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Potential Implementation of Nutrition-Focused Physical Examination (Nfpe) in Indonesia

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Potential Implementation of Nutrition-Focused Physical Examination (Nfpe) in Indonesia PERCEPTION STUDY OF DIETITIANS, NUTRITION STUDENTS, AND EDUCATORS: POTENTIAL IMPLEMENTATION OF NUTRITION-FOCUSED PHYSICAL EXAMINATION (NFPE) IN INDONESIA A thesis submitted to the Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Master of Science By Yosephin A. Pranoto May 2019 ⓒ Copyright, 2019 by Yosephin A. Pranoto All Rights Reserved Thesis written by Yosephin A. Pranoto M.S., Kent State University, 2019 Approved by _________________________________, Director, Master’s Thesis Committee Karen Lowry Gordon _________________________________, Member, Master’s Thesis Committee Natalie Caine-Bish _________________________________, Member, Master’s Thesis Committee Tanya R. Falcone Accepted by _________________________________, Director, School of Health Sciences Ellen Glickman _________________________________, Dean, College of Education, Health and James Hannon Human Services iii PRANOTO, YOSEPHIN A., RD, May 2019 Nutrition PERCEPTION STUDY OF DIETITIANS, NUTRITION STUDENTS, AND EDUCATORS: POTENTIAL IMPLEMENTATION OF NUTRITION- FOCUSED PHYSICAL EXAMINATION (NFPE) IN INDONESIA (93 pp.) Director of Thesis: Karen Lowry Gordon, PhD, RD, LD Objective- To determine the perception of potential implementation of NFPE in Indonesia on dietitians, nutrition students, and educator. Sample- A convenience sample of dietitians, nutrition students, and educators in Indonesia. Instrument- An electronic questionnaire with 31 questions including demographic data, five points Likert scale perception responses, and one open-ended question were used for this study. Statistical analysis- Demographic data was summarized and presented in table of distribution frequencies, perception data from all three groups of participant were summed and then averaged. To test the hypothesis, simple ANOVA was used with significance level of P ≤ 0.05. Outcomes- The average perception score for dietitians, students, and educators was 4.14, 4.13, and 4.24 respectively (i.e. A score of five being the most positive). The scores fell between the statement of “agree” and “strongly agree”. Dietitians, nutrition students, and educators in Indonesia have a statistically similar perception score regarding the potential implementation of NFPE (p=0.118). The top five potential barriers listed from participant’s answers are: inter-professional collaboration in clinical settings, lack of prior education and training about NFPE, limited availability of tools and resources to perform physical examination on patients, patients trust towards dietitian, and the high workload of a dietitian. Conclusion- There were no statistically significant difference between dietitians, nutrition students, and educator on their perception of potential implementation of NFPE in Indonesia. While initiating the NFPE education and training in both clinical settings and academic fields, several potential barriers also need to be addressed. ACKNOWLEDGEMENTS For there is nothing that I achieved until this day will ever be possible without the blessing of God Almighty and the support from: Dr. Gordon, Natalie, and Tany. Thank you for saying yes since day one on my idea and for believing in this passion and dreams of mine: to bring something home, something for my country, Indonesia. My dearest parents, Lorensius Hardi Pranoto and BR. Diah Utari. I know it is not easy to let this culprit flew across the universe by herself, but it is always your prayer that keeps me safe and fueled with courage to do this adventure. My sister Maria Anindita Pranoto, my little brother Emanuel Hardanto Pranoto, and my brother-from-another-parents Bonaventura A. A. Tresadi. Thank you all for filling my part of duties in our family while I am away. You guys with all of our furry-gang made it possible for me to achieve this milestone. My best friend and forever the better part of me: Lady Anjani. Thank you for always believing in me and stand by my side for the ups and downs. Leonardus Aviandika H. Pramana. Thanks to you I got to see myself in a different way that I may never think of. It warms my heart every time I realize I will never have to go on this adventure alone anymore My partners in crime and the best sisters: Fabiola Lopez and Tam Nguyen. Thank you for this togetherness and all the moments we have shared! What a blessing to have you two since day one here in the U.S.! The Kent family (that made my transition went smoother than I can ever imagine): Jillian Machamer; Walter and Gen Davis; The Frank’s and Grammy + Papa; my favorite girls Lavisha Singh and Wafa Al Awaisi; my Indonesian folks Mbak Noor, Mbak Susi and Family, Mbak Alice, and the whole Permias