SOCIAL MEDIA Standards and Guidelines

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DEFINITIONS 

Social Media [1,2]
Forms of electronic communication (e.g., websites and applications) through which dietitians may personally and/or professionally create and share information, ideas, messages, and content (e.g., text, video, audio and/or images) and/or provide comments and reactions to the social media posts of other users.

Social media may include (but are not limited to):
  • Blogs, vlogs, wikis, message boards, chat rooms and forums.
  • Podcasts, electronic polling, social bookmarking, clouds, social networking (e.g., Instagram), video platforms (e.g., YouTube), and more.
Social media platforms and technology are constantly evolving, and while the platforms and terminology may change (e.g., "sharing" or "liking" a "post" and the ways that people can interact on various platforms), the concepts provided in these Standards and Practice Guidelines apply to all social media use.
 
Social media [3] can be used for several reasons in dietetic practice, including:
  • Increasing dietitian capacity to reach the public, clients and their families with timely, high-quality health and nutrition information and resources;
  • Answering questions and obtaining feedback from clients, families and the public;
  • Raising public awareness of key nutrition issues;
  • Promoting and advertising upcoming events, programs, or dietetic services available;
  • Providing education to nutrition students and dietetic practicum students;
  • Networking with other professionals and sharing educational information;
  • Creating common interest groups on nutrition topics; and
  • Creating communities of practice to support health professionals and clients.

purpose 

The Standards and Guidelines articulate key principles for social media practice. The fundamental goal of the Social Media Standards and Guidelines for Registered Dietitians is to set out expectations for the professional conduct of dietitians while using social media. Standard statements articulate the minimum level of performance expectations for the professional conduct of dietitians while using social media, followed by a list of how the Standard is demonstrated in practice. The practice guidelines articulate best practice suggestions for safe, competent, and ethical dietetic practice.

The Social Media Standards and Practice Guidelines are meant to be used with relevant legislation, the Code of Ethics, and other College Standards and guidelines. This document is intended to serve dietitians, the College and its committees when considering dietitian practice or conduct. Dietitians should also consider their organizational and/or employer social media policies.
 
Social Media Standards and Guidelines may be used for several purposes, including:
  1. To inform the public, employers, other health care providers and dietitians about the expectations dietitians should meet when using social media in their dietetic practice.
  2. To help guide the College's decision-making in matters related to the professional conduct of dietitians in diverse practice settings.
  3. To support compliance with dietitians' required standards and performance expectations surrounding professional behaviours when communicating using social media.
  4. To fulfill the College's regulatory mandate of public protection. 

Social media can be a valuable tool for health professionals to communicate, collaborate and share information. However, there are also risks. Following a principled approach to risk reduction and public protection, principles are provided, and the Standard statements define the minimum practice expectations. The practice guideline statements provide practice suggestions.
 
Dietitians can refer to the Social Media Standard and Guidelines – Practice Scenarios for guiding questions, highlighting risks and challenges that dietitians may face while using social media. The scenarios illustrate, through practical examples, an application of the principles and how dietitians can apply the Standards and Guidelines personally and professionally in relation to social media use. [2]

1 Merriam Webster Dictionary (2022). Social Media. Retrieved from https://www.merriam-webster.com/dictionary/social%20media
2 Canadian Dietetic Regulatory Practice Advisory Network (2022). Social Media Guidelines. Unpublished.
3 College of Dietitians of Ontario (2021). Dietetic Practice and Social Media. Retrieved from https://www.collegeofdietitians.org/practice-advisory/jurisprudence-professional-practice-resources/virtual-care,-social-media-technology/dietetic-practice-and-social-media.aspx

Standard principles

Dietitians must identify themselves in a transparent manner that is identifiable to the public when practising dietetics via social media as per the Professional Misconduct Regulation.

A registered dietitian demonstrates the standard by:

Using the same name that appears in their profile on the College’s Public Register and professional designation, including either Registered Dietitian, RD or French equivalents when practising dietetics via social media.


Practice Guidelines

Dietitians are encouraged to:

  1. Consider maintaining separate personal and professional accounts. It is important to remember that professional and personal accounts are only sometimes distinguishable. When posting personally, one’s registration as a dietitian may be known, and/or dietitians may share personal details on their professional accounts. Dietitians should consider overall conduct and communication that maintains the profession’s reputation, upholds a culture of respect and trust with the public and does not harm the public or negatively impact client care. [6,7]
  2. Consider providing a transparent statement to the public when representing personal views, particularly unrelated to the profession or views that could affect the public’s trust in the profession. For example, “The posts on this site are my own opinions and do not necessarily represent the position, opinions and behaviour of other dietitians or the profession in general.” [6]
6 Adapted from the College of Dietitians of Alberta (2020). Social Media Practice Guidelines. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2020/12/Social-Media-Practice-Guidelines-November-2020.pdf and Social Media, Virtual Care and Cross Border Practice. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2021/04/Chapter-14-Social-Media-Virtual-Cross-Border-Practice-20212.pdf
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media
 

A registered dietitian demonstrates the standard by:

Conducting themselves respectfully and in a professional manner that does not impact the delivery of quality dietetic services, or the safety or perceived safety of others while using social media [7]. Others include but are not limited to the public, clients, colleagues, supervisors, employers, educators, professors, mentors, students or a regulatory body [5]. Dietitians are accountable to the public they serve, their colleagues in the profession and the College.

