Background: Reports from research have shown that mental illness has increased dramatically in recent years and is currently one of the biggest problems among Swedish children and adolescents.

Aim: The aim of this study was to describe how Swedish school nurses experience their work with schoolchildren who have mental illness

Method: Data were gained by individual interviews with school nurses (n = 10) and were analyzed by using manifest qualitative content analysis.

Results: The results of the study showed that school nurses used various tools when working with schoolchildren who have mental illness. The working tools were regular health talks, motivational interviewing, individual counseling, family counseling, creating trust, and affirming the child's confidence. 

Conclusion: Results of the study demonstrate the need for further research on schoolchildren's experience of getting help and support from the school nurse. 

The risk of malnutrition increases with ageing, resulting in poorer health and higher risk of disease. Eating difficulties are important risk factors for malnutrition. Moreover, independence in relation to food and meals is highly rated by the elderly and has been associated with health and well-being. The purpose of this literature overview was to provide insights into nutritional status, food choice and preferences as well as the meal situations of home-living elderly (65+) people with motoric eating difficulties focusing on Scandinavia. The overall aim is to support independence and to prevent malnutrition. Nutritional status in the elderly was found to be negatively influenced by motoric eating difficulties including problems with manipulating food on the plate and transporting food to the mouth. Motoric eating difficulties may result in practical simplifications such as use of pre-prepared meals, less advanced cooking, and omission of certain meal constituents in order to avoid e.g. mismanagement and spillage. Eating difficulties are often accompanied by feelings of guilt and shame. Choosing smaller portions, reducing the number of eating episodes and not cooking independently have been associated with a higher risk of malnutrition. The nutritional effects of eating difficulties may be exacerbated by diminished chemosensory functions. Furthermore, both past and present food preferences should be considered in order to meet nutritional needs and meal satisfaction. Development of refined and socially accepted eating aids, in combination with tasty and nutritious products, is important in order to promote healthy and independent living among home-living elderly with motoric eating difficulties.

Protein-energy malnutrition can be a problem among elderly. A way to increase protein intake may be to enrich home-cooked foods. In this, special attention should be given to that the food is conveniently prepared and well accepted by the target group.

Remaining independent in respect to eating is highly valued among elderly. By integrating various dimensions of the meal, including nutritional and sensory aspects, in the development of functional eating aids, the possibility of a healthy and independent living among elderly increases.

Prepared meals distributed by municipalities is a service to elderly people, or persons with health related impairments, who live in their own home, have difficulties preparing their own food and cannot meet their food requirements in any other way. This study aimed to provide a brief picture of how elderly people living at home perceive the food they receive through their municipal food service and what is important to them. The data was collected using questionnaires. 274 out of 276 participants answered the questionnaire (n=173 women 62% and n=101 man 37%). The data was analyzed using Principal Component Analysis (PCA).

The results showed that the elderly persons receiving meals through the service were often satisfied, especially with the size of the portions and the delivery time. Those who had been using the food delivery service for a longer time were not satisfied with the alternative dishes they were been offered. There was no significant difference between the views of either gender. Further, those who were receiving special food were, in general, unsatisfied with the meals delivered.

Development of the food distribution service by systematic quality insurance and interactive knowledge exchange between the producers and consumers seems to be a way to promote a more holistic and individual adjusted service. Evaluation of the municipal FD service is a powerful tool that can contribute to the development of this service. The food service can be improved and consequently even the quality of life and health of its receivers. The present survey should be revisited and developed in order to detect differences between genders.

The AR’s (Lewin, 1946) assumption was that human beings exist in life spaces through interaction, and communication, and that knowledge development is the result of changes in cognitive structures through communication and involvement in research processes. And further, from the construction of new knowledge gained by learning from each other, comes the presumption to change. The participation is described as "citizen power" (Arnstein, 1969), which means being included in the development process. The degree of citizen power is based on partnership, delegated power and citizen control. All these steps are positioned at the highest level when ranking participation. Partnership means engaging and negotiating with the high level decision makers. The result of delegated power is apparent when the negotiations result in achieving leading decisions that influence a particular plan or programme.

