BackgroundMealtimes are important to quality of life for residents in long-term care (LTC). CHOICE (which stands for Connecting, Honouring dignity, Offering support, supporting Identity, Creating opportunities, and Enjoyment) is a multi-component intervention to improve relationship-centred care (RCC) and overall mealtime experience for residents. The objective of this developmental evaluation was to determine: a) if the dining experience (e.g. physical, social and RCC practices) could be modified with the CHOICE Program, and b) how program components needed to be adapted and/or if new components were required.MethodsA mixed methods study conducted between April–November 2016 included two home areas (64 residents; 25 care staff/home management) within a single LTC home in Ontario. Mealtime Scan (MTS), which measures mealtime experience at the level of the dining room, was used to evaluate the effectiveness of CHOICE implementation at four time points. Change in physical, social, RCC dining environment ratings and overall quality of the mealtime experience over time was determined with linear mixed-effects analyses (i.e., repeated measures). Semi-structured interviews (n = 9) were conducted with home staff to identify what components of the intervention worked well and what improvements could be made.ResultsPhysical and overall mealtime environment ratings showed improvement over time in both areas; one home area also improved social ratings (p < 0.05). Interviews revealed in-depth insights into the program and implementation process: i) Knowing the context and culture to meet staff and resident needs; ii) Getting everyone on board, including management; iii) Keeping communication lines open throughout the process; iv) Sharing responsibility and accountability for mealtime goals and challenges; v) Empowering and supporting staff’s creative mealtime initiatives.ConclusionsThis developmental evaluation demonstrated the potential value of CHOICE. Findings suggest a need to: extend the time to tailor program components; empower home staff in change management; and provide increased coaching.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0964-3) contains supplementary material, which is available to authorized users.

BackgroundCulture change is a movement within the residential care sector (i.e., long-term care, nursing homes, assisted living) that embraces the transition away from biomedical models of care towards social models. Relationshipcentred care (RCC) is a philosophy that promotes social care through its emphasis on the interdependence and reciprocity between residents, staff, and the greater community (Nolan et al., 2004;Tresolini et al., 1994;Villar et al., 2017). RCC is distinct from person-centred care, which has historically focused on the needs and preferences of the individual; however, it falls short in recognizing the interconnectedness between the resident and their complex social and physical environments. Mealtimes are an