Professional competencies and public health content in the human nutrition and dietetics degree program: A qualitative study based on experts'' consensus

RESEARCH ARTICLE P o essional compe encies and public heal h con en in he human nu i ion and die e ics deg ee p og am: A quali a i e s udy based on expe s’ consensus Panmela Soa esID 1 , Ca men Vi es-CasesID 1,2,3 *, Vicen e Clemen e-Go ´mez 3 , Rocı ´o O iz- Moncada 1,3 , Elena Lobo-Escola 4,5,6 , Diego Rada-Fe na ´ndez de Jau egui 7 , Vic o ia A ija 8 , A ´ngel R. Zapa a-Moya 9 , Ma i Ca men Da o ´-Blanes 1,3 , G oup o pa icipan s in he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Human Nu i ion and Die e ics ¶ 1Public Heal h Resea ch G oup, Depa men o Communi y Nu sing, P e en i e Medicine and Public Heal h and His o y o Science, Uni e si y o Alican e, Alican e, Comunidad Valenciana, Spain, 2CIBER in Epidemiology and Public Heal h (CIBERESP), Mad id, Spain, 3Public Heal h Resea ch G oup, Uni e si y o Alican e, Alican e, Comunidad Valenciana, Spain, 4Depa men o Mic obiology, P e en i e Medicine and Public Heal h, Uni e si y o Za agoza, Za agoza, Spain, 5Ins i u e o Heal h Resea ch o A agon (IIS A ago ´n), Za agoza, Comunidad de A ago ´n, Spain, 6Cen e o Ne wo k Biomedical Resea ch in Men al Heal h (CIBERSAM), Minis y o Science and Inno a ion, Mad id, Spain, 7Depa men o P e en i e Medicine and Public Heal h, Uni e si y o he Basque Coun y/Euskal He iko Unibe si a ea (UPV/EHU), Vi o ia-Gas eiz, Pais Vasco, Spain, 8Nu i ion and Public Heal h Uni , Facul y o Medicine and Heal h Sciences, Uni e si a Ro i a i Vi gili, Reus, Ca alunya, Spain, 9Depa men o Social An h opology, Basic Psychology and Public Heal h, Pablo de Ola ide Uni e si y, Se illa, Andalucia, Spain ¶ The comple e membe ship o he au ho g oup is p o ided in he Acknowledgmen s. *ca men. [email p o ec ed] Abs ac Objec i e To ga he consensus on p o essional compe encies and basic public heal h con en o he deg ee p og am in Human Nu i ion and Die e ics (HND). Design In 2018, he Fi h Mee ing o Uni e si y Public Heal h P o esso s ook place in Za agoza (Spain). Fou een lec u e s in he HND deg ee p og am pa icipa ed om 11 Spanish uni e - si ies. They iden i ied compe encies and basic con en o aining o he HND deg ee using g oup dynamics and consensus s a egies. Resul s The p o esso s iden i ied 51 basic compe encies, dis ibu ed in he a eas o “e alua ion o popula ion heal h needs” (n = 20), “de elopmen o heal h policies” (n = 23), and “gua an ee- ing p o ision o heal h ca e se ices” (n = 8). In o de o each hese compe encies, 35 opics we e p oposed o ganized in o six hema ic blocks: ounda ions o public heal h, nu i ional PLOS ONE PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 1 / 13 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Ci a ion: Soa es P, Vi es-Cases C, Clemen e- Go ´mez V, O iz-Moncada R, Lobo-Escola E, Rada- Fe na ´ndez de Jau egui D, e al. (2021) P o essional compe encies and public heal h con en in he human nu i ion and die e ics deg ee p og am: A quali a i e s udy based on expe s’ consensus. PLoS ONE 16(1): e0246268. h ps://doi.o g/ 10.1371/jou nal.pone.0246268 Edi o : Mau o Lomba do, San Ra aele Roma Open Uni e si y, ITALY Recei ed: May 13, 2020 Accep ed: Janua y 15, 2021 Published: Janua y 29, 2021 Pee Re iew His o y: PLOS ecognizes he bene i s o anspa ency in he pee e iew p ocess; he e o e, we enable he publica ion o all o he con en o pee e iew and au ho esponses alongside inal, published a icles. The edi o ial his o y o his a icle is a ailable he e: h ps://doi.o g/10.1371/jou nal.pone.0246268 Copy igh : ©2021 Soa es e al. