Table 1. Overview of the studies, including aims, methods and their key findings
Study Aims Method Sample included Key findings
Arrish et al. (2016)11 Investigate midwifes’ nutrition knowledge, confidence and attitudes regarding providing nutrition education in pregnancy Cross-sectional online survey 329 Midwives (Australia); Convenience sampling 75.7% (n = 249) of Australian midwives recognised their role in delivering nutritional advice to pregnant women as highly significant. Midwives’ confidence ranged from moderate to low when discussing general and specific nutrition advice to pregnant women. Inadequate nutritional knowledge was recorded in several areas. Only half of the midwives (51.1%) indicated that they received nutrition education during midwives training or after registration (54.1%). 
Arrish et al. (2017)12 Explore midwives’ nutritional knowledge gained during midwifery education and following registration, and their perceived readiness to provide nutrition counselling Cross sectional written and online survey  393 Midwives (Australia); Convenience sampling 79.3% (n = 261) of midwives reported receiving some nutrition education during, before or after registration with many describing this coverage as limited. 94.2% (n = 310) of midwives indicated that they would benefit from receiving additional nutrition information and tailored guidelines for the provision of nutrition advice (87.8%, n = 289). A further 59.1% (n = 78) indicated that additional nutrition education would improve their knowledge of current evidence-based advice and increase their confidence.
Cass et al. (2014)8 Investigate practice nurses’ perceptions of their role and competency in the provision of nutrition advice to patients with chronic disease Semi-structured telephone interview   20 Practice nurses (Australia); Purposive sampling Lack of confidence, nutrition knowledge, time and unenthusiastic patient attitude towards nutrition influenced the provision of nutrition care to patients with chronic disease. Practice nurses recognised the significance of their role in promoting basic nutrition care, but the interpretation of basic varied. Practice nurses were concerned about the lack of accessibility and availability of current nutrition education opportunities.
Chapple et al. (2018)13 Explore the attitudes, experiences and barriers of healthcare practitioners that influence their decisions in providing nutritional therapy to patients with traumatic brain injuries (TBI) Semi-structured interview 18 Nurses 16 Physicians (Australia); Purposive sampling Health practitioners were unclear about the role they played in the provision of nutrition therapy to TBI patients, hence there was a lack of perceived responsibility in the management of nutrition. There were competing priorities when caring for patients with TBI, identifying a need for further education of the multidisciplinary team to gain an understanding of current evidence-based guidelines to enhance nutrition practices in the TBI population.
Crowley et al. (2016a)7 Identify and describe general practitioners’ interest, confidence and barriers in the promotion of nutrition care Cross-sectional online and written survey 322 GP’s* (Australia); Convenience sampling A large proportion of general practitioners (91.6%, n = 295) were very interested and 71.7% (n = 231) reported moderate confidence in providing nutrition care to patients where long-term strategies were well-established. General practitioners documented time constraints as the biggest barrier in the provision of nutrition care during consultations (52.8%, n = 170). An overwhelming majority of general practitioners were interested in undertaking additional education and training to improve nutritional knowledge and skills. The study concluded that general practitioners would benefit from educational programmes that focused on the delivery of healthy dietary practices within standard consultations and identification of nutritional risk.
Crowley et al. (2015)14 Describe general practitioner registrars and general practitioners perceived attitudes and skills in the provision of nutritional advice Cross-sectional paper-based questionnaire   51 GP registrars 57 General practitioners** (New Zealand); Convenience sampling General practitioners and general practitioner registrars reported positive attitudes towards the incorporation of nutrition care in consultation with patients. Lack of confidence in nutritional skills such as the role of food constituents in health and the basic metabolic role of protein, carbohydrates and fats was documented. An enhancement of knowledge in this area was identified as beneficial in future.
Crowley et al. (2016b)15 Explore the perceptions of general practitioners in the promotion of nutrition care to patients with chronic disease Focus groups   48 GP’s (New Zealand); Convenience sampling  Limited consultation time restricted nutritional competence while patients’ resistance to change restricted general practitioners in providing basic nutrition care to patients with chronic disease. General practitioners reported receiving inadequate education during medical training and expressed the need for further information to provide economically, socially and culturally sensitive nutrition care.
