Sustainable food systems and planetary health education for nutritionists and dietitians: prioritising curriculum concepts with Q methodology Open Access

Under the expert stewardship of Indigenous Peoples globally, the finely balanced ecosystems on Earth were managed for millennia. However, “humans have lost their identity as organisms within a larger system and thus have lost awareness of how to live sustainably with Mother Earth” (Redvers et al., 2022, p. 159). The health of current and future generations is under threat, triggering urgent calls for research and practice to promote planetary health (Whitmee et al., 2015). Such efforts must be transdisciplinary, solutions-oriented and address the ecosystem disruptions caused by human activities (Myers et al., 2025). The global food system contributes approximately one-third of global greenhouse gas emissions and requires urgent, transformative action (Crippa et al., 2021).

Nutritionists and dietitians are well-placed to contribute to this transformation, as they are deeply embedded in food systems (Ng and Cole, 2022). While current food systems do not promote health, equity or environmental sustainability, nutritionists and dietitians globally have defined such aspirational sustainable food systems (SFS)

(Carlsson and Callaghan, 2024, p. 4). Applying a planetary health lens to nutrition and dietetic practice recognizes the need to combine biomedical healthcare knowledge and skills with systems thinking to incorporate social, ecological and commercial determinants of health (Bergquist et al., 2024). Evidence indicates a hesitancy amongst some nutrition and dietetics professionals to engage in SFS work due to low confidence and insufficient training opportunities (Carlsson and Callaghan, 2024). However, there is also agreement that promoting SFS is within the scope of practice for nutritionists and dietitians, with competency standards related to SFS present in 20 of 29 countries (Carvajal Useche et al., 2023; Higgins et al., 2023).

At the university level, however, these standards are only beginning to translate into formal curriculum and vary by topic and country, highlighting opportunities to better support higher education programs in this emerging field (Muñoz-Martínez et al., 2023; Alberdi and Begiristain-Zubillaga, 2021). Wegener et al (2024) analysed SFS education in Canada, the UK and Australia and reported a wide variance. While some nutrition and dietetic programs had no obvious or explicit SFS content, others had relevant content in only one course, and very few had courses or units fully dedicated to SFS concepts. A comparable study in the Republic of Ireland also found minimal evidence of SFS education integration (Finnegan et al., 2024). Australian studies have monitored the evolving tertiary landscape over time, documenting a substantial increase between 2015, when 8% of nutrition and dietetics programs offered SFS education, and 2023, when 84% of nutrition programs and 95% of dietetics programs were doing so (Carino et al., 2020; Barbour and McCartan, 2025). Despite this promising shift, Australian scholars identified that most relevant learning outcomes remain focused on lower-order cognitive learning.

While as little as two weeks of sustainability education increases knowledge and positive attitudes about SFS sustainability (Innes et al., 2018), current training is inadequate and scholars have called for more systematic, robust curricular frameworks (Innes et al., 2018). The Planetary Health Alliance convened a task force of thought leaders to create a transdisciplinary framework, intended to be relevant across sectors and geographic locations (Guzmán et al., 2021). In additional, discipline-specific frameworks and curriculum tools in the field of planetary health education are advancing in medicine (Oudbier et al., 2023), nursing (Potter, 2021) and allied healthcare disciplines (Sorensen et al., 2023). A framework exists to guide SFS pedagogy across disciplines (Valley et al., 2018) however, to the authors’ knowledge a framework tailored specifically for nutrition and dietetics is yet to exist. Such a framework must acknowledge the diversity of professional contexts, stakeholder perspectives and the global nature of food systems (Valley et al., 2018; Pelly et al., 2025). This study aimed to engage food systems stakeholders and tertiary educators from geographically diverse contexts to identify curriculum concepts to advance food systems and planetary health education for nutritionists and dietitians.

This study was led by dietitians from Australia, Canada, Ireland and the UK who facilitate SFS education and contribute to pedagogic research in this emerging field (Wegener et al., 2024). In 2023, dietitians representing 11 nations came together to advance SFS education, calling for a co-designed curricula framework (Browne et al., 2024). In response, authors LB, SB, JW, LC, CP and TE facilitated a workshop at the International Congress of Nutrition and Dietetics (ICND) in Toronto, Canada (Dietitians of Canada, 2024). One conference stream focused on SFS, and included the workshop that collected data for this study, attended by international delegates working in the tertiary education and food system sectors.

