Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Graduate Studies

First Advisor

Elaine Amella

Second Advisor

Jane Zapka

Third Advisor

Martina Mueller

Fourth Advisor

Cornelia Beck


Background: For an event that occurs three times daily and offers the most opportunity for socialization, mealtimes warrant careful hand feeding implementation by NH staff. PWD may exhibit aversive feeding behaviors that are misinterpreted. This vital misinterpretation can lead to malnutrition in the PWD and increase the risk of mortality. Objective: The goal of this two-month study was to test clinical feasibility and collect pilot data for an intervention to train nursing home (NH) staff via a web-based dementia feeding skills training module with group coaching. The goal of training was to alleviate mealtime difficulties in persons with dementia (PWD) who require mealtime assistance. Methods: Two southeastern US nursing homes were randomized by cluster for implementation of the training module. Pre- and post-tests assessed NH staff knowledge and self-efficacy via web-based module. Meal observations assessed staff feeding skills and PWD behaviors during meal times at baseline, 2 and 8 weeks. Results: Baseline knowledge and self-efficacy scores were similar for both groups. Post-intervention, these scores showed a significant improvement within the intervention group. Feeding skill behaviors trended toward improvement for both groups. Despite increased aversive feeding behaviors in the intervention PWDs, more time was spent feeding and the food intake for the PWDs increased. In the control, aversive feeding behaviors also increased but less time was spent feeding and food intake decreased. Discussion & Conclusions: NH staff increased knowledge and self-efficacy after training. While feeding skill behaviors did not change in either group, with NH staff training, the intervention PWDs were given more time to eat and consumed more food; despite an increase in aversive feeding behaviors. The opposite occurred in the control group. This finding has the potential to negatively impact the morbidity and mortality in this vulnerable population that requires careful hand-feeding. Continued work is needed to test and implement the current clinical practice guidelines in the nursing home setting.


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