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Assessing themost-in-need leadership skills among community nutrition managers:

A qualitative exercise in Iranian health system Correspondence to:

Azadeh Davari School of Leadership and Education Sciences, University of San Diego, 5998 Alcala Park, CA 92110, USA [email protected] Azadeh Davari 1and Arash Rashidi 2 1School of Leadership and Education Sciences, University of San Diego, Alcala Park, CA, USA; 2National Nutrition and Food Technology Research Institute, and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Abstract Community nutrition is a multi-disciplinary and inter-sector branch of nutrition sciences, which sig- nificantly relies on multi-stakeholder understanding, collaboration, and action. In most countries, com- munity nutrition professionals operate within the larger governmental health system. Therefore, com- munity nutrition managers are not only supposed to fulfill their responsibilities within the health system, but also advocate, coordinate, and supervise for multi-disciplinary initiatives and activities. The diverse set of responsibilities and tasks requires high levels of commitment (confidence and motiv- ation) and leadership skills, besides technical com- petencies, among the target group. In this study, leadership requirements and most-in-needcapacity building necessities of community nutrition man- agers were derived from analyses of their latest role statements andsemi-structured interviews, made with four senior health policy leaders (key informants). Analysis of the role statement showed necessity of almost every leadership skill for the fulfillment of responsibilities. Similar leadership requirements emerged from key informant inter- views. The interviews also revealed that commit- ment and a number of leadership competencies, such as effective communication and team working skills, are highly in need, and must seriously be considered. Meanwhile, these skills are mainly in the inter-personal and organizational leadership domains. This study may argue, therefore, that aspects of self-leadership competencies, described as mental models and personal mastery elements by Senge, are somewhat masked by other aspects of leadership. According to the key infor- mants, leadership competencies could be devel- oped and flow in the system through organizing training courses for human resource professionals, as well as accurate selection of candidates for managerial positions andfacilitating on-the-job experiencing.

Keywords: Leadership competencies, Leadership skills, Work performance, Community nutrition, Needs assessment, Educational need The nutrition sector in a society relies on intra- and inter-disciplinary cell-to-society sciences and prac- tices. 1While some nutrition professionals work at the cellular /molecular level, other practitioners may work within other contexts such as the clinical, community, business, and policy levels. 2There is a need for understanding and teamwork between those who work at different levels and who have different sub-specialties, as well as between the nutrition sciences, in general, and other fields, which, together, determine the availability of, and the processes for purchasing, selecting, and consum- ing, food. 1 Only through a multi-stakeholder process will a society insure the nutritional well- being of its members. 3 Community nutritionists are nutrition professionals who have been trained and have the responsibility to assess, analyze, and take action for improving the nutritional status of any given subgroup in a society. They fulfill their tasks and responsibilities mainly through advocacy and facilitating multi-sta- keholder collaboration and coordination. In Iran, most community nutrition services are delivered through the country ’s health system; system services are supposed to be the translations of updated 18 © W. S. Maney & Son Ltd 2016 DOI: 10.1179 /2047971915Y.0000000023 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 technical knowledge and state-of-the-art infor- mation about different nutritional issues.

Universities, therefore, are expected to develop and monitor curricular programs, which build necessary technical competencies in graduates who will work in health system.Community nutrition professionals must be equipped with certain important general capabili- ties, including leadership skills. 4 –6 It is exceedingly important that a community nutritionist be empow- ered to fulfill key leadership-related tasks such as trust building, promoting collaboration with and coordination between and among different stake- holders, advocacy, and motivating the public to embrace nutritional practices. In general, many degree programs at the majority of universities all around the globe are heavily focused on developing just technical knowledge and skills. Consequently, the development of many general competencies related to such matters as leadership is not on the agenda of universities, which do not yet think out of the ‘science-research’ box. This general fact applies to the undergraduate and graduate programs in nutrition sciences in Iran. Therefore, while Iranian nutrition alumni and professionals might be considered highly competent in the technical aspects of the discipline, their lea- dership knowledge and capabilities are quite limited, as has been frequently noted by the experts and officials in both academia and at the ministerial level. 2,7 There is another challenging issue that further hampers the activities and performance of the com- munity nutritionists: more than 80% of them are female, in a culture that historically has been male- dominant. Gender inequity often means that com- munity nutritionists have lesser voice, power, and opportunities (e.g. authority /management pos- itions) to contribute to decision-making processes in different sectors and organizations. The health system is not an exception. In addition, female nutri- tionists who work for the health system are also often challenged by some of organizationally ‘ superior ’biomedical professionals such as medical doctors and pharmacists. As a result of both gender-based and role status, women commu- nity nutrition professionals frequently experience diminished respect, lowered work satisfaction, and less power and influence, resulting in the insuffi- ciency in the nutrition sector. 8 This gulf that currently exists between the need for community nutritionists to exercise leadership and their ability to do this can partly be bridged by the administration of tailor-made capacity build- ing programs. 5,9,10 Such programs, however, currently are absent in Iranian academic curricula of the current nutrition programs, as well as the training programs within the health system. Such capacity building programs should be built on the foundation of ‘real ’and ‘felt ’needs among the target audience. I define ‘real ’needs as those which are recognized by the system monitoring and analysis. The ‘felt ’needs, from other side, are those needs which are perceived and expressed by the target group itself. There has been a pressing need to study and deter- mine leadership educational needs of managers who lead provincial community nutrition departments.

