Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/
What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge, Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia Sarah A. Karim, Baharudin Ibrahim, Balamurugan Tangiisuran and J. Graham Davies JPEN J Parenter Enteral Nutr published online 3 March 2014 DOI: 10.1177/0148607114525209 The online version of this article can be found at: http://pen.sagepub.com/content/early/2014/03/03/0148607114525209
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
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525209
research-article2014
PENXXX10.1177/0148607114525209Journal of Parenteral and Enteral NutritionKarim et al
Brief Communication
What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge, Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia
Journal of Parenteral and Enteral Nutrition Volume XX Number X Month 201X 1–8 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607114525209 jpen.sagepub.com hosted at online.sagepub.com
Sarah A. Karim, MPharm1; Baharudin Ibrahim, PhD, MPharm2; Balamurugan Tangiisuran, PhD, MPharm2; and J. Graham Davies, PhD, FRPharmS3
Abstract Background and Aims: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers’ inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. Methods: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Result: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients’ nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the “average” score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Conclusion: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx)
Keywords knowledge; attitude; practice; nutrition support
Clinical Relevancy Statement Identification of patients’ risk of malnutrition by healthcare providers is fundamental to its treatment. However, insufficient knowledge among the healthcare providers and lack of clear guidelines may contribute as a barrier to implement patients’ nutrition support.
Introduction Malnutrition is common among hospitalized patients, with a prevalence of 20%–50%.1-3 Despite this, nutrition screening and adequate treatment in malnourished patients have been rarely applied structurally by medical staff. Nutrition screening has been defined by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) as “a process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is indicated.”4 In an attempt to improve nutrition care in the hospital setting, the European Society of Clinical Nutrition and Metabolism (ESPEN) has established several guidelines. These guidelines highlight that all patients should be screened on admission to the hospital and a
nutrition care plan developed and implemented if the patient is at risk of malnutrition. Furthermore, the results of screening, assessment, and nutrition care plans should be communicated to other healthcare providers when the patient is transferred to a different ward.5 This was further supported by the National Institute for Health and Clinical Excellence (NICE) guidelines, which recommended that those at risk of malnutrition should undergo From 1Pharmacy Department, Penang General Hospital, Pulau Pinang, Malaysia; 2Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia; and 3Institute of Pharmaceutical Science, King’s College London, London, United Kingdom. Financial disclosure: None declared. Received for publication July 26, 2012; accepted for publication February 2, 2014. Corresponding Author: Balamurugan Tangiisuran, PhD, MPharm, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia. Email: [email protected]
Downloaded from pen.sagepub.com at UNIV OF ALABAMA BIRMINGHAM/ Lister Hill Library on May 29, 2014
2
Journal of Parenteral and Enteral Nutrition XX(X)
nutrition assessment, so that treatment or nutrition care plans could be started.6 They recommended that a multiprofessional nutrition support team (NST) be established at all hospitals in the United Kingdom to improve the nutrition support given to patients.7 A study has shown that there is a large agreement among healthcare providers in implementing nutrition teams as a means to increase the quality of nutrition practice.8 Traditionally, the team includes the physician, pharmacist, dietitian, and nurse.9 Most of the studies to date on knowledge and attitudes toward nutrition support have focused on the doctors, nurses, and dietitians, with less attention given to the pharmacists.10-14 Over the years, pharmacists’ roles on the nutrition support team have evolved from nutrition screening of patients to the monitoring of route, composition of parenteral nutrition (PN), and evaluation of pharmacotherapy used in conjunction with specialized nutrition support.15,16 Before implementing the NST in a new setting, it is important to assess the current knowledge, attitudes, and practice (KAP) of doctors and pharmacists toward nutrition care. Hence, a study assessing their KAP on patient nutrition support is vital. In Malaysia, a study conducted in hospitalized geriatric patients demonstrated that 10.9% had chronic energy deficiency and 10% of subjects had muscle-wasting conditions.17 Despite this, only a few formal continuous training and teaching programs on nutrition are being provided in the hospitals. Thus, doctors rely totally on their knowledge and experience gained from their routine work in treating nutrition cases. Therefore, the purpose of this study was to determine and compare the KAP of doctors and pharmacists in relation to the nutrition support provided in a tertiary care hospital.
