Aizul Azri Azizan 1, Hanif Farhan Mohd Rasdi 2, Suzana Shahar 3, Zahara Abdul Manaf 3, Hasnah Haro
1 Faculty of Food Science and Nutrition, Universiti Malaysia Sabah , Jalan UMS, 88400, Kota Kinabalu, Sabah
2 Research Centre for Rehabilitation and Special Needs Studies (ICaRehab),, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur;
3 Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Malaysia;
4 Nutrition Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Malaysia
This study aimed to assesed the knowledge, attitude and practice (KAP DYS-Puree) towards pureed diet preparation among food handlers using newly developed questiobaire for dysphagia management.
A cross sectional design with purposive sampling study was conducted into 3 hospitals that are Hospital Kuala Lumpur, Hospital Serdang and Hospital Tuanku Ampuan Rahimah Klang. The questionaire were validated through face validation, content validity and test re-test reliability. The study involved 10 raters for content validity, 161 respomdents were participated to test the adequacy for Exploratory Factor Analysis (EFA) for internal consistenvy and 30 food handlers were involved for test re-test reliability. Then, the validated questionaire was distributed to 161 food handlers through online approach which comprised of 40 quantitative questions.
Results & Discussion
The questionaire was first validated and the findings revealed the content validity index I-CVI values: knowledge = 0.915, attitude = 0.922 and practice = 0.900 and modified kappa values (k*) knowledge = 0.983, attitude = 0.9214 and practice = 0.899. Cronbach’s alpha coefficient for attitude= 0.9933 and practice = 0.675 respectively. Construct validity was tested using exploratory factor analysis (EFA) based on principal axis of factoring with varimax rotation.
The. Exploratory factor analysis was employed for two dimension that is practice and attitude. The Kaiser-Meyer-Olkin (KMO) attitude= 0.816 and practice =0.776. Bartlett’s test of sphericity was significant at p<0.0001 for both indicating the suitability of this data for factor analysis. Interclass Correlation Index (ICC) attitude = 0.739 and practice = 0.789.
This questionaire were then distributed and 161 food handlers from 3 hospitals who involved directly in puree diet preparation were participated in this study. The study demonstrated low to moderate knowledge score among food handlers (57.54 ¬± 12.33) with scoring at 1.95% (very low), 28.6% (low) , 68.3% (moderate) and 1.2 % scored good in knowledge section towards pureed diet preparation. On the attitude among food handlers showed that food handlers were referred to the right source before preparing the pureed diet (3.97 ¬±1.35). The findings also clearly shown the practice of using the right equipment (4.41 ¬±1.19) is essential for pureed diet preparation.
As the questionaire are validated and reliable to be used for dysphagia management, the study revealed that most of the food handlers were not equipped with good knowledge on pureed diet preparation specifically for dysphagia management. As the patients with dysphagia are prone to aspirate due to the wrong texture of food, the findings clearly showed that level of knowledge of food handlers are worrying as the preparation of pureed diet for dysphagia patients are very technical and need to be accurate to be safe to consume. The reference or the standard operating procedures of the pureed diet preparation for dysphagia patient need to be comprehensively enhanced , accesible and can be use to refer at all time.
This instrument serves as a need assessment tool in the development of a comprehensive module for pureed diet preparations for dysphagia management. Such result demonstrated the opportunity of improvement in dysphagia management specifically in food preparation by food handlers.