Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study

Abstract Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality...

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Autores principales:	Liz Payne, Daniela Ghio, Elisabeth Grey, Joanna Slodkowska-Barabasz, Philine Harris, Michelle Sutcliffe, Sue Green, Helen C. Roberts, Caroline Childs, Sian Robinson, Bernard Gudgin, Pam Holloway, Jo Kelly, Kathy Wallis, Oliver Dean, Paul Aveyard, Paramjit Gill, Mike Stroud, Paul Little, Lucy Yardley, Leanne Morrison
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Person-based approach Malnutrition Eating patterns Intervention planning Ageing; primary health care General practice Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/4760819731a0485683f52a386719b666
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spelling	oai:doaj.org-article:4760819731a0485683f52a386719b6662021-11-14T12:32:28ZOptimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study10.1186/s12875-021-01572-z1471-2296https://doaj.org/article/4760819731a0485683f52a386719b6662021-11-01T00:00:00Zhttps://doi.org/10.1186/s12875-021-01572-zhttps://doaj.org/toc/1471-2296Abstract Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.Liz PayneDaniela GhioElisabeth GreyJoanna Slodkowska-BarabaszPhiline HarrisMichelle SutcliffeSue GreenHelen C. RobertsCaroline ChildsSian RobinsonBernard GudginPam HollowayJo KellyKathy WallisOliver DeanPaul AveyardParamjit GillMike StroudPaul LittleLucy YardleyLeanne MorrisonBMCarticlePerson-based approachMalnutritionEating patternsIntervention planningAgeing; primary health careGeneral practiceMedicine (General)R5-920ENBMC Family Practice, Vol 22, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Person-based approach Malnutrition Eating patterns Intervention planning Ageing; primary health care General practice Medicine (General) R5-920
spellingShingle	Person-based approach Malnutrition Eating patterns Intervention planning Ageing; primary health care General practice Medicine (General) R5-920 Liz Payne Daniela Ghio Elisabeth Grey Joanna Slodkowska-Barabasz Philine Harris Michelle Sutcliffe Sue Green Helen C. Roberts Caroline Childs Sian Robinson Bernard Gudgin Pam Holloway Jo Kelly Kathy Wallis Oliver Dean Paul Aveyard Paramjit Gill Mike Stroud Paul Little Lucy Yardley Leanne Morrison Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
description	Abstract Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.
format	article
author	Liz Payne Daniela Ghio Elisabeth Grey Joanna Slodkowska-Barabasz Philine Harris Michelle Sutcliffe Sue Green Helen C. Roberts Caroline Childs Sian Robinson Bernard Gudgin Pam Holloway Jo Kelly Kathy Wallis Oliver Dean Paul Aveyard Paramjit Gill Mike Stroud Paul Little Lucy Yardley Leanne Morrison
author_facet	Liz Payne Daniela Ghio Elisabeth Grey Joanna Slodkowska-Barabasz Philine Harris Michelle Sutcliffe Sue Green Helen C. Roberts Caroline Childs Sian Robinson Bernard Gudgin Pam Holloway Jo Kelly Kathy Wallis Oliver Dean Paul Aveyard Paramjit Gill Mike Stroud Paul Little Lucy Yardley Leanne Morrison
author_sort	Liz Payne
title	Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
title_short	Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
title_full	Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
title_fullStr	Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
title_full_unstemmed	Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
title_sort	optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/4760819731a0485683f52a386719b666
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Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study

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