This study uses Q methodology to prioritise curriculum concepts for nutritionists and dietitians to promote SFS and planetary health. Q methodology offers a structured approach to systematically examine the subjectivity of people’s viewpoints about a topic of interest (Brown, 1980). First introduced by William Stephenson in 1935, Q methodology has been increasingly applied across disciplines (Dieteren et al., 2023; Röös et al., 2023). Systematic reviews of its use in education (Lundberg et al., 2020) and healthcare research (Churruca et al., 2021) support its flexibility and value, provided the decision-making processes are transparent and rigorously reported. Norwood et al. (2025) used Q methodology to examine consumer perspectives on healthy and sustainable eating practices, claiming the approach enabled structured exploration of subjective and typically diverse viewpoints on this complex and multidimensional field. Dieteren et al.’s (2023) systematic review examined researchers’ methodological choices in a large number of Q studies (n = 613), publishing a checklist used in the present study to support greater transparency and more effective reporting (Supplementary Material A:Q Methodology Reporting Checklist). Ethics approval was obtained initially from <removed for blind review> Human Research Ethics Committee (Project ID: xxxxx), and subsequently from each of the co-facilitators’ research institutions (Supplementary Material B: Institutional Ethics Approvals).

This mixed methods study involves qualitative data analysis, and the personal experiences, world views and expertise of each author are reflected in the results (Crotty, 1998; Palermo et al., 2021). Guided by a social constructionist epistemology, the study embraces subjectivity and the co-construction of knowledge from multiple perspectives (Watts and Stenner, 2012). It is therefore important to acknowledge the interpretive lenses applied. Six authors (LB, JW, LC, CP and TE) are qualified dietitians, involved in developing and facilitating SFS education and contributing to pedagogic research in this emerging field both independently and collaboratively as an international research team. Three authors are research assistants, including one recent graduate (TF) and two current students (SK, CT) who bring a learner’s perspective to the data analysis and interpretation. One author (GB) has extensive experience with Q methodology and contributes a unique perspective outside of the health sector, grounded in curriculum, teaching and inclusive education.

This study involved a multi-phased process, applying the principles of co-design within a Q methodology approach (Figure 1). Each phase is outlined below, including definitions for the unique nomenclature that comes with Q methodology, also defined in Supplementary Material C: Glossary of terms used in Q methodology. Of the five phases, Phases 1 and 2 prepare for the main data collection to occur in Phase 3 (conference workshop) and Phases 4 and 5 focus on analysis and interpretation of this data.

This research engaged food systems stakeholders and tertiary educators to identify the curriculum concepts that should be prioritised to equip nutritionists and dietitians to promote SFS and planetary health. To ensure international relevance, evidence-informed foundations and alignment with real-world practice, Phase 1 involved developing a broad concourse of potential curriculum concepts. In Q methodology, this process is referred to as developing the concourse, as gathering material that “represents existing opinions and arguments, things lay people, politicians, representative organisations, professionals, scientists have to say about the topic; this is the raw material for Q methodology” (Van Exel and De Graaf, 2005, p. 4). The present study drew on both a ready-made concourse and a naturalistic concourse to capture a wide range of perspectives (Sandling, 2022).

The ready-made concourse was developed by completing a rapid review of existing literature (Supplementary Material D: Ready-made Concourse). This review was led by one researcher with extensive knowledge of the peer-reviewed and grey literature on this topic (LC) and cross-examined by the lead author. A total of 67 statements were defined, including eight affective, 38 knowledge-based and 21 skills-related statements. The naturalistic concourse was prepared by two authors (JW and TF) and cross-examined by the lead author (LB) through the analysis of responses to an online survey (Supplementary Material E: Naturalistic Concourse). Survey participants (n = 84) were located in 23 countries, representing six of the seven global regions, with most working in metropolitan areas (62%) compared to rural, remote and regional areas (Ritchie et al., 2023). Most survey participants were qualified nutritionists or dietitians (69%), while others worked within the food system from disciplinary backgrounds outside of nutrition or dietetics (10%), and most participants had over 10 years of experience in the field of food systems (60%). Based on survey responses, 118 statements about what should be taught to nutritionists and dietitians during their tertiary education were prepared by the research team, including 71 knowledge-based statements and 47 skill-related statements. Together, 185 statements were prepared in both the ready-made (n = 67) and naturalistic concourse (n = 118).

