Key behavioural issues | Design objective | Key intervention features and components |
---|---|---|
1) Denial of risk and low motivation to engage with lifestyle change: Older adults unaware or unwilling to acknowledge personal risk of malnutrition and its impact on health and wellbeing. Numerous physical and social barriers to eating well. | Motivate engagement with lifestyle change | • Provide credible evidence-based rationale • Dispel myth that decline in appetite and eating, and weight loss are normal and inevitable in older age • Clarify that everyone can be at risk of malnutrition • Outline that mainstream public health messages (e.g. low fat, low sugar) may be less appropriate for those with low appetite or unintended weight loss • Demonstrate empathy and acknowledge real barriers to changing eating behaviour |
2) Low self-efficacy to overcome physical and social barriers to eating well and make long-term changes, particularly resignation to age-related decline | Promote self-efficacy to manage malnutrition risk, and overcome barriers to eating well | • Positive tone to encourage beliefs about being able to overcome barriers • Align behavioural advice and support with need to be ‘well’ and ‘independent’ • Provide examples of small, easy to enact lifestyle-compatible changes • Allow self-tailoring to address personal barriers e.g. strategies for those who dislike eating alone • Offer longitudinal motivational support e.g. ongoing nurse appointments to encourage self-care • Support motivation in-the-moment e.g. suggest using visual cues (biscuit tin near kettle) to encourage eating between meals • Support personal goal and action planning • Provide stories to model successful ways to overcome barriers |
3) Rejection of imposed lifestyle change that contradicts existing knowledge, values and preferences, including desire to remain independent | Promote support and autonomy for choosing lifestyle changes that harness personally relevant motivations | • Present rationale for lifestyle change with a non-directive tone • Present behavioural suggestions as options to try • Invite expression of preferences e.g. possible reasons for wanting to eat well, with tick boxes for self-selection • Acknowledge and validate existing knowledge and experience before introducing new information and advice |