BACKGROUND AND AIMS: Lack of compliance on the part of old participants has been reported in several randomised nutritional intervention studies. However, lack of compliance by staff may also have a significant impact on the effect of interventions. The aim of this paper is to test the hypothesis that, in an intervention study with focus on nutrition, exercise and oral care in old nursing home residents, lack of compliance by staff rather than residents is the major problem.

METHODS: An eleven week randomized, controlled trial in seven nursing homes, with nutrition, exercise and oral care strategies, and 62 residents in the intervention group. Staff and researchers documented compliance of residents with the various strategies, including notes about problems.

RESULTS: The nutrition and exercise strategies were well accepted by participating residents. The main reason for non-compliance may be related to staff problems. Up to one-sixth of the planned nutrition interventions were not documented as having been given to the residents.

CONCLUSIONS: Lack of compliance by staff rather than residents seemed to be the main problem. In order to improve compliance in future studies, more focus should be put on the effect of practical implementation on staff. Insight into these matters may give valuable information to counteract staff problems, facilitate implementation in long term, and hence improve the benefits of nutrition interventions.