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce a e c edi ed. Da a A ailabili y S a emen : All ele an da a a e wi hin he pape . epidemiology, heal h p oblems and die and nu i ion s a egies, ood secu i y, heal h in all policies and heal h p omo ion and educa ion. Conclusion The consensus eached se es as a e e ence o o ien and upda e public heal h educa ion as a pa o he HND deg ee. 1. In oduc ion P o essional compe encies in public heal h a e hose capaci ies needed in o de o each public heal h objec i es such as he p e en ion o disease and heal h su eillance, p o ec ion, p omo- ion and ecupe a ion in indi iduals and g oups [1]. The de ini ion o public heal h shows he a eas o ac ion as well as he mul i-p o essional na u e o he ield. This di e si y o p o iles and o ac i i ies make he de ini ion o p o essional compe encies di icul . O e ime, di e en na ional and in e na ional ini ia i es ha e p oposed de ining compe encies in public heal h. One such ini ia i e was ha p oposed by he Uni ed S a es Ins i u e o Medicine, which was he designa ion o essen ial unc ions in public heal h p ac ice [2]. In o de o es ablish a com- mon amewo k in Spain in 2006, he Spanish Socie y o Public Heal h and Heal h Adminis- a ion and he Spanish Epidemiological Socie y published a lis o public heal h p o essional compe encies [3]. This wo k allowed o iden i ying he common compe encies and con en o public heal h educa ion o di e en deg ee p og ams [4,5]. The Fo um o Public Heal h Uni e si y P o esso s was es ablished in Spain in 2013. I began as a dynamic and pa icipa o y space in which o engage in deba e abou he p o es- sional compe encies o public heal h and come o a consensus on he basic compe encies equi ed o di e en deg ees as well as on app op ia e cu iculum o each hem [6]. In e ms o o um ac i i ies, he public heal h compe encies and con en o he pha macy deg ee we e ag eed upon in 2013 [7], o medicine in 2014 [8], e e ina y medicine in 2016 [9] and nu sing in 2017 [10]. Wi h he same objec i e, in 2018 he o um began o ocus on he Deg ee in Human Nu i ion and Die e ics (HND). The in e es in add essing educa ion in HND is shown by a ious s udies ca ied ou in di - e en coun ies [11–14]. In e es is g owing in he cu en con ex o inc easing public heal h p oblems ela ed o die [15,16]. Howe e , HND educa ion has been ca ied ou di e en ly in di e en coun ies. In Spain p o essional in e es in nu i ion as a pa o public heal h is jus beginning. I is es ima ed ha less han wo pe cen o nu i ionis s ca y ou hei p o essional wo k in a public heal h con ex [17]. The inse ion o HND in he a ea o public heal h equi es he aining o p o essionals p epa ed o use a public heal h app oach o add ess p oblems ela ed o nu i ion. Thus, de ining he compe encies and basic con en o public heal h educa- ion in Spain is an impo an poin o depa u e o achie e his objec i e. The i s depa men o nu i ion and die e ics a he uni e si y le el in Eu ope was es ab- lished in 1920, and in 1970 he Eu opean Fede a ion o Die ician Associa ions was c ea ed [18]. In Spain, he diploma in HND was egula ed by Royal Dec ee 433/1998 as i s -cycle edu- ca ion wi h a h ee-yea du a ion in which public heal h cons i u ed a ounda ional cou se o 4.5 c edi s [19]. The adap a ion o he diploma o he deg ee i le was ca ied ou in 2016 [20] aking in o accoun he p o essional and speci ic compe encies es ablished in he ecommen- da ions (Whi e Books) o he Na ional Agency o Quali y E alua ion and Acc edi a ion ( he agency linked o he Minis y o Educa ion in Spain) [17]. Howe e hese compe encies we e PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 2 / 13 Funding: The D . An oni Es e e ounda ion unded he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Die and Human Nu i ion & de publica ion ees o his pape . The unde s had no ole in s udy design, da a collec ion and analysis, decision o publish, o p epa a ion o he manusc ip . Compe ing in e es s: The au ho s ha e decla ed ha no compe ing in e es s exis . no es ablished by public heal h p o essionals, no we e hey es ablished speci ically o he a ea in