Shifting social perceptions of dietitians in Korea after the legislation of nutrition teachers: a keyword network analysis of unstructured data

Article information

Korean J Community Nutr. 2025;30(3):214-223

Publication date (electronic) : 2025 June 30

doi : https://doi.org/10.5720/kjcn.2025.00045

Yunkyoung Oh¹⁾, Eunsil Her^2),

¹⁾Professor, Department of Cosmetology, Changshin University, Changwon, Korea

²⁾Professor, Department of Food and Nutrition, Changshin University, Changwon, Korea

^†Corresponding author: Eunsil Her Department of Food and Nutrition, Changshin University, 262 Paryong-ro, Masanhoiwon-gu, Changwon 51352, Korea Tel: +82-55-250-1203 Fax: +82-55-250-1201 Email: heres@cs.ac.kr

Received 2025 February 24; Revised 2025 April 8; Accepted 2025 June 12.

Abstract

INTRODUCTION

Dietitians are healthcare professionals specializing in meal management and nutritional services to prevent diseases and promote overall health. They are officially recognized as healthcare personnel under the 「Act on Providing Assistance with Health Professionals」 [1]. In Korea, dietitian licenses have been issued since 1964, and as of 2020, approximately 42,000 dietitians are active. More than 78% are employed in foodservice facilities, including industry, schools, hospitals, social welfare facilities, infant care facilities, kindergartens, older adult care facilities, and the military. Additionally, they are active in education, research, the foodservice industry, public officials, and public health centers [2].

With the revision of the 「Elementary and Secondary Education Act」 in 2003, a nutrition teacher system was introduced in schools in 2007 [3], and the scope is expanding as nutrition teachers are assigned to kindergartens from 2021 [4]. Its scope continues to expand, with nutrition teachers assigned to kindergartens starting in 2021. Meanwhile, clinical dietitians are professionals with national licenses who play a major role in improving the quality of clinical nutrition services provided in hospitals and supporting disease prevention and treatment. Since the enactment of the 「National Nutrition Management Act」 in 2012 [5], the number of clinical dietitians has steadily increased.

With growing concerns over food poisoning at children’s foodservice facilities and the poor quality of meals for children, the Center for Children’s Foodservice Management was established in 2011 under the 「Special Act on Safety Management of Children’s Dietary Life」 [6]. In 2022, its scope was expanded under the 「Act on Foodservice Safety Support for Social Welfare Facilities for the Elderly and the Disabled」, it was expanded to the Center for Children’s and Social Welfare Foodservice Management [7]. As of 2024, approximately 2,500 dietitians are working across 236 centers nationwide [8]. In this way, both the scope and value of the dietitian profession are expanding, and in the Ministry of Employment and Labor’s mid- to long-term human resource supply and demand forecasts, an additional 370,000 health and social welfare workers are expected to be hired over the next 5 years (2025–2030) [9]. Accordingly, the demand for dietitians is also expected to increase. Therefore, there is a need to evaluate social perception among dietitians.

Most previous studies on social perception have relied on surveys conducted with sample groups [10, 11]. However, these methods have limitations, as they may not accurately reflect the general characteristics of the population, potentially leading to errors or researcher bias [12]. In contrast, the emerging field of big data analysis offers a more effective approach to understanding societal perceptions and trends by utilizing large datasets and can suggest meaningful opinions in analyzing the changing trends over time for a specific topic [13, 14]. Furthermore, by examining relationships between keywords, data can be visualized, and patterns can be derived, allowing for a clear understanding of the structural characteristics [15]. Today, social networking services are widely used, enabling people to communicate and exchange information and content. Additionally, news articles and online communities provided on internet portal sites reflect the thoughts and opinions of the conveyors of information, making it possible to understand the public perceptions through these sources [16]. Recently, studies utilizing big data have been conducted in the field of food and nutrition, such as analyzing the diet status at a specific point in time based on social media big data [17] or comparing the perception of diet before and after COVID-19 [18].

