[The situation of early career researchers in health services research: A survey study]. / Situation des wissenschaftlichen Nachwuchses in der Versorgungsforschung ­ eine Survey-Studie.

BACKGROUND: Early career researchers in health services research work in an interdisciplinary field of research. So far, information on early career researchers in health services research has only been available from surveys of individual disciplines, which do not adequately reflect the concerns in the field of health services research. Therefore, a working group of the German Network for Health Services Research (DNVF) conducted a first survey. The following research questions can be answered on the basis of the data obtained: (1) Which socio-demographic aspects characterize early career researchers in health services research? (2) What is the professional biographical background of early career researchers in health services research? (3) What are the research fields of early career researchers? (4) What are the career perspectives of early career researchers? METHOD: The survey among early career researchers was conducted as an online survey in January/February 2019. The study was addressed to individuals currently working as early career researchers in health services research in Germany. The online survey was conducted using a standardized questionnaire. Participants were recruited through the DNVF access points and by snowball sampling. RESULTS: 336 early career researcher aged between 23 and 57 participated in the online survey study, 102 of whom held a doctorate. The majority were employed as scientific staff (58%) and were in temporary employment (75%); 69% of them were emplyed at a university, followed by health care institutions (17%) and non-university research institutions (16%). About one-third of the respondents (36%) completed a vocational training prior to their studies. Of the participants, 50% said they were strongly or very strongly aspiring to a professional career in academia, 43% at a non-university research institution, and 30% at a university of applied sciences. DISCUSSION: The results of the online survey show the heterogeneity in terms of age and professional biography of early career researchers in health services research. Few researchers have permanent positions. However, the majority of respondents would like to have a professional future at a university, a research institute or a university of applied sciences. Further studies should be conducted to determine (possible) career paths taken by young scientists in health services research. CONCLUSION: There is still scope for improvement in the promotion of early career researchers.

Implementation of dementia care management in routine care (RoutineDeCM): a study protocol for process evaluation.

INTRODUCTION: Dementia care management is a complex intervention intended to support persons with dementia and their (caring) relatives in home-based care arrangements. Dementia care management was developed in the federal state of Mecklenburg-Western Pomerania in Germany and subsequently adapted for the German region of Siegen-Wittgenstein, where it will now be implemented. Four different service providers will carry out the implementation process. This study protocol describes the planned procedures for the parallel evaluation of the implementation process. METHODS AND ANALYSIS: A multiple embedded case study design was chosen for the planned process evaluation. Data collection and analysis will be informed by the Consolidated Framework for Implementation Research, the Expert Recommendations for Implementing Change, the Medical Research Council framework for conducting process evaluations of complex interventions and the Taxonomy of Outcomes for Implementation Research. Information (qualitative and quantitative) will be collected from all stakeholders involved in the dementia care management intervention (ie, dementia care managers, general practitioners, people with dementia). ETHICS AND DISSEMINATION: The process evaluation is conducted in accordance with the Declaration of Helsinki, the recommendations on good scientific practice, the research ethics principles of the Code of Ethics of the German Society of Nursing Science, and on the basis of ethical approval from the Clinical Ethics Committee of University Medicine Greifswald (BB 110/22). The results of the process evaluation will be disseminated through reports to the funders of the study and also as a summary of recommendations for the sustainable implementation of dementia care management for future implementers. We also plan to publish the results of this process evaluation in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05529277, Registered 7 September 2022, https://beta. CLINICALTRIALS: gov/study/NCT05529277.

Methods for the involvement of people living with dementia in research focused on the built environment: a protocol for a scoping review.