The Q-set refers to the final set of statements used during the Q-sort process. It must reflect a broad range of perspectives drawn from the concourse and be manageable for participants to rank meaningfully. While there is no standard number of statements in a Q-set, its size should reflect topic complexity and practical considerations related to its use (Watts and Stenner, 2012). For the current research, it was determined that a Q-set of 35 statements was appropriate based on the configuration of the score sheet (or Q-grid as described in the next phase).

Thematic analysis was used to distil the 185 concourse statements down to 35. Drawing upon Braun and Clarke’s approach, a process of coding, categorising and theming the statements was led by three researchers (SB, CP and TE), with input from the first and last authors (Braun and Clarke, 2006; Braun and Clarke, 2012). The final wording for the 35 statements (Supplementary Material F: Concept-based curriculum and example content included in the Q-Set) was agreed upon by all workshop facilitators (LB, SB, CP, TE, JW and LC). To guide selection, statements were prioritised if they described concept-based curriculum, as opposed to content or specific topics. Concept-based curriculum focuses on abstract, transferable ideas rather than factual content, supporting deeper understanding and long-term applicability (Tweedie et al., 2021). Once finalised, the Q-set of 35 statements was printed onto palm-sized cards, with the front displaying the concept name and a short explanation, and the reverse displaying a learning and teaching activity example relevant to that concept (Supplementary Material G:Q-set Cards).

The Q-sort is considered the main data collection phase in Q methodology, and involves participants sorting their deck of cards (the “Q-set”) onto a grid (the “Q-grid”). Lundberg et al (2020) describe this process as “inescapably subjective in the sense that the participant is sorting the cards from his or her own point of view – the subject therefore applies their own “meanings” and understanding to the items” (Cross, 2005, p. 211). The “Q-grid” is designed to force decision-making (ranking of the statements) amongst participants, which is believed to be an effective way to elicit true feelings and prompt participants to consider their attitudes more carefully (Lundberg et al., 2020). Although the curriculum concepts on the Q-set cards include a description and example, participants apply their own understanding and interpretations during the Q-sort process (Lundberg et al., 2020; Brown, 1980).

The Q-sort took place during the conference workshop. Participants self-selected the workshop based on the published session title and abstract. The session began with short presentations by the facilitators (LB, SB, CP, TE, JW, LC), who provided an overview of relevant literature and explained the development and structure of the Q-set. Five guiding principles of co-design were presented to participants with an intention to ensure the process was inclusive, respectful, participative, iterative and outcomes focused (NSW Council of Social Science, 2017). A complete deck of 35Q-set cards was given to each participant, together with one Q-grid. Participants were prompted to answer the question “What concepts are most relevant to prepare entry-level nutritionists and dietitians to address complex food systems challenges?” and instructed to place each of their 35 cards on the grid from least relevant to most relevant where all squares in each column are equally ranked (Figure 2). A more detailed description of the workshop activities is available in Supplementary Material H: Context and instructions for Q-sort. Of note, the Q-grid can take either a quasi-normal or flattened configuration, depending usually on the number of statements being ranked and the purpose of the Q-sort (Sandling, 2022). In the case of this research, a flattened distribution was chosen as the study aim is less concerned with the rankings of specific statements, rather their relative position compared with all statements.

Following the Q-sort, participants were asked to complete a short questionnaire to understand their decision-making process, as this enriches and informs the analysis of quantitative data (Bonar et al., 2025). Workshop participants were handed a written survey including four questions: (i) Why did you rank the statements you did as “most relevant”? (ii) Why did you rank the statements you did as “least relevant”? (iii) Were there one or two statements that were particularly difficult to rank? (iv) Are any key topics/concepts missing? Participants were also given an option to answer these questions orally and submit the audio file as an alternative to the written questionnaire. Participants were prompted to submit a photo of their completed Q-grid and questionnaire responses to an electronic drop box for analysis purposes. This submission process requested basic demographic details (country, metropolitan/rural/remote/other, area of practice, nutritionist/dietitian or other and self-perceived level of expertise) and informed consent for the data to be used for research purposes (Supplementary Material H: Context and instructions for Q-sort).

