Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States

Sunitha Zechariah; Jennifer L Waller; Gianluca De Leo; Judith Stallings; Ashley J Gess; Leigh Lehman

doi:10.3390/healthcare9091225

Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States

Healthcare (Basel). 2021 Sep 17;9(9):1225. doi: 10.3390/healthcare9091225.

Authors

Sunitha Zechariah¹, Jennifer L Waller², Gianluca De Leo¹, Judith Stallings¹, Ashley J Gess³, Leigh Lehman⁴

Affiliations

¹ College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
² Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
³ College of Education, Augusta University, Augusta, GA 30912, USA.
⁴ School of Occupational Therapy, Brenau University, Gainesville, GA 30501, USA.

Abstract

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs' NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach's alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and >0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings.

Keywords: Delphi consensus; competency; content validity; face validity; nutrition-focused physical exam; registered dietitian nutritionists.