Development, Validity, and Reliability of an Easy-to-Use Nutrition Counseling Tool for Thai Outpatients with Liver Cirrhosis

Objective: We developed a simple nutritional counseling tool for adults with liver cirrhosis, aiming for doctors, nurses, and patients as the tool’s primary users. Material and Methods: The tool was created in a booklet design and based on the European Society of Parenteral and Enteral Nutrition guideline, which comprises four parts, knowledge about cirrhosis, consequences of malnutrition, nutritional recommendations, and calculation of dry body weight and appropriate daily nutritional requirements. Content validity was assessed by three hepatologists using the item objective congruence (IOC) index wherein a score ≥0.5 indicated valid content. Face validity was evaluated by three doctors, three nurses, one dietitian, and three patients for readability, coherence, understandability, and attractiveness using a rating score of 0-10. A reliability test to calculate dry body weight and carbohydrate and protein intake per meal using an intraclass correlation coefficient (ICC) was conducted to determine the agreement among seven doctors and three nurses (inter-raters) using a total of nine case scenarios. Results: The contents of the booklet were valid (IOC: 1.00 for all 19 items). For face validity, the scores for readability, coherence, attractiveness, and understandability were 7.6, 8.6, 9, and 8.6 out of 10, respectively. The overall comments showed that the new instrument was attractive and convenient. All doctors and nurses correctly calculated the dry body weight, and carbohydrate and protein intake for nine case scenarios, indicating excellent agreement (ICC: 1.0, p-value<0.001). Conclusion: The novel nutritional counseling booklet is valid and shows excellent reliability among healthcare providers in calculating body status and nutritional requirements.