The Q-sort data were analysed using KADE (Banasick, 2019), an open-source software designed specifically for by-person factor analysis in Q methodology. Adhering to the procedures outlined by Watts and Stenner (2012), principal component analysis (PCA) with varimax rotation was applied, and multiple factor solutions were explored (Watts and Stenner, 2012). After several iterations, a three-factor solution was determined to be the most conceptually meaningful. The selection of this model was based on multiple criteria, including eigenvalues exceeding 1 and the presence of at least two significant factor loadings per factor, with significance set at p < 0.01, following Brown’s (1980) formula: 2.58 × (1 ÷ √number of items in the Q-set) (Brown, 1980). Based on this, five sorts were identified as either confounding (loading on more than one factor) or non-significant on any factor.

In Q methodology, analysis involves both an internal examination of each factor and a comparative assessment across factors. Investigating the internal structure of each factor allows for a holistic understanding of that particular perspective, while cross-factor comparisons highlight relative differences in opinion. This dual approach is crucial for identifying both points of divergence and shared areas of agreement. However, because participants rank statements in relation to one another, Q-sort analysis requires consideration of the overall configuration of statement placements rather than focusing solely on individual item rankings (Stenner et al., 2008).

In addition, the analysis distinguishes between consensus and distinguishing statements. Distinguishing statements are those whose placement on the grid differs significantly (p < 0.05) from their positioning in other factors, highlighting the defining characteristics of each viewpoint. Conversely, consensus statements are those that received similar rankings across all three factors (p > 0.05), indicating broad agreement among participants regardless of viewpoint.

This section presents a description of workshop participants and distinct viewpoints identified amongst them. Of the 48 workshop participants (Tables 1), 5 submitted Q-grids that did not significantly align with any of the distinct viewpoints and therefore, were not included in the analysis, as is standard practice in Q methodology (Brown, 1980).

Factor analysis of participants’ arrangements of the statements during the Q-sort identified three distinct viewpoints. These are discussed below and have been descriptively labelled as: Viewpoint 1: Start with core concepts; Viewpoint 2: Prioritise diverse knowledges and social justice; and Viewpoint 3: Develop soft skills to address systemic challenges. The following sections describe each viewpoint, drawing upon quantitative data from the composite Q sorts and qualitative data from the post-sort survey (Supplementary Materials I and J).

This viewpoint represents the Q-sorts completed by 23 participants, including those from Canada (n = 13), USA (n = 4), Spain (n = 2), Ireland (n = 1), Mexico (n = 1), New Zealand (n = 1) and Ghana (n = 1). The majority of these participants are employed in metropolitan locations (n = 14) as a nutritionist or dietitian (n = 14) in a range of areas of practice, with very high self-rated expertise in SFS (average 3.75 / 5) (Supplementary Material K: Demographics of participants loaded against Viewpoint 1).

A prominent feature of Viewpoint 1 is the prioritisation of “building block” concepts to enable more specialised and advanced learning “on the job”. Factor analysis revealed the Q-set statements that were ranked highest and lowest by participants who loaded heavily to this viewpoint (Supplementary Material L: Relative ranking of statements in Viewpoint 1). Analysis of post-Q-sort questionnaire data revealed that participants aligning with this viewpoint appeared to agree that certain concepts were considered foundational knowledge and a priority for “entry-level practice”, such as “Nutrition and health”, “Food systems literacy”, “Food and nutrition security”, “Planetary health” and “Dietary patterns”. The participant who loaded highest against this viewpoint (ten factor score weight, and 0.7301 in the factor loadings table) stated:

In describing why they ranked certain concepts as least relevant, participants aligning with this viewpoint considered them to be more specialised topics, such as “Food Industry” and “Emergency Preparedness”. Participants also stated that these topics require hands-on experience that is acquired over time and, therefore, are not a priority for tertiary educators in preparing nutritionists and dietitians for entry-level practice. For example, one participant described why they ranked certain statements as least relevant:

This also supports the distinguishing statement of “Leadership and advocacy” being ranked as not relevant (−2) for entry-level practitioners. Distinguishing statements, those which provide points of differentiation for each viewpoint, for Viewpoint 1 were “Nutrition and health”, “Planetary health”, “Scope and responsibility”, “Drivers” and “Leadership and advocacy” (Supplementary Material M: Composite Q sort for Viewpoint 1). These concepts were considered most or least relevant by participants aligning with Viewpoint 1, with some being significantly different (p <0.05) from their ranking within other viewpoints. Of these statements, all but “Leadership and advocacy” were considered relevant by participants.