5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media

 

Dietitians must consider their social media conduct and how it affects their own reputation and the reputation of the profession, including how it impacts the public trust [7]. While disagreements or conflicts can arise in professional practice, dietitians must act respectfully while using social media.

A registered dietitian demonstrates the standard by:

I. Avoiding unprofessional, disgraceful, or dishonourable behaviour that could impact the profession or the public interest.

Examples of unprofessional, disgraceful, or dishonourable behaviour may include, but are not limited to:
  1. using profanity towards others or about others, using language that is  disrespectful, insulting, intimidating, humiliating, or abusive.
  2. bullying, attacking, harassing, and making comments that may be, or perceived to be disparaging to others, unsubstantiated and/or defamatory, hate speech (related to race, ethnicity, religion, gender, sexual orientation, age, social class, economic status, disability, weight, or level of education), or discriminatory (e.g., racism, transphobia, sexism).
  3. posting images, videos and/or text that would reasonably, having regard to all the circumstances, be regarded as disgraceful, dishonourable or unprofessional  (e.g., impairment by any substance while practising).
II. Recognizing their professional obligation to report to the College and others as relevant (e.g., employer) incidents of unsafe or unethical conduct of dietitians that may cause harm to the public as per the Professional Misconduct Regulation. Examples may include but are not limited to discriminatory language, sharing client personal health information without informed consent, and sharing misleading or deceptive information.

7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media

A registered dietitian demonstrates the standard by:

Understanding how the law applies to professional practice for social media and complying with legal responsibilities. For example, Canada’s Anti-Spam Legislation (CASL) may affect dietitians using electronic channels to promote or market services, organizations, or products.  In addition, defamation [8], copyright, and plagiarism laws also apply to social media and social sharing. Dietitians must consider professional conduct and always provide attributions and links to original sources when sharing information, including content across different platforms (i.e., citing the original source).

Practice Guidelines
 

Dietitians are encouraged to:

  1. Consider clear, professional, audience-appropriate inclusive language, representation, design, and accessibility standards when using social media (e.g. use of alternative image text, captions, etc.). Social media that is inclusive and accessible demonstrates respect for all people.
  2. Consider the implications of liking, reposting, and reacting to comments, including how they may be interpreted and the possible consequences of these actions. For example, abbreviations, acronyms, dietetics and/or health-related terminology, or emojis can be misinterpreted or confusing. Posting short and incomplete sentences can add to this confusion. In addition, not all clients and social media users know online language culture and trends.​ For the purposes of this Standard and Practice Guideline, "liking" can be considered communicating a (positive) reaction to and "sharing" can be regarded as “reposting" information or forwarding information to users. Reactions may include emojis that can be interpreted as “positive” and/or "negative".
  3. Take responsibility for all information and content posted on their social media accounts, including monitoring and managing comments. Dietitians should take all reasonable steps to comment and/or remove content posted by others that is within their own control that may be seen as unprofessional (e.g., insults, inaccurate, misleading, or deceptive information). This means removing comments that do not comply with overall social media community guidelines to protect people from harmful content. This may include having a system for monitoring and/or limiting comments, as needed. While dietitians are not responsible for comments outside of their control (e.g., unsolicited reviews via public forums developed by members of the public), dietitians should take reasonable steps (e.g., contact the website administrator) to request corrections or deletions where information is inaccurate, misleading, fraudulent, or defamatory.
  4. Consider how responding to or “liking” a comment/post or image on someone else’s profile/page/app may be interpreted as agreeing with or supporting the comments.
  5. Use appropriate organizational communication channels to discuss, report and resolve workplace and/or other issues involving regulated health professionals.
  6. Consider developing their own social media policies and/or protocols/procedures for their practice, especially if they are employers, have employees, or manage a private practice. Topics may include the purpose of use, approved platforms, content expectations and guidelines, who can post and comment, guidelines for personal profiles, and consequences of not meeting policy obligations [5].
  7. Consider developing strategies on how to respond to clients if contacted through their personal account, including how to decline invitations and preserve the client-RD relationship.
  8. Have a strategy for approaching inappropriate (i.e., excessive or offensive) messages or negative client reviews without breaching client confidentiality. It may be helpful to evaluate the situation, the quality of care provided to the client, and assess any issues the client has described in their review. The dietitian may consider responding directly to the client if they are known, or a general response for the public. Comments should be consistent with principles in this Standard and Guideline and the Code of Ethics.
5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
8 Libel and Slander Act, RSO 1990, c.L.12. Retrieved from https://www.ontario.ca/laws/statute/90l12
 

A registered dietitian demonstrates the standard by:

Avoiding posting information that is misleading, deceptive, inappropriate, or harmful. Information must be supported by the best available evidence [7] and be consistent with the principles of equity, diversity, inclusion and belonging (EDI-B).

