Educational training of nutritionists in Public Health Nutrition: A systematic review

ALMEIDA, Géssica Mercia de; OLIVEIRA, Klébya Hellen Dantas de; MONTEIRO, Jordanna Santos; MEDEIROS, Maria Angélica Tavares de; RECINE, Elisabetta Gioconda Iole Giovanna

doi:10.1590/1678-98652018000100009

Géssica Mercia de ALMEIDA

Universidade Federal de Goiás, Faculdade de Nutrição. R. 227, Qd. 68 s/n., Setor Leste Universitário, 74605-080, Goiânia, GO, Brasil. Correspondência para/Correspondence to: GM ALMEIDA. E-mail: <gessicamercia@gmail.com>.

https://orcid.org/0000-0002-5722-7260

Klébya Hellen Dantas de OLIVEIRA

Universidade de Brasília, Programa de Pós-Graduação em Nutrição Humana. Brasília, DF, Brasil.

https://orcid.org/0000-0003-3600-4009

Jordanna Santos MONTEIRO

Universidade de Brasília, Programa de Pós-Graduação em Nutrição Humana. Brasília, DF, Brasil.

https://orcid.org/0000-0003-2590-5028

Maria Angélica Tavares de MEDEIROS

Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Laboratório de Segurança Alimentar e Nutricional e Políticas Públicas. São Paulo, SP, Brasil.

https://orcid.org/0000-0002-8982-7084

Elisabetta Gioconda Iole Giovanna RECINE

Universidade de Brasília, Programa de Pós-Graduação em Nutrição Humana. Brasília, DF, Brasil.

https://orcid.org/0000-0002-5953-7094

Criteria	Description
Participants (P)	Nutritionist, Dietician and Nutrition Technician.
Exposure (E)	Staff Development, Health Human Resource Training, Higher Education and Professional Training in Nutrition Public Health.
Comparison or control (C)	-
Outcome measures (O)	Health Promotion, Food and Nutrition Security, Food Advocacy, Food and Nutrition Education, Nutrition Education.
Types of Studies included (S)	Observational studies with quantitative and qualitative approach.

