The Emerging Landscape for Sustainable Food System Education: Mapping Current Higher Education Opportunities for Australia’s Future Food and Nutrition Workforce

Integrating the sustainable development goals into health professions' curricula: using the nominal group technique to guide their contextualisation

BACKGROUND

To embed the Sustainable Development Goals in health profession education, educators must contextualise them to their profession and geographical region. This study used the nominal group technique to contextualise the SDGs for Australian nutrition and dietetics tertiary education programs by determining the specific knowledge, skills, and values required for graduating dietitians to practise sustainably.

METHODS

In 2022, 23 experts in food and sustainability attended a group session that employed the nominal group technique to discuss the Sustainable Development Goals knowledge, skills, and values Australian dietetic students should develop. After the group session, participants ranked the Sustainable Development Goals according to their perceived level of importance for student dietitians. These data were analysed using multi-methods, including a summation of the rankings, directed qualitative content analysis and reflexive thematic analysis.

RESULTS

The three highest-priority Sustainable Development Goals identified were (1) Zero Hunger, (2) Good Health and Well-Being, and (3) Responsible Consumption and Production, which were then considered with the qualitative findings. The main categories that were generated from the content analysis reflected the broad knowledge, skills, and values student dietitians should develop. The preliminary codes provided specific details for each of the main categories. The thematic analysis generated two additional themes: the importance of Indigenous ways of knowing, being and doing, and authentic experiential learning activities.

CONCLUSIONS

The method employed for this study provides a useful framework for health professions to contextualise the Sustainable Development Goals to their profession and geographical region. For this study, the ranking process and the qualitative data analysis enabled the Sustainable Development Goals to be reframed in a way that would be meaningful for dietetic educators and students and demonstrate the interrelatedness of the goals. The direct qualitative content analysis and reflexive thematic analysis identified the knowledge, skills, and values student dietitians should develop.

Sustainability-informed dietetics education: key messages for educators and national dietetics associations

BACKGROUND

Dietetics curricula currently fail to meet the educational needs of the future dietetic workforce to contribute expertise in sustainable, healthy food systems in the settings in which dietitians work. A 'Global Networking Event on Sustainable Food Systems in Nutrition and Dietetics Education' was held in June 2023 with the goals of building relationships among international stakeholders and informing the development of shared curricula.

METHODS

Plenary lectures, panels and roundtable discussions were held over 2 days, designed to provide the background required to generate informed actions. Topics included recent research from practice and education, competency standards and relevant policy documents, examples from the field, 'big questions' about scope and student perspectives. Key messages were summarised thematically to inform educators and national dietetics associations.

RESULTS

Fifty-five delegates attended from 11 nations representing education, research, dietetic associations, industry and diverse practice backgrounds. Key priorities identified for educators included co-development of curricular frameworks and pedagogical theory, practical training supports and solutions to limited time and expertise. Key recommendations for national dietetics associations included strategic promotion of sustainable food systems in dietetic roles and practical supports.

CONCLUSIONS

Outcomes are anticipated to stimulate ongoing discussion, collaboration and actions on sustainable food systems education within the dietetics profession leading to shared curricular models and supports.

Systems Thinking and Sustainable Food Systems in Dietetics Education: A Survey of Directors

BACKGROUND

Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education.

OBJECTIVE

This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director.

DESIGN

Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale and a researcher-designed survey with 1-5 Likert-type scales.

PARTICIPANTS AND SETTING

The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics program directors, with a 27% (N = 163) response.

STATISTICAL ANALYSIS

Descriptive statistics (frequency or mean ± SD) were calculated using Excel. Inferential statistics were examined using R. Analysis of variance was used to compare experience as a registered dietitian nutritionist and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total Systems Thinking Scale score and demographic and programmatic variables.

