Mealtime Settings Research Articles

RESIDENT EXPERIENCES OF PERSON-CENTRED CARE AT MEALTIMES IN LONG-TERM RESIDENTIAL CARE: A RAPID ETHNOGRAPHY

Abstract Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. As part of the TRANS-SENIOR research network, rapid ethnographies were conducted across multiple sites (including interviews, observations and informal conversations), in long-term residential care homes in the UK, Switzerland and the Netherlands between October 2020 and December 2021. During analysis and interpretation of data, different themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed. We observed differences between the long-term care homes in as much as the setting could be considered, resident choice was implemented, residents were enabled, care was individualized in the communal setting and how much the person of the residents was known with their past and present. In the presentation we will discuss the possibility to provide person-centred care during mealtimes in view of differences between staff approaches, the overall environment (size of dining area, seating arrangements etc.), allocation of staff resources and country-specific rules and regulations. We see an interplay of factors in place for mealtimes to be moments of participatory choice, interaction, independence, and dignity.

Variability in parenting behaviours during play and during mealtimes with toddlers

AbstractFew empirical studies have explored variability in parenting behaviours observed in a mealtime setting as well as in a play setting with young children. We analysed data from 282 parent–toddler dyads who participated in the Play & Grow study in the United States in 2017–2019. Parent–child interactions were video recorded during play in the laboratory when the child was 18 months old and then during mealtime in the home 6 months later. Standardised coding procedures were used to rate parenting behaviours (sensitivity, cognitive stimulation, positive regard, detachment, intrusive control and negative regard). We describe correlations and differences and variability in parenting behaviour between the two assessments and relative to child sex, gestational age, parent education level, household composition and household income. Detachment was lower on average during play at 18 months compared to during mealtime at 24 months (Cohen's d = −0.40), and the other five parenting behaviours were greater on average during play than during mealtime (d = 0.18–0.43). Sociodemographic characteristics were unrelated to the magnitude of individual differences across contexts in any of the parenting behaviours. Implications for research on associations between parent–child interactions and risk for childhood obesity are discussed.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

IntroductionPoor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.MethodsAs part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. ResultsFollowing analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.ConclusionsThere are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.

Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub-acute hospital, rehabilitation and aged-care settings: A systematic review.

This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged-care facility settings. Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n=490) were associated with greater energy and protein intake and higher measures of quality of life than non-communal mealtime settings. Dining room enhancement interventions (14 studies, n=912), overall, contributed to increased intake of food, energy, protein and fluid. Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large-scale, well-designed experimental studies to assess the potential impacts of these interventions.

Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study

ObjectiveTo investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample.MethodsGrowth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children’s diet patterns, overall screen use, physical activity and sleep.ResultsFive trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30–5.00]; 1.62 [1.01–2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99–6.77]; 1.75 [1.17–2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13–2.36]).ConclusionBedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.

Children’s Mealtime Occupations in Diverse Settings: Emphasizing Influential Similarities and Differences Between Home and School

Abstract Date Presented 04/04/19 Children’s mealtime occupations at home and school were analyzed. The findings provide insight to what influences mealtime occupations and the similarities and differences between those influences in each setting. This topic will advance the profession by using the six elements that influence mealtime as a starting point for approaching assessment and intervention, and highlighting the importance of using the six elements to examine differences and similarities between mealtime settings. Primary Author and Speaker: Ashley Mason

Hospital meals are existential asylums to hospitalized people with a neurological disease: A phenomenological-hermeneutical explorative study of the meaningfulness of mealtimes.

