Survey results

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Results of the Living Rainbow Survey – Spring 2012


Executive Summary

ES.1 Aim of the Survey

This survey was developed by the Living Rainbow Foundation to identify the current provision and effectiveness of healthy eating programmes for people in supported living.  By including service users, their family members, support workers, and representatives of the organisations that serve them, we managed to get a 360 degree view of the current situation.  We also gathered data about how these services could be improved.

ES.2 About the Respondents

We are grateful to 226 participants for their help.  This included 43 people who live in supported living and 17 family members.  We also had information from 51 support workers and 115 other people working for organisations in the supported living sector.

ES.3 Responses from Support Workers

80% of the support workers said that they are aware of the 5-a-day campaign, but 60% of them only eat 1 to 3 portions of fruit and vegetables a day. It also appears that the longer a person has been a support worker, the less likely they are to be aware of the campaign.  30% of those who have been working 5 – 10 years, and 20% of those who have been working longer than 10 years, claimed that they were not aware of the campaign.

There does not appear to be any correlation between awareness of the “5-a-day” campaign and the importance that people give to healthy eating.  However, there does seem to be a correlation between the importance they give to a Healthy Diet and their choices. The general trend is that the more important a person considers a healthy diet to be, the more fruit and vegetables they eat.

We wanted to discover whether there was any relationship between a support worker’s own interest in cooking and their commitment to helping their clients to eat healthily.  The headline results indicate that 93% enjoy cooking – whether this is occasionally or more often.  In addition, most support workers felt that they had a reasonable capability with regard to cooking.

Many support workers take time to interact with their clients when it comes to choosing food, most often by finding out what their clients like eating, and pointing out healthy options when they go shopping.  In addition, most support workers report that their clients shop, cook and eat individually. Just under a quarter of houses have clients shopping, cooking and eating as a group.

Just over one-third of support worker respondents said that they had been given training in Healthy Eating when they became a Support Worker.  However, more than half of these felt that the training was either only slightly effective, or not effective at all. The majority of support workers have never had any training in Healthy Eating during their career.  However, 88% had been given training in food Health and Hygiene.  Around one in eight of support workers have had no training in relation to food at all as part of their job.

The majority (79%) of support workers who answered the relevant question, had at least one house where they “work actively to support a healthy eating programme”. On average, the effectiveness of these programmes was scored at 7 out of 10.  However, since many support workers did not even know about the government’s 5-a-day programme, this self-assessment should be considered with considerable caution.

The support workers in the survey are responsible for 406 clients between them. Of those, 41.3% eat at least 5 portions of fruit and vegetables.

The key Time and Resource barriers that prevent support of healthy eating can be categorised as:

  1. Time Constraints
  2. Lack of funding
  3. Culture and/or client needs

The Most Valuable Resource or ‘structure’ reasons for successful programmes include:

  1. The Support Worker’s Time and knowledge:
  2. Budgeting:
  3. Organisational Policy:
  4. Help from Colleagues:
  5. Working one-to-one with clients:
  6. Clients’ own interest in cooking
  7. Explaining the benefits to clients
  8. Culture
  9. Helping Strategies
  10. Providing a breakfast club
  11. Environmental (local) factors

We asked the respondents whether they have any support system to use which inspires them and encourage healthier options for their clients.  Only 29% of respondents felt that they did have a support system of this type. We also asked the support workers whether their management supports them with any practical or written material to help them deliver healthy options and ideas to their clients.  Most respondents (63%) said they did have access to practical or written materials to help them in this task.

There are a number of reasons given regarding barriers to clients making healthy food choices, such as:

  1. Client preferences and abilities and opinions
  2. Lack of Staff Imagination/Creativity , etc.
  3. The Cost of Healthier Food
  4. Conflicting ideals
  5. Difficulty of Cooking

We asked the participants where they get their recipes from.  Cookery books were the most popular source (21) with computers coming a close second (18).  In fact, of the 21 people who use recipe books, 15 of them also use computers.

