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Background: Recently, numerous initiatives have been taken to improve food and meals for hospital inpatients. Research providing in-depth knowledge on leading such improvement initiatives and implementing changes, specifically through facilitation within this multilevel context, is essential. This study aims to explore nutrition leaders' experiences in implementing changes to improve food and meal provision for hospital inpatients, focusing on facilitation activities.

Method: This is a qualitative interview study within the social constructivist paradigm. Participants were recruited through professional networks, advertisements, and snowballing. Eighteen semi-structured interviews were conducted individually with participants in leadership roles of food and meal improvement initiatives at Swedish hospitals. The interviews were transcribed verbatim and analysed thematically through an i-PARIHS lens.

Results: Three themes of facilitation activities were identified: 'Building Relationships', 'Placing Food and Meals on the Agenda', and 'Cultivating Skills'. Building relationships involved establishing connections between the service and clinical divisions. Creating common structures and multidisciplinary teamwork enabled collaboration across organisational boundaries. Placing food and meals on the agenda involved both initial and ongoing communication activities, as food and meal tasks were often considered low priority. Cultivating skills encompassed creating learning opportunities for implementing lasting changes, tailored to specific contexts and adopted within everyday practices.

Conclusions: Collaboration between foodservice and clinical professionals, along with the dissemination of knowledge, appears to be important for implementing changes. Active leadership supports successful implementations by providing structured approaches, including feedback systems, and by contributing to the recognition of improvement initiatives, according to experiences shared during interviews.

Background & Aim

Various initiatives have been taken and recommended to improve foodservice and nutritional care to hospitals patients. However, a broad description and analysis of what has been done to reach a better foodservice is lacking. Consequently, the aim of this paper is to map aspects highlighted as important in scientific articles pertaining to the improvement of foodservice for hospital inpatients.

Methods

A scoping review was conducted, including literature searches in four databases (CINAHL, PubMed, Scopus, Web of Science) and an article selection process. Included studies were peer reviewed primary research written in English, published in 2000–2023, focusing on quality and improvement work in organisations and practice concerning provision of food and meals to hospital inpatients. Besides data charting of article characteristics, data were obtained for qualitative synthesis.

Results

Out of the 103 included articles, almost all (n=102) contained aspects associated with systems of different kinds. Foremost were systems for ordering, production, delivery and menus. Additionally, there were systems for structures, evaluation, and control. Other frequently occurring aspects concerned patients (n=84), e.g. considering their nutritional requirements, preferences, and cultural habits, as well as empowering patients with freedom of choice, information and guidance. Aspects concerning professional development, e.g. training, competence and teamwork were scarcer (n=46) and even fewer articles entailed aspects regarding leadership (n=21).

Conclusions

The broad spectrum of aspects that were identified may provide guidance to quality improvement of hospital foodservice. It also indicated research gaps in this field, foremost concerning relational competence and leadership.

Background

Eating is fundamental not only to survival and health, but also to how humans organise their social lives. Eating together with others is often seen as the healthy ideal, while eating alone is highlighted as a risk factor for negative health outcomes, especially among older adults. This paper, therefore, investigates the relationship between the frequency and subjective experience of eating alone and food-related outcomes among 70- to 75-year-olds in Sweden.

Methods

A survey was distributed to a nationally representative random sample of 1500 community-living in Sweden, aged 70–75 years. Two different constructs of eating alone (objective and subjective) were measured, along with the following food-related outcomes: a food index, intake of food groups, consumption of ready-made meals, number of main meals per day, and body mass index (BMI).

Results

In total, 695 respondents were included in the final sample. A quarter of the respondents were categorised as eating alone, of which a small proportion reported that doing so bothered them. There were no associations between eating alone and food index scores, BMI, or intake frequencies of fruits and berries, or fish and shellfish. However, people eating alone were less likely to report eating three meals per day (OR: 0.53, CI: 0.37–0.76, p = 0.006), less likely to report higher intake frequencies of vegetables and snacks, sugary foods, and sweet drinks (adjusted OR: 0.68, CI: 0.48–0.95, p = 0.023 resp. OR: 0.59, CI: 0.43–0.81, p = 0.001), and more likely to report higher intake frequencies of ready-made meals (adjusted OR: 3.71, CI: 2.02–6.84, p < 0.001) compared to those eating together with others. The subjective experience of eating alone did not have an impact on food-related outcomes.

Conclusion

Eating alone or with others played a role in participants’ food intake, and seemed to influence aspects of the organisation of everyday eating routines rather than overall dietary healthiness or weight status. Our findings add to the previous body of research on commensality, eating alone, and health among the older population, providing insights into the development of future health policies and research.

The plate model is widely used to promote healthy eating. Despite extensive adoption in dietary guidelines, the model’s role in food educational practices is scarcely studied. The present study aimed to explore the plate model as a food educational tool in the school subject Home Economics (HE). Use of the plate model was investi-gated with Rogoff’s three planes of analysis as a framework. The research question was: “How is the plate model used in a food educational practice, considering institutional, interpersonal, and personal planes?” Data from video-recorded classroom observa-tions, focus groups, interviews, and text documents were analyzed. The data were generated through a case study, with twelve stu-dents and two HE-teachers followed over the course of a school year. Results show how the plate model was framed as the right way of eating. Nutritionally “proper” food was described, with the model functioning as a bridge linking (abstract) nutritional content with (concrete) dishes. This way of using the model might hamper understandings of fundamental principles for nutritional classifica-tion. Moreover, those who do not eat plate model-type dishes may be wrongly judged. Supported by empirical events, this study shows how the plate model can be useful – but also overused – in food education.