RESULTS

Seventy-seven percent of program directors scored high on the Systems Thinking Scale (mean score = 65.2 ± 8.4 on a 0 to 80 scale), and more than 85% of directors agreed that including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed that systems thinking was adequately addressed in Accreditation Council for Education in Nutrition and Dietetics standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate Accreditation Council for Education in Nutrition and Dietetics standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low.

CONCLUSIONS

Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators' perceived importance and program coverage. Enhancing program directors' awareness and utilization of Academy of Nutrition and Dietetics Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.

Understanding nutrition students' knowledge, perceived barriers and their views on the future role of nutritionists regarding sustainable diets

Nutrition professionals are important stakeholders in sustainable food systems with skills to promote the connection between health, food production, environment, culture and economics. Higher education institutions are increasingly recognising the importance of teaching about sustainability, yet there exists a gap in the literature detailing the awareness of sustainability issues by nutrition students. This study aimed to ascertain the level of knowledge of sustainable diets (SDs), the perceived barriers to their adoption in their own diets, students' experience of university-based teaching about SDs and their views on the future role of the nutrition profession in relation to SD amongst nutrition students on Association for Nutrition (AfN)-accredited degrees. The study assessed environmental and sustainable food literacy (SFL) through an online questionnaire and explored the issues in more detail in virtual or face-to-face interviews in 2019. Quantitative data were analysed using descriptive statistics (Kruskal-Wallis, Jonckheere-Terpstra, independent t-test, Spearman, Pearson Correlations). Qualitative data were analysed using the Braun and Clark (2006) six-step approach to thematic analysis. The questionnaire responses (n = 51) represented 17 AfN-accredited undergraduate courses (35% of AfN-accredited universities in 2019). The majority (76%) of students had received an introduction, partaken in a module or received teaching on SDs throughout their whole degree. Students were predominantly environmentally literate, yet had a fragmented understanding of SDs, focusing on the environmental aspects of SDs. There was no correlation between SFL and reported sustainability content of university courses, highlighting a need for more effective teaching on sustainability topics. Additionally, no relationship between self-reported diet intake and SFL was found. Students identified a lack of knowledge and education as barriers preventing them from adopting sustainable practices in the present and future. To integrate sustainability into their future practice more consistently and effectively, nutrition students require more structured, holistic sustainability education and knowledge.

How do dietetics students learn about sustainability? A scoping review

AIM

Globally, sustainability and planetary health are emerging as areas of critical importance. In 2015, the 2030 Agenda for Sustainable Development was adopted by the United Nations member states. Since then, the United Nations Educational, Scientific and Cultural Organization and the Commonwealth Secretariat have published guidelines for educators to embed sustainability content into curricula. This scoping review aims to identify how student dietitians learn about sustainability, how learning opportunities are evaluated, their outcomes, and whether these guidelines have translated into teaching activities contained in dietetic degrees.

METHODS

A scoping review was used to address the aims. Eight electronic databases and Google Scholar were searched from inception to March 2022 for articles describing dietetics students' participation in learning activities focused on sustainability. Data that addressed the research aims were charted independently by two researchers, then narratively synthesised.

RESULTS

Twelve articles met the inclusion criteria. A range of teaching approaches and evaluation methods were used, from passive learning in lectures to experiential learning activities. A change in knowledge or behaviour was found for experiential learning activities (n = 5). For articles published after 2015 (n = 9), two mentioned the Sustainable Development Goals and no articles referenced the published guidelines.

CONCLUSIONS

A paucity of evidence exists describing how dietetics students learn about sustainability and their learning outcomes. Of the 12 articles published, varied teaching approaches and evaluation methods have resulted in inconsistencies in the reporting of outcomes. The minimal reference to the Sustainable Development Goals and published guidelines suggests a slow translation of knowledge to practice.

Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices

Background

The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals).

Methods

For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared.

Findings

There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy.

Interpretation

These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.