Kent gang! Thank you and thank God I have you all here at Kent! My Fulbright family. Thank you for all the adventures we got to spend together. Especially for my favorite Mendocina, Marisol Masso! It has been the best experience in my life to be part of you all. I will always treasure each one of you in my heart. My forever inspiration, my one and only grandma: Eyang Uti. My big family and their constant prayers and support for me. The Martini’s and The Pranoto’s. I am so sorry I missed a lot of big moments these past two years, but I know we are always close by heart. *** Last but not least, for each and every one of you that I cannot mention by names. Thanks for your friendship, prayers, and support, it’s truly saved me from all the obstacles that I had to conquer. You know who you are. Thank you! iv TABLE OF CONTENTS Page ACKNOWLEDGEMENTS ………………...……………………………….……… iv LIST OF TABLES ……………………...………………………….………………. vii CHAPTER I. INTRODUCTION ………………………………………………….………....… 1 Overview of Literature ……………...……….…………..………………….…… 1 Statement of The Problem ……………...…………………..……………….…… 3 Purpose Statement ………...………...…………………..…….…………….…… 4 Null Hypotheses ……………...……………..……………………...……….…… 5 Operational Definitions …...…......…………..……………………..……….…… 5 II. LITERATURE REVIEW …....…………………..………………...……….…… 6 Malnutrition …...…………………………..……………………...………....…… 6 Prevalence of Malnutrition ...….…………..……………………...……….…… 6 Risk and Consequences of Untreated Malnutrition ………….......……….…… 7 Malnutrition Criteria …...………………………………………...……….…… 9 Nutritional Screening and Assessment Tools …..…………………..…………… 10 Available Tools to Assess Malnutrition …....….………………..……….…… 11 Dietary Assessment …....…………………..….………………...……….…… 12 Laboratory Values …...……………………..…………………...……….…… 13 Body composition …...…………………..……………………...……….…… 15 Malnutrition Screening/Assessment Tools In the Developing Countries .…… 17 Nutrition-Focused Physical Examination (NFPE) ………...……………….…… 18 NFPE Strength and Benefit ..…………...……………………………...……… 19 Procedure of NFPE ..…………………...……………………………...……… 19 Guidelines for NFPE ..…………………...…………….……………...……… 21 Nutrition Field in Indonesia ..……………………..……………………...……… 22 The Field of Study/Education System ………………..….…………...……… 23 Accreditation and Licensing of Dietitians ………………..…………...……… 24 Clinical Application/Scope of Pratice of Nutrition in the United States ..….…… 26 The Implementation of NFPE ..………………...………………………...……… 27 In The United States (U.S.) ..…………………..……………………...……… 28 Perception of Dietitians ..……………………………………………...……… 29 Perception of Other Health Providers ..…..…………………………...……… 29 Potential Implementation in Indonesia ..……………………………...……… 30 Rates of Deficiencies/Toxicities ..…………...………………………...……… 31 Barriers of NFPE Implementation ..…………………………………...……… 32 III. METHODS ..………………...……………………..…………………...……… 34 Overview ..……………………………..…………..…………………...……… 34 Sample ..………………………………..…………..…………………...……… 34 Survey Development ..…………………………………..……………...……… 35 Procedures ..………………………………………..…………………...……… 36 Data Analysis ..……………………...……………..…………………...……… 37 IV. JOURNAL ARTICLE..…………………………………..………………...…… 38 v Introduction ..………………….…………………..…………………...……… 38 Methodology..……………………………………..…………………...……… 42 Research Sample ………………………………..…………………...……… 42 Instrument of Measurement ……………………..………...………....……… 42 Procedures ………..……………………………..…………………...……… 43 Data Analysis …….……………………………..…………………...……… 44 Results ..…………………….……………………..…………………...……… 45 Demographics ………………………………..…………………...……… 45 Perception ……….…………………………..…………………...……… 46 Potential Barriers …………...………………..…………………...……… 46 Discussion ..……………………...………………..…………………...……… 52 Limitations ..………………………………..……..…………………...……… 56 Applications ..……………………………………..…………………...……… 57 Conclusion ..………………………………..……..…………………...……… 58 APPENDICES ..…………………………………..……….………………...……… 60 APPENDIX A. PERCEPTION OF DIETITIANS, NUTRITION STUDENTS, AND EDUCATORS TOWARDS NFPE QUESTIONNAIRE ………………...……… 61 APPENDIX B. TRANSLATED VERSION OF QUESTIONNAIRE (BAHASA ...INDONESIA) ………………………………………………....…..…………...…. 69 APPENDIX C. E-MAIL COVER LETTER OF QUESTIONNAIRE …...….…… 78 APPENDIX D. E-MAIL REMINDER …………………..…….………....………. 80 REFERENCES …...…...………………………………..……………...……...……. 82 vi LIST OF TABLES Table Page 1. Academy/A.S.P.E.N. malnutrition characteristics …………………………...… 22 2. The Demographic Data of Study Participants Surveyed on Perception Study of Nutrition-Focused Physical Examination Implementation in Indonesia …......... 47 3. The Average Perception Score of Nutrition-Focused Physical Examination (NFPE) Among Dietitians, Students, and Educators in Indonesia …………..… 48 4. The Differences in Average Perception Score of Nutrition-Focused Physical Examination (NFPE) Among Dietitians, Students, and Educators in Indonesia..52 5. Potential Barriers of NFPE Implementation in Indonesia
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