AimHospital meals are challenging for neurological patients. Patients struggle with both physical eating disabilities and social issues during mealtimes. The aim of this study was to examine the meaningfulness of the phenomenon of hospital meals for hospitalized patients with a neurological disease.DesignInterviews (N = 23) with neurological patients were analysed and interpreted to gain in‐depth comprehensive knowledge of the phenomenon of hospital mealtimes.MethodData were analysed and interpreted in a three‐phased process using a phenomenological–hermeneutic approach inspired by Paul Ricouer.ResultsFour themes were identified: (a) A lonely ride together with others; (b) Letting the chaotic setting fade into the background; (c) Mechanical activity with great personal significance; and (d) Humanizing the setting when eating in the hospital. Mealtimes were supporting existential moments to patients. Offering a calm mealtime setting was experienced by the patients as an asylum where uplifting and comforting feelings were raised.

Reported and Observed Controlling Feeding Practices Predict Child Eating Behavior after 12 Months1–3

Background: Controlling feeding practices are linked to children’s self-regulatory eating practices and weight status. Maternal reports of controlling feeding practices are not always significantly related to independently rated mealtime observations. However, prior studies only assessed 1 mealtime observation, which may not be representative of typical mealtime settings or routines.Objectives: The first aim was to examine associations between reported and observed maternal pressure to eat and restriction feeding practices at baseline (T1) and after ∼12 mo (T2). The second aim was to evaluate relations between maternal and child factors [e.g., concern about child weight, child temperament, child body mass index (BMI)-for-age z scores (BMIz)] at T1 and reported and observed maternal pressure to eat and restriction feeding practices (T1 and T2). The third aim was to assess prospective associations between maternal feeding practices (T1) and child eating behaviors (T2) and child BMIz (T2).Methods: A sample of 79 mother–child dyads in Victoria, Australia, participated in 2 lunchtime home observations (T1 and T2). BMI measures were collected during the visits. Child temperament, child eating behaviors, maternal parenting styles, and maternal feeding practices were evaluated at T1 and T2 via questionnaires. Associations were assessed with Pearson’s correlation coefficients, paired t tests, and hierarchical regressions.Results: Reported restriction (T1) was inversely associated with observed restriction at T1 (r = −0.24, P < 0.05). Reported pressure to eat (T2) was associated with observed pressure to eat (T2) (r = 0.48, P < 0.01) but only for mothers of girls. Maternal weight concern was associated with reported restriction at T1 (r = 0.29, P < 0.01) and T2 (r = 0.36, P < 0.01), whereas observed restriction (T1) was prospectively associated child BMI at T2 (β = −0.18, P < 0.05).Conclusions: Maternal reports may not always reflect feeding practices performed during mealtimes; it is possible some mothers may not be aware of their practices or observations may not capture covert controlling strategies.

Communication between children and carers during mealtimes

Mealtimes are identified as an important learning environment where socialisation and language development takes place. Caregivers can facilitate the structure of a child's learning in the mealtime setting. The aim of this study was to gain an understanding about the nature of communication in a normal population during mealtimes. This is important to help understanding about the nature of communication and interaction in children with disabilities during mealtimes.Participants were six typically developing preschool children aged from 8 months to 3;05 years. Caregivers of the children supported their child having a typical meal at home. Each mother–child dyad was video‐recorded by the researchers during a typical meal for up to 30 minutes. Each recording was transcribed by the researchers, and specific communicative features were counted and coded; caregiver comments about appropriate mealtime behaviour, child verbal and nonverbal initiation, caregiver questions and comments about meal enjoyment, caregiver praise of child, and caregiver repetition to coax feeding. A caregiver questionnaire was also completed to obtain information about the child's feeding, any early history of feeding difficulties and typical mealtime routine.The results indicated that the most considerable difference were between the dyads who had reported early feeding difficulties and those who had not reported any. Carers who supported children who had a history of early feeding difficulties used more language to manage and guide the child's behaviour during the mealtime. Caregivers who reported early feeding difficulties appeared to be more concerned with how their child was presenting at the meal (i.e., appropriate behaviour and meal enjoyment). This information has important implications for supporting children with complex needs during mealtimes.