ES.4 Responses from Family Members

The survey was completed by 17 family members of clients. Most of these were parents and most of their relatives (93%) live in supported housing.

We asked the respondents whether their relatives had been diagnosed with any weight problems (e.g. over or under weight).  85% reported that there was a diagnosis, or that they were concerned about their relative’s weight.  Most of those diagnosed were overweight.

All those who responded to the question stated that they were aware of the Government’s “5-a-day” campaign. 85% of the respondents felt that their family member does not reliably “eat a varied and fresh diet which includes plenty of fruits and vegetables”. In addition, 75% described themselves as being unhappy with the support their relative gets to help them choose a healthy diet.  A large majority of the respondents (92%) are concerned, very concerned or extremely concerned about their relative’s diet. Those people who were ‘not so happy’ or ‘very unhappy’ about the support being given to their relatives had often attempted to address the issue, but generally with limited success.

ES.4 Responses from Organisations

Most (58%) of the respondents completing the survey on behalf of their organisations described themselves as ‘management’.   The remainder were generally nurses, health workers and other practising professionals. There was an almost even split between respondents who work for national companies and those who work for regional organisations.

The organisation’s approach to Healthy Eating can be categorised as ‘very committed/very good’, ‘medium/improving’ and ‘passive/bare minimum’.  The great majority of responses given appear to fall in the first two categories.  This contrasts clearly with the experience of some family members (described above).

Most (54%) of the respondents said that their organisation gave either a half-day or one-day practical training in health eating and food preparation for their new recruits. While a significant minority gave more than this more than one-third of organisations give no practical training in this area to new recruits.

While one in five people did not know whether or not there organisation gives ongoing training in food preparation to their support workers, the majority of those who did know, said that their organisation does provide this training. Most of this training relates to Basic Food Hygiene, although there were a handful of organisations offering training that was clearly much greater than the basic or legal minimum.

Training is delivered through a number of formats, including:

  1. Face-to-face training:
  2. Distance / e-learning:
  3. Informal approach (including cascade):
  4. “Mature” approach (with partnerships):
  5. No Training provided:

It is clear from the open-ended responses that most organisations deliver their training in house. However, a substantial minority (46%) do use external providers.

The majority of respondents (79%) felt that their organisations do provide support materials covering healthy eating. However, it is worth noting that just over one-third of respondents said that they did not know what percentage of people were using the support materials provided.  This indicates that a significant minority (one-in-three) of organisations do not currently track the impact or Return on Investment of the provision of this type of resource.

We asked the respondents what they see as the main challenges in delivering healthy eating programmes. 36 people replied and the key themes can be considered as:

  1. Cost and Time
  1. Service user preferences
  2. Staff attitude and skills
  3. Lack of Training and accesible resources
  4. Special factors

One in five organisations does not give training in food preparation. When asked a question about training for healthy eating, 47% felt that their organisation could benefit from more training; while another 31% were not sure. The key reasons given for wanting additional training around healthy eating include:

  1. Reinforcing or supplementing other training
  2. Ensuring support workers can support residents with different needs
  3. A Commitment to Ongoing Learning
  4. Attempt to create culture change
  5. Improving the understanding of Healthy Eating

In addition to traditional training programmes (including e-learning and distance learning), we were interested to discover how many organisations felt that they could benefit from using healthy eating coaches for their clients and support workers. 50% felt this would help, and a further 27% were not sure.

ES.4 Responses from Service Users

The survey was completed by 43 service users (61% had help to fill it in). The survey was almost equally split between those who live alone, and those who said they live with friends.  Most of the respondents (61%) were female.The average (mean) age of respondents was 46 years and 7 months.  Almost one-third of respondents were aged 41 – 50.  There were no respondents less than 21 years old, nor any in their 60s or 80s.

