The perception and understanding of the terminology used to describe malnutrition from the perspective of patients and health workers: A meta-synthesis of qualitative studies

Abstract

Malnutrition is prevalent across healthcare settings and has adverse outcomes for patients and the health system. However, some patients do not recall being informed about their malnutrition risk/diagnosis. This meta-synthesis of qualitative studies aimed to identify and synthesise patient, carer and health worker perceptions and understanding of the terminology used by health workers for malnutrition risk/malnutrition. Four databases were searched (Medline, CINAHL, PsycINFO and Embase) up until August 2023. Title, abstract and full text screening were independently completed by 2 reviewers. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were analysed by the review team using thematic synthesis. The resulting themes informed review findings. The confidence in each finding was assessed using GRADE-CERQual. Seventeen studies were included contributing perspectives from patients (n=7 studies), health workers (n=5 studies) or both patients and health workers (n=5 studies); no studies included carer perspectives. There were 5 themes: "Patients have differing understanding, interpretation of, and identification with malnutrition risk and malnutrition terminology" (very low confidence); "Health workers perceive that patients do not identify with or understand malnutrition risk and malnutrition terminology" (low confidence); "Patients do not routinely perceive their malnutrition risk or malnutrition diagnosis as problematic" (low confidence); "Health workers use varied terminology for malnutrition risk and malnutrition" (low confidence); "Action is required to improve malnutrition diagnostic communication" (low confidence). Findings highlighted disparity in patients' perspectives regarding the terms used for malnutrition risk and malnutrition. Varied terms were used by health workers and patients did not often associate these terms with a health condition that required treatment. Health workers and patients called for action to improve the communication of malnutrition. To do this, further research exploring malnutrition terminology and the broader concept of malnutrition communication is required with patients, carers and health workers.