Materiality and family consumption: the role of the television in changing mealtime rituals

This interpretivist study contributes to our understanding of how materiality mediates everyday family life by exploring the role of material objects in changing family rituals. We show how the television acts as an agent of cultural change when intermixed with family mealtimes. Our findings present a conceptual framework to explain the ways in which family life is altering across four key areas, namely: (1) mealtime settings and practices; (2) type of food consumed; (3) family structure and membership; and (4) family values and identity. This analytical framework illustrates how technologies such as the television mediate family relationships and how technologies become progressively more embedded in everyday practices. Revealing a transfer of mealtime practices from the formal environment into the informal environment, and vice versa, our study shows how mealtime rituals are altered and changed in form when mediated by the television, but not ultimately abandoned.

Closing the loop

Closing the loop

The effect of context on mother’s interaction style with Down’s syndrome and typically developing children

Several studies suggest that difficulties with production or comprehension of language might be associated with the number of interactions initiated by parent or child, responsiveness or ability to sustain ongoing interactional sequences, or the distribution of parental interaction, control and reinforcement strategies. In this study Down’s syndrome and typically developing preschool children were observed interacting with their mothers in free play and mealtime settings. We expected interaction patterns in the mothers of Down’s syndrome children to be different from those in the mothers of typically developing children. Sixteen mother-child dyads (eight with Down’s syndrome children and eight with typically developing children) served as subjects. Mothers of Down’s syndrome children use more teacher and helper behaviors, particularly in meal time context, and less positive verbalizations than the mothers of typically developing children. Down’s syndrome children also showed higher frequency of eye gazes during mealtime context. Patterns of such differences are discussed in terms of how mothers’ style interactions during home activities might be differentially affected by different types of parent training interventions.

Feeding Problems and Dysphagia in Six-Month-Old Extremely Low Birth Weight Infants

It is commonly assumed that feeding problems in extremely low birth weight (ELBW) infants, experienced during the neonatal period, dissipate with time and increasing maturity and experience of both the infant and the caregiver. This study compared objective feeding and oral-motor assessments at home of 20 ELBW infants aged 6 months corrected for gestation and 20 healthy infants matched for corrected chronological age, race, gender and socio-economic circumstances using a Maternal Interview, the videotaped Feeding Assessment Schedule (FAS), the Feeding Environment Checklist, Tester's Ratings of Infant Behaviour (TRIB), the Infant Feeding Questionnaire, and a Dietary Analysis. Compared with controls, ELBW infants had sigruficant ongoing feeding difficulties, char-acterised by inconsistencies in oral-motor skill development, fewer readiness behaviours for solids, fewer self-feeding and biting skills, fewer smooth sequences in their mealtimes, and frequent environmental features such as poor positioning and inappropriate feeding equipment and mealtime settings. Behaviourally, they were more aversive, had poor attention, little vocalisation, and were less socially interactive. ELBW infants were receiving diets with lower energy and iron intake. Surprisingly, mothers of ELBW infants reported no signhcant feeding aversion or negative feelings about feeding. ELBW infants had significant feeding problems, behavioural disruption, and limited interpersonal skills. Links between early feeding dysfimction, nutritional status, and later communication and eating problems require further investigation. Working with parents to optimise early feeding and communication development in ELBW infants, both in neonatal intensive care wards and later at home, would appear important.

The Effects of an Aided Augmentative System on Communication and Speech in a Preschool Child with Developmental Delay: A Case Study

The effect of an aided graphic augmentative communication system on communication and speech in a 4‐year 7‐month‐old child with developmental delay was evaluated in this case study. An alternating treatment design was used across 2 mealtime settings (morning tea and lunch) over a 6‐week period with counterbalancing of aided and unaided conditions. Once graphic symbol use emerged, there were slightly higher levels of unprompted communication and requests in the aided condition and a lower proportion of acts contained nonsymbolic communication. There was also a higher number of different words + symbols used in the aided condition. The introduction of the graphic symbols did not appear to have detrimental effects on speech but there was no evidence of sustained increase in frequency of speech or spoken vocabulary in the aided condition. Substantial increases were noted in the number of unprompted communicative turns and range of total vocabulary over the course of the study in both conditions. The need for further research on the effects of AAC on speech and communication in preschool children is highlighted.