Each department is affiliated with a medical univer- sity, the major health system operator in each province throughout the country. The nutrition department is mainly responsible to manage nutrition programs in the several districts under its geographical /territorial coverage. The study will, therefore, focus on the per- ceived leadership skill needs among the 45 commu- nity nutrition managers working at the 45 medical universities dealing with health issues in the 30 pro- vinces throughout the country.

Aims and questions The purpose of this study was to investigate the per- ceived educational needs of the community nutri- tion professionals who worked for the health system and acted as the provincial managers of nutrition departments and programs. The following research questions guided the study:

1. According to the job descriptions (role state- ments), what leadership skills do community nutrition managers need in order to be suc- cessful in the Iranian health system?

2. According to those interviewed, what leader- ship skills do community nutrition managers need in order to be successful in the Iranian health system?

3. According to those interviewed, what leader- ship skills are most in need of development among community nutrition managers in the Iranian health system?

This study had also a number of other applied aims, including sensitizing interviewed nutrition policy-makers to the issue of leadership develop- ment among community nutrition managers, pro- vision of data to design a complementary quantitative study to find out ‘felt ’leadership needs among community nutrition managers, and to develop a tailor-made training program for the target audience. Davari and Rashidi –Leadership requirements among community nutrition managers 19 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 Methodology The needs assessment was conducted through ana- lyzing the role statements of community nutrition managers and through long-distance interviewing of a small group of key informants (KIs) who had in-depth knowledge about the community nutrition managers’roles and tasks in the Iranian health sector, as well as their expected and current per- formance levels.

Underpinning theories The theory discussed by Senge 11 in his book The Fifth Discipline was used as the conceptual frame- work for this study. Based on this theory, learning organizations are organizations where people strive to create the results they desire by increasing capacity, nurturing new ways of thinking, and working together toward a shared vision. Senge identifies five essential elements within a learning organization: system thinking ,personal mastery , mental models ,shared vision , andteam learning .

System thinking involves a way of thinking and explanation language for understanding forces and interactions that control a system ’s behavior.

Personal mastery involves creation of an enabling environment and expansion of personal capacities to create desirable outcomes toward the goals.

Mental models involve continuous reflection upon, analysis, clarification, and improvement of internal pictures of the world by each employee within organization to improve personal actions and decisions. Shared vision involves commitment and shared image within a workgroup of desired future as well as general agreement on principles and guiding practices to support journey to such future. Team learning involves relevant thinking skill, which enables a working group to develop col- lective intelligence and ability greater than sum of members ’talents and performance.

Within each element, there are leadership skills or competencies demonstrated by the individuals in the organization. For example, behaviors such as being open to criticism, admitting mistakes, seeking feedback, and empowering their employees to make decisions and take risks are competencies that leaders exhibit when committed to the goals of the organizations. 12 Senge ’s theory has been applicable to different organizational settings. 12,13 Design A multi-method design was employed in this research. The study ’s design was focused on collect- ing and analyzing two data sources of relevant legal document and KIs interviews. The legal document which was analyzed in this study was the latest update (September 2014) of the role statements of community nutrition man- agers working for the health sector in Iran. For the exploration of the leadership skill needs, in-depth semi-structured interview with open- ended questions was deemed most appropriate.

The semi-structured design gave the KIs respect as well as flexible time to express their diverse opinions.

