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The quality of the physical environment and its association with activities and well-being among older people in residential care facilities
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society.ORCID iD: 0000-0003-3356-7583
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society , 2016.
National Category
Nursing
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-23790ISBN: 978-91-7676-404-6 (print)OAI: oai:DiVA.org:du-23790DiVA: diva2:1060785
Public defence
2016-12-08, Hörsal H3, Karolinska Institutet, Huddinge, 09:00
Opponent
Supervisors
Available from: 2016-12-29 Created: 2016-12-29 Last updated: 2017-06-21Bibliographically approved
List of papers
1. Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)
Open this publication in new window or tab >>Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)
2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 3, 1-11 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability.

Methods

SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics.

Results

Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832).

Conclusions

Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

Keyword
Instrument, translation, residential care facilities
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-16597 (URN)10.1186/1471-2318-15-3 (DOI)25563507 (PubMedID)
Available from: 2015-01-02 Created: 2015-01-02 Last updated: 2017-06-21Bibliographically approved
2. Exploring environmental variation in residential care facilities for older people
Open this publication in new window or tab >>Exploring environmental variation in residential care facilities for older people
2017 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 10, no 2, 49-65 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM).

BACKGROUND: Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality.

METHODS: Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities.

RESULTS: There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents' needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low.

CONCLUSIONS: Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.

Keyword
assessment; long-term care facility; older people; person-centered care; physical environment
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21601 (URN)10.1177/1937586716648703 (DOI)000400141500005 ()27240564 (PubMedID)
Available from: 2016-06-03 Created: 2016-06-03 Last updated: 2017-06-21Bibliographically approved
3. The physical environment, activity and interaction in residential care facilities for older people: a comparative case study
Open this publication in new window or tab >>The physical environment, activity and interaction in residential care facilities for older people: a comparative case study
Show others...
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, 1-12 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents’ affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents’ activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently.

Keyword
activities, case study, interactions, mixed-method, older people, physical environment, residential care facilities
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23388 (URN)10.1111/scs.12391 (DOI)27862156 (PubMedID)
Note

Open Access APC beslut 16/2016

Available from: 2016-11-16 Created: 2016-11-16 Last updated: 2017-06-21Bibliographically approved

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