ques ion. Thus, he public heal h aining p og ams in he 31 uni e si ies (15 public) whe e he deg ee was o e ed we e highly he e ogeneous. Some included con en s ela ed o he unc ions o public heal h and ood policies, while o he s did no include hese opics and pu mo e emphasis on heal h planning [21,22]. In Spain g adua es o HND p og ams a e e e ed o as Die i ian Nu i ionis . Cu en ly his deg ee p og am includes 240 Eu opean c edi s and is dis ibu ed in o 4 yea s. The cou ses ela ed o public heal h a e equi ed. They ep esen a o al o 21.5 Eu opean c edi s ha a e dis ibu ed in o cou ses such as public heal h, epidemiology, communi y nu i ion and nu i- ion educa ion. Fu he mo e, s uden s much acqui e 21.5 Eu opean c edi s in ex e nal p ac i- cums [17]. Wi h espec o pos -g adua e aining, he e is no speci ic mas e o doc o a e in nu i ion in public heal h [23]. These opics make up a pa o o he p og ams such as human nu i ion and die e ics, public heal h and heal h sciences. In p o essional wo k, Die i ian/Nu i ionis ha e di icul y inding jobs in public heal h. They ypically wo k in clinics and p i a e consul ancies [17]. In o de o p omo e he p o essional de elopmen o Die i ians/Nu i ionis s in public heal h, i is use ul o adap he aining con en s o p o essional compe encies in public heal h [3,24–26]. The objec i e o his s udy is o ga he consensus on p o essional compe encies and basic public heal h con en o he deg ee p og am in HND. 2. Me hods This wo k comp ises pa o a p ojec ha has been ca ied ou since 2013 and whose me hod- ology has been desc ibed p e iously [7–10]. In his s udy we gene a ed consensus on p o essional compe encies and public heal h con- en o he HND deg ee h ough a quali a i e s udy ha used he nominal g oup echnique [26] wi h p o esso s who had expe ience eaching in he HND deg ee. Pa icipan selec ion was ca ied ou by iden i ying, h ough he webpage o he Con e ence o Spanish Uni e si y Rec o s, hose public Spanish uni e si ies (N = 50) ha o e ed he HND deg ee du ing he 2017–18 academic yea . Fi een uni e si ies we e iden i ied dis ibu ed in 9 o he 17 Au onomous Communi ies. Looking a he eaching guides o he public heal h cou ses o hese uni e si ies, ull- ime p o esso s who we e esponsible o he cou se we e selec ed, p e e ably om he a ea o p e- en i e medicine and public heal h. The p o esso s in scien i ic a eas such as ood and animal science and animal p oduc ion and nu i ion we e no included. Con ac wi h he p o esso s was ca ied ou by email. They we e explained he objec i e and an eceden s o he mee ing and he eason hey we e being b ough oge he . In he case hey couldn’ pa icipa e, a eques was made o a ecommenda ion o ano he indi idual om hei a ea o expe ise om he same uni e si y. Following he same p ocedu e, con ac was made wi h he sugges ed pa icipan , and epea edly his was ca ied ou un il a de ini i e lis o pa ic- ipan s was ob ained. A o al o 25 people we e con ac ed, and 14 ended up pa icipa ing in he s udy (10 women and 4 men) om 11 uni e si ies: Uni e si y Complu ense o Mad id, Uni e - si y o Alican e, Uni e si y o G anada, Uni e si y o San iago de Compos ela, Uni e si y o he Basque Coun y, Uni e si y o Za agoza, Uni e si y Pablo de Ola ide, Uni e si y o Ba celona, Uni e si y o Lleida, Uni e si y o València, and Uni e si y Ro i a i Vi gili. Each uni e si y had a ep esen a i e, excep in he case o Za agoza and Alican e, which had h ee and wo ep esen- a i es, espec i ely. The e we e i e assis an p o esso s, ou associa e p o esso s, one enu ed p o esso , one pos -doc o al esea che , and h ee adjunc p o esso s. Academic aining o he PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 3 / 13 pa icipan s was ela ed o a mul idisciplina y public heal h app oach. Pa icipa ion in he wo kshop included doc o s (n = 5), Die i ians/Nu i ionis s (n = 3), pha macis s (n = 3), nu s- ing (n = 