title: That's why I take my ONS. Means-end chain as a novel approach to elucidate the personally relevant factors driving ONS consumption in nutritionally frail elderly users.
abstract: Oral nutritional supplements (ONS) are a recommended form of nutritional intervention for older malnourished persons when a 'food first' approach and/or food fortification prove ineffective. The efficacy of ONS will depend on, amongst other factors, whether persons do, or do not, consume their prescribed amount. Factors influencing ONS consumption can be product, context, or person related. Whereas product and context have received some attention, little is known about the person factors driving ONS consumption. In addition, the relative importance of the product, context, and person factors to ONS consumption is not known. Using the means-end chain (MEC) method, the current study elucidated personally relevant factors (product, context, and person factors) related to ONS consumption in two groups of older nutritionally frail ONS users: community-dwelling persons and care home residents with mainly somatic disorders. To our knowledge, the current work is the first to apply the MEC method to study older nutritionally frail ONS users. Forty ONS users (n = 20 per group) were recruited via healthcare professionals. The level of frailty was assessed using the FRAIL scale. Both groups were interviewed for 30 to 45 minutes using the soft laddering technique. The laddering data were analysed using LadderUX software™. The MEC method appeared to work well in both groups. The majority of the participants took ONS on their doctor's or dietician's prescription as they trusted their advice. The community-dwelling group took ONS to prolong their independence, whereas the care home group reported values that related more to small improvements in quality of life. In addition, care home residents perceived themselves as dependent on their caregiver for their ONS arrangements, whereas this dependence was not reported by community-dwelling persons. Key insights from this work will enable doctors and dieticians to customize their nutritional interventions to ONS users' personal needs and thus positively impact health outcomes.
authors.affiliation: Wageningen UR Food & Biobased Research, Consumer Science & Health, Bornse Weilanden 9, 6708 WG Wageningen, The Netherlands. Electronic address: louise.denuijl@wur.nl.
authors.forename: Louise C
authors.initials: LC
authors.lastname: den Uijl
authors.affiliation: Wageningen UR Food & Biobased Research, Consumer Science & Health, Bornse Weilanden 9, 6708 WG Wageningen, The Netherlands.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kremer
authors.affiliation: Wageningen UR, Department of Human Nutrition, Bomenweg 2, 6703 HD Wageningen, The Netherlands.
authors.forename: Gerry
authors.initials: G
authors.lastname: Jager
authors.affiliation: Nutricia Research, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands.
authors.forename: Annelies J
authors.initials: AJ
authors.lastname: van der Stelt
authors.affiliation: Wageningen UR, Department of Human Nutrition, Bomenweg 2, 6703 HD Wageningen, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: de Graaf
authors.affiliation: Healthcare Research Worldwide Ltd., 46 High St, Wallingford OX10 0DB, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibson
authors.affiliation: MMR Research Worldwide, 104-110 Crowmarsh Battle Barns, Preston Crowmarsh, Wallingford OX10 6SL, UK.
authors.forename: James
authors.initials: J
authors.lastname: Godfrey
authors.affiliation: Nutricia Research, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands.
authors.forename: J Ben
authors.initials: JB
authors.lastname: Lawlor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged; D006801:Humans; D057187:Independent Living; D008297:Male; D044342:Malnutrition / Q000517:prevention & control*; D009042:Motivation; D009752:Nutritional Status; D010349:Patient Compliance; D055656:Prescriptions; D011788:Quality of Life
keywords: Frail older persons; Malnutrition; Means-end chain method; Oral nutritional supplements