Skip to content

Healing Tool Series: Starting the Conversation on Diet

A brief screening instrument designed for non-dietitians in clinical practices for assessing patients’ diet and guiding nutritional counseling.

“Healing Tools” summaries are a collection of evidence-based resources to help providers and patients use integrative health approaches to improve health and wellbeing.

This tool is for: Providers

This tool was created by: The Center for Health Promotion and Disease Prevention, at the University of North Carolina at Chapel Hill


What is this tool for?

Nutritional counseling in primary care can help patients prevent or manage chronic diseases, and even small changes can significantly improve health. Yet, providers rarely discuss nutrition with their patients, largely due to the lack of a fast, simple way to assess diet and guide counseling.,

Starting the Conversation on Diet is a free, brief screening tool for primary care providers to assess patients’ diet and to guide nutritional counseling. The eight-item dietary assessment focuses on dietary patterns that impact the development of chronic diseases. It is available in English and Spanish.

How can providers use this tool?

Providers can use Starting the Conversation on Diet:

  • Before seeing the patient, with administration by a medical assistant or as part of the initial assessment
  • As part of the pre-screening paperwork that the patient completes online or in the waiting room

How does this contribute to an integrative approach?

Combining conventional medicine, self-care, and complementary and alternative medicine can help patients achieve optimal healing and health. Nutritional counseling enables patients to play a key role in self-care and can help them prevent or slow the progression of chronic diseases.

What does the evidence say about this tool?

With funding from the National Institute of Diabetes and Digestive and Kidney Diseases, researchers at the University of North Carolina at Chapel Hill, Oregon Research Institute, and Institute for Health Research, Kaiser Permanente, Colorado developed and assessed Starting the Conversation on Diet.

Researchers at the University of North Carolina at Chapel Hill created the instrument, along with North Carolina Prevention Partners.


The researchers reported the following findings, based on data from 463 patients with diabetes who participated in a self-management intervention study in the primary care setting, in the American Journal of Preventive Medicine:

  • The eight items in Starting the Conversation on Diet and the summary score performed well.
  • “The tool identified healthful and unhealthful dietary behaviors in a diverse sample, indicating the measure’s feasibility for use in public health and primary care settings.”
  • The tool “was robust across a variety of participant characteristics, was stable over time in the absence of treatment, was sensitive to treatment, and was a reasonably valid measure of dietary intake compared to the previously validated dietary-fat–focused NCI screener.”

The researchers concluded:

“The brief STC is a relatively simple, valid, and efficient tool for dietary assessment and intervention in the clinical setting.”

JAMA mentions Starting the Conversation on Diet

A viewpoint article in JAMA about nutritional counseling in clinical practice mentions Starting the Conversation on Diet as one step clinicians can take to add nutritional counseling in their daily practices.

What are the drawbacks to using this tool?

While Starting the Conversation on Diet is fast and simple, using the tool and providing nutritional counseling does take time. This tool does not provide a comprehensive dietary assessment and so may be less accurate than more comprehensive tools.

Who created this tool?

Researchers at the University of North Carolina at Chapel Hill’s Center for Health Promotion and Disease Prevention and North Carolina Prevention Partners created Starting the Conversation on Diet.  The center, a CDC Prevention Research Center, collaborates with communities to conduct research, provide training, and translate research findings into policy and practice.

North Carolina Prevention Partners, which advocated for prevention policies and practices, closed in 2017.

For more information, see full article  and PowerPoint. 


At Healing Works Foundation, we believe that achieving optimal health and wellbeing requires an integrative health approach—one that combines and coordinates conventional medicine, self-care, and complementary and alternative medicine.

Translating Evidence into Action

The goal of these summaries is to help providers and patients learn about and access evidence-based integrative health tools.


Healing Works Foundation is a nonprofit organization and does not profit from any of the tools featured in these summaries.

Patients: Contact your provider before starting any new health program.  Show him/her these resources.

Share This
Back To Top