Validación y fiabilidad del cuestionario NUTrition COMPetence (NUTCOM) en español colombiano para evaluar competencias en cuidado nutricional en médicos de atención primaria

Validity and reliability of the NUTrition COMPetence (NUTCOMP) questionnaire in Colombian Spanish to assess nutrition care competencies among primary care physicians

Introducción. El NUTrition COMPetence (NUTCOMP) es un instrumento para evaluar las competencias autopercibidas de médicos de atención primaria (AP) para brindar cuidado nutricional a pacientes con enfermedades crónicas.

Objetivo. Determinar la validez y fiabilidad de la versión en español colombiano del cuestionario NUTCOMP para la evaluación de competencias en cuidado nutricional en médicos de AP.

Materiales y métodos. Estudio de validación transcultural. Una vez se realizó la traducción y adaptación cultural al español colombiano del NUTCOMP, el instrumento fue administrado a 40 médicos de AP de un hospital de Neiva (Colombia), con una segunda aplicación 3 semanas después para evaluar la fiabilidad test-retest. La validez de contenido se determinó mediante juicio de expertos; la concordancia entre expertos se analizó usando el coeficiente de concordancia de Kendall; la consistencia interna se evaluó mediante el alfa de Cronbach y la fiabilidad test-retest, mediante el coeficiente de correlación intraclase (CCI). Igual que en el estudio de validación del instrumento original, solo se tuvieron en cuenta las secciones 1-4 (constructos) para evaluar la validez y fiabilidad de la versión en español colombiano del cuestionario NUTCOMP.

Resultados. En comparación con el cuestionario original, la versión en español colombiano del NUTCOMP incluye 7 ítems más (4 en la sección 2 y 3 en la sección 3) y 2 secciones nuevas, aunque estas últimas pueden omitirse, pues no son tenidas en cuenta para el cálculo de la puntuación total, ni fueron consideradas en la evaluación de la validez y fiabilidad del instrumento. Se observó una validez de contenido muy alta (W de Kendall: 0.93), una consistencia interna excelente (α=0.931) y una fiabilidad test-retest excelente (CCI: 0.931).

Conclusión. La versión en español colombiano del cuestionario NUTCOMP mostró una validez de contenido muy alta, una consistencia interna excelente y una fiabilidad test-retest excelente para la evaluación de competencias en cuidado nutricional en médicos de AP.

Introduction: The NUTrition COMPetence (NUTCOMP) questionnaire is an instrument for assessing primary care (PC) physicians’ self-perceived competencies when providing nutritional care to patients with chronic diseases.

Objective: To determine the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire for assessing nutritional care competencies among PC physicians.

Materials and Methods: Cross-cultural validation study. After the NUTCOMP was translated and culturally adapted into Colombian Spanish, the instrument was administered to 40 PC physicians from a hospital in Neiva (Colombia). It was administered again three weeks later to assess test-retest reliability. Content validity was determined by expert judgment; inter-rater agreement was analyzed using Kendall’s coefficient of concordance; internal consistency was assessed using Cronbach’s alpha; and test-retest reliability was assessed using the intraclass correlation coefficient (ICC). As in the validation study of the original instrument, only sections 1–4 (constructs) were considered to assess the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire.

Results: Compared to the original, the Colombian Spanish version of the NUTCOMP questionnaire contains 7 additional items (4 in Section 2 and 3 in Section 3) and 2 new sections, although the latter two can be omitted, as they are not included in the calculation of the total score, nor were they considered in the assessment of the instrument’s validity and reliability. Very high content validity (Kendall’s W: 0.93), excellent internal consistency (α =0.931), and excellent test-retest reliability (CCI: 0.931) were observed.

Conclusion: The Colombian Spanish version of the NUTCOMP questionnaire demonstrated very high content validity, excellent internal consistency, and excellent test-retest reliability for assessing nutritional care competencies among primary care physicians.

Original research

Dagoberto Santofimio-Sierra1,2 José Domingo Alarcón1 Lisímaco Vallejo-Cuellar1,3
Pedro León Reyes-Gaspar1

1 Universidad Surcolombiana - Faculty of Health Sciences - Department of Public Health - Medical School - Neiva - Colombia.

2 Hospital Universitario Hernando Moncaleano Perdomo - Department of Epidemiology and Infectious Diseases - Neiva - Colombia.

3 Universidad Pedagógica Nacional - Faculty of Physical Education - Bogotá D.C. - Colombia.

Open access

Received: 03/04/2025

Accepted: 07/01/2026

Corresponding author: Dagoberto Santofimio-Sierra. Departamento de Salud Pública, Facultad de Ciencias de la Salud, Universidad Surcolombiana. Neiva. Colombia. E-mail: dagosanto@gmail.com.

Keywords: Education; Primary Helath Care; Health Promotion; Reliability and Validity (MeSH).

Palabras clave: Educación; Atención Primaria en Salud; Promoción de la Salud; Confiabilidad y Validez (DeCS).

How to cite: Santofimio-Sierra D, Alarcón JD, Vallejo-Cuellar L, Reyes-Gaspar PL. Validity and reliability of the NUTrition COMPetence (NUTCOMP) questionnaire to assess nutrition care competencies in primary care physicians. Rev. Fac. Med. 2026;74:e118738. English. doi: https://doi.org/10.15446/revfacmed.v74.118738.

