Relationship-Centered Mealtime Training Program Demonstrates Efficacy to Improve the Dining Environment in Long-Term Care

Developmental Evaluation of the CHOICE+ Champion Training Program

“…CHOICE+ is a unique concept and program that has been shown to improve mealtime environments in residential care (Keller et al, 2020 a The values for question 6b were reverse coded due to the negative wording compared to questions 6a and 6c-j. As a result, this item could not be included in the bivariate analysis as there were 0 values in one category when dichotomized.…”

“…In response to the need to up-skill staff in relationshipcentred dining practices, the CHOICE+ Champion Leadership Training Program was created. CHOICE+ supports residential care settings to promote and support relationship-centred mealtime practices using six key principles, with the letter of each principle spelling out the program name: Connecting, Honouring dignity, Offering support, Identity, Creating opportunities, and Enjoyment (Table 1) (Keller et al, 2020;Wu et al, 2018). This program was developed over several years of research that identified an incongruence between the social significance of eating with others and the undervaluing of mealtime experiences in residential care settings, in addition to opportunities to vastly improve dining in this sector (Ducak et al, 2015;Gibbs-Ward & Keller, 2005;Keller et al, 2020;Wu et al, 2018).…”

“…CHOICE+ supports residential care settings to promote and support relationship-centred mealtime practices using six key principles, with the letter of each principle spelling out the program name: Connecting, Honouring dignity, Offering support, Identity, Creating opportunities, and Enjoyment (Table 1) (Keller et al, 2020;Wu et al, 2018). This program was developed over several years of research that identified an incongruence between the social significance of eating with others and the undervaluing of mealtime experiences in residential care settings, in addition to opportunities to vastly improve dining in this sector (Ducak et al, 2015;Gibbs-Ward & Keller, 2005;Keller et al, 2020;Wu et al, 2018). The Knowledge-to-Action Cycle (Straus et al, 2017) guided the development of CHOICE+ to ensure that program components were 'tailorable' to meet the current needs of those who eat and work in a particular dining room (i.e., residents, staff, families, volunteers).…”

“…The Knowledge-to-Action Cycle (Straus et al, 2017) guided the development of CHOICE+ to ensure that program components were 'tailorable' to meet the current needs of those who eat and work in a particular dining room (i.e., residents, staff, families, volunteers). An external facilitator model was developed and evaluated (Keller et al, 2020;Wu et al, 2018) and found to be successful at improving mealtimes. However, to scale this innovation, training of Champion Leaders embedded within their own home was considered an efficient and feasible model.…”

“…staff using spatulas to remove uneaten food from plates to reduce excess noise during clean up. The dynamics between these stakeholders are influenced by the leadership style of middle and senior management, such as registered dietitians, directors of food service, and the director of care, which is the motivation to provide members of leadership with additional resources to implement this relationship-centred mealtime program (Keller et al, 2020;Wu et al, 2018). A charter or agreement amongst leadership to support direct care workers, residents, and families is encouraged to ensure accountability and sustainability of the program.…”