Table 5.

Collective action—real and ideal conditions for implementing nutrition guidelines

Real conditions	Ideal conditions	Strategies to promote collective action
Inadequate knowledge of nutritional content of foods among cooks and care staff	Consistent understanding of nutritional content of foods, the principles of menu development, and strategies for adapting recipes	Provide detailed training for cooks
		Provide basic training for care staff
		Access to study dietitian to support changes
Additional workload absorbed by existing resources	Employment of supernumerary staff to manage additional workload	Negotiate with County Council for payment for cooks for time spent on menu development
	Dedicated time for existing cooks to work on menu development
Complex and unreliable procurement systems	Adjust procurement systems to ensure access to required ingredients/foods	Liaise with County Council to revise supply list
	Provide starter pack for homes containing small quantities of new products	Provide cooks with codes of preferred ingredients/foods
Inconsistent systems for monitoring implementation (reflected in variable practice between cooks)	Consistent, agreed-upon approach between cooks	Engage all cooks in training and drafting revised menus/recipes
	Monitoring of implementation	Provide feedback on nutritional content of baseline and modified menus
		See strategies for improving coherence and cognitive participation