CAFÉs Protocol
Project details
CAFÉ - Changes Around Food Experience (Impact of reduced contact with food on the social engagement and well-being of older women)
Purpose of project
Food conveys significant social and cultural meanings - food practices express gender, class, location, ethnicity and beliefs and convey a sense of identity and self. Food reinforces family and social relationships and marks social occasions, rites of passage, cultural and religious events(1). Changes in women’s engagement with food activities in later life may have specific and meaningful consequences for their relationships and associated well-being.
Older people prioritise remaining independent in their own homes and work to retain independence around food provision(2,3). Though physical needs for food may be supported by services such as congregate or frozen meals, meals-on-wheels, and/or informal family/friend support, the meanings and implications of changes in older women's relationship with food have not been fully explored in relation to their social, service development or policy consequences.
Aims and purpose
To discover the impact on older women of a major lifecourse event, how they make transitions regarding primary responsibility for food provision, on meanings of food, social engagement and well-being
To understand if and how this impact alters over time
To explore the potential for restoring greater contact with food in these women
To discuss community development and policy implications
Research questions include:
For older women who no longer cook their own main meals,
1. How has their contact with food changed?
2. What meanings do older women associate with their previous involvement with shopping, preparing, growing, cooking and presenting food?
3. What meanings do older women associate with changed involvement around food?
4. Do these meanings change over time?
5. Do transitions in food affect social engagement and well-being?
6. Do older women want to re-establish contact with food (and if so, how)?
7. What are the implications of these findings for community development and policy?
8. How do women contribute to positive meanings around food in others?
Methodology:
Sample:
We will recruit a purposive sample of 40 women aged 65+, living at home, fluent in English, who appear able to discuss their current and past food experience, who have prepared their main meal on <3 days/week for <6 months. (Criteria have altered slightly since beginning of the study and we are now more liberal with time period over which women have been preparing less of their food from scratch.) Initial contact will be through luncheon clubs or a leaflet (with pre-paid envelope) through friends/relatives attending luncheon clubs, delivered with meals-on-wheels, or through Norfolk Adult Social Services waiting lists. A short screening questionnaire will be used to check eligibility and participant’s questions answered before written informed consent is obtained.
Data to be collected
Qualitative semi-structured interviews (≤90 minutes) will be audiotaped and field notes made on body language and emotions displayed and food-or-drink-related social activity during the individual interview or focus group. For both individual and group interviews, opening questions will explore positive associations with, and memories about, food. These will be followed by more probing questions from the interviewer to qualify and contextualise, contrasting accounts and experiences will be identified and examined in the data analysis.
Individual interviews. The interview schedule has been piloted with three women in their seventies and modified according to their feedback. The advisory team will listen to selections from the first two interviews conducted and adjust the topic guide as needed.
Semi-structured first interview topic guide:
1. Name, date of birth, previous employment, living circumstances, education, type, frequency and duration of food support, ethnicity, contact with family, friends and neighbours, longstanding illness and problems with sight, hearing and mobility.
2. Examples of food you have prepared, cooked and enjoyed over the years.
3. An eating occasion you remember with pleasure from several years ago.
4. An eating occasion you remember with pleasure from the past few weeks.
5. Your involvement with food at different stages of your life
6. Your current involvement with food
7. Future involvement with food
For those who have an individual interview a second interview (4 to 5 months after the first) will be based around a summary of the first interview. The purpose is to increase the involvement of the participants, help them make connections with their own experiences, value their input, empower them in further shaping their own narrative and discuss changes since the first interview; and remind participants of the previous discussion. In addition, we will explore positive ways that women are still involved with food, including the positive influence and social contact over food with others.
Outline of second interview (semi-structured, ~60 minutes long):
Share the summary of the first interview and explore:
1. Agreement with the summary (chance to comment on, clarify, alter, add or remove points).
2. Changes since the first interview.
3. How do you see these changes?
4. Your main concern about food at this time.
5. Tell us about when you help others enjoy food and when you enjoy food or drink with others.
Focus group interviews. Four or five focus groups of 4-6 participants will be carried out with participants recruited from luncheon clubs. These will follow a similar format to the initial individual interview, and the topics covered will be similar but in less depth.
Observation:
Around 4 weeks after each individual interview the researcher will observe the participant eating a meal at the luncheon club, receiving and eating a meal-on-wheels, a frozen prepared meal or one provided by relatives/friends. She will take an ‘onlooker’ role where possible, paying particular attention to roles taken around food and drink provision, interaction with food and with others around food, conversation around food and drink, and social contact. Her role will be explained to all those present. In a group setting all those present will be informed of the observation and be requested not to talk to, or ask questions of, the researcher - only the comments and reactions of those being observed will be noted (where there is a response to another individual present only general information about the comment or behaviour that caused a reaction will be noted and no people identified in any way that could allow others to identify them). Others in the room will not be asked for explicit consent. The researcher will sit or stand in an inconspicuous spot where they can hear and see what is going on but cannot influence the process or take part in it. If addressed she will say ‘I am observing at present, may I talk to you later?’. In a setting with only one or two people again only the comments and reactions of those being observed will be noted, and others in the room, or who come in, will not be asked for explicit consent. In this setting the person who is observed will be told well before the observation that the researcher will not be needing a meal, and will bring some food and drink of her own. The researcher will not accept any food or drink during the observation, but will eat some of her own food so that the person being observed does not feel very awkward. However, again, when the observation period begins everyone will be told, and the same standard response will be used to questions or comments.
Framework and methods for analysis
Qualitative interviews, focus groups, and field notes will be transcribed verbatim. Analysis will be an iterative process drawing on modified grounded theory, with preliminary analysis after each interview, using results to guide further interviews, carrying out data generation and data analysis simultaneously(6, 7). Nvivo software will be used to create and organise data files.
Analysis will proceed in two cycles, the first during the set of initial interviews, the second cycle during and after the second individual interview. The interviews will be analysed systematically using the constant comparison method(8). Axial codings will be developed to explore the interrelationship between codes, one category will be identified as the central phenomenon (by discussion of the researchers and advisory team), a coding paradigm will be developed. After the second cycle the coding paradigm will be refined, presented as a visual model, and compared with pre-existing theory.
Throughout analysis, to test emerging patterns, negative or disconfirming cases will be sought, highlighted and discussed. Those identified in the first set of interviews will be noted and discussed with participants during second interviews. Differing points of view will be noted and presented. Ethical principles will be adhered to throughout. The advisory group will meet for a day to discuss results, agree the final central phenomenon and coding paradigm, discuss service development and policy issues and finalise the dissemination plan.
Dissemination
Expected outputs include:
Publication in a sociological journal
Presentation and written research summary, plus full publication if desired, for participants, relatives and carers.
Research summary published in newsletters and websites.
Database lodged with the Economic and Social Data Service
Research abstracts for ESRC
References
1. Caplan P. Food, health and identity. London: Routledge, 1997.
2. Gustafsson K, Andersson I, Andersson J, Fjellstrom C, Sidenvall B. Older women's perceptions of independence versus dependence in food-related work. Public Health Nursing 2003;20(3):237-247.
3. McKie L. Older people and food: independence, locality and diet. British Food Journal 1999;7:528-36.
4. DoH. National Service Framework for Older People. London: Stationary Office, 2001.
5. Murphy E. Assessing validity. Health Technology Assessment 1998;2(16):178-198.
6. Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage, 1990.
7. Cresswell J. Qualitative Inquiry and Research Design: Sage, 1998.
8. Ezzy D. Qualitative Analysis- Practice and Innovation. Oxford: Oxford University Press, 2002.