Publication Date


Document Type


First Advisor

Henry, Beverly W.

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Interdisciplinary Health Professions


Background: Evidence-based practice (EBP) guidelines are valuable tools that can help promote the implementation of research into practice. Implementation of EBP guidelines can improve the standardization and quality of healthcare, but unfortunately, they are not routinely used in daily practice. Evidence-based practice is a core component of nutrition and dietetics practice, yet little is known about registered dietitian nutritionists’ (RDNs’) implementation of EBP guidelines. Purpose: The purpose of this study was to investigate RDNs’ reported self-efficacy for using implementation strategies and their reported implementation behaviors for EBP guidelines. Methods: An explanatory mixed methods study guided by the Theory of Planned Behavior was conducted to investigate the distribution of RDNs’ reported self-efficacy, implementation behaviors, and the association between the two variables. A cross-sectional online survey was distributed to a convenience sample of RDNs working in clinical settings. Semi-structured interviews were conducted to confirm and explain survey results. Descriptive data was reported for self-efficacy and implementation behaviors, and spearman’s correlation was conducted to evaluate their association. A constant comparative method with open coding was used to analyze qualitative data. Results were integrated to investigate if qualitative results confirmed, explained or were in discordance with quantitative results. Results: There was a wide distribution (1.28% - 100%) and low average score (66%) of RDNs’ self-efficacy to use implementation behaviors; and wide distribution (0-72) and low average implementation behavior score (23 out of 72 maximum points) among 135 RDN participants. Self-efficacy [rs=.291, P=.001] and research proficiency [rs =3.63, P=.009] were significantly associated with implementation behavior. Quantitative results were confirmed and expanded by qualitative results. RDNs’ self-efficacy is influenced by their ability to overcome infrastructure barriers, their proficiency in research, training and education, experience and motivation, and their familiarity with implementation science. RDNs’ implementation behaviors are associated with not only self-efficacy but also their attitudes and subjective norms. Conclusion: RDNs’ report relatively low self-efficacy for using implementation strategies, and a low frequency of implementation behaviors. Further investigation of factors that may impact RDNs’ self-efficacy for using implementation strategies, and their implementation behaviors for EBP guidelines is needed. Research is warranted for EBP and implementation science training, advocacy for the dietetics profession, and appropriate resources and job descriptions for RDNs.


108 pages




Northern Illinois University

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