COVID-19-related disruptions in implementation of a randomized control trial: An autoethnographic report.

BACKGROUND AND AIMS: The SARS-Cov-2 virus (COVID-19) has not only threatened the health of the world's population but also presented challenges for conducting human subject research studies. Although many institutions have now established guidelines for conducting research during the COVID-19 pandemic, reports of the practical experiences of researchers are limited. This report presents the challenges nurse researchers encountered when conducting a randomized controlled trial to develop an arthritis self-management application during the COVID-19 pandemic in Taiwan and how researchers responded to the challenges. METHODS: Qualitative data from five nurse researchers were collected from August 2020 to July 2022 at a rheumatology clinic in northern Taiwan. This collaborative autoethnographic report was drawn from data comprised of detailed field notes and weekly discussions regarding research challenges we were confronting. Data were analyzed to determine successful strategies employed to overcome the challenges and allow for completion of the study. RESULTS: Minimizing the risk of exposure to the virus for researchers and participants resulted in four major challenges to conducting our research: patient screening and recruitment, delivery of the intervention, obtaining follow-up data, and unanticipated budget increases. CONCLUSIONS: Challenges reduced sample size, altered intervention delivery, increased time and money beyond what was originally budgeted, and delayed completion of the study. Adapting to a new healthcare environment required flexibility for recruitment, alternate means of providing intervention instructions, and an awareness of disparities in participants' internet proficiency. Our experiences can serve as an example for other institutions and researchers faced with similar challenges.

It Is Like a Puppet Show-Experiences of Rheumatoid Arthritis Among Adult Chinese: A Qualitative Study.

Rheumatoid arthritis results in progressive destruction of the joints. However, descriptions of patient's experiences with the disease are limited. This qualitative study aimed to explore patients' personal experiences with rheumatoid arthritis in Taiwan. Face-to-face interviews were conducted with 30 patients from January to May 2019; interview data were analyzed with content analysis. Most participants were female (90%); their mean age was 57 years. Three main categories emerged from analysis of the data: "physical suffering," "limitations of abilities," and "coexisting with the disease." Physical suffering was due to personal lifelong hardships from chronic pain and stiffness. Limitations of abilities occurred from loss of physical function and limited social life, due to participants discomfort with joint deformities and their appearance to others. Participants coexisted with the disease by making changes in their outlook and comparing their lives with others in order to gain a positive perspective.

Expectations of an Online-Self-Management Program for Rheumatoid Arthritis.

This qualitative descriptive study aimed to explore expectations of patients and healthcare experts for an online self-management program for rheumatoid arthritis. Participants were recruited from rheumatology clinics, medical centers, and universities in Taiwan. Individual face-to-face, semi-structured interviews were conducted with patients (n = 16) and healthcare experts (n = 7). Content analysis of the interview data resulted in five subthemes for expectations of an online self-management program: information about how the disease trajectory would impact future health status, availability of opportunities for self-monitoring, opportunities to interact with fellow patients and healthcare providers, simplicity and ease-of-use of the program, and methods to facilitate patient-motivation. These subthemes formulated two overarching themes: content and format. An online self-management program for patients with rheumatoid arthritis should provide evidence-based information about disease variables and behaviors aligned with the specific needs of the individual and adopt strategies that encourage and increase motivation and confidence.

Effects of Mobile Application Program (App)-Assisted Health Education on Preventive Behaviors and Cancer Literacy among Women with Cervical Intraepithelial Neoplasia.

OBJECTIVE: This study aimed (1) to study the effects of health education on preventive behaviors and cancer literacy among women with cervical intraepithelial neoplasia (CIN); (2) to compare the effects of mobile application program (App)-assisted health education with traditional book-form health education. PARTICIPANTS: A total of 132 women ages 20 to 69 years women. METHODS: This prospective longitudinal study enrolled 132 CIN women who were evaluated three times. Propensity score matching was used by controlling subjects' age strata, body mass index, education level, occupation, and type of surgery. RESULTS: The influences of various educational tools were investigated. Four domains were assessed, including health behavior, attitude towards behavior change, self-efficacy of behavior, and cervical cancer (CCa) literacy. Significant improvements in behavior change and CCa literacy due to a health education program were observed (p ≤ 0.002). The App combined with a traditional booklet had the highest score for behavior change and was significantly greater than the booklet-only learning (p = 0.002). The App-assisted form, either App alone or combined with booklet, had a significantly better impact on health promotion when compared to the booklet alone (p = 0.045 and 0.005, respectively). App-only learning had the highest score of CCa literacy (p = 0.004). CONCLUSION: Health education interventions can have positive effects in terms of change of behavior and CCa literacy. App-assisted learning could be used as a supportive technology, and App learning alone or combined with a traditional booklet may be an innovative model of clinical health promotion for women with CIN.