This viewpoint represents the Q-sorts from nine participants, all from high-income countries. The majority were employed in Canada (n = 7) as nutritionists or dietitians (n = 7), most working in population and community health (n = 7) and practising in rural or remote settings (n = 5). They rated their expertise in SFS and planetary health at a level comparable to those who aligned with Viewpoint 1 (average 3.67/5; see Supplementary Material N: Demographics of participants loaded against Viewpoint 2a and 2b).

Factor analysis showed that Factor 2 is bipolar and is therefore split between two opposing views, whereby eight participants loaded on Factor 2a and one participant on Factor 2b (Supplementary Material O: Relative ranking of statements in 2a and 2b and Supplementary Material P: Composite Q sort for Viewpoint 2a and 2b). In Q methodology, a bipolar factor captures two ends of the same viewpoint - participants on one pole rank most statements in diametrically opposite order to those on the other pole, although some statements can still register consensus between them (Brown, 1980). A dominant feature of Viewpoint 2a is its emphasis on equity and inclusion-centred curriculum concepts such as “Food Sovereignty”, “Determinants of Health”, “Prioritising Indigenous knowledges”, “Respect for diverse knowledges and cultures” and “Social justice”. Participants aligning with this pole acknowledged the historic nature and value of Indigenous knowledges. “Because they [Indigenous knowledges] address onto-epistemological issues/knowledge creation, I think exposing and undoing coloniality and nurturing radical alternatives is paramount and I chose cards that approximated to this” (Participant #29, HIC, Nutritionist-Dietitian, Population and/or community health and Education and research areas of practice).

Although participants recognised the complexity of teaching these political and social topics, they described them as “critical information that dietetics need to support sustainable food systems” and felt they “must be understood before the rest of the food system can make sense” (Participant #20, HIC, Nutritionist-Dietitian, Population and/or community health area of practice and #24, HIC, Nutritionist-Dietitian, Population and/or community health area of practice respectively). They added that such topics are “very complex” for entry-level practitioners and “not taught elsewhere”. Practice context and moral obligation also motivated high rankings; “It is our treaty duty/obligation (Canada) to do this work.” (#19, HIC, Nutritionist-Dietitian, Population and/or community health area of practice).

Participants explained low rankings for other statements in two ways; some felt the concepts were “covered in other aspects of nutrition training” (#24, HIC, Nutritionist-Dietitian, Population and/or community health area of practice), while others saw them as lower priorities given limited curriculum time, for example “I am also not a fan of putting time/making space to talk about emerg prep when we need to focus on upstream issues.” (#19, HIC, Nutritionist-Dietitian, Population and/or community health area of practice).

This viewpoint represents the Q-sorts submitted by 11 participants, all from high-income countries and similar to Viewpoint 2, majority are employed in Canada (n = 8) (Supplementary Material Q: Demographics of participants loaded against Viewpoint 3). Most participants aligning with this viewpoint were nutritionists and dietitians (n = 7, 64%) however a higher ratio than other viewpoints described themselves as non-nutritionists/dietitians (n = 4, 36%). The majority were working in metropolitan locations (n = 8) in areas of practice focused on education and research (n = 7) and/or population and community health (n = 7). The average self-rated expertise in SFS and planetary was slightly higher than those aligning with Viewpoints 1 and 2 (average 3.73 / 5).