Crowley et al. (2016c)16 Investigate the ability of general practitioner registrars to counsel patients on nutrition Cross-sectional survey   47 GP registrars (New Zealand); Convenience sampling  General practitioner registrars recorded a positive attitude towards the implementation of nutrition care but only moderate confidence in the implementation of this care. A limited number of general practitioner registrars provided evidence-based nutrition advice which was identified as potentially due to gaps in their nutrition knowledge. Lack of experience, lack of assessment opportunities, attitude and awareness of nutrition guidelines were considered factors that may influence the quality of nutrition care provided by general practitioner registrars.
El-Mani et al. (2014)17 Assess the knowledge of pharmacists regarding folic acid and iodine supplementation during pregnancy Cross-sectional survey   41 Pharmacists (Australia); Convenience sample Pharmacists’ knowledge regarding the mandatory fortification program was limited as only 46% (n = 19) and 68% (n = 28) correctly identified that bread must be fortified with folic acid and iodine respectively in Australia. 49% (n = 20) of pharmacists selected the correct dietary sources of folic acid, but only 12% (n = 5) correctly identified dietary sources of iodine. In order to enhance pharmacists’ knowledge of current evidence-based nutrition guidelines in pregnancy, additional education of pharmacists was identified as needed.
Fieldwick et al. (2019)18 Explore general practitioners’ knowledge and practice regarding gestational weight management Survey   200 GP’s (New Zealand); Cluster/Random sampling Sixty-six general practitioners reported always discussing nutrition during pregnancy-related consultations. The knowledge and practice of general practitioners regarding gestational weight gain was not in accordance with national guidelines. Twenty-three general practitioners identified a lack of time and 19 suggested financial stress as barriers to providing all necessary nutritional advice.
Forsyth et al. (2012)19 Evaluate the confidence and knowledge of nurses in the provision of evidence-based practice advice to patients in a forensic psychiatry rehabilitation unit Semi-structured interviews 9 Nurses (New Zealand); Convenience sampling Although they recalled having basic nutritional knowledge, nurses felt that they had low confidence in the provision of simple nutritional information to patients. Lack of formal nutrition education amongst nurses, and patient’s resistance to change were key barriers preventing the promotion of nutritional changes. An evaluation of nutrition education needs of nurses was identified as necessary to enhance the promotion of nutritional practices to patients.
Lucas et al. (2014)20 Assess the nutritional knowledge and practices of pregnant women and healthcare providers who participate in antenatal shared care Survey     50 GP’s 11 Nurses (Australia); Convenience sampling General practitioners and nurses had poor knowledge about the importance of iodine and the role of iodine in pregnancy. Most healthcare practitioners reported interest in undertaking additional education training or education regarding iodine in pregnancy.
Martin et al. (2014)21 Investigate the opinions of practice nurses on the promotion of nutrition care in chronic disease management Cross-sectional online survey   181 Practice nurses (Australia); Convenience sampling A large proportion (89%, n = 143) of practice nurses understood the significance of their role in addressing nutrition behaviours of patients, but 61% (n = 95) were uncertain whether their nutrition counselling was effective in improving the nutrition behaviour of patients. 53% (n = 85) of practice nurses agreed/strongly agreed that practice nurses do not have the adequate training to discuss nutrition with patients, and most desired further education. Insufficient time restricted practice nurses in providing nutrition care to every patient.
Mitchell et al. (2011)22 Discuss general practitioners and practice nurses’ role in the delivery of nutritional information to patients in a primary health setting Mixed methods cross-sectional study: questionnaire, semi-structured telephone interview and online survey 10 GP’s 12 Practice nurses (Australia); Convenience sampling A large proportion of general practitioners (90%, n = 9) and practice nurses (83.3%, n = 10) agreed/strongly agreed that dietary assessment and counselling was integral to their professional role. Most general practitioners (n = 6) and practice nurses (n = 6) disagreed that they had enough time to provide nutrition advice. Further nutrition education, availability of resources and nutrition-related guidelines was identified as required to effectively provide nutritional advice.
