Mapping Assessment Approaches to Midwife-Led Perinatal Nutrition Counselling: A Scoping Review of Existing Instruments, Competency Frameworks, and Measurement Gaps.

Background

Nutrition counselling during the perinatal period is an important component of midwifery care and health promotion. Existing competency frameworks recognize nutrition-related education and counselling as part of midwifery practice, while several studies have assessed midwives' nutrition knowledge, attitudes, confidence, and self-reported practices. However, it remains unclear to what extent existing assessment approaches capture the quality of nutrition counselling as experienced by women receiving midwife-led care.

Objective

This scoping review aimed to map existing tools, questionnaires, competency frameworks, checklists, and other assessment approaches related to nutrition counselling, nutrition education, and nutrition-related competencies in midwifery and perinatal care; to compare the measurement domains represented across these approaches; and to identify remaining measurement gaps.

Methods

The review was conducted according to established scoping review methodology and reported in accordance with PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science Core Collection, CINAHL, and Embase were searched from database inception to 1 July 2026 using two complementary search strategies targeting both nutrition-related assessment approaches and patient-experience/counselling-quality concepts. Eligible sources included studies or documents describing instruments, competency frameworks, questionnaires, screening tools, checklists, or other assessment approaches related to nutrition counselling within midwifery or perinatal care. Data were charted according to assessment type, target population, intended purpose, domains assessed, development methodology, validation evidence, and relevance to midwife-led nutrition counselling, and were synthesized descriptively and conceptually across assessment domains.

Results

The database searches identified 186 records, of which 42 duplicates were removed, leaving 144 records for title and abstract screening. Thirty-four reports underwent full-text assessment, of which 25 were excluded, resulting in nine included reports. These reports represented a smaller number of distinct assessment tools, frameworks, and approaches because three reports evaluated or applied the same underlying instrument, the FIGO Nutrition Checklist. The included evidence comprised nutritional-risk screening, provider-focused knowledge-, attitude-, and practice-based assessment, observational approaches to counselling delivery, and a professional competency framework. Cross-cutting synthesis identified four conceptually distinct measurement levels: nutritional risk and dietary status, professional knowledge and competence, counselling delivery and implementation, and women's experience of nutrition counselling. No eligible nutrition-specific patient-reported experience measure was identified, leaving the intersection between nutrition-specific content and woman-reported counselling experience insufficiently represented.

Conclusions

Existing approaches provide fragmented assessment of nutrition-related care and do not comprehensively capture women's experiences of midwife-led nutrition counselling. Further research should determine whether existing measures can be adapted or combined or whether a new patient-reported experience measure (PREM) is warranted.