Identification and Critical Appraisal of Food Service Satisfaction Questionnaires for Use in Nursing Homes: A Systematic Review

  • Author Footnotes
    ∗ APD = accredited practising dietitian (certified in Australia).
    Morgan Pankhurst
    ∗ APD = accredited practising dietitian (certified in Australia).
    College of Nursing and Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
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  • Author Footnotes
    ∗ APD = accredited practising dietitian (certified in Australia).
    Alison Yaxley
    Address correspondence to: Alison Yaxley, BNutrDiet, BSc (Hons), PhD, APD, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide SA 5001.
    ∗ APD = accredited practising dietitian (certified in Australia).
    College of Nursing and Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
    Search for articles by this author
  • Author Footnotes
    † AdvAPD = advanced accredited practising dietitian (certified in Australia).
    Michelle Miller
    † AdvAPD = advanced accredited practising dietitian (certified in Australia).
    College of Nursing and Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
    Search for articles by this author
  • Author Footnotes
    ∗ APD = accredited practising dietitian (certified in Australia).
    † AdvAPD = advanced accredited practising dietitian (certified in Australia).



      Food service provision in nursing homes is a complex, adaptive system through which multiple stakeholders interface. Organizational stakeholders include staff involved in preparing and delivering meals. Consumer stakeholders are the end users including residents and family. Questionnaires can be an economical and efficient method of measuring food service satisfaction in nursing homes and a powerful quality improvement tool.


      (1) To identify questionnaires that measure food service satisfaction of various stakeholders in a nursing homes and (2) to critically appraise the psychometric properties of identified questionnaires.


      Five electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Medline, ProQuest, Scopus, and Cochrane) in April 2020. Data from the eligible studies were extracted, and the psychometric properties were critically appraised using the Consensus-Based Standards for the Selection of Health Measurement Instruments.


      This review identified 129 studies that used a questionnaire to measure food service satisfaction in nursing homes. Of those, 107 studies representing 75 unique general nursing home satisfaction questionnaires were excluded for failing to adequately explore aspects related to food service. From the remaining 22 studies, 7 food service satisfaction questionnaires were identified; 5 intended for consumers (residents) and 2 intended for organizational stakeholders (staff). Using the Consensus-Based Standards for the Selection of Health Measurement Instruments quality criteria, most questionnaires had flaws in content validity and construct validity, primarily due to small sample sizes. No questionnaires explored food service satisfaction from the family perspective.


      Nursing homes collect satisfaction information for accreditation, marketing, benchmarking, and quality improvement. Although questionnaires are easy to administer, the quality of the data they collect is impacted by the validity and reliability of the questionnaires used. Using unreliable satisfaction data may mean that nursing homes are not accurately able to understand the impact of changes in the system on stakeholder satisfaction.