This study aims to contribute to the understanding of food for health as educational content in Home and Consumer Studies (HCS), specifically targeting three educational functions: (i) qualification, (ii) socialization, and (iii) subjectification. Data came from a comprehensive case study, where one school class and two HCS teachers were followed during one school year. Fourteen classroom observations and eight teacher interviews were included. It is shown how qualification functions comprise nutrition knowledge and cooking skills, how socialization functions entail, e.g., dichotomous values of food as “good” or “bad,” and how conscious consumers who take personal responsibility for themselves and the environment become promoted subjects. Taken together, the results illustrate how educational content can have consequences beyond those intended. Based on the results, an argument is made about the relevance for HCS teachers to critically reflect on their teaching and its potential educational consequences.

Food is a part of everyday life, and formal food education is included in compulsory education in many countries, for example through the subject Home and Consumer Studies (HCS). While food education is often underpinned by public health concerns such as preventing non-communicable diseases and promoting cooking skills, there has been little focus on aesthetic aspects of teaching and learning about food. This study therefore aims to gain understanding of aesthetic values as a part of HCS food educational practices. Aesthetic values are here regarded as socially and culturally shared, and related to notions of pleasure and taste. As this study uses a pragmatist approach, aesthetic values are seen as constituted in encounters, encompassing experiencing individual(s), artifacts, and context. By thematically analyzing empirical data from an exploratory case study, including classroom observations, student focus groups, and teacher interviews, we show how values are constituted as culinary, production, and bodily aesthetics. Culinary aesthetics involved cooking processes, cooking skills, and presentation of food and meals. Production aesthetics involved foods’ origin and degree of pre-processing, whereas bodily aesthetics related to bodily consequences of eating. Aesthetic values were vital features of the educational practices studied and played a key role in bringing the practices forward. They also indicated what counted as valid, or desired, outcomes and thereby steered events in certain directions. The study highlights the significance of aesthetic values and argues in favor of acknowledging aesthetics in planning, undertaking, and evaluating HCS food education.

The practice of eating together, commensality, is often considered as something positive in later life, particularly regarding peoples' nutritional status and psychosocial well-being. Eating alone, in contrast, is treated as a risk factor, although literature indicates that it is not necessarily something negative. Still, analyses that specifically target older peoples' varied experiences and notions of eating alone are scarce. This study has explored perceptions and experiences of eating alone among older people in Sweden, a country considered highly individualistic, yet with relatively low levels of loneliness in the older population. Semi-structured interviews were conducted with 20 community-living and retired Swedes, 70-90 years of age. A thematic analysis identified three themes: i) 'Eating alone as a manifestation of loss'; ii) 'Eating alone as an everyday routine'; and iii) 'Eating alone as independence and contentment'. General perceptions of eating alone were often related to the current living situation (e.g., cohabiting or single-living). One key finding was an identified tension between the idea of eating alone as something problematic among those living and eating with a partner and the practical experience of an uncomplicated routine among those living and eating alone. Eating together is discussed as a possible social need for many, but perhaps not for all. Some can feel content with eating alone or even enjoy it. Future studies should approach potential disadvantages of eating alone among older people as an open empirical question that is likely to depend on both the individual and the cultural context.

Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples’ life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.

Aim:The aim of this study was to explore patient satisfaction with hospitalfoodservice in the Swedish setting, using a validated instrument, adding thiscontext to the existing body of research.

Methods:The study was carried out at three hospitals employing cyclicmenus and conventional cook-serve foodservice systems with centralised trayassemblies and hot-trolley distributions to the wards for service. Patient satis-faction was explored using a translated version of the validated Acute CareHospital Foodservice Patient Satisfaction Questionnaire. Groups were com-pared with Mann-WhitneyU-test and Kruskal Wallis test with a set signifi-cance level ofP< .05.

Results:Questionnaires from 439 patients were included in the analysis. Themajority (80%) reported an overall satisfaction of“good”or“very good.”Questionsrelated to Staff and Service received mostly the highest possible ratings, while ques-tions related to Food Quality and Meal Size had slightly lower ratings and highervariation. Comparisons between groups showed that differences were small evenwhen statistically significant. Low appetite and a long hospital stay had an adverseeffect on overall satisfaction and food quality-related questions. Men and youngerpatients reported more often beinghungry after and between meals.

Conclusions:Hospital foodservice faces the challenge of catering to multiplepatient needs. Monitoring patient satisfaction is crucial to ensure thatfoodservice operations remain evidence based. The Acute Care HospitalFoodservice Patient Satisfaction Questionnaire provided a general overviewthat indicated foodservice areas with potential for improvement, althoughpatient satisfaction overall was high. However, patient satisfaction is a complexmeasure and reflexivity is required when interpreting empirical results.