1), g adua es in poli ical science and adminis a ion (n = 1) and humani ies g adua es (n = 1). All o he pa icipan s held doc o a es in public heal h o ela ed a eas: public heal h (n = 6), medicine (n = 4), pha macy (n = 3), social sciences (n = 1). The majo i y o pa icipan s had mo e han i e yea s o eaching expe ience in public heal h and HND: mo e han 10 yea s (n = 4), be ween 5 and 10 yea s (n = 6), less han 5 yea s (n = 4). In o ma ion was collec ed du ing he Decembe o 2018 a he Fi h Mee ing o he Fo um o Uni e si y Public Heal h P o esso s, which ook place in Za agoza. The mee ing las ed one day and a hal , du ing which h ee consensus ac i i ies we e ca ied ou in g oups o ou o i e pa icipan s and in plena y. The same p o esso s pa icipa ed in he h ee ac i i ies. The i s ac i i y was ca ied ou in g oups o ou o i e pa icipan s. Wi h he help o an online ques ionnai e, each g oup was p esen ed wi h a lis o 80 p o essional compe encies in public heal h (de ined o Spain) g ouped in o h ee essen ial a eas: “e alua ion o popula ion heal h needs”, “de elopmen o heal h policies”, and “gua an eeing p o ision o heal h ca e se ices” [3]. Each g oup classi ied he compe encies in o one o he ollowing ca ego ies: a. belonging o he HND deg ee; b. pos -g adua e; c. ans e sal (compe encies ha could co e- spond o bo h he deg ee as well as pos -g adua e) and; d. no applicable (conside ed no app op ia e o he deg ee). The esul s o his i s ac i i y we e p esen ed in plena y. When less han 2/3 o he g oups ag eed, consensus on he compe ency was a i ed a h ough con- sul a i e discussion. In he second ac i i y new g oups o ou o i e pa icipan s we e o med, di e en om hose in he i s ac i i y. In his ac i i y he pa icipan s discussed and ag eed o a lis o basic con en s, which in hei opinion would be necessa y o de elopmen o he compe encies ha we e ag eed o in consensus. Based on hei eaching p og ams and hei own expe ience, hey we e old o ag ee o a maximum o i e con en blocks, each o which would con ain a maxi- mum o i e hema ic uni s. The con en block was p esen ed as cohe en g oup, o ganized by hema ic uni s. The hema ic uni s also e e ed o he con en s ha would con ibu e o each- ing he compe ences iden i ied in ac i i y 1. In he hi d ac i i y, he p oposal o he h ee g oups was e iewed and g ouped by wo expe s, epea ed con en was excluded and di e ences we e agg ega ed un il a consensus o maximums was eached. The esul was p esen ed in plena y, whe e he numbe o hema ic blocks and hei speci ic i les we e ag eed o. La e in he plena y he e was discussion abou hei con en s un il an ag eemen was eached. Consensus was eached h ough consul a i e discussion in which pa icipan s p esen ed and de ended hei poin s o iew. In cases o dis- c epancy, ag eemen was eached by a simple majo i y o e. P io o he mee ing, we sen pa icipan s an in i a ion le e o in o m hem abou he objec- i e o ou s udy and ga he hei consen o ake pa in i . The pa icipa ion was olun a y, and all pa icipan s had he chance o e iew he consensus eached a e he mee ing ended. 3. Resul s O he 80 public heal h compe encies p esen ed o he p o esso s, 51 we e iden i ied as basic o he HND deg ee, 25 o he pos -g adua e p og am, and 4 we e classi ied as no applicable. Fu he mo e, he pa icipan s added a compe ency o he p ede ined lis , which was ag eed o by consensus as basic o he deg ee. Table 1 shows he classi ica ion o he p o essional compe encies o Die i ians/Nu i ion- is s in he a ea o “e alua ion o popula ion heal h needs”. O he 30 compe encies o his a ea, 25 o hem ob ained a high le el o consensus among he g oups, while he emaining 5 we e PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 4 / 13 discussed in plena y. In he end, 20 o he 30 compe encies we e conside ed app op ia e o he deg ee and 10 o he pos -g adua e p og am. Table 2 shows he classi ica ion o compe