Database	Descriptors used
PudMed	(Nutritionist OR Dietician OR Nutritionists OR Dieticians OR “Nutrition Technician”) AND (“Staff Development” OR “Health Human Resource Training” OR “Higher Education” OR “Human Resources Capacity Building Centers” OR “Human Resources Development Centers” OR “Capacity Building” OR “Professional Training”) AND (“Nutrition Public Health” OR “Public Health”) AND (“Health Promotion” OR “Food and Nutrition Security” OR “Food Advocacy” OR “Food and Nutrition Education” OR “Nutrition Education”)
Lilacs	( ( ( ( ( “NUTRICIONISTA” ) or “NUTRICIONISTAS” ) or “DIETISTAS” ) or “DIETISTA” ) or “TECNICO EN NUTRICION” ) or “TECNICO EM NUTRICAO” [Palavras] and ( ( ( ( ( ( ( ( “DESARROLLO DE PERSONAL” ) or “DESENVOLVIMENTO DE PESSOAL” ) or “CAPACITACION DE RECURSOS HUMANOS EN SALUD” ) or “CAPACITACAO DE RECURSOS HUMANOS EM SAUDE” ) or “EDUCACION SUPERIOR” ) or “EDUCACAO SUPERIOR” ) or “CAPACITACION PROFESIONAL” ) or “CAPACITACAO PROFISSIONAL” ) or “FORMACAOPROFISSIONAL” or “FORMACAO PROFISSIONAL” [Palavras] and ( ( ( “NUTRICION EN SALUD PUBLICA” ) or “NUTRICAO EM SAUDE PUBLICA” ) or “SALUD PUBLICA” ) or “SAUDE PUBLICA” [Palavras]
Scopus	( ALL ( nutritionist OR nutritionists OR dietician OR dieticians OR “Nutrition Technician” ) ) AND ( ALL ( “Staff Development” OR “health human resources training” OR “Higher Education” OR “human resources capacity building centress” OR “Human Resources Development Centers” OR “Capacity Building” OR “Professional Training” ) ) AND ( ALL ( “Nutrition Public Health” OR “Public Health”) AND ( ALL ( “Health Promotion” OR “Food and Nutrition Security” OR “Food Advocacy” OR “Food and Nutrition Education” OR “Nutrition Education” ) )
Web of Science	TS= (Nutritionist* OR Dietician* OR “Nutrition Technician”) AND TS= (“Staff Development” OR “Health Human Resource Training” OR “Higher Education” OR “Human Resources Capacity Building Centers” OR “Human Resources Development Centers” OR “Capacity Building” OR “Professional Training”) AND TS= (“Nutrition Public Health” OR “Public Health” OR “Nutrition”) AND TS= (“Health Promotion” OR “Food and Nutrition Security” OR “Food Advocacy” OR “Food and Nutrition Education” OR “Nutrition Education”)
PsycINFO	Any Field: Nutritionist OR Nutritionists OR Dietician OR Dieticians OR “Nutrition Technician” AND Any Field: “ Staff Development” OR “ Health Human Resource Training” OR “ Higher Education” OR “ Human Resources Capacity Building Centers” OR “ Human Resources Development Centers” OR “ Capacity Building” OR “ Professional Training” AND Any Field: “ Nutrition Public Health” OR “ Public Health” OR “ Nutrition” AND Any Field: “ Health Promotion” OR “ Food and Nutrition Security” OR “ Food Advocacy” OR “ Food and Nutrition Education” OR “ Nutrition Education”
Science Direct	All (Nutritionist* OR Dietician* OR “Nutrition Technician”) AND All (“Staff Development” OR “Health Human Resource Training” OR “Higher Education” OR “Human Resources Capacity Building Centers” OR “Human Resources Development Centers” OR “Capacity Building” OR “Professional Training”) AND All (“Nutrition Public Health” OR “Public Health”) AND All (“Health Promotion” OR “Food and Nutrition Security” OR “Food Advocacy” OR “Food and Nutrition Education” OR “Nutrition Education”)
Open Grey	Nutritionist* OR Dietician* AND “Staff Development” OR “Higher Education” AND “Nutrition Public Health” AND “Health Promotion” OR “Food and Nutrition Security” OR “Food and Nutrition Education”
