Older patients' perspectives on mealtimes in hospitals: a scoping review of qualitative studies.

The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer-reviewed articles in English or Swedish that used qualitative methods to examine older patients' (>65 years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one's independence. The review also clearly indicated a shortage of studies that solely focus on older patients' experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.

Perceptions and reasons for choice of fat- and fibre-containing foods by Swedish schoolchildren.

This study investigated schoolchildren's breakfast choices focusing on their reported usual intake and perceptions of fat-reduced or fibre-enriched alternatives. A total of 184 eleven- to fifteen-year-old were asked to participate, and 181 completed the study. Using pictures of food items, the children were instructed to reproduce their usual breakfast, and then breakfasts that would be: healthy, tasty, consumed by their parents, or approved by their parents. Participants' usual breakfast included breads and breakfast cereals containing a higher fibre content than that of the breakfast reported as most palatable. Their usual breakfast also contained products with less fibre than was the case for their healthy or perceived parental norm breakfasts. This may be interpreted as evidence that high-fibre bread and breakfast cereals are perceived as healthy but that consumption of these products is limited by palatability. In contrast to the ambivalence towards cereal products, corresponding disagreements between breakfasts were not observed for milk, and only a small systematic disagreement was observed for spread. Thus, the majority consumed the kind of milk and spread perceived as being healthy, tasty and parentally sanctioned despite the fact that full-fat products were frequently consumed. In conclusion, the results suggest that taste may be a barrier to consumption of high-fibre products, while consumption of low-fat products appears to be impeded by health beliefs.

Relation between breakfast food choices and knowledge of dietary fat and fiber among Swedish schoolchildren.

PURPOSE: To investigate dietary knowledge and beliefs of schoolchildren, in relationship to breakfast choices, with specific attention to fat and fiber content. METHODS: Food choice and perceptions were studied by interviews using the "stacking box methodology". Youth (n = 181) aged 11-15 years were instructed to select food items among photographs of breakfast foods. In addition to choosing their own typical breakfasts, they were asked to exchange foods in hypothetical breakfasts to create meals with less fat and more fiber. The interview also dealt with recent changes in breakfast habits, and perceptions of healthy breakfasts, dietary fat, and foods rich in fiber. Data were analyzed by logistic regression. RESULTS: Knowledge concerning sources and health attributes of dietary fiber was associated with usual consumption of bread and breakfast cereals rich in fiber. In a similar way, a positive attitude toward limited fat intake predicted consumption of reduced-fat milk products. However, no association was observed between food choices and knowledge of a food-packaging symbol indicating low-fat and fiber-enriched foods. CONCLUSION: Lack of awareness of, and knowledge about, healthy eating may be important barriers to the development of health promoting food habits by schoolchildren.

Choice of food and food traditions in pre-war Bosnia-Herzegovina: focus group interviews with immigrant women in Sweden.

OBJECTIVES: Immigrants in Sweden have on average poorer health than native Swedes, including the risk of nutritional problems. In Sweden's multicultural society there is a need for increased knowledge about eating habits in public health work within health and education. A survey of refugees from Bosnia-Herzegovina living in Sweden was undertaken to describe the choice of food and food traditions in pre-war Bosnia. The purpose was to introduce the subject of food, health and migration into public health work and develop culture-adapted food and health advice. DESIGN: Focus-group interviews were undertaken with a total of 20 women refugees from Bosnia-Herzegovina. RESULTS: Qualitative data analysis identified a large consumption of bread as a staple food with meat, vegetables, milk, cheese, legumes, egg and fish as additions. Self-sufficiency was noted with milk souring, jam making and the production of sweet fruit drinks. Home made cheese and drying or smoking of meat were common methods of food storage. In child rearing, breast-feeding for 6-8 months was most common. Home made breast milk replacements were made from semolina, rice and 'petit biscuits'. CONCLUSION: Several important factors need to be taken into account when giving culturally adapted food and health advice to Bosnian families, such as encouraging bread, vegetable and legume consumption and giving advice on substituting sweet fruit drinks for natural fruit. One should be conscious of how religious beliefs as well as socio-cultural, historical, ecological, economical and psychological influences may guide food choices.