The Theoretical Application of Corporate Training and Development Techniques to DietitianClient Interaction

Introduction
A dietitian has many scopes of practice: nutrition care, foodservice systems and food
systems management, education, research, technology, business, communication, health
promotion, disease prevention, and nutrition policy (A & S). In all scopes, the dietitian is
committed to improving the health of both individuals and groups of people, which requires
knowledge of both training and development as seen in business practices in order to provide
clients with accurate, responsible, and successful care.
Current dietetic approaches to nutrition counseling include a variety of techniques for
clients, but seem to be lacking an important psychological component that is important to
facilitating behavior change. A survey of the techniques that Canadian dietitians used to help
weight loss patients showed that the treatment for weight loss was variant depending on the
general attitude toward being overweight or obese. The dietitians who took a more holistic
approach did not see weight loss as a major goal, whereas those who saw weight loss as a
preventative for many long-term conditions associated with obesity (diabetes, heart disease, etc.)
encouraged their clients to successfully lose weight.
The researchers who performed this study also concluded that for the past few decades,
the role of the dietitian has been mainly to provide and advocate good nutrition advice, but now
that dietitians are expanding their areas of expertise to be more specialized they may want to
create more of an emphasis on the counseling aspect of nutrition therapy, especially in scenarios
where lifestyle changes are a necessity. Many of the dietitians who participated in the study

found it easy to perform their role as nutrition educator, but struggled with nutrition counseling
as the clients had their own goals that were different from the dietitians recommended
approaches (Chapman 2005).
In another study, researchers Brown et al. found that only 41% of select motivational
strategies were used to motivate behavior change in patients with diabetes and that these
strategies tended to be the ones that were easier to utilize. More sophisticated strategies (such as
cognitive restructuring, simulation, stimulus control, and modeling) that have been found to be
effective in facilitating behavior change were not commonly used, and strategies that have a
definite correlation to the success of behavior change were lacking as well. These results were
also similar to those of at least three other, separate studies that found that psychological
components were not widely used to facilitate behavior change in dietitian-client interaction
(Brown 1998). It is clear that the psychological component of nutrition counseling could use
some improvement, and it is probable that the business theories applied to training and
development of employees could lead to further client success.
Training Importance
Training, in business, usually refers to short-term improvement and is narrowly focused
on teaching an employee what to do and how to do the tasks required for his or her job. This can
mean training in using technology, safety, customer service, etc. (Saylor). Poor training can be
due to a number of factors: irrelevant information, a lack of intrinsic motivation, inaccurate
information, lack of clarification of the instructor, lack of understanding of the employees, a bad
distribution method, etc. Poor or no training, according to The Saylor Academy, can cause bad
customer and boss-employee relations, job dissatisfaction, and negative productivity. The
American Society for Training and Development found that 41% of employees who received

poor training planned to leave the company within the year, but only 12% of those with
successful training planned to leave in the same time frame (Saylor). Poor training can hurt
employee satisfaction and relations of all kinds, but successful and impactful training can
improve employee satisfaction and relation ratings as well as raise a companys reputation of
their work environment. According to Bohlander and Snell, Training magazine reported that
businesses spend about 25 hours training their employees, but all of the companies in Fortune
Magazines 100 Best Companies to Work For provided at least twice the amount of training for
their employees.
Since the importance of optimal training has such clear implications for businesses and
their employees, it would make sense if the value of training was similar in dietitian-client
interaction. Considering that one of the duties of a dietitian is to encourage better health, the
dietitian should supply the knowledge of how to accomplish a goal for the client (i.e. training).
Designing a Training Program
According to Managing Human Resources, the approach to designing a training program
should include four steps: a needs assessment, program design, implementation, and evaluation.
The goal of training is to supplement and reach the organizations goals, and in terms of client
interaction, the organization can be thought of as the client and the dietitian working together.
The dietitian would be described as the clients manager as the dietitian keeps track of client
progress, provides suggestions and constructive criticism for the client, and gives the client
feedback on his or her progress. According to Robert D. Lee and David C. Neiman, the dietitian
is to praise the client for his or her successes, make the client aware of problems he or she might
face, and empower the client to see the benefits of his or her changes (Lee 2010). The goals of