We asked the respondents what they do during the day. At least half of the respondents living in care homes do not go to Day Care, college, work or work experience.

Almost all those respondents who answered the question about whether they get help going shopping said that they did (97%).  However, more than a quarter of respondents did not answer this question.  Combining this with data from the support workers indicates that it is likely that most people living in supported accommodation have help with their shopping.

Almost three-quarters of respondents buy fruit and vegetables every time they go shopping.  However, the data indicates that at least 6 out of 10 people living in supported accommodation do not eat 5 portions of fruit and vegetables per day.  82% of the respondents eat no fruit or just 1 or 2 portions per day.  Similarly, 70% eat 2 or fewer portions of vegetables a day.

More than 60% of respondents buy ready meals.Two-thirds of the people who say they buy ready meals have 1 or 2 per week, but more than a third buy at least three ready meals a week with 10% eating more than four.

Of the 20 people who buy ready meals:

  • 75% heat them up in a microwave
  • 25% heat them up in an oven

While a quarter of respondents never eat out in a pub, café or restaurant; 54% do so at least once or twice a week.  One in five respondents eat out at least twice a week and up to four times a week.

While only 36% of respondents eat at least 5 portions of fruit and vegetables a day, 97% of those who answered the question said that they knew that this campaign referred to fruit and vegetables (not cigarettes, walking, or eating 5 meals a day).

When asked whether they enjoy cooking, 79% of the respondents said that they enjoy cooking, whether this is ‘a lot’, ‘sometimes’ or ‘with others’. More than six out of ten of the respondents would like to know more about cooking.  63% of respondents said that they would like support to learn more about eating healthily.

When asked what kind of support they would like, 26 respondents selected 43 responses (as they could choose more than one answer for this question.  This revealed that the most popular options were to learn in their own home either with their friends or with someone who visits the house to help the client learn about healthy eating.

Almost three-quarters of respondents answered the question about a local café with healthy eating options. Of these, over 90% said they would like to use it.  Four respondents wanted to work in a café, although none of those people currently work. A further two people said that they would like to serve food to people in the café. Only 4 people said that they were not interested in this idea.  This contrasts strongly with the importance that the family members, support workers and organisations gave to such a café (e.g. the service users appear to rate it more highly).

We asked the respondents how much they spend on food each week. The average spend is in the order of £40 per week.  95% said they own and use a computer.  One of these people also has and uses smartphone.  None of the respondents owned or used an iPad or Kindle.

ES.5 Recommendations by Respondents

Finally, we asked all respondents to tell us which of nine options they felt were most important, 84 people replied:

  • None of the respondents to this question were service users.
  • 11 have a relative in supported living.
  • 31 were support workers.
  • 42 work for organisations that provide supported living.

The results for all 84 respondents for this section indicate that the in-house practical support programme for both clients and support workers is by far the most popular option.  Further analysis by the type of respondent shows that this idea is considered the most important by all the different types of respondents.  The next most popular ideas were simple steps such as written healthy eating guidelines and accredited healthy eating programmes and cookery classes for service users.

ES.6 Conclusions

This study clearly demonstrates that while some supported living organisations are heavily committed to healthy eating programmes for their residents, many others only provide basic food hygiene training to their staff.  While time and cost are a barrier to support workers and organisations providing more support to their clients, there is a clear appetite to do so.

The majority of family members have concerns about their relatives’ weight. Support workers would generally like to offer more help to their clients to eat healthily, and are working to overcome a series of challenges to this aim. A key challenge is the attitude of clients to healthy food.  This is also reflected in the fact that most clients buy fruit and vegetables, but very few eat 5 portions a day.

It is clear that there is significant demand, therefore, for an in-house practical support programme for both clients and support workers to encourage healthy eating.  This is therefore the first priority for the Living Rainbow Foundation. However, we note the popularity of the café with service users and will research this further in the future.

Report by Dr Emma Langman Spring 2012