Table 2

Identified themes and subthemes from care home staff and residents regarding their experiences of the trial procedures:

ThemeSubthemesDirect quotations
Care home staff
 Perceived acceptability of involvement in the trialNot viewed as additional work‘No different to usual at all’ (CH1)
‘No additional work (collecting healthcare resource usage data)—all in the notes’ (CH1)
“I can’t say that it was a hassle, we just treated it as we should do anyway” (CH2)
‘All the required information is documented in care plans anyway—not extra information’ (CH2)
“No, wasn’t really any different….it’s (SC) what we are doing anyway” (CH3)
‘Carers would be fortifying anyway, and working with the kitchen’ (CH4)
“I was happy that you chose us to be involved—it wasn’t any extra work” (CH6)
‘It didn’t seem like extra work—it was very organised’ (CH1)
Importance of all staff being made aware“We had a list in the kitchen to make it easy for staff to deliver the intervention” (CH2)
“We put extra copies of the sheets (personalised dietetic FB plans) in the residents rooms to make sure the carers understood and knew what it was all about” (CH4)
‘Everyone had a list of the residents that needed the FB intervention, they also had all the recipes to follow, so it was not challenging’ (CH6)
‘It was straightforward so long as staff knew to sign that they (ONS) had been given’ (CH1)
 Staff completion of nutritional screeningConfident in the process‘Very confident in completing’ (CH1)
“We do the MUST (the seniors)— no problem with completing it’ (CH2)
‘Staff are confident in doing this and knowing what to do next’ (CH3)
“I think we have gained more confidence in using MUST” (CH6)
The value of ‘MUST’ training“I found it hard to begin with, but it’s alright now we’ve had lots of training” (CH2)
“We have a good knowledge now we’ve been trained” (CH5)
‘Further training on completing MUST is always useful’ (CH4)
“The only challenge is we don’t always have heights, but now I know how to take the arm measurement (ulna length) if I can’t get height” (CH5)
 The challenge of undertaking physical measurements with care home residentsFluctuating mood and capacity‘The patients were not refusing you because it was a study, they refuse to do things for us as well’ (CH1)
‘It’s dementia and it’s really hard—it depends on the day’ (CH2)
‘It’s a challenge of the care home setting’ (CH3)
‘It’s just a challenge of care homes—If they refuse, they refuse’ (CH4)
‘it depends on the individual, not all of them will be weighed either’ (CH5)
‘Challenging in a care home—with people that have dementia, it depends on the day’ (CH6)
‘They behave differently at different times of the day’ (CH6)
‘Limitation of time— you are committed to come on that day—if the residents are having a bad day, you won’t be able to get the measurements properly’ (CH6)
Potential for staff training Would be good if staff could be shown how to do these other measurements’ (CH2)
‘It might work better if staff could be trained to do these measurements’ (CH4)
‘If they can’t do the weight, it would be good for staff to have more skills’ (CH5)
The challenge of delivering a nutritional intervention protocol in a care home:
the care home staff cited challenges including physical space for supplements, additional work for kitchen staff and encouraging the residents to take the interventions
It’s quite hard to get the residents (with dementia) to have things every day, whatever it is’ (CH2)
‘There are a couple of residents that won’t comply whatever the intervention’ (CH4)
"Only negative we had was all the supplements arriving at the same time—we don’t have that much space!" (CH1)
‘There was more for the kitchen staff to do, but they didn’t see it as extra work’ (CH6)
 Resident completion of PROMs questionnairesFeasible for more residents to have completed them‘Some (residents without capacity) would be able to take part, but it depends on the day—are they having a good day?’ (CH1)
‘More of them could have completed them’ (CH2)
“We have a couple on here that could have been able to answer these” (CH3)
“I like these (The Dartmouth Cooperative Functional Assessment Charts (COOP) QoL tool), I’ve never seen these before- more residents could have completed them” (CH4)
‘Not all of them, but yes 2 or 3 could have done’ (CH5)
“Yes, they would have been able to complete these or tell you” (CH6)
Value of more residents completing them’It would be nice for them to be able to give their thoughts’ (CH2)
‘Would be useful to know what they think…sometimes this generation like to just agree with everything’ (CH3)
“I think it is important for more of the residents to have a say” (CH6)
 Perceived acceptability of taking part in PROMs data collection‘Didn’t take up much time, it was alright’ (R1)
‘It was alright—not too much of a burden’ (R2)
‘It was okay’ (R3)
‘Don’t think it’s taken up much time’ (R4)
 Completion of PROMs questionnairesUnderstanding of the tools‘Understood, was not complicated’ (R1)
‘Fine as it was, no need to change them’ (R1)
“Yes, understood what you were asking me” (R2)
‘Yes, easy to understand’ (R3)
‘They made sense’ (R4)
Value of residents completing them‘Good to have a say, would be good if more residents could have done them’ (R1)
“It’s nice to give an opinion if I can. Some of the other residents could have done them too” (R3)
‘It’s very important to be asked about the food and your appetite’ (R4)
‘Could have asked other residents the questions’ (R2)
 Perceived acceptability of the physical measurements‘It was ok, not a hassle’ (R1)
‘It was fine to take the measures in the bedrooms’ (R1)
“No trouble, but probably depends what mood I’m in!” (R2)
‘Yes, it was okay to do’ (R3)
‘It (handgrip) was quite fun’ (R3)
‘Yes, it was alright—it didn’t hurt’ (R4)
 Perceived acceptability of the nutritional intervention protocolDisagreement regarding acceptability“I Liked those” (ONS) (R1)
“I liked the flavour and it was good that they were quite small” (compact supplements) (R1)
“Quite liked them (ONS) when I did have them” (R3)
“Yes it is acceptable (SC), I have extra glasses of milk” (R4)
“I had one (ONS) a day, if I have two, they upset my stomach” (R2)
“I think I prefer the homemade ones” (R2)
No perceived impact of ONS on appetite“No, they were good for my appetite” (R3)
“No they didn’t reduce my appetite” (R2)
“No effect on my appetite for meals” (R1)
  • FB, food-based; ONS, oral nutritional supplement; PROM, participant-reported outcome measure; SC, standard care.