the organization would be whatever the dietitian and client are hoping to accomplish in their time
together.
Needs Assessment
To conduct a proper needs assessment, the current state of organization, tasks, and people
need to be evaluated to determine what the nature of the training should be. In an organization
analysis, the resources, strategies, and environment are assessed. For a business, resources may
include people, finances, and technology (Bohlander 2010). In terms of a dietitian-client pair,
resources may also include money and technology as affording different types of food, exercise
equipment or a gym membership, or the dietitians services may be an obstacle for a client. New
exercise and food technologies (new exercise equipment, electric stoves, genetic engineering,
etc.) should also be resource considerations for a dietitian-client pair.
Task Analysis
For a task analysis in a company, job descriptions are evaluated to determine the
knowledge, skills, and abilities (KSAs) needed to perform the tasks assigned to a job. The first
step in a task analysis is to list out all of the tasks included in the job description, and the second
is to list all of the steps needed to accomplish each of the tasks in the first list. The skills needed
to perform the job can then be clearly defined, which will allow for the most accurate type of
training to be planned (Bohlander 2010).
For example, if the job of the client of a dietitian was to lose weight, the tasks under the
job description would be to perform extra physical activity, to reduce food intake, and perhaps
eat some more high-fiber foods to help the client feel fuller for longer. In order to perform more
physical activity, a client would want to learn how to work weight and aerobic machines at a

gym and learn how to treat a minor exercise injury. If he or she were to attend a gym, he or she
might learn gym etiquette or the basics of any exercise classes offered. Reducing food intake
might include learning how to use measuring cups to properly account for the serving size and
learning the difference between hunger and appetite. Once a task analysis has been completed,
the person analysis can provide further insight into what kind of training may be required.
Person Analysis
The person analysis determines which employees may need training and which may not.
A person analysis is important because it avoids sending employees into training who do not
need training, and also determines specific areas in which employees may need training so that
they can improve on the skills that they are deficient in. This avoids employees being
unnecessarily re-trained for all aspects of a job when they may only need training in a few key
areas. To determine in which areas employees may need training, Bohlander and Snell say that
managers and employees will typically have a face-to-face meeting where they jointly discuss
and decide upon potential areas of improvement. This approach works better than a simple
performance appraisal because it gets to the issue of why an employee is not performing as well
in an area the issue could be educational, but it also could be motivational, which is not
reflected in a performance appraisal.
In the instance of a dietitian-client team, the person analysis is an extremely important
aspect of developing an idea of what the client may need to learn versus what he or she already
knows. A client who is recovering from a heart attack needs to learn different information from a
client who is trying to gain weight, and that client needs different information from another who
is running a marathon. Therefore, all clients cannot have the same information session, although
there could be some overlap of general educational needs. The outcome of a person analysis for

clients will differ from the outcomes for business employees as a dietitian deals with personally
planned and designed training and development programs, rather than for a large workforce
where the program has to fit the multiple needs of multiple people. It is important; however, for
dietitians to gain a general idea of what a client knows before putting them through needless (and
pointless) training. This will ensure appropriate outcomes and an increase in client motivation.
Program Design
After the needs assessment is completed, the training program can finally be designed
and the information gathered from the needs assessment used to supplement program design.
There are several factors that go into design, including instructional objectives, trainee readiness
and motivation, characteristics of learning, and characteristics of instructors (Bohlander 2010).
Design of the program may be the most important part of the training and development process
as the design, to some degree, determines the effectiveness of the training.
Instructional Objectives
There would be little point in having a training session if no one knew what the training
was supposed to accomplish, so a training must have instructional objectives (Bohlander 2010).
For a dietitian-client team, the objectives of a training session for a patient with prehypertension
might be to lower blood pressure from 139/89 to 120/80 within six months, learn how to reduce
sodium to less than 1500mg per day, or learn two or three cardiovascular exercises (running,
swimming, hiking, etc) that will strengthen the heart in order to prevent another attack (Lee
2010).
Trainee Readiness and Motivation

A second factor going into designing the training program is trainee readiness and
motivation. Trainee readiness, according to Bohlander and Snell, consists of both the maturity
and experience of trainees. Trainees should have the appropriate background necessary to
complete the training, as well as the ability to absorb the information being presented to them.
Otherwise, the training is moot as no information would be retained.
Trainee Motivation is perhaps the most important part of a training plan because
motivation is the driving force behind actions. For employees, completing a training program
might be financially, socially, or intrinsically motivated. A raise, approval of ones coworkers, or
the knowledge that one might gain from a training in order to perform better might be enough
motivation to complete the training to go further in the process of becoming a more
knowledgeable employee (Bohlander 2010).
For a client of a dietitian; however, the point of motivation is slightly more complex as
the rewards may be less tangible. Clients may have a hard time seeing the benefits of lowering
their blood pressure, for example, if they might not be able to feel a difference in their daily lives
(and therefore will be discouraged from following their dietary change plan). Clients whose
goals include losing weight, however, may be more motivated as they can see the results of the
weight loss (smaller clothes, better body image, etc.). The training may also lead to an entire
lifestyle change in the client rather than solely a work-life change as an employee would
experience. This may also tend to discourage client motivation as total lifestyle change can be a
daunting and seemingly impossible task when clients are first presented with the idea.
Many hospital dietitians see patients who have been newly diagnosed with a variety of
conditions: high blood pressure, recovery from a heart attack or stroke, diabetes, etc (Lee 2010).
These conditions are typically brought on by lifestyle factors such as a lack of exercise, eating

