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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