Development and content validation of a Greek electronic tool for the process for nutrition and dietetic practice...

Standardized documentation frameworks such as the Nutrition Care Process (NCP) and the Process for Nutrition and Dietetic Practice (PNDP) aim to improve consistency of clinical reasoning, transparency of decision-making, and patient-centered care in dietetics. However, implementation remains inconsistent and is often limited by time constraints, insufficient applied training, and inadequate integration within digital health systems.

A sequential three-phase mixed-methods design was employed to develop and validate a Greek electronic PNDP tool (e-PNDP) for routine dietetic practice in Cyprus. In Phase 1, an exploratory national web-based survey was conducted among nutrition and dietetic professionals (n = 63) to examine awareness, implementation patterns, and perceived barriers related to structured documentation. In Phase 2, the electronic PNDP tool was developed based on these findings and aligned with the PNDP framework. In Phase 3, the tool underwent expert content validation and usability evaluation by a purposive multidisciplinary panel (n = 7). Panel members rated relevance, clarity, and simplicity using a 5-point Likert scale, and item-level and scale-level content validity indices (I-CVI and S-CVI) were calculated.

Survey findings demonstrated high awareness of structured documentation frameworks but variability in sustained implementation, with time burden and challenges in nutrition diagnosis formulation identified as key barriers. Expert evaluation indicated strong content validity across tool modules (I-CVI range: 0.86-1.00; S-CVI/Ave = 0.92) and consistently high usability ratings for relevance, clarity, and simplicity. Qualitative feedback suggested minor refinements related to wording clarity, interface presentation, and inclusion of selected clinical fields, without requiring structural modifications to the PNDP framework.

The electronic PNDP tool (e-PNDP) demonstrated strong content validity and usability, supporting its feasibility as a structured documentation solution within the Cypriot healthcare context. Integration within existing digital workflows and targeted training-particularly in nutrition diagnosis formulation-may enhance sustainable implementation and contribute to improved transparency and standardization of dietetic documentation.