Understanding and Usefulness of Effect Size and Certainty of Evidence: A Cross-sectional Survey of Evidence-Based Practice Competencies Among Registered Dietitians

Introduction: Understanding of absolute and relative estimates (i.e., effect size), and certainty of evidence corresponding to those estimates, is a fundamental evidence-based practice competency to promote informed clinical decision-making. While research has been conducted in the medical profession, there is no published research on these competencies in the nutrition and dietetics profession. Methods: Among registered dietitians, our main objectives were to assess (1) their understanding and perceived usefulness of three absolute and two relative estimate approaches to assess effect size, (2) their perceived usefulness of certainty of evidence, and (3) factors influencing their understanding and perceived usefulness. We conducted a web-based, cross-sectional survey among dietitians recruited from the Academy of Nutrition and Dietetics (United States). Participants received effect estimates based on hypothetical dietary interventions vs. usual diet for reducing myocardial infarction risk. Results: Of the 11,050 dietitians who received the survey link, 210 participated (2.0% response rate), and only completers (n=114) were included in the analysis. Participants demonstrated a similar understanding of the relative (27.6%) and absolute (27.5%) estimates, with Risk Difference (30.7% correct responses) being the best understood approach and Number Needed to Treat (24.6%) being the least. The understanding of five approaches was not different than random guessing (p>0.05). While perceived usefulness scores were similar between five approaches, they were highest when data was presented as Relative Risk [mean (SD): 4.82 (1.50)]. Dietitians rated the usefulness of certainty of evidence favorably [mean (SD): 5.07 (1.83), on a 7-point scale), and no factors were associated with correct understanding. Conclusion: Dietitians may have limited understanding of how to interpret effect sizes, a finding consistent with surveys of other health professionals. To optimize informed decision-making between dietitians and clients, dietetic programs and continuing education platforms should consider additional training on interpreting effect sizes and certainty of evidence for effect sizes.