Materials and Methods This was a cross-sectional survey conducted from November to December 2011 in a tertiary teaching hospital in the state of Penang, Malaysia. A self-administered questionnaire was distributed to 76 pharmacists and 324 doctors working in the hospital using a drop-and-collect method over a 1-week period. Those working in pediatric departments were excluded because there were no universal screening tools available for children. An additional week was given to the nonrespondents in an attempt to increase the response rate. A reminder was given 1 week after the intended end of data collection to encourage nonrespondents to return the questionnaire.
Survey Instruments A questionnaire with 4 sections containing 30 questions was developed by adapting questionnaires from previously published studies.8,10,12,14 Section 1 focused on the demographic data, in which the pharmacists and doctors were required to record their age, ethnicity, place of graduation, gender, designation, year of starting service, and department. Sections 2 and 3 consisted of questions about the practice and attitudes of doctors and pharmacists toward nutrition support using 5-point Likerttype scale responses (1 = strongly agree, 2 = agree, 3 = neutral,
4 = disagree, 5 = strongly disagree).18 For the attitude part, a score of 7–13 was defined as “positive attitude,” a score range of 14–20 as “ambivalence attitude,” and score between 21 and 28 as “negative attitude.” Ambivalence can be defined as existence of both positive and negative attitudes toward an object.19 In the final section, the doctors and pharmacists were asked to answer multiple-choice questions regarding their knowledge on nutrition support. The knowledge component was designed to assess healthcare providers on nutrition screening and assessment. A score lower than 3 was defined as “not good,” a score range from 4–7 was considered “average,” and score more than 8 was “good” on a scale ranging from 1–10, based on a previously published study.14 Seven individuals (2 academics, 2 general surgeons, and 3 pharmacists) performed the face and content validity. Changes were made accordingly before conducting a pilot study of the questionnaire using 24 healthcare providers (15 doctors and 9 pharmacists) from another hospital. The questionnaire was later revised for clarity and ease of use based on comments received from the pilot study analysis.
Data Analysis Statistical analysis was carried out using SPSS version 17 (SPSS Inc, Chicago, IL). Descriptive analysis was used to compute frequencies of responses for all demographic items and KAP questions. An independent-sample t test was used to compare the responses of pharmacists and doctors. The χ2 or Fischer exact test was used for cross-tabulation on the nominal level. Statistical significance was defined as P < .05. Internal reliability was assessed using Cronbach alpha (α).20,21 Ethical approval for conducting this research was obtained from the Medical Review and Ethics Committee, Ministry of Health Malaysia. The registration ID for the National Medical Research Register is 11-87-8440.
Results The Cronbach α values obtained for each section were .771 (attitude), .821 (practice), and .497 (knowledge). Of the 400 questionnaires distributed, 242 were returned, 12 of which were excluded because of incomplete or missing data. Thus, a total of 230 questionnaires were included in the final analysis. A response rate of 58% was achieved, representing 158 doctors and 72 pharmacists. More female (60.9%) and local graduates (61.7%) responded to this survey. Most (84.3%) of the respondents had no more than 5 years’ work experience in the clinical setting. A complete description of the demographic characteristics of the respondents is depicted in Table 1.
Knowledge of Nutrition Support Table 2 outlines that most (70.4%) of the healthcare providers were grouped in the “average” score range. However, more pharmacists obtained the scores in the range of 8–10 as
Downloaded from pen.sagepub.com at UNIV OF ALABAMA BIRMINGHAM/ Lister Hill Library on May 29, 2014
