Food and fight against the disparities in healthcare sector – ALIMS

WP1 - «Monitoring and identification of meal service practices in care units«
Main objective: To carry out a bibliographic watch and a documentary investigation concerning the meal and its care in units of care.

WP2 - «Study of real practices and representations in units of care«
Main objective: To grasp the reality of the meal and its representations in units of care, to grasp the disparities existing in the units explored.
Several protocols have been developed:
- Interview survey of caregivers, patients, kitchen staff, dieticians
- Protocol impact and effect of the choice of the meal on the food wastage and the representations of the patient
- Protocol on compliance and representations around oral nutritionsupplementation
- Protocol on the food representations of patients b

WP3 - «Measure of the well-being related to the food sphere in units of care«
Main objectives: To adapt a tool for measuring food well-being to the care unit, to measure nutritional well-being in relation to the nutritional status of patients, to compare two care units.

WP4 - «Development and exploitation of new management devices«
Main objectives: Develop new educational content for health professionals and enhance the results of the project.

WP1 - «Monitoring and identification of meal service practices in care units«
Result: a national inventory of the actions implemented in the various French hospitals in order to enhance the social, sensitive and symbolic dimensions of the meal was realized. This open access survey on our website provides an overview of the situation in France.

WP2 - «Study of real practices and representations in units of care«
Conversations: meals between caring and caring, between the institutional urgency of caregivers and the symbolic time of patients
Protocol choice: the choice of the meal reduces the food waste of 20% and promotes a more positive image of the meal
Oral nutrition supplementation protocol: 50% of the supplements are not consumed, the malnourished women are those who consume the least. Differences in representation of the oral nutrition supplementationbetween the interns (in charge of the prescription of the oral nutrition supplementation), the caregivers (in charge of the oral nutrition supplementation) and the patients.

WP3 - «Measure of well-being related to the food sphere in units of care«
A measurement tool was developed in order to objectify a notion a priori subjective (food well-being) by making it based on tangible parameters (presentation of meals, variety of menus, friendliness, environment, commensality, pleasure ...) allowing establish a score of the nutritional well-being of the patients that we will then link to the nutritional status of the patient.

Work on oral nutrition supplementation continues to be developed.

As part of our WP4, we want to enhance our work with professionals and the general public.

We have developed a better understanding and fight against undernutrition campaign on our website.
This campaign aims to raise the awareness of healthcare professionals, patients and caregivers about the issue of undernutrition, which currently affects more than 2 million people in France.
She is made of :
- 4 posters for the general public,
- 4 posters for caregivers to promote their essential role in the care of patients,
- 1 awareness booklet.

We have also released on our website a monitoring of tools for the assessment and management of undernutrition.

We have developed training modules that we want to expand today. On the basis of the results of the ALIMS research project, the team's researchers worked on the development of 4 training modules to think about food as a whole and put the patient-eater at the heart of their meal.
These 4 modules of 3 hours can be taken separately or collectively, the training with your teams can thus last 1/2 day to 2 full days.
These multidisciplinary training courses are aimed at carers and kitchen staff in hospitals, clinics and nursing homes.

