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J Am Diet Assoc. 2003 Jul;103(7):844-51.

Using focus groups to determine what constitutes quality of life in clients receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey.

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  • 1School of Pharmacy, National Education and Research Center for Outcomes Assessment, Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA.



As the first part of a multiphase process to develop a Nutrition Quality of Life (NQOL) survey, our objective was to identify items that later will be psychometrically evaluated for inclusion into the NQOL survey, a survey that can be used in routine practice to monitor the impact of medical nutrition therapy (MNT).


We used a prospective, six-step iterative process involving focus groups, surveys, and consensus processes to build a conceptual framework to describe health-related quality of life in individuals receiving MNT, to identify items for inclusion in an NQOL survey, and to refine these items and the survey format. Subjects/Setting and Methods Items were generated from 65 patients in five geographically diverse locations participating in 10 focus groups and 46 dietitians in the same geographic locations participating in seven focus groups. Patients represented a variety of ages, ethnicities, and clinical and economic conditions. Dietitians were primarily from outpatient locations with both general and speciality practices. Sixty-one percent of the participants provided feedback via mailed surveys. Additional input was received from audience attendees at sessions at two national nutrition meetings.


Based on comments generated in client and dietitian focus groups, we identified 50 items in six clusters: 9 items in food impact; 6, self-image; 10, psychological factors; 7, social/interpersonal; 9, physical; and 9, self-efficacy. Whenever possible, we developed items using the clients' own words. Clients, responding to the mailed survey, indicated that they took approximately 10 minutes to complete the NQOL survey. Applications/Conclusions At this time, dietitians may use the 50 questions to probe the impact of MNT on their clients' NQOL. However, psychometric and clinical testing will be necessary to further refine these items before the NQOL survey can be scored and used to measure the NQOL of patients at baseline, to monitor the impact of MNT over time, and to manage future MNT interventions by using an NQOL survey in a quality improvement program.

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