Studies on social perception of specific occupations are being conducted using social big data, and these studies have shown that changes in social issues or policies have an impact on changes in social perception of specific occupations [19, 20]. Occupational prestige can be defined as the evaluation of a specific occupation shared by members of society, and is useful for examining social changes and changes in perception. A first big issue for dietitians since 2000 was that dietitians who previously worked as school food sanitation officers could legally be assigned to schools as nutrition teachers. Secondary school teachers ranked 6th in occupational prestige in 2009 [21]. By comparing the three years from 2007 (2007–2009), when the nutrition teacher who had a major influence on the dietitian paradigm were placed in each school, with the recent three years (2022–2024), we can assess the changes in the social perception of dietitians due to the revision of laws and regulations related to dietitians and the introduction of the system. The purpose of this study was to understand and use these as basic data to establish and improve dietitian awareness. The specific research questions are as follows:

RQ1: What are the characteristics of dietitian-related keywords between 2007–2009 and 2022–2024 as analyzed through big data?

RQ2: What is the network structure of dietitian-related keywords between 2007–2009 and 2022–2024 as analyzed through big data?

METHODS

RESULTS

1. Frequency analysis of keywords related to dietitian

The results of a frequency ranking of the top 50 keywords related to dietitian in the first period (2007–2009) of three years after the nutrition teachers were legislated (Table 1) showed that ‘Food’ ranked the highest, followed by ‘School’, ‘Nutrition’, ‘Examination’, ‘Foodservice’, ‘Health’, ‘Hospital’, ‘Certificate’, ‘University’, ‘Education’, ‘Nutrition’, ‘Teacher’, ‘Enrollment’, and ‘Study’. As in the first period, the keyword with the highest frequency in the second period (2022–2024) was ‘Food’, followed by ‘Examination’, ‘Enrollment’, ‘Foodservices’, ‘Certificate’, ‘Work’, ‘Nutrition’, ‘License’, ‘Qualification’, ‘Health’, ‘School’, ‘Hospital’, ‘Nutrition science’.

Table 1.

Frequency analysis of keywords related to dietitian by period

2. The structural form of the network

The network structure properties of keywords related to dietitian in first period were as follows: Nodes were 50, density was 0.989, average degree was 48.44, average distance was 1.011, and diameter was 2 (Fig. 1). The network properties in second period were as follows: Nodes were 50, density was 0.969, average degree was 47.48, average distance was 1.031, and diameter was 2 (Fig. 2). These results mean that in first period, one keyword was connected to an average of 1.011 other keywords, and in second period, one keyword was connected to an average of 1.031 other keywords, and in both periods, all keywords were connected after passing through a maximum of two keywords. In both periods, keywords within the network were densely connected, showing the complexity of social perception of dietitians.

Fig. 1.

The overall network of dietitian keywords by the first period (2007–2009).

Fig. 2.

The overall network of dietitian keywords by the second period (2022–2024).

3. Degree centrality analysis

Degree centrality, which is measured by the number of links connected to a node, can be used to determine the degree of interaction between keywords. The higher the value, the wider the network formed with surrounding keywords, and the keyword can be said to act as a hub. As a result of analyzing degree centrality (Table 2), keywords with high degree centrality rankings for Period 1 were ‘Food’ (0.192) > ‘School’ (0.107) > ‘Examination’ (0.106) > ‘Nutrition’ (0.094) > ‘Certificate’ (0.084) > ‘University’ (0.080) > ‘Enrollment’ (0.074), etc. Words such as ‘Certificate’, ‘University’, ‘Enrollment’, and ‘Graduation’ have higher degree centrality than frequency rankings, indicating a tendency for relatively higher connection strength than other keywords. Keywords with high degree centrality rankings in the 2nd period were ‘Food’ (0.232) > ‘Examination’ (0.182) > ‘Certificate’ (0.159) > ‘Enrollment’ (0.146) > ‘Qualification’ (0.133) > ‘Foodservice’ (0.126) > ‘Acquisition’ (0.121), etc. Words such as ‘Certificate’, ‘Qualification’, ‘Acquisition’, and ‘Application’ had higher degree centrality than frequency ranking.

