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Burfeindt C, Darmann-Finck I, Stammann C, Stegbauer C, Stolle-Wahl C, Zündel M, Rothgang H. Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes. BMC Nurs 2024; 23:201. [PMID: 38528537 DOI: 10.1186/s12912-024-01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm 1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm 1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development. METHODS The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm 1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm 1.0 into Algorithm 2.0 will be derived. DISCUSSION In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).
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Affiliation(s)
- Corinna Burfeindt
- SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany.
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Ingrid Darmann-Finck
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Carina Stammann
- Department of Evaluation and Implementation Research, aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Constance Stegbauer
- Department of Evaluation and Implementation Research, aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Claudia Stolle-Wahl
- Centre for Nursing Research and Counselling, Hochschule Bremen City University of Applied Sciences, Am Brill 2-4, 28195, Bremen, Germany
| | - Matthias Zündel
- Centre for Nursing Research and Counselling, Hochschule Bremen City University of Applied Sciences, Am Brill 2-4, 28195, Bremen, Germany
| | - Heinz Rothgang
- SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
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Bucholc J, McCaffrey N, Ugalde A, Muldowney A, Rand S, Hoefman R, Mihalopoulos C, Engel L. How well do the adult social care outcomes toolkit for carers, carer experience scale and care-related quality of life capture aspects of quality of life important to informal carers in Australia? Qual Life Res 2023; 32:3109-3121. [PMID: 37356076 PMCID: PMC10522516 DOI: 10.1007/s11136-023-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Identify aspects of quality of life (QoL) important to Australian informal carers and explore how well the Adult Social Care Outcomes Toolkit for Carers, Care-related Quality of Life instrument and Carer Experience Scale capture these aspects in the Australian context. METHODS Online questionnaires were completed by Australian informal carers. Socio-demographics, open-ended questions: positive/negative aspects of caring and QoL aspects missing from the instruments, and ranking of the instrument domains was used to explore the content of the instruments. Instruments were scored using preference-weighted value sets (reported in another paper). Content analysis was used to analyse the open-ended responses. Chi-squared test looked at differences in domain importance. Descriptive analyses summarised all other information. RESULTS Eight themes were identified: Behaviour-mood of the care recipient, Caring responsibilities, Finances, Health, Own life, Perception of carers, Relationship with care recipient and Support. Many aspects of carer QoL mentioned as missing in the instruments appeared covered by the domains, of which all were reported as important. The highest ranked domain was relationship with the care recipient. The influence of the care recipient specific support, behaviour/mood and health on carer QoL appear absent in all instruments. CONCLUSION The content of the three instruments appears relevant in an Australian setting. The influence of care recipient's health and well-being on carer QoL should be considered, along with spillover effects. A content and/or face validity analysis is required to confirm differences in item interpretation in Australian informal carers.
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Affiliation(s)
- Jessica Bucholc
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | | | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Building, University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Cathrine Mihalopoulos
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Melbourne, VIC, Australia
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Rand S, Towers AM, Malley J, Silarova B. Exploring the structural characteristics of the Adult Social Care Outcomes Toolkit (ASCOT) and ASCOT-Carer. NIHR OPEN RESEARCH 2023; 2:21. [PMID: 37881301 PMCID: PMC10593358 DOI: 10.3310/nihropenres.13259.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 10/27/2023]
Abstract
Background Measurement models inform the approach to assess a measure's validity and also how a measure is understood, applied and interpreted. With preference-based measures (PBMs), it is generally accepted that they are formative; however, if they are applied without preferences, they may be reflective, formative or mixed. In this study, we sought to empirically test whether the reflective, formative or mixed measurement model best describes PBMs of social care-related quality of life (SCRQoL) - specifically, the ASCOT and ASCOT-Carer. We also explored the network approach, as an alternative. Methods ASCOT and ASCOT-Carer data were analyzed using confirmatory factor analysis and Multiple Indicators Multiple Causes models to test reflective, formative or mixed measurement models, respectively. Network analysis of partial correlations using the Gaussian graphical model was also conducted. Results The results indicated that the reflective measurement model is the worst fit for ASCOT and ASCOT-Carer. The formative or mixed measurement models may apply to ASCOT. The mixed measurement model was the best fit for ASCOT-Carer. The network analysis indicated that the most important or influential items were Occupation and Personal cleanliness and comfort (ASCOT) and Time and space and Self-care (ASCOT-Carer). Conclusions The ASCOT and ASCOT-Carer are best described as formative/mixed or mixed measurement models, respectively. These findings may guide the approach to the validation of cross-culturally adapted and translated versions. Specifically, we recommend that EFA be applied to establish structural characteristics, especially if the measure will be applied as a PBM and as a measure of SCRQoL. Network analysis may also provide further useful insights into structural characteristics.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Juliette Malley
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Barbora Silarova
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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Rand SE, Silarova B, Towers A, Jones K. Social care-related quality of life of people with dementia and their carers in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2406-e2418. [PMID: 34921481 PMCID: PMC9541270 DOI: 10.1111/hsc.13681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
People with dementia and their carers are a growing subgroup of people who use community-based social care. These services are designed to maintain people's quality of life while living at home. The ASCOT measure of social care-related quality of life (SCRQoL), designed to evaluate quality and effectiveness of social care, has been adapted for proxy-report when someone is unable to self-report. The ASCOT-Carer has been developed to measure carer's own SCRQoL. This study sought to establish the factors related to SCRQoL of people living with dementia (PLWD, proxy-reported by carers) and their carers. Data were collected via a self-administered postal or online survey of 313 carers in England, from January 2020 to April 2021. Carers were eligible if they supported someone living with dementia at home, who was unable to self-complete questionnaires. The person living with dementia or their carer had to use at least one social care service, e.g. home care. We recruited participants via an online volunteer panel and NHS sites. Multiple regression was applied to explore the factors significantly related to ASCOT SCRQoL by self- and proxy-report. Key influences on carers' own SCRQoL were their health, financial difficulties associated with caring, and satisfaction with social care support. Inadequate home design was significantly negatively associated with SCRQoL for PLWD. The latter stages of the pandemic-related restrictions (the tier system from 2nd December 2020 to study end, April 2021) were associated with significantly worse SCRQoL for PLWD, but not for carers. The study offers insight into the factors associated with SCRQoL. In particular, the findings highlight the importance of adequate home design for people with dementia; satisfactory social care support and limiting any adverse financial impact of caring are important for carers. The findings indicate a negative effect of COVID restrictions on SCRQoL of people with dementia.
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Affiliation(s)
- Stacey E. Rand
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
| | - Barbora Silarova
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
| | - Ann‐Marie Towers
- Centre for Health Services Research (CHSS)University of KentCanterburyUK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
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Nguyen L, Linnosmaa I, Jokimäki H, Rand S, Malley J, Razik K, Trukeschitz B, Forder J. Social care-related outcomes in Finland. Construct validity and structural characteristics of the Finnish ASCOT measure with older home care users. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:712-728. [PMID: 33639030 DOI: 10.1111/hsc.13328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded home care services, which was conducted in 2016-2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi-square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well-being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ-5D-3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.
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Affiliation(s)
- Lien Nguyen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ismo Linnosmaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Hanna Jokimäki
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, United Kingdom
| | - Juliette Malley
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, United Kingdom
| | - Kamilla Razik
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, United Kingdom
| | - Birgit Trukeschitz
- Research Institute for Economics of Aging, WU Vienna University of Economics and Business, Vienna, Austria
| | - Julien Forder
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, United Kingdom
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