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File: Nutrition Questionnaire Pdf 132747 | Vol 26(2) Mj0047 Mariem Boughoula (online First)
mal j nutr 26 2 141 155 2020 development of a tool to measure patients satisfaction of hospital foodservice in a government hospital 1 1 1 mariem boughoula rosita jamaluddin ...

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          Mal J Nutr 26(2): 141-155, 2020
          Development of a tool to measure patients’ satisfaction 
          of hospital foodservice in a government hospital 
                                 1                       1*                                  1
          Mariem Boughoula , Rosita Jamaluddin , Nurul Aqmaliza Abd Manan , Hazizi 
                     1                                       2
          Abu Saad  & Muhammad Sharim Ab Karim
          1
           Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, 
                                                              2
          Universiti Putra Malaysia, Selangor, Malaysia;  Department of Food Service and 
          Management, Faculty of Food Science and Technology, Universiti Putra Malaysia, 
          Selangor, Malaysia
                                                   ABSTRACT
               Introduction: Dissatisfaction towards the quality of foodservice can affect several 
               important aspects such as nutritional intake and financial burden. The effect of 
               dissatisfaction towards nutritional aspect can be observed via a decline in dietary 
               intake.  Therefore,  reliable  and  valid  questionnaires  are  important  to  measure 
               patients’ satisfaction with hospital foodservice. The main purpose of this study 
               was to investigate the construct validity and reliability of a developed questionnaire 
               in a local setting.  Methods: A questionnaire adapted from previous studies and 
               consisting of 27 statements from four dimensions, was administered to a total of 
               277 hospitalised patients in a government hospital. Factor analysis and reliability 
               analysis were conducted using SPSS version 25.  Results: Principal component 
               of  factor  analysis  revealed  that  the  final  questionnaire  contained  four  main 
               foodservice dimensions, namely food properties, staff and meal service reliability, 
               customisation, and physical and social aspects. The reliability analysis revealed 
               that the Cronbach’s alpha value ranged from 0.55 to 0.84 for these foodservice 
               dimensions. The analysis showed that the alpha value differed from one dimension to 
               another such as food properties (α=0.84), staff and meal service reliability (α=0.67), 
               customisation (α=0.69) and physical and social aspects (α=0.55).  Conclusion: 
               Twenty-seven questionnaire items were retained because their factor loadings were 
               greater than 0.35. Therefore, the questionnaire on patients’ satisfaction towards 
               hospital foodservice was considered reliable and valid. The classification of the four 
               dimensions provided detailed information of the satisfaction level, relationship and 
               influence on the foodservice dimensions, which contributed to satisfaction towards 
               hospital foodservice. 
               Keywords:  Patients’  satisfaction,  hospital  food,  hospital  foodservice,  reliability, 
               validity, factor analysis
          INTRODUCTION                                     2002).  The  term  satisfaction  can  be 
          The importance of patients’ satisfaction         defined as the experience of a customer 
          towards foodservice stems from its ability       using a service and can evoke positive 
          to  influence the overall satisfaction on        feelings (Namkung & Jang, 2007). In 
          hospital care quality (Demir & Celik,  health care service, patients’ satisfaction 
          __________________________
          *Corresponding author: Associate Professor Dr. Rosita Jamaluddin 
          Faculty of Medicine and Health Sciences, Department of Nutriton and Dietetics,
          Universiti Putra Malaysia, Serdang, Selangor, Malaysia
          Tel: (6)(03)89472467; Fax: (6)(03)89426769; E-mail: rositaj@upm.edu.my
          doi: https://doi.org/10.31246/mjn-2019-0047
             142                  Boughoula M, Jamaluddin R, Abd Manan NA et al.
             can also be defined as an evaluation of       service were responsiveness, assurance, 
             a patient’s experience of health care  reliability,  empathy  and  tangibility. 
             services via their cognitive and emotional    However, because it was derived from a 
             reactions (Keegan & McGee, 2003). From        service/hospitality setting rather than 
             the  definition,  satisfaction  is  always    a healthcare setting, SERVQUAL failed 
             related with service. Thus, this indicates    to produce clear dimensions for hospital 
             that a strong relationship exists between     service  because  the  evaluation  of 
             patients’ satisfaction and health care  hospital service by patients is different 
             service, especially foodservice (Wright,      when compared with customers from 
             Comelly & Capra, 2006).                       other  service  industries  (Babakus  & 
                Modernisation of the healthcare  Mangold, 1991; Johns & Howard, 1998).
