Evaluation of a mentoring intervention for public health nutrition workforce development

Public health nutrition is a field of practice that is concerned with the prevention of nutrition related disease and the maintenance of nutritional health of populations. Public health nutrition efforts are dependent on the capacity of the workforce to respond to priority issues. Developing the public health nutrition workforce is therefore a key strategy to build society’s capacity to address public health nutrition challenges and improve health. The evidence available suggests that the public health nutrition workforce in Australia does not have the capacity to respond to current health and nutrition issues. On-the-job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition. However there is limited evidence of their effectiveness. This study aimed to evaluate mentoring as a public health nutrition workforce development strategy. Action research methodology embedded within an evaluation framework provided the approach from which to guide this research, which had three phases. Formative evaluation (phase 1) involved an iterative literature review to define the role and models of mentoring as well as in-depth interviews with 18 advanced-level public health nutritionists in Australia to explore the role of mentoring in competence development. The results of phase one were used to inform the intervention (phase 2). This involved a mentoring circle, defined by the literature, where one mentor worked with a group of mentees. Thirty two recently graduated dietitians participated in the intervention and self-selected to one of two face-to-face mentoring circles or the electronic (video-link) mentoring circle for those in rural areas. Participants were required to complete a learning plan and attend the mentoring circle, every six weeks, for two hours, over a six month period. Each session was structured similarly including written reflective practice and facilitated group discussion. After the six month intervention a subset of 12 of the initial participants requested to continue with the mentoring circle for an extended nine months (phase 3). The one mentor, the PhD candidate, facilitated all mentoring circles. Process, impact and outcome evaluation data were obtained through mixed methodologies. A pre-intervention baseline questionnaire, estimation of time dedicated to public health nutrition practice within the participants’ work role and competence importance ranking were used. In-depth interviews with participants following the six month intervention, mentor reflections/observation diary and focus groups at the end of the extension phase added qualitative data. A competency self-assessment was designed and administered at baseline, post the six month mentoring intervention and 12 months post the completion of the intervention. The process evaluation identified that the intervention met participants’ expectations. The participants explained the intervention facilitated the sharing of ideas and strategies and promoted reflective practice. The important attributes of the mentor as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback were described. The impact evaluation revealed that participants reported an increase of 15% (p<0.05) in the sum of self-reported competence during the six month intervention. Outcome evaluation showed that many participants described reorienting their practice towards population based prevention and increasing the time dedicated to public health nutrition within existing work roles by an average of 1.5 hours per week per participant, equating to an addition of 1.5 Effective Full Time (EFT) positions to the workforce. This study revealed that mentoring is a potentially powerful experience for the public health nutrition workforce in Australia. Mentoring may be viewed as part of a multi-strategy approach to workforce development in public health nutrition in Australia that is focused on developing competencies and organisational supports for population based prevention in the practice setting.