too many foods that contain saturated fat, or eating too much food in general. An issue that many
dietitians find with these clients is that they dont want to make a lifestyle change, they have to
make a lifestyle change due to their condition. While the outside observer may see getting more
exercise, eating more vegetables, or sodium reduction as a simple and logical solution, clients are
faced with the reality that they have to change their entire way of life in order to simply survive
and changing habits that may be 60 years old is not an easy task, especially when it is something
that the person is being forced to do.
Three factors that influence performance, according to Bohlander and Snell, are
motivation, ability, and environment. An employee who is having performance issues may be in
the wrong position, not have the right tools to complete the job, or simply not want to do the job.
Rewards and incentives may have an impact on motivation, but not on the environment or ability
of the employee. Training can have an impact on the ability of the employee and subsequently on
the motivation, but not on the environment. Changing an employees job has an impact on the
environment and possibly motivation, but not on ability. Clearly, there needs to be a balance of
all three factors for an employee to have excellent performance (Bohlander 2010). These three
factors may also play a part in client progress. Client, like employee, motivation may be
increased by offering rewards (for example, a weight loss of only about ten pounds can decrease
snoring), an environment change, or something similar to training (for example, a session where
new ideas for exercise or recipes are shared).
Currently, the tactic for encouraging clients to embrace and then make a lifestyle change
is motivational interviewing, which is both a treatment philosophy and a set of methods
employed to help people increase intrinsic motivation by exploring and resolving ambivalence
about behavioral change. (Lundahl 2009) Brad Lundahl and Brian Burke confirm that the

purpose of motivational interviewing is to build a strong relationship with clients while reducing
barriers to change. Reduction of barriers relies on two key principles: encouraging the client to
see the difference between his or her current behavior and the healthy one that he or she is trying
to achieve, and encouraging the client to speak positively about change so that he or she will be
impacted by his or her advocacy for the change (Lundahl 2009).
According to Lundahl and Burke, motivational interviewing has been very successful for
changing substance abuse behavior, gambling behavior, parenting problems, and lifestyle
change. They say that effectiveness of a session increases by at least 10% when motivational
interviewing is used, and that outcomes of a motivational interviewing session may last for up to
a year (Lundahl 2009). Sarah Hardcastle and Martin Hagger performed a study of the reactions
of obese patients to motivational interviewing. They found four core themes in their results of
interviews of the participants: listening support, monitoring and support, motivation and selfregulation, and barriers (Hardcastle 2011). Listening to clients, motivating clients, and removing
client barriers are all characteristic of Motivational Interviewing, which suggests that
Motivational Interviewing is a correct and viable approach to take with dietetic clients in order to
help them achieve their goals. Motivational Interviewing workshops and courses can be found
through MINT (Motivational Interviewing Network of Trainers) and through various public
universities and medical schools, which may be beneficial for dietitians to attend as motivational
interviewing has seen such success with clients.
The dominant needs of the participants of Hardcastles study were those of monitoring
and support, and although there was some significant provision of those needs from outside
social sources, participant responses suggested that these needs were mainly met by the
practicing dietitians in charge (Hardcastle 2011). This suggests that the role of the dietitian has a

