According to the Korean Health and Social Research Institute's Disability Survey[1], 79.3% of people with disabilities suffer from chronic diseases lasting > 3 months, and the types of chronic diseases among people with disabilities who reported having a chronic disease were 54.4% for hypertension, 25.6% for diabetes, and 18.8% for dyslipidemia. People with disabilities may develop chronic diseases at an earlier age owing to their relatively poor health status compared to people without disabilities [2]. International studies [3, 4] have demonstrated that people with disabilities have a higher prevalence of chronic diseases than people without disabilities, and their complications and reduced life expectancy are also more severe than those without disabilities. In a previous study [5] comparing the prevalence of chronic diseases among people with and without disabilities, the odds ratio was 1.36 times higher for hypertension, 1.55 times higher for diabetes, and 1.46 times higher for heart disease, and the prevalence of chronic diseases among registered people with disabilities in Korea as of 2014 was 40.4% for obesity, 42.9% for hypertension, and 19.1% for diabetes, all of which were higher than the prevalence of obesity, 28.9% for hypertension, and 11.1% for diabetes among people without disabilities [6]. World Health Organization [7] has suggested that the occurrence of chronic diseases such as obesity, diabetes, and cardiovascular diseases, including cancer, is highly related to dietary habits, and in order to manage chronic diseases in Korea, a pilot project for chronic disease management is being conducted at public health centers, and education on non-drug therapies such as exercise diet is provided to patients diagnosed with hypertension or diabetes along with drug therapy [8]. The results of a previous study [9] revealed that dietary modification and nutrition education were effective in preventing complications by maintaining proper blood pressure and blood sugar levels.

According to a survey by the Ministry of Food and Drug Safety in 2021, meals are provided in 12,995 of 83,906 (15.5%) welfare facilities for the older people and persons with disabilities operating nationwide. Among the facilities that provide such meals, approximately 80% of 10,238 operate without a nutritionist. Of the 2,181 welfare facilities for people with disabilities, 1,097 (50.3%) operated canteens without a dietitian; by type of welfare facility, 59% of residential facilities for people with disabilities, 45% of vocational rehabilitation facilities for people with disabilities, and 42% of community rehabilitation facilities for people with disabilities had a dietitian managing the cafeteria [10]. Social welfare facilities without dietitians, who are in charge of providing comprehensive nutrition services, such as nutrition education and meal management, need professional support for nutrition, hygiene management, and education. Accordingly, the government has implemented the Act on the Safety Support of Meal Food in Social Welfare Facilities for older people and persons with disabilities, to expand customized meal services and nutrition management policies for social welfare facilities (July 28, 2022) and established a social welfare meal management support center to support meal facilities operated without nutritionists for such population [11]. The Support Center for Social Welfare Meal Management provides guidance on hygiene and nutrition visits to meal centers, customizes diets according to health conditions, and supports dietary education for each target [12]. To provide nutrition education tailored to social welfare facilities for people with disabilities, research is needed on the direction of education and program composition required in the field; however, current research on nutrition education for people with disabilities in Korea often focuses on dietary nutrition education for people with disabilities who live independently or at home rather than those who are residents or users of social welfare facilities for people with disabilities [13, 14]. In addition, depending on the type of social welfare facility, the time of day differs, which leads to differences in the level and frequency of meals and snacks provided; therefore, the nutrition education conducted in residents and users needs to be differentiated. Therefore, this study aimed to determine the demand for nutrition education programs intended to improve the health of users of social welfare facilities for the persons with disabilities and ultimately provide basic data to develop nutrition education programs that meet the needs of such social welfare facilities.

This study aimed to identify the nutrition education needs of facility workers to develop a nutrition education program to improve the health of residents and users of social welfare facilities for persons with disabilities. Thus, basic data on how to provide nutrition education that meets the needs and demands of social welfare facilities for persons with disabilities were derived, along with the following directions for developing nutrition education programs for social welfare facilities for persons with disabilities.

First, nutrition education programs differentiated according to the type of social welfare facility for persons with disabilities need to be developed. In this study, the results were analyzed by dividing social welfare facilities for people with disabilities into admission facilities and use facilities. Differences in the characteristics of admission and use facilities, diet management methods, disease diet management, and nutrition education management were observed.

In the case of residential facilities, the proportion of residents who need help with mobility or have to eat in their bedrooms is high, and social workers are in charge of meals (26.13%), followed by nutritionists (54.95%). Hence, social workers prepare and serve various types of special diets despite their lack of expertise. Therefore, residential facilities should strengthen education for facility workers, who are caregivers, and provide nutrition education on a wide range of topics related to nutrition, disease, and hygiene to help them manage and serve meals appropriately. A qualitative study on the health management of residents and users of social welfare facilities [18] has mentioned the need for training on dietary management for facility staff caring for people with brain lesions as important in residential facilities, but not in user facilities. However, the percentage of users with free mobility is high, and the time to stay in the facility is fixed in the form of back and forth; therefore, the time to receive nutrition management in the facility is relatively small. Additionally, the percentage of users who only provide lunch or entrust their meals to a catering company is high; therefore, they are not directly involved in meal preparation. Therefore, developing and providing nutrition education courses for users at the developmental level are necessary to help them manage their nutrition.

Secondly, nutritional education programs need to be developed for individuals with developmental disabilities. In this study, 78.71% of the residents and users of social welfare facilities for persons with disabilities had developmental disabilities, and 13.90% had multiple disabilities, totaling 92.61% of the persons with disabilities living in the facilities. According to statistics on persons with disabilities (2023), the number of people with autism and intellectual disabilities, which are the main types of developmental disabilities, was 263,311 in 2022, which increased from 247,910 in 2020. Such increase in the number of people with developmental disabilities is expected to continue because of medical development and extended life expectancy [19]. Hence, developing nutrition programs that reflect the characteristics and needs of persons with developmental disabilities is important as the need for expanding social services to protect the lifelong needs of the growing population with developmental disabilities increases [20]. Developmental disability is a diagnosis that covers a "spectrum" of symptoms due to developmental delays or imbalances in intelligence, language, social, motor, sensory, and other areas; the symptoms and characteristics of each individual are unique [21]. However, Yoon and Choi [22] noted that children with developmental disabilities lag behind their peers in the development of food intake skills and face several dietary challenges. In addition, problems caused by interactions while taking medications owing to disabilities, excessive appetite, and severe eating disorders have been observed in children with developmental disabilities [23]. A qualitative study on the health management of residents and users of social welfare facilities [18] also mentioned the importance of obesity management education for people with developmental disabilities, and that educating facility workers on nutritional management for people with brain lesions is necessary. In this study, the need for characteristics (4.10 points) of nutrition education among facility workers was also confirmed, and the overall understanding of disability was emphasized as a competency expected of nutrition educators to conduct nutrition education in social welfare facilities for persons with disabilities. Lee and Park [24] identified knowledge of various learning styles and teaching methods for children with disabilities and the selection of strategies and materials according to the characteristics of children with disabilities as job performance skills required for educators in the field.

Third, hygiene and obesity-related nutrition education should be prioritized to improve the nutrition of residents and users of social welfare facilities for people with disabilities. In this study, hygiene management was the most important topic of nutrition education for residents and users. A previous study [25] has also reported that providing hygienic meals in facilities for people with disabilities is important because people with disabilities are at a higher risk of food poisoning owing to their lower immunity than people without disabilities. According to the five causes of food poisoning outbreaks reported by the U.S. Food and Drug Administration [26], food poisoning can be caused by poor personal hygiene in addition to the distribution of foods made from contaminated raw materials, improper cooking, improper storage temperatures, and hygiene of meals such as contaminated equipment. A previous study on junior high school students [27] has also indicated that preventing foodborne illness depends not only on the clean cooking process of meals but also on the personal hygiene of students receiving meals; therefore, hygiene education of meal recipients should be emphasized. In addition, in this study, the obesity rate of residents and users was high (34.29%), and accordingly, the demand for nutrition education on obesity diet management was also high (≥ 4.25 points). In a study [28] that analyzed domestic research trends on obesity in people with disabilities, 18 out of 25 previous studies focused on obesity in people with intellectual disabilities because obesity among people with intellectual disabilities is increasing for various reasons. Han et al. [29] have reported that the obesity rate of people with intellectual disabilities is increasing because they have a higher tendency to consume high-calorie foods owing to a lack of physical and social activities, irregular meals, overeating, and convenience eating compared to other people with disabilities. In this study, the need for prevention of convenience eating was confirmed by demonstrating a high need with a score of 4.18. Choi and Lee [30] have emphasized that convenience eating should be corrected in nutrition education for children with obesity because such children who eat convenience food consume more animal protein and fat than healthy children, which can cause major problems in nutritional balance. Therefore, obesity management and improvement in the convenience of eating should be addressed as essential topics in nutrition education for users, residents, and workers of social welfare facilities with disabilities.

Although this study was conducted to improve the health of residents and users of social welfare facilities for persons with disabilities, a limitation exists in analyzing the needs of residents and users of facilities other than those with disabilities. If more direct needs are derived through follow-up studies, it can contribute to the development of effective educational programs. In addition, as understanding caregivers is necessary to improve the effectiveness of nutrition education for users of social welfare facilities, nutrition education courses that link facilities and homes can be developed by expanding the study population to families. Nevertheless, this study is important because it provides basic data for establishing nutrition education programs in the field, where data on nutrition education for people with disabilities in social welfare facilities are scarce. This study may also suggest the direction of nutrition education for improving the health of residents and users.

This study aimed to provide basic data for the development of nutrition education programs that meet the needs of social welfare facilities for persons with disabilities, by identifying the needs of nutrition education programs aimed at improving the health of residents and users of social welfare facilities. Depending on how persons with disabilities live in social welfare facilities, the analysis was conducted by dividing them into admission facilities and facilities used. Significant differences in the characteristics of admission and users, diet operation method, disease operation status, and nutrition education operation status were observed according to the type of facility. Additionally, significant differences in nutrition education topics and media needs were also noted according to the type of operation of social welfare facilities for people with disabilities. Therefore, customized nutrition education programs need to be developed according to the needs of the site and type of operation to improve the nutritional status and health of people with disabilities in facilities.