The University of Southampton
University of Southampton Institutional Repository

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

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

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.

Ageing, Dietary supplements, Eating patterns, Independent living, Intervention planning, Malnutrition, Person based approach, Primary health care, general practice, health services for the aged
1471-2296
Payne, Liz
862f8fcf-711d-4146-a723-a9109339c70a
Ghio, Daniela
3883f706-2f5b-4607-a4ab-4d911dff9e55
Grey, Elisabeth
ac02c8bd-8bc8-4b6a-8966-e7259bcd3d1a
Slodkowska-Barabasz, Joanna
18182048-55ee-474c-9790-1f5b81fa585c
Harris, Philine S.
f58996a4-7dfc-4960-aa27-0bc5d40674e8
Sutcliffe, Michelle
223dd288-72e7-4da0-baf7-f9937260bbae
Green, Sue
bfc312c9-261e-474d-ad68-b36712330976
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Childs, Caroline
ea17ccc1-2eac-4f67-96c7-a0c4d9dfd9c5
Robinson, Sian
d7683d0f-07a4-4cca-8c96-3a382f89c043
Gudgin, Bernard
e832fb17-bfdd-42ab-a9dc-7312629c743e
Holloway, Pam
7e2199dd-89d1-45ea-9a65-bd1a15f9063b
Kelly, Joanne Marie
b7094829-aeb1-4bc1-b64c-7b7c716f73b5
Wallis, Kathy
89f0afa3-3f12-4cc4-8a73-4d5b0dbabf1e
Dean, Oliver
1bcf2cae-e6ef-4e00-a8d9-a700a5196030
Aveyard, Paul
52ed3854-13ad-4680-8d49-408a81a558d4
Gill, Paramjit
41509cbc-f24c-47f4-b384-ba57b7c39841
Stroud, Mike
758c69a8-43db-4d7a-aa57-0151feacf515
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Payne, Liz
862f8fcf-711d-4146-a723-a9109339c70a
Ghio, Daniela
3883f706-2f5b-4607-a4ab-4d911dff9e55
Grey, Elisabeth
ac02c8bd-8bc8-4b6a-8966-e7259bcd3d1a
Slodkowska-Barabasz, Joanna
18182048-55ee-474c-9790-1f5b81fa585c
Harris, Philine S.
f58996a4-7dfc-4960-aa27-0bc5d40674e8
Sutcliffe, Michelle
223dd288-72e7-4da0-baf7-f9937260bbae
Green, Sue
bfc312c9-261e-474d-ad68-b36712330976
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Childs, Caroline
ea17ccc1-2eac-4f67-96c7-a0c4d9dfd9c5
Robinson, Sian
d7683d0f-07a4-4cca-8c96-3a382f89c043
Gudgin, Bernard
e832fb17-bfdd-42ab-a9dc-7312629c743e
Holloway, Pam
7e2199dd-89d1-45ea-9a65-bd1a15f9063b
Kelly, Joanne Marie
b7094829-aeb1-4bc1-b64c-7b7c716f73b5
Wallis, Kathy
89f0afa3-3f12-4cc4-8a73-4d5b0dbabf1e
Dean, Oliver
1bcf2cae-e6ef-4e00-a8d9-a700a5196030
Aveyard, Paul
52ed3854-13ad-4680-8d49-408a81a558d4
Gill, Paramjit
41509cbc-f24c-47f4-b384-ba57b7c39841
Stroud, Mike
758c69a8-43db-4d7a-aa57-0151feacf515
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Payne, Liz, Ghio, Daniela, Grey, Elisabeth, Slodkowska-Barabasz, Joanna, Harris, Philine S., Sutcliffe, Michelle, Green, Sue, Roberts, Helen, Childs, Caroline, Robinson, Sian, Gudgin, Bernard, Holloway, Pam, Kelly, Joanne Marie, Wallis, Kathy, Dean, Oliver, Aveyard, Paul, Gill, Paramjit, Stroud, Mike, Little, Paul, Morrison, Leanne and Yardley, Lucy (2021) Optimising an intervention to support home-living older adults at risk of malnutrition: A qualitative study. BMC Family Practice, 22 (1), [219]. (doi:10.1186/s12875-021-01572-z).

Record type: Article

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.

Text
Optimising an intervention Payne - BMC Family Practice - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Text
s12875-021-01572-z - Version of Record
Available under License Creative Commons Attribution.
Download (1MB)

More information

Accepted/In Press date: 22 October 2021
Published date: 11 November 2021
Additional Information: Funding Information: This paper is from the STREAM project, which aims to develop and test an intervention targeting healthcare professionals and older adults in primary care, funded from an NIHR Programme Grant for Applied Research, Reference RP-PG-0614-20004. The intervention development methods used for this intervention were developed with support from the Southampton Biomedical Research Centre (BRC). The funding body approved the project team’s study design, but was not involved in data collection, analysis or write-up. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Ageing, Dietary supplements, Eating patterns, Independent living, Intervention planning, Malnutrition, Person based approach, Primary health care, general practice, health services for the aged

Identifiers

Local EPrints ID: 452725
URI: http://eprints.soton.ac.uk/id/eprint/452725
ISSN: 1471-2296
PURE UUID: c97d6f74-d8a8-4961-85cb-cc4f33ca1fd0
ORCID for Liz Payne: ORCID iD orcid.org/0000-0002-6594-5668
ORCID for Philine S. Harris: ORCID iD orcid.org/0000-0001-6289-129X
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880
ORCID for Caroline Childs: ORCID iD orcid.org/0000-0001-6832-224X
ORCID for Leanne Morrison: ORCID iD orcid.org/0000-0002-9961-551X
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 16 Dec 2021 17:42
Last modified: 17 Mar 2024 03:20

Export record

Altmetrics

Contributors

Author: Liz Payne ORCID iD
Author: Daniela Ghio
Author: Elisabeth Grey
Author: Philine S. Harris ORCID iD
Author: Michelle Sutcliffe
Author: Sue Green
Author: Helen Roberts ORCID iD
Author: Caroline Childs ORCID iD
Author: Sian Robinson
Author: Bernard Gudgin
Author: Pam Holloway
Author: Kathy Wallis
Author: Oliver Dean
Author: Paul Aveyard
Author: Paramjit Gill
Author: Mike Stroud
Author: Paul Little
Author: Leanne Morrison ORCID iD
Author: Lucy Yardley ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×