encies o he HND deg ee in he a ea o “de elop- men o heal h policies”. In his a ea, he e was consensus among he g oups o 24 o he 30 com- pe encies. The o he 6 we e deba ed in plena y un il consensus was eached. In he end, 23 we e classi ied as ele an o he deg ee, 6 as pos -g adua e and one was iden i ied as no ele an . In Table 1. Compe encies ag eed o in he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Human Nu i ion and Die e ics o he A ea o “E alua ion o Popula ion Heal h Needs”. Compe encies (N = 30) Deg ee n (%) Pos -g adua e n (%) 1—Analysis o he heal h si ua ion o he communi y (n = 10) 9 (90) 1 (10) Iden i y ac o s ha de e mine heal h X In e p e heal h and disease p ocesses in human popula ions X Collec , p ocess and s o e in o ma ion (demog aphic and heal h- ela ed) X E alua e he quali y o he in o ma ion X P oduce heal h indica o s and indices X Ca y ou quan i a i e and quali a i e analysis o da a X Analyze he spa ial and empo al dis ibu ion o heal h in o ma ion X a E alua e he dis ibu ion o en i onmen al, biological and cul u al isks X E alua e heal h inequali ies X P oduce and communica e in o ma ion o di e se audiences X 2—Desc ibe and analyze he associa ion and impac o isk ac o s on heal h p oblems and he impac on heal h se ices (n = 11) 6 (55) 5 (45) Gene a e a hypo hesis wi h a scien i ic basis X Design app op ia e esea ch p oposals X a Manage app op ia e epidemiological and s a is ical echniques X Design ins umen s o measu e and collec da a X P ocess and s o e in o ma ion in da abases X E alua e da a quali y X a Manage esea ch echniques ela ed o se ices and in e en ions X Apply economic e alua ion echniques X Syn hesize esul s app op ia ely X Be amilia wi h pe inen bibliog aphical in o ma ion and iden i y in o ma ion sou ces, including bibliog aphic sea ches X Respec he e hical aspec s o heal h documen a ion and esea ch X 3 –Con ol diseases and eme gency si ua ions (n = 9) 5 (56) 4 (44) Ve i y he exis ence o an eme gency heal h si ua ion X Analyze he causes o an eme gency X Be amilia wi h e iciency and sa e y in e ms o a ailable con ol measu es X Be amilia wi h a ailable esou ces and hei o ganiza ion and esponsibili ies X P opose ex ao dina y measu es o he esolu ion o eme gency si ua ions X Apply measu es and a ailable esou ces X a Gene a e c edibili y and us X a E alua e po en ial communi y eac ions ( isk pe cep ion) X a Communica e ele an in o ma ion o he popula ion and o p o essionals in a c isis si ua ion X TOTAL 20 (67) 10 (33) a Compe encies ag eed o in he plena y session. h ps://doi.o g/10.1371/jou nal.pone.0246268. 001 PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 5 / 13 Table 2. Compe encies ag eed o a he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Human Nu i ion and Die e ics o he a ea o “De elopmen o Heal h Policies”. Compe encies (N = 31) Deg ee n (%) Pos -G adua e n (%) 1—Con ibu e o de ining heal h sys em o ganiza ion (n = 9) 8 (89) 1 (11) Use in o ma ion on he heal h p oblems and heal h needs o he popula ion X Es ablish heal h p io i ies o a de ined popula ion X Fo mula e heal h objec i es ha a e compa able and measu able X Be amilia wi h di e en heal h sys ems X Be amilia wi h cu en heal h legisla ion and p ocesses o de elopmen o egula ions X Be amilia wi h mechanisms o assignmen o heal h esou ces X E alua e he heal h, economic and social impac o heal h policies, including in e -sec o al heal h policies X Be amilia wi h he objec i es and poli ical p io i ies in he a ea o heal h X Be amilia wi h Eu opean heal h policies and policies o in e na ional agencies and o ganiza ions X 2—P omo e he de ense o heal h in in e -sec o al policies (n = 5) 3 (60) 2 (40) Be amilia wi h he objec i es and p io i ies o public policies ela ed o heal h X Be amilia wi h basic en i onmen al, wo k- ela ed, ag icul u al, ood- ela ed, anspo a ion, and educa ional