Sites and participants The latest draft of the role statement draft for com- munity nutrition managers covers all responsibil- ities and tasks which are expected to be fulfilled by the target group. To fulfill responsibilities and tasks, a community nutrition manager needs pos- sessing and practicing a wide range of technical as well as managerial and leadership competencies. The KIs were four knowledgeable experts from academy (Professors) andnational policy-level leaders at the Ministry of Health. They were selected through a combination of purposeful and conven- ience sampling methods. The KIs ’diversity in edu- cation backgrounds, age, and gender maximized the data triangulation. They all, however, shared an extensive understanding of the community nutri- tion function in Iran. To increase data triangulation, as mentioned by Denzin, 14 we had decided to include one retired KI. This approach could extend the analysis of community nutrition status in the health system in Iran to a 35-year time frame.

There was no interviewee ’s drop out. The KIs group is shown in Table 1.

Data collection Analysis of the job description of community nutrition managers : The latest role statement of community nutrition managers was obtained from Iranian Ministry of Health.

In-depth semi-structured interviews : The KIs were invited to participate in an open-ended interview.

All the KIs positively responded to the invitation.

The interviews, in Persian language, were made at pre-arranged times, and upon getting an oral informed consent from each interviewee.

The interview protocol was focused on the leader- ship requirements, current leadership competencies, and the areas needing improvement among the community nutrition managers. Detailed notes were taken in Persian language. All interviews took between 26 and 43 minutes (average 37 minutes), depending on the interviewees ’avail- ability and desire to explain in details. Davari and Rashidi –Leadership requirements among community nutrition managers 20 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 The semi-structured format of the interview allowed interviewers to raise probing questions.

The list of guiding questions is found in Table 2.

There was no follow-up interview.

Data analysis An analytical framework approach, as described by Patton, 15 was used to organize and report the data.

For this purpose, the interview protocol was orga- nized question-by-question in order to make the comparisons. This approach could show the poss- ible convergence ,inconsistency , andcontradictory aspects of opinions resulted from data triangulation in the study. 14 The priori categories and codes were extracted and listed in the codes book, based on four sources of research and interview questions, the available literature, 5,16 and Senge ’s theory. 11 Responsibilities and tasks ,basic leadership requirements , most-in-need leadership skills , anddevelopment method were determined as categories. The codes emerged from analyses of the role statements and interview transcripts, and codes collected during the study process were used to finalize categories. Results Review of the role statements of community nutri- tion managers shows a diverse set of responsibilities and duties (Table 3). Disaggregated task analysis shows a complete portfolio of leadership skill requirements (right column) for the target group, to be able to fulfill their tasks. Needless to say, there are a number of common skills between differ- ent task categories, such as holistic thinking and practice, trust building, team working, and effective communication. A general consensus was found among the KIs regarding responsibilities and duties of community nutrition managers. However, it was shown that they had mainly focused on managerial aspects of tasks, including planning and organizing, budget- ing and staffing, and control and problem solving. 17 For example, Paul counted the responsi- bilities as:

For sure, one of the main tasks [of community nutrition managers] is to detect nutrition pro- blems in different community sub-sectors, and to take action in order to solve them; moreover, they must educate the community; they should continuously come up with innovative ideas for solving problems; furthermore, they must feed- back so that we can improve our policies and Table 2: List of guiding interview questions Opening 1. In what capacity do you know the nutrition component of the health system in Iran?

2. Which nutrition policy and programs have you been involved in throughout your career?

Main 3. What are the main roles and tasks of provincial community nutrition managers?

4. What do you think, in general, about the task fulfillment by provincial community nutrition managers in Iran? Do they perform properly?

5. If not, how can they fulfill the tasks or better perform? Any non-technical knowledge or skill requirement?

Which general or leadership knowledge and skills?

6. What leadership skills do they need most in your opinion?

7. How can they acquire the skills?

Closing 8. Any additional remarks? Table 1: KIs participated in the long-distance interviews Interviewee Name* Description 1 Paul University Professor; one of the most influential senior leaders and policy-makers in more than three decades in Iranian health system; with active engagements in diverse sets of community health policies and programs.

2 Peter University Faculty; with long policy and management experience at vice-deputy and Director General levels in the last 30 years in Iranian health system.

3 Juliette Retired Director General at Iranian Ministry of Health; one of the most influential nutrition authorities in 1990s and early 2000s.

4 Sara Present Director General at Iranian Ministry of Health; a senior staff for many years, with bottom-line knowledge about nutrition programsandhuman resource working at provincial level.