Cómo citar: Santofimio-Sierra D, Alarcón JD, Vallejo-Cuellar L, Reyes-Gaspar PL. [Validación y fiabilidad del cuestionario NUTrition COMPetence (NUTCOM) en español colombiano para evaluar competencias en cuidado nutricional en médicos de atención primaria]. Rev. Fac. Med. 2026;74:e118738. English. doi: https://doi.org/10.15446/revfacmed.v74.118738.

Copyright: ©2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

Abstract

Resumen

Introduction

Evidence suggests that, to adequately promote healthy eating habits in primary care (PC) settings, physicians must develop the skills to assess, counsel, and motivate their patients.1-5 As a result, healthcare professionals must develop strong competencies in nutrition assessment and the ability to educate and encourage patients to improve adherence to nutritional recommendations.2

Currently, multiple instruments are available to assess nutritional counseling competencies among PC physicians and residents based on clinical best practices, and some of them have been developed for specific cultural or clinical contexts (e.g., patients with obesity and hypertension).5-15 The assessment of such competencies has led to the development of educational and technological resources in the medical field to implement interventions aimed at improving the quality of nutritional counseling in primary care.7,13,15-17

The NUTrition COMPetence (NUTCOMP) questionnaire is an instrument for measuring the self-perceived competencies of PC professionals when providing nutritional care to patients with chronic lifestyle-related diseases.10,11 It complies with the standards described in the literature on nutrition competencies for physicians, which include nutritional assessment, evaluation of counseling skills, determination of professional attitudes toward clinical practice, and identification of modifiable barriers to care.2 The questionnaire was developed and validated by Ball & Leveritt,10 demonstrating high internal consistency, concurrent validity, and very high test-retest reliability. Although this instrument has been used in at least 28 countries,18 including a Spanish version derived from an official translation,19 it has not yet been validated in Spanish-speaking countries.

The NUTCOMP comprises four constructs based on knowledge, skills, communication, and attitudes. It also includes questions about prior education and training in nutrition, as well as questions on demographics, to enable researchers to analyze associations between these variables and the professional’s self-perceived competencies when providing nutrition counseling.10 Therefore, it can be used to design and evaluate strategies for improving nutritional care provided by PC professionals.10 Similarly, it can be used to measure the impact of continuing education and professional development interventions on PC physicians’ confidence and perceived competence when providing nutrition counseling (e.g., baseline and post-intervention assessments).10

Given the above, the objective of this article was to determine the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire for assessing nutritional care competencies among PC physicians.

Materials and methods

Study type

Cross-cultural validation study.

Instrument

The NUTCOMP is a questionnaire designed to measure self-perceived competencies among PC professionals when providing nutritional care to patients with chronic diseases. The original version (English language) showed high internal consistency (Cronbach’s alpha of 0.98 for the instrument and between 0.88 and 0.98 for the four constructs) and very high test-retest reliability (Pearson’s correlation coefficient of 0.95 overall and between 0.89 and 0.94 for the four constructs).10 It should be noted that this questionnaire was selected by a group of experts in medical education, family medicine, public health, nutrition, and statistics following a rigorous review of the instruments described in the literature for measuring these competencies.5,6,8,11,12

The original instrument consists of 42 items divided into the following six sections: 1) confidence in knowledge of nutrition and chronic diseases (7 questions); 2) confidence in nutrition skills (11 questions); 3) confidence in nutrition communication and counseling (9 questions); 4) attitudes toward nutrition care (8 questions); 5) prior education and training in nutrition (3 questions); and 6) demographics (4 questions).10 It is worth mentioning that the four constructs of the instrument correspond to sections 1 through 4.

Two 5-point Likert scales are used for items in sections 1–4: level of confidence (extremely confident [5 points], very confident [4 points], moderately confident [3 points], not very confident [2 points], and not confident at all [1 point]) and level of agreement (strongly agree [5 points], agree [4 points], neutral [3 points], disagree [2 points], and strongly disagree [1 point]). The final score is a number between 35 and 175. Both the final score and the score for each construct are calculated by adding up the points assigned to each response. Due to their nature, the questions in sections 5 and 6 (open-ended and multiple-choice) are not included in the calculation of the total score.

Translation and cultural adaptation into Colombian Spanish

The original version of NUTCOMP10 was translated from English into Spanish by a healthcare professional with an advanced proficiency level in English (version 1). This version was then reviewed and discussed by a panel of experts consisting of a biostatistician, three family physicians, and a physician specializing in clinical nutrition (all with more than five years of teaching experience) to produce a consolidated version in Colombian Spanish after incorporating the adjustments suggested during that review. These adjustments included several modifications aimed at improving the comprehensibility of certain questions in the Colombian context and at enhancing the construct’s consistency, thereby yielding the version to be used in the pilot study (version 2).

Pilot study

To conduct the pilot study, 42 PC physicians from a tertiary care hospital in Neiva, Colombia, were asked to participate via email. Among them, 40 agreed to participate, so they were emailed the Colombian Spanish version of the NUTCOMP questionnaire (Google Forms), along with instructions on how to complete it.

To assess test-retest reliability, the instrument was administered again to the 40 physicians 3 weeks later. This time interval was chosen because it was considered sufficient to reduce any chance that participants could recall their previous answers and short enough to reduce the chance of any actual change in their ability to provide nutritional care. This second administration followed the same procedure as the first.

As in the validation study of the original instrument,10 only sections 1–4 were considered when assessing the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire.

Content validity

Content validity was assessed by a panel of experts (one in statistics and three physicians specializing in public health, family medicine, and clinical nutrition, respectively), all of whom had more than five years of teaching experience.