larger part to play in client success and also suggests that more frequent follow-up appointments
may be more beneficial than phone calls or emails to further client success. It also brings up the
point of terminology: many dietitians and clients refer to their appointments as counseling
sessions, where the dietitian typically employs the motivational interviewing technique and has a
discussion with the client about what changes may need to be made in his or her life. With the
consideration that more frequent dietitian/client visits may be of use and that a lifestyle change
may be necessary, is it appropriate to refer to these sessions as counseling?
The formal definition of counseling according to Miriam-Webster, is professional
guidance of the individual by utilizing psychological methods especially in collecting case
history data, using various techniques of the personal interview, and testing interests and
aptitudes. This does seem to fit the description of a dietitian-client session: motivational
interviewing is a psychological interviewing technique, case history data is generally used to
assist the discussion, and a dietitian does have to find out what the client will and will not do in
order to help develop the best plan for the client. However, this definition of counseling leaves
out an important aspect: the necessary tracking and feedback of an individuals progress by the
dietitian. A plan can be developed by the dietitian and client, but, as seen by Hardcastle, the
motivation to stick to the plan is largely provided by continuing accountability to the dietitian.
This is where the business idea of coaching may be beneficial.
Coaching, according to Bohlander and Snell, involves a continuing flow of
instructions, comments, and suggestions from the manager to the subordinate. (Bohlander 2010)
In this case, the dietitian would be acting as a manager and the client would be acting as the
subordinate. In order to successfully change his or her lifestyle, the client should be receiving
feedback from an authority (dietitian, doctor, nutritionist) on what practices may be beneficial

and which may be detrimental to progress. Much like employee development, client progress
should be fairly dependent on feedback, especially when the client is learning skills and
adjusting to changes for the first time. Perhaps it would be reasonable to refer to dietitian-client
interaction in two phases: phase one being that of counseling, where the dietitian analyzes the
client, uses motivational interviewing to derive motivation, and develops a plan with the client;
and phase two being that of coaching, where the dietitian responds to client feedback to
modify and make further progress on the plan. This terminology may be more acceptable to
clients as coaching seems to have a generally more positive connotation.
Principles of Learning
Bohlander and Snell outline eight principles of learning that should go into training: goalsetting, modeling, meaningfulness of the presentation, feedback and reinforcement, massedversus-distributed learning, whole-versus-part learning, active practice and repetition, and
individual differences. All appointments with the dietitian could be considered trainings in that
the dietitian is training the client to become autonomous while reaching his or her health goals.
Throughout the clients time with the dietitian, many of these principles are incorporated.
Goal-setting and individual differences are probably most apparent in the initial
appointment with the dietitian as this is where the clients needs are assessed and goals are set
based on his or her needs or abilities. Modeling and whole-versus-part learning are the most
flexible of the learning principles as a client may not need concepts broken down or shown to
them. Meaningfulness of the presentation should be apparent throughout all appointments with
the dietitian so that the client feels some connection to his or her goals and, therefore, will be
more motivated to achieve them. Feedback and reinforcement and massed-versus-distributed

learning are occurring on an appointment-to-appointment basis as progress is assessed and new

skills are learned or old skills are reviewed based on the progress made.
Characteristics of Instructors
Bohlander and Snell say that instructors should have several desirable characteristics:
knowledge of the subject, adaptability, sincerity, sense of humor, interest, clear instructions,
individual assistance, and enthusiasm (Bohlander 2010). All of these characteristics are also
desirable in dietitians as few clients would want to visit a health professional who is confusing,
uninterested, vague, and does not have the right answers or advice. In addition to these
characteristics, Lee and Nieman also list some traits that make a counselor more effective:
empathy, respect, warmth, genuineness, concreteness, self-disclosure, and potency and selfactualization (Lee 2010). For a dietitian, it is important to have traits listed in both texts because
the dietitian must be empathetic and tactful when using motivational interviewing, as well as be
enthusiastic and knowledgeable of the material he or she is presenting to the client.
Implementing the Training Program
Bohlander and Snell have a variety of techniques on implementation of the training
program once the goals have been established. Methods of presenting the training include on-thejob, apprenticeships, cooperative training, internships, classroom learning, programmed learning,
audiovisual methods, simulations, E-learning, and seminars (Bohlander 2010). While these are
viable techniques for the business world, each with their pros and cons, they may not be
applicable for dietitians, as client interaction typically occurs one-on-one and is more of a
counseling/coaching-style session. There are cases, however, such as that of a diabetes educator,
where the educator may be presenting information to a group of diabetes patients and their

