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• W2913703441 abstract "Dietetics operates within a web of connections formed by the context in which practice occurs. In health-care settings, the focus is on the patient, and collaborative practice is essential. Inter-professional practice occurs where health-care teams work together with the patient to solve complex problems, determining treatment decisions and best ways forward. In clinical and other settings, working with the best evidence requires an integration of practice with scientific research, but this research can, and needs to, come from a number of disciplines. Scientific disciplines maintain the standards and assure rigour for knowledge generation, but an interdisciplinary approach is needed to bring forward the breadth of available knowledge for translation to practice. From the laboratory bench to the community and beyond, nutrition science itself reflects a range of disciplinary expertise. Finally, protecting health involves more than translating health sciences to practice; it also requires advocacy beyond the health sector. This pushes practice to inter-sectoral domains. In this light, WHO recognises that, for effective and sustainable action on health, there is a need to address the social determinants of health and equity issues.1 These considerations add significantly to the scope of research in Dietetic practice while maintaining a sense of how it all fits together. This first issue of the journal for 2019 explores the three concepts of inter-professional, interdisciplinary and inter-sectoral Dietetic practice. The array of papers in this issue exemplifies how Dietetic practice, and the associated research, is aligned to these concepts. Both practice and research have come a long way since the inception of the journal 75 years ago, and it is worth taking a moment to reflect on that history. The journal began in 1944 with the Australian Institute of Anatomy publication, Food and Nutrition Notes and Reviews.2 It was later transferred to the Commonwealth Department of Health and became known as the Journal of Food and Nutrition, where in 1979, the distinguished dietitian and head of the Nutrition Section, Dr. Ruth English AO, became Editor. The early connections with the academy and government reflect the underpinnings of Dietetics practice in the scientific disciplines and in service to public health. The journal was subsequently transferred from the Commonwealth Department of Health to the Dietitians Association of Australia and, in 1989, became the Australian Journal of Nutrition and Dietetics and, in 2002, Nutrition & Dietetics. All three titles of the journal are catalogued in the US National Library of Medicine (NLM),3 with the Mesh term Dietetics* latterly added. Dietetics involves the application of scientific knowledge to support the health of individuals and populations. At the heart of Dietetics is assuring and advocating for the delivery of nutrients in combinations of foods based on evidence from a body of sound science. Eating food, however, is a part of everyday life, and foods are made available through systems and processes reflecting societies and their use of the environment. Thus, an awareness of context is essential in Dietetics practice. After much hard work by the profession, Nutrition & Dietetics is now indexed by Medline, Pub Med and Index Medicus, broadening the reach to many scientific disciplines and health professions. Publishing our research exposes the inherent expertise of authors as well as the range of methodologies used. Indeed, the journal’s Table of Contents now demonstrates an array of research designs and methods used to provide the scientific underpinnings for practice. With a focus on inter-professional, interdisciplinary and inter-sectoral practice, this issue of the journal presents worthwhile examples of the range of methodologies applied. Under ‘Health Services Research’, the need for inter-professional practice is well emphasised in delivering health care related to home enteral nutrition services,4 advancing practice in gastronomy management5 and considering the role of nutrition assistants in conducting head and neck cancer (HNC) clinics.6 Role delineation is one of the key aspects emerging from this research. Publishing the findings helps to communicate and consolidate the evolving role of Dietetics in health-care services. Publication also enables a critical mass of research to be built up. For example, in another study of HNC clinics in Australia and the USA, factors influencing the role of the dietitian were identified as dietetic autonomy, the scientific evidence for protocols and collaboration with medical and nursing staff.7 In this context, qualitative interviews/focus groups, surveys and program evaluation are common research methods, providing evidence to support improvements as well as building theoretical frameworks for practice. There is a need for more of this research. A 2017 Cochrane review argued that, although poor inter-professional health care can produce adverse outcomes, there is insufficient evidence on effects from interventions. This is a developing field, with studies needing rigorous mixed methods and longer-term follow up.8, 9 Interdisciplinary practice is particularly evident in research as it reflects the knowledge base and the technical skill required to build that knowledge through scientific methods. By its nature, dietary assessment methodology is a central tenet of Dietetics, and developments are often led by Dietitian-researchers. The development of the ASA24 Australia is a good example, linking researchers in Australia and the USA.10, 11 Dietary assessment is prominent in ‘Nutritional Epidemiology’ and clinical trials, where it contributes significantly to study design (see in this issue Matsuo et al.,12 Senevirathne et al.,13 Truby et al.14 and Rozendaal et al.15). Of course, this research has many facets, meaning dietitians work with other disciplines in these studies, particularly from medicine, the basic sciences and biostatistics. As epidemiological research often provides the evidence for practice, Dietetic researchers need to have strong commitment to interdisciplinary research. The same applies to research relating to food and effects of food consumption (e.g. see Easton et al.16), relevant biomarkers and standards of health (in this issue, see Ash et al.17) and educational research (in this issue, see Morgan et al.18 and Kittisakmontri et al.19). Inter-sectoral practice moves beyond health services and considers the social aspects of food consumption. Research in this area often applies qualitative and mixed methods as well as ‘Survey Research’ to address problems associated with influences on health behaviour. For example, in this issue of the journal, Kittisakmontri et al. report on the attitudes, knowledge and practices within urban families in Northern Thailand on complementary feeding of infants.20 From a food service perspective, Williams provides a historical commentary on Australian cookbooks outlining the advice and recipes in the disabled and convalescent context.21 The letter to the Editor takes a public health advocacy position in relation to Australia’s Health Star Rating System.22 This area of practice (and research) has a broad focus, albeit linked back to nutrition science and health priorities for health protection. The categories of inter-professional, interdisciplinary and inter-sectoral practice are helpful in mapping out the scope for informative research, but like most categories, they overlap. The Primary Health Centre (PHC) setting, for example, provides a new horizon for research in inter-professional practice, particularly as multiple professions provide expertise in preventive health care.23 An inter-professional PHC service, however, requires a full appreciation of the discipline expertise, but the PHC setting itself can also be considered from an inter-sectoral perspective given the different social groups it serves. In this light, a recent systematic review on PHC for migrants and asylum seekers shows there are challenges and facilitators for health professions23 Publishing practice-oriented research not only confirms the knowledge contribution of nutrition-related disciplines, it also exposes the methodological expertise available to Dietetics. In this 75th anniversary year of the journal Nutrition & Dietetics, we celebrate where we have come from and look forward to our ongoing efforts to build expertise, across professions, across disciplines and across sectors in support of better nutritional health for all. The author received no funding to write this Editorial. Linda Tapsell is the Editor in Chief for Nutrition & Dietetics. Linda Tapsell was the sole author of this manuscript." @default.
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