Morphet et al. (2016)23 Explore nurses’ enteral nutrition knowledge and sources of information Online questionnaire   359 Nurses (Australia); Convenience sampling Most nurses rated their knowledge of enteral nutrition as good (60.1%, n = 205) or excellent (10.3%, n = 35). Knowledge deficits were identified in the following areas: gut physiology, malnutrition, feed formulation, and administration rates. Respondents recalled receiving very little enteral nutrition education during professional nursing training. 272 respondents (or 75.8%) indicated that they wanted further education regarding enteral nutrition, and many identified the need for increased access and availability of enteral nutrition guidelines and policies.
Nowson and O’Connell (2015)24 Assess general practitioner registrars’ knowledge, confidence and perceived role regarding the provision of nutrition advice Online survey   93 GP registrars (Australia); Convenience sampling Approximately half of general practitioner registrars (51%) felt moderately confident and 16% very confident in their ability to provide nutrition advice. All participants agreed that they have a role in the provision of nutrition care to patients. Additionally, although most of the participants recalled getting nutrition information during training (84%), only 34% recalled having to demonstrate their nutritional knowledge during their training. Overall, general practitioner registrars lacked consensus with regards to their role in providing nutritional advice.
Parry Strong et al. (2014)25 Assess the knowledge, skills and resources of practice nurses used to advocate nutrition advice to patients with type 2 diabetes Questionnaire   113 Practice nurses (New Zealand); Convenience sampling The confidence of practice nurses in the counselling of dietary behaviours to people with type 2 diabetes decreased from 83% to 70% between 2007 and 2012. Across surveys, dieticians were the most sought-after healthcare professionals for practice nurses seeking advice beyond their own nutrition knowledge. Future training sessions that address culturally specific dietary advice and quick nutritional assessment skills are warranted.
Puhringer et al. (2015)26 Investigate the nutrition promotion practices, beliefs and barrier of cancer nurses Online questionnaire   123 Cancer nurses (Australia and New Zealand); Convenience sampling A proportion of cancer nurses (35%, n = 43) identified dieticians as the primary source of the provision of nutrition care to patients, while an equal proportion (32.5%, n = 40) regarded themselves as the primary healthcare professionals that addressed the nutritional requirements of cancer patients. Most nurses agreed/strongly agreed that healthy eating improves health-related quality of life. Lack of time and nutrition expertise were cited as the most common barriers to promoting healthy eating.
Waterland et al. (2020)27 Report general practitioners’ experiences, barriers and enablers regarding providing nutrition and exercise advice to cancer patients Semi-structured telephone interviews   33 GP’s (Australia); Purposive sampling General practitioners acknowledged the importance of their role in the ongoing promotion of nutrition and exercise counselling in patients with cancer. General practitioners noted the influence of patients’ attitudes, insufficient time, and the lack of resources and programs on nutrition advice and exercise practices. As general practitioners expressed feeling underqualified to counsel cancer patients in these areas, a strong desire for additional education and training was evident.
Whitelock and Kapur (2018)28 Determine the knowledge, practices and attitudes of interns about malnutrition and hydration in an acute tertiary-care hospital Questionnaire     34 GP registrars (Australia); Convenience sampling General practitioner interns recorded poor knowledge of the principles regarding malnutrition and hydration management. Overall, almost all interns agreed that further training in malnutrition (90%, n = 76) and hydration (88%, n = 74) would be beneficial and improve the health outcomes of patients. Competing priorities, lack of interest and unclear sense of responsibility were identified as barriers that restricted the provision of nutritional advice to patients.
Winter et al. (2017)29 Understand general practitioners and practice nurses’ experiences and current practices regarding the nutrition care of patients Online survey/ questionnaire   45 Practice nurses and GP’s (Australia); Convenience sampling 63% (n = 24) of practice nurses and general practitioners felt moderately to very confident in their ability to promote nutritional recommendations. Despite high perceived confidence, 68% (n = 26) indicated the need for further professional development in this area. Inadequate understanding of knowledge and the absence of guidelines were regarded as challenges to the provision of nutritional information.

*GP = General Practitioner; **Articles also investigated other population samples, including primary healthcare practitioners from other countries, allied health practitioners, students, and the general population. These findings were excluded from our analyses.

Int J Med Educ. 2022; 13:124-137; doi: 10.5116/ijme.6271.3aa2