Quality of Life and Associated Factors in Older Adults With Heart Failure.

BACKGROUND: Although heart failure (HF) is negatively known to affect older adults physically, psychologically, and socially, only a few studies have explored the predictors of quality of life (QoL) in older adults with HF in Taiwan. PURPOSE: This study was designed to determine the relationships among depression, demographic characteristics, clinical characteristics, and QoL in older patients with HF. METHODS: This was a cross-sectional study. From January 2013 to June 2014, convenience sampling was used to collect data from 175 older adults with HF at two hospitals in Northern Taiwan. Participant data were collected from medical records and researcher-administered structured questionnaires in face-to-face interviews. RESULTS: The QoL of the participants was found to be associated with clinical characteristics, including hospital readmission for > 10 days with an increased level of HF-related symptom distress (HFSD) and more-severe depression. Depression was found to have a mediating effect, with the New York Heart Association (NYHA) functional class and HFSD both affecting the QoL of the participants through this intermediary. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: HF is a chronic and debilitating disease that often reduces QoL in older adults significantly. Interventions designed to increase QoL by improving the NYHA functional class and alleviating HFSD are valid treatment options only in cases with depressive symptoms. Nurses treating older adults with HF should consider factors such as NYHA functional class and HFSD to reduce HFSD and readmission rates and to enhance the QoL of these patients. In addition, after both hospital admission and discharge, older adult patients should be assessed regularly to monitor for and quickly address the development of comorbid depression.

Who did it better? Gender differences in effects of a dietary self-management intervention for older community-dwelling adults.

This study aimed to determine whether there were gender differences in the effectiveness of a 12-week dietary self-management program for older community-dwelling adults in northeast Taiwan. This was a secondary analysis of a previous study; participants (N = 58) were purposively sampled from two public health centers. Non-parametric models examined differences in outcome measures because of the small sample size; 20 males and 38 females completed the study. The results showed males scored significantly better than females for nutritional status, internal health locus of control, and responsibility for food preparation, which may have implications for older female adults' nutritional health.

Effectiveness of a self-management program for joint protection and physical activity in patients with rheumatoid arthritis: A randomized controlled trial.

BACKGROUND: Rheumatoid arthritis is a chronic, systemic disease, which results in progressive destruction of the joints and a reduction in quality of life. Joint protection can minimize injuries that worsen arthritis and pain and certain activities can help patients control or reduce the symptoms of this chronic disease. OBJECTIVES: To determine the effectiveness of a self-management program for joint protection and physical activity for patients with rheumatoid arthritis based on self-efficacy theory. DESIGN: A two-arm (experimental vs control) randomized trial. PARTICIPANTS: Adult patients with rheumatoid arthritis were recruited from rheumatology departments of a medical center in Northern Taiwan. A total of 224 patients met the inclusion criteria and agreed to participate in the study. METHODS: Eligible participants with rheumatoid arthritis were randomly assigned to either an 8-week program in self-management of joint protection and physical activity with nursing support (intervention group, n = 112) or standard care for rheumatology (control group, n = 112). Outcome variables were assessed at baseline and 2-, 3-, and 6-months after commencement of the intervention, which included measures of disease activity, and self-assessments for self-efficacy, quality of life, and self-management behaviors. Differences in outcome variables over time between the groups were analyzed with generalized estimating equations; the level of significance was set at p < 05. RESULTS: The mean age of participants was 58.8 years, duration of the rheumatoid arthritis was 10 years, and most participants (86%) were female. Characteristics and assessment variables did not differ between the two groups at baseline. When compared with the control group at 6 months following initiation of the self-management program, participants in the intervention group demonstrated significantly greater improvement in physical functioning (B = 4.08, p < 05), self-efficacy of pain (B = 4.89, p < .05), and self-management behaviors (B = 4.65, p < 05). CONCLUSIONS: A self-management program based on self-efficacy theory that focused on joint protection and physical activities resulted in significant improvements in physical functioning, self-efficacy, and self-management behaviors 6 months following commencement of the intervention. Nurses provided individualized evaluations and support, which may have made it easier for participants to learn and perform the activities. After commencement of participation in the intervention, no improvements were seen until 6 months of participation. This delay may suggest patients with chronic disease may need a longer duration of self-management training and increased follow-up time to incorporate lifestyle changes. Future studies measuring long-term outcomes are suggested.