Google Scholar	Nutritionists OR “Higher Education” OR “ Nutrition Public Health”
ProQuest	Nutritionists OR “Higher Education” OR “ Nutrition Public Health”

Author Year Country	Target audience/ sample	Research Method/ Methodology	Method of data collection	Variables of interest	Main results	Conclusion
Pinheiro et al. [¹¹11 Pinheiro ARO, Recine E, Alencar B, Fagundes AA, Sousa JS, Monteiro RA, et al. Percepção de professores e estudantes em relação ao perfil de formação do nutricionista em saúde pública. Rev Nutr. 2012;25(5):631-43. http://dx.doi.org/10.15 90/S1415-52732012000500008 https://doi.org/10.15 90/S1415-527320120... ] Brazil-Latin America	206 participants: Students, nutritionists, lecturers, and FCN supervisor	Mixed- methods study (quali-quantitative approaches)	-Structured Questionnaire and Focus Group - Descriptive analysis and Collective Subject Discourse	Teaching, participation in extension projects, and skills and competencies in PHN	According to the students, PHN was the second most common area of interest (35.0%). The theory-practice relationship shows linear approach in the teaching method adopted and the biologicist focus of the courses. The lack of integrality in the educational training of nutritionists indicates curricular structure fragmentation. Fifty-six percent of the students took PHN extension courses during their undergraduate studies. Due to the lack of nutritionists in the teaching-service programs, HEI need to adopt education strategies in order to provide students with practical experience, and students have to play the role of a professional during the curricular internships. Desired skills and competencies: reflection, proactivity, individual and collective attention, program coordination activities, teamwork, FNS assessment, implementation of actions to promote healthy eating, and participation in Nutritional Surveillance.	There is a need to review the traditional and hegemonic pedagogical perspective, which is based on the vertical knowledge transmission. New pedagogical practices should improve dialogue dimensions, interdisciplinary approach, problem-posing and critical analysis in PHN education.
		Mixed- methods study (quali-quantitative approaches)
Aksoydan & Mizikaci [¹³13 Aksoydan E, Mizikaci F. Evaluation of nutrition and dietetic programs in Turkey as perceived by stakeholders. Nutr Diet. 2015;72(2):176-82. http://doi.org/10.1111/1747-0080.12161 https://doi.org/10.1111/1747-0080.12161... ] Turkey- Eurasia	283 participants students, (lecturers, and nutritionists) 6 universities from 3 different provinces	Mixed methods study	- Questionnaire - 5-point Likert scale to evaluate the effectiveness of the programs	Importance and effectiveness of the knowledge and skills taught in undergraduate programs	All students, scholars, and nutritionists rated theory, practice, and extracurricular courses as “important” and “very important” to acquire skills and knowledge. There was a difference between the students, nutritionists, and lecturers in terms of the importance of theoretical courses in basic science and community nutrition. Practical teaching was considered as the most important by all participants. As for the	Nutrition and dietetics programs should be systematically evaluated and revised to ensure that the needs and expectations of society and the profession are met.


