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

From: Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

Real conditions Ideal conditions Strategies to promote cognitive participation
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