Studiens övergripande syfte var att utifrån äldre hemmaboende personers, olika professioners samt beslutsfattarnas erfarenheter få insikt och beskriva matdistribution inom den kommunala omsorgen. De övergripande resultaten visade att matdistribution är komplex en organisation och att den är fragmenrerat organiserad. Dc involverade professionerna tog enbart ansvar för sina egna delar av matdistributionskedjan och det saknades en övergripande funktion som hade en övergripande bild och ansvar för matdistributionsprocessen. Resultaten visade även att vissa professioner (personalen i köket och taxichauffören) tog mer ansvar än der var tänkt i förhållande till deras komptens. Således finns det behov att beskriva ansvarsområden för alla involverade i matdistribution. Äldre personers erfarenheter indikerade att matdistribution inte bör ses som en fragmenterad social insats och symbol för heroende av andras hjälp. Srudien visar att matdistribution behöver organiseras så att de äldre personernas engagemang stärks. Systematiskt arbete och involvering på alla nivåer i denna organisation har visat sig vara en gynnsam startpunkt för utvecklingen av den kommunala mardisrriburionen. Denna studie visar vikten av kontinuerlig uppdatering av kunskaper hos olika professioner som är involverade i matdistributionskedjan. Resultaten visar att matdistribution inte enbart bör ses som en logistikfråga utan en samverkansfråga.

The purpose of the present study was to describe how one of 290 Swedish municipalities improved its FS service by terminating their earlier service of food distribution (FD) which was the delivery of ready cooked meals produced at a central kitchen in the community and introducing food preparation at the client’s home. The revised system is referred to as the new FS. This study was performed using an action research approach. The data was collected by individual- and group interviews and through participatory observations. The transcribed interview material was analysed using qualitative content analysis. The (n=30) subjects were recruited The findings of this study revealed that the new FS was experienced as being a good service, that the new municipal FS met individual needs in a better way and that the elderly recipients could participate more actively in planning and preparing their meals. In conclusion, it was found that having their food prepared at home was considered by many of the recipients to be synonymous with individually adjusted help. The results of the study could have implications for nursing, public administration and gerontology.

Food distribution (FD) is a part of the public social and care service in Sweden aiming to prevent improper food intake for persons that they are unable to do their own shopping, and prepare their own meals, and in that way ensure reasonable standard of living. Before a person can be granted the FD service, from any municipality, an assessment of their individual requirements has to be made by a public home care officer.

The aim of this study was to explore how public home care officers reason when they make a needs assessment for homebound elderly people.

The data was collected through individual interviews (n=18). The transcribed interview material was analysed by means of the grounded theory method.

The findings showed that the public home care officers were confronted with many challenges when making an assessment of a person’s individual needs. They are influenced by their subjective feelings related to their personal views as to what should be the right solution for the individual. However, they remained aware that they needed to be guided by the legal requirements.  Further, they described that the level of an individual’s living standard is a leading concept in the governing laws that they need to interpret. Interpretation of this concept is very subjective with the possible consequence that an assessment result may lead to inefficient support.

In conclusion, the concept of a reasonable standard of living needs to be clearly defined, decision regarding FD should not take long time, need assessment and decision should be based on the whole picture behind each individual case and there are needs to develop general guidelines for making needs assessment. The findings in this study have implications for public administration, nursing and gerontology.

