Core functions and forms in home-delivered meal programs: a stakeholder-driven approach to identifying essential practices

BackgroundThe rapid growth of the aging population underscores the need for programs tailored to older adults' complex health needs. Home-delivered meal programs are critical, providing nutrition and socialization support to older adults with greatest economic and social need. However, variations in local implementation complicate our understanding of how specific program practices influence older adult outcomes. This present study applies the core functions and forms framework to identify and prioritize essential home-delivered meal practices-or forms-that can be replicated by other meal programs.MethodsThis study was conducted within a pragmatic randomized effectiveness trial comparing two home-delivered meal models and their impacts on health outcomes among older adults. The study involved nine meal programs across the United States and used a three-phase approach characterized by the following: (1) core functions of home-delivered meal programs were identified based on Title III of the Older Americans Act; (2) the full spectrum of program "forms" was gathered through site visits, surveys, and listening sessions; and (3) a modified e-Delphi process was conducted with stakeholders to determine consensus on the most essential forms of home-delivered meal programming.ResultsThree core functions were identified from Title III of the Older Americans Act: provide meals to reduce hunger and malnutrition, provide opportunities for socialization, and provide opportunities to promote health and well-being. Out of 103 identified program forms, 25 were deemed essential for achieving the core functions of home-delivered meal programs. Essential practices included dietary customization, emergency meal provision, and meaningful client-driver interactions, as examples.DiscussionThis study demonstrates that while program variability allows flexibility to meet local client needs, establishing core functions and essential forms provides a foundation for evaluating home-delivered meal program effectiveness. The findings inform home-delivered meal program improvements at the national level, emphasizing a balance between standardized practices and local adaptations. This work serves as a model for characterizing complex interventions in community-based settings, advancing the science of implementation and the impact of home-delivered meals on older adult populations.Trial registrationNCT registration: NCT05357261; April 27, 2022.