					effectiveness of the programs in providing knowledge and skills, the students gave higher ratings than the lecturers and nutritionists. Lecturers gave Higher ratings to the effectiveness of the programs in providing knowledge and skills to theory and practice of community nutrition (4.30±0.23 and 4.14±0.15, respectively) than the other participants (p<0.05). Importance and effectiveness of Community nutrition programs received the lowest ratings in terms of importance and effectiveness in promoting knowledge and skills, when compared to other fields such as, basic science, nutrition science, and nutrition and dietetics.
Looy et al. [¹⁴14 Looy A, Naumann E, Govers E. Thematic Network DIETS mapping dietetic education in Europe 2006-2009: Comparisons to the European Academic and Practitioner Standards for Dietetics. Act Diet. 2010;14(3):109-19. https://doi.org/10.1016/S1138-0322(10)70022-5 https://doi.org/10.1016/S1138-0322(10)70... ] Europe^a a European countries that participated in the study conducted by Looy et al. [14]: Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Italy, Ireland, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, Turkey, and United Kingdom.	HIE partners of The DIETS network in 2007 (n=37) and 2009 (n=4) 25 European countries	Longitudinal study	- Online questionnaire with qualitative and quantitative questions	Teaching, Disciplines, and Knowledge area	Most HEI offer practice in health promotion and primary health care, but the highest prevalence is in the clinical area. Length in weeks of internships in the areas of health promotion and primary health care varied between countries; one week in Slovenia and 20 weeks in the Netherlands. Unlike other countries, the courses in Slovenia were strictly focused on educational training in Public Health. In 2002/2007, Public Health and Health promotion were taught in 60.0%-70.0% of HEI; in 2009, they were taught in 70.0%-80.0% HEI. Students were trained to counsel groups (100.0%) and individuals (94.0%), and to take responsibility for feeding groups of people (83.0%).	The time spent in practical learning is on average in agreement with the EDBS. Despite the many advances, many HEI have not yet included the full breadth of subjects accepted by the EFAD, which means that this may hinder the ability of nutritionists to meet workplace challenge.
		Longitudinal study		Teaching, Disciplines, and Knowledge area
Menezes et al. [²³23 Menezes TB, Borges LSB, Santos LM, Noro LRA. Bibliometric analysis of undergraduate final research projects in nutrition courses in the state of Rio Grande do Norte, Brazil. Rev Nutr. 2016;29(1):139-49. http://dx.doi.org/10.1590/1678-98652016000100013 https://doi.org/10.1590/1678-98652016000... ] Brazil-Latin America	195 SYP from 5 nutrition courses in Rio Grande do Norte state.	Bibliometric study	- Document and statistical analysis	Core knowledge areas and settings for research	The area of interest in most senior year projects was public health (p<0.001). Public health services accounted for 10.3% of the places or settings where the research was carried out. Most research projects used the quantitative approach. Collective health was the most researched topic.	Core knowledge areas which indicates a social perspective that goes beyond the biological focus. Ineffective methods were used in the research projects, suggesting the need to improve the scientific method in undergraduate courses.
Vieira & Cervato-Mancuso [²⁴24 Vieira VL, Cervato-Mancuso AM. Professional training in the context of food and nutrition security. Prim Health Care Res Dev. 2015;16(5):540-4. https://doi.org/:10.1017/S1463423614000334 https://doi.org/10.1017/S146342361400033... ] Brazil-Latin America	39 participants (nutritionists and lecturers/course coordinators) 6 curricula of HEI' Nutrition courses	Qualitative exploratory study	- Semistructured interviews, focus group, and document analysis - Descriptive analysis and Collective Subject Discourse	Topics included in the educational training in FNS	According to nutritionists and course coordinators: FNS course contents are fragmented; humanistic approach is important, but there is a need for a more comprehensive approach; practical activities are considered as important but insufficient, and there is a lack of professional supervision; the courses contribute to FNS actions through internships, visits and extension courses; education of nutritionists is inadequate showing essentially technical characteristics; there is limited and superficial reflection about Public Health and Public Health policies; teaching projects should have interdisciplinarity of the FNS contents; the proposed professional profile includes the humanistic approach; there is a combination between theory and practice. Desired skills and competencies: communication and teamwork. Education and training in Public Health and public policies were not mentioned in the curricula.	There is a need for human resource training that can effectively contribute to FNS promotion. HEI need more support to redesign the courses they offer. There is also a need to implement the measures according to the intersectoral policies between health and education.
		Qualitative exploratory study		Topics included in the educational training in FNS
Recine et al. [²⁵25 Recine E, Sugai A, Monteiro RA, Rizzolo A, Fagundes A. Saúde coletiva nos cursos de nutrição: análise de projetos político-pedagógicos e plano de ensino. Rev Nutr. 2014;27(6):747-60. http://dx.doi.org/10.1590/1415-52732014000600009 https://doi.org/10.1590/1415-52732014000... ] Brazil-Latin America	46 Public and private HEI that offer the Nutrition undergraduate courses 517 of PHN syllabuses 46 political-pedagogical projects	Qualitative cross sectional study	Document analysis of teaching plans and pedagogical political projects Use of Alceste data analysis software	Significant and recurrent words in the documents of the PHN disciplines	Most of the content addressed in the PPP referred to course structure and design. The structure and design of the courses are related to the teaching/research/extension triad; integration between academy and community; curricular approaches (practical activities, disciplines, and internship). In the PPP of the nutrition courses, the term educational training was related to curricular process and SYP. Disciplines such as nutritional assessment and those related to life stages corresponded to 34.2% of the syllabuses, whereas only 9.7% of the disciplines addressed aspects related to educational training and professional performance. In the syllabuses, educational training for professional practice referred to actions, such as analyzing, reflecting, planning, and identifying, associating interventions with the local reality. Topics such as culture and social sciences in nutrition were briefed mentioned in the syllabuses.	The PPP have less information about the role of the professionals than information about operational and descriptive characteristics of the professional practice. The proposals of the nutrition courses need to go beyond the Cartesian paradigm, which focuses on treatment overlooking prevention and promotion. There is a need to bridge the gap between the biological and social and to encourage and promote reflection and attention to the professional practice.