Independently, the experts evaluated each item within the instrument’s four constructs (sections 1–4) based on criteria of comprehensibility, coherence, accuracy, and relevance, using a 4-point Likert scale (strongly agree [4 points], moderately agree [3 points], moderately disagree [2 points], or strongly disagree [1 point]). Inter-rater agreement for each construct and for the entire instrument was analyzed using Kendall’s coefficient of concordance, which is a number between 0 and 1, where values of 0–0.2 indicate strong disagreement; 0.21–0.4, low agreement; 0.41–0.6, moderate agreement; and >0.6, strong agreement.

Hypotheses for determining agreement:

H0: There is no significant agreement among the experts.

H1: There is significant agreement among the experts.

H0 is rejected when the observed value is greater than the critical value (with p≤0.05).

Internal consistency

Internal consistency was assessed using Cronbach’s alpha, which was calculated for the instrument (39 items across the 4 constructs) and for each construct (sections 1–4). Cronbach’s alpha values range from 0 to 1, with internal consistency classified as excellent (<0.90), good (0.80–0.89), acceptable (0.70–0.79), questionable (0.60–0.69), poor (0.50–0.59), and unacceptable (<0.59).

Test-retest reliability

Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) based on data obtained after administering the instrument twice. ICC values of <0.5, 0.5–0.75, 0.75–0.9, and >0.90 indicate poor, moderate, good, and excellent reliability, respectively.

All statistical analyses were performed using the statistical software Jamovi (version 2.3.28.0).

Ethical considerations

The study adhered to the ethical principles for biomedical research involving human subjects set forth in the Declaration of Helsinki20 and the scientific, technical, and administrative standards for health research established in Resolution 8430 of 1993 issued by the Colombian Ministry of Health.21 Moreover, it was approved by the Ethics Committee of the Faculty of Health at the Universidad Surcolombiana via Minutes No. 002 CIEB and Memorandum No. 010 CEIB dated October 26, 2023.

Results

Adaptation of the instrument to the Colombian context

Based on the consensus reached by the experts, the following changes were made:

• In Section 1, Guía Australiana para la Alimentación Sana (Australian Guide to Healthy Eating) was replaced by Guías Alimentarias para la población colombiana mayor de 2 años (Dietary Guidelines for the Colombian Population Aged 2 and Older).
• In Section 2, the following items were added to supplement the assessment of self-perceived competencies in terms of waist-to-hip ratio interpretation, identification of psychosocial issues among patients with obesity, referral of patients to specialized nutrition counseling, and prescription of a physical activity plan, respectively: Interpretar los datos de circunferencia de cintura y cadera contra los rangos de referencia (item 9), Reconocer y detectar problemas psicosociales comunes en pacientes obesos (item 13), Referir a los pacientes con trastornos alimentarios para asesoramiento nutricional especializado (item 18), and Prescribir un plan de ejercicio/actividad física (item 19). Some words were also added or modified to expand on the examples provided or to adapt them to the Colombian context.
• In Section 3, the following items were added to expand the assessment of physician’s confidence when answering questions about obesity treatment, providing guidance on physical activity, and helping to set goals for changes in body composition, respectively: Responder a las preguntas de un paciente respecto a las opciones de tratamiento para la obesidad, incluido el cambio de comportamiento, los medicamentos y la cirugía bariátrica (Responding to patient questions regarding treatment options for obesity, including behavioral changes, medications, and bariatric surgery - item 29), Proporcionar orientación para establecer objetivos de actividad física para una salud óptima (Prescribir un plan de ejercicio/actividad física) (Providing guidance on setting physical activity goals for optimal health [prescribing an exercise/physical activity plan] - item 30), and Ayudar al paciente a establecer metas realistas según los objetivos de pérdida de masa grasa, visceral o ganancia muscular basadas en cambios permanentes en el estilo de vida (Helping the patient set realistic goals based on fat loss, visceral fat reduction, or muscle gain objectives grounded in permanent lifestyle changes - item 31).
• A new section (Provision of Nutritional Care) was added after Section 5 to inquire about the frequency and time spent providing nutrition care through the following items: Durante un mes determinado, ¿con qué frecuencia brinda atención nutricional a sus pacientes? (In a typical month, how often do you provide nutritional care to your patients? - item 43) and ¿Cuánto tiempo en promedio dedica durante una consulta a brindar atención nutricional? (On average, how much time do you spend providing nutritional care during a consultation? - item 44). Consequently, Section 6 of the original instrument (Demographics) became Section 7.
• In the Demographics section, 8 items (items 49–56) were added to strengthen the data collected and, consequently, control for potential confounding factors in the responses: Estado civil (marital status - item 49), Tiempo de dedicación laboral en la institución (years of service at the institution- item 50), Tipo de contrato laboral (type of employment contract - item 51), Estado de bienestar o condición actual de salud (current health status - item 52), Nombre de la universidad donde se graduó como médico (pregrado) (university that awarded the medical degree [undergraduate] item 53), Tiempo de ejercer la profesión en meses o años (years of professional practice - item 54), Antecedentes personales (personal background - item 55), and Antecedentes familiares (family history - item 56).
• A new section (Section 8) with 9 items was added to evaluate the content of a training program in nutrition counseling skills: ¿Cree que la consejería en nutrición debería ser parte de la práctica médica de atención primaria? (Do you believe that nutrition counseling should be part of primary care medical practice? - item 57), ¿Tomaría la decisión de integrar el asesoramiento nutricional en las consultas de sus pacientes? (Would you consider providing nutrition counseling during your patients’ visits? - item 58), ¿Participó en todos los cinco módulos del programa? (Did you participate in all five modules of the program? - item 59), Después de participar en el programa, ¿qué módulos le llamó la atención para su práctica? (After participating in the program, which modules were most relevant to your practice? - item 60), ¿Recomendaría este programa de competencias en nutrición a otros médicos de atención primaria? (Would you recommend this nutrition competency program to other primary care physicians? - item 61), Después de participar en los módulos, ¿planea comenzar algún tipo de evaluación dietética en el cuidado de sus pacientes? (After participating in the modules, do you plan to implement some type of dietary assessment in your patient care routine? - item 62), ¿Cree que este programa es una forma útil de entrenar en competencias en nutrición a los médicos de atención primaria? (Do you believe this program is a useful way to train primary care physicians in nutrition competencies? - item 63), ¿Cree usted que hicieron falta temas trascendentales para incluirlos en el programa de competencias? (Do you think the competency program was missing any important topics that should have been included? - item 64), ¿Cómo calificaría la calidad de la instrucción brindada? (How do you rate the quality of the training provided? - item 65).