Feasibility and Acceptability of a Self-Management Program for Patients With Rheumatoid Arthritis.

BACKGROUND: Joint activity and protection are key components in the management of rheumatoid arthritis (RA). Despite a shift from care in health settings to empowering patients to play an active role in the day-to-day management of their own chronic conditions, there is little evidence on RA self-management, especially for Chinese patients. PURPOSE: This pilot study sought to determine the feasibility and acceptability of a self-management program for patients with RA in Taiwan. METHODS: Participants were recruited at a medical center in northern Taiwan. The intervention group participated in a 6-week self-management program; the control group received standard rheumatology care. Both groups underwent baseline assessments before the intervention and at 12 weeks. RESULTS: A total of 32 participants were recruited: 15 in the intervention group and 17 in the control group. Patients in the intervention group found the self-management protocol beneficial to their joint protection and activity behaviors and reported higher motivation to perform RA self-management. The posttest score for joint protection and activity self-management behavior were significantly greater for the intervention group than for the control group (p = .02). CONCLUSIONS: Participants in the intervention group were highly satisfied with home visits (which included peer story-telling and goal setting) and telephone calls to support their daily home-based joint protection and self-management activities (which included self-monitoring and self-evaluation). To mitigate the fear of scammers, researchers should begin by building a trust relationship with participants.

Depression in Community-Dwelling Elderly Patients With Heart Failure.

The present cross-sectional study discussed the relationship between comorbid depression, demographic characteristics, clinical characteristics, and dietary self-efficacy among Taiwanese community-dwelling elderly patients with heart failure (HF). Specifically, the study examined 175 community-dwelling elderly patients with HF between July 2013 and June 2014. In total, 47.13% of the patients exhibited symptoms of depression. Those without a spouse, who were currently employed, who had an ejection fraction <30%, who had been readmitted to the hospital 2 or more times, and who had a high level of HF symptom distress were significantly more likely to be depressed. Therefore, it is crucial that care programs designed for these patients include the self-management of HF symptoms, psychological consultations, cognitive behavioral therapy, and physical exercise.

Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients.

AIMS AND OBJECTIVES: To explore risk factors for a single fall and multiple falls in the first and second postoperative years among older hip fracture patients. BACKGROUND: Older hip fracture patients have a high probability of falling again after a fall incident. Risk factors for postoperative falls among older hip fracture patients in Taiwan remain to be confirmed. DESIGN: Secondary analysis. METHODS: Data collected from control groups of two clinical trials conducted during 2001-2004 and during 2005-2009 were selected. Overall, 181 older adults who underwent hip fracture surgery were assessed at predischarge and postdischarge. Participant data were collected through home visits. RESULTS: Decline in unaffected limb quadriceps muscle endurance was a crucial predictor of a single fall in the first postoperative year for older hip fracture patients. Advanced age and more severe depressive symptoms were the crucial predictor for multiple falls. Engagement in activities of daily living was the crucial predictor for falls during the first to second postoperative years among older hip fracture patients. CONCLUSION: In Taiwan, postoperative falls that occur within 1-2 years of a hip fracture are associated with a high incidence of single and multiple falls in older people. The crucial predictors of falls in the first and second year after a hip fracture include unaffected limb quadriceps endurance, age, depression status and postdischarge activities of daily livings in older people. RELEVANCE TO CLINICAL PRACTICE: The identified factors associated with subsequent falls within one and two years of a hip fracture should be incorporated into clinical strategies and taught in nursing courses. Early postoperative lower extremity muscular endurance rehabilitation must be provided. Furthermore, as part of the healthcare plan before hospital discharge, it must be ensured that the community where the older adults live has nutritional education, cognitive screening and psychological support.

