Purpose of change | Issues targeted | Examples and details |
---|---|---|
Strengthen perceived relevance of the booklets | Booklets not useful for those who already know about healthy eating and who are self-reliant | • Added emphasis that booklets provide new information on how eating needs change in older adulthood NOT general healthy eating advice • Added emphasis that suggestions in the booklets/goal setting can support continued independence and meeting eating needs • Added rationale that self-care ‘can help you to keep meeting your eating needs’ |
Misunderstood purpose of booklets: interpreting them as purely promoting healthy eating rather than supporting eating for those with low appetite, weight loss or underweight | • Changed cover design to show varied high-energy food examples, including cake. • Entitled the main booklet ‘Meeting your eating needs as you get older’. • Clarified intended purpose on first page of each booklet (e.g. to address low appetite and unintended weight loss) | |
Belief that weight loss is normal/inevitable and intervention not needed | • Clarified weight loss is not normal and highlighted the intervention can provide support to address reasons contributing to weight loss | |
Booklets did not include enough information to suit individual needs and circumstances | • Expanded range of food suggestions to suit a variety of preferred and prescribed diets, following guidance from dietitians and nutritionists | |
Acknowledge and validate users’ prior experiences | Booklets did not acknowledge the range of challenges experienced by participants | • Added acknowledgement that it can be difficult to follow the advice and suggestions when appetite is low or you are unwell or in pain • Expanded content to address specific challenges experiences by participants e.g. changing taste sensations, reasons for finding cooking and shopping a chore, preparing food when in pain |
Booklets perceived as dictatorial and condescending | • The tone of the booklets was adjusted to offer suggestions to try | |
Encourage participants to seek support | Concern that nurses and doctors did not have enough time to discuss the booklets | • Added a ‘talk’ symbol to indicate key sections where discussion with a nurse or doctor would be most useful (e.g. making plans and goals). • Clarified that other people could also offer support (e.g. friend, family member, carer) |
Use appropriate language | Confusion about key strategies for increasing nutritional intake | • Simplified key strategies and renamed to ‘adding tasty extras’ and ‘eating little and often’ |
Specific phrases were off putting | • Replace aversive phrases with participants own language (e.g. ‘eating more’ replaced with ‘eating regularly’ or ‘adding tasty extras’, ‘snack’ replaced with ‘small bite’ • Removed reference to ‘full fat’ or ‘sugar’ and included these elements within a range of examples, e.g. adding cheese, fruit, jam or honey • Rationale and stories added to emphasise and model the benefits of regular eating and drinking |