Development And Preliminary Application Of Dietary Nutritional Knowledge,Attitude And Practice Questionnaire In Malignant Tumor Patients With Chemotherapy

Objective(1)To develop “the questionnaire of dietary nutritional Knowledge,Attitude and Practice(KAP)in malignant tumor patients with chemotherapy” and test its reliability and validity,and to provide an effective measurement tool for the medical workers to evaluate the nutritional KAP level of cancer patients.(2)To investigate the current situation of nutritional KAP level in malignant tumor patients with chemotherapy by using the questionnaire,and to analyze the related influencing factors for providing reference for the medical staffs to implement targeted nutritional intervention.Methods(1)By literature review,depth interviews and research team discussion,the questionnaire item pool including 3 dimensions and 51 items was initially established;16 experts were selected for two rounds of Delphi expert consultation to form the pre-test version of "the questionnaire of dietary nutritional knowledge,attitude and behavior in malignant tumor patients with chemotherapy".(2)A total of 360 malignant tumor patients with chemotherapy were investigated using the pre-test questionnaire,and the items were screened and improved by project analysis,homogeneity test,reliability and validity analysis to form the applied version of "the questionnaire of dietary nutritional knowledge,attitude and behavior in malignant tumor patients with chemotherapy".(3)Convenience sampling method was used to investigate the current situation of nutritional knowledge,attitude and Practice among230 malignant tumor patients with chemotherapy in two Grade 3A hospitals in Hunan Province.T-test,univariate analysis of variance and multiple linear stepwise regression analysis were used to analyze the levels of nutritional knowledge,attitude and practice in malignant tumor patients with chemotherapy and their influencing factors.Results(1)By depth interviews,3 themes were summarized.It was lack of correct nutritional cognition in the patients with chemotherapy.However,the patients had positive attitude to acquire nutrition knowledge,high demand for nutrition guidance,and poor compliance of nutrition behavior.Through literature review and depth interviews,three dimensions and 51 item pools were formed.After the expert consultation with 2 rounds and the discussion by the research team,15 items were deleted,5 items were modified,5 items were added,and 1 item was merged.Then,“The questionnaire of dietary nutritional knowledge,attitude and behavior in malignant tumor patients with chemotherapy(pre-test version)” with 3dimensions and 39 items was formed.(2)The correlation coefficients for each dimension of the questionnaire and the total score were 0.786～0.872.Four items(K3,K4,K15,K16,K20,P9)were deleted by the project analysis.The content validity was 0.83～1.00,and the average content validity was 0.85.The structural validity analysis showed that three common factors were limited to be extracted,and the cumulative contribution rate was 51.955%by deleting K13 item.Then,“The questionnaire of dietary nutritional knowledge,attitude and behavior in malignant tumor patients with chemotherapy(application version)” with 3 dimensions and 32 items were developed.The Cronbach’s α coefficients of 3 dimensions of the questionnaire were 0.902,0.878 and 0.883,respectively.The Cronbach’sα coefficient of the total score of the questionnaire was 0.911.The total test-retest reliability coefficient of the questionnaire was 0.862.(3)Among 223 malignant tumor patients with chemotherapy,whose questionnaires were valid,the score of dietary nutritional knowledge was(6.91±2.52),the pass rate was 31.84%;the score of nutritional attitude was(29.62±2.92),the pass rate was 99.10%;the score of nutritional behavior was(26.90±7.78),the pass rate was 26.46%.Univariate analysis of variance and multiple linear stepwise regression analysis showed that educational level,age,family per capita monthly income,family location and cancer classification were important factors influencing the total score of dietary nutritional knowledge,attitude and practice in malignant tumor patients with chemotherapy.These five variables could explain74.4% of the total variance of KAP score.Conclusion(1)The questionnaire with good reliability and validity can be used to evaluate the dietary nutritional knowledge,attitude and behavior in malignant tumor patients with chemotherapy.(2)The knowledge and behavior of dietary nutrition in malignant tumor patients with chemotherapy were at a low level,and their attitude was positive.Education level,age,family per capita monthly income,family location and cancer classification were the main factors influencing nutritional knowledge level in malignant tumor patients with chemotherapy.