The overall aim of this study was to gain insight into municipal food distribution from several perspectives: that of the clients, mainly elderly people, and also from the perspectives of different professionals and decision makers. An action research approach was chosen, as the characteristics of this method were deemed to be correct in relation to the basic aim of the study. This thesis is based on four empirical studies. Study I aimed to explore various professionals’ experiences of involvement in food distribution (FD) in order to get a comprehensive understanding of the organization, responsibilities and roles. The results showed that FD is a fragmentary intervention where a comprehensive perspective and clear roles of responsibility are lacking. Study II aimed to gain insight and to describe the experiences of home-living elderly people who receive hot meals distributed by their municipality. The results showed that there were feelings of dependency, and loneliness among the elderly participants, however they also expressed gratitude for the opportunity to have their meals delivered to their home.  Study III aimed to describe how the professionals can identify needs for improvement and improve the municipal FD service to home living elderly people. The need to update and increase the FD recipient’s knowledge in nutrition by sending information letters was found to be an important area to focus on. Evaluation of letters resulted in the decision to continue preparing and distributing information letters to all FD recipients twice a year and to make the information letters assessable on the websites of the six municipalities and county councils involved. Study IV aimed to describe the decision maker’s views on FD and to report their suggestions for which areas reported from studies I-III should be taken into consideration as starting points to improve the municipal FD. The findings resulted in the decisions to monitor the elderly’s health and wellbeing while providing FD and to increase the professionals’ competence and to create a forum for inter-professional communication. In conclusion, this thesis illustrates that there is a necessity to identify the needs for general improvement of FD by involving the participants and to start out from their personal experiences and in their own context.

Promoting breastfeeding is important work for health-care personnel in the Swedish context. This promotion is multifaceted and demands the ongoing development of knowledge and competence among both health-care  personnel and patients.  The aim of the present study was to describe the nursing students’ perspectives on breastfeeding in Sweden. Data were obtained in the form of written reflections from nursing students (n=65) and examined using manifest content analysis. The results show that the factors of importance in promoting successful breastfeeding are information about breastfeeding’s benefits, traditions and cultural acceptance of the practice, and by government prohibition of infant formula. We conclude that knowledge about the benefits of breastfeeding needs to be prioritized continuously during education.

The municipal Food distribution service (FD) to the elderly living at home is a part of the public social and care service in Sweden, The objective of this service is to ensure proper food intake for persons who are unable to do their own shopping, and prepare their own meals. The foremost reasons for the need of the FD service are in situations where there are illness related physical or psychological limitations.This means that the Swedish welfare system takes on the responsibility for its citizens when they have a legal social related need of care. Further, according to the Swedish social legislation, children or other relatives have no legal obligations to take care of their parents or elderly disabled relatives. This also means that the children or relatives of elderly people requiring social support have no legal right to be involved in the evaluation procedure of need assessment or the outcome of any social and care services granted by the Swedish social welfare system.

The aim of the present study was to gain insight into how the relatives of elderly people living at home in Sweden experience the municipal service of ready-made meals distributed daily.

The data was collected using in-depth interviews with relatives of elderly persons who use the municipal food distribution (FD) service (n=8). The transcribed interview material was analysed using the grounded theory method.

The findings of this study revealed that the relatives of the municipal FD service recipients advocate for a food preparation service in the home of the recipient rather than the distribution of ready-made meals from a central kitchen. The results also revealed that the participating relatives felt frustrated by the legal limitations that make it impossible for them to influence the municipal FD service. The findings in this study also indicate that relatives should be considered as a resource in this matter and could actively participate, and have a positive influence on the quality of the municipal FD service for the elderly. The results of the study could have implications for nursing, public administration and gerontology.

Den nya matservicen, matlagning i hemmet, är en insats som riktar sig till en heterogen grupp äldre och som involverar ett stort antal personalgrupper. Vård- och omsorgsförvaltningen i Lunds kommun genomförde under år 2012 en förändring när det gäller matservice. Förändringen inriktades på att upphöra med matdistribution den 31 mars 2012 och införa insatsen matlagning i hemmet den 1 april 2012. Matlagning i hemmet definierades som en enklare form av matlagning med beräknad schablontid på ca 30 minuter. Intentionen med att införa matlagning i hemmet var att skapa en fungerande helhetslösning för brukare med stora vård- och omsorgsbehov, att öka valfriheten, öka kvaliteten på äldres måltider och att använda ekonomiska resurser på ett bättre sätt.

