The Development Of The Nutrition Knowledge, Attitude And Practice Questionnaire Among Digestive Cancer Patients And Its Clinical Application

Objective To develop and establish initial reliability and validity of the DigestiveCancer Patients Nutrition Knowledge,Attitude and Practice Questionnaire(DCNKAPQ).To investigate the condition and the influence factors of nutrition knowledge, attitudeand practice of digestive cancer patients, and provide a foundation for nutritioneducation.Methods The study include three stages. The first stage: a qualitative research. Fifteenpatients with digestive cancer were chosen in a general tertiary hospital in Anhuiprovince. Data were collected by using semi-structured in-depth interviews and wereanalyzed with the Colaizzi analysis of phenomenological method. The second stage:development and psychometric assessment of questionnaire. The original questionnaireitems were developed based on literature, books and semi-structured interview.40digestive cancer patients had a small-scale pre-survey to screen the items. Eight expertshad a expert survey to further screen items. Digestive cancer patients who planning toundergo surgery in two of the top three hospitals in Anhui Province were conductedon-site investigations by using the modified questionnaire. Then six statistical analysismethods such as correlation coefficient analysis, discrimination analysis, the degree ofdispersion analysis. The formation of digestive cancer patients nutrition knowledge,attitude, behavior questionnaire was combined with statistical analysis and expertopinions ultimately. Finally,203digestive system cancer patients were used to assess the reliability and validity of the questionnaire. The Cronbach’s α coefficient and thePearson correlation coefficient of total questionnaire and dimension were calculated, theitem content validity and scale content validity were calculated, exploratory factoranalysis was used to evaluate the structural validity. The third stage: a cross-sectionalstudy.With convenience sampling,digestive cancer patients who planning to undergosurgery in two of the top three hospitals in Anhui Province were conducted on-siteinvestigations. The questionnaire included General Questionnaire, Digestive CancerPatients Nutritional Knowledge, Attitude and Behavior Questionnaire (DCNKAPQ),Social Support Rating Scale (SSRS). The data were analyzed by descriptive statistics,quantitative data that were normal distribution were described by mean and standarddeviation, non-normal distribution were described by median and quartile pitch,qualitative data were described by frequency and percentile. Using t test, analysis ofvariance, pearson correlation, stepwise multiple regression analysis to analyze theinfluence factors of digestive cancer patients nutrition knowledge, attitude, behavior.Results Four themes were identified in the qualitative research: the attitude towardlearning nutrition knowledge, nutrition knowledge reserve, application and assess. Thequestionnaire was constructed with3dimensions and40items. Nutrition knowledgedimension was24items, attitude dimension was5items, practice dimension was11items. The Cronbach’s α coefficient was0.89, the retest reliability of the totalquestionnaires was0.78. The content validity of questionnaire items were all more than0.87and the average content validity of the scale was0.96. Factor analysis result inaccordance with the previous theoretical design. Average score of nutrition knowledgewas11.58±5.59, passing rate was34.00%; average score of nutrition attitudewas15.38±4.41, passing rate was84.70%; average score of nutrition practice was20.33±6.41, passing rate was18.70%; average score of nutrition KAP was47.29±12.70, passing rate was31.10%. The average score of digestive system cancer patients’ social support was39.76±6.14, higher than the normal score with thedifference was statistically significant (P<0.05). Digestive cancer patients nutritionknowledge, attitudes, behavior was positive correlation with the difference wasstatistically significant (P<0.05). Age, educational level, payment of medical expenses,home address and objective support were influence factors of nutrition knowledge,attitude and practice.Conclusion DCNKPAQ can be used to assess nutrition knowledge, attitudes, andpractice of digestive system cancer patients as an appropriate tool. Nutrition knowledgewas inadequate, nutrition attitude was positive, nutrition behavior was poor, overallnutrition knowledge attitude practice was not good. Nutrition knowledge,attitude andpractice were influenced by general information, such as education level, place ofresidence and social support.We should assess the level of nutrition knowledge, attitudeand practice when starting nutrition education and should fully consider the influencefactors to improve the level of nutrition knowledge, attitude and practice.