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dc.contributor.supervisorHickson, Mary
dc.contributor.authorMole, Louise
dc.contributor.otherFaculty of Healthen_US
dc.date.accessioned2021-11-26T13:18:17Z
dc.date.available2021-11-26T13:18:17Z
dc.date.issued2021
dc.identifier268821en_US
dc.identifier.urihttp://hdl.handle.net/10026.1/18412
dc.descriptionThere are three studies in this thesis which have been published. The substantial contribution to co-authored papers was made by the candidate. Chapters 3, 4 and 5 contain the manuscripts, and are presented in the format requested by the respective journal.en_US
dc.description.abstract

In this thesis I developed a complex intervention to help people living at home with dementia to eat well, and improve nutritional care. This was achieved through four studies conducted using multiple methods.

A scoping review found 61 studies reported in 63 articles after searching six databases from inception to July 2016. Content analysis was used, and the overarching categories were: ‘timely identification of nutritional risk and subsequent regular monitoring of nutritional status’, ‘multi-component tailored interventions’, and the ‘influence of the caregiving dyad on nutritional status’. Most studies were cross-sectional (n=24), cohort (n=15) or qualitative (n=9). Only three were randomised controlled trials. People living at home with dementia are identified as a vulnerable group (n=35), however only four studies tested interventions to improve nutritional care. In two qualitative studies, semi-structured interviews were used (alongside diaries and a vignette) to explore the experiences of the nutritional care of people living with dementia at home from the perspectives of family members, healthcare professionals and homecare workers. Eight family carers (mean age of 69.6 years) and seven healthcare professionals and homecare workers (mean time spent in profession = 8.9 years) were purposively recruited and interviewed between October 2017 and March 2018. An Interpretative phenomenological analysis approach was used. Three superordinate themes were identified for family carers: ‘becoming carer and cook’, ‘changing role and relationships’, and ‘emotional eating’. Four superordinate themes were identified for healthcare professionals and homecare workers: ‘responsibility to care’, ‘practice restrained by policy’, ‘in it together’, and ‘improving nutritional care’. Family carers, healthcare professionals and homecare workers feel that they do not have adequate knowledge to support someone if they are nutritionally compromised. They are conscious about ‘doing the right thing’ when it comes to providing nutritional care.

The acceptability and feasibility of three podcasts designed for homecare workers about providing nutritional care to someone with dementia were trialled. Six homecare workers took part between October and December 2019, attending a focus group, and completing a quiz. Normalisation process theory underpinned the thematic analysis of qualitative data. Knowledge improved from a score of 5.5 (median) before listening to 7.5 (median) after listening. Eight themes represented the views of the participants. Podcasts about nutritional care and dementia are acceptable to homecare workers, and knowledge of the nutritional concerns associated with dementia improved.

Family carers and people living at home with dementia should be supported when making appropriate food and drink choices, preventing the risk of malnutrition. It is anticipated that the findings of the studies included in this thesis, will encourage healthcare professionals and researchers to place more focus on the nutritional needs of people with dementia living at home. Further development is required for podcasts, and evaluation of their impact in terms of practice and clinical outcomes are required.

en_US
dc.description.sponsorshipThis study was financed with the aid of a studentship from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, now recommissioned as NIHR Applied Research Collaboration (ARC) South West Peninsulaen_US
dc.language.isoen
dc.publisherUniversity of Plymouth
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subjectDementiaen_US
dc.subjectNutritionen_US
dc.subjectDieteticsen_US
dc.subjectSocial careen_US
dc.subject.classificationPhDen_US
dc.titleHelping people with dementia to eat well at home: An investigation to understand and enhance nutritional careen_US
dc.typeThesis
plymouth.versionpublishableen_US
dc.identifier.doihttp://dx.doi.org/10.24382/700
dc.rights.embargoperiodNo embargoen_US
dc.type.qualificationDoctorateen_US
rioxxterms.versionNA
plymouth.orcid.idhttps://orcid.org/0000-0002-6039-9573en_US


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