RELIABILITY AND VALIDITY OF A NUTRITION SCREENING TOOL TO BE USED WITH CLIENTS WITH LEARNING-DIFFICULTIES

Background: People with learning difficulties are nutritionally vulner able for many reasons. There is a need for a nutrition screening tool (NST) to enable carers to identify those at nutritional risk. However, a validated NST for clients with learning difficulties does not exist . Aim: To assess the reliability and validity of a NST being used in a long-stay hospital in North Staffordshire for people with learning di fficulties. The NST investigates three areas of risk: nutritional adeq uacy (food groups), weight and nutrition-related problems such as dysp hagia or gastrointestinal disorders. Method: Thirty-six subjects were randomly selected. The reliability of the NST was assessed by three nu rses familiar with the participants. Each subject was independently sc reened using the NST. Validity was assessed by forming an expert panel of three dietitians. Each participant's nutritional status for each o f the three risk areas was assessed independently by the dietitians us ing their own methods. A comparison of the majority opinion of the die titians with that of the nurses gave an indication of validity. Result s: Reliability was analysed using variance component models and indice s of agreement. There was good agreement between nurses in the assessm ent of risk relating to nutrition adequacy (r=0.658), moderate agreeme nt in the assessment of nutrition-related problems (r=0.576), but only fair agreement in the assessment of weight-related risk (r=0.263). Va lidity was assessed using Cohen's kappa statistic. There was good agre ement between the majority opinions of the nurses and dietitians for t he assessment of nutritional adequacy-related risk (r=0.708) and for n utrition-related problems (r=0.691), but only fair agreement for weigh t (r=0.300). Conclusion: Use of tile NST in the area of nutrition adeq uacy gave good repeatability and validity. Similarly, there was good v alidity in the area of nutrition-related problems. The NST was not sat isfactory in assessing weight-related risk and further work is needed in this risk area. There was also a suggestion from the results of the study that tile dietitians differed in their approach to assessing nu tritional risk.