Recine et al. [²⁶26 Recine E, Gomes RCF, Fagundes AA, Rizzolo A, Teixeira BA, Sousa JS, et al. A formação em saúde pública nos cursos de graduação de nutrição no Brasil. Rev Nutr. 2012;25(1):21-33. http://dx.doi.org/10.1590/S1415-52732012000100003 https://doi.org/10.1590/S1415-5273201200... ] Brazil- Latin America	65 coordinators of HEI undergraduate nutrition courses	Cross-sectional study	- Online questionnaire	PHN disciplines, workload, and theoretical and practical classes	In 89.2% of the courses evaluated, up to 50.0% of lecturers were responsible for Public Health Nutrition disciplines (80.0% in public institutions and 95.0% in private ones). On average, the courses offered 14.06 disciplines (mandatory and elective) that were considered PHN disciplines; 13.1 in public HEI and 14.7 in private institutions. The percentage of the course credits (or hours in class hours) allocated to the study of Public Health disciplines, considering only the compulsory disciplines, was between 12.0-44.5%. Most courses (72.2%) allocated a maximum of 30.0% of the total workload to PHN disciplines. On average, 82.2% of PHN disciplines are mandatory. Almost a quarter of the PHN disciplines' workload referred to practical activities. The most commonly offered PHN disciplines were: Nutrition Assessment, Nutrition Education, Social Nutrition Internship, PHN, and Epidemiology.	There is a need to offer more disciplines that can contribute to the educational training of professionals focusing on the Unified Health System. The alignment between educational training of nutritionists and current and future challenges faced by Health and PHN areas requires a deep reflection about its social role and insertion in public policies and programs.

