The five aspect meal model as a conceptual framework for children with a gastrostomy tube in paediatric care

Abstract

Background Cancer treatments may induce side effects and cause eating problems. A gastrostomy tube may be required in order to maintain and optimise the child's nutritional needs. Despite the use of a gastrostomy tube, it is important to maintain a natural and attractive mealtime for the child. The Five Aspect Meal Model is age neutral and originally designed to improve restaurant visits. Its five aspects conceptualise what is necessary to ensure a complete meal experience. To date, there is lack of knowledge to guided model development about mealtimes adapted to children and limited knowledge regarding mealtime experiences for children with a gastrostomy tube. Aim The aim was to investigate whether the Five Aspect Meal Model could be appropriate to be used for children with a gastrostomy tube in caring science and paediatric care. Methods The design followed steps retrieved from Renjith and colleagues. Seven interviews were performed with the Five Aspect Meal Model as a base in the interview guide. The transcripts were analysed by using a qualitative directed content analysis with a deductive approach, which finally passed into a more inductive one. Findings All aspects of the Five Aspect Meal Model were represented in the interviews. There were also experiences related to the gastrostomy tube and the mealtimes that did not fit into any of the five predetermined categories. As a result, the modified version was developed, an adapted prescribing practice model that includes seven aspects, whereof bodily discomfort and time for change and acceptance are specific to children with a gastrostomy tube. Conclusion Based on children and their parent's experiences, the Five Aspect Meal Model has been developed and adapted into a modified version, which includes seven aspects. The modified version seems to be appropriate to use within caring science and paediatric care.

Experiences before and after nasogastric and gastrostomy tube insertion with emphasis on mealtimes: a case study of an adolescent with cerebral palsy

“…The empirically grounded modified version of the Five Aspect Meal Model (M-FAMM) (Mårtensson et al, 2021 ) was developed from the Five Aspect Meal Model (FAMM) (Gustafsson, 2004 ; Gustafsson et al, 2006 ; J S A Edwards & Gustafsson, 2008 ). The FAMM, which incoroprates—the room, the meeting, the product, the management control system and the atmosphere, focused on improving mealtimes and the mealtime experience at restaurants (Gustafsson, 2004 ; Gustafsson et al, 2006 ; J S A Edwards & Gustafsson, 2008 ).…”

“…The FAMM, which incoroprates—the room, the meeting, the product, the management control system and the atmosphere, focused on improving mealtimes and the mealtime experience at restaurants (Gustafsson, 2004 ; Gustafsson et al, 2006 ; J S A Edwards & Gustafsson, 2008 ). The FAMM (Gustafsson, 2004 ; Gustafsson et al, 2006 ; J S A Edwards & Gustafsson, 2008 ), has been tested and validated in children with cancer, i.e., a short-term use of a G-tube in a hospital environment, with the conclusion that an adaption of the model was needed (Mårtensson et al, 2021 ). Consequently, the M-FAMM, developed and adapted specifically for children with a G-tube, includes two further aspects, bodily discomfort and time of change and acceptance (Mårtensson et al, 2021 ), see Table I .…”

“…The FAMM (Gustafsson, 2004 ; Gustafsson et al, 2006 ; J S A Edwards & Gustafsson, 2008 ), has been tested and validated in children with cancer, i.e., a short-term use of a G-tube in a hospital environment, with the conclusion that an adaption of the model was needed (Mårtensson et al, 2021 ). Consequently, the M-FAMM, developed and adapted specifically for children with a G-tube, includes two further aspects, bodily discomfort and time of change and acceptance (Mårtensson et al, 2021 ), see Table I . The M-FAMM (Mårtensson et al, 2021 ) has been evaluated using criteria developed by Risjord (Risjord, 2019 ) and seems to be an appropriate meal model to use in children with a G-tube.…”

“…Consequently, the M-FAMM, developed and adapted specifically for children with a G-tube, includes two further aspects, bodily discomfort and time of change and acceptance (Mårtensson et al, 2021 ), see Table I . The M-FAMM (Mårtensson et al, 2021 ) has been evaluated using criteria developed by Risjord (Risjord, 2019 ) and seems to be an appropriate meal model to use in children with a G-tube. Thus, the M-FAMM (Mårtensson et al, 2021 ) constitutes the theoretical framework employed in this study in order to further test and validate the model in a new context, i.e., in an adolescent with CP in a home environment with a long-term need for a G-tube.…”

“…By interviewing an adolescent with CP and her parents, this important area can be highlighted and better understood. In addition, the M-FAMM (Mårtensson et al, 2021 ) can be examined further in order to clarify if this meal model can also be used in the context of children with disabilities in paediatric care. Consequently, the purpose of the present study was to describe and better understand how one adolescent with CP and her parents experienced mealtimes before and after an NG- or G-tube insertion and how the use of these feeding tubes is experienced in daily life.…”