Dietitians' opinions and experiences of client-centred nutrition counselling

Although participants agreed or strongly agreed with a further eight items in the first-round questionnaire, the IQR for the responses to those items was slightly broader. This finding indicates some differences in opinion about the importance of those issues in a client-centred approach to nutrition counselling. The finding may have been due to differing perceptions of the meaning of some of the words in those items. For example, participants' comments made apparent the fact that the terms "advocate," "set protocol," and "nutrition care process" were not universally understood. The word "allow" also concerned some participants; comments indicated that the term suggested an imbalance of power in the client-dietitian relationship. This may have caused some participants to disagree with items containing this word or to rate them lower on the scale. However, this finding also likely reflects participants' concerns about implementing these concepts in practice. Many participants indicated that they had experienced barriers in their attempts to deliver nutrition counselling services using a client-centred approach. This finding is similar to those by researchers in the occupational therapy profession, who found that lack of time and resources, as well as the therapist's and client's differing goals, were significant challenges to implementing this approach (16,17). These researchers also identified the need to develop an organizational culture that supports client-centred practice, and for ongoing education to increase practitioners' knowledge and understanding of a client-centred approach. Interestingly, when asked to identify factors that facilitate the use of a client-centred approach in nutrition counselling, current survey participants indicated the helpfulness of working as part of a team that supported its use. Of concern, however, is the finding that some participants had little or no education/training in nutrition counselling during their undergraduate education or dietetic internship. Further, about one-third of participants had had no additional training/education in counselling since they had started their practice.