Adapting in Complex Environments: A Mix Methods Convergent Study of Structural Empowerment and Systems Thinking Among Public Health Dietitians

Registered dietitian nutritionists (RDNs) play critical roles in healthcare, public health, and food systems. RDNs, specifically those who work in public health, can have a profound impact on population health by implementing individual plus policy, system, and environmental (I+PSE) strategies (Tagtow et al., 2022) that improve dietary patterns, lower rates of diet-related chronic diseases, reduce health care expenditures, strengthen food and nutrition security, and establish greater resiliency in food supply chains. However, public health RDNs face complex work environments. They may not be keeping pace with societal, organizational, or practice changes (Academy of Nutrition and Dietetics, Council on Future Practice, 2020; Kicklighter et al., 2013, 2017); or with the leadership development skills of allied health professionals, specifically regarding empowerment and systems thinking (Buckley et al., 2007; El-Kour et al., 2021; Hewko et al., 2021; Kicklighter et al., 2017; A. Lee et al., 2021; Mislevy et al., 2000; K. Morgan et al., 2020).

The aim of this mixed methods convergent research was to understand how public health RDNs adapt and thrive in complex environments. Specifically, to explore their perceived access to organizational power structures (i.e., structural empowerment); how they applied systems thinking in practice; how their education and training prepared them to adapt and thrive in complex environments; and the relationship between structural empowerment and systems thinking. Semi-structured interviews were conducted with public health nutritionists who work in state governmental agencies and a self-administered online survey was implemented with public health RDNs who work in municipal, county, state, tribal, or federal governmental public health.