Original Article Experiences of food access in hospital. A new questionnaire measure Smriti Naithani a , Jane E. Thomas b , Kevin Whelan b , Myfanwy Morgan a , Martin C. Gulliford a, * a Department of Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London SE1 3QD, UK b Nutritional Sciences Division, King’s College London, London SE1 3QD, UK article info Article history: Received 23 March 2009 Accepted 26 April 2009 keywords: Hospitals Food service, hospitals Patient care Questionnaires Validation study Food access Food choice Hunger Feeding difficulties Malnutrition summary Background & aims: People in hospital experience problems gaining access to food. We aimed to develop an experience-based measure of access to food. Methods: The 27-item questionnaire has five domains: feeling hungry, physical barriers, organisational barriers, food choice and food quality. A survey was implemented on 29 wards in four hospitals using both self-completion and interview administration formats. Results: Questionnaires were analysed for 764/1154 (66%) eligible participants. Values for Cronbach’s alpha were: feeling hungry 0.886; physical barriers 0.809; organisational barriers 0.632; food choice 0.414; and food quality 0.738. The proportions of compromised patients in each domain were: hunger 30%; physical barriers 24%; organisational barriers 29%; food choice 24%; and food quality 21%. Poor self- rated health was associated with increased problems from feeling hungry (adjusted odds ratio 2.39, 95% confidence interval 1.10–5.18); older age was associated with increased difficulties with physical prob- lems (2.67,1.31–5.42) as were admission to a stroke ward (16.8, 5.09–55.3) or elderly care ward (3.50, 1.08–11.40). Problems with food access varied between hospitals and wards. Conclusions: We have developed a reliable and valid questionnaire measure of hospital food access. The measure reveals widespread problems of food access in hospital. Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Survey data show that undernutrition is common in hospitals, affecting between 13% and 40% of hospital inpatients. 1–5 Hospital admissions may be associated with deterioration in the nutritional status of both normally nourished and undernourished patients. 1 Nutritional problems are complex and result from a range of factors including the pathophysiological and metabolic consequences of illness together with a relative failure of food intake. Undernutri- tion is associated with a number of negative clinical outcomes including increased complication rates, 6 mortality, 7 longer hospital stays 8 and increased costs. 9 Ensuring that hospital patients receive adequate nutrition is recognised as an essential part of clinical care. 4 Core standards for hospital food service delivery recommend that there should be sufficient information to allow patients to access appropriate food, food provided should meet the patient’s needs, missed meals should be replaced, assistance to eat and drink should be provided where necessary, and food should be appropriately presented and consumed in a pleasant environment. 10 Previous measurement tools have either focused on methods of screening for risk of undernutrition in hospital patients 11 or have studied patients’ satisfaction with hospital food service. 12 Patient satisfaction questionnaires typically evaluate patients’ perceptions of food quality, while nutritional screening tools do not measure the factors that result in poor food intake. Few studies have evaluated patients’ experiences of gaining access to food in hospital, even though our qualitative research shows that difficulties of food access are common. 13 This research aimed to develop and evaluate a new patient experience-based measure of food access for use in hospitals. The conceptual framework for the new questionnaire was derived from in- depth qualitative interview data reported previously. 13 2. Methods The study was approved by the Research Ethics Committee of Guy’s Hospital, London and all participants gave written informed consent before participation. 2.1. Questionnaire development A questionnaire was developed to evaluate hospital patients’ experiences of access to food. The questionnaire items were derived * Corresponding author. Tel.: þ44 (0)20 7848 6631; fax: þ44 (0)20 7848 6620. E-mail address: martin.gulliford@kcl.ac.uk (M.C. Gulliford). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ – see front matter Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2009.04.020 Clinical Nutrition 28 (2009) 625–630