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        • United Nations
        World population prospects 2019: highlights. 2019.
        • Australian Government
        Life expectancy and disability in Australia 1988 to 2003. 2006.
        • World Health Organization
        The global health observatory.
        (Accessed January 7, 2020)
        • Australian Institute of Health and Welfare
        Residential aged care in Australia 2011-2012: A statistical overview. 2012.
        • Koren M.J.
        Person-centered care for nursing home residents: The culture-change movement.
        Health Affairs. 2010; 29: 312-317
        • National Health Service
        The Health and Social Care Act 2008 (regulated activities) regulations 2014.
        (Accessed May 14, 2020)
        • Dietitians of Canada
        Best practices for nutrition, food service and dining in long term care homes. 2019.
        • Crogan N.
        • Evans B.
        • Severtsen B.
        • Shultz J.A.
        Improving nursing home food service: Uncovering the meaning of food through residents’ stories.
        J Gerontol Nurs. 2004; 30: 29-36
        • Evans B.C.
        • Crogan N.L.
        • Shultz J.A.
        Quality dining in the nursing home.
        J Nutr Elder. 2003; 22: 1-17
        • Watkins R.
        • Goodwin V.A.
        • Abbott R.A.
        • Hall A.
        • Tarrant M.
        Exploring residents’ experiences of mealtimes in care homes: A qualitative interview study.
        BMC Geriatr. 2017; 17: 141
        • Anderson R.A.
        • Issel L.M.
        • McDaniel Jr., R.R.
        Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes.
        Nurs Res. 2003; 52: 12-21
        • Evans B.C.
        • Crogan N.L.
        • Shultz J.A.
        The meaning of mealtimes: Connection to the social world of the nursing home.
        J Gerontol Nurs. 2005; 31: 11-17
        • Plaku-Alakbarova B.
        • Punnett L.
        • Gore R.J.
        Nursing home employee and resident satisfaction and resident care outcomes.
        Saf Health Work. 2018; 9: 1-8
        • Chong A.
        Cognitive predictors of satisfaction in Hong Kong institutional care residents.
        J Appl Gerontol. 2012; 31: 354-376
        • Oliver R.L.
        • DeSarbo W.S.
        Processing of the satisfaction response in consumption: A suggested framework and research propositions.
        Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior. 1989; 2: 1-16
        • Moran L.
        • White E.
        • Eales J.
        • Fast J.
        • Keating N.
        Evaluating consumer satisfaction in residential continuing care settings.
        J Aging Soc Policy. 2002; 14: 85-109
        • Herzberg F.
        Motivation-hygiene theory.
        in: Miner J.B. Organizational Behavior One: Essential Theories of Motivation and Leadership. M.E. Sharpe, Inc, 2005: 61-74
        • Edwards J.R.
        • Bagozzi R.P.
        On the nature and direction of relationships between constructs and measures.
        Psychol Methods. 2000; 5: 155-174
        • Mokkink L.B.
        • De Vet H.C.
        • Prinsen C.A.
        • et al.
        COSMIN risk of bias checklist for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1171-1179
        • Terwee C.B.
        • Prinsen C.A.
        • Chiarotto A.
        • et al.
        COSMIN methodology for evaluating the content validity of patient-reported outcome measures: A Delphi study.
        Qual Life Res. 2018; 27: 1159-1170
        • Prinsen C.A.
        • Mokkink L.B.
        • Bouter L.M.
        • et al.
        COSMIN guideline for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1147-1157
        • Acreman S.
        Nutrition in palliative care.
        Br J Community Nurs. 2009; 14: 427-431
      1. Covidence Systematic Review Software. Veritas Health Innovation, Melbourne, Australia2020 (Accessed April 1, 2020)
        • Levy-Storms L.
        • Schnelle J.F.
        • Simmons S.F.
        A comparison of methods to assess nursing home residents’ unmet needs.
        Gerontologist. 2002; 42: 454-461
        • Robinson J.P.
        • Lucas J.A.
        • Castle N.G.
        • Lowe T.J.
        • Crystal S.
        Consumer satisfaction in nursing homes: current practices and resident priorities.
        Res Aging. 2004/07/01 2004; 26: 454-480
        • Mokkink L.B.
        • Terwee C.B.
        • Patrick D.L.
        • et al.
        The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study.
        Qual Life Res. 2010; 19: 539-549
        • de Almeida R.S.
        • Bourliataux-Lajoinie S.
        • Martins M.
        Satisfaction measurement instruments for health care service users: A systematic review.
        Cad Saude Publica. 2015; 31: 11-25
        • Salame N.
        • Perez-Chada Lourdes M.
        • Singh S.
        • et al.
        Are your patients satisfied? A systematic review of treatment satisfaction measures in psoriasis.
        Dermatology. 2018; 234: 1-9
        • West G.E.
        • Ouellet D.
        • Ouellette S.
        Resident and staff ratings of foodservices in long-term care: Implications for autonomy and quality of life.
        J Appl Gerontol. 2003; 22: 57-75
        • Grøndahl V.A.
        • Aagaard H.
        Older people’s involvement in activities related to meals in nursing homes.
        Int J Older People Nurs. 2016; 11: 204-213
        • Carrier N.
        • Ouellet D.
        • West G.E.
        Nursing home food services linked with risk of malnutrition.
        Can J Diet Pract Res. 2007; 68: 14-20
        • Kenkmann A.
        • Price G.M.
        • Bolton J.
        • Hooper L.
        Health, wellbeing and nutritional status of older people living in UK care homes: An exploratory evaluation of changes in food and drink provision.
        BMC Geriatr. 2010; 10: 28
        • Donini L.M.
        • Neri B.
        • De Chiara S.
        • Poggiogalle E.
        • Muscaritoli M.
        Nutritional care in a nursing home in Italy.
        PLoS One. 2013; 8e55804
        • Buckinx F.
        • Reginster J.Y.
        • Morelle A.
        • et al.
        Influence of environmental factors on food intake among nursing home residents: A survey combined with a video approach.
        Clin Interv Aging. 2017; 12: 1055-1064
        • Jeong J.
        • Seo S.
        Importance of satisfaction with food for older adults’ quality of life.
        British Food Journal. 2014; 116: 1276-1290
        • Bartl R.
        • Bunney C.
        Best Practice Food and Nutrition Manual for Aged Care Facilities.
        2.1 ed. Central Coast Health, 2015: 194
        • Crogan N.L.
        • Evans B.
        • Velasquez D.
        Measuring nursing home resident satisfaction with food and food service: Initial testing of the FoodEx-LTC.
        J Gerontol A Biol Sci Med Sci. 2004; 59A: 370-377
        • Evans B.C.
        • Crogan N.L.
        Using the FoodEx-LTC to assess institutional food service practices through nursing home residents’ perspectives on nutrition care.
        J Gerontol A Biol Sci Med. 2005; 60: 125
        • Crogan N.L.
        • Evans B.C.
        The shortened food expectations-long-term care questionnaire.
        J Gerontol Nurs. 2006; 32: 50-59
        • Crogan N.L.
        • Short R.
        • Dupler A.E.
        • Heaton G.
        The influence of cognitive status on elder food choice and meal service satisfaction.
        Am J Alzheimers Dis Other Demen. 2015; 30: 679-685
        • Crogan N.L.
        • Evans B.C.
        Food expectations-long term care Spanish questionnaire.
        Res Gerontol Nurs. 2010; 3: 282-290
      2. Evans B, Crogan NL. Measuring food and food service satisfaction in aging Mexican American nursing home residents. Hawaii: 16th International Nursing Research Congress; July 14, 2005.