             industry has shown many improvements              Shortly after SERVQUAL was 
             in almost every aspect of the component.      developed, Deluco & Cremer (1990) 
             In a hospital setting, the foodservice  conducted a telephone interview with 
             department often undergoes upgrading          223 randomly selected adults in Ohio 
             in almost every aspect to improve  to determine consumers’ perceptions 
             quality, as well as patients’ satisfaction.   on the quality of hospital foods, food-
             The  influence  of  patients’  satisfaction   related service, clinical service, and 
             towards foodservice affects the overall       their importance. Four years later, Dube 
             satisfaction towards hospital care et al. (1994) developed a questionnaire 
             quality (Ganasegeran et al., 2015).  to determine  the overall satisfaction 
             Several studies have shown that the  with meals and with foodservice, and 
             satisfaction towards hospital foodservice     satisfaction with 26 specific foodservice 
             is influenced by different factors such as    attributes.  Food  quality  was  the  main 
             food quality, interpersonal dimension,  predictor of the survey. Seven dimensions 
             and physical environment (Naithani  representing patients’ perceptions of 
             et al., 2009; Hartwell, Edwards &  foodservice were identified: food quality, 
             Symonds, 2006; Stanga et al., 2008). The      service timeliness, service reliability, food 
             measurement of patients’ satisfaction  temperature, attitude of the staff who 
             becomes an important tool to measure          deliver the menus, attitude of the staff 
             the quality given to patients. However,       who serve the meals, and customisation 
             the measurement of satisfaction in a  (Dube et al., 1994).
             hospital  setting  is  difficult  to  analyse     The Acute Care Hospital Foodservice 
             because it involves the degree of feeling     Patient Satisfaction Questionnaire 
             towards a service and is influenced by        (ACHFPSQ)  developed  by  Capra  et al. 
             other factors.                                (2005)  was the first  reliable  and  valid 
                There are various tools often used         questionnaire to measure patients’ 
             to measure patients’ satisfaction with  satisfaction towards hospital foodservice 
             hospital food or foodservice. (Deluco  (Capra et al., 2005). The questionnaire 
             &  Cremer,  1990;  Dube,  Trudeau &  was initially developed to measure 
             Belanger,  1994; Capra et al., 2005).  patients’ satisfaction with acute care 
             The earliest tool used to evaluate the        hospital foodservice and contained 
             satisfaction towards a service is the  16 statements relating to four factors 
             Service Quality (SERVQUAL) model. This        describing  food  quality,  meal  service 
             model rose from a study by Parasuraman,       quality, staff/service issues and physical 
             Zaithaml & Berry (1988) in which  environment (Capra et al., 2005). Since 
             the tool stated that the dimensions  then,  the  tool  had  been  used  widely 
             of customer satisfaction towards a  to measure patients’ satisfaction with 
                                  Patients’ satisfaction towards hospital foodservice                   143
           hospital  foodservice  because  it  was           MATERIAL AND METHODS
           considered to be a comprehensive and              Study design and data collection
           complete tool.                                    This is a cross-sectional study that 
               Numerous satisfaction surveys had             was  conducted  in  a  620-bed  urban 
           been performed in Malaysia. However, the          government hospital in Malaysia. The 
           results of these studies were too general         duration for data collection for this 
           without studying the actual causes that           study was three months. Prior to data 
           contribute  to  dissatisfaction  towards          collection, permission was obtained from 
           foodservice. This study will identify the         the Ministry of Health (MOH) Malaysia 
           actual factors that are associated with           and the Director of the hospital. Ethical 
           dissatisfaction in hospital foodservice.          approval  was  granted  by  the  Medical 
           The importance of this tool is that it            Research Ethics Committee of the MOH 
           can be useful for assessing the level of          Malaysia and the Medical Research 
           satisfaction towards hospital foodservice,        Ethics Committee of the Faculty of 
           as well as patients’ perceptions towards          Medicine and Health Sciences, Universiti 
           hospital meals. Dietitians can use the            Putra Malaysia. Data collection involved 
           results obtained as a reference to improve        hospitalised  patients  who  fulfilled  the 
           or modify any part of the foodservice             inclusion criteria. Patients were recruited 
           components in order to enhance the  based on the following inclusion criteria: 
           quality of hospital meals and to create           consumed normal diet from hospital, 
           a positive perception among patients  stayed at least two days in the ward 
           towards hospital meals, resulting in  and able to give solid opinion. However, 
           an increase in food consumption. This             patients were excluded from the study 
           research will create awareness among  if they consumed therapeutic diet, 
           hospital foodservice personnel on the  received enteral or parenteral nutrition, 
           actual foodservice dimensions that  nil  by  mouth,  and/or  were  unable  to 
           influence food intake. Thus, the specific         communicate well. The collected data 
           dimensions  identified  can  ensure  that         were  patients’  specific  characteristics 
           meals provided meet the requirement  (age, gender), and questionnaire 
           for patient recovery. In addition, the tool       on patients’ satisfaction towards 
           will  hopefully  enable  these  personnels        foodservice. A total of 562 respondents 
           to address issues pertaining to the high          were interviewed. Out of that, 285 were 
           volume of food wastage. Data from this            unable  to  complete  the  questionnaire 
           study can be used as baseline for further         due to various reasons. As a result, only 
           research regarding hospital foodservice           277 respondents successfully completed 
           systems.                                          the questionnaire. Approximately 116 
               The tool used in this study was  patients were in second-class wards, 
           based on international studies and the            while 161 were in third-class wards.
           questions were modified to fit the local 
           hospital setting. There is no published           Measurements
           evidence that the tool used is valid and          In this study, the satisfaction of 
           reliable for hospital setting in Malaysia.        respondents towards hospital 
           Hence, this study was conducted to  foodservice was measured using a 
           determine the construct validity and  questionnaire adapted from studies by 
           reliability  of  the  questionnaire  using        Capra et al. (2005), Hartwell, Edwards 
           factor analysis and reliability analysis. 
