Factors affecting patient and nursing staff adherence to an integrated physical activity and nutritional intervention targeting functional decline on an acute medical ward: a qualitative study

Figures & data

Figure 1 A schematic view of the TEMP intervention framework.

Abbreviations: D, dietician; N, nutrition; PA, physical activity; Pt, physiotherapist; TEMP, Training and Eating for Medical Patient study.

Table 1 Demographic information and data source for patients and staff

Patients age (years)	Gender	Marital status	Comorbidities	Nutritional risk by NRS-2002	Length of stay (days)	Focus group interview	Individual telephone interview
80	M	Married	Vascular stroke Type 2 diabetes mellitus	Yes	8	X
62	F	Married	0	Yes	16	X
81	F	Married	Back problems	No	5	X
66	F	Married	0	Yes	8	X
69	F	Widow, living alone	COPD vascular	Yes	12		X
67	M	Married	Shoulder problems	Yes	13		X
72	F	Widow, living alone	COPD Type 2 diabetes mellitus	Yes	13		X
Staff age (years)	Gender	Profession	Years in the ward	Day watch and shift		Focus group interview
32	F	Nurse	7	X		X
31	F	Nurse	5	X		X
24	F	Nurse	0.5	X		X
47	F	Nurse	5.5	X		X
39	F	Nurse	6	X		X

Table 2 Main topics in the interview guide for both groups

1. How did you experience your participation in the intervention?

2. What changes did you experience due to the project?

3. What elements and factors supported your participation and motivation and what elements and factors did the opposite?

4. If the intervention should continue on the ward, what advice would you give to improve and ensure a successful intervention?

Table 3 Summary of findings in relation to the identified themes, consisting of facilitators and barriers from both a patient and a staff perspective

Themes	Selected quotations	Effect on adherence
Patient perspective:		Positive:
Becoming aware	“I find this thinking about taking physical activity and nutrition seriously from the point when you are very ill; if you hope to recover that is really the right thinking!”	Knowledge provides meaningfulness and awareness
Being the center	“And if you were not capable, it was quite all right. I had days where I could do nothing, but she steadily showed up the day after to hear how I felt that day. And yes, it is the insistent way that does not allow you to drop out, you need in a situation where you yourself do not have the strength/power.”	Strong facilitator as the patients felt they were seen and somebody believed in their ability to recover
Staff perspective:		Positive:
An eye-opener	“I am still surprised that the percentages that H [the physiotherapist] put forward … how much bed rest means for muscle mass and things like that. And that is quite an eye-opener, that, okay I may use five minutes more on that the next time.”	Knowledge and easy access to questions provided enthusiasm and affected the staff and the patients
Culture change	“It would be super-nice because it is evident that this is really important to learn … stuff that we cannot and which we do not have the resources to do. Actually one can say that, mood-wise, people were much happier and engaged and when you arrived on duty, they (the patients) said: I have been walking so and so much and the day is not even over!”	Positive relations on a more personal level contributed to interest and collaboration between staff, project personnel and patients
Reducing bad conscience	“I cannot find any negative. I find that it was really good. And it took a large part of my bad conscience in relation to the patients; as you know you yourself do not do that part well enough.”	The project personnel motivated the patients and did work the staff normally would do, and their time spent with the patients gave staff less bad conscience
Patient perspective:		Negative:
The situation	“The situation … And then you have many guests while you are admitted; much time is spent on visits.”	Worries about the situation and illness, not having the initiative to adhere to the program
Not being seen	“She wanted me to drink whole milk and cream and everything. And I didn’t want that. That was not my thought of food, that it should be fat and stuff like that.”	A barrier affecting motivation and adherence
Staff perspective:		Negative:
Time barriers	“But we cannot do it in our daily practice. It is medicine and it is the changing of diapers and it is Ms. Hansen, it is wounds and things like that. That is the focus.”	The constant time pressure negatively affected the adherence of the staff
Knowledge shortcomings	“For me it seems to be in vain, that they should have to change their lifestyle while they are here for four days. Honestly, it is a man in his seventies, who suddenly must become physically active.”	Resistance towards health promotion in an acute setting was a barrier