Table 4 Cognitive participation—real and ideal conditions for investing in nutrition guidelines

Varied views on existing menus

Scope for improving existing menus widely recognized

Provide feedback on nutritional content of baseline menus

Highlight role of modified menus in managing diabetes

Perceived threats to autonomy and expertise

Control over pace, extent, and nature of changes to menus/recipes

Delegate responsibility for drafting revised menus/recipes to cooks

Provide training for all staff

Lack of leadership for implementation

Key individuals take a lead role in creating and sustaining momentum for change

Extend principle of ownership by involving care staff in the process of menu development

Active support of senior managers with practical issues and in managing any negative feedback on changes