Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study.

Shelley Roberts,Alan Spencer,Lauren T Williams,Zane Hopper,Andrea P Marshall,Laurie Grealish,Julie Jenkins

doi:10.3390/healthcare7020079

Shelley Roberts, Alan Spencer + Show 5 more

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https://doi.org/10.3390/healthcare7020079

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Abstract

Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation.

Highlights

Malnutrition is a significant issue that health organisations, clinicians and researchers have attempted to address for decades [1,2]
The implementation record noted that the acute medical unit (AMU) nutrition assistant was on leave for two out of the four weeks of data collection without position backfill
This paper highlights the importance of an integrated knowledge translation (iKT) approach in the development, implementation and evaluation of complex interventions

Summary

Introduction

Malnutrition is a significant issue that health organisations, clinicians and researchers have attempted to address for decades [1,2]. Malnutrition continues to affect up to 50% of hospitalised patients [3], resulting in poor outcomes for both patients and hospitals [4,5]. Malnutrition may be pre-existing (i.e., patients are malnourished upon admission) or hospital-acquired (i.e., patients become malnourished during hospitalisation). 5400 episodes of hospital-acquired malnutrition occur annually in Australian hospitals [6] with financial consequences, that health services receive funding penalties for hospital-acquired complications. Healthcare 2019, 7, 79 of hospital-acquired malnutrition occur annually in Australian hospitals [6] with financial consequences, that health services receive funding penalties for hospital-acquired complications such as as malnutrition malnutrition [7].

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