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    • Abstract: FOOD PROVISION IN MALAYSIANHOSPITALS:Practices and Implications for Patients FoodPreferences and IntakeReena Kumari VijayakumaranDr Anita EvesDr Margaret Lumbers Research AimAim of this research was to carry out an extensive

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Practices and Implications for Patients Food
Preferences and Intake
Reena Kumari Vijayakumaran
Dr Anita Eves
Dr Margaret Lumbers
Research Aim
Aim of this research was to carry out an extensive
preliminary work to understand how the
foodservice system works in Malaysian public
Literature review
• Early reports on hospital food such as by Florence Nightingale reported that patients
admitted in the hospital often starve due to lack of provision although there are
adequate food supplies (Nightingale, 1859)
• Over the years, little has changed as there are still problems in food provision as
patient’s nutritional needs are often not met simply because the foodservice system
did not cater appropriately for those who are unwell or have appetite suppressed by
effects of disease or injury (Incalzi et al., 1996; Gall, 1998; Barton et al.,2000, Almdal
et al., 2003)
• Proper foodservice and nutritional care benefits – includes faster recovery of patients
and better quality of life (Cumming, 2004; Kondrup, 2004)
• Improved hospital foodservice can be achieved by knowing patients’ expectations and
how they want the service to be provided. Therefore, patients’ perception and
preferences was explored and investigated
Theoretical framework
Food Preparation Ordering Menu Service
Hospital foodservice
Hospital Staff Patient
Involvement in food Health Condition
Food Transportation Food Habits
Empathy Religion
Feeding Other Foods
Impact on
Patients’ Preferences and
Food Intake
Qualitative methodology
Face to face semi- structured interviews
• Key informants- patients, foodservice managers, doctors, nurses
and dietitians (n = 38 in total)
• Each interview lasted approximately 30-40 minutes
• Used to gather information to reflect ‘real life’ behaviour by
observing patient meal times - their food intake and plate wastage
and including provision of food brought in from visitors
Summary of Data Collection
Data Collection - Location
North Malaysia Central Malaysia South Malaysia
rural area urban/ city rural area urban/ city rural area urban/ city
Type of Catering
In- house Outsourced In- house Outsourced In- house Outsourced
Individuals involved in delivering the service Individual receiving the service
managers dietician doctors
N=3 N=6 N=5
N=6 2nd class 3rd class
N=8 N=10
Data Analysis
Data were transcribed, translated (Malay to English)
and coded into categories
The data are being analyzed using Content analysis,
which is a useful method in coding open-ended
questions in surveys and describing attitudinal and
behavioral response to communications (Krippendorff,
History of Organization of Government Hospitals
Currently there are 135 government hospital in Malaysia
According to the 1957 ‘Hospital Food Policy’, provision of food and
charges for it should be based on the class system - 1st, 2nd and 3rd
1st class patients pay the highest, the 3rd class patients pay the
The differences in payment is for food and room charges though
it is subsidized by the government
Example of Meals
Breakfast Lunch
2 slices of white bread with butter and jam. Drinks: hot chocolate drink One bowl of white rice, stir-fried vegetable (pak-choy), fish curry -
or milk tea mackerel, a piece of watermelon
Evening tea
Fried noodles with vegetables and chicken , plain water
Outsourced / In-House System
All hospitals were established with own catering system (‘In-
House’), run by the hospital
In 2000, one hospital which was newly built was
‘Outsourced’,- so far - 8 out of 135 hospitals has been
‘Outsourced’, mostly newly built and in urban/town area
‘Outsourced’ catering is tendered to catering companies, the
company will bring in their own manpower but uses the facility
and equipments provided by the government
Plating System
Outsourced Hospitals In-House Hospitals
Centralized Plating Decentralized Plating / Bulk
Differences in Patients’ Opinion
due to ‘In- House’ and Outsourced
Cooking methods Taste
In house/
Accuracy of meal
(wrong diet)
Main aspects that influenced patients’ preferences and food
1) PRESENTATION - patients feel food served in central plating
more attractive then decentralized
- presentation is the first impression which
patients decide upon whether to eat or not
2) TASTE - main reason patients decide whether they want to
continue to eat or not
patients in ‘Outsourced’ hospital and those on therapeutic diet
were not satisfied with taste
3) TEMPERATURE - patients feel they may continue to eat hospital
food even if its not tasty if its hot
- only patients in hospitals where food delivered
using trolleys with temperature control are satisfied
Patients are not given opportunity to choose what they want
17 out of 18 patients want menu to be given
3rd class patients don’t know there are choices available
breakfast (6.30/7.00am), lunch (12.30/1.00pm), evening tea
(3.30/4.00pm) and dinner (6.30pm)
patients feel breakfast and dinner is too early
most patients skip breakfast, wait for their family members to bring
food instead
•Dissatisfaction with environment was obvious among 3rd class patients
•Eating environment has impact on patient’s food intake as it is different from how they
usually eat at home
•Patients say they can tolerate sound (crying, vomiting) but not the smell
•Patients prefer to have a separate area where they can eat in the ward, separating dining
and sleeping area
•Eating alone was considered as a lonely process, preferred to eat with other patients
•Nurses are usually very busy, hard to request for help during meal time, therefore usually
wait until family members comes
•Trainee nurses are more helpful and reliable in assisting them during meal time
•Hardly given any encouragement during meal time and dietetic advice although patients
feel it has impact on their food intake
Main Findings to Date
Hospital Settings
- eating environment
- smell / sounds
-class differences
- taste
- presentation
Decision on
preference on whether to eat Regularity of
- temperature
- ethnic based food hospital food or hospital food or finishing hospital
- food habits outside food outside food food
- serving time
- no of meals
- food choice
- cooking methods
- portion size
Hospital Staffs
- empathy
- responsiveness
- assistance
•Positive conceptualization of hospital food is a trend seen on hospitals
which has been outsourced in this study (in many aspects)
•Major implications on food preferences were influenced by factors that
are both general and distinctive according to different geographic
location, among different groups of people and different foodservice
management administrated.
•System used is for the convenience of management control rather than
focusing on patients needs
•Staff generally assume patients were satisfied without taking into
consideration their preferences and food habits
•Future study will be focused on role of staff (esp. dietician) in the
foodservice system
Thank you

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