Identifying the Structure and Elements of Nutritional Guidance Techniques: Cross-Sectional Analytic Hierarchy Study

Background: Registered dietitian nutritionists (RDNs)-referred to as registered dietitians in Japan-contribute to disease management, prevention of complications, and improvement in quality of life through individualized nutritional guidance. However, these techniques often rely on individual experience, leading to variations in quality. The nutrition care process provides a standardized framework for nutritional care, but the specific techniques used in clinical practice and their interrelationships remain unclear. Interpretive structural modeling (ISM) is a method that visualizes and hierarchically organizes interrelationships among multiple elements, making it useful for structuring complex practical skills. Therefore, clarifying the structure of nutritional guidance techniques may support the standardization of practice and the development of educational frameworks. Objective: This study aimed to identify the elements influencing nutritional guidance techniques in clinical practice, clarify their hierarchical structure using ISM, and explore their potential applicability to the education of registered dietitians. Methods: Three experienced RDNs participated in an expert panel. Elements influencing nutritional guidance techniques were identified through structured brainstorming and consensus-building sessions. The extracted elements were analyzed using ISM to generate a reachability matrix and derive a hierarchical structure that visualized the interrelationships among the elements. Results: A total of 14 elements were identified and organized into a 6-level hierarchical structure. The upper levels included nutrition care process-related elements, with the "nutritional intervention plan" positioned at the top, whereas the lower levels consisted of foundational elements such as "clinical knowledge" and "understanding of patient background." Conclusions: This study identified 14 elements influencing nutritional guidance techniques in clinical practice and systematically visualized their interrelationships as a 6-level hierarchy using ISM. The resulting model provides an initial framework that may inform the development of clinical education curricula and competency evaluation frameworks for RDNs, and it could contribute to the advancement of standardized approaches in nutritional guidance education.