legisla ions ela ed o heal h X E alua e he heal h impac o public policies X Nego ia e he ole o heal h in he de elopmen o public policies ela ed o heal h X Mobilize and gene a e public opinion in de ense o heal h X 3—Con ibu e o he design and implemen a ion o heal h p og ams and in e en ions b (n = 12) 8 (67) 3 (25) Iden i y heal h p oblems, needs and inequali ies in he popula ion X Es ablish heal h p io i ies o a de ined popula ion X In e p e po en ial bene i s and ba ie s o heal h in e en ions X a, b Be amilia wi h he ac o s unde lying human and g oup beha io X Design heal h educa ion p og ams X Design popula ion-based accina ion p og ams NA NA Design p og ams o p o ec ion agains en i onmen al isks X a Design ood sa e y p og ams X Design popula ion-based seconda y p e en ion p og ams X a E alua e he e hical aspec s o heal h in e en ions. Design heal h and social ca e p og ams X Con ibu e o he in e -sec o al na u e o p og ams X a Design in e en ion p og ams in he a ea o ood and nu i ion X c 4—P omo e social pa icipa ion and s eng hen he le el o con ol o ci izens o e hei own heal h (n = 5) 5 (100) 0 (0) P epa e and p o ide w i en and e bal in o ma ion o di e se g oups X Facili a e and ein o ce he capaci y o ci izens ela ed o hei own heal h X Ac in de ense o he heal h o he mos ulne able g oups in socie y X Iden i y and in ol e communi y leade s in he p ac ice o public heal h X Demons a e leade ship and coo dina ion o di e se eams X a TOTAL 24 (77) 6 (19) a compe encies ag eed o in he plena y session / b change in he name o he ac i i y o compe ency ag eed o in he plena y session / c addi ional compe ency added in he plena y session / NA = No applicable. h ps://doi.o g/10.1371/jou nal.pone.0246268. 002 PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 6 / 13 his a ea he pa icipan s added a compe ency no ini ially included in he lis : “design o in e en- ion p og ams in he a ea o ood and nu i ion”, classi ied as ele an o he deg ee. Fo some compe encies he e was consensus abou he modi ica ion o adap a ion o he names. Table 3 shows he classi ica ion awa ded by he pa icipa ions o each o he compe encies o he a ea “gua an eeing p o ision o heal h ca e se ices”. O he 20 compe encies in his a ea, 15 we e selec ed by he majo i y o he g oups and 5 o hem we e deba ed in plena y. In he end, he pa icipan s classi ied 8 as ele an o he deg ee, 9 o he pos -g adua e p og am and h ee as no ele an . Based on he compe encies ag eed o as ele an o he deg ee, and a e deba e, 35 hema ic uni s we e g ouped in o six blocks: 1) undamen als o public heal h, 2) nu i ional epidemiol- ogy, 3) heal h p oblems and ood and nu i ion s a egies, 4) ood secu i y, 5) heal h in all poli- cies, and 6) heal h p omo ion and educa ion. Table 4 shows he blocks and hema ic uni s ag eed o by consensus by he public heal h p o esso s o he HND deg ee. Table 3. Compe encies ag eed o a he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Human Nu i ion and Die e ics o he a ea o “Gua an eeing P o ision o Heal h Ca e Se ices”. Compe encies (N = 20) Deg ee n (%) Pos -G adua e n (%) 1—Manage se ices and p og ams (n = 5) 1 (20) 3 (60) Facili a e he accessibili y o heal h se ices o ulne able g oups NA a NA a Ins all heal h p og ams X De elop budge s and p epa e unding p oposals X Iden i y heal h p io i ies in any si ua ion X Manage mul idisciplina y eams and esol e con lic s X a 2—E alua e se ices and p og ams (n = 4) 0 (0) 4 (100) E alua e he e iciency, e ec i eness, u ili y, sa e y, and geog aphic, social, e hnic o gende equi y o heal h in e en ions X Analyze popula ion, p o essional and p o ide sa is ac ion wi h heal h se ices X Use he me hods o s uc u e, p ocess and esul s ha a e mos app op ia e in each case, including quali y o li e, sa is ac ion, accep ance, e c. X Know how o apply es ablished c i e ia o he acc edi a ion o heal h se ices