK dietitians are involved in theeducation of other health professionals,and more US specialists review patients'medical records as part of their job func-tion. The latter difference may be explainedby the comparatively larger number ofcommunity dietitians in the l K who work

with patients at home and work with groupsrather than individuals.

Both UK specialists (86%) and general-ists (74%) thought their image had im-proved during the previous 5 years; fewerUS specialists (74%) andgeneralists (72%)reported positive changes. According toboth the US and UK dietitians, the positivechanges perceived were increased recog-nition, greater participation ill the healthcare team, and more involvement ithpatients at all levels. Nevertheless, only63% of the UK specialist dietitians and43% of the US specialist diet itians (P <.01 )thought the profession had more statusand a better image than it did 5 yoars ago.

APPLICATIONSProfessional image of dietitians is improv-ing in the UK and the IS, i part because ofspecialization (12) and because dieteticsexpertise is more known and available.Both US and UK dietitians are movingtoward an image defined in terms of pro-fessional expertise rather than by specificjob functions.

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.fissioz(n l)e clop elctI ( :om nOr ittee o' theBritish Dietetic Associatioz Birmingham,United Kingdom: British Dietetic Association1989.10. Aslett-Bentley Al). Improvingourimage-a pause for radical thought. DA.4 Aditlser1987;26:32-34.11. Robertson A. Improving the image of thedietitian--a personal view .1 hrm Nutr Diet.1991;4:3-12.12. Owen AL, )ougherty D), Bogle M.President's Page: Specialization in dietetics--the time has come. .1m )icrt .4ssor1986;86: 1)72-1 0)7{i

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