Denna utvärdering är ett sätt att blicka tillbaka och kritiskt granska hur den nya matservicen har fallit ut och mvilka förbättringsmöjligheter som finns, i syfte att erbjuda matservice av hög kvalitet till kommunens invånare.

Findings from international research as well as fromSwedenshow that breastfeeding is important for infant health. Further there are still needs to continuously invest on the society level to promote the breastfeeding. Working together in international research collaborations can empower all partners involved.

The project have  two aims: both to describe the successful factors of  Swedish and Norwegian breastfeeding interventions programs on national level, and to elucidate the present situation and background of the present low rates of  breastfeeding.

Data will be collected by individual interviews with obstetricians, midwifes, district nurses, paediatricians and voluntary breastfeeding advisers in both countries.

The findings will be used to promote breastfeeding and inspire other countries spatially high-income countries to focus on the benefits and importance of the breastfeeding to infant’s health.

Findings from international research as well as from Sweden show that breastfeeding is important for infant health. Further there are still needs to continuously invest on the society level to promote the breastfeeding. Working together in international research collaborations can empower all partners involved.

The projects’ aims are to describe the successful factors of Swedish and Norwegian breastfeeding interventions programs on national level, and to elucidate the present situation and background of the present low rates of breastfeeding. Further the aim is to develop the Nordic breastfeeding model.  

Data will be collected between September and December 2013 by individual and focus group interviews with obstetricians, midwifes, district nurses, paediatricians and voluntary breastfeeding advisers in both countries. Further the outcomes from the interviews will be used to creation of the questionnaire that will be tested and power analysis performed during the spring at 2014.

The findings will be used to promote breastfeeding and inspire other countries spatially high-income countries to focus on the benefits and importance of the breastfeeding to infant’s health.

Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.

There is an urgent need to facilitate the development of more effective breastfeeding support strategies. The desired research will focus on knowledge-based service innovation that include intervention in form of computer-based training program aimed for training of health and care professionals involved in breastfeeding support. The intervention in the proposed study will contribute to more effective adoption of new knowledge in healthcare organisations. Further, the proposed project will be organised as an interdisciplinary and crosswise sectorial collaboration and will be customized at a national and international level, by involving decision-makers, researchers, health care professionals and care users. Ambition with this project is to contribute to increased breastfeeding frequency by increasing competence in professional support in related healthcare services and midwife education program. There is also an urgent need for evidence based technical solutions as a professional support for the professionals to more effectively implement new research in practice. This project will contribute health care with high quality and resource use. The overall aim for the project is to implement and evaluate new innovative solutions in order to improve long-term strategies for professional support and quality of care, related to knowledge-based breastfeeding support. The design method for the project is longitudinal randomized controlled intervention trial. The intervention will be computer-based training education program developed in collaboration with decision-makers, professionals and researchers. Data will be gained before and after intervention by using: Breastfeeding attitudes among counselling health professionals (An instrument based on WHO standards was developed to measure breastfeeding attitudes), Mother-to-infant Relation and Feelings (MIRF) scale and Mother-Perceived-Professional-Professional support (MoPPS) scale. For successful intervention, it is important that decision-makers are involved in the research process, so that suggested changes can be possible if they actively participate and encourage the project as well as the adoption of research results in practice. Involvement of stakeholders in the research demand facilitation of the research process. This can enable cooperation by using project management techniques as co-counselling and clinical reflection. The outcome of the project will be multiple may be placed in a regional, national, international or global context. Firstly, the project will contribute to development of knowledge-based professionals’ competence with focus on to support breastfeeding from first breastfeeding time, to minimise usage of infant formula during first week of life, longer exclusive- and predominant breastfeeding and stronger connection between mother and child. This topic will fit with theme Nutrition and Lactation.

In this paper, we will discuss a study whose concern is to identify and develop areas of food distri­bution by testing a model that allows the practitioners to participate in the exploring of their own stories of everyday practice. The fundamental reason for engaging the practitioners in the research was to facilitate them in obtaining tools to reflect on practice and to inform about future actions. Our in­tention was to use PAR as the approach as to building a bridge between theory and practice for which the SDM proved to be suitable for gaining and analysing data. Some of the links between the PAR approach and the SDM are that both consist of continuous cycles of reflection and learning. The stories should be used as a powerful vehicle to discover new knowledge and to deepen the under­standing of professional practice issues. Reflection and story telling are closely related to the proces­sing of information and gaining new insights from experiences. To take stories from practitioners’ own experience is similar to that of the ‘look phase’ of PAR, which implies that what is happening is described and thus clarifies the core problem of what the practitioners would like to change. The ‘think phase’ of PAR, and the structured dialogue in the SDM, involves detailed de­scriptions, explanations and the exploring of the issues that are aggregated and focused on in the structured dialogue around questions such as: What can we do to move on; what actions could be taken; what happens if nothing is done; and what are the possible effects. Actual stories were used as “triggers” when probing questions were asked in a dialogical and structured form. The process involves the combination of having a dialogue and writing memo notes. The dialogue on various strategies, in­clu­ding weaknesses and strengths, continues until each action and the expected benefits of a chosen action have been adequately discus­sed. The dialogue has a constant focus on what is of greatest im­por­tance for a chosen action from an ethical, legal, economic, colla­borative and organisational point of view. Furthermore, the dialogue evaluation emphasises on how participants reflect on what the expected change is, how change comes about, and what the consequences of the change imply. Our conclusion is that the PAR approach and the use of SDM are suitable and systematic methods to generate data and to encourage collaboration between various professional groups, i.e. an active participation through dialogue where there are no restrictions in the communication and everybody’s voice is heard equally. In this study, as to critically reflect on how the SDM embodies a participatory and an ‘action’ oriented approach implies that, as a platform, an actual, real, case from practice was used. Chosen jointly and in agreement by the practitioners, the case should always be one with which all can be familiar and treat as their own. The starting point was our perception that the practitioners are the experts in their particular everyday work, and that they are able to identify problems them­selves, which would be resolvable through actions and changes in the daily routines. Another benefit of involving the practitioners was how their motivation to make changes to a particular problem they had deemed important to resolve increased. The systemic issues, which were identified in the study, call attention to the importance of systematic collaboration, and by using the SDM, issues that concern the organisation and its practice directly may be explored. This cyclical process provided an expanded understanding about the food distribution context. In addition, the dialogue has developed over time from focusing on formal aspects, such as routines, competence levels, responsibility and how to fill in forms, to include more organisational aspects. The practitioners felt that structured dialogues and ref­lecting gave them a better understanding about the food distribution context. The reciprocal relations that were rendered in the non-restrictive communication – down-up and up-down in PAR – were identified as important. Another important insight was that support from the parent organisation was necessary when actions were to be taken and changes in practice were to be made. In closing, the study stems from our shared deep engagement and absorption in practice and together we saw how stories unfolded. It became clear that a greater understanding of and by the various professional groups would have to be obtained in order to achieve changes in the practice of food distribution to elderly persons for which such understanding is a necessary starting point.

The purpose of this paper is to describe the implementation of action research (AR) in the context of Swedish municipal care from a facilitator’s’ perspective. Four empirical studies using the AR approach were performed during 2007–2012 in six municipalities. Establishing support for AR was time-consuming when it concerns starting up processes that were created and were changeable over time. Further, the processes were focused on the sustainable development of practice, based on practitioners’ and care consumers’ knowledge, that is a precondition of organizational change. An important precondition was that the participants were motivated and participated actively in all phases of the AR cycle. Another important precondition was that the participants got along with each other and trusted each other. The participants’ engagement and the collaboration that was established between the participants and the facilitator were likely a result of this. Moreover, even positive interaction with participants representing a “top–down” perspective was important for the implementation of proposed changes to the practice. In conclusion, AR enhanced sustainable action based on participant’s everyday knowledge relating to areas they want to change and improve in the context of municipal care practice.

This study is the final part of a larger project with an action research approach focusing on food distribution (FD) within municipal service and care for elderly persons, living at home (≥65 years), from various perspectives. The aim was to describe the decision-makers’ the politicians and top level administrative manager’s views on the FD service, and to give feedback from the results of earlier studies based on information given by FD receivers, the perspectives of involved professionals, and the results of an intervention study and further to report the decision-makers suggestions for which areas should be taken into consideration as starting points to improve the FD process and practice. Data was gathered in two steps: step 1, through individual interviews (n=12) with the decision-makers during the spring of 2009, step 2a through feedback from previous studies, received during the autumn of 2011 and step 2b from discussions based on the feedback. The interview data was analysed using qualitative content analysis. The findings indicated a discrepancy between the reality and the political visions. It was shown that decision-maker’s needed to make decisions despite their uncertain knowledge of the complexity of the FD programme. They considered what has been, what is, and will be, when setting goals. Their goal was that elderly person’s rights and needs should be fulfilled. This included freedom of choice and individual consideration. In addition, it meant, meeting elderly people’s medical and social needs. Three areas were found to require facilitation for change related to FD: 1) the monitoring of the elderly’s health and wellbeing while providing FD, 2) the increasing of professional competence, and 3) the creation of a forum for inter-professional communication. The findings in this study have implications for nursing, gerontology and public administration.

The purpose of the study was to describe the experiences of elderly people, living at home who receive hot meals that are distributed by their municipality. Qualitative content analysis was used to analyse the (n=13) interviews. The results showed that feelings of dependency, loneliness and gratitude were expressed by the participants in the study related to their meals being delivered home. Dependency was expressed as not having influence over the food products the meals were made from. Loneliness was expressed as being isolated and being confined at home alone due to difficulties getting out of the house, which was associated with the costs of taxis transportation. Gratitude was expressed by the sincere thanks for the possibility of receiving traditional meals delivered daily.

The major conclusion of the study was the indication that greater attention should be paid to meet both the practical and psychological needs of elderly people.

Findings from international research as well as from Sweden show that food distribution as a single inter­vention involves various professional groups on the various levels in organisation.

The present research is one of several Action Research projects initiated as a result of a resolution on the highest political level aiming at achieving improvements within the care and service through collaboration between different levels in the organisations.

The overall aim of this specific study is to describe the “top-down” perspective i.e. decision-makers involvement in identifying areas for the development of the food distribution chain.

Data was collected in two steps, firstly by individual interviews with decision makers (politicians n=21, one administrative manager and one medical responsible nurse) and secondly by evaluation dialogue in group (n=23) discussion. The group discussions were based on findings from individual interviews and results from two previous studies focused on interviews with various professionals and food distribution recipients.

The findings were that food distribution was seen as a multifaceted system that included three interrelated issues: the administration of work, the professional’s competence in nutrition and the relationship between various professional groups. To achieve a change, the central component of complexity needs to be clarified. When the issues are multifaceted the solutions need to regard the whole picture rather than its parts.

Findings from international research as well as fromSwedenshow that food distribution as a single inter­vention involves various professional groups on the various levels in organisation.

The present research is one of several Action Research projects initiated as a result of a resolution on the highest political level aiming at achieving improvements within the care and service through collaboration between different levels in the organisations.

The overall aim of this specific study is to describe the “top-down” perspective i.e. decision-makers involvement in identifying areas for the development of the food distribution chain.

Data was collected in two steps, firstly by individual interviews with decision makers and secondly by group discussions. The group discussions were based on findings from individual interviews and results from two previous studies focused on interviews with various professionals and food distribution recipients.

The findings were that food distribution was seen as a multifaceted system that included three interrelated issues: the administration of work, the professional’s competence in nutrition and the relationship between various professional groups. To achieve a change, the central component of complexity needs to be clarified. When the issues are multifaceted the solutions need to regard the whole picture rather than its parts.

Keywords: action research, decision-makers, food distribution in Swedish context, “top-down” perspective

The short paper and presentation would fit in the key theme Health Care Management of the congress.

The present research project is one of Action Research (AR) projects in a region in southern part of Sweden, Scania. All the AR projects originate as result of a decision on the highest political level. The decision was to do changes within the care service where collaboration between different care organisations should be advocated in aim to support and help care consumers. The care should be provided in more care consumer centred ways in which care consumers should be in the centre. These changes should emphasise public and care users’ involvement and participation in decisions around the treatment, service development and evaluation. The participatory service should be performed through a constructive dialogue between care users, health care professionals as a catalyst to common practice change.  The overall aim of the project was to explore FD to older people living alone in their own  homes from different perspectives: elderly as consumers, decision-makers and various professionals.  The specific aims were: 1)to explore various professionals’ experiences in relation to their involvement in food distribution in order to get a comprehensive understanding of the organisation, responsibilities and roles in the specific context (“bottom-up” perspective);

2) to explore older people’s experiences of food distribution and their suggestions what they whish to change (“bottom-up” perspective); 3) to identify, suggest, implement and evaluate chosen actions issues together with various professionals and elderly people (“bottom-up” perspective); 4) the results from the studies 1-3 will be given as feedback to the decision-makers level and it will be start point for reflective reasoning by using Story Dialogue Method in aim to identify conditions for development of food distribution chain (“top-down” perspective).

The short paper and presentation, on how to identify the practical issues involved and what can be done to create a receptive context for change, would fit in the fourth key theme of the congress.

Background: Research focusing on Food Distribution (FD) from various professionals’ and organisational perspectivesare lacking. The aim of this study was therefore to explore various professionals’ experiences of involvement in FD inorder to get comprehensive understanding of the organisation, responsibilities and roles.

Methods: This qualitative study is a part of a larger project with an action research approach focusing on FD in themunicipal home service and care for home-living elderly persons in a municipality in southern Sweden. The data wascollected through participatory observations (n=90 occasions and in total 480 hours), repeated focus group interviews (n =4) with different professionals (n =10) involved in the FD process and one individual interview. The material was analysedby qualitative manifest and latent content analysis.

Results: The study indicates that Food Distribution is a fragmentary intervention where a comprehensive perspective andclear roles of responsibility are lacking. The FD organisation seemed to be strictly divided and limited by constraintsregarding time and money. The fragmented organisation led partly to staff only taking responsibility for their part of thechain and no one having the full picture of and responsibility for the FD process, but also to some professionals takingmore responsibility than they were supposed to.

Conclusions: The aim of the study was met by using an action research approach. The study was however limited by thatno home help officers were represented. The FD appeared as an extremely complex chain of different but connectedactivities. It is not merely the distribution of a product, i.e. the meal box. The fragmentation of FD means that staff onlytakes responsibility for their part of the chain, and that no one has the full picture of or responsibility for the FD process.Consequently, there is a need for an outline of responsibilities. The findings have implications for nursing, gerontology,and in the care for the elderly.

Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden.

Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method.

Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved.

Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.

Introduction: Requirements to implement scientific knowledge in practice within the Swedish health and social care sectors have increased during the last decades. One of these networks was the Network for Eating and Nutrition that began in 2003. The aim of this study was to retrospectively evaluate how the Network for Eating and Nutrition has functioned during a period of ten years and in what way it has affected work practice.

Methods: This is a descriptive qualitative study. Data sources for this study were meeting records collected over 10 years and two evaluation surveys (at five and 10 years).  Participants were members of the Network for Eating and Nutrition (n=12 at five years and n=10 at 10 years). The manifest qualitative content analysis was used.

Results: The Network for Eating and Nutrition was seen as offering support for personal and organisational knowledge development. Further aspects of support from the workplaces of the members and the significance for the work places were described. Further the Network for Eating and Nutrition reached out to care receivers by using specifically tailored education programmes and material. The Network for Eating and Nutrition results and recommendations were described as important references for the development of nutrition routines.

Conclusion: Networks between organisations with different professional backgrounds can form a basis for knowledge exchange both for focus on the specific topic but also on how to work with quality improvement, i.e. evidence based practice.