Table 2.

Degree centrality for keywords related to dietitian by period

4. CONCOR analysis

In order to cluster keywords with similarities in the social perception of dietitian and to identify their characteristics, CONCOR analysis was performed. According to the CONCOR analysis results for first period (Table 3), Cluster 1 contained a total of 20 keywords, including ‘University’, ‘Student’, ‘Subject’, ‘Nutrition science’, ‘Qualification’, ‘Study’, ‘Pass’, and ‘National examination’, and was named ‘Major education’. Cluster 2 contained a total of 16 keywords, including ‘Society’, ‘Healthcare’, ‘Patient’, ‘Exercise’, and ‘Health’, and was named ‘Wellness’. Cluster 3 contained a total of 7 keywords, including ‘Welfare’, ‘Enrollment’, ‘Recruitment’, and ‘Nurse’, and was named ‘Health and welfare’. Finally, Cluster 4 contained a total of 7 keywords, including ‘Teacher’, ‘School’, and ‘Occupation’, and was named ‘Occupation’.

Table 3.

CONCOR analysis of keywords related to dietitian by the first period (2007–2009)

CONCOR analysis results for the second period (Table 4), cluster 1 included 17 keywords including ‘University’, ‘Open university’, ‘Specialist’, ‘Major’, ‘License’, and ‘University transfer’, and was named ‘Major education and qualification’. Cluster 2 included 13 keywords including ‘Welfare’, ‘Work’, ‘Task’, ‘Region’, and ‘Recruitment’, and was named ‘Health and welfare regional service’. Cluster 3 included 10 keywords including ‘Subject’, ‘Qualification’, ‘Study’, ‘Pass’, ‘National examination’, and ‘Graduation’, and was named ‘Professional competency certification process’. Finally, cluster 4 included 10 keywords including ‘Society’, ‘Recommendation’, ‘School’, and ‘Foodservice’, and was named ‘Foodservice management’.

Table 4.

CONCOR analysis of keywords related to dietitian by the second period (2022–2024)

DISCUSSION

According to the 「National Nutrition Management Act」, a dietitian can take the exam only after graduating from the Department of Nutrition or Food and Nutrition, holding an undergraduate degree in Food Science, Nutrition, or Food and Nutrition, and completing 52 credits in 18 nutrition-related subjects [5]. Reflecting this, the top 10 keywords related to dietitians in this study included ‘Food’, ‘Nutrition’, ‘Examination’, and ‘Certificate’. In the first period, keywords such as ‘School’ (2nd) and ‘Education’ (10th), which reflect the institutionalization of nutrition teachers, were among the top 10, with ‘Teacher’ ranking 12th. However, in the second period, these keywords dropped out of the top 10, while healthcare-related keywords like ‘Health’ (6th place) and ‘Hospital’ (7th place) ranked 9th and 12th, respectively. Meanwhile, the keyword ‘Foodservice,’ which is closely associated with the primary work setting for many dietitians, remained prominent, ranking 5th in the first period and 4th in the second. The dietitian licensing system, which was established with the enactment of the「Food Sanitation Act」 in 1962, and transitioned to a nationwide examination in 1978, is reflected in the study [22]. The keyword ‘License’ rose from 23rd in the first period to 8th place in the second period. Additionally, ‘University transfer’, which did not appear in the top 50 during the first period, ranked 19th in the second period, and considering that employment-related keywords such as ‘Recruitment’, ‘Work’, and ‘Qualifications’ are at the top, the purpose of university transfer is to obtain a professional license and get a job rather than to improve academic ability at university.

