The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties

Background & Aims Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. Methods The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach’s alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. Results The feasibility study (n=42, 55% women, 19% 80+ y) showed that the MAS took 12±6 min to complete. Most participants found it not (at all) annoying (81%) and not (at all) difficult (79%) to complete the MAS, and found it (very) comprehensible (83%). Psychometric analyses (n=216, 63% women, 28% 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach’s alpha of 0.67. The mean MAS score in our sample (n=216) was 14.8±3.2. The lowest obtained score was 6 (n=3) and the highest 22 (n=1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. Conclusion The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.