Food Preferences of Inpatients in an Australian Teaching Hospital—What Has Happened in the Last 12 Years?
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Food preferences of inpatients in an Australian teaching hospital—what has happened in the last 12 years? Suzanne Kennewell and Maria Kokkinakos Abstract The aim of this study was to survey the food prefer- Methods ences of patients in a large teaching hospital in Australia and to compare the results to a similar study conducted in 1986. Possi- The survey instrument ble differences between genders also were examined. Five hundred and twenty-four patients completed a food preferences A slightly modified version of the questionnaire used by survey, using a nine-point hedonic scale, to indicate how much Williams was used to gather information on the food pref- they liked or disliked 223 different food items. Fresh fruit, poul- erences of hospital inpatients. The questionnaire consisted try and red meat remained the most popular food classes. Nine of of a list of 223 food names, arranged in random order. the 15 most popular individual food items were fresh fruit. Sig- Respondents were asked to indicate how much they liked nificant differences were found between the food preferences of or disliked a food item using the same nine-point hedonic males and females for a number of food classes and individual scale previously described (6). Alternatively, respondents food items. Compared to the 1986 results there appears to be a could select a ‘never tried’ category. greater preference for nutritionally desirable items, more food from various cultures and more traditionally gourmet or ‘novel’ The list included a number of foods commonly availa- foods. It is hoped that the results of this survey may assist other ble and some ‘luxury’ foods, but excluded items that are nutrition and food service staff plan menus for Australian hospi- routinely available on most menus (including breakfast tal patients. (Aust J Nutr Diet 2001;58:37–44) cereals, bread and spreads, tea and coffee). Twelve food items were added to the original survey tool used by Wil- Key words: food preferences, menu planning, male, female, liams. These represented items that were omitted from the hospital inpatients. original survey or have been introduced to Australian diets since that time—roast chicken, chocolate mousse, Fruche, satays, mixed green salad, potato salad, pasta Introduction salad, rice salad, tabouleh, lentil patties, chickpea curry and soya burger. The menu forms the heart of any food service operation. It The same eleven duplicate items as used in the 1986 dictates the complexity of meals that will be prepared, the survey were included to test the reliability of responses. equipment that will be required and the level of skill Three nonsense food names (boiled ermal, trake and needed by the staff who will provide the service. Optimal punistro) were included to estimate how often subjects menu planning assists with cost control and the provision responded to a word that looked like a food or responded of a high quality service. The menu planners must take automatically without actually reading the name. into account not only the nutritional requirements of their The questionnaire was piloted amongst staff members clients, but also their food habits and preferences (1–5). of the food services and the nutrition and dietetics depart- ments of Royal Prince Alfred Hospital, Sydney, New The first comprehensive survey of the food prefer- South Wales. The addition of 12 items did not signifi- ences of Australian hospital patients was undertaken in cantly increase the time required to complete the survey, 1986 by Williams (6). This survey demonstrated that the with 20 minutes being the average time taken to complete results of similar surveys conducted overseas are not nec- the survey. essarily applicable in Australia. Anecdotal evidence suggests that there have been changes in the food prefer- Sample selection ences of Australians in the last 12 years, but few studies The survey took place over a 12-month period, from have been conducted since the mid 1980s, and these have March 1998 to March 1999. Those patients who could not examined the changes in food preferences of patients with speak English or who were too ill to answer the question- a particular disease state (7) or have examined a particular naire, were excluded from the survey. The general age group (8). psychiatric unit was not included in the survey. Data were not collected on the number of patients who were ineligi- The aim of this study was to survey the food prefer- ences of patients in the same large teaching hospital in Royal Prince Alfred Hospital, Food Services Department, Australia and to compare the results to those found by Camperdown, New South Wales Williams to establish if changes have occurred in food