Implementing Nutrition Screening in Community Care for Older People

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Funded by the Burdett Trust for nursing, the INSCCOPe project aims to improve nutritional health of older people in the community, by supporting implementation of a new procedure for screening and treatment of malnutrition.


Who we are, and what we do

  • We are a research team (led by Professor Jane Murphy), who are part of a project to improve screening and treatment of malnutrition for older people in the community.
  • The INSCCOPe project focuses on how best to implement service improvements for screening and treatment for malnutrition in older people. A new model of nutritional care has been developed in order to enable integrated community teams to better identify and support older people considered at-risk. This is currently being implemented within one area of Southern Health NHS Foundation Trust, alongside associated training for healthcare staff.
  • Our aim is to maximise scalability and cost effectiveness of this new procedure, by providing an evidence base to support implementation across wider settings in the health service.

Project updates

20/11/2018 Professor Jane Murphy presents findings from phase 1 at the BAPEN’s 2018 Annual Conference poster session

You can view the poster in full-size by clicking on the miniature below.


19/11/2018 The impact of the Nutrition Project Lead discussed in Complete Nutrition 

The findings from phase 1 of our study highlighted that community nurses felt there was a gap in the provision of specialist dietetic support, due to a lack of community-based dietician. As a result, a Nutrition Project Lead post was introduced in March 2018, as a 6 month pilot project. The post was taken up by a registered dietician, Grace Paterson.

Grace provided  staff with training on malnutrition, the ‘MUST’ tool, and the new procedure for screening and treatment of malnutrition. She run a dietician helpline to provide teams with specialist advice, created a two-year training plan, and developed Nutrition Link roles within the teams to continue to support staff and drive the procedure forward.

Grace just published an article discussing the results of her work in the Complete Nutrition.

Click here to read the article.


The participating staff within Integrated Community Teams are now completing the third and final NoMAD questionnaire to help us understand their experiences of screening and treatment of malnutrition following the introduction of the new procedure. We are also interviewing the participants to explore their views in more depth. We aim to complete the data collection by mid-November.

Based on the results of the interviews with the Procedure Design and Delivery Group (PDDG), we have updated the NoMAD questionnaire with three additional questions exploring the impact of electronic patient records system (RiO) on the work around nutritional screening and care planning.

The final phase of data collection began today. We start by interviewing the Procedure Design and Delivery Group (PDDG). We will explore the PDDG’s observations and experiences of how the design and delivery of the procedure have gone. The interviews will inform whether any additional areas should be explored in the upcoming questionnaire.

Dr Mike Bracher presented findings from the first phase of the study at the British Sociological Association 50th Medical Sociology Conference.

Dr Daria Tkacz joined the team to take the lead on the data collection and analysis for the second phase of the study.

Dr Mike Bracher delivered a half-day seminar exploring the principles and applications of Normalization Process Theory (NPT) in healthcare implementation.

click here to view the presentations

Dr Mike Bracher presented findings from baseline to the BAPEN 2017 Annual Conference poster session.

(click here to download/view the poster).

Baseline and phase 1 interim findings were presented to the Southern Health NHS Foundation Trust Nutrition and Hydration Committee.

We started the data collection for the first phase of the study.  Drawing on findings from interviews at the baseline, we have expanded the questionnaire to explore some emerging issues, within the wider sample.  These include: access to dietetic services; reasons for non-completion of training; factors mitigating engagement in non-mandatory training. [Update: we completed this in 09/2017]

We began the baseline data collection to explore staff’s experiences of screening and treatment of malnutrition prior to the introduction of the new procedure. We are asking staff within Integrated Community Teams (ICTs) and Older Persons Mental Health (OPMH) Teams to complete the NoMAD questionnaire and to take part in an interview exploring their responses in more depth. We are also interviewing staff involved in the Procedure Development and Delivery Group (PDDG). [Update: we completed this in 07/2017)





Tagged:dementiahealth services researchimplementation sciencemalnutritionnutritionprocess evaluation. service developmentundernutrition

Latest news from this project:

The problem

  • Malnutrition is a significant health problem for older people living in the community, with around 3 million older adults estimated to be at risk of undernutrition.
  • The health consequences can be far reaching and include slower recovery from illnesses and an increased need for healthcare, whether at home or in a hospital setting.
  • The cost of providing that care can be high, but could easily be prevented by screening and early intervention.

Our approach

  • The new model for screening and treatment of malnutrition is currently being implemented by Intergrated Community (ICTs) and Older People’s Mental Health (OPMH) Teams in Andover, Winchester and Basingstoke, with plans to further roll out across Hampshire, and then further afield across England.
  • In addition to understanding the effectiveness of the model with respect to staff knowledge and patient outcomes, we aim to understand the factors that may help or hinder implementation of the new model, and embedding it as a routine aspect of care.
  • The project is informed by Normalization Process Theory (NPT –
  • Study design, data collection, and analysis have been led by Dr Mike Bracher (for the baseline and the phase 1) and by Dr Daria Tkacz (for phase 2).
  • Professor Jane Murphy (Chief Investigator), and Dr Mike Bracher (Post-doctoral Research Fellow) explain what the team hope to achieve;

[Prof. Murphy] The cost of under nutrition in the UK is estimated to be around £19.6 billion, around half of this being spent on older people. We’ll be working with a number of different community and mental health teams within the Southern NHS Trust, representing both rural and urban areas, rehabilitation and hospital admission prevention.  We hope this mix will give us a real insight into the different issues faced by a number of different touch points older people may have with the health system.

[Dr Bracher] By understanding factors that influence implementation of new procedures, we can maximise their efficiency and effectiveness. Informed by Normalization Process Theory, the INSCCOPe project explores how best to do this in community settings, and thereby improve nutritional care for older people.

Further information

Links to other resources



  • Professor Jane Murphy
    • Professor of Nutrition/ co-lead, Ageing and Dementia Research Centre (ADRC), Bournemouth University
  • Dr Daria Tkacz
    • Post-doctoral Research Fellow, Ageing and Dementia Research Centre (ADRC), Bournemouth University
  • Dr Mike Bracher
    • Post-doctoral Research Fellow, Ageing and Dementia Research Centre (ADRC), Bournemouth University