Table 1 presents the resulting version of the NUTCOMP following the translation and cultural adaptation process into Colombian Spanish. Given that several items were added (4 in Section 2 and 3 in Section 4), the procedure used to obtain the final score for each construct is similar to that used in the original instrument, except that the scores obtained on these items are included. Therefore, the final score for the instrument translated and adapted into Colombian Spanish ranges from 39 to 195. Furthermore, it should be noted that, as with the items in sections 5 and 6 of the original instrument,10 the sections added to the Colombian Spanish version are not included in the calculation of the total score.

Table 1. NUTCOMP instrument translated into Colombian Spanish and adapted to the Colombian context.

Sección 1. Conocimientos sobre nutrición y enfermedades crónicas no transmisibles: Por favor, evalúe su nivel de seguridad en sus conocimientos sobre:	Completamente inseguro	No muy seguro	Parcialmente seguro	Muy seguro	Extremadamente seguro
1. Cómo los diferentes sistemas del cuerpo se ven afectados por los alimentos y nutrientes	☐	☐	☐	☐	☐
2. Cómo influyen los alimentos y los nutrientes en el desarrollo y manejo de enfermedades crónicas	☐	☐	☐	☐	☐
3. Cómo la composición corporal de un individuo (tamaño y forma, peso) puede impactar en el desarrollo de enfermedades crónicas	☐	☐	☐	☐	☐
4. Las “Guías Alimentarias para la población colombiana mayor de 2 años”, incluido el número de porciones recomendadas de grupos de alimentos y tamaños de porciones para diferentes edades y géneros	☐	☐	☐	☐	☐
5. Guías para el manejo relacionado con la nutrición de enfermedades crónicas (incluyendo diabetes tipo 2 y enfermedades cardiovasculares)	☐	☐	☐	☐	☐
6. Cómo interactúan los alimentos y los nutrientes con los medicamentos	☐	☐	☐	☐	☐
7. La evidencia revisada por pares publicada más recientemente sobre nutrición y enfermedades crónicas	☐	☐	☐	☐	☐
Sección 2. Habilidades en nutrición: Por favor, evalúe su nivel de seguridad en su capacidad para:	Completamente inseguro	No muy seguro	Parcialmente seguro	Muy seguro	Extremadamente seguro
8. Interpretar datos sobre altura, peso, composición corporal contra rangos de referencia	☐	☐	☐	☐	☐
9. Interpretar los datos de circunferencia de cintura y cadera contra los rangos de referencia	☐	☐	☐	☐	☐
10. Interpretar los datos biológicos de una persona (p. ej., glicemia, hemoglobina glicosilada, presión arterial, niveles de colesterol, triglicéridos) contra los rangos de referencia	☐	☐	☐	☐	☐
11. Recoger información sobre los alimentos que el paciente usualmente consume (p. ej., utiliza el recordatorio de 24 horas, el registro de alimentos o la frecuencia de los alimentos para obtener el historial dietético)	☐	☐	☐	☐	☐
12. Utilizar una herramienta de evaluación dietética cuando tomo el historial dietético del paciente en busca de idoneidad de la ingesta de alimentos	☐	☐	☐	☐	☐
13. Reconocer y detectar problemas psicosociales comunes en pacientes obesos	☐	☐	☐	☐	☐
14. Determinar los objetivos alimentarios o nutricionales apropiados para cada paciente con enfermedad crónica no transmisible, de acuerdo con las creencias de salud y la etapa de cambio	☐	☐	☐	☐	☐
15. Formular un plan de comidas para un paciente con una enfermedad crónica	☐	☐	☐	☐	☐
16. Recomendar cambios en la elección de alimentos para un paciente con enfermedad crónica	☐	☐	☐	☐	☐
17. Supervisar y evaluar los cambios en el tiempo con respecto a los alimentos que el paciente suele comer	☐	☐	☐	☐	☐
18. Referir a los pacientes con trastornos alimentarios para asesoramiento nutricional especializado	☐	☐	☐	☐	☐
19. Prescribir un plan de ejercicio/actividad física	☐	☐	☐	☐	☐
Sección 3. Comunicación y asesoramiento nutricional: Por favor, evalúe su nivel de seguridad en su capacidad para:	Completamente inseguro	No muy seguro	Parcialmente seguro	Muy seguro	Extremadamente seguro
20. Describir claramente lo que los pacientes pueden esperar de las discusiones con usted sobre alimentos o nutrición	☐	☐	☐	☐	☐
21. Comprobar la comprensión del paciente sobre la influencia de los alimentos y nutrientes en su salud	☐	☐	☐	☐	☐
22. Trabajar con los pacientes para identificar posibles formas de mejorar la comida que suelen comer	☐	☐	☐	☐	☐
23. Demostrar empatía genuina a los pacientes sobre sus experiencias y objetivos relacionados con los alimentos	☐	☐	☐	☐	☐
24. Mantener una actitud sin prejuicios en las conversaciones con pacientes sobre los alimentos que comen	☐	☐	☐	☐	☐
25. Comunicarse con los pacientes sobre alimentación y nutrición utilizando lenguaje culturalmente apropiado	☐	☐	☐	☐	☐
26. Considerar cómo lo personal, social, cultural, psicológico y económico pueden influir en los alimentos que come un paciente	☐	☐	☐	☐	☐
27. Identificar las personas que necesitan apoyo adicional de otros profesionales o servicios de salud en relación con los alimentos que consume un paciente	☐	☐	☐	☐	☐
28. Comunicarse con otros profesionales de la salud sobre conversaciones que haya tenido con pacientes sobre la alimentación	☐	☐	☐	☐	☐
29. Responder a las preguntas de un paciente respecto a las opciones de tratamiento para la obesidad, incluido el cambio de comportamiento, los medicamentos y la cirugía bariátrica	☐	☐	☐	☐	☐
30. Proporcionar orientación para establecer objetivos de actividad física para una salud óptima	☐	☐	☐	☐	☐
31. Ayudar al paciente a establecer metas realistas según los objetivos de pérdida de masa grasa, visceral o ganancia muscular basadas en cambios permanentes en el estilo de vida	☐	☐	☐	☐	☐