Mapping the Roles of Nutrition and Dietetics Professionals in Sustainable Food Systems and Exploring Opportunities for Strategic Collaboration

Current food systems drive environmental damage, social injustices, and undermine health, and these challenges are complex and seemingly intractable. Collaboration is required to transition to more sustainable food systems (SFS). Registered Dietitians and Nutritionists (RDs) are an under-leveraged and well-positioned group to contribute to addressing food systems challenges because of their locations in the system and their existing skillsets. Drawing on research with dietitians, this perspective paper presents both a theoretical proposal as well as collective expertise in supporting sustainable development of the global food system. It highlights where RDs work in food systems with the aim to reveal multiple points of entry where RDs can and do contribute to SFS across food systems, approaches to apply, as well as opportunities for collaboration within and beyond the profession. Educational and societal barriers exist that prevent systematic RD engagement; however, examples of established work provide models to follow.

Sustainable Agri-Food Systems: Environment, Economy, Society, and Policy

Agri-food systems (AFS) have been central in the debate on sustainable development. Despite this growing interest in AFS, comprehensive analyses of the scholarly literature are hard to find. Therefore, the present systematic review delineated the contours of this growing research strand and analyzed how it relates to sustainability. A search performed on the Web of Science in January 2020 yielded 1389 documents, and 1289 were selected and underwent bibliometric and topical analyses. The topical analysis was informed by the SAFA (Sustainability Assessment of Food and Agriculture systems) approach of FAO and structured along four dimensions viz. environment, economy, society and culture, and policy and governance. The review shows an increasing interest in AFS with an exponential increase in publications number. However, the study field is north-biased and dominated by researchers and organizations from developed countries. Moreover, the analysis suggests that while environmental aspects are sufficiently addressed, social, economic, and political ones are generally overlooked. The paper ends by providing directions for future research and listing some topics to be integrated into a comprehensive, multidisciplinary agenda addressing the multifaceted (un)sustainability of AFS. It makes the case for adopting a holistic, 4-P (planet, people, profit, policy) approach in agri-food system studies.

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.

Food Next Door: From Food Literacy to Citizenship on a College Campus

Industrial agriculture and food corporations have produced an abundance of food that is highly processed, nutritionally poor, and environmentally burdensome. As part of a healthy campus initiative, generated to address these and other food production and consumption dilemmas, a student-run “local and sustainable” food establishment called Food Next Door (FND) was created. This intrinsic case study evaluated food literacy in health science students, faculty, and staff first as a pilot to build the case for FND and further explicated customers’, volunteers’, and leads’ experiences with FND, identifying potential pathways from food literacy to citizenship. Ten returning customers, eight recurring nutrition student volunteers, and three graduate student leads participated in interviews that were analyzed for themes and subthemes. The findings show a progression in themes. Customers’ experiences highlight FND’s fresh, flavorful food, smiling and supportive staff, and personal transformation. Volunteers’ themes identified greater awareness of new foods and plant-based eating, acquiring new knowledge and skills in commercial kitchens, and deepening their connection to food, each other, and to where food comes from. Leads’ themes show opportunities to gain managerial skills, a deeper understanding of food and skills from being immersed in value-based food systems, and confidence in peer teaching. Experiencing and becoming part of the food value chain through FND built food literacy, shifted values, and transformed students into food citizens.

Assessing Community Contributions to Sustainable Food Systems: Dietitians Leverage Practice, Process and Paradigms