7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media

Dietitians must be aware of and transparent about the limits of their knowledge and skill, and not misrepresent their qualifications when sharing content related to food and nutrition. [7]

A registered dietitian demonstrates the standard by:

  1. Ensuring the professional misconduct regulation is met, which prohibits the inappropriate use of a term, title or designation in respect of a dietitian's practice. Inappropriate use may include:
  • Modifying the legislated title, and/or using a false or misleading term such as Medical Dietitian when the person is not a physician; or
  • Implying specialization or certification such as Paediatric Dietitian since there are no recognized and certified specialties in dietetics. Dietitians should avoid the use of the word “specialist” in title and in self-description.
  • Dietetic Students are reminded that using the title dietitian in Ontario is prohibited under the Dietetics Act, 1991, unless a person is a registrant of the College of Dietitians of Ontario. 
Practice Guidelines


Dietitians are encouraged to:

  1.  Take reasonable steps to ensure all information is current, accurate and reliable. Dietitians may state that information is valid as of the date of publication; including the date that a post is published [5].
  2. Follow organizational policies and consider what information, if any, requires documentation or archival (e.g., what information provides evidence of actions, events, facts, thought processes, and/or decisions within dietetic practice) in relation to social media and their dietetic practice.
  3. Consider identifying their practice area or health condition focus (e.g., public health, diabetes, etc.) on their social media accounts or platforms to assist the public in finding their services. It is also generally acceptable to indicate that a practice is focused on a particular group, such as children. As social media handles and/or hashtags can be considered use of the RD title (e.g., equivalent to an advertisement or business card), dietitians should describe any focused area of practice after the RD title when using social media to prevent modifying the legislated title or implying specialization. Consider whether separate hashtags can accomplish this (e.g., #RD #pediatric_care).
5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media

Dietitians must obtain client consent prior to collecting and using client personal health information that is available online for the purposes of nutrition assessment and/or treatment [7], unless absolutely necessary for providing dietetic care or for safety concerns. The Personal Health Information Protection Act, 2004 (PHIPA) does permit indirect collection without consent in limited circumstances (i.e., appropriate rationale related to safety concerns).

A registered dietitian demonstrates the standard by:

Following the Professional Practice Standard for the Collection, Use and Disclosure of Personal Health Information, if collecting, using and disclosing personal health information via social media.  Dietitians comply with the legislative requirements of (PHIPA) and the Health Care Consent Act, 1996.
 
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media
 

Dietitians must de-identify client personal health information and/or obtain and document express informed consent from the client or their substitute decision maker (SDM) for disclosure and publication of client personal health information via social media [7].(e.g., if posting client case studies for learning and/or collaboration with other dietitians and/or health care providers).

A registered dietitian demonstrates the standard by:

  1. Ensuring clients are not able to identify themselves as the subject of the post. Dietitians must remove any information/circumstances that the personal health information could be used, either alone or with other information to identify the individual. If it is in doubt that anonymity can be maintained (e.g., smaller communities where clients are identifiable with little information such as location or medical condition), informed consent must be obtained from clients or their SDM and documented.
  2. Following the Professional Practice Standard – Consent to Treatment and for the Collection, Use and Disclosure of Personal Health Information if posting a client’s identifiable personal health information on social media, to ensure knowledgeable consent is obtained and documented, as well as, requirements to obtain express informed consent from clients or their SDM - see iii and iv below.
  3. Obtaining express informed consent from clients or their SDM to collect, use and disclose personal health information on social media. Dietitians must show the client the content to be posted on social media, inform them that consent can be withdrawn at any time, inform them of any risks of the content (e.g., once posted, it may be challenging to have it completely removed), and provide information such as the purpose, where it will be posted, and any other relevant information used (e.g., client education materials) [7].
  4. Taking reasonable steps to mitigate power imbalances inherent in client-RD relationships. Clients may be vulnerable and feel pressured to consent. Dietitians must take reasonable steps to prevent potential effects (e.g., inform clients that if they do not consent, it will not affect their care.).
  5. Complying with any CDO requirements and limitations regarding the use of client testimonials.
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media
 

Dietitians must follow their obligations for handling privacy breaches if unauthorized use, disclosure, loss or theft of personal health information occurs via social media.

A registered dietitian demonstrates the standard by:

Ensuring compliance with the legislative requirements in PHIPA.

Practice Guidelines


Dietitians are encouraged to:

  1.         Consider and apply privacy settings to determine who can view their posts. It may be helpful to routinely review privacy settings and policies of the platforms used, as they may change. Dietitians should be aware that others can copy, screenshot, and share information without their knowledge or permission.

Dietitians must apply their professional judgment and carefully consider risks of providing any client-specific, individualized advice via social media (i.e. the advice provided creates a reasonable perception that a dietitian-client relationship exists).

In the event that client-specific individualized advice must be provided over social media, dietitians must be able and willing to meet professional obligations in a client-dietitian relationship as noted in the Virtual Care Standards and Guidelines, including fulfilling privacy obligations as per PHIPA. Providing dietetic assessment and/or treatment/intervention via remote technology is considered providing dietetic virtual care. Dietitians are expected to comply with all their existing professional expectations including those set out in relevant legislation, the Code of Ethics, and College Standards.

A registered dietitian demonstrates the standard by:

Understanding the limits to what can be communicated safely and how social media may make meaningful, client-RD communication more difficult. When interactions with clients become more complex and individualized, dietitians should consider providing communication options off social media. When general information is being provided, it should be clearly stated that the information posted is not intended to replace individualized dietetic advice [5].

5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf

Dietitians must maintain professional boundaries when interacting with clients with whom a client-RD relationship exists, persons associated with these clients, and dietetic learners via social media.

A registered dietitian demonstrates the standard by:

Considering the risks of dual relationships (e.g., compromised professional judgment and/or unrealistic client expectations) and the impact. Dietitians must not exploit power imbalances in the dietitian-client relationship or persons closely associated with them, and any relationship with dietetic learners (mentoring, teaching, supervising, or evaluating student learners) [7].

Practice Guidelines
 

Dietitians are encouraged to:

Consider context regarding professional boundaries. In smaller communities, dietitians may  be in the same social media networks as clients, or friends and family. Consider the type and length of care, and vulnerability of the client. The Boundary Guidelines provide guidance to dietitians when interacting on social media, advising dietitians to be mindful of sharing personal information and considering separating personal and professional communications.

