Dietetic practice in type 2 diabetes: An ethnographic study of Australian dietitians

Objectives: To explore and describe the work patterns of Australian dietitians working in type 2 diabetes and to identify variations in practice and gaps in applying evidence. Subjects and design: In-depth telephone interviews were conducted with a purposive sample of 20 Australian dietitians working in the area of type 2 diabetes to determine elements of current practice and views on best practice. For the purpose of the present study a diabetes dietitian was defined as spending >= 50% of their patient management time in type 2 diabetes. Data were content-analysed and ethnographic descriptions were developed for practitioners' daily activities that were sensitive to the context in which the research was conducted. Results: Interviewees described a standard dietetic process, involving assessment, education, goal setting and the monitoring of outcomes. Their descriptions were consistent with practice guidelines established elsewhere and found in the literature; however, there was some variation in the management of elements within practice. These included dietary assessment, weight management, access to relevant assessment data such as test results and the description of dietary goals and outcome measures. Six components of best practice were identified: the dietetic process, client centredness, multidisciplinary teamwork, reference to evidence-based practice guidelines, continuing professional development and practice-based research and quality assurance activities. Conclusion or application: The present research demonstrated a consistency in practice in diabetes management by Australian dietitians. The ability of interviewees to determine the consequences of competent practice further suggests that the present research would support the development of practice guidelines.