The centrality analysis in the first period revealed a higher connectivity between the ‘Food’, ‘School’, ‘Examination’, and ‘Nutrition’ keywords, as confirmed by the frequency analysis results, but the keywords ‘Foodservice’, ‘Health’, and ‘Hospital’ were outside the top 10. Instead, keywords related to qualification acquisition and credentials, such as ‘Enrollment’, ‘Qualification’, and ‘Examination’, were more closely associated with dietitians. In the second period, the connectivity between keywords like ‘Food’, ‘Examination’, ‘Certification’, ‘Foodservice’, ‘Nutrition’, ‘License’, and ‘Acquisition’ was stronger than in the first period. As the perception of dietitians is shaped around these keywords, it is essential to provide opportunities to obtain a dietitian license and related certifications through a systematic food and nutrition major curriculum, which includes food, nutrition, and foodservices. This approach can ultimately lead to employment. As a result of structural analysis to see the positioning of keywords related to dietitians, in the first period, a close network was shown centered on the keywords ‘Teacher’, ‘School’, ‘Health’, ‘University’, and ‘Specialization’, showing that the legislation of nutrition teachers was influencing social perception. In the second period, connections were concentrated on keywords such as ‘Specialist’, ‘Qualification’, ‘Work’, and ‘Task’, showing that the expertise of dietitians was being strengthened and their perception the profession was being solidified.

Changes in social issues or policies can change perceptions about occupations [23]. According to the results of the first CONCOR analysis of the social perception of dietitians, the ‘Major education’ cluster included subjects related to ‘Food’, ‘Nutrition science’, ‘Public health’, and ‘Cooking’, as well as acquired ‘Certificate’ and ‘License’. Wellness is a recent concept in healthcare that has rapidly spread in Korea since 2000 and includes disease treatment and prevention, health promotion, and quality of life improvement [24]. The ‘Wellness’ cluster included wellness-related keywords such as ‘Healthcare’, ‘Health’, ‘Meal’, ‘Culinary’, ‘Education’, and ‘Counseling’, all of which are connected to physical wellness and linked to dietitians. Additionally, through the ‘Health and welfare’ cluster, dietitians are recognized as healthcare personnel alongside nurses [1]. The ‘Occupation’ cluster expressed interest in nutrition teachers, newly institutionalized in the dietitian profession, through keywords such as ‘Teacher’, ‘School’, and ‘Nutrition’.

The CONCOR analysis results for the second period revealed the advancement and differentiation of dietitian awareness compared to the first period. The keywords forming the ‘Major education and qualifications’ cluster have evolved from the ‘Major education’ cluster in the first period. This indicates that a dietitian can now obtain a license only by completing the required curriculum prescribed by law. Additionally, the license can be obtained through institutions such as the Korea Communications and the Communications University or via university transfer. This indicates an awareness of the possibility of obtaining this qualification. The ‘Health and welfare regional service’ cluster showed the advancement of ‘Health and welfare’ from the first period, with the recognition that dietitians are active in providing health and welfare services in the community. This was reflected in keywords such as ‘Welfare’, ‘Region’, ‘Hospital’, and ‘Education’. Recently, as the position and role of the curriculum have become more important in university education, efforts are being made to increase external competitiveness by operating a competency-based curriculum to improve quality [25]. Reflecting this trend, the ‘Professional competency certification process’ cluster emerged, differentiating itself from the ‘Major education’ cluster of the first period. Dietitian competencies are now recognized as being developed and equipped with a focus on ‘Subject’, ‘Practice’, ‘Examination’, and ‘Certification’. The ‘Foodservice management’ cluster included keywords such as ‘Menu’, ‘Culinary’, ‘Diet’, ‘Health’, and ‘Nutrition’, which are related to foodservice, the sector in which most dietitians are engaged.

Nonetheless, this study is valuable in that it examined the evolution of social perceptions of dietitians by exploring the structural relationships between keywords after implementing policies, such as the legalization of nutrition teachers and the transition to national certification for clinical dietitians. This study highlights the need to train dietitians who will play active roles in community health, welfare, and foodservice fields through a major curriculum that enables the acquisition of professional competencies as a dietitian.

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