7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media

 

Dietitians must avoid an actual or perceived conflict of interest that are not manageable by safeguards when using social media.

A registered dietitian demonstrates the standard by:

Complying with any applicable advertising laws, standards, and guidelines, including the Standards and Guidelines for Professional Practice – Conflict of Interest when advertising and promoting dietetic services on social media.


Practice Guidelines

Dietitians are encouraged to:

Be aware of potential conflicts of interest that could arise when a dietitian promotes products or services that are unrelated to dietetics through a social media account that identifies them as a dietitian. In addition, dietitians should carefully consider the endorsement of a specific brand or product. Principles of transparency, honesty, evidence-informed practice, professional judgment, and ethics should be considered.

Guiding Principles

Principle 1: Personal and Professional Use of Social Media

Generally, the College's interest lies in regulating actions performed within the scope of practice. There are times, however, when a dietitian's personal life can have potential implications for public protection and may be within the purview of the College for its public protection mandate. This could apply where a dietitian's actions impact professional ethics or public safety, whereby the College would have a legitimate public protection interest in regulating the behaviour. This commitment to public protection requires dietitians to be mindful of their professional practice at work, at home, and in public.
 
The Supreme Court of Canada has ruled that off-duty conduct can be considered in investigations and discipline, where a sufficiently negative impact on the profession and the public’s interest can be demonstrated [4]. Dietitians are responsible for balancing their responsibilities as regulated health professionals with their right to freedom of expression in their private lives [5,6]. While personal accounts can provide limited access through strong privacy settings, dietitians should consider that even private posts, or content and comments made in “private/closed” groups or via direct message may have the potential to be public and accessible to all and potentially subject to regulatory investigation and discipline.

4 Ross v. New Brunswick School District No. 15, 1996 CanLII 237 (SCC), [1996] 1 SCR 825, https://canlii.ca/t/1frbr
5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
6 Adapted from the College of Dietitians of Alberta (2020). Social Media Practice Guidelines. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2020/12/Social-Media-Practice-Guidelines-November-2020.pdf and Social Media, Virtual Care and Cross Border Practice. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2021/04/Chapter-14-Social-Media-Virtual-Cross-Border-Practice-20212.pdf

Principle 2: Professionalism and Social Media Conduct

Practising dietetics requires upholding the Code of Ethics, including beneficence (to do good), non-maleficence (do no harm), respect for persons/justice and respect for autonomy, all of which guide evidence-informed dietetic practice. Dietitians' interactions with clients and colleagues demonstrate values such as honesty, reliability, and compassion. Dietitians gain the trust of their clients, practising with cultural humility and providing culturally safe care. The same principles of professionalism used by dietitians in face-to-face communications apply to social media, including professional judgment and critical thinking.

Principle 3: Evidence-Informed Practice on Social Media

Employers, clients, and the public rely on a dietitian’s expertise to provide accurate and timely nutrition information.

Principle 4: Informed Consent, Confidentiality and Privacy on Social Media 

Dietitians have an ethical and legal obligation to maintain client confidentiality and privacy [2] and obtain informed consent from clients when providing services and interacting with clients using social media [5]. In many cases, consent may be implied when clients choose to engage in communication via social media [5].
Dietitians follow the Professional Practice Standard for the Consent to Treatment and for the Collection, Use and Disclosure of Personal Health Information. Dietitians exercise professional judgment to determine when informed consent can be expressed (oral or written) or implied.

Most social networking sites do not provide a secure platform for sharing confidential client information, such as personal health information.

2 Canadian Dietetic Regulatory Practice Advisory Network (2022). Social Media Guidelines. Unpublished.
5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf

Principle 5: Professional Boundaries and Social Media

Dietitians share food, nutrition and health information related to the dietetic scope of practice for educational or informational purposes. When using their professional designation or providing health-related info, dietitians are acting in a professional capacity.

Principle 6: Conflict of Interest and Social Media 
 
Dietitians always use professional judgment to keep clients, colleagues, the public and the professions’ obligations a priority [2]. A dietitian is in a conflict of interest when they consider their own (or someone else's) interests ahead of or instead of the interests of their client [9]. Given the casual nature of social media and the opportunities to market and advertise services and products, be aware of behaviours and actions that may lead to conflicts of interest. For more information on conflict of interest, refer to the Standards and Guidelines for Professional Practice: Conflict of Interest.

2 Canadian Dietetic Regulatory Practice Advisory Network (2022). Social Media Guidelines. Unpublished.
9 College of Dietitians of Ontario (2017). Standards and Guidelines for Professional Practice – Conflict of Interest. Retrieved from https://www.collegeofdietitians.org/resources/standards/standards-and-guidelines-coi.aspx

Principle 7: Advertising and Promoting Dietetic Services on Social Media

Social media provides opportunities for dietitians to promote their dietetic services. A group or an individual dietitian can create sites for various purposes such as describing nutrition services, sharing nutrition education and resources, summarizing recent nutrition research, and professional opinions. The College encourages professional advertising of dietetic services. When advertising, keep in mind the public’s best interest and apply safeguards to avoid conflict of interest.
 

Questions and Answers

The questions and answers provide information on how the expectations in the Social Media Standards and Guidelines can be met.