*All names in the article text related to interviews are pseudonyms. Davari and Rashidi –Leadership requirements among community nutrition managers 21 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 programs; and of course, they should be able to build good connections with others.

Similar notion was made by Juliette, as she said: These [community nutrition managers] are pro- fessionals whom must find out nutritional problems [in the community] and report them; they are supposed to implement, monitor and evaluate those nutrition policies and programs which have been notified to them from the top, or have been developed locally; they must be able to advocate, be able to effectively network with other food security stakeholders, and be able to properly Table 3: Role statements of community nutrition managers and their leadership skill requirements Task category Duties Leadership skill requirements 1 Planning 1. Situation analysis of food and nutrition security, detection and prioritization of nutrition problems within university territory 2. Development of periodical plan of action in collaboration with program stakeholders to improve nutrition and food security (according to the goals and targets in National Document on Nutrition and Food Security) Holistic thinking and practicing, creating shared vision, multi- stakeholder coordination /aligning, trust building, team working, networking, effective communication, and advocacy and lobbying 2 Organizing of the processes 3. Improving nutrition and growth in children 4. Improving nutrition in adolescents and students 5. Improving nutrition in youth 6. Improving nutrition in pregnant and lactating women 7. Improving nutrition in middle-age population 8. Improving nutrition in elderly 9. Improving nutritional knowledge and culture in the community 10. Controlling and preventing of micronutrients 11. Nutritional management during disasters 12. Improving nutrition in group facilities (restaurants, factories, etc.) 13. Controlling and preventing overweight and obesity 14. Nutritional management in different health conditions /diseases Holistic thinking and practicing, multi-stakeholder coordination / aligning, trust building, team working, creativity, effective communication, crisis resolution, advocacy and lobbying, and networking 3 Human resource (training and capacity building) 15. Contribution in needs assessment, development of training modules, and organizing educational courses for the nutrition staff at headquarters andthe first executive level of the healthcare system affiliated with Medical Universities 16. Contribution in healthy nutrition education and information sharing in community /public 17. Coordination and organizing educational and refreshing courses on nutrition for intra-sector staff Empowering others, inspiring, motivating others, effective presentation, public speaking, and networking Continued Davari and Rashidi –Leadership requirements among community nutrition managers 22 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 Table 3:Continued Task category Duties Leadership skill requirements 4 Monitoring and evaluation (M&E) 18. Developing comprehensive program of M&E of community nutrition programs at Medical Universities 19. Supervision and monitoring of nutrition programs in affiliated units within Medical Universities 20. Follow-up to and supervising proper implementation of decisions made at Provincial Council on Health and Food Security (PCHFS), as well as reporting implementation process of decisions 21. Evaluating provincial nutrition programs, reporting program progress, and providing feedbacks to revise programs Team working, advocacy, effective presentation, written communication, creativity, and effective feedback 5 Intra- and inter-sector coordination 22. Building an inter-sectorial working group on nutrition and food security in order to operationalize the National Document on Nutrition and Food Security at provincial level 23. Development of agenda and strategy drafts for nutrition improvement among target groups to be discussed at PCHFS 24. Collaborating in and managing national food fortification programs in the area 25. Finding and approaching non- governmental organizations, especially charities, and facilitate their contribution and involvement in nutrition interventions for vulnerable groups 26. Facilitating contribution and support of other sectors and organizations (such as IRIB, Ministry of Education, and Ministry of Agriculture) toward implementation of nutrition programs 27. Facilitating intra-sector coordination for the nutrition programs Holistic thinking and practicing, creating shared vision, trust building, team working, multi- stakeholder coordination /aligning, effective presentation, motivating others, networking, and fund raising 6 Reporting and documentation 28. Collecting and analyzing data and information, and regular preparation of periodical executive reports according to policies and plan of actions 29. Preparing regular reports on food security situation at province level to update PCHFS and Department of Nutrition in the Ministry of Health Advocacy and written communication Continued Davari and Rashidi –Leadership requirements among community nutrition managers 23 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 communicate with people and local policy- makers in a way that everybody can under- stand them; They must also be able to make good working relations with their subordinates in their districts.

And Sara similarly described responsibilities of community nutrition managers as: They must implement the policies we adopt at headquarter [Ministry of Health] within their provinces. They must do provincial program planning, and implement them effectively in collaboration with different stakeholders; they must also monitor the programs and remove possible obstacles; to build good relations with other sectors and organizations in order to progress the task. They must educate the public and supervise district staff. In many cases, these [community nutrition managers] are experts who are invited to headquarter to collaborate in policy development.