Sección 4. Actitudes hacia el cuidado nutricional: Por favor, evalúe su nivel de acuerdo con las siguientes afirmaciones:	Completamente en desacuerdo	Parcialmente en desacuerdo	Ni de acuerdo ni en desacuerdo	Parcialmente de acuerdo	Completamente de acuerdo
32. Es importante que todos los individuos consuman habitualmente alimentos saludables independientemente de la edad, el peso corporal y los niveles de actividad física	☐	☐	☐	☐	☐
33. Si surge el tema, es importante que anime a mis pacientes para comer alimentos saludables	☐	☐	☐	☐	☐
34. Es importante que aproveche todas las oportunidades posibles para animar a mis pacientes a comer alimentos saludables	☐	☐	☐	☐	☐
35. Animar a mis pacientes a comer alimentos saludables, es una forma efectiva de uso de mi tiempo profesional	☐	☐	☐	☐	☐
36. Proporcionar recomendaciones nutricionales específicas a mis pacientes que pueden ayudar a controlar su enfermedad crónica, es una forma efectiva de uso de mi tiempo profesional	☐	☐	☐	☐	☐
37. Animar a mis pacientes a comer alimentos saludables está dentro de mi ámbito de práctica	☐	☐	☐	☐	☐
38. Brindar a mis pacientes recomendaciones de nutrición específicas que puedan ayudar a controlar su enfermedad crónica está dentro de mi alcance de práctica	☐	☐	☐	☐	☐
39. Es importante que anime a mis pacientes a buscar apoyo de otros profesionales de la salud si no puedo satisfacer sus necesidades relacionadas con la nutrición	☐	☐	☐	☐	☐
Sección 5. Educación nutricional previa:
40. ¿Cuál de las siguientes afirmaciones describe mejor su educación nutricional anterior? (Seleccione uno). ☐ Completé una carrera que no incluía contenido de nutrición ☐ Completé una carrera que incluía algún contenido de nutrición ☐ Completé una carrera que se centró predominantemente en la nutrición
41. ¿Alguna vez ha participado en educación continua sobre el tema de nutrición? ☐ Sí ☐ No
Sección 6. Prestación de atención nutricional:
43. Durante un mes determinado, ¿con qué frecuencia brinda atención nutricional a sus pacientes?
44. ¿Cuánto tiempo en promedio dedica durante una consulta a brindar atención nutricional?
Sección 7. Datos demográficos
45. Edad en años: __________________
46. Género: ☐ Masculino☐ Femenino
47. Nacionalidad: ☐ colombiano ☐ No colombiano, Cual: ____________
48. Cualificación profesional: ☐ Médico general ☐ Medicina familiar ☐ Residente ☐ Especialista ☐ Auditor / Consultor ☐ Otra, ¿cuál? ________________________
49. Estado civil: ☐ Soltero ☐ Casado ☐ Unión libre
50. Tiempo de dedicación laboral en la institución: ☐ Medio tiempo ☐ Tiempo completo ☐ Otra, Cual? __________________
51. Tipo de contrato laboral: ☐ Planta ☐ Agremiación ☐ Orden de prestación de servicios
52. Estado de bienestar o condición actual de salud: ☐ Excelente ☐ Bueno ☐ Regular ☐ Otra, ¿cuál? ___________________________________
53. Nombre de la universidad donde se graduó como médico (pregrado) ___________________________
54. Tiempo de ejercer la profesión en meses o años ( ) Meses ( ) Años
55. Antecedentes personales: ☐ Obesidad ☐ Hipertensión ☐ Diabetes ☐ Dislipidemias ☐ Cáncer ☐ Otras, ¿cuál? ___________________________
56. Antecedentes familiares: ☐ Obesidad ☐ Hipertensión ☐ Diabetes ☐ Dislipidemias ☐ Cáncer ☐Otras, ¿cuál? ___________________________
Sección 8. Evaluación de los contenidos de un programa de entrenamiento en competencias en consejería nutrición
57. ¿Cree que la consejería en nutrición debería ser parte de la práctica médica de atención primaria?: ☐ Muy en desacuerdo ☐ En desacuerdo ☐ Ni de acuerdo ni en desacuerdo ☐ De acuerdo ☐ Muy de acuerdo
58. ¿Tomaría la decisión de integrar el asesoramiento nutricional en las consultas de sus pacientes?: ☐ Muy en desacuerdo ☐ En desacuerdo ☐ Ni de acuerdo ni en desacuerdo ☐ De acuerdo ☐ Muy de acuerdo
59. ¿Participó en todos los cinco módulos del programa?: ☐ Sí ☐ No. Si no, ¿por qué no? ☐ No alcancé a leer los módulos ☐ No tenía tiempo para ir a la capacitación ☐ Se cruzó con el turno ☐ Otro, _____________________
60. Después de participar en el programa, ¿qué módulos le llamó la atención para su práctica? ☐ Evaluación del estado nutricional, ☐ Pautas de nutrición y actividad física basadas en la evidencia, ☐ Superando las barreras de cambio, ☐ Consejería nutricional, ☐ Pautas y criterios para remisión de pacientes a nutrición especializada. Si ninguno de los anteriores, favor sugiera un módulo para ser discutido con el equipo de educación médica __________________________
61. ¿Recomendaría este programa de competencias en nutrición a otros médicos de atención primaria? ☐ Sí ☐ No
62. Después de participar en los módulos, ¿planea comenzar algún tipo de evaluación dietética en el cuidado de sus pacientes? ☐ Ninguna vez, ☐ En algún tiempo, ☐ Todo el tiempo
63. ¿Cree que este programa es una forma útil de entrenar en competencias en nutrición a los médicos de atención primaria? ☐ Sí ☐ No. Si no, ¿puede sugerir una estrategia o método preferible? Por favor describa la estrategia _______________________________________ ☐ Prefiero no responder
64. ¿Cree usted que hicieron falta temas trascendentales para incluirlos en el programa de competencias? ☐ Sí ☐ No. Si su respuesta fue “SÍ”, ¿puede sugerir el o los temas faltantes en el programa? Por favor escriba el o los temas ________________________________ ☐ Prefiero no responder
65. ¿Cómo calificaría la calidad de la instrucción brindada? ☐ Excelente ☐ Muy bueno ☐ Bueno ☐ Regular ☐ insuficiente