A) Can you describe what “professionalism,” and “reputation of the profession” means? How does the College determine this?  
A recent systematic review [10] sought to define professionalism in the dietetics profession for the purpose of teaching nutrition and dietetics. As noted by Dart et al. (2019), professionalism is central to safe and ethical dietetic care and crucial to maintaining trust from the public in healthcare providers. As such, trust is an important part of professionalism. Conduct on social media that undermines the public’s trust and confidence in the profession may impact client access to dietetic care and client care itself.
 
Generally, College Standards and resources, including the Code of Ethics and other professional resources such as the Integrated Competencies for Dietetic Education and Practice (ICDEP) [11] inform what is considered professional.
 
Professionalism is contextual. Concepts of equity, diversity, inclusion and belonging (EDI-B) are relevant to how professionalism has been defined and conceptualized, historically related to the cultural norms of dominant groups [12]. The College is committed to informed EDI-B action to minimize systemic barriers and build a more inclusive and equitable health system for all, including Indigenous peoples, immigrants, refugees, people who are racialized, people with disabilities and the 2SLGBTQIA communities.
 
To evaluate alleged dietitian unprofessional conduct or communication on social media and the impact on professional reputation, the College ensures that the complaints and reports process is fair, consistent, and unbiased. An EDI-B lens is applied to concepts of professionalism, including declaration of bias. Each complaint or report is handled on a case-by-case basis through a neutral, objective fact-finding process. For example, if a complaint arose about a dietitian’s alleged unprofessional conduct on social media, the complaint would be investigated based on the facts and circumstances of the case, including the performance expectations in the Social Media Standard & Guidelines using an evidence-informed approach. In addition, being a professional means practising while considering the following abilities [13].
  1. Being reflective and committed to safe, competent, ethical practice
  2. Practising integrity, cultural humility, honesty, diligence, respect and treating others fairly and equitably.
  3. Valuing dignity and worth of all persons regardless of age, race, culture, creed, sexual orientation, gender identity and expression, body weight, ableness and/or health status
  4. Complying with legal requirements and professional obligations
  5. Applying the principles of sensitive practice and functioning in a client-centred manner
  6. Working within areas of personal knowledge and skills
  7. Maintaining a safe work environment
  8. Maintaining personal wellness consistent with the needs of the practice
  9. Using an evidence-informed approach to your work
  10. Acting ethically, respecting autonomy, beneficence, non-maleficence, and respect for justice.
10 Dart, J., McCall, L., Ash, S., Blair, M., Twohig, C., & Palermo, C. (2019). Toward a Global Definition of Professionalism for Nutrition and Dietetics Education: A Systematic Review of the Literature. Journal of the Academy of Nutrition & Dietetics, 119(6), 957–971. https://doi.org/10.1016/j.jand.2019.01.007
11 Partnership for Dietetic Education and Practice (2020). Integrated Competencies for Dietetic Education and Practice (ICDEP). Retrieved from https://www.pdep.ca/library/PDEP-Policies/Integrated-Competencies-For-Dietetic-Education-And.aspx   
12 College of Physicians and Surgeons of Ontario (2022). Advice to the Profession: Social Media. Retrieved from https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media/Advice-to-the-Profession-Social-Media
13 College of Dietitians of Ontario (2022). Policy on Determining Currency Hours for Dietitians in Ontario. Retrieved from https://www.collegeofdietitians.org/CDO/media/CDO-2018/News/2022/2022-Policy-on-Determining-Currency-Hours-for-Dietitians-in-Ontario.pdf

B) What does practising dietetics on social media mean?  
Dietitians should exercise reasonable professional judgement to determine if they are practising dietetics on social media based on individual circumstances related to their specific role and practice setting. The definition of practising dietetics is quite broad and can include various practice areas and workplace settings.
 
As noted in the College’s definition of practising, dietetic practice can be in a paid or unpaid capacity (e.g., volunteer work) for which registrants use food and nutrition-specific knowledge, skills and judgment while engaging in:
  • the assessment of nutrition related to health status and conditions for individuals, groups and populations;
  • the management and delivery of nutrition therapy to treat disease;
  • the management of food services systems; building the capacity of individuals and populations to promote, maintain or restore health and prevent disease through nutrition and related means; and
  • the management, education or leadership that contributes to the enhancement and quality of dietetic and health services.
For greater clarity, dietetic practice includes the following activities:
  • Assessing, promoting, protecting, and enhancing health and the prevention of nutrition-related diseases in populations using population health and health promotion approaches, as well as strategies focusing on the interactions among the determinants of health, food security and overall health.
  • Conducting dietetic, health and evaluation research, product development, product marketing, and consumer education to develop, promote and market food and nutritional products and pharmaceuticals related to nutrition disorders or nutritional health.
  • Developing or advocating for food and nutrition policy.
  • Communicating food & nutrition information in any print, radio, television, video, Internet, or multi-media format. 
NB: This is an excerpt from the Definition of Practising Dietetics. Please see the link for complete details.
 
Professional liability insurance is mandatory for all College members who practise dietetics as defined in the College’s definition. Dietitians engaging in the practice of dietetics are responsible for confirming they have coverage that meets Section 15.1, College By-Law No. 1: General.

C) Can you elaborate on (Principle 2, Standard 2 i) “Dietitians must conduct themselves respectfully and in a professional manner that does not impact the delivery of quality dietetic services, the safety or perceived safety of others while using social media.” What is meant by safety or perceived safety? Someone might feel or perceive that they are unsafe (e.g., at danger, risk, or harm) by viewing photos, videos, posts or comments that contain disrespectful, insulting, intimidating, humiliating, or abusive language and/or content. Examples may include bullying, attacking, harassing, and making comments that may be, or are perceived to be, disparaging to others, unsubstantiated and/or defamatory [3], hate speech (related to race, ethnicity, religion, gender, sexual orientation, age, social class, economic status, disability, weight, or level of education), or discriminatory (e.g., racism, transphobia, sexism). Dietitians should consider various population groups they interact with, and how social media can impact initiatives relating to mental health, anti-racism, health equity, etc.
 