Effects of a dietary self-management programme for community-dwelling older adults: a quasi-experimental design.

RATIONALE: Nutritional health plays a crucial role in determining successful ageing and differs by different living area. Although nutritional interventions have long been advocated, little research has directly assessed the effectiveness of nutritional interventions on community-dwelling older adults in urban and rural areas and compared intervention effects on these two populations. AIMS AND OBJECTIVES: To examine the effectiveness of a 12-week dietary self-management programme for salt-, fluid-, fat- and cholesterol-intake behaviours of community-dwelling older adults and to compare these effects in rural- and urban-dwelling older adults. METHODS: For this quasi-experimental two-group study, older adults (≥65 years old) were recruited from two randomly selected public health centres in a rural north-eastern county and a northern city of Taiwan from January through December 2011. Outcomes included nutritional status, nutritional self-efficacy and health locus of control. Data were collected at baseline and 12 weeks later. To compare changes in outcome variables over time between the control (usual care) and intervention (nutritional programme) groups and between the urban- and rural-dwelling participants in the experimental group, we used generalised estimating equation analysis. RESULTS: Of the 129 participants, 120 completed this study (58 in the intervention group and 62 in the control group). After 12 weeks, the intervention group had significantly better nutritional status and higher internal health locus of control than the control group. Moreover, older rural participants who received the intervention tended towards higher nutritional self-efficacy and internal health locus of control than their urban counterparts. CONCLUSIONS: Our research findings support the positive effect of our nutritional self-management programme for community-dwelling older adults. The knowledge gained from this study can help stakeholders recognise the need for healthcare policy to establish effective strategies and sustainable intervention programmes for this population, especially those living in rural areas.

[The Perspectives and Expectations of New Nursing Graduates Regarding the Hospital-Based Nursing Students Scholarship].

BACKGROUND: The hospital-based scholarship is a relatively recent incentive used by hospitals to recruit new nursing graduates. Few studies have explored the impact of these scholarship programs on hospital recruitment. PURPOSE: To explore the perspectives and expectations of new nursing graduates on the application of a hospital-based scholarship for nursing students. METHODS: This study used a qualitative research approach. Purposive sampling was used to recruit 20 new nursing graduates from one university in northern Taiwan in 2013. Content analysis was applied to analyze the data. RESULTS: Two themes were identified by participants who had applied for a hospital-based scholarship: "aspire to be a nursing-scholarship recipient and work towards this aspiration" and "look forward to receiving a nursing-scholarship and imagine possible features of the future life." One theme was identified by participants who had not applied for a hospital-based scholarship: "agree with the policy of hospital-based scholarship but resist the restrictions on their life." CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Although both groups agreed that the scholarship program helped relieve financial stresses, participants who had applied for the scholarship tended to hold positive and aggressive attitudes towards the nursing scholarship. Conversely, participants who had not applied for the scholarship did so due to the perceived conflicts between the scholarship and their career plans. It is recommended to consider providing career-planning assistance to new graduates and to arrange that students who sign a scholarship contract have their clinical practice in their working unit in order to improve adaptation.

Development and evaluation of a dietary self-management programme for older adults with low literacy and heart disease: pilot study of feasibility and acceptability.

AIMS: To develop a dietary self-management programme for salt-, fluid-, fat- and cholesterol-intake behaviours for older adults with low literacy and heart disease and evaluate the feasibility and acceptability of the programme. BACKGROUND: Eating behaviours such as fluid, salt, fat and cholesterol intake are an important factor related to heart disease outcomes. People with low literacy have difficulty following recommended health behaviours, but limited research has investigated intervention programmes for this population. DESIGN: Programme development and pilot testing its feasibility and acceptability. Recommendations were also collected from participants and the research assistant for future large-scale interventions. METHODS: The study had two phases. Phase I consisted of programme development based on previous qualitative findings, a systematic review of the literature, clinical practice experience and expert opinion. In Phase II, we pilot tested the programme from January - June 2014 in a convenience sample of 10 older adults with low literacy, heart disease and recruited from a medical centre in northern Taiwan. RESULTS: Pilot testing showed that our programme was feasible and acceptable to older adults with low literacy and heart disease. Moreover, the final version of the programme was revised based on participants' and the research assistant's recommendations. CONCLUSION: Our study results suggest that with guidance and assistance, older adults with low literacy and heart disease can be motivated to take action for their health and are empowered by learning how to self-manage their heart-healthy eating behaviours.

