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Reforming Foodservice in Elderly Care: National Actions and Local Outcomes
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 Statistics.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
2018 (English)In: Nutrition & Dietetics, ISSN 1446-6368, E-ISSN 1747-0080, Vol. 75, no 1, p. 79-86Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions.

Methods: A survey using a web-based questionnaire about elderly care foodservice targeting all Swedish municipalities (n=290) was conducted in 2006 and 2013/14. The questionnaire included the topics: organisation of foodservice, its practice in elderly care, and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%).

Results: The response rate from municipalities was 80% in 2006 and 56% in 2013/14; 45% participated in both surveys. The results showed increased use of local food policies (P=0.03) and meal choice (P<0.001), while access to clinical/community dietitians declined (P=0.01) between the surveys. In home-help services, daily delivered cook-serve meals declined (P<0.001) and chilled meals delivered three times a week increased (P=0.002) between the surveys. City municipalities used private foodservice organisations the most, (P<0.001) and reported reduced use of cook-serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook-serve system (94%) were firmly established. Urban municipalities were placed between the other groups.

Conclusions: National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 75, no 1, p. 79-86
Keywords [en]
dietitians, food policy, food services, health services for the elderly, surveys and questionnaires
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-330116DOI: 10.1111/1747-0080.12388ISI: 000424386500013PubMedID: 29105254OAI: oai:DiVA.org:uu-330116DiVA, id: diva2:1144321
Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2018-04-13Bibliographically approved
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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Skinnars Josefsson, MalinNydahl, MargarethaPersson, IngerMattsson Sydner, Ylva

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