Effectiveness of Online Education Training (OET) for Nursing Staff on Enhancing Nutritional Care for Older Adults with Dementia in Chinese Nursing Homes: A Cluster Randomized Controlled Trial

INTERVENTION: Participants allocated to the intervention group will receive a structured person‐centred mealtime care intervention in addition to usual nursing home care. The intervention will be delivered during routine mealtimes over a 12‐week study period. For outcome observation and intervention monitoring, one routine meal will be observed for each participating resident at each assessment time point. The observed meal may be breakfast, lunch, or dinner, depending on the resident’s usual mealtime schedule and facility arrangements. The estimated duration of direct participant contact will depend on the resident’s usual meal duration, typically approximately 10–30 minutes per observed meal. The intervention will include assessment of eating difficulties, individualized mealtime care planning, tailored feeding assistance, communication strategies, environmental strategies, and monitoring of mealtime duration and food intake during the observed meal. Feeding assistance may include verbal prompting, cueing, pacing, encouragement, positioning support, hand‐over‐hand assistance where appropriate, and assistance with utensils or food presentation. Communication strategies may include simple instructions, eye contact, reassurance, and allowing sufficient time for responses. Environmental strategies may include reducing distractions, ensuring comfortable seating, maintaining a calm mealtime environment, and presenting food clearly and accessibly. The intervention will be delivered by trained nursing staff and/or care workers during routine meals under the supervision of the research team. Training will be provided before the intervention commences by members of the research team. The training will consist of one session of approximately two hours, delivered face‐to‐face or CONDITION: Diet and Nutrition ‐ Other diet and nutrition disorders Malnutrition and dementia; ; Malnutrition and dementia Neurological ‐ Dementias Public Health ‐ Health promotion/education PRIMARY OUTCOME: Nurses’ attitudes towards person‐centred mealtime care for older adults with dementia.[Nurses’ attitudes towards person‐centred mealtime care for older adults with dementia, assessed using a structured questionnaire; validated Assisting Mealtime Scale for Dementia Care Before the first training session, immediately after training, 3 months after training (primary timepoint), and 6 months after training.] Nurses’ knowledge of person‐centred mealtime care for older adults with dementia.[Assessed using a structured questionnaire developed for the study . The questionnaire will assess nurses’ knowledge of dementia‐related eating difficulties, nutritional risk, feeding assistance, communication strategies, environmental support, and person‐centred mealtime care principles. Baseline, immediately after training, 3 months post‐baseline (primary timepoint), and 6 months post‐baseline.; ] Nurses’ skills in providing person‐centred mealtime care and feeding assistance for older adults with dementia.[The nursing encouragement and practice assessment was developed specifically for this study and had not been previously validated. It was administered using a structured questionnaire designed to assess participants’ self‐reported mealtime care skills. The skills component included items related to identifying eating difficulties, providing appropriate feeding assistance, using verbal prompting and cueing, pacing feeding support, supporting resident independence, communicating effectively during meals, and adapting the mealtime environment. Higher scores indicated better self‐reported skills. Before the first training session, immediately after training, 3 months after training (primary timepoint), and 6 months after training.] SECONDARY OUTCOME: Older adults’ mealtime eating‐challenge behaviours. ; [Nurses’ person‐centred mealtime care practice will be assessed using a structured observation audit checklist designed specifically for this study. The checklist was developed by the research team to record observable mealtime care practices, including verbal prompting, cueing, pacing, respectful communication, appropriate feeding assistance, positioning support, environmental modification, and allowing sufficient time for residents to eat. The checklist has not been formally validated. Baseline, immediately after training, 3 months post‐baseline (primary timepoint), and 6 months post‐baseline. ; ] Residents’ eating difficulties, assessed using the Feeding Difficulty Index. Higher scores indicate greater eating difficulty. [Residents’ eating difficulties will be assessed using the Chinese Feeding Difficulty Inde X(Ch‐FDI), a validated instrument developed by Liu et al. (2015) to assess feeding difficulties in people with dementia. The Ch‐FDI includes 19 items and records observable feeding difficulty behaviours during mealtimes. Higher scores indicate greater feeding difficulty. Baseline, immediately after training, 3 months post‐baseline (primary timepoint), and 6 months post‐baseline.] Residents’ nutritional status, assessed using the Mini Nutritional Assessment–Short Form. The total score will be used to classify residents as malnourished, at risk of malnutrition, or having normal nutritional status. Higher scores indicate better nutritional status. Assessments will be conducted at baseline and post‐intervention.[Mini Nutritional Assessment–Short Form Baseline, immediately after training, 3 months post‐baseline (primary timepoint), and 6 months post‐baseline.] INCLUSION CRITERIA: Inclusion criteria for nursing staff: 1. Aged 18 years or older. 2. Full‐time, frontline clinical nursing staff who are actively engaged in assisting older people with dementia during mealtimes in Chinese nursing homes (CNHs). 3. Have access to a smart device, such as a computer, mobile phone, or tablet, with internet access to online platforms. 4. Proficient in Chinese. Exclusion criteria for nursing staff: 1. Aged under 18 years. 2. Part‐time, temporary, agency, or casual nursing staff. 3. Nursing staff who are not frontline clinical staff or are not actively involved in assisting older people with dementia during mealtimes. 4. Do not have access to a smart device, such as a computer, mobile phone, or tablet, with internet connectivity. 5. Not proficient in Chinese.