Perceptions about eating experiences of low-literate older adults with heart disease: a qualitative study.

AIMS: To explore perceptions of low-literate older adults with heart disease about their eating experiences. BACKGROUND: Heart disease has been closely linked with nutrition, and nutritional status is poor in patients with limited education, but no studies have explored the eating experiences of low-literate adults with heart disease. DESIGN: Qualitative descriptive study. METHODS: Data were collected in tape-recorded semi-structured interviews from March-June 2012. A convenience sample of 13 low-literate older adults with heart disease was recruited from a cardiovascular ward of a medical centre in northern Taiwan. Participants were recruited until findings reached saturation and data were analysed using qualitative content analysis. FINDINGS: Analysis of participants' interview data on eating experiences identified three main categories: (1) eating-related hardships because of low literacy; (2) eating adjustments due to low literacy; and (3) misinformation about dietary modifications for heart disease. CONCLUSION: Because of their low literacy, these older adults had difficult life experiences, gained inappropriate or inadequate eating information and held a passive, fatalistic perspective about eating with heart disease. Healthcare practitioners caring for this population need to appreciate their unique eating challenges and respect their eating customs. Nurses could play a greater role in educating and supporting low-literate older adults in selecting appropriate foods and preparing meals. Strategies to help this population learn to select, prepare and cook their food should be easy and practical, using specific symbols, concrete signs and simple labels.

A multi-perspective focus-group approach to revise items in a dietary self-efficacy scale for older Taiwanese adults.

AIM: To revise items in the Cardiac Diet Self-Efficacy Scale, Chinese version (CDSE-C) using focus groups. BACKGROUND: There is limited literature on using focus groups with older adults as well as nursing and nutrition professionals to revise a questionnaire. METHODS: A qualitative research with multi-perspective focus-group approach was used from February through June 2009. Four serial focus groups were conducted including two focus groups of older adults from Taipei County (n = 6) and Yilan County (n = 6), one group of 5 nursing professionals, and one group of 4 nutritionists. RESULTS: Serial focus group discussions added one category to the CDSE-C (reducing salt) and 3 items, resulting in an 18-item scale with six categories: healthy eating behaviors, reducing fat and cholesterol, resisting relapse, increasing fiber and vegetable, reducing sugar, and reducing salt. CONCLUSIONS: This revised measure can serve as a reliable tool for assessing older Chinese adults' healthy eating self-efficacy to evaluate and improve nutritional status in this population.

Nutritional status and its health-related factors among older adults in rural and urban areas.

AIM: To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan. BACKGROUND: The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health. DESIGN: Cross-sectional, comparative. METHODS: Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March-July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test. RESULTS: Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts. CONCLUSIONS: Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.

Stressors and coping strategies of 20-45-year-old hemodialysis patients.

OBJECTIVES: This study attempted to describe stressors, levels of stress, and coping strategies of 20-45-year-old Taiwanese patients undergoing chronic hemodialysis. METHODS: A cross-sectional descriptive design was used. A convenience sample of 88 patients with a mean age of 38.55 years was recruited at six dialysis centers in southern Taiwan. Data were collected using the Hemodialysis Stressor Scale and the Jalowiec Coping Scale. RESULTS: The results show that this group of patients had higher levels of stress than those reported in previous studies. The three most frequently reported stressors were limitations of liquids, limitations of food, and fatigue. The two most frequent coping methods were trying to find meaning in the situation and trying out different ways of solving problems to see which works the best. These patients had more physiological stressors than psychosocial stressors and used more problem-oriented coping strategies than affective-oriented ones. Additionally, the longer the patients had received hemodialysis, the lower stress level they had, and patients with jobs, with partners, or with children used significantly more coping strategies than those without jobs, partners, or children. Gender differences were not found in the total stress level or coping strategies of these patients, except that female patients had greater psychosocial stressors than male patients. CONCLUSIONS: The 20-45-year-old hemodialysis patients experienced considerable levels of stress and had a unique ranking order of stressors and coping strategies. These findings will provide healthcare professionals with detailed information to identify priority areas for future intervention development.