The KIs ’reflections on tasks and responsibilities of community nutrition managers were also very con- sistent with what had been reflected in the official role statements. Moreover, the leadership skill requirements of community nutrition managers, expressed by the KIs, were similar to those emerged upon role statement analysis. Such simi- larities reveal that the interviewees have been quite aware of the technical and managerial duties of the study target group as well as their leadership requirements.

The KIs also provided a number of clues as the immediate and underlying causes of poor perform- ance among community nutrition managers.

‘ System limitations, inadequate number of staff, and preference to work for private sector due to higher work prestige and incomes, and less bureauc- racy ’were among challenges mentioned by Sara.

She also emphasized on two requirements of ‘self- confidence ’and ‘avoiding self-underestimation ’ among community nutrition managers. In agree- ment with that notion, Paul believed that the ‘super- iority ’in the health system, characterized as a physician-dominant culture, could result in ‘ inadequate voice and power ’among community nutrition managers. This phenomenon causes low motivation among non-physician human resources:

‘ Low levels of motivation [in turn] create problems in the system ’, Paul argued. He also explained how occupying managerial positions by academi- cians at the Ministry of Health had created a ‘low discipline environment which challenges the very high discipline-demanding area of administration ’.

Peter emphasized on ‘lack of professional attitude ’, meaning ‘lack of strong belief in the discipline pro- fessionals have been graduated in ’, as another important missing element among some of commu- nity nutrition managers. In agreement with this notion, Sara mentioned that ‘a number of the most successful community nutrition managers in our system, such as Tara, Maya and Fred, are not even nutritionists by their educational background ’.

Table 3: Continued Task category Duties Leadership skill requirements 7 Budgeting and financial analysis 30. Developing and implementing financial analysis projects, such as cost-effectiveness analysis, with collaboration of technical units, in order to implement nutrition programs at healthcare system Multi-stakeholder coordination / aligning and fund raising 8 Innovation and research 31. Using information technology to facilitate processes through electronic systems 32. Contributing to the research prioritization process in accordance with national nutrition policies and regional nutritional problems 33. Contributing to development and implementation of applied research projects for nutrition priorities using HSR framework Creativity and innovation and multi- stakeholder coordination /aligning Davari and Rashidi –Leadership requirements among community nutrition managers 24 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 Table 4 lists themost-in-needleadership skills among community nutrition managers, derived from the KIs ’interview transcripts. The leadership skills mentioned in the table do not necessarily follow any prioritized order from the KIs ’perspec- tives. Each set of skills has been emerged from the KIs ’responses to the interview questions.

Lastly, several years of on-the-job experiencing was mentioned by all KIs as the key requisite to develop leadership competencies among commu- nity nutrition managers. Meanwhile, they all believed that training courses could also dramati- cally complement and help. Paul and Peter argued that due to genetic factors in leadership, there should be appropriate criteria to select community nutrition managers, considering their ‘leadership talent ’(Paul ) and ‘passion to lead ’(Peter).

Discussion Leadership development has already opened its way into different branches of nutrition discipline, from the clinic to the community. 5,6,18 Nowadays, even official role statements accommodate and emphasize on several aspects of leadership compe- tencies. For example, the Australian ‘Public health and community nutrition role statement ’, developed by Dietitians Association of Australia, 4includes the following leadership competencies among skills required by community nutritionists:

… ability to engage key stakeholders across a range of sectors and establish and maintain col- laborative partnerships for action on identified public health nutrition issues …. Inter-personal communication skills and the ability to adapt communication styles to a range of audiences, including professional and community stake- holders as well as funding bodies …. written communication skills, ranging from pro- fessional report preparation to the development of health information that is inclusive and appropriate to target populations ….[and] ability to strategically and effectively advocate for identified public health nutrition issues … Inclusion of such requirements has partly resulted from the inter-disciplinary nature of community nutrition field, and partly from available research findings collected in the last decade. 16 These research findings are, however, still preliminary and shall be complemented by ‘felt ’needs, inquired directly from the target group. In this study, similar set of leadership skills to those amplified by ADD emerged upon analysis of the role statements. The KIs also pointed to the similar competencies during their interviews. This study, therefore, shows high levels of data conver- gence ,as‘agreement between data collected from different sources’ , 14 between different sources.