and ac i i ies X 3—Ca y ou heal h inspec ions and audi s (n = 6) 4 (67) 0 (0) Be amilia wi h cu en legisla ion on heal h isks X Be amilia wi h ac ion mechanisms o he p ima y heal h isks X Be amilia wi h and ained in audi echniques X a Be amilia wi h legisla ion applicable o each a ea o heal h egula ion X P opose and/o adop special measu es (seizu es, p ecau iona y in e en ions, e c.) NA a NA a P opose and ca y ou ac ion o imp o e se ice deli e y NA a NA a 4—De elop guides and p o ocols (n = 5) 3 (60) 2 (40) Syn hesize cu en knowledge abou he impac o heal h in e en ions o in e es X Be amilia wi h p ocesses o de elopmen o guides and s anda dized wo k p o ocols X Adap a ailable guides o ce ain a eas X De elop s anda dized con ol measu es and p ocedu es X In ol e ele an agen s (p o essional associa ions, expe s, p o essional ep esen a i es, e c.) in he de elopmen and applica ion o guides and p o ocols X a TOTAL 8 (40) 9 (45) a compe encies ag eed o in he plena y session / NA = No applicable. h ps://doi.o g/10.1371/jou nal.pone.0246268. 003 PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 7 / 13 4. Discussion This s udy shows he consensus eached by a subse o 14 p o esso s o he 11 public Spanish uni e si ies ha each in he deg ee in HND, wi h espec o he p o essional compe encies and basic con en a eas o public heal h ha should be included in he deg ee p og am. The compe encies ha we e ag eed o by consensus co espond o h ee a eas o public heal h, Table 4. Thema ic blocks and a eas ag eed o a he Fi h Mee ing o Uni e si y Public Heal h P o esso s o he Deg ee in Human Nu i ion and Die e ics. 1. FOUNDATIONS OF PUBLIC HEALTH (n = 6) The concep o heal h and disease. Public heal h and i s unc ions Heal h de e minan s and inequali ies Na u al his o y o disease and le els o p e en ion Heal h sys ems. Public heal h legisla ion In o ma ion sys ems and heal h indica o s In e na ional and na ional o ganiza ions ela ed o public heal h 2. NUTRITIONAL EPIDEMIOLOGY (n = 10) Gene al concep s in epidemiology Measu es o equency, associa ion and impac Types o s udy and design o s udies in nu i ional epidemiology Causali y Validi y and p ecision. Biases and andom e o . Diagnos ic es s. Con usion E alua ion me hods o ood consump ion and da a sou ces E alua ion me hods o popula ion nu i ional s a us Die a y pa e ns Analysis o da a in nu i ion s udies E idence-based nu i ion 3. HEALTH PROBLEMS AND FOOD AND NUTRITION STRATEGIES (n = 5) T ansmissible diseases and hei p e en ion Non- ansmissible diseases and hei p e en ion S a egies and p og ams in public heal h Nu i ional ecommenda ions and objec i es. Die a y guides Impac o in o ma ion echnologies in public heal h 4. FOOD SECURITY (n = 5) Concep and indica o s in ood secu i y. Food so e eign y Food sys ems and sus ainabili y Heal h isks associa ed wi h ood p oduc s Heal h audi s and inspec ions Nu i ional labelling 5. HEALTH IN ALL POLICIES (n = 5) Heal hy public policies In e en ions o educe inequali ies in heal h Managemen and planning in heal h Design o communi y in e en ion p og ams ela ed o die and nu i ion and hei e alua ion Die a y and nu i ion policies in he Eu opean and Spanish con ex 6. HEALTH PROMOTION AND EDUCATION (n = 4) Heal h p omo ion: concep s and s a egic lines o heal h p omo ion Heal h educa ion Design o nu i ion educa ion p og ams Die and nu i ion communica ion s a egies h ps://doi.o g/10.1371/jou nal.pone.0246268. 