Food systems are not sustainable, and efforts to address this are paralyzed by the complex networks of food system actors and factors that interact across sectoral and geographic scales. Actions at the community level can positively contribute toward globally sustainable food systems (SFS). Assessing such contributions has two central challenges: 1) a lack of methods that support alignment between communities and across scales, balanced against the need to involve the community in developing relevant indicators; and 2) the absence of adequate, fine grained data relevant to the community. Addressing these two challenges, this paper illustrates a proposed procedure that supports community engagement with, and assessment of, their contributions. Engaged by a community of Canadian dietitians, researchers used the Delphi Inquiry method, guided by the Framework for Strategic Sustainable Development, to address the first challenge, and causal loop diagrams informed by the Cultural Adaptation Template to address the second. Indicators were developed for dietitian-identified actions and outcomes for SFS. Modeling indicator interactions provide insight into how some actions are influenced by and reinforce the value placed on SFS within the professional cultural paradigm, as well as priority areas for action and measurement. Process-oriented assessment is useful in the context of partial and subjective understandings of a dynamic system, and supports continual adjustment in action. This article offers theoretical and practical insight for community engagement in addressing some of the systemic challenges in food systems. It accommodates community-based knowledge, applies process-indicators, and emphasizes the importance of cultural paradigms as a driving force of community-level actions, and overall system change. Under current conditions, facilitating SFS literacy among dietitians can amplify adaptations for broader SFS development.

Sustainability: Nutrition and Dietetic Students’ Perceptions

Opportunities exist for nutrition and dietetic (N&D) professionals to contribute to sustainable development and support actions towards the attainment of the UN’s Sustainable Development Goals (SGD’s). Students undertaking higher education are well-placed to develop skills and capabilities in creative and critical problem solving for sustainability. However, there is limited literature exploring nutrition and dietetic students’ perceptions of sustainability that would help to inform an effective and constructively aligned embedding of sustainability content and active learning opportunities into curriculum. This descriptive cohort study design utilised a 17-question online survey to explore 95 Australian N&D undergraduate students’ self-reported familiarity with and perceived importance of sustainability and related concepts, and view of sustainability for future practice. Participants reported being more familiar with the term environmental sustainability and related concepts than economic or social sustainability. Varying levels of familiarity of 42 sustainability related concepts within economic resilience, environmental integrity, social development and cross-cutting issues were reported. Most participants (82%, n = 78) reported sustainability was very important in general (82%, n = 78), and for professional practice (63%, n = 60). Over half of the participants identified government led initiatives to address the future of society (65%, n = 71). Our study highlights the complexity of sustainability in a discipline specific context and the need for understanding students’ perceptions of sustainability to inform N&D curriculum design.

How do foodservice dietitians and dietetic students learn about environmental sustainability? A scoping review protocol

INTRODUCTION

Healthcare services are responsible for 7% of Australia's carbon emissions, or 35 772 kt per annum, with 44% of these attributed to hospitals and an unknown proportion originating from the kitchen. Carbon emissions contribute to climate change that is predicted to adversely impact health outcomes. Healthcare professionals and institutions have an opportunity to reduce their impact on the climate. Australian dietitians, however, are not required to learn about environmental sustainability during their tertiary education. This scoping review will identify pedagogical frameworks employed by educational institutions and providers of professional development, to describe how foodservice dietitians and dietetic students develop environmental sustainability capabilities.

METHODS AND ANALYSIS

The scoping review methodology established by Arksey and O'Malley will be used for this review. Papers will be included if they focus on dietitians or dietetic students learning about environmental sustainability in the foodservice domain. Nine databases, Business Source Complete, CINAHL, Cochrane, Edge (via informit), EMBASE, MEDLINE, Proquest, Scopus and Web of Science, will be searched from their inception. Grey literature will also be identified by searching theses databases, professional bodies databases and Google Scholar. Eligible articles will be identified by screening papers by their title and abstract, followed by a full-text review. The study selection process will be completed independently by the primary investigator and the research team. Any discrepancies will be resolved through discussion. The extracted data including citation information, information on the intervention and outcomes will be summarised using descriptive statistics. Themes describing the pedagogical underpinnings of the interventions, the measurement tools and the impact of the learning activities will be synthesised narratively.

ETHICS AND DISSEMINATION

The results will inform the development of evidence-based pedagogical frameworks to enhance the capabilities of foodservice dietitians and dietetic students in environmental sustainability. Dissemination will occur through conference presentations, peer-reviewed journals and distribution through national accrediting bodies.