It seems, however, that low levels of self-confi- dence and motivation among community nutrition managers, as mentioned by the KIs, can act as important barriers to realization of leadership com- petencies in workplace. Blanchard 19 has used the word ‘commitment ’as the combination of the terms confidence and motivation. He explains:

‘ Confidence is a measure of a person ’s self-assured- ness –a feeling of being able to do a task well with much supervision, whereas motivation is a person ’s interest and enthusiasm in doing a task ’.

19However, it is confusing that in a low commitment, and there- fore, low satisfactory status, it would not be clear whether the target group do not possess adequate leadership skills (ineffective andincompetent), or they just refuse employing competencies they already possess (ineffective butcompetent).

While there are many leadership skill require- ments among community nutrition workers and managers –mainly due to wide range of responsi- bilities and duties –effective communication skills shall be highlighted as a most-in-needset of skills.

Competencies in advocacy and lobbying, presen- tation, public speaking, giving feedback, written communication, counseling, and building dialog are all under the ‘effective communication ’ umbrella, necessary for success in health system, multi-stakeholder processes, and in the community. Last but not the least, Senge ’s theory of five disci- plines of learning organizations 11 illuminates lights on some other critical aspects of leadership develop- ment among community nutrition managers. It goes Table 4: The most-in-needleadership skills in community nutrition managers according to the KIs Interviewee The most-in-need leadership skills in community nutrition managers Paul Creativity, communication skills, working discipline, motivation, and feedback Peter Communication skills, advocacy, holistic thinking, courage (to speak up), and team working Juliette Trust building, motivation, vision and belief, passion, advocacy, and team working Sara Passion, motivation, hard-working, self-confidence, and communication skills Davari and Rashidi –Leadership requirements among community nutrition managers 25 International Journal of Healthcare Management 2016 VOL. 9 NO. 1Downloaded by [Kraft Foods/ GT&Q], [mounika indupriyal] at 02:36 15 June 2016 well beyond the requirements in inter-personal and organizational leadership competencies, emerged in this study through analyses of the role statements and the interview transcripts. Whilesystem thinking, team learning , andshared vision were explicitly or implicitly expressed by the KIs, least attention was paid to personal mastery andmental models elements.

These are key to the self-leadership domain, and central to personal development. They seem to build a matrix, in which competencies such as effec- tive communication, team learning, and networking could develop. There have been a number of limitations in this study which necessitates caution when interpreting the results. These kinds of studies provide data to develop training courses for community nutrition managers. It is, however, clear that any training program should simultaneously target ‘felt ’needs, to be expressed by the target group. The present study did not determine ‘felt ’leadership needs.

In addition, this needs assessment did not provide data on intra-group variation of leadership compe- tencies among community nutrition managers in Iran. Therefore, the evaluation made by KIs may not be transferable to all members of the target group. The process and results of the present study have had a number of implications. First, it could sensi- tize the KIs about the issue of leadership empower- ment among community nutrition managers in the health sector. Importantly, these KIs represent experts who are invited to develop and update aca- demic curricular programs as well as to revisit the role statements of the community nutrition man- agers. Second, it has provided evidence that sup- ports developing training programs as an effective strategy, to improve leadership competencies among the target group. Third, the study has deter- mined the most-in-need leadership skills in commu- nity nutrition managers, necessary for tailor- making capacity building programs.

Conclusion There was high level of convergencebetween data obtained from two sources of role statements and KIs in this study. The research also showed com- mitment (confidence and motivation), communi- cation skills, and team working as the most- in-need areas for improvement among community nutrition managers. Meanwhile, main aspects of self-leadership development, highlighted as per- sonal mastery andmental models by Senge, have not been sufficiently emphasized by either data sources in this study. Acknowledgment The contribution of the interviewees in sharing their invaluable experience and insights is the most pre- cious asset in this research; we would like to express our heartfelt appreciation to our KIs. We shall also acknowledge the support made by the Nutrition Department (MoH) and UNICEF repre- sentative in Iran to the study.

Disclaimer statements Contributors The first author designed, executed, analyzed, and wrote the manuscript draft. The second author consulted regarding the research design, re-analyzed the data, and reviewed and commented the manuscript draft.

Funding None.

Conflicts of interest No conflicts of interest exists for authors of the manuscript.

Ethics approval The research received IRB approval from University of San Diego.

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