A defining feature of Viewpoint 3 is the prioritisation of skill-based concepts as opposed to knowledge-based concepts, with the five highest ranked statements being “Systems-thinking”, “Critical thinking”, “Collaboration”, “Leadership and advocacy” and “Knowledge translation”. The distinguishing statements for Viewpoint 3 that were ranked as most relevant are “Systems-thinking” (p < 0.001), “Leadership and advocacy” (p < 0.005) and those ranked as least relevant are “Food waste” (p < 0.005) and “Food service” (p < 0.05) (Supplementary Material R: Composite Q sort for Viewpoint 3 and Supplementary Material S: Relative ranking of statements in Viewpoint 3).

Participants reflected on their ranking that aligned with this viewpoint as prioritising skills considered essential to “navigate complexity to truly have an impact” and “prepare them for practice”. One participant prioritised this “inner work”, considering it to be “the foundation… to grasp some of the other [knowledge-based] statements in the ‘least relevant’ section”. Other participants prioritised these cognitive skills as they were considered more difficult to teach or that they “personally struggled within in school”. One participant described:

For some participants, scope of practice informed their ranking decisions. They described lower ranked statements as being “outside the scope of a dietitian. Though I do see our role expanding in the future I’m sure!” and another had concept-specific reflections about “agricultural and food waste, which has the least to do from a consumer perspective and they are unlikely to be included as counselling topics or being part of [the] work responsibility of nutritionists and dietitians.”

Amongst the 43 participants whose perspectives have been represented in the aforementioned viewpoints, there was a strong consensus on the level of relevance of three curriculum concepts for entry-level nutritionists and dietitians.

Firstly, Respect for Diverse Knowledges and Cultures (Concept D) was described as curricula to develop an understanding and respect for diverse ways of knowing and doing. Participants strongly agreed that this concept is highly relevant, with rankings ranging from +2 (Z score 1) to +3 (Z score 1.4). This agreement may be because participants described this concept as one that encompassed other similar concepts. As stated by one participant, “There is an overlap between some of the concepts, namely, social justice, respect for diverse knowledges and cultures, prioritising Indigenous knowledge.” (Participant #12, HIC, non-Nutritionist-Dietitian, Population and/or community health and Education and Research areas of practice) Of note, “Prioritising Indigenous knowledges” and “Social justice” were described equally as being the most difficult to rank (n = 8, 17%) (Supplementary Material J: Curriculum concepts considered most difficult to rank by participants).

Secondly, Policy (Concept H) as a curriculum concept described the use of governance structures to shape health, equity and sustainability priorities. Participants were in agreement that this concept is not as relevant when compared to other concepts; however, they did not believe it to be completely irrelevant, with rankings ranging from 0 (Z score 0.12) to −2 (Z score 0.99). In the post-sort survey, many participants described certain concepts as being critical to enable students to address complex food systems, however, they didn’t necessarily see them as a priority for “entry-level” practitioners. For example, one participant wrote:

Finally, the third concept that achieved consensus amongst workshop participants was Food Industry. This was ranked least relevant (−3, Z score −1.466) by many participants, with one noting that topics like food industry were de-prioritised because they are more specialised. “I ranked items lower/lowest that were either more specialised topics (e.g. food service) or could be encompassed within other, larger concepts (e.g. food industry is one player in larger discussions of policy, power, systems-thinking).” (Participant #1, HIC, non-Nutritionist-Dietitian, Education and Research areas of practice). Further to this idea of specialised concepts, participants suggested that the concept of food industry was not prioritised as it was seen as a skill that can be taught elsewhere: “There were general skills (not SFS specific) so I ranked as “less relevant”. These concepts are often taught in other contexts.” (Participant #20, HIC, Nutritionist-Dietitian, Population and/or community health areas of practice).

Of note, across viewpoints 1, 2a, 2 b and 3, there is more consensus about which concepts shouldn’t be prioritised as opposed to the concepts that should be. Regarding the comprehensiveness of the Q-set, participants identified curriculum concepts that they believed were missing via their post-sort survey (Supplementary Material I: Key concepts participants (n = 48) identified as missing from the Q-set). Of the 26 curriculum concepts identified as missing, those most frequently described were “cultural consideration and responsiveness” (n = 4), “communication” (n = 4), “social equity” (n = 3) and “governance” (n = 3).

