Advice over empathy: a national cross-sectional examination of communication in United States dietetic education

Abstract Background Empathy is an important element of patient communication and is well operationalized in established approaches to one-on-one communication, such as motivational interviewing (MI). The accurate demonstration of empathy is especially important when seeking to facilitate a change in...

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Main Authors: Ashlea Braun, Sarah Corcoran, Gena Wollenberg, Kristen McClanahan, Rachel Liebe, Michael Businelle, Jillian Joyce
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Medical Education
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Online Access:https://doi.org/10.1186/s12909-025-07254-z
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author Ashlea Braun
Sarah Corcoran
Gena Wollenberg
Kristen McClanahan
Rachel Liebe
Michael Businelle
Jillian Joyce
author_facet Ashlea Braun
Sarah Corcoran
Gena Wollenberg
Kristen McClanahan
Rachel Liebe
Michael Businelle
Jillian Joyce
author_sort Ashlea Braun
collection DOAJ
description Abstract Background Empathy is an important element of patient communication and is well operationalized in established approaches to one-on-one communication, such as motivational interviewing (MI). The accurate demonstration of empathy is especially important when seeking to facilitate a change in behavior, such as in lifestyle or diet, given these issues often involve psychological barriers versus knowledge deficits. Registered dietitians are a key licensed healthcare provider tasked with facilitating changes in diet, but the extent to which current educational standards in the United States (US) contribute to cultivation of empathy as a professional skill has not been systematically evaluated. The objective of this study was to characterize therapeutic empathy and communication among US dietetics students. Methods A cross-sectional survey-based study was conducted among US-based dietetics students, recruited via forwarded e-mail messages from directors of accredited programs. Personal characteristics and responses to the Helpful Responses Questionnaire (HRQ)– a validated measure of therapeutic empathy– were collected. All HRQ responses (6/participant) were reviewed and scored from 1 to 5 based on the use of reflections and communication roadblocks (1 = least empathetic, 5 = most empathetic) per established methods. One mean total HRQ score was computed per participant and precise roadblocks used were tabulated. Given the distribution of the final data set, a binary variable was created to capture whether participants had a total HRQ score of 1 or > 1. Logistic regression and chi-square tests were used to identify participant attributes associated with achieving scores > 1. Results Participants (n = 506) were mostly white females (95.06% female, 79.05% white). The mean total HRQ score was 1.21 (SD: 0.47), with n = 175 participants (34.6%) achieving a mean total HRQ score > 1. Age, being married, having a previous non-nutrition-related career, or enrollment in a standalone internship were associated with HRQ score > 1 (P ≤ 0.001). The most common roadblock used was advising followed by using logic. Conclusion US-based dietetics students may not be consistently using empathetic communication, instead prioritizing problem-solving-oriented strategies (e.g., giving advice). Exploring optimal strategies to training that facilitate improved empathy, and the relative importance of empathy versus problem-solving strategies in facilitating behavior change, are important next steps. Further, the HRQ was successfully implemented, and its use should be replicated in other regions and populations.
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spelling doaj-art-71e8aaec4a5344e4b8099c7399fe61802025-08-20T02:29:26ZengBMCBMC Medical Education1472-69202025-05-0125111310.1186/s12909-025-07254-zAdvice over empathy: a national cross-sectional examination of communication in United States dietetic educationAshlea Braun0Sarah Corcoran1Gena Wollenberg2Kristen McClanahan3Rachel Liebe4Michael Businelle5Jillian Joyce6TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health SciencesDepartment of Nutritional Sciences, Oklahoma State UniversityDepartment of Nutritional Sciences, Oklahoma State UniversityDepartment of Nutritional Sciences, Oklahoma State UniversityDepartment of Nutritional Sciences, Oklahoma State UniversityTSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health SciencesDepartment of Nutritional Sciences, Oklahoma State UniversityAbstract Background Empathy is an important element of patient communication and is well operationalized in established approaches to one-on-one communication, such as motivational interviewing (MI). The accurate demonstration of empathy is especially important when seeking to facilitate a change in behavior, such as in lifestyle or diet, given these issues often involve psychological barriers versus knowledge deficits. Registered dietitians are a key licensed healthcare provider tasked with facilitating changes in diet, but the extent to which current educational standards in the United States (US) contribute to cultivation of empathy as a professional skill has not been systematically evaluated. The objective of this study was to characterize therapeutic empathy and communication among US dietetics students. Methods A cross-sectional survey-based study was conducted among US-based dietetics students, recruited via forwarded e-mail messages from directors of accredited programs. Personal characteristics and responses to the Helpful Responses Questionnaire (HRQ)– a validated measure of therapeutic empathy– were collected. All HRQ responses (6/participant) were reviewed and scored from 1 to 5 based on the use of reflections and communication roadblocks (1 = least empathetic, 5 = most empathetic) per established methods. One mean total HRQ score was computed per participant and precise roadblocks used were tabulated. Given the distribution of the final data set, a binary variable was created to capture whether participants had a total HRQ score of 1 or > 1. Logistic regression and chi-square tests were used to identify participant attributes associated with achieving scores > 1. Results Participants (n = 506) were mostly white females (95.06% female, 79.05% white). The mean total HRQ score was 1.21 (SD: 0.47), with n = 175 participants (34.6%) achieving a mean total HRQ score > 1. Age, being married, having a previous non-nutrition-related career, or enrollment in a standalone internship were associated with HRQ score > 1 (P ≤ 0.001). The most common roadblock used was advising followed by using logic. Conclusion US-based dietetics students may not be consistently using empathetic communication, instead prioritizing problem-solving-oriented strategies (e.g., giving advice). Exploring optimal strategies to training that facilitate improved empathy, and the relative importance of empathy versus problem-solving strategies in facilitating behavior change, are important next steps. Further, the HRQ was successfully implemented, and its use should be replicated in other regions and populations.https://doi.org/10.1186/s12909-025-07254-zMotivational interviewingEmpathyDiet therapyEducationNutritionistsBehavior change
spellingShingle Ashlea Braun
Sarah Corcoran
Gena Wollenberg
Kristen McClanahan
Rachel Liebe
Michael Businelle
Jillian Joyce
Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
BMC Medical Education
Motivational interviewing
Empathy
Diet therapy
Education
Nutritionists
Behavior change
title Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
title_full Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
title_fullStr Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
title_full_unstemmed Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
title_short Advice over empathy: a national cross-sectional examination of communication in United States dietetic education
title_sort advice over empathy a national cross sectional examination of communication in united states dietetic education
topic Motivational interviewing
Empathy
Diet therapy
Education
Nutritionists
Behavior change
url https://doi.org/10.1186/s12909-025-07254-z
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