Workpackage 4: Satisfaction with food-related services available to seniors

Workpackage led by:
Dr Margaret Lumbers
(to view contact details click here)

Overall objective of Workpackage 4:
The overall objective of this WP is to investigate user satisfaction with food-related services. It will address a range of food-related services (e.g. home help, meals on wheels, luncheon clubs, delivery services, shopping facilities) available to older people.

The detailed objectives of this WP are to:
• To identify and appraise the alternative approaches to measuring user satisfaction with food-related services
• To clarify the role that user satisfaction measurement should play in service delivery and policy formation
• To compare user satisfaction with food-related services across cultures, age groups and living circumstances
• To identify items relating to user satisfaction with food-related services for inclusion in a Senior Food-QOL questionnaire for use with older people

Participating Centres:
• Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN), Italy
• Federal Research Centre for Nutrition (FRCN) (Bundesforschungsanstalt fuer Ernaehrung BFE), Germany
• Department of Public Health and Caring Sciences, Uppsala University, Sweden
• MAPP, The Aarhus School of Business, Denmark
• Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Portugal
• Department of Human Nutrition, University of Warmia and Mazury, Poland
• Grup d’Estudis Alimentaris, University of Barcelona, Spain

Aim
The aim of WP4 in the Food in Later Life project was to investigate users’ satisfaction with food services ("meals on wheels" and day centre meals) and providers’ perceptions of the quality of service delivery. A detailed review of the nature and type of food related services available to older users across cultures and, identification of approaches used to measure user satisfaction with food services for older people, was also undertaken.

Method
Twenty five users and 25 providers (including five key informants) of "meals on wheels" (Germany, Sweden and Denmark) and day centre users and providers (UK, Italy, Portugal, Poland and Spain) were interviewed. Interviews incorporated the Critical Incident Technique - a method used to identify quality improvement points and to reflect users’ and providers’ perceptions of satisfaction/dissatisfaction with the service based on positive and negative critical incidents.

The twenty five users interviewed in each country were asked about their mobility, dentition, food choice as well as health (SF36) and nutrition status. The 20 providers were recruited to ensure different that different service provider types were represented (commercial; non-commercial; local government; charities), Similarly the five key informants were chosen to represent different managerial/professional levels such as contract/purchasing/commissioning managers; marketing directors/strategic operations managers; dieticians with responsibility for community provision.

Results
Users and providers see the problems and successes of the food service operation in different ways. For day centre users, what matters most is the quality of food offered. This includes the quality of ingredients, cooking skills, presentation, portion size and temperature. Food quality is critical to user satisfaction; it is praised when good, but complained about when it fails to meet expectations. Users do not perceive the management issues that affect the quality of food, only the end result.

Providers of food services tend to see the management issues (especially operational difficulties) as key negatives that prevent optimal service delivery. Inter-personal issues (staffing and customer relations) are secondary difficulties.
Providers’ priorities (food choice and variety) do not match the priorities of users (food quality). This may suggest that providers should focus less on choice and more on quality as users seem more likely to be dissatisfied on this count. Provision of special themed or festive meals is appreciated but providers may also need to pay more attention to the general environment in day centres.

The "meals on wheels" service aims to provide ready-made, nutritious and tasty meals to older people in the community. The benefits extend beyond the provision of food to fulfil a social function in terms of personal interaction and even practical help.