Development and Psychometric Testing of the Mealtime Engagement Scale in Direct Care Providers of Nursing Home Residents With Dementia

Gerontologist. 2021 Nov 15;61(8):e410-e420. doi: 10.1093/geront/gnaa097.


Background and objectives: Mealtime engagement is defined as verbal and nonverbal assistance provided by caregivers to guide and motivate care recipients in eating. Quality mealtime engagement is critical to improve mealtime difficulties and intake among older adults with dementia requiring eating assistance. Few tools are feasible and valid to measure mealtime engagement. This study developed and tested the Mealtime Engagement Scale (MES).

Research design and methods: Items were developed based on literature review and expert review and finalized based on content validity and corrected item-total correlation. A secondary analysis of 87 videotaped observations capturing 18 nursing home staff providing mealtime care to residents with dementia was conducted. Internal consistency, interrater reliability, and intrarater reliability were assessed. Concurrent and convergent validity were examined through correlation (rs) with the Relational Behavior Scale (RBS) and the Mealtime Relational Care Checklist (M-RCC), respectively.

Results: The 18-item MES was developed with adequate content validity (Scale-content validity index [CVI] = 1.00; Scale-CVI/Average = 0.962-0.987). Each item is scored from 0 (never) to 3 (always). The total scale score ranges from 0 to 54. Higher scores indicate greater mealtime engagement. The MES had very good internal consistency (Cronbach's α = 0.837), outstanding interrater reliability (interclass correlation = 0.920), outstanding intrarater reliability (interclass correlation = 0.956), adequate concurrent validity based on strong correlation with the RBS (rs = 0.821, p < .001), and fair convergent validity based on weak correlation with the M-RCC (rs = 0.219, p = .042).

Discussion and implications: Findings provide preliminary psychometric evidence of MES to measure mealtime engagement. Future testing is needed among more and diverse samples in different care settings to accumulate psychometric evidence.

Trial registration: NCT01324219 NCT02269956.

Keywords: Behavioral engagement; Caregiving; Instrument development; Psychometrics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dementia*
  • Humans
  • Meals
  • Nursing Homes
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires

Associated data