Toledo & Gambardella [²⁷27 Toledo AAD, Gambardella AMD. Saúde, formação e trabalho: a perspectiva do nutricionista ao longo de sete décadas [dissertação]. São Paulo: Universidade de São Paulo; 2014.] Brazil- Latin America	12 nutrition graduates (from 1940 to 2006)	Qualitative exploratory descriptive study	- Semistructured interviews - Content analysis	Educational training Perception	According to the graduates, education training in public health made them aware of social issues and taught them critical and comprehensive thinking, which are distinct characteristics of Nutrition undergraduate courses in Brazil. Some weaknesses of the educational training programs pointed out include: insufficient PHN practical activities (in the first programs) and availability of PHN internships. According to the graduates, PHN internships should be associated with public services instead of private companies. They considered Nutrition public policies as important factors to enhance professional practice.	The educational training of nutritionists included health disciplines, especially public health, with strong influence of educators who were sanitarists and recognized the value of community actions.
	12 nutrition graduates (from 1940 to 2006)	Qualitative exploratory descriptive study	- Semistructured interviews - Content analysis	Educational training Perception
Lourenço et al. [²⁸28 Lourenço AEP, Cordeiro AA, Capelli JCS. O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) e a formação do nutricionista num campus de interiorização. Demetra. 2017;12(1):41-58.] Brazil-Latin America	16 participants (9 students, 4 preceptors, 3 lecturers)	Qualitative study	- Written reports - Thematic content analysis	Training Extension activities	The education extension activities proved to be an important experience enabling the interaction between theory and practice, promoting a greater contact of students with the local reality and with the Sistema Único de Saúde (SUS, Unified Health System) routine, contributing to a more socially engaged education.	The education extension activities are important to redirect Nutrition education, allowing the interaction between undergraduate students and practical field experiences within the SUS.
	16 participants (9 students, 4 preceptors, 3 lecturers)	Qualitative study	- Written reports - Thematic content analysis	Training Extension activities
					Practical experience enables learners to be participatory actors in the learning process. The education extension activities stimulated interdisciplinarity. According to the lecturers, having contact with preceptors made them feel closer to professional practice and contributed to their education.
Fox et al. [²⁹29 Fox A, Chenhall C, Traynor M. Public health nutrition practice in Canada: A situational assessment. Public Health Nutr. 2008;11(8):773-81. http://dx. doi.org/10.1017/S1368980007001516 https://doi.org/10.1017/S136898000700151... ] Canada- North America	29 key informants (Nutrition professionals and representatives of regulatory agencies, Public Health stakeholders, and government representatives)	Qualitative study	Situational assessment of PHN practice using key informant telephone interviews	Training and qualification	A small number of internship programs focus on community and public health; however, educational training in clinical nutrition and food services remain the focus of most programs.	Most participants considered the development of specific competencies for PHN practice as an important strategy for the promotion of knowledge construction through various education channels.
Looy et al. [³⁰30 Looy A, Markaki A, Joossens S. Practice learning a prelude to work: Studies by DIETS2. Nutr Food Sci. 2015;45(1):112-24. https://doi.org/10.1108/NFS-04-2013-0047 https://doi.org/10.1108/NFS-04-2013-0047... ] Europe^b b European countries that participated in the study conducted by Looy et al. [30]: The Netherlands, Portugal, Belgium, The Czech Republic, France, Greece, Spain, Austria, Hungary, Israel, Sweden, Lithuania, Ireland, Luxembourg, The Slovak Republic, The United Kingdom, Iceland, and Liechtenstein.	39 HEI or National Associations of Dietitians from 19 European countries	Cross sectional study	- Online questionnaire	Diversity of fields for internship	Internships in Public Health, education, and social care were mentioned by 28% of the respondents as important in the pre-qualification placement of nutrition students, with a period of practice of 5 weeks. In the Public Health education and social care areas the most mentioned internships locations were: health promotion (39.0%); Local council and public health; government department; and nongovernmental agency (33.0%); Health centers (33.0%); and schools and kindergarten (31.0%). The duration in weeks of the internships in Public Health according to the median and the inter quartile range were: local health center (7.5, 3.5-20.0); health promotion (5.0, 2.5-7.8); schools and kindergarten (2.0, 2.0-4.0); local council/public health/ government department/ non-governmental agencies (6.0, 3.5-8.5).	There was a diversity of internship locations, selection methods, and duration among the countries. Higher education has an important role in quality of learning experiences learning and ensuring that the learning environment is able to offer new work environments for health professionals.
Pham et al. [³¹31 Pham QTH, Worsley A, Mark L, Marshall B. Opportunities and barriers to public health nutrition education in Vietnamese universities. Asia Pac J Clin Nutr. 2017;26(3):494-503. https://doi.org/10.6133/apjcn.042016.06] Vietnam-Asia	139 Nutrition Lecturers	Cross sectional study	- Online questionnaire -5-point Likert scale to assess educational barriers	Barriers to teaching FNS and nutrition training courses to lecturers	The main barriers to teaching FNS are: large classes preventing lecturers from using interactive teaching methods (81.7%); lack of on-the-job training for nutrition lecturers (78.8%); and very rigid curricula framework (70.2%). Nutrition training courses that teachers would like to take the following courses related to food policies: food security and sustainability (28.1%); food system (18.8%); and food policies (18.8%).	The participant professionals showed a strong preference for training in the traditional focus on the biological dimension of nutrition science. This suggests the need to improve PHN professional development among university lecturers in Vietnam.
	139 Nutrition Lecturers	Cross sectional study

