Meeting food hygiene challenges in older people : mobilising health assets for health promotion

Background: Listeriosis is a serious foodborne infection with significant rates of morbidity and mortality in the older population. The majority of food safety research has focused on food behaviour, practices and perceptions of 'risk'; isolating actions from their social and health context and historical significance. The alternative, positive and novel approach presented in this dissertation is to identify the accumulated resources, or health 'assets', that older people draw upon in daily life at home to protect themselves against foodborne illness informing future health promotion interventions. This research will also further the theoretical development of the 'asset model' and its contribution to health promotion theory and practice. Methods: There were three chronological phases to the study. Phase I: Sought to gather contextual information about the older people recruited in Phase II through the collection of socio-demographic, health and summary current food hygiene asset related data collected through a researcher completed questionnaire at i) five AgeUK lunch clubs ii) one County Council-run lunch club and iii) via a 'University of the Third Age' webpage advert across Buckinghamshire and Hertfordshire. Fifty respondents were recruited via self-selection (20 men, 30 women, mean age of 78.98 years (SD 8.82) mean Visual Analogue Scale of subjective health, 6.89 cm/10cm). Quantitative data were analyzed using SPSS. Phase II: Fifteen semi-structured interviews with older people selected via purposive sampling from the questionnaire cohort to seek their accounts of how food is acquired, stored and cooked and the historical events and influences that shaped these practices (7 men and 8 women, mean age 77.87 (SD 8.06) years, mean Visual Analogue Scale of subjective health, 6.62cm/10cm). Phase III: Three semi-structured interviews with sheltered housing staff in Buckinghamshire recruited via snow-ball sampling. Qualitative data were analyzed using a Grounded Theory approach with NVivo software. Results and Discussion: All of the data indicated that older people have a multiplicity of external food hygiene assets through which to acquire 'safe' and 'fresh' food. Differences in the frequency and type of external asset utilisation were identified between men and women and those reporting severe restrictions in activities of daily living recorded by the EQ5D Quality of Life tool from the questionnaire employed in Phase I. The qualitative data from Phases II and III indicated that food hygiene assets were contextdependent, many being accumulated through the life course and fulfilling non-food related purposes. A number of historically formed internal assets were also identified which served to either facilitate or hinder access to the external food hygiene assets. Members of the social network, specifically the family, were identified as being the principal food hygiene asset throughout the life course from all data sources, fulfilling the newly conceptualised role of 'foodcarers' in the lives of (older) people in a context-dependent manner. Conclusions: The cause of foodborne infections in the older population may be influenced by complex historical factors beyond specific food hygiene knowledge and practice. Current competing or allied concerns in daily life may also serve to motivate or demotivate the employment of 'safe' food hygiene practice. Strategies aimed to reduce the incidence of foodborne illness in the older population could be addressed by placing health promotion within the home setting through the mobilisation of the social network. The contextdependent nature of asset mobilisation has called in to question the validity of some sections of the asset model for use in negotiated small-scale health promotion initiatives and whether the model can serve as a coherent whole.