Feasibility and Process Evaluation of a Screening Intervention for Early Detection of Malnutrition Risk Among Community-Dwelling Older Adults Receiving Home Care Services

Vollständiger Abstract

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Background: Malnutrition is prevalent among older adults (OAs), ≥65 years, receiving home care services. Despite recommendations for early detection and multifactorial interventions, a gap remains between routine practice and evidence. We therefore developed a complex intervention for early detection of malnutrition risk in a Danish home care setting, comprising an implementation strategy with staff learning activities and a screening procedure with a start-up conversation and follow-up screenings. This article outlines the feasibility test and process evaluation of the intervention. Methods: Guided by the Medical Research Council (MRC/NIHR) framework for complex interventions and MRC process evaluation guidance, the evaluation was conducted in two parts. Part 1 focused on case-level feasibility, while Part 2 examined implementation feasibility within routine home care practice. Qualitative data were collected through participant observations, informal interviews, semi-structured individual interviews, focus group interviews, and a participatory workshop. Quantitative data were extracted from the electronic patient record (NEXUS, Systematic A/S, Aarhus, Denmark). Qualitative data were analysed using qualitative content analysis, and quantitative data using descriptive statistics. Results: All eligible OAs (12/12) received a start-up conversation in Part 1 compared with 5/16 (31%) in Part 2, while follow-up screenings declined from 61/71 (86%) to 37/50 (74%). Overall, staff perceived the learning activities as useful and were able to deliver the screening procedure. However, delivery and implementation were influenced by time constraints, leadership support, workplace culture, and organisational infrastructures. OAs showed willingness to participate, yet their prerequisites for engagement were more limited than anticipated. Conclusion: The intervention could be delivered in a real-world home care setting, but delivery, implementation, and activation of proposed mechanisms were constrained by resource limitations, competing priorities, workplace culture, and organisational infrastructures. To improve uptake, intervention adaptations and a stepwise implementation approach are recommended.