Karim et al
3 Table 2. Score Range for Knowledge and Attitudes of the Doctors and Pharmacists Toward Patient Nutrition Support.
Table 1. Demographic Characteristics of the Respondents. Designation, n (% ) Demographic
Doctor
Gender Female 84 (36.5) Male 74 (32.2) Place of graduation Local graduate 89 (38.7) Overseas graduate 69 (30) Years in service 0–5 127 (55.2) 6–10 21 (9.2) 11–15 7 (3.0) 16–20 2(0.9) 21–25 1(0.4) Designation Total respondents 158 (68.7) House officer/provisional 82 (35.7) registered pharmacist Medical officer/registered 63 (27.4) pharmacists Specialist 13 (5.7)
Pharmacist
Total
56 (24.4) 16 (6.9)
140 (60.9) 90 (39.1)
53 (23) 19 (8.3)
142 (61.7) 88 (38.3)
67 (29.1) 4 (1.8) 0 (0) 1 (0.4) 0 (0)
194 (84.3) 25 (11) 7 (3.0) 3 (1.3) 1 (0.4)
72 (31.3) 19 (8.3)
53 (23)
—
compared with doctors (22.2% vs 3.2%). Pharmacists’ total mean scores on nutrition knowledge were significantly higher than that of the doctors (6.07 ± 1.76 vs 4.59 ± 1.87, P < .001). Focusing on the individual designation, it was found that registered pharmacists had the highest mean score (6.17 ± 1.74), followed by provisional registered pharmacists (5.79 ± 1.84), specialists (4.92 ± 1.55), house officers (4.63 ± 1.86), and medical officers (4.48 ± 1.94). The proportions of healthcare providers’ correct responses to each specific nutrition support question are presented in Table 3. Most (85.2%) of the respondents were aware of the measurement of body mass index (BMI), although slightly more than half (58.7%) were able to recall the normal range of BMI for Asian population. A similar trend was noticed with regard to the ability of providers to calculate a patient’s weight loss. Despite being the simplest method for the assessment of nutrition status during hospital admission, only 57.8% of the healthcare providers were able to calculate percentage weight loss. Only a small percentage (15.7%) of the healthcare providers knew the answer of the poor indicator for nutrition status. Overall, 52.6% knew the basic energy required for an adult patient who was receiving PN, and 53% accurately answered the question regarding total calories present in 1 g carbohydrate, fat, and protein. More than half (54.3%) of the providers correctly answered the question on anthropometry assessment in malnourished patients.
Attitudes Toward Nutrition Support Most of the survey participants appear to have an ambivalent attitude toward nutrition support. Table 4 outlines the
Score Range (Category)
Designation, n (%) Doctors Pharmacists
Knowledge 0–3 (not good) 40 (25.3) 4–7 (average) 113 (71.5) 8–10 (good) 5 (3.2) Attitudes 7–13 (positive) 29 (18.4) 14–20 106 (67.1) (ambivalence) 21–28 (negative) 23 (14.6)
Total
P Valuea
7 (9.7) 47 (20.4)
What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge, Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia Sarah A. Karim, Baharudin Ibrahim, Balamurugan Tangiisuran and J. Graham Davies JPEN J Parenter Enteral Nutr published online 3 March 2014 DOI: 10.1177/0148607114525209 The online version of this article can be found at: http://pen.sagepub.com/content/early/2014/03/03/0148607114525209
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Mar 3, 2014 What is This?
Downloaded from pen.sagepub.com at UNIV OF ALABAMA BIRMINGHAM/ Lister Hill Library on May 29, 2014
525209
research-article2014
PENXXX10.1177/0148607114525209Journal of Parenteral and Enteral NutritionKarim et al
Brief Communication
What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge, Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia
Journal of Parenteral and Enteral Nutrition Volume XX Number X Month 201X 1–8 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607114525209 jpen.sagepub.com hosted at online.sagepub.com
Sarah A. Karim, MPharm1; Baharudin Ibrahim, PhD, MPharm2; Balamurugan Tangiisuran, PhD, MPharm2; and J. Graham Davies, PhD, FRPharmS3
Abstract Background and Aims: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers’ inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. Methods: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Result: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients’ nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the “average” score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Conclusion: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx)
Keywords knowledge; attitude; practice; nutrition support
Clinical Relevancy Statement Identification of patients’ risk of malnutrition by healthcare providers is fundamental to its treatment. However, insufficient knowledge among the healthcare providers and lack of clear guidelines may contribute as a barrier to implement patients’ nutrition support.