The effects of an aided augmentative system on communication and Speech in a preschool child with developmental delay: A case study

The effect of an aided graphic augmentative communication system on communication and speech in a 4‐year 7‐month‐old child with developmental delay was‐evaluated in this case study. An alternating treatment design was used across 2 mealtime settings (morning tea and lunch) over a 6‐week period with counterbalancing of aided and unaided conditions. Once graphic symbol use emerged, there were slightly higher levels of unprompted communication and requests in the aided condition and a lower proportion of acts contained nonsymbolic communication. There was also a higher number of different words + symbols used in the aided condition. The introduction of the graphic symbols did not appear to have detrimental effects on speech but there was no evidence of sustained increase in frequency of speech or spoken vocabulary in the aided condition. Substantial increases were noted in the number of unprompted communicative turns and range of total vocabulary over the course of the study in both conditions. The need for further research on the effects of AAC on speech and communication in preschool children is highlighted.

Mealtimes in Head Start Classrooms as a Opportunity For Literacy Development

The ways teachers in 23 ethnically diverse Head Start classrooms in central and Eastern Massachusetts facilitate literacy development by fostering children's discussion of non-present events and experiences was investigated. Mealtime settings in which the teacher was present and stationary were found to be especially conducive to literacy- enhancing teacher-child conversations.

Drinker prototypes in American society

Based on a national probability sample of 2,401 Americans age 21 and over (1,069 of whom were deemed "drinkers" on the basis of having consumed at least one alcoholic beverage in the past 7 days), this study develops profiles of the drinker and heavier drinking prototypes for beer, distilled spirits, wine, and wine cooler drinkers. Both beer-drinking prototypes are mainly composed of less well-educated males who drink beer in circumstances unconnected with any mealtime setting. Wine drinkers are more often women (although the heavy drinking prototype is more likely to be a man), usually with education at or beyond the "some college" level, who typically drink wine in moderation with a meal such as dinner. Both prototypes of the distilled spirits drinkers are likely to be men, age 45 or over, who are not currently married, who usually drink in a bar, before a meal, when they feel somewhat happy or calm. Wine cooler drinkers are much more heterogeneous, and hence less distinguishable than the other drinking prototypes. The heavier wine cooler drinker, however, is likely to be single, with 12 or 13 years of schooling. This person usually drinks when feeling very stimulated, very happy, very romantic, or else very bored, and often does so at bars or in friends' homes.

Increasing distance and independence of ambulation in elderly nursing home residents.

We tested the effectiveness of a prompt-and-praise procedure for increasing walking distance and independence in eight nursing home residents. Walking distance and method of ambulation were observed just prior to mealtimes; in addition, mobility and social interaction were time-sampled in the living areas throughout the day. Treatment was lagged in a multiple baseline design across lunch and dinner meals within subjects, and across subjects within each of three units. In the mealtime setting, two subjects began walking the maximum scored distance during baseline; the other six subjects showed a marked increase in walking beginning with the first meal in which the intervention was applied. Six of the eight subjects also progressed to more independent means of ambulation. Generalization of walking to the second meal was observed in all four of the subjects in whom this could be assessed. Generalization across subjects was not observed nor was generalization to the living areas. Staff successfully implemented the procedures in the mealtime settings and the effects were maintained at the 4-month follow-up.

Communication/Interaction Development at Mealtimes for the Multiply Handicapped Child

The mealtime setting can be creatively used by the speech-language pathologist to increase the positive interactions between the child and caregiver and to establish the basic prerequisites for the development of communication. Specific program suggestions are provided to enable the speech-language pathologist to utilize the mealtime setting to integrate both vocal and nonvocal communicative objectives. The roots of interaction and communication which underly both vocal and nonvocal systems are described.