Digital and face-to-face home care provision for people with long term conditions - exploring the part nutrition plays

  • Sophie McFarland

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Malnutrition is the combined definition of overnutrition and undernutrition. In the UK, over 60% adults are overweight or obese and 5% are underweight. Long-term conditions are associated with malnutrition, but evidence around its management in homecare is lacking. Technological solutions to health and social care are of interest to commissioners, as technology may alleviate current constraints on staffing, resources, and budgets but robust evidence of its benefits in home care are difficult to quantify. Therefore, this thesis explores evidence of digital and face to face home care in people with long-term conditions and the current context of nutrition management in this setting.

    A systematic review, meta-analysis, and narrative synthesis to compare telehealth to standard home care in people with long term conditions, and their quality of life outcomes.
    An ethnographic exploration of the culture in home care provision in people with long-term conditions and the context of nutrition in this setting. In-depth focus on a small sample of clients, their carers, and the care provider to produce narratives and knowledge based on purposeful conversation, participatory observations, insight, and reflections.

    Systematic review:
    9 studies were included in the systematic review, 2 of which were qualitative studies, reporting on a total of 2611 home care adults living with chronic condition. Meta-analyses showed telehealth was not statistically significant different to face-to-face homecare in terms of quality of life. Qualitative studies showed telehealth provided peace of mind and legitimized contact with healthcare professionals.
    Reflective narratives demonstrate overnutrition and undernutrition are concerns not currently addressed in CareCo Healthcare clients . Barriers to good nutrition exist from all perspectives and include constraints of staff recruitment and training, nutrition as low priority in care planning and respect for patient autonomy. Whilst knowledgeable clients, cooking ability and advocacy facilitates good nutritional practices.

    Much work is needed to optimise nutrition for those with long term conditions receiving home care where many complex factors come into play. The thesis discusses ways in which these complexities maybe negotiated and potential solutions reached, including those which would need to be done face to face and those which could potentially embrace telehealth.
    Date of AwardJul 2021
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SupervisorDeborah Lycett (Supervisor), Faith Martin (Supervisor) & Anne Coufopoulos (Supervisor)

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