Influencing factors on nutritional knowledge, attitudes, and practices among nursing assistants in nursing homes

The nutritional status of older adults requires focused attention. In Chinese nursing homes, nursing assistants are often the primary caregivers responsible for the daily care of older adults, and their knowledge and attitudes toward nutrition play a fundamental role in providing adequate nutritional care. However, research on the knowledge and attitudes of nursing assistants is limited, despite the fact that these factors play a fundamental role in providing adequate nutritional practices.

The aim of this study is to investigate the knowledge, attitudes, and practices (KAP) of nursing assistants in nursing homes and to analyze the influencing factors.

This cross-sectional study was conducted from January to September 2023, involving 692 nursing assistants from 76 nursing homes in Shanghai. We used validated Nutrition Knowledge, Attitude, and Practice Questionnaire for nursing assistants.

The findings indicated that the mean scores for nutritional knowledge, attitudes, and practices were 45.07 ± 16.18, 76.22 ± 10.03, and 69.94 ± 21.46, respectively. Notably, the mean score for nutritional knowledge was the lowest, with 66.04% of nursing assistants scored below 50% accuracy. A significant negative correlation was observed between nutritional knowledge and practices (r=-0.194, p < 0.001), while a positive correlation was found between attitudes and practices (r = 0.422, p < 0.001). Key predictors of higher nutritional knowledge included education level (B = 3.907, p < 0.001), whereas skill deficiency (B=-3.714, p = 0.006), years of caring (B=-2.789, p < 0.001) and regular supervision (B=-3.422, p = 0.018) were negatively associated. Positive nutritional attitudes were associated with higher education (B = 2.453, p < 0.001), years of caring (B = 1.177, p < 0.001), and participation in nutrition training (B = 4.138, p < 0.001). Nutritional practices were positively influenced by age (B = 3.068, p = 0.002), participation in nutrition training (B = 11.474, p < 0.001) and regular supervision (B = 14.597, p < 0.001), but negatively affected by insufficient income (B=-3.189, p = 0.030).

This study reveals a significant deficiency in nutritional knowledge among nursing assistants in Shanghai's nursing homes, which adversely impacts their nutritional practices. The findings underscore the urgent need for enhanced training programs and to improve the nutritional competencies of nursing assistants. By addressing these gaps through targeted education and consistent supervision, the quality of nutritional care provided to older adults in nursing homes can be substantially improved.