families. In this case, a classroom learning style would be appropriate but, typically, the client
and dietitian are meeting privately and mutually sharing information, which does not fall strictly
under one of the training categories that Bohlander and Snell list. It would more closely fall
under the idea of coaching that has been previously discussed.
Evaluating the Training Program
According to Bohlander and Snell, there are four main criteria that should be used to
evaluate the effectiveness of the training on employees: reactions, learning, behavior, and results.
Reactions evaluates the feedback of employees to see how they felt about the training they
experienced. Learning tests participants to see what they actually remembered from the
training, which is helpful in seeing how beneficial the training really was and if the goals of the
training were met. Behavior refers to what the trainees do after they leave the training
program. If they do what theyve always done, then there was no transfer of learning from the
training to real-life. If their behavior is modified in accordance with the training, however, the
training will have been effective. Results are the measurable aspects of the employee takeaway
from training: Did the company make a bigger profit? Did customer complaints go down? If the
statistics show that the training helped accomplish these goals, then the training was effective.
Follow-up visits with a dietitian should be a combination of the above four criteria.
Learning, Behavior, and Results are closely intertwined in the case of the client because in order
to be successful and show good results, the client must change his or her behavior, and in order
to change his or her behavior, the client must learn what tools work for him or her and how to
make beneficial and sustainable changes in his or her lifestyle.

For example, if a weight-loss client were to show a net loss of one and a half pounds per
week during the first month after their initial plan was created, but is now showing a net loss of
one half-pound per week (the results), the dietitian would address the issue with the client during
the next appointment. The client would describe what he or she has been eating and if he or she
has been exercising (the behavior). If, at first, the client was successfully avoiding his or her
favorite ice cream, but now is eating two cups every night before bed, the client would have to
learn how to reduce the amount of ice cream he or she was eating, or eliminate the snack entirely
(the learning).
Reactions would be given by the client during the next appointment with the dietitian as
he or she would report to the dietitian the success of and confidence in the diet plan as well as
obstacles encountered. The dietitian would provide feedback to the client as well, in response to
the progress that the client has made. If the client who likes ice cream came back to his or her
next appointment and had successfully avoided the ice cream, but found it very difficult, the
dietitian might suggest eating frozen Cool-Whip instead so that the sweetness and texture of the
snack would remain intact but the calorie count would be significantly reduced.
While counseling is an everyday interaction that a dietitian has with his or her clients, a
dietitian may not realize that he or she is incorporating the principles of evaluating a training
program into the counseling session. It would be wise to keep these four evaluation criteria in
mind when interacting with clients because they give a well-rounded evaluation for a clients diet
plan, and should help both the client and the dietitian critique and modify the plan as needed for
the most efficient and effective client success.
Conclusion

Bohlander and Snell outline many strategies, practices, and theories for training
employees. While the ideas outlined are intended for managers in a business setting, they may
also be applied to a dietitian and his or her client where the organization is considered to be the
dietitian and client: the manager, the dietitian and the client, the employee.
Bohlander and Snell detail the importance of knowing the state of the organization
through the needs assessment, (composed of the task, organization, and person analyses) to
determine the need and extent of training. A dietitian can use the principles of the needs
assessment to determine the clients knowledge and experience in order to determine what the
client may need to learn in order to prepare to follow his or her diet plan.
The second step is to design the training program, where instructional objectives, trainee
readiness and motivation, the principles of learning, and characteristics of instructors are
established. The instructional objectives should align with client needs, and the dietitian should
exhibit characteristics such as enthusiasm and empathy in order to be effective in counseling the
dietitian. The dietitian typically uses a technique called Motivational Interviewing to encourage
the client to become enthused, ready, and motivated to make a lifestyle change, which has shown
to be successful. Characteristics of learning should also be incorporated while educating the
client to make advising and explaining the principles of the diet plan to the client the most
effective they can be.
Implementing training can take place through several media: face-to-face, electronically,
classroom learning, etc. Typically, dietitians use the face-to-face technique with a client as body
language and intonation play a large part in client understanding, but group education is
sometimes used, as in the case of a diabetes support group.

Finally, evaluating the training incorporates four principles: learning, reactions, results,
and behavior. These four areas assess whether the training was successful or could use some
improvements. If every session with a dietitian is considered client training, then these four
criteria should be utilized when a client comes in for a follow-up visit. Client feedback should
reflect problems and benefits of the diet plan, while numerical results, such as weight loss,
should reflect both their learning and behavior. Diet logs and simple conversation should also
show what a client has learned or needs to be reminded of.
It is clear that there are positive links between the idea of formal business training and the
dietitian-client relationship. There is a closer focus on long-term results in the dietitian-client
relationship, which Bohlander and Snell would refer to as career development. The success of
the principles outlined by Bohlander and Snell with clients would be best evaluated by putting
them into practice, and this may warrant a future, formal study so that the role of a dietitian can
be taken from more than solely a nutrition educator to someone who encourages and is actively
involved in his or her clients success.

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