Accepted for/Published in: JMIR Formative Research
Date Submitted: Aug 29, 2025
Date Accepted: Dec 12, 2025
Identifying the Structure and Elements of Nutritional Guidance Techniques: An Analytic Hierarchy Approach
ABSTRACT
Background:
Registered dietitians (RDNs) contribute to disease management, prevention of complications, and improvement of quality of life (QOL) through individualized nutritional guidance. However, these techniques often rely on individual experience, leading to variations in quality. The Nutrition Care Process (NCP) provides a standardized framework for nutritional care, but the specific techniques used in clinical practice and their interrelationships remain unclear. Interpretive Structural Modeling (ISM) is a method that visualizes and hierarchically organizes interrelationships among multiple factors, making it useful for structuring complex practical skills.
Objective:
This study aimed to identify the factors influencing nutritional guidance techniques in clinical practice, clarify their hierarchical structure using ISM, and explore their applicability to the education of registered dietitians.
Methods:
Three experienced RDNs were selected as an expert panel. Elements influencing nutritional guidance were extracted through brainstorming and consensus-building sessions. The extracted elements were analyzed using ISM to generate a reachability matrix and a hierarchical structure diagram, thereby visualizing the interrelationships among these elements.
Results:
14 elements were identified and organized into a six-level hierarchical structure. The upper levels represented comprehensive NCP-related elements, with the “Nutritional Intervention Plan” at the top, while the lower levels consisted of foundational elements, such as “Clinical Knowledge” and “Understanding of Patient Background”, which support the development of these upper-level elements.
Conclusions:
This study is the first to systematically visualize the components and hierarchical structure of nutritional guidance techniques using ISM. The resulting model provides a foundation for developing clinical education curricula and competency evaluation frameworks for RDNs and is expected to contribute to the standardization of nutritional guidance education.
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Copyright
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