004 PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 8 / 13 wi h a g ea e numbe o compe encies o he a ea o “de elopmen o heal h policies”, ol- lowed by “e alua ion o popula ion heal h needs”, and inally “gua an eeing p o ision o heal h ca e se ices”. To achie e hese compe encies, pa icipan s p oposed 35 hema ic uni s ela ed o public heal h and epidemiology, public heal h policy, s a egies o he p e en ion o poo heal h ela ed o die and nu i ion, heal h p omo ion and ood secu i y. Ou esul s iden i y a se ies o p o essional compe encies in public heal h ha any HND s uden should de elop du ing he deg ee p og am. Howe e , hey do no include all he basic compe encies de ined by he Spanish Public Heal h Socie y o p o essionals who wo k in pub- lic heal h. These esul s a e simila o hose shown in p io s udies o o he deg ee p og ams in Spain [7–10] and could be explained by he di e si y o ac i i ies ca ied ou in he a ea o public heal h and by he mul idisciplina y na u e o he ield. Despi e he e o s o di e en o ganiza ions o de ine a eas o ac ion and p o essional com- pe encies o Die i ians/Nu i ionis s [27], hei ac i i y in public heal h is jus beginning. This could be explained by he ac ha he deg ee in HND is ela i ely ecen , and he inclusion o hese p o essionals in he heal h sys em is no ye consolida ed in he majo i y o coun ies in Eu ope. These esul s wa an ecogni ion, because he numbe o compe encies in public heal h a ibu ed o his ype o p o essional is g ea e han wha has been p oposed o o he deg ees in p io s udies [8,10]. This shows he g ea po en ial ha pa icipan s a ibu e o Die i ians/Nu i ionis s in ca ying ou ac i i ies ela ed o p e en ion, p o ec ion, su eillance and p omo ion o popula ion heal h. Simila o he consensus achie ed o he deg ees in nu sing and medicine in Spain [8,10], he numbe o compe encies iden i ied o he a ea o “gua an eeing p o ision o heal h ca e se ices” was lowe . This was he case o he compe encies ela ed o he managemen and e alua ion o se ices and p og ams, which ag ees wi h o he p io s udies in o he coun ies [13,28], conside ed app op ia e o pos -g adua e p og ams. Thus, ou indings show he ele- ance o pos -g adua e p og ams o achie ing de elopmen o hese compe encies in nu i- ion and die e ics. In his way, e hics, communica ion and leade ship a e included in a ious compe encies, which, acco ding o ou esul s, should be ini ia ed du ing he deg ee and com- ple ed du ing pos g adua e. In ac , he e is e idence ha p o essionals wi h a pos g adua e deg ee eel ha hey ha e g ea e abili ies in e ms o planning and adminis a i e e alua ion, as well as in e ms o o ganiza ion, esea ch, o e sigh and leade ship [11]. In e ms o con en , he consensus o HND p oposed an ini ial module o app oach gene al aspec s o public heal h, such as he concep o heal h and i s de e minan s. Also, con en a eas we e es ablished o epidemiology and heal h p oblems. Fu he mo e, a module was p oposed wi h speci ic opics om he p o ession. The s udy o he s a e o nu i ion was p oposed and he ood consump ion o he popula ion as well as o gi e g ea e emphasis o heal h p oblems ela ed o die . These esul s show a common heme in aining in public heal h o Die i ians/ Nu i ionis s and o he heal h p o essions, which should be complemen ed by opics ha a e speci ic o each p o ession. Heal h p omo ion was conside ed an impo an opic, and a speci ic block was ag eed o in o de o add ess he issue. On he con a y, con en s ela ed o su eillance ecei ed less a en- ion, possibly because his heme has been a ibu ed gene ally o o he p o essions. Howe e , he inc ease in heal h p oblems ela ed o die [15] shows he need o s eng hen a die a y and nu i ional su eillance sys em ha suppo s he p ocess o e alua ion and planning o die and nu i ion s a egies. This opic could be augh in he HND deg ee, aking in o accoun ha su eillance is one o he ac ion a eas o he Wo ld Heal h O ganiza ion Wo ld S a egy on Die , Physical Ac i i y and Heal h [29]. In addi ion o he consensus in he a eas o e e ina y heal h and pha macy [7,9], a he- ma ic block was es ablished i led “ ood secu i y” o he HND deg ee, albei wi h di e en PLOS ONE Public heal h con en in he human nu i ion and die e ics deg ee p og am PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0246268 Janua y 29, 2021 9 / 13