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CAFE - Changes Around Food Experience
CAFE is a research project funded by the Economic and Social Research Council (ESRC) and run by the University of East Anglia, the University of Surrey and Age Concern Norfolk to help uas understand the impact of reduced contact with food on the social engagement and well-being of older women.
Background
We use food to express ourselves socially and culturally. Reduced involvement in purchasing, preparation and cooking of food could affect women's sense of well-being, identity, self-esteem and engagement with family and friends. The implications of reduced involvement with food had not previously been fully explored in relation to their social, service development or policy consequences.
The CAFE study explored how older women responded to reduced contact with food.
Aims and Purpose
- To discover the impact on older women of reduced contact with food in terms of meanings of food, social engagement and well-being
- To understand how this impact alters over time
- To explore the potential for intervening to restore greater contact with food in these women
- To contribute to service and policy development
Participants
Forty women took part in CAFE in Norfolk in 2007/8. Twenty women had individual interviews, with follow-up interviews 5 months later. A further twenty women took part in group interviews. To participate women had to be aged 65+ and have recently started to cook fewer than 3 main meals a week from sratch.
Of the 40 participants (a purposive sample, average age 82, many contacted through our consumer advisors), half lived in sheltered accommodation and half live independently. All had been responsible for shopping and cooking for a partner and/or family in the past. About half regularaly used ready meals, half attended a lunch club or day centre, and 5 used mobile meals. Almost half relied on others for their main shop.
Interviews and Analysis
Interviews were audio-taped and typed in full, using a chosen pseudonym. The semi-structured individual interview questions were adjusted by the advisory team after the two interviews. The second interview (about 5 months after the first) was based around a summary of the first interview, to value participants' input, empower them in telling their own stories, remind them of topics discussed previously and allow them better to note and discuss changes between the interviews. The seven focus group interviews, each of 2 to 4 participants, used similar topic guides and assessed how participants discussed food and food-related work.
In working to understand underlying meanings we kept in mind previously published theories, but also looked for distinct new meanings. Differing points of view were noted and have been presented. Ethical principles were adhered to throughout.
What Did We Learn from CAFE
Impact of Reduced Contact with Food on Social Engagement and Well-being
Women were making active choices around shopping, cooking and eating that helped to maintain and enhance their socialising and enjoyment of life. Many had actively chosen to cook from scratch less frequently, and appeared well supported using a combination of services including meals shared with friends and family (often reciprocal), ready meals, meals eaten out in cafes, pubs, lunch clubs and day centres, and mobile meals, plus occasional cooking from scratch. The choice to cook less often allowed women to spend more time and energy on social and preferred activities, so appeared lief-enhancing. However, women who had been prevented from cooking by deterioration in their health often found not cooking and less satisfactory.
For many women food shopping was more important in maintaining quality of life and independence than cooking. All the women in CAFE shopped if they were able to - even if they didn't enjoy it. Shopping got them out, allowed them to meet friends and family, and enabled them to stay organised and in charge. Loss of the capacity to do their own food shopping appeared to impact on the quality of food eaten, making it more monotonous.
Meanings
Three main themes on the meanings of food, shopping, food preparation and eating emerged: social food (social roles constructed around food); being organised and in charge (maintaining control over ones own life and health); and hedonism (the emotional and pleasurable aspects of food).
- CAFE participants missed the role of cooking the "proper meal" and its place at the centre of family life, and often found simpler ways to provide food for friends and relatives. Looking after others, in providing food and/or drink, remained central to socialising, and women who found it harder to simplify their provision for others sometimes found that their social lives were diminished as a result. Cooking for "just myself" daily was often not seen to be worth the time and energy.
- More surprising was the importance of demonstrating being organised and in charge through food related work. This appeared to be an important way for older women to express their engagement, skills, problem solving and competence in the world.
- Eating was enjoyed by most women, even when the task of cooking, shopping and preparing were not. Food provided comfort, new experiences, wicked pleasures, a boost to the spirits, tactiles enjoyment, memories of past food and reflected emotional state.
Change in Impact Over Time
Nearly all the CAFE women experienced continuing changes in their lives, which they actively managed in creative ways.
The Potential for Intervening to Restore Greater Contact with Food in these Women
Women need better information on services to support them in doing their own shopping, greater transport choices and more food marketed in individual portions.
Dissemination
The CAFE researchers and advisory group, including our partners and consumer representatives*, have been involved in;
- Local newspaper articles and radio interviews
- Results leaflets sent to all participants, Norfolk lunch clubs, sheltered housing and day centres and 250 delegates at a Norfolk POPPs (Partnership for Older People Projects) meeting
- Age Concern Norfolk mailing to 530 interested Norfolk organisations
- Websites
- Two conferences (British Society for Gerontology 2007, "Transforming Care" in Copenhagen June 2008)
- Writing academic papwers (one submitted to Social Science and Medicine, several more in preparation).
Impact on Policy and Practice
We are feeding CAFE's results to Norfolk Councy Councils "More Choices, Better Choices" consultation on service provision for older people, into Norfolk-wide planning via Hilary MacDonald, Chief Executive of Age Concern Norfolk and advisory team member, and hope our presentation at "Transforming Care" (Copenhagen, June 2008) will widen CAFEs impact beyond Norfolk. We have begun to use CAFE data in teaching medical undergraduates at the University of East Anglia.
To Find out more about CAFE, please visit the CAFE website or contact Lee Hooper (l.hooper@uea.ac.uk phone 01603 591268
* Our three consumer representatives are members of PPIRes, Patient and Public Involvement in Research www.norfolkhealthresearch.nhs.uk/nhr/47.html