Development and feasibility of nutrition screening guideline using mini nutritional assessment short-form (MNA-SF) in elderly attending health clinics for the use of healthcare staff in clinic settings

Abstract

Elderly population are susceptible to malnutrition. However, malnutrition identification among community-living elderly through nutrition screening is not routinely performed in Malaysia health clinics; although it is recommended to be performed routinely in all healthcare setting. Major issue to this is due to no specific nutrition screening guideline and validated tool in this setting. Due to this gap, development of nutrition screening guideline is essential for use among healthcare staff. The aimed of this study are to develop a nutrition screening guideline for use by healthcare staff in health clinic setting and assess its feasibility. This study has taken a mixed-method approach and action research to address the research objectives. This study was divided into three phases; Phase 1: Identification of barriers and opportunities of nutrition screening in elderly patients in the health clinic setting; Phase 2: Development of nutrition screening guideline by using Mini Nutritional Assessment Short-Form (MNA® -SF) for healthcare staff in health clinic setting; and Phase 3: To assess the feasibility of newly developed nutrition screening guideline for health clinic setting among healthcare staff. Four health clinics from urban and rural areas in Kuantan, Pahang involved in this study. In Phase 1, in-depth interviews were conducted among twenty healthcare staff. Non-participant observations that acted as triangulation were conducted among twenty-one elderly patients. Both data from interviews and observations were analysed thematically using NVivo software version 12. Four themes emerged for barriers and opportunities were Theme 1: Time; Theme 2: Patient factors; Theme 3: Organization factors and; Theme 4: Nutrition screening knowledge. Findings from Phase 1 has become guidance in content development of the nutrition screening guideline. In Phase 2, twenty-three documents have been included from conducted scoping review for the content development of the guideline. Following this, A4-sized guideline has been developed. The guideline has been validated among six experts by using Item-Content Validity Index (I-CVI). Items that have achieved ≥0.83 were remained. Meanwhile, items with a score <0.83 were revised accordingly. Next, face validity among twelve healthcare staff has been conducted and all participants showed positive responses. Amendment has been made based on provided suggestions. For Phase 3, 22 healthcare staff from similar health clinics participated and had screened five elderly patients each (total=110, mean age= 68.7±6.1 years). After completing nutrition screening, individual in-depth interviews were conducted with the healthcare staff. All data were analysed thematically. The themes obtained were Theme 1: Ease of use; Theme 2: Identification and management of malnutrition; Theme 3: Acceptability; and Theme 4: Implementation of nutrition screening. In summary, this multiphase study has identified appropriate approaches in implementing nutrition screening among elderly patients in health clinic setting. Provision of a comprehensive newly developed nutrition screening guideline tailored to this setting was well-accepted among healthcare staff and feasible in health clinic setting. This nutrition screening guideline is recommended to be adopted nationwide in Ministry of Health’s health clinics towards optimum nutritional status of elderly population and achieving healthy ageing; whilst policy related to nutrition screening implementation in health clinics can be further enforced.