Ting, Chen Seong
(2014)
Development, implementation and evaluation of nutrition module for trainers of persons with disabilities in community-based rehabilitation centres,Kelantan.
PhD thesis, Universiti Sains Malaysia.
Abstract
Persons with disabilities (PWD) are susceptible to malnutrition. However,
little is known about the nutritional status and nutrition strategies among the local
disability population. This study was conducted from June 2010 to July 2012. It
aimed to assess the nutritional status of PWD, develop and evaluate the effectiveness
of Nutrition Module for Trainers of Persons with Disabilities in community-based
rehabilitation (CBR) centres, Kelantan. This study included three phases. At Phase I,
nutrition assessment of PWD in CBR centres, Kelantan was conducted. A total of
467 PWD (281 children and adolescents; 186 adults) were recruited and their feeding
and anthropometric data were collected using a structured questionnaire. The
nutrition module and Nutrition Knowledge, Attitude and Practice Questionnaire
about Persons with Disabilities (KAP-nOKU) were developed and validated in Phase
2. At Phase 3, an intervention study was conducted. Forty-five CBR teachers from
Kelantan were recruited as the intervention group and 42 CBR teachers from
Terengganu as the comparison group. The intervention group received the nutrition
module training while the comparison group was trained on general health care
issues about PWD. Baseline (TO) and follow up KAP-nOKU assessments at 1-month
(Tl) and 6-month (T2) intervals after intervention were administered for both
groups. Qualitative semi-structured interviews were conducted among 13 teachers
from intervention group to explore the perceived motivations and barriers to their
nutrition management for PWD at CBR centres. Results showed that there was a
prevalence of 20.3% of PWD (17.8% children and adolescents; 24.2% adults) who
were underweight while 22.8% (15.2% children and adolescents; 33.9% adults) were
overweight or obese. At Phase 2, the validated KAP-nOKU contained 57 items with
good-to-excellent internal consistencies for knowledge (KR20=0.63), attitude
(a=0.67) and practice (a=0.82) domains. At Phase 3, repeated measures ANCOV A
demonstrated that intervention group attained significantly higher nutrition
knowledge (p<O.OOl) and practice (p=O.OOl) scores than comparison group at Tl
(mean difference for knowledge= 6.95; mean difference for practice= 2.93) and T2
(mean difference for knowledge= 1 0.30; mean difference for practice= 4.78).
Significant higher nutrition attitude (p=0.004) score for intervention group was
observed at T2 (mean difference= 3.08). Teachers' positive personal attributes were
identified as the primary motivation while PWD's resistance to teachers' positive
nutrition management and lack of parental social support were the major barriers. In
conclusion, this nutrition module is effective on improving the nutrition knowledge,
attitude and practice of CBR teachers in Kelantan.
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