An example may include posting disparaging comments about a person who follows a specific diet (whether it is evidence-informed or not). Disparaging statements (made in jest or not) could subject a person to potential risk or harm. Dietitians have an obligation to maintain a professional presence when posting and providing advice as a dietitian, as it reflects on them and the profession.
 
Dietitians may consider developing strategies on how to respond to followers/clients’ comments and reflect on how their communications represent the profession and its credibility.

3 College of Dietitians of Ontario (2021). Dietetic Practice and Social Media. Retrieved from https://www.collegeofdietitians.org/practice-advisory/jurisprudence-professional-practice-resources/virtual-care,-social-media-technology/dietetic-practice-and-social-media.aspx

D) Principle 3, Standard 5 i. speaks to avoiding posting information that is “misleading, deceptive, inappropriate or harmful. Information must be supported by best available evidence [7] and be consistent with the principles of equity, diversity, inclusion and belonging (EDI-B).” Can you elaborate? It may be helpful to explain this with an example. Consider how dietitians respond to client comments on social media with cultural humility*. Clients may approach their own health and wellness, food and nutrition in various ways. Dietitians may need to learn and unlearn to honour and respect client knowledge and ways of knowing.

Cultural or Indigenous ways of knowing refers to how cultures develop diverse worldviews over time. There is no single way of “knowing,” and different cultures may approach knowledge in different ways [15]. There is much complexity and diversity in people’s experiences and lived realities.
 
By embedding EDI-B and client-centred care in practise, dietitians seek to understand, honour and recognize client approaches to their own health and wellness as legitimate and integral, particularly in the context of Indigenous clients. In responding to any social media posts, dietitians consider this complexity.
 
Evidence-informed practice, as noted in the ICDEP, “brings together the best available research evidence and the dietitian’s experiential knowledge, along with the client’s preferences, context, and available resources.” Evidence-informed practice places emphasis on the client – their contributions, preferences, experiences, culture and traditions, and more. It is beyond the scope of this Standard to provide detailed guidance on how dietitians implement evidence-informed practice while addressing the complex needs of their clients, however, dietitians should consider the limitations of evidence-informed practice, which may not always consider the context, traditions and ways of knowing from less dominant groups. Dietitians acknowledge systems and worldviews (e.g., Positivism, Western worldview) through which they approach their practice, recognizing the importance of all forms of knowledge, which includes cultural perspectives, and Indigenous/traditional knowledge (e.g., ways of life, healing and/or educational experiences) for client practices and an awareness of the complexity and diversity of the experiences and lived realities of clients. 
 
Dietitians may consider the following as they work towards the process of reconciliation – naming the knowledge system (s) from which they are working when appropriate, not immediately prioritizing or privileging Western knowledge systems or worldviews and not giving feedback on practices or approaches in a way that is biased or centered only on dominant views.
 
*Cultural humility: “a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.” (First Nations Health Authority (n.d.). Retrieved from: https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/cultural-safety-and-humility).

7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media
15 Stinson, J. (2018). What are Indigenous and Western Ways of Knowing? Retrieved from https://www.criaw-icref.ca/images/userfiles/files/Fact%20Sheet%202%20EN%20FINAL.pdf


E) Can you clarify what is meant by cultural safety and cultural humility (Principle 2) via social media use? Dietitians can embed EDI-B through social media use by committing to practising in a manner that promotes cultural humility and cultural safety.
 
Although definitions may vary in the literature, for this document, practising cultural humility involves self-reflection, curiosity and adopting a learner’s mindset to understand the experiences of another person [12,13]. Cultural humility includes empathy and respect, practicing in a client-centred manner and being open to the experiences, preferences and worldviews of clients and colleagues. It also means being aware of one’s position and privilege [13].
 
Culturally safe care, as defined in the ICDEP [11] is an outcome based on respectful engagement when power imbalances are recognized and addressed in the provision of dietetic care. Free of racism and other discrimination, clients, colleagues, and students should feel safe receiving and/or working with and accessing care from dietitians and dietitians should be safe and respected providing care [12,13].

Dietitians should be aware that conduct on social media (which may include liking, sharing, and/or commenting on content) and unprofessional comments and/or behaviour can impact safety and trust for clients and the public, potentially impacting willingness to access care and/or create harm.

11 Partnership for Dietetic Education and Practice (2020). Integrated Competencies for Dietetic Education and Practice (ICDEP). Retrieved from https://www.pdep.ca/library/PDEP-Policies/Integrated-Competencies-For-Dietetic-Education-And.aspx   
12 College of Physicians and Surgeons of Ontario (2022). Advice to the Profession: Social Media. Retrieved from https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media/Advice-to-the-Profession-Social-Media
13 College of Dietitians of Ontario (2022). Policy on Determining Currency Hours for Dietitians in Ontario. Retrieved from https://www.collegeofdietitians.org/CDO/media/CDO-2018/News/2022/2022-Policy-on-Determining-Currency-Hours-for-Dietitians-in-Ontario.pdf

F) How might dietitians approach potential or actual clients who are contacting a dietitian inappropriately (repeatedly or offensively) on social media? Dietitians may consider developing their own code of conduct and/or social media policy and/or protocols/procedures for their practice [5]. Standard 3, i., may help guide expectations. Dietitians may develop a strategy for how to respond to a client/potential client and what steps may occur based on the communication or behaviour (i.e., notification, blocking, etc.). A code of conduct, policy, protocol, or procedure may include how to deal with public relations issues and how negative comments will be responded to.

