CHOICE+ Quality Improvement for Long Term Care Homes (CHOICE+)

August 3, 2026 updated by: Heather Keller, University of Waterloo

A Time Series Design to Evaluate the Implementation and Effectiveness of the Virtual CHOICE+ Mealtime Experience Training Program for Long Term Care Homes

CHOICE+ is an eLearning program that empowers staff to improve the mealtime experience of long-term care (LTC) residents. This program is based on principles that align with relationship-centered care and promote resident quality of life and food intake. In a prior study, the investigators have showed that this program can improve the mealtime experience; eLearning has been created to promote spreading of this training. The investigators have created an implementation model that supports uptake of this eLearning. Designated home staff Champions will complete the eLearning, be provided four virtual training sessions to reinforce key concepts and be mentored in monthly virtual community of practice sessions around making improvements. Champions will work with a small team of staff, residents, and family to identify and make improvements (e.g., less rushed mealtime). This study will evaluate this model of implementation in 13-18 LTC homes. Homes in the region of research centres are invited to apply, and where required, will be randomly selected. Investigators will also determine if the mealtime experience, resident health (body weight and food intake), resident/family food and care satisfaction, and staff job satisfaction improve. This implementation study is designed to sustain improvements that the Champions and their team make and build capacity to improve the quality of care in their home. The research team will track implementation activities and influences on implementation through champion diaries, monthly meetings, and end of study interviews. Researchers will measure the mealtime experience with a standardized observational tool and aggregate food waste (to assess food intake). Resident body weight to determine nutritional status will be collected monthly. Questionnaires will be used with staff, residents, and family members for other outcomes. Outcomes will be measured six months before, during, and six months after the one year of implementation. Findings and learnings about implementation will support the scaling of CHOICE+ to other LTC homes.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

All long-term care (LTC) residents participate in mealtimes daily, offering an ideal opportunity to enhance quality of life through relationship-centred mealtime practices. Unfortunately, task-focused mealtime practices are the norm in LTC with efficiency being prioritized over the social and emotional needs of residents. Compared with relationship-centred mealtimes, residents in a task-focused dining environment have reduced food intake and poorer nutritional status. Building on 20 years of research, the CHOICE+ staff training program supports relationship-centred care using the principles of Connecting, Honouring Dignity, Offering Support, Identity, Creating Opportunities and Enjoyment. CHOICE+ principles and eight steps of implementation have undergone developmental and efficacy evaluation using an external facilitator model. To promote scale and spread, an implementation model consisting of an asynchronous eLearning module, synchronous virtual training sessions, and a virtual monthly community of practice has been created. Staff Champions are trained on behaviour change and implementation techniques to make locally initiated changes that are aligned with the CHOICE+ principles, tailored to their dining room. Staff Champions work with their Dining Team to make these changes. This study's goals are to evaluate this implementation model in 13- 18 diverse homes across Canada and demonstrate that this training improves mealtime experience, resident health, and quality of life for residents, family and staff. A type 2 hybrid implementation study (co-primary purposes of evaluating implementation processes and effectiveness) based on a multi-site three-phase interrupted time series design will be used. Specific research aims are to: a) evaluate this CHOICE+ implementation model according to the Consolidated Framework for Implementation Research (CFIR), b) identify what program adaptations are required for future scaling, and c) determine if the mealtime experience, resident health outcomes, resident/family food and care satisfaction, and staff work life are impacted by CHOICE+. Champion training is evaluated via questionnaires and on-line polling. Implementation processes will be assessed with monthly recorded virtual community of practice sessions, weekly staff Champion diaries, and end-of study interviews with staff, residents and family. Framework Analysis using CFIR as an analytical framework for deductive coding will be completed to evaluate the implementation model. Standardized meal observations, aggregate food waste (to assess food intake), and monthly body weight of residents will be collected six months prior to implementation, during one year of implementation, and six months post-implementation (5 meals observed at each of 13 observation periods in each home). Standardized questionnaires pre- and post-implementation will assess resident/family food and care satisfaction and staff work-life perceptions, and findings will be mapped to the home implementation process. The research team includes clinician researchers with experience in intervention development, implementation, and evaluation in LTC. The findings and knowledge generated will support the scaling and spread of the CHOICE+ program.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
800

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Manitoba
      • Winnipeg, Manitoba, Canada, R3T2N2
        • University of Manitoba
    • Nova Scotia
      • Antigonish Nova Scotia, Nova Scotia, Canada, B2G 2W5
        • St Francis Xavier University
    • Ontario
      • Waterloo, Ontario, Canada, N2L 3G1
        • University of Waterloo
    • Saskatchewan
      • Saskatoon, Saskatchewan, Canada, S7N 5A2
        • University of Saskatchewan

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

long term care home residents and staff

Description

Inclusion Criteria:

  • residents will eat in the intervention dining room on a routine basis
  • team members will work in the intervention dining room
  • champions will be home leaders who can support the implementation effort

Exclusion Criteria:

  • residents not in the intervention dining room
  • team members who rarely work in the intervention dining room

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
13- 18 long term care homes
Homes will be provided a quality improvement program called CHOICE+. Home staff will be trained on the principles of CHOICE+ and an 8 step process to implement mealtime improvements in their home.
Other: CHOICE+ virtual training program
The CHOICE+ virtual training program consists of three components a) an elearning course for home champions, b) virtual training of key concepts for home champions, and c) a monthly virtual community of practice to support implementation and mentor home champions.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Mealtime Scan+
Time Frame: 21 months
a standardized validated observational tool that measures the physical, social and relationship-centred practices; score 0-32, higher scores indicate a better mealtime environment
21 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Food /fluid intake
Time Frame: 21 months
food and fluid waste will be measured in kilograms/grams; lower scores indicate less waste and thus better food and fluid intake
21 months
body weight
Time Frame: 21 months
weight collected on residents who attend the intervention dining room, measured in kilograms; a stable or increasing body weight would indicate a positive outcome
21 months

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Team member Mealtime Experience Questionnaire
Time Frame: week 0 and week 52
measures relationship centred practices; scale 0- 115, a higher score indicates better team functioning at mealtimes
week 0 and week 52
Mealtime Satisfaction Questionnaire
Time Frame: week 0 and week 52
resident or family perceptions of mealtimes; scale 0- 42, a higher score indicates better mealtime satisfaction
week 0 and week 52

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Waterloo

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
University of Manitoba
University of Saskatchewan
St. Francis Xavier University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Heather H Keller, PhD, University of Waterloo

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 30, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 30, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
March 17, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 25, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 1, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 6, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 3, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
March 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • REB #46942

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The resident level data will only be body weight and is not anticipated to be relevant to other researchers. Similarly the other measures are quite specific to this research and unlikely to be of use to other researchers, as it is an implementation study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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