Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people

Journal of Multidisciplinary Healthcare, Jun 2012

Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people Ulrika Söderhamn, Bjørg Dale, Kari Sundsli, Solveig T Tomstad, Olle SöderhamnCenter for Caring Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, NorwayBackground: Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard.Methods: A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO.Results: A Cronbach's alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of –0.37 (P < 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of ≥4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard.Conclusion: NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA®) as a standard for NUFFE-NO. The obtained cut-off point of ≥4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard.Keywords: nutritional screening instrument, reliability, sensitivity, specificity, validity

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Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people

Journal of Multidisciplinary Healthcare Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people 0 Center for Caring Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder , Grimstad , Norway 8 1 0 2 - l u J - 2 1 n o 0 . 5 1 . 5 3 1 . 5 y b / m o c . s s e r p e v o .dw l.y PowerdbyTCPDF(ww.tcpdf.org) Background: Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard. Methods: A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO. Results: A Cronbach's alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of -0.37 (P , 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of $4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard. Conclusion: NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA®) as a standard for NUFFE-NO. The obtained cut-off point of $4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard. - reliability and validity. It also has to demonstrate sensitivity and specificity in order to be used by health professionals in clinical practice8 and research. Reliability of an instrument is the degree of consistency with which it measures the attribute it is supposed to be measuring, and validity refers to the degree to which an instrument measures what it is supposed 8 to be measuring. An instrument’s sensitivity is its ability to 120 identify cases correctly and its specificity is the ability to l--Ju identify non-cases correctly.11 12n The Mini Nutritional Assessment (MNA®) is a well .0o known nutritional screening instrument designed for older .551 people12 and is considered to be a reliable13 and valid screen.531 ing instrument for use in Europe and western health care /yb practice settings.14 A short form of the MNA (MNA-SF), com using some of the items in the MNA, has been found to be .sse equal to the full form of the MNA and can be used for quick rvpe nutritional screening of older people.15 However, body mass .odw l.y index (BMI) is included in both the MNA and MNA-SF, and /ww no may cause some difficulties in performing screening among :/s se disabled older persons. Tsai et al16 have found that the MNA ttp lu h an could maintain full functionality and enhance the usefulness from rsoe without BMI. This result was based on the fact that both the deda ropF MNA with BMI and without BMI could effectively grade lon the nutritional status of neuropsychiatric patients and show dow good correlations with BMI, calf circumference, and length rcae of hospital stay. Furthermore, MNA-SF has been found to ltah be easier to administer and less time-consuming when the yeH particular item of BMI was replaced with calf circumference liirscanp meaTshueremNuentrti.t1i7onal Form For the Elderly (NUFFE) nutriilitd tional screening instrument has been developed specifically fuM as a simple instrument for screening in older people. The loan intention with NUFFE is that it should be an instrument that rJuo is easy to use and, therefore, no anthropometric measurements are included. Thereby, it is also suitable for use as a self-report instrument. NUFFE was originally developed in Sweden and has been translated into several languages. It is considered to be an instrument with sufficient evidence of reliability and validity.18–21 The MNA has been found to be a suitable standard in testing procedures both for the original Swedish version19,20,22 and for the Norwegian version (NUFFE-NO)21 regarding concurrent validity, sensitivity, and specificity among older hospital patie (...truncated)


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Ulrika Söderhamn, Bjørg Dale, Kari Sundsli, Solveig T Tomstad, Olle Söderhamn. Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people, Journal of Multidisciplinary Healthcare, 2012, pp. 121-128, DOI: 10.2147/JMDH.S32502