TABLE 3.

Summary of identified dietitian and client‐related factors as facilitators or barriers to the development of the client–dietitian relationship

	Attributes		Techniques
	Facilitators	Barriers	Facilitators	Barriers
Dietitian‐related factors	Genuineness Supportiveness Caring Positivity Enthusiastic Empathic Understanding Respectful Honesty Having integrity Trustworthy Invested in client's wellbeing Friend/Friendliness Non‐judgemental Openness Dress	‘Unhelpful engagement style’: patronising tone, not listening to patients’ needs, biochemical agenda, instructive advice giving, overbearing support Manipulative Dishonest Unaccepting of client Anxious Lacking confidence	Individualising recommendations Organising content Quality of introduction Clarifying reason for referral early in consultation Clarifying client's understanding of role of diet Using theories and models of behaviour change Explanation of health consequences to client Developing rapport Mode of communication (e.g., telephone calls) Communication skills: using advanced‐level language and visual means, listening skills, questioning and reflection, warmth, courtesy, attentiveness Acknowledging client's challenges Self‐disclosure Holistic understanding of client Asking client evaluative questions Respecting the client's expertise Using knowledge effectively with clients Clarifying dietetic approach Enabling client choice in continuing relationship Prioritising relationship in the first consultation Expressive touch Specific named approaches: ‘Healthy Conversation Skills’ intervention, 56 ‘Narrative Dietary Counselling’ (use of whiteboards and narrative learning strategies), 9 ‘Counselling and Therapeutic’ approach 41	Sub‐optimal counselling skills Creating parent‐child dynamic Leading practitioner‐centred consultation from parental ego state Expressive touch
Client‐related factors	Facilitators		Barriers
	Completing preparatory work for consultations Attending follow‐up consultations Respect for dietitian Client response to dietitian interaction: feeling prioritised, heard and remembered, comfortable, engaged, empowered, an important individual, motivated by sense of accountability, having received personalised care, reassured by expertise of dietitian		Poor perception of dietitian: lacking integrity, untrustworthy Unrealistic expectations of diet Prejudices and assumptions Openness to disclosing eating behaviours