              144                    Boughoula M, Jamaluddin R, Abd Manan NA et al.
              &  Beavis  (2007),  Hwang  &  Desombre              questions in the staff issue dimension. 
              (2003), O’Hara et al. (1997), and Dube              The questions were related to courtesy 
              et al.,  (1994).  Initially,  there  were  five     and attitude of the staffs, punctuality 
              dimensions and a total of 31 items applied          of the staff who served the food and 
              and used to measure the satisfaction  other related questions. There were 
              level among hospitalised patients.                  seven questions in the dimension of 
                  Quality of food is an important  timeliness and reliability. The questions 
              dimension because this factor normally              were mostly related with the suitability 
              gives  a  major  influence  on  patients’           of mealtimes and the time provided 
              satisfaction during hospitalisation to  finish  the  foods.  The  meal  service 
              (Dube  et al. 1994; Lau & Gregoire  dimension had three questions and most 
              1998; Wright et al., 2006). In addition,            of them were related with the quality of 
              according to previous literatures, the  cutlery and crockery, and options given 
              interaction  or  communication  between             to patients. The last dimension was the 
              staffs  and  patients  also  influences             environmental presentation containing 
              the satisfaction towards foodservice  two questions in this dimension. The 
              (Dubé et al., 1994). The delay in food              questions were related with the smell 
              delivery  and  serving  by  service  staffs         and noise of the ward.
              can make patients less satisfied towards                Items  labelled  as  FQ1,  FQ2,  FQ3, 
              the quality of service (Stanga et al.,              FQ4, FQ7, FQ9, FQ10, FQ11, FQ12, SI1, 
              2003). Some studies suggested that  SI2, SI4, MS1, MS2, PE1 and PE2 were 
              interpersonal or service aspects were the           adapted from Capra et al. (2005), FQ5 
              most significant in contributing towards            and FQ6 were adapted from Hartwell 
              patients’ satisfaction (Deluco & Cremer,            et al.  (2007),  eight  items  labelled  as 
              1990; Hartwell et al., 2007). Physical  FQ13, FQ14, TR5, TR6, TR7, SI3, S15 
              environment factors, such as smell,  and MS3 were adapted from Hwang & 
              colour, lighting and ambient temperature,           Desombre (2003), while only four items 
              eating location and social variables can            labelled as TR1, TR2, TR3 and TR4 were 
              also affect patients’ perceptions towards           adapted from Dube et al. (1994), and an 
              hospital foodservice (Capra et al., 2005;           item labelled as FQ8 was adapted from 
              Hartwell  et al., 2006). Finally, other  O’Hara et al. (1997).
              important foodservice dimensions are                    The questions were modified to fit the 
              timeliness  and  reliability.  Dubé  et al.         hospital setting as presented in Table 1.  
              (1994) stated that timeliness is related            To measure satisfaction towards these 
              with the duration for eating and the time           foodservice  dimensions,  a  five-point 
              for staff to pick up the tray, whereas              Likert scale was used as previously 
              reliability is more related to punctuality          done by Capra et al. (2005). The scale 
              of the foodservice and service hours.               was  coded  as  “strongly  dissatisfied”, 
                  Based on the literature discussed  “dissatisfied”, “average”, “satisfied” and 
              previously,      five    dimensions       were      “strongly satisfied”. The lowest value was 
              selected as follows: 1. Food quality, 2.            coded  as  “strongly  dissatisfied,”  while 
              Timeliness and reliability, 3. Staff issue          the highest value was coded as “strongly 
              4. Meal service quality and 5. Physical             satisfied”. A score was given based on 
              environment. There were fourteen  the answer - strongly dissatisfied was 
              questions in the food quality dimension.            scored as 1, dissatisfied was scored as 
              The questions were related with food  2,  average  was  scored  as  3,  satisfied 
              texture,  quality  of  fish  and  meat,             was scored as 4 and strongly satisfied 
              temperature,  food  flavour  and  other             was scored as 5. The composite score, 
              food quality attributes. There were five            that is the sum of all dimension scores, 
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...Mal j nutr development of a tool to measure patients satisfaction hospital foodservice in government mariem boughoula rosita jamaluddin nurul aqmaliza abd manan hazizi abu saad muhammad sharim ab karim department nutrition and dietetics faculty medicine health sciences universiti putra malaysia selangor food service management science technology abstract introduction dissatisfaction towards the quality can affect several important aspects such as nutritional intake financial burden effect aspect be observed via decline dietary therefore reliable valid questionnaires are with main purpose this study was investigate construct validity reliability developed questionnaire local setting methods adapted from previous studies consisting statements four dimensions administered total hospitalised factor analysis were conducted using spss version results principal component revealed that final contained namely properties staff meal customisation physical social cronbach s alpha value ranged for ...

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