Implementation and expected intervention outputs

The training programme was designed to be used in a diverse range of care settings. As every care home is different, strategies to improve the dining experience for residents will depend on current practice, the resources

available, and the views, opinions and ideas elicited from staff participants. The training programme was also designed to be flexible, to be used as and when required to address the topic(s) of social interaction, choice, and / or

independence. The workshops could be delivered to new staff or delivered on an ad hoc basis to enable staff to reflect on their delivery of care and refresh their approach to mealtimes if and where necessary. In the short-term, it is anticipated that this will help to raise awareness amongst staff of the importance of mealtimes, as well as reinvigorate aspects of the mealtime for residents. Longer-term, it is hoped that simple changes to mealtime care, conceived by staff, will have positive effects on resident health and wellbeing, and that certain

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indicators of health and wellbeing will be measurably improved (e.g., nutritional status, BSPD, and quality of life). Moreover, these changes could be brought about at little or no cost to the care home.

6.2.1.4. Aims of the current research

The findings from the primary and secondary research to date

collectively underscore the importance of accommodating individuals’ shared needs and preferences. The needs and preferences are particularly poignant at mealtimes, which are a focal point of care, and described as the highlight of the day(293) for many residents. An intervention that address this would support the Care Quality Commission’s assertion that residents’ needs and preferences should be identified and documented on admission and regularly reviewed, with input from the individual and their relatives(44). With regard to maintaining autonomy at mealtimes, it is clear that sufficient staffing levels are required and that the staff have the skills necessary to meet residents’ identified needs. Moreover, the changing needs of residents mean that staff need to be flexible, as well as skilled, with the knowledge and experience to adapt to change, and in particular, care for individuals with dementia. Therefore, the current study aims to evaluate whether it is feasible to implement a training programme, focussed on staff, that addresses social interaction, choice, and independence at mealtimes.

Figure 7 illustrates how this intervention has evolved from identifying the evidence base (Study 1 and 2), investigating and exploring the mealtime

experiences of residents (Study 2), to developing a theory-based intervention that aims to enhance the mealtime experience for residents (Study 3). It incorporates an extension of Engel’s (1977) biopsychosocial model of health, intended to illustrate that mealtimes have social and psychological dimensions –

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in addition to the purely physiological (biomedical) effects of eating – which have the potential to impact health and wellbeing. The systematic review (Study 1) identified the overarching role of care provision in influencing the mealtime experience, and this informed the staff-focussed nature of the intervention. The findings from Studies 1 and 2 informed the targets of the intervention, listed in the logic model at the bottom of Figure 7. As indicated to the left of the figure, the empirical work conducted in this thesis is broadly aligned with the first four steps adopted in an Intervention Mapping (IM) approach, as described in

Chapter 3. Figure 7 also shows how the empirical work in this thesis is focussed on the ‘development’ (Studies 1, 2 and 3) and ‘feasibility/piloting’ (Study 3) components of the MRC framework for developing complex interventions. Future development work would incorporate an evaluation element to help establish causality (i.e.. the link between intervention and the effect), as well as an implementation phase to assess roll out and the long-term effectiveness of the intervention.

Given the integral role of mealtimes, the complex needs of residents, and the resource-stretched nature of care homes, this research aims to empower staff to improve the mealtime experience for residents within current working patterns and limited time availability. More generally, positive social identity as a member of the care home is more likely to occur and be reinforced when the care home meets residents’ fundamental need to belong – when it enables them to interact with others, when it enables them to make choices and retain some independence, and when the transition from independence to

dependence is well-managed. Consistent with social identity literature, it is hypothesised that a greater sense of personal control will increase residents’ identification with staff as well as their peers, enhance their sense of citizenship

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(belonging), and improve wellbeing(268). The first step is to test whether in- house, self-managed training workshops are feasible and whether the content is acceptable to participants (section 6.3).

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Figure 7. Theoretical model of intervention development

Study 1: Attitudes, perceptions and experiences of

mealtimes among residents and staff in care homes for older adults: A systematic review of the qualitative literature

Study 2: Exploring residents’ experiences of mealtimes in care homes: A qualitative interview study

Study 3: Improving social interaction, promoting resident choice, and

maintaining resdient independence at mealtimes in care homes or older adults: Testing the feasibility of a staff training programme

Step 1: Needs Assessment Step 2: Matrices Step 3: Theory-based intervention methods and practical application Step 4: Intervention program Step 5: Adoption and Implementation Step 6: Evaluation plan Theory- based model drawing on bio- psycho- social theory, MRC guide- lines & IM

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