Schlegel-University of Waterloo Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
J Am Med Dir Assoc. 2021 Sep;22(9):1933-1938.e2. doi: 10.1016/j.jamda.2020.11.008. Epub 2020 Dec 9.
Mealtimes in residential care tend to be task-focused rather than relationship-centered, impacting resident quality of life. CHOICE+ uses participatory approaches to make mealtimes more relationship-centered. The aim of this study was to demonstrate the efficacy of the 12-month external-facilitated implementation of CHOICE+ to improve the mealtime environment.
Modified stepped-wedge time series design.
Dining rooms in 3 homes were entered into the intervention every 4 months; total study length was 20 months. Pre- and postintervention evaluations were attained from residents (n = 27, n = 19) and staff (n = 39, n = 29) respectively.
Five meals in each home were observed by a blinded trained assessor every 4 months using the Mealtime Scan+ to assess physical, social, and relationship-centered practices and overall quality of the dining environment. Repeated measures analysis determined change in mealtime environment scores. The Team member Mealtime Experience Questionnaire and 5 questions from the InterRAI Quality of Life Questionnaire for residents and family were administered at pre- and postintervention.
There were significant increases in physical and social environments, relationship-centered care practices, and overall quality of the mealtime environment during the intervention period at all sites (all P < .001) and significant site by intervention interactions for physical (P = .01) and relationship-centered care (P = .03). Statistically significant site differences were noted for relationship-centered care practices (P < .001) and overall quality of the dining environment (P < .002). There was no significant difference in staff and resident/family pre-/postintervention questionnaire results.
The external facilitated model of CHOICE+ resulted in significant improvements in the mealtime environment. Although site context impacted implementation, this study demonstrates that mealtimes can be improved even in homes that have challenges. Future work should determine impact of these improvements on other outcomes such as resident quality of life, using more specific measures.
养老院的用餐时间往往注重任务，而不是以人际关系为中心，这影响了居民的生活质量。CHOICE+采用参与式方法使用餐时间更加以人际关系为中心。本研究的目的是展示为期 12 个月的外部协助实施 CHOICE+以改善用餐环境的效果。
改良的阶梯式时间序列设计。
每 4 个月进入干预措施的 3 个家庭的餐厅；总研究时间为 20 个月。分别从居民（n=27，n=19）和工作人员（n=39，n=29）获得干预前后的评估。
使用盲法训练评估员每 4 个月观察每个家庭的 5 餐，使用 Mealtime Scan+评估物理、社交和以人际关系为中心的实践以及用餐环境的整体质量。重复测量分析确定用餐环境得分的变化。在干预前后，向团队成员提供用餐体验问卷和居民和家庭的 InterRAI 生活质量问卷的 5 个问题。
在所有地点，干预期间物理和社交环境、以人际关系为中心的护理实践以及用餐环境的整体质量均显著增加（均 P<0.001），并且物理（P=0.01）和以人际关系为中心的护理（P=0.03）的地点与干预的交互作用显著。在以人际关系为中心的护理实践（P<0.001）和用餐环境的整体质量（P<0.002）方面，注意到显著的地点差异。工作人员和居民/家庭在干预前后的问卷结果没有显著差异。
外部协助的 CHOICE+模式导致用餐环境的显著改善。尽管地点背景会影响实施情况，但本研究表明，即使在面临挑战的家庭中，也可以改善用餐时间。未来的工作应该使用更具体的措施来确定这些改进对其他结果（例如居民的生活质量）的影响。
