Supporting Responsive Practice: Training Dietitians to Meet Clients' Interactional Needs

INTRODUCTION: Patient-centered counseling approaches tend to emphasize what practitioners are expected to do, providing limited guidance on how to respond to client contributions in real-time interactions. This study aimed to explore the value of a dietitian-client interaction (DCI) training program to enhance dietitians' awareness of client uptake, that is, how clients respond to dietitians' conversational contributions. METHODS: A mixed-methods pilot study was conducted in two phases. First, a DCI training program was developed for primary care dietitians treating clients with (risk of) malnutrition, based on analyses of video-recorded consultations. Next, the training was delivered and evaluated through: (a) determining changes in dietitians' awareness of client uptake using a pre-post 5-point Likert scale questionnaire and focus groups, and (b) dietitians' views on the training program's relevance, explored through focus groups. Changes in awareness scores were analyzed using descriptive analyses, while inductive thematic analysis examined themes regarding attention to client uptake. Quantitative and qualitative findings were integrated to assess convergence, divergence or complementarity. Deductive analysis with a priori codes (acceptability, appropriateness, and feasibility) explored dietitians' perspectives on the training's implementation potential. RESULTS: At T0, median item scores ranged between 4 (somewhat aware) for 8/10 items and 5 (aware) for 2/10 items. At T1, 2/10 items scored 4 and 8/10 items scored 5. Focus group analysis identified three key themes: (1) The role of precise wording: it is the exact phrasing, not only the content or intent, that shapes client responses; (2) Evidence-oriented listening: listening is considered successful when client responses indicate they feel heard; and (3) Moving beyond a biomedical perspective: addressing the social and emotional aspects of the client's dietary problem feels outside the dietitians' professional identity and requires flexibility. Integrated results indicate the training fostered deeper, instead of surface-level, awareness of uptake, demonstrating complementarity between quantitative and qualitative findings. Dietitians described the training as meaningful, highly appropriate, and easily accessible. CONCLUSIONS: The novel DCI training program deepens understanding of what an uptake-oriented approach and effective listening entails. Despite already high pre-training awareness, it shows promise in increasing dietitians' awareness of client uptake, potentially enhancing their responsiveness to client needs and improving the dietary treatment of (risk of) malnutrition.