A randomized controlled trial of self-management programme improves health-related outcomes of older people with heart failure.

AIMS: This paper is a report on the effectiveness of a self-management programme based on the self-efficacy construct, in older people with heart failure. BACKGROUND: Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in fluid and sodium retention. Hence, managing salt and fluid intake is important and can be enhanced by improving patients' self-efficacy in changing their behaviour. DESIGN: Randomized controlled trial. METHODS: Heart failure patients attending cardiac clinics in northern Taiwan from October 2006-May 2007 were randomly assigned to two groups: control (n = 46) and intervention (n = 47). The intervention group received a 12-week self-management programme that emphasized self-monitoring of salt/fluid intake and heart failure-related symptoms. Data were collected at baseline as well as 4 and 12 weeks later. Data analysis to test the hypotheses used repeated-measures anova models. RESULTS: Participants who received the intervention programme had significantly better self-efficacy for salt and fluid control, self-management behaviour and their heart failure-related symptoms were significantly lower than participants in the control group. However, the two groups did not differ significantly in health service use. CONCLUSION: The self-management programme improved self-efficacy for salt and fluid control, self-management behaviours, and decreased heart failure-related symptoms in older Taiwanese outpatients with heart failure. Nursing interventions to improve health-related outcomes for patients with heart failure should emphasize self-efficacy in the self-management of their disease.

Barriers to research utilization by registered nurses in Taiwan.

This cross-sectional study was designed to identify barriers to research utilization among registered nurses (N = 510) in clinical settings in Taiwan. Data were collected by mailed survey. Barriers were measured by the Barriers to Research Utilization Scale-Chinese version, which has four subscales: characteristics of the adopter (nurse), organization (setting barriers and limitations), innovation (research qualities), and communication (presentation/accessibility of the research). Research utilization was predicted by frequency of reading professional literature, years of research experience, hospital classification, and the barriers of communication, innovation, and adopter characteristics. These findings indicate the need to enhance Taiwanese nurses' research efficacy, research-based information, and research experiences. Nursing administrators should create a research-friendly climate and support implementing research findings.

'Have you had your bowl of rice?': a qualitative study of eating patterns in older Taiwanese adults.

AIM: The purpose of this study was to explore the eating patterns of older Taiwanese adults. BACKGROUND: The number of older adults in Taiwan is increasing and they have been shown to have poor nutritional status. However, little attention has been directed at uncovering eating patterns among this population as part of their aging process. DESIGN: To explore older Taiwanese adults' eating patterns, a qualitative research design was chosen. METHODS: Eating patterns of older Taiwanese adults were explored in narrative interviews conducted from April-June 2007. Of the 156 participants who participated in a larger correlational, cross-sectional study, 58 agreed to answer one open-ended question about their eating patterns. All interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS: Analysis of interview data identified three major categories: 'eating and old age', 'eating and faith' and 'eating and family harmony'. Subcategories in each major category included 'achieving good health', 'upholding old customs'; 'depending on God/fate', 'enjoying later life'; and 'following the family eating rules', 'self-sacrificing for the family', respectively. CONCLUSIONS: Older Taiwanese people adopt eating patterns not only for health reasons, but also in keeping with their faith and the need to preserve family harmony. This research supports and contributes to understanding the eating patterns of older adults in Taiwan. RELEVANCE TO CLINICAL PRACTICE: Disseminating these findings may increase nurses' awareness of nutrition issues in older adults. Older Taiwanese adults' eating patterns centred on family values. Nursing intervention programmes, therefore, should address key family members involved in food preparation. Our findings also suggest that older adults followed old customs in their eating practices. Nurses are suggested to acknowledge and respect these customs as special food needs of older adults.