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Trinca V, Iraniparast M, Morrison-Koechl J, Duizer L, Keller H. Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients. Clin Nutr 2021; 40:4011-4021. [PMID: 34144411 DOI: 10.1016/j.clnu.2021.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Low food intake is a primary contributor to iatrogenic hospital malnutrition and can be influenced by perceptions of poor food quality. Valid and reliable tools to assess the food experience of hospital patients are lacking. This study aimed to determine the internal reliability, convergent construct and predictive validity of the new Hospital Food Experience Questionnaire (HFEQ) and to methodically derive and test a shortened version of the questionnaire (HFEQ-sv). METHODS Data from a multi-site study on 1087 patients from 16 Ontario hospitals were used. The HFEQ was developed to assess the importance of food (n = 6) and food-related (n = 10) traits using a 5-point Likert scale anchored by "not important" (1) and "very important" (5), and ratings of a single meal served (n = 7) using a 5-point Likert scale anchored by "very poor" (1) and "very good" (5). Food intake at the same meal was assessed using visual estimation (0%, 25%, 50%, 75%, 100%). Internal reliability was determined using Cronbach's alpha, and principal components analysis (PCA). Convergent validity was assessed using ordinal logistic regression with a single question on patients' overall meal quality rating. Cross validation was conducted in an attempt to shorten the questionnaire and binary logistic regression determined predictive validity with food intake. RESULTS The HFEQ demonstrated good internal reliability (α = .86), and all but one of the questionnaire items clustered together in PCA, revealing 5 factors. Subscales and the total HFEQ demonstrated convergent validity, with the importance of food taste, choice, easy-to-open packaging, easy-to-eat food and local food provision, in addition to meal ratings of taste, appearance, texture, temperature and combination of food served being associated with the overall meal quality rating (p < .050). These items became the basis for the HFEQ-sv, which was found to independently predict food intake (LRT(42) = 142.17, p < .001). CONCLUSIONS The HFEQ is internally reliable, demonstrates convergent validity with the construct of meal quality and predicts food intake. The 11-item HFEQ-sv promotes feasibility. The HFEQ has potential to be used globally to benchmark and quantify the patient food experience in hospital, contributing to quality improvement strategies that will support food intake among patients.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Maryam Iraniparast
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
| | - Jill Morrison-Koechl
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Duizer
- Food Science Department, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada; Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
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Mathieu ME, Reid RER, King NA. Sensory Profile of Adults with Reduced Food Intake and the Potential Roles of Nutrition and Physical Activity Interventions. Adv Nutr 2019; 10:1120-1125. [PMID: 31121014 PMCID: PMC6855938 DOI: 10.1093/advances/nmz044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/20/2018] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
The sensory profile, referring to sight, smell, taste, hearing, and touch, plays an essential role in optimizing the habitual intake of energy and macronutrients. However, specific populations, such as older adults, are known to have impaired energy intake. In this paper, the relevance of sensory impairments in this older population is described, and the extent to which nutritional and physical activity interventions can modulate these sensory responses when food intake is insufficient is explored. With aging, all senses deteriorate, and in most cases, such deteriorations diminish the nutritional response. The only exception is sight, for which both positive and negative impacts on nutritional response have been reported. From a prevention perspective, nutritional interventions have been understudied, and to date, only hearing is known to be positively affected by a good nutritional profile. In comparison, physical activity has been more frequently studied in this context, and is linked to an improved preservation of 4 senses. Regarding treatment, very few studies have directly targeted sensory training, and the focus of research has tended to be on nutrition and physical activity intervention. Sensory training, and nutritional and physical activity treatments all have beneficial effects on the senses. In the future, researchers should focus on exploring gaps in the literature specifically concerning prevention, treatment, and sensory response to understand how to improve the efficacy of current approaches. In order to maintain sensory acuity and recover from sensory impairment, the current state of knowledge supports the importance of improving nutritional habits as well as physical activity early on in life. A combined approach, linking a detailed lifestyle profile with the assessment of numerous senses and one or more interventional approaches (nutrition, physical activity, sensory training, etc.), would be required to identify effective strategies to improve the nutritional state of older individuals.
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Affiliation(s)
- Marie-Eve Mathieu
- École de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, Canada,Sainte-Justine University Hospital Center, Montréal, Canada,Address correspondence to M-EM (E-mail: )
| | - Ryan E R Reid
- École de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, Canada,Sainte-Justine University Hospital Center, Montréal, Canada
| | - Neil A King
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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Roberts HC, Lim SER, Cox NJ, Ibrahim K. The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients 2019; 11:E808. [PMID: 30974825 PMCID: PMC6521101 DOI: 10.3390/nu11040808] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
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Affiliation(s)
- Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK.
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Skinnars Josefsson M, Nydahl M, Persson I, Mattsson Sydner Y. Quality Indicators of Nutritional Care Practice in Elderly Care. J Nutr Health Aging 2017; 21:1057-1064. [PMID: 29083448 PMCID: PMC5662708 DOI: 10.1007/s12603-017-0970-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. DESIGN Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. MEASUREMENTS Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. RESULTS Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. CONCLUSION Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.
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Affiliation(s)
- M Skinnars Josefsson
- Malin Skinnars Josefsson, MSc, Department of Food, Nutrition and Dietetics, Uppsala University, Box 560, 751 22 Uppsala, Sweden, , +46 18-471 23 95, +46 76-555 78 80
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Ahmed M, Jones E, Redmond E, Hewedi M, Wingert A, Gad El Rab M. Food production and service in UK hospitals. Int J Health Care Qual Assur 2015; 28:40-54. [PMID: 26308401 DOI: 10.1108/ijhcqa-07-2013-0092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food. DESIGN/METHODOLOGY/APPROACH Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. FINDINGS The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations. RESEARCH LIMITATIONS/IMPLICATIONS Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. PRACTICAL IMPLICATIONS The paper identifies opportunities for enhancing hospital food production systems. ORIGINALITY/VALUE The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.
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Affiliation(s)
- Mohamed Ahmed
- Cardiff Metropolitan University, Cardiff, UK and Fayoum University, Fayoum City, Egypt
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Maria Ugolini M, Rossato C, Baccarani C. A five-senses perspective to quality in hospitals. TQM JOURNAL 2014. [DOI: 10.1108/tqm-01-2014-0010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to report on research on the sensory perceptions that patients and bystanders experience during hospitalisation. Sight, hearing, smell, taste and touch influence both clinical outcomes and satisfaction. The paper offers suggestions to hospital management on ways to improve receivers’ sensory perceptions.
Design/methodology/approach
– Considering services as social interactions, a subjectivist view of reality is adopted and, accordingly, a qualitative research approach implemented. Data are collected through participant observation. Desk activity includes reasoned literature review, categorisation and model adaptation.
Findings
– A simplified system model for service provision in the hospital ward is proposed. A management tool is provided in the form of a check list that the ward management can employ to assess its service-provision system from a five-senses perspective.
Research limitations/implications
– The paper is affected by judgements subject to cultural biases. The validity of the management tool is still to be tested.
Practical implications
– Once up and running, the model and the check list will be able to guide health managers towards improvements of satisfaction, clinical outcomes and working environment.
Originality/value
– The paper represents an original effort to adapt tools already used in the commercial field to influence health service receivers’ perceptions positively. While the positive results of improvements to a single sensory perception have been well documented, an integrated approach has not been put forward previously in the health industry.
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