Hugol-Gential, C. (2016) (Ed). Se nourrir ou manger ? Les enjeux du repas en établissement de santé. Préfacé par Stéphane LeFoll, Ministre de l’Agriculture de l’Agroalimentaire et de la Forêt. Postfacé par le Professeur Eric Fontaine, Président de la SFNEP. l’Harmattan, collection questions alimentaires et gastronomiques.
Hugol-Gential, C. (2018) (Ed.). Le bien et le bon à manger : penser notre alimentation du quotidien à l'institution. Editions Universitaires de Dijon, collection Arts, Archéologie et Patrimoine
Noacco, A. Betting, S. Dorléan, C. Hugol-Gential, C. (2018). Les ateliers de cuisine : un outil d’éducation thérapeutique collaboratif innovant ? Nutrition Clinique et métabolisme.
Simon, S. Noacco, A. Hugol-Gential, C. (2018). De la représentation alimentaire de patientes atteintes d’un cancer à la modification de leur alimentation. Nutrition Clinique et métabolisme.
Noacco, A. Brindisi M-C. Aït Boudaoud Hansai, A. Hugol-Gential, C. (2018). Qualité de l’évaluation de l’état nutritionnel et évaluation de l’observance des compléments nutritionnels oraux chez des patients hospitalisés au CHU de Dijon. Nutrition Clinique et métabolisme
Hugol-Gential C. (2019, accepté). Les ateliers de cuisine, un outil thérapeutique pour le soin et le plaisir des patients. Recherches en communication
Hugol-Gential, C. (2016). Le repas à l’hôpital : un défi pour demain. In Stengel, K. et Boutaud, J-J. (Eds). Cuisine du futur et alimentation de demain. Paris : L’Harmattan, collection questions alimentaires et gastronomie : 97-112.
Hugol-Gential, C. (2017). Les traces alimentaires du patient hospitalisé. In Galinon-Mélenec, B. (Ed.). L'Homme-trace : Des traces du corps au corps trace. Paris : CNRS Editions : 333-349.
Hugol-Gential, C. (2015). Le repas à l’hôpital et ses enjeux identitaires. Lexia, journal of semiotics, 19-20 : 169-182.
Hugol-Gential, C. Noacco, A. (2017). Place du repas et du choix dans la prise en charge alimentaire des patients. Techniques hospitalières, 763.

The CLAN (French acronym standing for committee handling the link between diet and nutrition) were created more than 15 years ago. However, the creation of a CLAN in a healthcare institution is not an obligation but a recommendation which actually leads to a difference in the resources granted and in the awareness campaign of the teams about the importance of the meals. The fight against under nutrition sometimes implies the approach of the meal as a simple ingestion of nutriments. The medicalization of the meal therefore erases the social (Hartwell & al, 2013), sensitive and symbolic (Boutaud, 2005) dimensions of eating, although they are essential. However, during a hospital stay, the meal is part of the treatment and constitutes a treatment itself. Again, not only in terms of nutrition, but also in terms of moral, affective and psychological recovery.
The meal at hospital, according to the treated pathologies and the care units, is thus on the junction of the cure (preventive, curative) and to take care. So the meal is central in the hospital institution and plays a fundamental role in the nursing of patients. Nevertheless, we notice that its status varies a lot according to the care units and that it is even sometimes totally trivialized. This disparity can be attached to the stay types, to the treated pathologies but also to the raising awareness of the teams to the importance of the meal as nursing of the patient, his pathology and its support during his stay.
The hospitalization is a break in the life of the person which becomes patient in an institution in which the routines, the socialities and the rites are not any more the same. The meal loses its identity and commensal dimensions in favour of the medical and nutritional dimensions. Even if most studies about public health agree on the fact that it is important to give priority to the social link and to the conviviality at the table during the meal, none of them give an empiric or systematic report on the subject. It is then a question of understanding the sociological, sensitive and symbolic dimensions of the food consumption; not only by suggesting a project that combines different methodologies (documentary observation, analysis of practices, analysis of representations, measure of the well-being connected to the food sphere and adapted to hospital), but also by working with several experts from different disciplines in the field of nutrition and/or health (doctors, nutritionist, philosopher, semiologist, researchers in the field of information and communication sciences, researchers in the field of food behaviour, economist). It consists in giving a complete insight on the approach of the meal in healthcare institutions (hospitals, clinics), on its meaning and its representation, by considering nutrition as a “total social fact” (Mauss, 1925 – Corbeau, 2012).
The whole project questions the proposed services’ quality and the possible changes of managerial organization, in order to improve the current life conditions of the patients. It invites us to “redefine” the meal beyond the physiological act. This project is also in line with the PNNS (Plan National Nutrition et Santé) and in the new public health policy (October 2014). A better understanding of the impact of social and environmental factor such as the service quality and interaction on the food taking will allow to develop new multidisciplinary interventional approaches to improve at the same time the well-being sensed of patients towards their food and their nutritional status. From then on, new concepts of catering and nursing for the patients will be imagined.