Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands.
Clin Nutr. 2024 Feb;43(2):446-452. doi: 10.1016/j.clnu.2023.12.023. Epub 2024 Jan 1.
BACKGROUND & AIMS: Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years.
The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity.
The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0.
The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.
定性研究表明，老年人的营养不良意识较差。本研究旨在开发一种问卷，以定量评估 60 岁以上社区居住的老年人的营养不良意识。
营养不良意识量表（MAS）基于综合变化模型的意识阶段制定，包括四个领域：知识、感知线索、风险认知和认知。使用主要定性研究的结果和作者的专业知识，制定了 26 个量表项目。对 10 名荷兰老年人进行试点研究，采用大声思考的方法优化措辞。在可行性研究中，测试了 MAS 的烦恼、难度和完成时间及其可理解性。经过最终修订，MAS 应用于大样本，以测试其心理测量特性（即项目间相关性、克朗巴赫的 alpha、分数分布），并由 12 名专家对项目的相关性进行 5 分制评分，以确定内容有效性。
可行性研究（n=42，55%为女性，19%为 80 岁以上，）表明 MAS 需要 12±6 分钟才能完成。大多数参与者认为完成 MAS 不（根本）麻烦（81%），不（根本）困难（79%），并认为 MAS 非常（非常）易懂（83%）。心理测量分析（n=216，63%为女性，28%为 80 岁以上，）表明没有多余的项目，但有两个项目与其他项目呈负相关，一个与其他项目相关性很低。剔除后，最终的 MAS 由 23 个项目组成，评分范围从 0 到 22（得分越高表示意识越高），整体克朗巴赫的 alpha 为 0.67。我们样本（n=216）的平均 MAS 得分为 14.8±3.2。获得的最低分数为 6（n=3），最高分数为 22（n=1），表明没有地板或天花板效应。基于相关性评分，22 个项目的整体中位数为 4.0，IQR 为 4.0-5.0。
营养不良意识量表是一种新颖、可行且可靠的工具，具有良好的内容有效性，可定量评估社区居住的老年人的营养不良意识。该量表现在可用于识别营养不良意识较差的人群，为开展增加营养知识和意识的干预措施奠定基础。