Introduction Malnutrition is common among hospitalized patients, with a prevalence of 20%–50%.1-3 Despite this, nutrition screening and adequate treatment in malnourished patients have been rarely applied structurally by medical staff. Nutrition screening has been defined by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) as “a process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is indicated.”4 In an attempt to improve nutrition care in the hospital setting, the European Society of Clinical Nutrition and Metabolism (ESPEN) has established several guidelines. These guidelines highlight that all patients should be screened on admission to the hospital and a
nutrition care plan developed and implemented if the patient is at risk of malnutrition. Furthermore, the results of screening, assessment, and nutrition care plans should be communicated to other healthcare providers when the patient is transferred to a different ward.5 This was further supported by the National Institute for Health and Clinical Excellence (NICE) guidelines, which recommended that those at risk of malnutrition should undergo From 1Pharmacy Department, Penang General Hospital, Pulau Pinang, Malaysia; 2Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia; and 3Institute of Pharmaceutical Science, King’s College London, London, United Kingdom. Financial disclosure: None declared. Received for publication July 26, 2012; accepted for publication February 2, 2014. Corresponding Author: Balamurugan Tangiisuran, PhD, MPharm, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia. Email: [email protected]
Downloaded from pen.sagepub.com at UNIV OF ALABAMA BIRMINGHAM/ Lister Hill Library on May 29, 2014
2
Journal of Parenteral and Enteral Nutrition XX(X)
nutrition assessment, so that treatment or nutrition care plans could be started.6 They recommended that a multiprofessional nutrition support team (NST) be established at all hospitals in the United Kingdom to improve the nutrition support given to patients.7 A study has shown that there is a large agreement among healthcare providers in implementing nutrition teams as a means to increase the quality of nutrition practice.8 Traditionally, the team includes the physician, pharmacist, dietitian, and nurse.9 Most of the studies to date on knowledge and attitudes toward nutrition support have focused on the doctors, nurses, and dietitians, with less attention given to the pharmacists.10-14 Over the years, pharmacists’ roles on the nutrition support team have evolved from nutrition screening of patients to the monitoring of route, composition of parenteral nutrition (PN), and evaluation of pharmacotherapy used in conjunction with specialized nutrition support.15,16 Before implementing the NST in a new setting, it is important to assess the current knowledge, attitudes, and practice (KAP) of doctors and pharmacists toward nutrition care. Hence, a study assessing their KAP on patient nutrition support is vital. In Malaysia, a study conducted in hospitalized geriatric patients demonstrated that 10.9% had chronic energy deficiency and 10% of subjects had muscle-wasting conditions.17 Despite this, only a few formal continuous training and teaching programs on nutrition are being provided in the hospitals. Thus, doctors rely totally on their knowledge and experience gained from their routine work in treating nutrition cases. Therefore, the purpose of this study was to determine and compare the KAP of doctors and pharmacists in relation to the nutrition support provided in a tertiary care hospital.
Materials and Methods This was a cross-sectional survey conducted from November to December 2011 in a tertiary teaching hospital in the state of Penang, Malaysia. A self-administered questionnaire was distributed to 76 pharmacists and 324 doctors working in the hospital using a drop-and-collect method over a 1-week period. Those working in pediatric departments were excluded because there were no universal screening tools available for children. An additional week was given to the nonrespondents in an attempt to increase the response rate. A reminder was given 1 week after the intended end of data collection to encourage nonrespondents to return the questionnaire.
Survey Instruments A questionnaire with 4 sections containing 30 questions was developed by adapting questionnaires from previously published studies.8,10,12,14 Section 1 focused on the demographic data, in which the pharmacists and doctors were required to record their age, ethnicity, place of graduation, gender, designation, year of starting service, and department. Sections 2 and 3 consisted of questions about the practice and attitudes of doctors and pharmacists toward nutrition support using 5-point Likerttype scale responses (1 = strongly agree, 2 = agree, 3 = neutral,
4 = disagree, 5 = strongly disagree).18 For the attitude part, a score of 7–13 was defined as “positive attitude,” a score range of 14–20 as “ambivalence attitude,” and score between 21 and 28 as “negative attitude.” Ambivalence can be defined as existence of both positive and negative attitudes toward an object.19 In the final section, the doctors and pharmacists were asked to answer multiple-choice questions regarding their knowledge on nutrition support. The knowledge component was designed to assess healthcare providers on nutrition screening and assessment. A score lower than 3 was defined as “not good,” a score range from 4–7 was considered “average,” and score more than 8 was “good” on a scale ranging from 1–10, based on a previously published study.14 Seven individuals (2 academics, 2 general surgeons, and 3 pharmacists) performed the face and content validity. Changes were made accordingly before conducting a pilot study of the questionnaire using 24 healthcare providers (15 doctors and 9 pharmacists) from another hospital. The questionnaire was later revised for clarity and ease of use based on comments received from the pilot study analysis.