S. Kennewell, BSc, MNutrDiet, MDAA, APD, Administrative Dietitian preferences since 1986. The study also aimed to establish M. Kokkinakos, BSc, DipNutrDiet, MMgt, MDAA, APD, Deputy Director Food Service Nutrition, CSAHS whether or not significant differences existed in food pref- Correspondence: S. Kennewell, Food Services Department, Royal erences between the genders. Prince Alfred Hospital, Camperdown, NSW 2050 Australian Journal of Nutrition and Dietetics (2001) 58:1 37 Food preferences in hospital ble, or who declined, to participate in the survey. meat, red and yellow vegetables, salad vegetables, Therefore, a response rate for the survey could not be savoury dishes, seafood, smallgoods and soup. calculated. The mean and standard deviation of hedonic scores The intention of this survey was to compare results were calculated for each food item and class. The paired t- with those found by Williams and the patient selection cri- test was used to test if the responses between repeat items teria were the same as those used in 1986. Therefore, were consistent. The Mann-Whittney U test was used to although a paediatric ward has been opened at Royal identify significant differences between genders. Prince Alfred Hospital since the 1986 survey was con- ducted, patients under 10 years of age were excluded from the survey. In completing the survey, patients would occa- Results sionally miss an individual food item. As these omissions were believed to be accidental and would not affect conse- quent scores, these surveys were included, unless more Demographic data % than 10 of items were missed. A total of 524 usable sur- Table 1 summarises the demographics of the survey popu- veys were collected. lation. Information on the total inpatient population (excluding patients less than 10 years of age) in Royal Administration of the questionnaire Prince Alfred Hospital for the period July 1998 to June The questionnaire was distributed by diet aides or food 1999 is presented for comparison. While the age ranges service assistants. These staff were trained in the adminis- are represented reasonably, the survey under-represents tration of the survey by the same researcher. Patients males and patients born outside Australia when compared meeting the selection criteria were asked if they wished to to the hospital’s general population. Results of the 1996 participate in the survey. Those who agreed to participate census population (10) are also shown. were given a copy of the questionnaire, which was col- lected one to two hours later. Prior to attempting the Reliability of results questionnaire, the participant received oral instructions on how to complete the questionnaire, with emphasis on the Table 2 shows the difference and the standard deviation of points listed below. the difference of the 11 duplicate food items. The overall mean difference for the duplicate food items was –0.02 1. The survey was not intended to be an evaluation of and the standard deviation of the differences was 1.223 the quality of the food in the hospital—only of gen- (P = 0.232). This indicates there was no significant differ- eral preferences among a list of specific items. ence overall between the scores for duplicate food items. 2. The opinion of each person was important and infor- An average of 57.7% of subjects gave an identical score mation on items that had never been tried was also for duplicate items. This compares to 58%, 62.5% and valuable. 55.1% found in previous studies (6–8). 3. The survey was best done one food at a time. The fol- lowing prompt was used to explain the survey method Table 1. Demographic data comparing survey sample with to patients: Royal Principal Alfred Hospital (RPAH) inpatients and Australian Bureau of Statistics For each food first decide whether you have ever had it; if (ABS) census (10) not, circle the number zero and move on to the next food. If you have had the food item, circle the number that best cor- RPAH patients responds to your feelings about the food generally. Survey sample 1998/1999 NSW 1996 ABS (n = 524) (n = 52 640) census(a) 4. The response should reflect an opinion about the food (%) (%) (%) item when prepared to an average acceptable stand- ard, not the very best or worst example the respondent Gender had tried. Male 37.8 44.9 49.4 While questions were welcome during the survey, sub- Female 62.2 55.1 50.6 jects were not told the identity of any food they were not Age range (years) sure about. If they were able to identify the food correctly, 10–19 2.3 3.1 16.0 their view was corroborated; if not, they were advised to answer ‘never tried’. 20–29 14.2 14.8 17.2 30–39 21.9 18.2 18.0 Analysis of results 40–49 11.7 13.1 16.6 50–59 19.4 14.9 12.7 Results were analysed using the Statistical Package for the Social Sciences (SPSS Inc, Cary, NC, SPSS base version 60–69 17.5 15.6 9.1 6.1.3 for Windows, 1995).