5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
 

Social Media Practice Scenarios

Please review the Social Media Standard and Practice Guidelines prior to reviewing the Social Media Practice Scenarios.
 
There are no simple answers to these scenarios.
 
The scenarios provide accompanying guiding questions, applying the principles from the Standard and Guidelines. This provides an example of how dietitians can apply the Standards and Guidelines personally and professionally in relation to social media use.

Scenario 1: TikTok Trouble 

Together with colleagues, some dietitians have used Tik Tok at their local hospital to post collaborative team dances of healthcare providers in their uniforms during the pandemic. However, one dietitian has created their own videos using the tag name “Dietitian Dilemmas.” The dietitian has been complaining about a staff member on TikTok video reels and has frequently complained that the staff member is “ignorant” and that they do not have a good relationship with them. There are also posts about clients who are “difficult,” albeit anonymously. The dietitian has also commented negatively about their employer on TikTok video reels.
 
Considering the principle of professionalism and social media conduct and apply the following guiding questions:
  1. Is the dietitian practicing dietetics?
  2. Is this a professional account? If so, is the dietitian identifiable (via name and designation)? For example, even if using a separate tag name, does the dietitian’s professional designation and same name appear somewhere on their profile?
  3. How can this dietitian’s social media presence impact the public’s perception of the dietitian and the profession, including diminishing the dietitian’s credibility and the public’s trust and confidence in the profession?
  4. Could any content/comments be perceived as offensive, discriminatory, or disrespectful? Is the post true? Is it helpful?
  5. Has the dietitian used appropriate organizational/communication channels to discuss, report and resolve workplace or other professional issues?
  6. While disagreements or conflicts can arise in professional practice, is the dietitian acting respectfully towards her colleagues and clients?

Scenario 2: Tricky Tweets

A dietitian uses their name and designation on Twitter and provides advice on all sorts of topics (often not dietetic related). One post covers the topic of essential oils for healing, and the next is about antioxidants to boost immunity and “prevent infections.” Tags include “Immunologist RD.”  Links to other materials provided appear inaccurate and unreliable.
 
Consider the principles of evidence-informed practice and apply the following guiding questions:
  1. Is the information shared evidence-informed (i.e., accurate, current, appropriate) and not misleading, deceptive, inappropriate, or harmful?
  2. What are the limits of the dietitian’s knowledge and skill?
  3. Does the dietitian misrepresent their qualifications when sharing content related to food and nutrition?
  4. Is there an inappropriate use of a term, title or designation in respect of a dietitian’s practice (i.e. using a term or implying specialization or certification)?
  5. Are links to other information and resources in posts current, accurate and reliable?

Scenario 3: Oversharing on FB?

A dietitian shares a client case through a private Facebook group open only to other dietitians and dietetic students. The case is complex, and the dietitian appreciates gathering insights on the client’s clinical management from other dietitians. Through several posts, the dietitian provides details, including the personal health information of the client (e.g., medical diagnosis, lab results, and health history). However, they do not share any demographic info, nor the client’s name. The dietitian practices in a small community and in a less common area of dietetic practice. A dietetic student in the group recognizes the content and believes the case is about their aunt.
 
Consider the principles of informed consent, confidentiality and privacy and apply the following guiding questions:   
 
  1. Has the dietitian de-identified information or obtained client express informed consent for disclosure and publication via social media?
  2. If obtaining express informed consent from clients or their substitute decision-maker (SDM) to collect, use and disclose personal health information on social media, has the dietitian showed the client the content to be posted on social media, including informing the client that consent can be withdrawn at any time? Have any risks of the content and information such as the purpose, where it will be posted, and any other relevant information used be provided?
  3. Although the content and comments are made in a “private/closed” group, do the posts have the potential to be public and accessible to all?

Scenario 4: Negative Reviews

A client posts a negative review of a dietitian’s service via an online review website and writes comments about the dietitian, some of which are untrue. The dietitian is upset and feels somewhat vulnerable. The dietitian is ready to type up their post, then pauses and reflects.
 
Consider the principles of the Social Media Standard and Practice Guidelines and apply the following guiding questions:
 
  1. Has the dietitian evaluated the situation? Consider the quality of the care provided to the client and assess any issues the client describes in the review.
  2. Is there any content posted by the client that may be insulting, inaccurate or misleading? How can the dietitian’s response be consistent with the Code of Ethics, Standards of Practice, principles of equity, diversity, inclusion and belonging (EDI-B)? How can the dietitian’s response provide accurate information that is evidence-informed?
  3. Would contacting legal counsel for advice be warranted in this situation?
  4. Can the dietitian contact the website to request a correction or deletion?
  5. Would responding to the post be helpful? If posting a response, does the response ensure confidentiality (i.e., responding either directly to the client if they are known, or by providing a general response for public viewing, carefully considering what should be included (e.g., what care you strive to provide, how you deal with client concerns generally, etc.)?
  6. In what ways can the dietitian’s entire professional profile help to build a positive online presence?
  7. In what ways, if any, can the client’s experience be improved? How does the dietitian foster client feedback and act on suggestions?