        • Evans B.C.
        • Crogan N.L.
        Translating a food and food service satisfaction measure into Spanish.
        J Transcult Nurs. 2007; 18: 233-237
        • Lengyel C.O.
        • Smith J.T.
        • Whiting S.J.
        • Zello G.A.
        A questionnaire to examine food service satisfaction of elderly residents in long-term care facilities.
        J Nutr Elder. 2004; 24: 5-18
        • Keller H.H.
        • Carrier N.
        • Slaughter S.
        • et al.
        Making the most of mealtimes (M3): Protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.
        BMC Geriatrics. 2017; 17: 15
        • Wright O.R.
        • Capra S.
        • Connelly L.B.
        Foodservice satisfaction domains in geriatrics, rehabilitation and aged care.
        J Nutr Health Aging. 2010; 14: 775-780
        • Wright O.R.
        • Connelly L.B.
        • Capra S.
        • Hendrikz J.
        Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care.
        Health Expect. 2011; 16: 251-265
        • Miller M.
        • Hamilton J.
        • Scupham R.
        • et al.
        Development and psychometric testing of a novel food service satisfaction questionnaire for food service staff of aged care homes.
        J Nutr Health Aging. 2018; 22: 205-215
        • Keller H.H.
        • Vucea V.
        • Morrison-Koechl J.
        Reliability testing of the team member mealtime experience questionnaire.
        J Nutr Health Aging. 2020; 24: 570-575
        • Bolarinwa O.A.
        Principles and methods of validity and reliability testing of questionnaires used in social and health science researches.
        Niger Postgrad Med J. 2015; 22: 195-201
        • Evans J.D.
        Straightforward Statistics for the Behavioral Sciences.
        Brooks/Cole, 1996
        • Crogan N.L.
        • Dupler A.E.
        • Short R.
        • Heaton G.
        Food choice can improve nursing home resident meal service satisfaction and nutritional status.
        J Gerontol Nurs. 2013; 39: 38-45
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Chou S.-C.
        • Boldy D.P.
        • Lee A.H.
        Measuring resident satisfaction in residential aged care.
        Gerontologist. 2001; 41: 623-631
        • Larrabee J.H.
        • Bolden L.V.
        Defining patient-perceived quality of nursing care.
        J Nurs Care Qual. 2001; 16: 34-60
        • Castle N.G.
        A review of satisfaction instruments used in long-term care settings.
        J Aging Soc Policy. 2007; 19: 9-41
        • Gasquet I.
        • Dehé S.
        • Gaudebout P.
        • Falissard B.
        Regular visitors are not good substitutes for assessment of elderly patient satisfaction with nursing home care and services.
        J Gerontol A Biol Sci Med Sci. 2003; 58: M1036-M1041
        • OECD
        Health at a Glance 2019..
        ( Accessed April 25, 2021) Organisation for Economic Co-operation and Development, 2019
        • Prevention Centers for Disease Control and Prevention
        Long-term care providers and service users in the United States, 2015-2016. Analytical and epidemiological studies. 2019.
        • Walton K.
        • Williams P.
        • Tapsell L.
        • et al.
        Observations of mealtimes in hospital aged care rehabilitation wards.
        Appetite. 2013; 67: 16-21
        • Smith G.
        On construct validity: Issues of method and measurement.
        Psychol Assess. 2005; 17: 396-408
        • Hinkin T.R.
        • Tracey J.B.
        • Enz C.A.
        Scale construction: Developing reliable and valid measurement instruments.
        J Hosp Tour Res. 1997; 21: 100-120
        • Nunally J.C.
        Psychometric Theory.
        McGraw Hill, 1978
        • Costello A.B.
        • Osborne J.
        Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis.
        Prac Assess Res Evaluation. 2005; 10: 1-9
        • Kasprzyk D.
        Measurement error in household surveys: sources and measurement.
        Household Sample Surveys in Developing and Transitioning Countries. United Nations, 2005
        • Matell M.S.
        • Jacoby J.
        Is there an optimal number of alternatives for Likert scale items? Study I: Reliability and validity.
        Educ Psychol Meas. 1971; 31: 657-674
        • Fok C.
        • Henry D.
        Increasing the sensitivity of measures to change.
        Prev Sci. 2015; 16: 978-986
        • Weiss D.
        • Dawis R.
        • England G.
        • Lofquist L.
        Manual for the Minnesota Satisfaction Questionnaire. 1967.
        • Agency AACQ
        Consumer experience report. September 2018.


      M. Pankhurst is a PhD candidate, nutrition and dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia.


      A. Yaxley is a lecturer in nutrition and dietetics, food service placement coordinator, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia.


      M. Miller is dean (people and resources), College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia.