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Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization
Claire Bamford1, Ben Heaven, Carl May
1Institute of Health and Society, Newcastle University, UK. claire.bamford@ncl.ac.uk
Implementation Science : IS
|November 1, 2012
Summary
Implementing nutrition guidelines in care homes is challenging. Staff found them restrictive, lacking knowledge and support, hindering adoption and perceived benefits for older adults.
Area of Science:
- Gerontology
- Public Health Nutrition
- Healthcare Management
Background:
- Optimizing nutrition in older adults prevents deficiencies and diseases, enhancing quality of life.
- Care home residents often have suboptimal diets, high in saturated fat, salt, and sugars.
- UK guidance exists, but its acceptance and feasibility in care homes are unproven.
Purpose of the Study:
- To evaluate the acceptability and feasibility of UK nutrition guidelines in care homes.
- To identify barriers and facilitators to guideline implementation using Normalization Process Theory (NPT).
Main Methods:
- A qualitative process evaluation was conducted in five North England care homes.
- Observations and interviews were used, involving managers and various staff levels.
- Thematic analysis of data was performed, mapping findings to NPT constructs.
Main Results:
- Staff viewed guidelines as restrictive and irrelevant, impacting perceived sense (coherence).
- Limited staff engagement (cognitive participation) and implementation support (collective action) were observed.
- Lack of perceived client benefits reinforced negative staff views (reflexive monitoring).
Conclusions:
- Addressing perceived value and alignment with priorities is crucial for successful guideline implementation.
- Specialist support is needed for staff's nutritional knowledge, menu analysis, and outcome evaluation.
- NPT effectively conceptualized barriers; integrating behavior-change theories could enhance practical utility.
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