Notes: Blue shading: additional items and/or sections. Bold text: modified words. Question number “4” was changed to Guías Alimentarias para la población colombiana mayor de 2 años.

Source: Own elaboration.

Pilot study

Of the 40 physicians who participated in the study, 35 were general practitioners, 2 were family medicine specialists, and 3 were internal medicine specialists. The mean score on the NUTCOMP was 145.07 (SD: 17.42) on the first administration and 146.52 (SD: 18.03) on the second administration. The mean scores for each construct on both administrations are presented in Table 2.

Validity, internal consistency, and test-retest reliability

Regarding content validity, Kendall’s W coefficient for the instrument was 0.93, while it ranged between 0.92 and 0.94 for the constructs, with significant agreement in all cases (p<0.05). These results demonstrate high inter-rater agreement for both the overall instrument and each construct (Table 2).

Concerning internal consistency, Cronbach’s alpha was 0.931 for the instrument and between 0.88 and 0.95 for the constructs, indicating high internal consistency (excellent for the instrument and construct 4, and good for the remaining three constructs) (Table 2).

Finally, the instrument demonstrated excellent reliability (ICC: 0.931) with a 95% confidence interval (CI 0.896–0.958), and the constructs showed good to excellent reliability (0.89–0.95), with statistical significance in all cases (p=0.0001).

Table 2. Inter-rater reliability for each construct and for the entire NUTCOMP instrument.

Construct (number of items)	Mean score		AgreementA	Internal consistencyB	ICCC
	First administration	Second administration
1. Nutrition knowledge (7)	24.3	24.4	0.92	0.88	0.87
2. Nutrition skills (12)	40.95	41.38	0.94	0.88	0.90
3. Nutrition communication and counseling (12)	43.85	44.45	0.92	0.86	0.87
4. Attitudes toward nutrition care (8)	36.97	36.3	0.94	0.95	0.94
Total (n=39)	145.075	146.525	0.93	0.931	0.931

A Kendall’s W coefficient.

B Cronbach’s alpha. Significance of agreement, consistency.

C p<0.05.

Source: Own elaboration.

Discussion

This study involved the translation, cultural adaptation, and validation of the NUTCOMP questionnaire for use in the Colombian context.

The original NUTCOMP questionnaire contains 42 items focusing on confidence, knowledge, skills, and communication when providing nutrition counseling; attitudes toward nutrition care; and prior nutrition education and demographics.10 However, in the Spanish version presented here, new items were added to strengthen the assessment of these competencies (4 items in Section 2 and 3 in Section 3), as well as two sections to investigate the frequency and time spent providing nutrition care (Section 6) and to evaluate the content of a training program in nutrition competencies (Section 8). In any case, the instrument validated here can be used without these two sections, since—similar to sections 5 and 6 of the original questionnaire—they are not included in the calculation of the score and, therefore, were not considered in the assessment of its validity and reliability.

