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

BMC Family Practice

Sian Robinson¹  Helen C. Roberts²  Mike Stroud³  Elisabeth Grey⁴  Sue Green⁵  Michelle Sutcliffe⁶  Oliver Dean⁷  Caroline Childs⁸  Paul Aveyard⁹  Daniela Ghio^1,10  Paul Little^1,10  Jo Kelly^1,10  Pam Holloway^1,11  Bernard Gudgin^1,11  Philine Harris^1,12  Joanna Slodkowska-Barabasz^1,12  Liz Payne^1,12  Leanne Morrison^1,13  Lucy Yardley^1,14  Paramjit Gill^1,15  Kathy Wallis^1,16 

[1] AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK;NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK;Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK;Clinical Nutrition, University of Southampton, Southampton, UK;Department for Health, University of Bath, Bath, UK;Department for Nursing Science, Bournemouth University, Poole, UK;Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK;Faculty of Medicine, University of Southampton, Southampton, UK;Human Development and Health, University of Southampton, Southampton, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK;Public and Patient Involvement, University of Southampton, Southampton, UK;School of Psychology, University of Southampton, Southampton, UK;School of Psychology, University of Southampton, Southampton, UK;Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK;School of Psychology, University of Southampton, Southampton, UK;School of Psychological Science, University of Bristol, Bristol, UK;Warwick Medical School, University of Warwick, Coventry, UK;Wessex Academic Health Science Network, Southampton, UK;

关键词: Person-based approach;    Malnutrition;    Eating patterns;    Intervention planning;    Ageing;    primary health care;    General practice;    Independent living;    Health services for the aged;    Dietary supplements;   

DOI  :  10.1186/s12875-021-01572-z

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsUsing 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.ResultsParticipants’ 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.ConclusionsUsing 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.

【 授权许可】

CC BY