Validity and reliability of a targeted nutrition-risk screening tool for mental health services.
TL;DR
The NutriMental Screener demonstrated acceptable reliability, clinically meaningful validity, and high feasibility and provides an alternative to undernutrition-focused screening tools currently employed in mental health settings and preliminary evidence for use in AOD services.
Abstract
Aim
To evaluate the measurement properties of a targeted nutrition-risk screening tool developed for mental health and alcohol and other drug (AOD) services.
Methods
A multicentre validation study was conducted in 12 public and private mental health and AOD services in Australia. People receiving care in inpatient, community, forensic and residential mental health settings and one AOD setting were recruited through convenience sampling. The NutriMental Screener was administered at three timepoints to assess inter-rater reliability (two healthcare professionals within 24-hours) and test-retest reliability (repeat administration approximately one week later). Concurrent criterion validity was examined through comparison with a dietitian-completed nutrition assessment incorporating established measures of constipation, malnutrition risk, eating disorder symptomatology, and food insecurity. Reliability was evaluated using Cohen's κ coefficients, and sensitivity and specificity analyses were conducted for domain-specific validity. Feasibility was assessed using completion time and referral outcomes. Findings were reviewed through a structured expert consultation process to refine tool instructions, scoring response layers, and referral processes and frameworks.
Results
A total of 207 participants completed the initial screening, with 198 completing all assessments. Test-retest and inter-rater reliability demonstrated moderate to almost perfect agreement across items (κ = 0.421-0.939, all p's < 0.001). Domain-specific concurrent validity analyses showed clinically acceptable sensitivity-specificity trade-offs across constructs. Median completion time was approximately five minutes. Screening generated a dietitian referral in 40.1% of cases and prompted clinical team discussion in a further 34.8% of cases. Expert-informed refinement resulted in minor modifications to wording and referral framework, producing a clinically ready tool.
Conclusion
The NutriMental Screener demonstrated acceptable reliability, clinically meaningful validity, and high feasibility. This tool provides an alternative to undernutrition-focused screening tools currently employed in mental health settings and preliminary evidence for use in AOD services.