Table 4.

Cognitive participation—real and ideal conditions for investing in nutrition guidelines

Real conditions	Ideal conditions	Strategies to promote cognitive participation
Varied views on existing menus	Scope for improving existing menus widely recognized	Provide feedback on nutritional content of baseline menus
		Highlight role of modified menus in managing diabetes
Perceived threats to autonomy and expertise	Control over pace, extent, and nature of changes to menus/recipes	Delegate responsibility for drafting revised menus/recipes to cooks
		Provide training for all staff
Lack of leadership for implementation	Key individuals take a lead role in creating and sustaining momentum for change	Extend principle of ownership by involving care staff in the process of menu development
	Active support of senior managers with practical issues and in managing any negative feedback on changes