This research is the first to intentionally apply the principles of co-design within Q-methodology to enable experts from multiple perspectives to consider which of the many curricular concepts are most relevant to prepare nutrition and dietetics professionals to promote SFS and planetary health. Results are informed by the literature and the professional opinion of 127 individuals (84 survey participants and 43 workshop participants) representing 28 countries. Offering this multi-national perspective is essential due to the global nature of food system sustainability and climate change, and the need for collaborative approaches (Myers et al., 2025). The uniquely informed perspectives from each individual involved were also critical. More than half of workshop participants work in education roles, with experience training the future nutrition workforce, while the remainder are working in other areas of practice either within or at the interface of food systems. As a result, this study presents a range of perspectives about what is feasible in tertiary education and what is required in real-world practice, to adequately equip our future nutrition and dietetic workforce. Findings reveal three compatible and mutually supportive viewpoints; firstly, foundational building blocks for on-the-job learning; secondly, prioritise diverse knowledges and social justice; and thirdly, develop soft skills to address systemic challenges. These viewpoints represent pedagogical layers that range in depth, according to the domains outlined in Bloom’s revised taxonomy (Anderson and Krathwohl, 2001). Viewpoint 1 is centred in the cognitive domain, focused on a more shallow depth of knowledge while Viewpoint 2 moves into the affective domain, calling for attention to the underlying values that inform practice and Viewpoint 3 reflects the need for contemporary skills and approaches (Anderson and Krathwohl, 2001).

Viewpoint one represents foundational scientific knowledge about human and ecological health, necessary for nutrition professionals at the new graduate or entry-level of practice. Participants aligning with this viewpoint expressed that without this foundational knowledge, nutrition and dietetic professionals would struggle to develop applied expertise in their future roles and thus contribute to effective and appropriate interventions. This is a similar finding to Valley et al (2018) who positioned such knowledge at the “surface structure” of their pedagogical framework (Valley et al., 2018). This type of knowledge includes factual information about relevant topics (e.g., biodiversity), their impact on human health (e.g. declining biodiversity impacts nutrient diversity and therefore nutritional status), and their food-related applications (e.g. inclusion of diverse and indigenous food sources can support biodiversity and nutritional status). The agreed-upon most relevant concepts within this study are: nutrition and health, food systems literacy, food and nutrition security, planetary health and dietary patterns, drivers and food waste. Acknowledging the challenges with a crowded curriculum, consensus statements two and three can help guide educators regarding which knowledge can be deprioritized. Specifically, curriculum concepts that are more specialised (e.g. food industry) and those that extend beyond the expectations of an entry-level practitioner (e.g. policy). Comparable foundational knowledges are included in existing curriculum frameworks, for example “the Anthropocene and health” and “interconnection with nature” domains of the Planetary Health Education Framework (Guzmán et al., 2021) and “knowledge and analytic skills” regarding the impacts of climate change on health (Sorensen et al., 2023). Notably, our results generated curriculum concepts that are specific to food systems challenges and sit within the scope of nutrition and dietetic practice.

Foundational knowledge is dynamic and contextual to the local socio-ecological system (Luke and Stamatakis, 2012; Swinburn et al., 2019). As such, educators need to prepare students for continual learning and to contextualize these concepts in ways relevant to the local environment where students are learning and will later practice (e.g. which plant species are in decline and what nutrients are at risk). Similarly, contextual Indigenous knowledge is critical in practice that aims to promote planetary health by building more culturally and ecologically sustainable food systems (Kuhnlein, 2015) . There was strong agreement amongst workshop participants that inclusion and prioritization of Indigenous knowledges are highly relevant to this foundational knowledge. To adequately prepare future nutrition and dietetic professionals, educators must prioritise the skills and attributes that enable respectful engagement with Indigenous knowledge keepers, as has been urged across health disciplines (Brand et al., 2023).

Moving beyond knowledge-based curriculum concepts, viewpoint three presents a range of cognitive skills that transcend topic areas and are necessary to contextualise and apply the knowledge. Skills prioritised within this viewpoint include systems thinking, critical thinking and collaboration, which are echoed in other curriculum frameworks that call for systems thinking and change, an ability to work in dynamic complexity and interdisciplinary or interprofessional learning (Valley et al., 2018; Guzmán et al., 2021; Ng and Cole, 2022). Our results also emphasized the need for leadership and advocacy, knowledge translation, reflective practice, ethical and values-based practice to be nurtured amongst our future workforce. Of note, these are essential competencies for nutritionists and dietitians to address emerging challenges, beyond the field of planetary health (D‘acoz et al., 2023; Bergquist et al., 2024).

