P520 - NAVIGATING BETWEEN INVOLVING AND ADVISING: AN ANALYSIS OF DIETITIANS’ ADVISORY PRACTICES WHEN TREATING CLIENTS WITH (RISK OF) MALNUTRITION

P520

NAVIGATING BETWEEN INVOLVING AND ADVISING: AN ANALYSIS OF DIETITIANS’ ADVISORY PRACTICES WHEN TREATING CLIENTS WITH (RISK OF) MALNUTRITION

A. Barkmeijer^1,*, J. Lamerichs², H. T. Molder³, H. Jager-Wittenaar^1,4

¹Hanze, Groningen, ²Windesheim, Zwolle, ³VU, Amsterdam, ⁴Radboud UMC, Nijmegen, Netherlands

Rationale: Although dietitians’ daily practice has shifted from a traditional expert-led medical model to a client-centered approach that includes shared decision-making, little is known about how advice is actually provided and its (interactional) consequences.

Methods: Based on 40 dietitian-client conversations in relation to treatment of malnutrition, we used conversation analysis (CA) to investigate how dietary advice is provided. CA focuses on the structure and organization of talk, including features such as turn-taking, pauses, pitch, and multimodal behaviors, all of which influence the delivery of advice.

Results: Dietitians invite clients to co-create the basis of the advice, by giving clients their own access to ‘tools’ for decision-making (e.g., protein table). However, once clients engage in establishing the underlying logic of the advice, it becomes difficult to raise objections or suggest alternative solutions, especially when dietitians bypass the points at which clients might commit to the advice or show resistance. Dietitians bypass those commitment points by justifying the rationale for the advice. While these justifications allow clients to follow up on the reasoning behind the advice, they also limit the opportunity for clients to (positively) evaluate the advice or show emerging concerns, ultimately resulting in minimal client commitment to the advice. 

Conclusion: Our study highlights the importance of timing in engaging clients during dietary counseling. Engaging clients through technical details before and directly after delivering advice limits their involvement in the evaluation and commitment process once the advice has been given. Raising dietitians' awareness of their interactional practices and their consequences may help to improve client involvement, to further improve effectiveness of dietary interventions to treat (risk of) malnutrition.

Disclosure of Interest: None declared