The NUTCOMP, translated and adapted into Colombian Spanish, demonstrated very high content validity (Kendall’s W: 0.93), excellent internal consistency (α=0.931), and excellent test-retest reliability (ICC: 0.931). For the constructs, very high content validity (Kendall’s W: 0.92–0.94), good or excellent internal consistency (α=0.88–0.95), and good or excellent test-retest reliability were observed (ICC: 0.89-0.95). This is similar to the results reported in the study on the development and validation of the original instrument (35 items across 4 constructs), in which, after conducting a pilot study with 118 primary care professionals (dietitians and speech therapists), an internal consistency of 0.98 was determined for the instrument and of 0.88–0.98 for the constructs. Also, very high test-retest reliability was found for both the instrument (0.95) and the constructs (0.89–0.94).10

A review of the relevant literature revealed no studies that have translated and culturally adapted this instrument into other languages. However, an academic poster presented at the 55th Annual Meeting of the ESPE (European Society for Paediatric Endocrinology) in 2016 reported preliminary results from the validation of the Korean-translated and culturally adapted version of the NUTCOMP, showing a very similar Cronbach’s alpha (0.934).22

As demonstrated in studies conducted in countries such as Saudi Arabia11 and Ireland,23,24 the NUTCOMP allows for the assessment of nutrition counseling competencies among general practitioners, physical therapists, and other PC professionals, and establishes a baseline for investigating the impact of interventions aimed at improving these competencies. Furthermore, since self-perceived competence can serve as an indicator of actual competence,10 assessing PC professionals’ competencies for providing nutritional care using the NUTCOMP questionnaire could be helpful in evaluating health services and developing strategies to improve such competencies. Likewise, the gaps in nutrition knowledge revealed by this questionnaire can be used to identify opportunities for improvement in undergraduate and graduate curricula in medicine and other health sciences.

Although this instrument has reportedly been used in at least 28 countries18 (primarily English adaptations, although an official Spanish translation has been identified),19 to the best of our knowledge, this is the first study to validate a Spanish version, which will undoubtedly contribute to its widespread use in Spanish-speaking countries by eliminating the language barrier. Nevertheless, since this version was validated in a Colombian context, it is recommended that, when administering it in other countries, the necessary adjustments be made to adapt it to each country’s specific circumstances (e.g., each country’s dietary guidelines).

The main limitation of this study is that the questionnaire was administered exclusively to physicians. Consequently, the reliability of the validated questionnaire is compromised because it is not possible to guarantee that it consistently measures the competencies of all PC health personnel, while its content validity is limited because the test does not accurately assess the construct ‘Nutrition Counseling Competencies’ in its entirety, as it overlooks the specific skills and knowledge of other professions that also play a crucial role in this field.

In light of the above, it is recommended that all professionals working in PC (e.g., nurses, dietitians, psychologists, and others) be included in future reliability and validity tests and that the results be analyzed separately, so that each professional group identifies significant differences in their competencies. It is also advisable to adapt test items to ensure that they are relevant to the responsibilities and knowledge of each profession.

Conclusion

The Colombian Spanish version of the NUTCOMP questionnaire demonstrated very high content validity, excellent internal consistency, and excellent test-retest reliability. Therefore, it is a valid and reliable instrument for assessing PC professionals’ self-perceived competencies when providing nutrition care in Colombia and other Spanish-speaking countries, provided that the necessary adaptations are made. It can also be used to evaluate the impact of interventions aimed at improving these competencies.

Conflicts of interest

None stated by the authors.

Funding

None stated by the authors.

Acknowledgments

To the Hospital Universitario Hernando Moncaleano Perdomo in Neiva, Colombia, for its valuable support, and in particular to each of the physicians who participated, as their dedication and readiness to take part in this research were essential to the project’s success.

References

1.Córdoba-García R, Camarelles-Guillem F, Muñoz-Seco E, Gómez-Puente JM, José-Arango JS, Ramírez-Manent JI, et al. Recomendaciones sobre el estilo de vida. Actualización PAPPS 2018. Aten Primaria. 2018;50 Suppl 1(Suppl 1):29-40. Spanish. doi: 10.1016/S0212-6567(18)30361-5. PMID: 29866355; PMCID: PMC6836940.

2.Lepre B, Mansfield KJ, Ray S, Beck EJ. Nutrition competencies for medicine: an integrative review and critical synthesis. BMJ Open. 2021;11(3): e043066. doi: 10.1136/bmjopen-2020-043066. PMID: 33766841; PMCID: PMC7996665.

3.Alzaben AS, Aljahdali AA, Alasousi LF, Alzaben G, Kennedy L, Alhashem A. Nutritional Knowledge, Attitudes, and Practices among Family Physician Practitioners in Gulf Countries (Bahrain, Kuwait, Saudi Arabia, and UAE). Healthcare (Basel). 2023;11(19):2633. doi: 10.3390/healthcare11192633. PMID: 37830670; PMCID: PMC10572505.

4.Salas-Salvadó J, Mena-Sánchez G. El gran ensayo de campo nutricional PREDIMED. Nutr Clin Med. 2017;11(1):1-8. doi: 10.7400/NCM.2017.11.1.5046.

5.Hseiki RA, Osman MH, El-Jarrah RT, Hamadeh GN, Lakkis NA. Knowledge, attitude and practice of Lebanese primary care physicians in nutrition counseling: a self-reported survey. Prim Health Care Res Dev. 2017;18(6):629-34. doi: 10.1017/S1463423617000330. PMID: 28606212.