While these knowledges and skills are essential, Ng and Cole (2022) highlight that teaching about food systems and sustainability is inherently values-driven. This creates tension within nutrition and dietetics, with roots in conventional epistemologies and reductionist inquiry, where objectivity (helpful in some areas of nutrition study) has been traditionally prioritised (Ng and Cole, 2022). The shared perspective amongst those aligning with Viewpoint 2 move beyond this, proposing that epistemology (e.g. respect for diverse knowledge and cultures) and ethics (e.g. applying an equity lens to practice) can shape attitudes, values and interests, and subsequently inform practical decisions and activities amongst nutritionists and dietitians, and therefore must be prioritised in curriculum. The Planetary Health Education Framework positions equity and social justice as a core domain (Guzmán et al., 2021). Participants aligning with Viewpoint 2 rated curriculum concepts such as food sovereignty, determinants of health (social, commercial), prioritizing Indigenous knowledges and social justice, also central to the transdisciplinary Planetary Health Education Framework (Guzmán et al., 2021). In essence, these values-driven pedagogical concepts (Viewpoint 2) inform the foundational knowledge required (Viewpoint 1) to apply the skills necessary to critically evaluate and act on that knowledge (Viewpoint 3).

Results from this research will inform the development of a discipline-specific curriculum framework to support educators involved in facilitating SFS and planetary health education amongst future nutrition and dietetics practitioners. This framework, currently underway but beyond the scope of this paper, can prioritise the curriculum concepts defined in this study, which to the best of our collective knowledge, captures the essential competencies required for entry-to-practice nutritionists and dietitians to promote SFS and planetary health. True to the principles of effective codesign, those involved in both education and food systems activities (both within and beyond nutrition and dietetics) should be involved in the iterative process of pilot testing and refining such a framework over time to ensure that it is fit-for-purpose, grounded in evidence and globally relevant.

While this research engaged a diverse range of perspectives, various voices are not adequately represented, limiting the global applicability of the results. Despite intentional recruitment efforts, representation from individuals living in low and middle-income countries is minimal in both the survey and workshop activities. Similarly, participants are mostly working in metropolitan settings and have formal training in nutrition and dietetics. It is likely that different curriculum concepts would have been prioritised by those working in low and middle-income country contexts, as well as those working rurally and with professional backgrounds outside of nutrition and dietetics. While this is a limitation, it does not undermine the value of this present study to inform the development of an initial curriculum framework. To ensure under-represented stakeholder groups are prioritised and engaged in this future work, enabling conditions should be created, for example securing financial resources to ensure in-person and virtual contribution to future workshops and workforce capacity development activities.

The tertiary education sector plays a critical role in preparing future workforces to promote planetary health for current and future generations. This study identified and prioritised curriculum concepts for nutritionists and dietitians, based on the multi-national perspectives of educators, food systems stakeholders and practitioners. Three viewpoints emerged regarding priority curriculum concepts; 1) Foundational building blocks for on-the-job learning (nutrition and health, food systems literacy, food and nutrition security, planetary health and dietary patterns, drivers and food waste); 2) Prioritise diverse knowledges and social justice (food sovereignty, determinants of health, prioritizing Indigenous knowledges and social justice); and 3) Develop systems-thinking and leadership skills to address complex challenges (systems thinking, critical thinking, leadership and collaboration). The three viewpoints work together to inform curricular and pedagogical structure. Diverse knowledges and values (Viewpoint 2) inform the foundational building blocks required (Viewpoint 1) and the skills necessary to critically evaluate and act on that knowledge (Viewpoint 3). From these viewpoints and prioritised concepts, the authors are preparing a curriculum framework that will be iteratively field-tested and refined into an internationally relevant tool. Such a tool has the potential to support educators globally who are tasked with preparing future nutritionists and dietitians to promote sustainable food systems and planetary health, as is urgently required.

The authors would like to express their gratitude to all individuals involved in the online survey and workshop in Toronto.

The supplementary material for this article can be found online.