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Table 5 Collective action—real and ideal conditions for implementing 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 collective action
Inadequate knowledge of nutritional content of foods among cooks and care staff Consistent understanding of nutritional content of foods, the principles of menu development, and strategies for adapting recipes Provide detailed training for cooks
   Provide basic training for care staff
   Access to study dietitian to support changes
Additional workload absorbed by existing resources Employment of supernumerary staff to manage additional workload Negotiate with County Council for payment for cooks for time spent on menu development
  Dedicated time for existing cooks to work on menu development  
Complex and unreliable procurement systems Adjust procurement systems to ensure access to required ingredients/foods Liaise with County Council to revise supply list
  Provide starter pack for homes containing small quantities of new products Provide cooks with codes of preferred ingredients/foods
Inconsistent systems for monitoring implementation (reflected in variable practice between cooks) Consistent, agreed-upon approach between cooks Engage all cooks in training and drafting revised menus/recipes
  Monitoring of implementation Provide feedback on nutritional content of baseline and modified menus
   See strategies for improving coherence and cognitive participation