Scenario 5: “Liking” the wrong post?

A dietitian who is passionate about plant-based diets and animal rights gets into a highly debated online discussion with a PhD who cites research about animal foods. One participant in the thread makes a defamatory comment toward the professor. The dietitian “likes” the post.

 Consider the principles of the Social Media Standard and Practice Guidelines and apply the following guiding questions:
  1. Is the dietitian practicing dietetics?
  2. Is this a professional account? If so, is the dietitian identifiable (via name and designation)? For example, even if using a separate tag name, does the dietitian’s professional designation and the same name that appear somewhere on their profile?
  3. If using a professional account, could a “like,” “follow,” “thumbs-up,” or reaction be perceived as an endorsement of the post?
  4. If this is not a professional account, could this conduct sufficiently have a negative impact on the profession and the public’s interest?
  5. How can this dietitian’s social media presence impact the public’s perception of the dietitian and the profession, including diminishing the dietitian’s credibility and the public’s trust and confidence in the profession?
  6. Could any content be perceived as offensive, discriminatory, or disrespectful?
  7. Is the dietitian acting respectfully?

Scenario 6: Hanging out on Messenger

A dietitian supervises practicum students and sends messages to them on Facebook Messenger and Instagram Direct Message.
 
Consider the principles of professional boundaries and apply the following guiding questions: 
  1. Is this a professional or personal account?
  2. Is professional language used?
  3. Has the preceptor maintained professional boundaries (consideration of power imbalances in the dietitian-student relationship)?
  4. When interacting with clients/students, is the dietitian using electronic communication and social media to enhance the student’s learning or for personal reasons?

References

1 Merriam Webster Dictionary (2022). Social Media. Retrieved from https://www.merriam-webster.com/dictionary/social%20media
2 Canadian Dietetic Regulatory Practice Advisory Network (2022). Social Media Guidelines. Unpublished.
3 College of Dietitians of Ontario (2021). Dietetic Practice and Social Media. Retrieved from https://www.collegeofdietitians.org/practice-advisory/jurisprudence-professional-practice-resources/virtual-care,-social-media-technology/dietetic-practice-and-social-media.aspx
4 Ross v. New Brunswick School District No. 15, 1996 CanLII 237 (SCC), [1996] 1 SCR 825, https://canlii.ca/t/1frbr
5 Adapted from the College of Dietitians of British Columbia (2021). CDBC Social Media Guidelines. Retrieved from https://collegeofdietitiansofbc.org/wp-content/uploads/2021/08/Social_Media_Guidelines.pdf
6 Adapted from the College of Dietitians of Alberta (2020). Social Media Practice Guidelines. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2020/12/Social-Media-Practice-Guidelines-November-2020.pdf and Social Media, Virtual Care and Cross Border Practice. Retrieved from https://collegeofdietitians.ab.ca/wp-content/uploads/2021/04/Chapter-14-Social-Media-Virtual-Cross-Border-Practice-20212.pdf
7 Adapted from the College of Physicians and Surgeons of Ontario (2021). Social Media – Policy. Retrieved from http://policyconsult.cpso.on.ca/wp-content/uploads/2021/06/Social-Media-Draft-Policy.pdf and https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media
8 Libel and Slander Act, RSO 1990, c.L.12. Retrieved from https://www.ontario.ca/laws/statute/90l12
9 College of Dietitians of Ontario (2017). Standards and Guidelines for Professional Practice – Conflict of Interest. Retrieved from https://www.collegeofdietitians.org/resources/standards/standards-and-guidelines-coi.aspx
10 Dart, J., McCall, L., Ash, S., Blair, M., Twohig, C., & Palermo, C. (2019). Toward a Global Definition of Professionalism for Nutrition and Dietetics Education: A Systematic Review of the Literature. Journal of the Academy of Nutrition & Dietetics, 119(6), 957–971. https://doi.org/10.1016/j.jand.2019.01.007
11 Partnership for Dietetic Education and Practice (2020). Integrated Competencies for Dietetic Education and Practice (ICDEP). Retrieved from https://www.pdep.ca/library/PDEP-Policies/Integrated-Competencies-For-Dietetic-Education-And.aspx  
12 College of Physicians and Surgeons of Ontario (2022). Advice to the Profession: Social Media. Retrieved from https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Social-Media/Advice-to-the-Profession-Social-Media
13 College of Dietitians of Ontario (2022). Policy on Determining Currency Hours for Dietitians in Ontario. Retrieved from https://www.collegeofdietitians.org/CDO/media/CDO-2018/News/2022/2022-Policy-on-Determining-Currency-Hours-for-Dietitians-in-Ontario.pdf
14 College of Occupational Therapists of Ontario (2022). Culture, Equity, and Justice in Occupational Therapy Practice. Retrieved from https://www.coto.org/docs/default-source/culture-equity-justice/coto-culture-equity-and-justice-in-occupational-therapy-en.pdf?sfvrsn=4392a2c6_16
15 Stinson, J. (2018). What are Indigenous and Western Ways of Knowing? Retrieved from https://www.criaw-icref.ca/images/userfiles/files/Fact%20Sheet%202%20EN%20FINAL.pdf
16 Swidrovich, J. (n.d.). Evidence-Based Medicine Through an Indigenous Lens. Webinar. Canadian Pharmacists Association. Retrieved from https://www.pharmacists.ca/cpha-ca/assets/File/education-practice-resources/WebinarSlideDeck/2019/EvidenceBasedMedicinethroughanIndigenousLens.pdf

 

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