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National survey in elderly care on the process of adopting a new regulation aiming to prevent and treat malnutrition in Sweden
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.ORCID iD: 0000-0002-5423-4262
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
2018 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 26, no 6, p. 960-969Article in journal (Refereed) Published
Abstract [en]

Guided by the i-PARIHS framework, this study investigates perceived facilitators in the process of adopting a new regulation launched in 2015 which aims to prevent and treat malnutrition. In May 2016, a national web-based questionnaire was emailed to chief medical nurses in elderly care in all Swedish municipalities (n = 290). The response rate in this cross-sectional study was 75% (n = 217). Fifty per cent of the municipalities had adopted new routines, 42% had started and 8% had not. One third of the respondents considered malnutrition to be a major problem in elderly care and about half considered the new national regulation to have strengthened local work. A logistic regression showed that the odds for having adopted new routines were higher for CMNs with long experience in elderly care and who had previously worked to prevent malnutrition, and for those who considered the new national regulation helpful. To extract underlying factors in the adoption process, two principal component analyses were performed for key actors and support. For key actors, the analysis yielded four factors, explaining 67% of the total variance; (a) first line team, (b) expert team, (c) management team and (d) surrounding resources. For support, the analysis yielded three factors, which explained 65% of the total variance; (a) agile teamwork, (b) management and leadership and (c) acceptance. The slow adoption rate of the regulation raises questions about its impact; this might be an effect of the general trend of decentralisation in the Swedish welfare sector, and in elderly care in particular, making it hard to attain change that is steered centrally. However, malnutrition is a pronounced problem in elderly care and the mandatory nature of the new regulation therefore warrants further investigation of whether its launch has contributed to a reduction of malnutrition by investigating outcomes and preventive actions carried out in practice.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 26, no 6, p. 960-969
National Category
Nursing
Research subject
Food, Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-348476DOI: 10.1111/hsc.12625ISI: 000446431800019PubMedID: 30033527OAI: oai:DiVA.org:uu-348476DiVA, id: diva2:1197671
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-01-07
In thesis
1. Food Service and Nutritional Care in Swedish Elderly Care: The Progress of National Actions and their Local Interpretations
Open this publication in new window or tab >>Food Service and Nutritional Care in Swedish Elderly Care: The Progress of National Actions and their Local Interpretations
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aim of this thesis is to study local level outcomes regarding food service and nutritional care in Swedish elderly care in relation to the progress of national actions. Study I compared results from a repeated national survey using a questionnaire investigating the general structure and organisation of food service in elderly care. Study II built on data merged from a questionnaire, open comparison survey data and records from the quality registry Senior Alert to investigate nutritional care practice, focusing on quality indicators related to food service. Study III was a web-based questionnaire that described perceived facilitators in the process of adopting a national regulation that aims to prevent and treat malnutrition. Study IV explored associations between the level of adoption of the regulation and registrations in Senior Alert using registry data and results from a questionnaire.

       Differences were found primarily between rural and city municipality groups. The predominant food service organisation was public, but city municipalities reported a higher and increased use of private providers, chilled production and meal choices. The number of clinical/community dietitians had declined significantly between the surveys. Access to this profession was associated with being well-nourished. Food service dietitians and private providers were positively associated with meal satisfaction, while the food production system cook-chill was negatively associated. One year after the launch of the regulation, 50% of municipalities had adopted new routines. The odds for adoption were higher in municipalities where preventive work was already in progress, the regulation was considered helpful, and where facilitators had long experience of working in elderly care. The most important support factors for the adoption of new routines were cooperation between professions and well-defined goals. There was no significant difference in nutritional screening scores associated with adoption rate, but, in general, the number of individuals registered in Senior Alert increased after the entry into force of the regulation.

     In conclusion, this thesis contributes increased knowledge about the different outcomes in local level practices in relation to central actions. The results indicate a strong local autonomy and the importance of local access to sufficient capacity and knowledge.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 153
Keywords
food service, nutritional care, elderly care, national actions, municipality, questionnaire, registry data
National Category
Social Sciences
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-348484 (URN)978-91-513-0337-6 (ISBN)
Public defence
2018-06-08, sal A1:111a, Biomedicinskt centrum, Husargatan 3, (ingång A11), Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-16 Created: 2018-04-13 Last updated: 2018-10-08

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