6.Dash S, Delibasic V, Alsaeed S, Ward M, Jefferson K, Manca DP, et al. Knowledge, Attitudes and Behaviours Related to Physician-Delivered Dietary Advice for Patients with Hypertension. J Community Health. 2020;45(5):1067-72. doi: 10.1007/s10900-020-00831-x. PMID: 32415518.

7.Fitzgerald JD, Andrade JM, Curl SL, Smith EB, Torna E, Nelson DS. Development of nutrition counselling resources for family medicine using the knowledge to action framework. Fam Pract. 2021;38(1): 32-7.
doi: 10.1093/fampra/cmaa020. PMID: 32255188.

8.McLeod MR, Chionis L, Gregg B, Gianchandani R, Wolfson JA. Knowledge and attitudes of lower Michigan primary care physicians towards dietary interventions: A cross-sectional survey. Prev Med Rep. 2022;27:101793. doi: 10.1016/j.pmedr.2022.101793. PMID: 35656221; PMCID: PMC9152810.

9.Al-Zahrani AM, Al-Raddadi RM. Nutritional knowledge of primary health care physicians in Jeddah, Saudi Arabia. Saudi Med J. 2009;30(2):284-7. PMID: 19198721.

10.Ball LE, Leveritt MD. Development of a validated questionnaire to measure the self-perceived competence of primary health professionals in providing nutrition care to patients with chronic disease.
Fam Pract. 2015;32(6):706-10. doi: 10.1093/fampra/cmv073. PMID: 26415817.

11.Al-Gassimi O, Shah HBU, Sendi R, Ezmeirlly HA, Ball L, Bakarman MA. Nutrition competence of primary care physicians in Saudi Arabia: a cross-sectional study. BMJ Open. 2020;10(1):e33443. doi: 10.1136/bmjopen-2019-033443. PMID: 31911521; PMCID: PMC6955539.

12.Al Shammari E, Ashraf SA, Al Shammari R, Al Rashidi A, Awadelkareem AM, Elkhalifa AEO. Nutritional Knowledge and Awareness of Primary Health Care Physicians Working in Hail Region, Saudi Arabia: A Cross-Sectional Study. Curr. Res. Nutr Food Sci Jour. 2021;9(2):402-8. doi: 10.12944/CRNFSJ.9.2.04.

13.Jain S, Feldman R, Althouse AD, Spagnoletti C, Proksell S. A Nutrition Counseling Curriculum to Address Cardiovascular Risk Reduction for Internal Medicine Residents. MedEdPORTAL. 2020;16:11027.
doi: 10.15766/mep_2374-8265.11027. PMID: 33204843; PMCID: PMC7666832.

14.Znyk M, Kaleta D. Healthy lifestyle counseling, and barriers perceived by general practitioners in Poland. Front Public Health. 2023;11:1256505. doi: 10.3389/fpubh.2023.1256505. PMID: 37829088; PMCID: PMC10565007.

15.Iyer S, Jay M, Southern W, Schlair S. Assessing and counseling the obese patient: Improving resident obesity counseling competence. Obes Res Clin Pract. 2018;12(2):242-5. doi: 10.1016/j.orcp.2018.02.007. PMID: 29555317.

16.Gadenz SD, Harzheim E, Amaral HG, Drehmer M. Development and Assessment of a Mobile Nutritional Counseling Tool for Primary Care Physicians. Telemed J E Health. 2020;26(6):805-11. doi: 10.1089/tmj.2019.0070. PMID: 31556810.

17.Johnston E, Beasley J, Jay M, Wiedemer J, Etherton PK. Practical Nutrition for the Primary Care Provider: A Pilot Test. Med Sci Educ. 2019;29(2):363-73. doi: 10.1007/s40670-019-00700-w. PMID: 32832196; PMCID: PMC7439974.

18.Ball L, Lepre B, Van Dorssen C. Measurable and immeasurable spread of knowledge for research impact: a reflection on the validated NutComp tool. BMJ Nutr Prev Health. 2023;6(2):413-5. doi: 10.1136/bmjnph-2023-000723. PMID: 38618538; PMCID: PMC11009542.

19.Polo-García C. Conocimientos sobre nutrición y alimentación en el adulto mayor del personal sanitario de atención primaria: detección de necesidades y propuesta de acciones de mejora [Master's thesis]. Valladolid: Universidad de Valladolid; 2024.

20.World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA. 2025;333(1):71-4. doi: 10.1001/jama.2024.21972. PMID: 39425955.

21.Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud [Internet]. Bogotá D.C.; October 4 1993 [cited 2026 Feb 12]. Available from: https://bit.ly/3Q3R0t8.

22.Kim K, Kim GM, Jeong MY, Kim Y, Lee KR, Kim SH, et al. Preliminary Findings on Nutrition Care Competence in Health Care Professionals Using a Standardized Questionnaire NUTCOMP Korean Version. ESPE Abstracts [Internet]. 2016 [cited 2026 Jan 7];86:2-520. Available from: https://tinyurl.com/jpnjz273.

23.Griffin A, Conway H, Chawke J, Keane M, Douglas P, Kelly D. An exploration of self-perceived competence in providing nutrition care among physiotherapists in Ireland: a cross-sectional study. Physiother Theory Pract. 2024;40(10):2223-32 doi: 10.1080/09593985.2023.2243624. PMID: 37540212.

24.Keaver L, O’Meara C, Mukhtar M, McHugh C. Providing Nutrition Care to Patients with Chronic Disease: An Irish Teaching Hospital Healthcare Professional Study. Journal of Biomedical Education. 2018;2018(1):1657624. doi: 10.1155/2018/1657624.