Development and assessment of a nutrition literacy scale for patients with end-stage kidney disease undergoing dialysis and its correlation with quality of life

Abstract

Objectives

To construct a valid and reliable Nutritional Literacy Scale for patients with end-stage kidney disease (ESKD) receiving dialysis and evaluate associations between nutrition literacy and quality of life.

Methods

A total of 208 ESKD patients receiving dialysis were selected for this study. Nutrition literacy evaluation items were drafted based on dietary guidelines for chronic kidney disease (CKD), Literature reviews and expert consultation. Scale reliability and validity were then assessed. Factors influencing nutrition literacy and the associations among nutrition literacy, nutritional status, and quality of life were evaluated.

Results

The scale consists of 28 items with a scale-level content validity index of 0.91 and item-level content validity indices ranging from 0.83 to 1.00. Factor analysis identified 4 common factors (dimensions) named nutrition knowledge, cognitive attitude, behavioral practice, and information acquisition ability that collectively explained 56.31% of literacy score variation. The overall Cronbach’s α coefficient of the scale was 0.83, the dimensional Cronbach’s α coefficients ranged from 0.79 to 0.87, and the retest reliability was r = 0.73 (p < 0.05). Age, education level, residence (urban vs. Rural), occupational status and dialysis modalities were significant factors influencing nutrition literacy. Nutrition literacy score was negatively correlated with SGA score and positively correlated with serum albumin and prealbumin concen- trations, and with SF-36 quality of life score (all p < 0.05).

Conclusions

This new Nutrition Literacy Scale demonstrates high reliability and validity for Chinese ESKD patients undergoing dialysis. The nutrition literacy is influenced by age, education level, residence, occupational status and dialysis modalities, associated not only with nutritional status but also with quality of life.

Keywords:

• End-stage kidney disease
• dialysis
• nutrition literacy
• reliability
• validity
• quality of life
• malnutrition

Acknowledgment

The authors thank the Department of Nephrology of Banan Hospital affiliated to Chongqing Medical University for their great support of this project. J.Z. and Y. Z. both contributed equally to this work and are both corresponding authors.

Ethical approval

This study complies with the principles of the Helsinki Declaration and was approved by the Ethics Committee of School of Public Health and Management, Chongqing Medical University. Informed consent was exempted since the study only involved an analysis of anonymized existing data and records.

Author contributions

Research idea, study design, article writing, and guidance on revision: JZ and YZ; Data analysis, article writing, revision and submission: ZL; data collection, collation, and summary: ZL and TZ.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used to support the findings of this study are restricted by the Ethics Committee of School of Public Health and Management, Chongqing Medical University to protect patient privacy. Data are available from School of Public Health and Management, Chongqing Medical University for researchers who meet the criteria for access to the data.

Additional information

Funding

This work was supported by Public welfare science and technology project of Yongchuan District, Chongqing [Ycstc, 2019nb02021].