Data Analysis Statistical analysis was carried out using SPSS version 17 (SPSS Inc, Chicago, IL). Descriptive analysis was used to compute frequencies of responses for all demographic items and KAP questions. An independent-sample t test was used to compare the responses of pharmacists and doctors. The χ2 or Fischer exact test was used for cross-tabulation on the nominal level. Statistical significance was defined as P < .05. Internal reliability was assessed using Cronbach alpha (α).20,21 Ethical approval for conducting this research was obtained from the Medical Review and Ethics Committee, Ministry of Health Malaysia. The registration ID for the National Medical Research Register is 11-87-8440.
Results The Cronbach α values obtained for each section were .771 (attitude), .821 (practice), and .497 (knowledge). Of the 400 questionnaires distributed, 242 were returned, 12 of which were excluded because of incomplete or missing data. Thus, a total of 230 questionnaires were included in the final analysis. A response rate of 58% was achieved, representing 158 doctors and 72 pharmacists. More female (60.9%) and local graduates (61.7%) responded to this survey. Most (84.3%) of the respondents had no more than 5 years’ work experience in the clinical setting. A complete description of the demographic characteristics of the respondents is depicted in Table 1.
Knowledge of Nutrition Support Table 2 outlines that most (70.4%) of the healthcare providers were grouped in the “average” score range. However, more pharmacists obtained the scores in the range of 8–10 as
Downloaded from pen.sagepub.com at UNIV OF ALABAMA BIRMINGHAM/ Lister Hill Library on May 29, 2014
Karim et al
3 Table 2. Score Range for Knowledge and Attitudes of the Doctors and Pharmacists Toward Patient Nutrition Support.
Table 1. Demographic Characteristics of the Respondents. Designation, n (% ) Demographic
Doctor
Gender Female 84 (36.5) Male 74 (32.2) Place of graduation Local graduate 89 (38.7) Overseas graduate 69 (30) Years in service 0–5 127 (55.2) 6–10 21 (9.2) 11–15 7 (3.0) 16–20 2(0.9) 21–25 1(0.4) Designation Total respondents 158 (68.7) House officer/provisional 82 (35.7) registered pharmacist Medical officer/registered 63 (27.4) pharmacists Specialist 13 (5.7)
Pharmacist
Total
56 (24.4) 16 (6.9)
140 (60.9) 90 (39.1)
53 (23) 19 (8.3)
142 (61.7) 88 (38.3)
67 (29.1) 4 (1.8) 0 (0) 1 (0.4) 0 (0)
194 (84.3) 25 (11) 7 (3.0) 3 (1.3) 1 (0.4)
72 (31.3) 19 (8.3)
53 (23)
—
compared with doctors (22.2% vs 3.2%). Pharmacists’ total mean scores on nutrition knowledge were significantly higher than that of the doctors (6.07 ± 1.76 vs 4.59 ± 1.87, P < .001). Focusing on the individual designation, it was found that registered pharmacists had the highest mean score (6.17 ± 1.74), followed by provisional registered pharmacists (5.79 ± 1.84), specialists (4.92 ± 1.55), house officers (4.63 ± 1.86), and medical officers (4.48 ± 1.94). The proportions of healthcare providers’ correct responses to each specific nutrition support question are presented in Table 3. Most (85.2%) of the respondents were aware of the measurement of body mass index (BMI), although slightly more than half (58.7%) were able to recall the normal range of BMI for Asian population. A similar trend was noticed with regard to the ability of providers to calculate a patient’s weight loss. Despite being the simplest method for the assessment of nutrition status during hospital admission, only 57.8% of the healthcare providers were able to calculate percentage weight loss. Only a small percentage (15.7%) of the healthcare providers knew the answer of the poor indicator for nutrition status. Overall, 52.6% knew the basic energy required for an adult patient who was receiving PN, and 53% accurately answered the question regarding total calories present in 1 g carbohydrate, fat, and protein. More than half (54.3%) of the providers correctly answered the question on anthropometry assessment in malnourished patients.
Attitudes Toward Nutrition Support Most of the survey participants appear to have an ambivalent attitude toward nutrition support. Table 4 outlines the
Score Range (Category)
Designation, n (%) Doctors Pharmacists
Knowledge 0–3 (not good) 40 (25.3) 4–7 (average) 113 (71.5) 8–10 (good) 5 (3.2) Attitudes 7–13 (positive) 29 (18.4) 14–20 106 (67.1) (ambivalence) 21–28 (negative) 23 (14.6)
Total
P Valuea
7 (9.7) 47 (20.4)
