A Mixed-Methods Study on Carers' and Aged-Care Staff's Perception and Appropriate Utilization of Molded Puree in...

While molded puree is marketed as a dignified alternative to traditional texture-modified diets for older adults and patients with dementia, the clinical implications of their rapid commercialization remain under-examined. To investigate the knowledge, clinical expectations, and psychosocial drivers regarding molded puree for older adults among community carers and aged-care professionals.

This concurrent mixed-methods study recruited 164 community carers (public cohort) and 60 aged-care professionals (staff cohort) who work in non-governmental residential aged-care networks in Hong Kong SAR. Quantitative data were collected via cross-sectional surveys evaluating self-rated knowledge, swallow safety perceptions, and clinical expectations on consumption of molded puree in older adults. Qualitative data were obtained through semi-structured, in-depth interviews with a purposive sub-sample of 12 community carers to explore underlying behavioral drivers. Quantitative differences were analyzed using Mann-Whitney U and Chi-Square tests, while qualitative data underwent thematic analysis.

Self-rated knowledge about molded puree was significantly lower in the public cohort compared to professional staff (p < 0.001). A puree equivalence fallacy was prevalent; 23.8% of the public believed molded puree shares the exact texture of conventional puree, and 39.3% assumed it requires no chewing. Staff were significantly more aware of biomechanical differences (65.0% disagreed with equivalence). The public held significantly higher expectations regarding improvements in feeding behaviors (50.6% agreement) and nutritional value (26.2%) compared to professionals (p< 0.05). Qualitatively, thematic analysis revealed twohigher-order themes: psychosocial motivations centered on restoringdining dignity and avoiding dietary stigma, and structural hurdlesinvolving procedural ambiguity.

A significant knowledge-perception gap exists between the general public and healthcare professionals. While molded puree offers substantial psychosocial benefits, the prevalence of the puree equivalence fallacy underscores a potential risk for vulnerable older adults. Clinical interventions should prioritize evidence-based swallow safety and standardized screening over aesthetic appeal.