Development,Reliability And Validity Of The Nutrition Literacy Assessment Tool For Family Caregivers Of Postoperative Patients With Digestive System Tumors

Objective To develop a nutrition literacy assessment tool for family caregivers of postoperative patients with digestive system tumors and test its reliability and validity,so as to provide clinical healthcare workers with a nutrition literacy assessment tool for family caregivers of postoperative patients with digestive system tumors.Methods In this study,with the Knowledge Attitude and Practice theory and the hierarchical model of health literacy as the theoretical framework,a qualitative interview was conducted on 14 family caregivers of postoperative patients with digestive system tumors and 11 medical staff engaged in medical treatment or nursing care of postoperative patients with digestive system tumors that met the inclusion criteria from a Grade Ⅲ Level A hospital in Anhui Province using the purposive sampling method.Combined with the summary of previous literature,an item pool for the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors was compiled.Nineteen experts were selected nationwide for consultation using the Delphi method.According to the feedback and scores of the items from the experts,the items were modified and screened,and the quality of consultation was evaluated.A small-sample-size pre-survey with 30 subjects was conducted to develop the clinical test version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors.A total of 302 family caregivers of postoperative patients with digestive system tumors from four Grade Ⅲ Level A hospitals in Anhui Province were surveyed using the convenience sampling method.The items were screened based on the obtained data: item analysis（critical ratio method,correlation coefficient method,internal consistency coefficient method）and exploratory factor analysis,to develop the clinical validation version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors.Additionally,subjects different from those in the item screening stage were selected as samples by the convenience sampling method.Using the clinical validation version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors and the general information questionnaire,324 family caregivers of postoperative patients with digestive system tumors from four Grade Ⅲ Level A hospitals in Anhui Province were surveyed.According to the obtained data,confirmatory factor analysis,validity evaluation（content validity,structural validity,and criterion-related validity）,and reliability evaluation（Cronbach’s αcoefficient,split-half reliability,and test-retest reliability）of the assessment instrument were performed,and the clinical official version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors was finally developed.Results Based on literature summary and qualitative interview,an item pool of nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors was developed,which was composed of 55 items from four dimensions: nutritional care attitude,nutrition and health knowledge,nutritional care skills,and nutritional information and communication.The recovery rates of the two rounds of Delphi expert consultation questionnaires were 95.45% and 90.48%,the authority coefficients of the experts were 0.860 and 0.850,and the Kendall coordination coefficients were 0.121 and 0.117,respectively.Finally,an assessment instrument composed of four dimensions and 46 items was developed.The small-sample-size presurvey revealed that the comprehensibility of the items and the difficulty of reading and writing were moderate.The results of item analysis showed that each item had good discrimination.The items with a correlation r < 0.4 between the scores of two items and the total score were deleted,and the scores of the remaining items had high correlations with the total score.The overall Cronbach’s α coefficient of the assessment instrument after deleting an item did not increase significantly,and the homogeneity of the assessment instrument was high.The results of exploratory factor analysis presented that a total of six common factors were extracted with the cumulative contribution rate of71.06% and the load range of 0.588–0.868.Finally,the clinical validation version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors was developed,which was composed of four dimensions and 40 items,including 6 items of nutritional care attitude,11 items of nutrition and health knowledge,16 items of nutritional care skills,and 7 items of nutritional information and decision-making.Using samples different from those in the item screening stage combined with the investigation and analysis results of the clinical validation version of the nutritional literacy assessment instrument,it was shown that the overall Cronbach’s α coefficient was 0.971,the Cronbach’s α coefficient of each dimension was 0.923–0.973,the split-half reliability was 0.816,and the test-retest reliability was 0.894,suggesting high reliability of the scale.In the confirmatory factor analysis,the fitting indexes were: x~2/df = 2.646,RMSEA = 0.071,NFI = 0.869,IFI =0.914,and TIL = 0.908,which all met the requirements.The content validity of the scale was: I-CVI = 0.833–1,and S-CVI = 0.954.The correlation between each dimension and the criterion-related indexes was 0.598–0.830,and the correlation coefficient between the overall scale and the criterion-related indexes was 0.735,indicating the high validity of the scale.Finally,the clinical official version of the nutrition literacy assessment instrument for family caregivers of postoperative patients with digestive system tumors was developed.Conclusion The nutrition literacy assessment tool for family caregivers of postoperative patients with digestive system tumors developed in this study includes 40 items in four dimensions: nutritional care attitude,nutrition and health knowledge,nutritional care skills,and nutritional information and decision-making.The development process is scientific and rigorous,the contents of the items are comprehensive,and the research results are veritable and reliable,comprehensively reflecting the nutrition literacy level of family caregivers of postoperative patients with digestive system tumors.The evaluation tool has high reliability and validity,which is suitable for clinical work.