Health Educators and Nutrition Education: Food for Thought—A Commentary

As health educators involved in our profession, as members of our professional organizations, and as authors, reviewers, and members of various professional journal editorial boards, and along with involvement with professional preparation programs, our interest was piqued by the journal article titled, "What About Health Educators? Nutrition Education for Allied Health Professionals: A Review of the Literature." (1) This study had three purposes: (1) to determine the definition of, and criteria for, nutrition education among allied health professionals; (2) to identify commonalities across health professions for nutrition education definitions and training requirements; and (3) to determine if there are criteria for nutrition education and training for health educators. Specifically, we do not take exception that, according to the authors, "Common across the studies of allied health professions included in this review was a sense of the importance of nutrition training and education of these professionals." The paper does document some shortcomings and obstacles in some other professional areas. Nor do we take exception with the general recommendations to improve such training, which included suggestions to "increase the number of clinical hours spent in nutrition, increase the number of nutrition-focused continuing education hours, or integrate nutrition into the current training curriculum." However, after reading the article, our initial enthusiasm quickly waned and then evaporated in terms of its major purpose to "determine if there are criteria for nutrition education and training for health educators." While the topic of nutrition education certainly is worthy of inquiry, our concerns are threefold. This article appears to be a classic example of reporting findings and conclusions based on: (1) inadequate and faulty methodology, (2) a demonstrated misunderstanding of the health education discipline and, (3) several practical limitations. INADEQUATE AND FAULTY METHODOLOGY Scope of the Search Once the methodology was described, we anticipated that the findings and the conclusions would be self-evident without further reading. Not surprisingly, they are consistent and perfectly fit the methodology. Unfortunately, the limitations inherent in their methodology render any valid conclusions inadequate. Specifically, the study is based on a reported comprehensive review of the literature. According to the authors, "This review involved rigorous search and assessment strategies to examine the body of literature advocating for the teaching of nutrition in the university curriculum for allied health professionals." To accomplish their review the authors searched two major heath science bibliography databases, MEDLINE and EBSCO. Reviews of literature, regardless of topic, require very detailed search strategies that have become more complicated over the years given the many new electronic databases that now exist. These search and data mining strategies were not described in enough detail to give us confidence that they accurately located all the existing articles in the professional literature. The small sample size of articles used in this review provides some evidence of this. For example, while the authors used the National Library of Medicine's MEDLINE bibliographic database that contains over 19 million references, these are primarily journal articles in the life sciences with a concentration in biomedicine. Further, while one of the key distinctive features of MEDLINE is its use of Medical Subject Headings known as MESH[R], the authors do not specifically mention their use of MeSH descriptors or terms used in their searches. Using different MeSH terms and even reordering these terms can elicit very differing results. While they do describe using words such as, "students, health, occupation and nutrition/dietetics" they seem to have omitted other search terms such as "curriculum and education" that may have provided different results. …