Checklist for Qualitative Research²²

Risk of bias¹ 1 The risk of bias was classified as 'high' if 49% of the answers to the signaling questions were yes; 'moderate' for 50%-69% of "yes" answers; and 'low' for 70% or more of "yes" answers.

Studies

1

2

3

4

5

6

7

8

9

10

Vieira & Cervato-Mancuso [²⁴24 Vieira VL, Cervato-Mancuso AM. Professional training in the context of food and nutrition security. Prim Health Care Res Dev. 2015;16(5):540-4. https://doi.org/:10.1017/S1463423614000334
https://doi.org/10.1017/S146342361400033... ]

a

c

b

a

Low

Fox et al. [²⁹29 Fox A, Chenhall C, Traynor M. Public health nutrition practice in Canada: A situational assessment. Public Health Nutr. 2008;11(8):773-81. http://dx. doi.org/10.1017/S1368980007001516
https://doi.org/10.1017/S136898000700151... ]

c

a

b

c

a

c

b

a

Moderate

Toledo & Gambardella [²⁷27 Toledo AAD, Gambardella AMD. Saúde, formação e trabalho: a perspectiva do nutricionista ao longo de sete décadas [dissertação]. São Paulo: Universidade de São Paulo; 2014.]

c

a

b

a

Low

Lourenço et al. [²⁸28 Lourenço AEP, Cordeiro AA, Capelli JCS. O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) e a formação do nutricionista num campus de interiorização. Demetra. 2017;12(1):41-58.]

a

c

a

b

a

b

a

Low

Checklist for Analytical Cross Sectional Studies²¹

1

2

3

4

5

6

7

8

Menezes et al. [²³23 Menezes TB, Borges LSB, Santos LM, Noro LRA. Bibliometric analysis of undergraduate final research projects in nutrition courses in the state of Rio Grande do Norte, Brazil. Rev Nutr. 2016;29(1):139-49. http://dx.doi.org/10.1590/1678-98652016000100013
https://doi.org/10.1590/1678-98652016000... ]

a

b

a

Low

Recine et al. [²⁶26 Recine E, Gomes RCF, Fagundes AA, Rizzolo A, Teixeira BA, Sousa JS, et al. A formação em saúde pública nos cursos de graduação de nutrição no Brasil. Rev Nutr. 2012;25(1):21-33. http://dx.doi.org/10.1590/S1415-52732012000100003
https://doi.org/10.1590/S1415-5273201200... ]

a

b

a

Low

Looy et al. [³⁰30 Looy A, Markaki A, Joossens S. Practice learning a prelude to work: Studies by DIETS2. Nutr Food Sci. 2015;45(1):112-24. https://doi.org/10.1108/NFS-04-2013-0047
https://doi.org/10.1108/NFS-04-2013-0047... ]

c

a

b

a

Moderate

Pham et al. [³¹31 Pham QTH, Worsley A, Mark L, Marshall B. Opportunities and barriers to public health nutrition education in Vietnamese universities. Asia Pac J Clin Nutr. 2017;26(3):494-503. https://doi.org/10.6133/apjcn.042016.06]

a

c

a

Low

Checklist adapted for evaluation of mixed methods studies²⁰

1

2

3

4

5

6

7

8

9

Pinheiro et al. [¹¹11 Pinheiro ARO, Recine E, Alencar B, Fagundes AA, Sousa JS, Monteiro RA, et al. Percepção de professores e estudantes em relação ao perfil de formação do nutricionista em saúde pública. Rev Nutr. 2012;25(5):631-43. http://dx.doi.org/10.15 90/S1415-52732012000500008
https://doi.org/10.15 90/S1415-527320120... ]

c

a

Low

Recine et al. [²⁵25 Recine E, Sugai A, Monteiro RA, Rizzolo A, Fagundes A. Saúde coletiva nos cursos de nutrição: análise de projetos político-pedagógicos e plano de ensino. Rev Nutr. 2014;27(6):747-60. http://dx.doi.org/10.1590/1415-52732014000600009
https://doi.org/10.1590/1415-52732014000... ]

a

b

a

b

a

Low

Aksoydan & Mizikaci [¹³13 Aksoydan E, Mizikaci F. Evaluation of nutrition and dietetic programs in Turkey as perceived by stakeholders. Nutr Diet. 2015;72(2):176-82. http://doi.org/10.1111/1747-0080.12161
https://doi.org/10.1111/1747-0080.12161... ]

b

c

a

Low

Checklist adapted for evaluation of longitudinal studies²⁰

1

2

3

4

5

6

7

8

9

10

Looy et al. [¹⁴14 Looy A, Naumann E, Govers E. Thematic Network DIETS mapping dietetic education in Europe 2006-2009: Comparisons to the European Academic and Practitioner Standards for Dietetics. Act Diet. 2010;14(3):109-19. https://doi.org/10.1016/S1138-0322(10)70022-5
https://doi.org/10.1016/S1138-0322(10)70... ]

a

b

a

c

a

b

Low

[1] Note: PECOS: Participants, Exposure, Comparison or control, Outcome measures, Studies included.

Brasil

Brasil

Educational training of nutritionists in Public Health Nutrition: A systematic review

Formação do nutricionista em Saúde Pública. uma revisão sistemática

ABSTRACT