Study type and population

A mixed methods, cross-sectional design was used. Quantitative data were collected by means of an online self-administered survey. Qualitative data were collected by means of focus group discussions. The sampling frame consisted of all dietitians within South Africa registered with the Health Professions Council of South Africa (n 4452). The main aim of the research was to determine the knowledge, perceptions, behaviours and practices of dietitians in South Africa regarding The Regulations Relating to Foodstuffs for Infants and Young Children (R991) (The Regulations). Refer to Table ​Table11 for the main objectives of the study.

Main study aims and objectives to assess South African dietitians’ perspectives on the Regulations legislating the International Code of Marketing of Breast-milk Substitutes

HCP, Health care provider/(s); Reps, representatives; DoH, Department of Health.

The secondary objectives were to determine the differences in level of knowledge according to various sub-groups and to investigate associations between knowledge, perceptions, behaviours and practices. A study by Borggreve and Timen found that barriers were related to knowledge and attitudes in the implementation of a policy guideline in the Netherlands⁽¹⁶⁾. Byham-Gray et al. found in their study of predictors of research involvement among registered dietitians that there was a linear relationship between research score (based on practice in research), perceptions, attitudes and knowledge of evidence-based practice score⁽¹⁷⁾. Thus, it is plausible that these factors may be associated with one another, and it was decided to carry out sub-group comparisons for this study to determine where interventions can take place or where attention is needed. Refer to Fig. ​Fig.11 for a conceptual framework of the study outcomes adapted from that of Cochrane et al.⁽¹⁸⁾.

Conceptual framework of study outcomes to assess South African dietitians’ perspectives on the Regulations legislating the International Code of Marketing of Breast-milk substitutes using an online survey and focus group discussions. HCP, Health care provider/(s). Adapted from Cochrane et al.’s conceptual framework on Barriers to Physician Adherence to Practice Guidelines in Behavior Change⁽¹⁸⁾