Client-centred nutrition counselling : an exploratory study
Maclellan, Deborah Lynn
The purpose of this research was to determine the meaning that dietitians ascribe to the client-centred approach to nutrition counselling and to identify the important concepts and issues inherent in this approach to practice. A two-round, reactive Delphi survey, followed by indepth telephone interviews was used to collect the data. The first round survey was sent to 65 members of Dietitians of Canada who indicated that they had advanced level counselling skills in the member database. Fifty-seven questionnaires were returned in the first round and 48 in the second round for response rates of 88% and 84%, respectively. The follow-up survey was conducted with a subsample of 25 of the Delphi participants. The raw data from these interviews were transcribed verbatim and a form of inductive, thematic analysis was used to analyse the transcripts. Results indicated that participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice, however, when asked about their experience in these areas, it was clear that they had some difficulty in the implementation of this approach. Participants appeared to be struggling in their attempt to find a balance between their beliefs about what a client-centred approach 'should' be and what was possible, given the realities of their workplaces. The results of the indepth interviews suggested that participants believed that using a client-centred approach is essential for successful nutrition counselling outcomes; however how they defined that approach varied depending on the context in which the counselling took place. In Canada, the client-centred approach is considered one of the core concepts of dietetic practice. These findings suggest, however, that no common understanding exits of what it means to counsel in a client-centred manner. Thus, there is a need to reexamine the professional standards for dietitians in Canada and to broaden this discussion to clarify the fundamental principles related to nutritional care. Even more importantly, dietitians need to find out from their clients what they believe is important in a nutrition counselling relationship.