Maggie Beer’s Big Mission: implementation and service-system outcomes of a multi-component and multi-disciplinary mealtime model in residential aged care

BACKGROUND: Older people living in residential aged care homes are at high risk of malnutrition. This study evaluated the implementation and service system outcomes of a multi-component and multi-disciplinary mealtime model that sought to transform the meals and dining experiences in a single aged care home. METHODS: Mixed methods were used to examine the acceptability and adoption of the model through semi-structured interviews, alongside audits and direct observations of mealtimes. Measures were taken at three time points: baseline (T0), early implementation (T1), and early maintenance (T2), spanning a 10 month period. Normalisation Process Theory was used to examine mechanisms supporting early embedding of the model. RESULTS: Staff and residents endorsed the acceptability and adoption of the mealtime model, with perceived improvements in aspects of meal quality, meal access, and mealtime experiences. Audit and mealtime observation data demonstrated service-system change with a transition towards more person-centred mealtime care practices and a calmer, more home-like dining environment. Factors mediating implementation and service-system outcomes included a shared vision, project timelines, external accountability, communication, training, role modelling, and leadership. There was evidence that normalisation processes had been activated to help embed the model into routine mealtime care. CONCLUSIONS: The study provides evidence for the acceptability and adoption of the multi-component mealtime model from the perspectives of staff and residents. The findings demonstrate that aspects of meal quality, meal access, and mealtime experiences can be transformed simultaneously, enabled by a systematic and multi-disciplinary approach. Future research is needed to examine the sustainability and cost-effectiveness of the model.