INTRODUCTION: The positive influence of a well-designed built environment in dementia-specific care has been known for several years. Many studies focusing on the built environment have captured the perspectives of people living with dementia. However, it remains unclear to what degree and with which methods these individuals have been actively involved in research especially when attempting to understand their perspective. The planned scoping review aims to (1) synthesise methods and results from research about the built environment according to active involvement of people living with dementia and (2) describe facilitators and barriers to this active involvement to capture their perspectives in research. METHODS AND ANALYSIS: We will use four search strategies: (1) searches in academic databases MEDLINE via PubMed, CINAHL and APA PsycINFO via EBSCO, and Scopus; (2) grey literature searches via Google Scholar; (3) handsearches of non-academic environmental planning and design journals and (4) identifying other publications of key authors in the field. Additionally, backward and forward citation tracking will be performed via reference lists and Google Scholar, respectively. Relevant literature published between 2013 and 2023 will be identified for data extraction and synthesis. One researcher will perform each strategy. Title-abstract/full text-screening will be conducted using Covidence by two researchers. Results will be displayed in a table and through figures illustrating identified facilitators and barriers. ETHICS AND DISSEMINATION: We raised no ethical concerns for the planned scoping review. We will prepare the findings including the identified barriers with long-term care practitioners from our network to identify how changes in practical application methods can be addressed. This dialogue can serve as a basis for including people living with dementia to discuss highlighted barriers when researching their perspectives on the built environment. The scoping review results will be reported in both academic and non-academic journals and at academic conferences.

Theory-based evaluation and programme theories in nursing: A discussion on the occasion of the updated Medical Research Council (MRC) Framework.

Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient. TWEETABLE ABSTRACT: The latest iteration of the MRC Framework for developing and evaluating complex healthcare interventions could lead to a renewed understanding of what constitutes useful knowledge for nursing.

Adapting the Australian Environmental Assessment Tool-High Care (EAT-HC): Experiences and Practical Implications From Germany, Japan, and Singapore.

BACKGROUND: Assessing the built environment in nursing homes is part of several established instruments. Measurements are primarily published in English, so there is a need for cross-cultural adaptation to be able to use them in other countries. This procedure should be carried out alongside translation guidelines to ensure successful adaptation not only for assessments that capture complex constructs, such as the built environment, but also for assessments to be applied in healthcare in general. OBJECTIVE: This article presents different approaches to adopt the Australian Environmental Assessment Tool-High Care (EAT-HC) based on the World Health Organization (WHO) guidelines for instrument translation. The comparison of these processes should provide implications for further adaptations of the instrument. METHODS: The adaptation processes carried out in Germany, Japan, and Singapore were compared using thematic analysis. Steps taken to achieve linguistic validation and to adopt the tool were analyzed qualitatively in the context of overarching needs for adjustment. RESULTS: Every perspective adapted the WHO guidelines for their respective purposes of applying the EAT-HC. The order of steps varied, but elements to validate the results with the instruments' creators and to ensure validity were included in all three countries. For items that might be challenging, we detected possible reasons that might help future adaptors manage this process more efficiently. CONCLUSION: The EAT-HC benefits from adaptation alongside the WHO guidelines in terms of enhancing the quality of translation and feasibility of application. Individual supplementary adaptation steps allow the identification of culture-specific needs for application in other countries.

Measuring person-centred care in german nursing homes - exploring the construct validity of the Dementia Policy Questionnaire: a cross-sectional study of a secondary data set.

BACKGROUND: To ensure the sustainable implementation of dementia-specific person-centred care (PCC) in nursing homes, internal policies are crucial. The preliminary German Dementia Policy Questionnaire, which features 19 dichotomous items, assesses the existence of and evaluates these policies. This article reports the results of an exploration of the construct validity of the preliminary Dementia Policy Questionnaire. METHODS: This study is a cross-sectional study that references a secondary data set drawn from a national survey study of a randomized, stratified sample of 134 nursing homes in Germany. To explore the construct validity of the preliminary Dementia Policy Questionnaire, we conducted an adjusted multiple correspondence analysis of the pretested 19-item assessment. We included data assessed using the preliminary Dementia Policy Questionnaire from 134 care units associated with 134 nursing homes; these data were collected via telephone interviews with nursing home administrators or their representatives. RESULTS: Two items assessing visitor regulations and regulations regarding the inclusion of residents in staff selection were less frequent and were therefore excluded from the adjusted multiple correspondence analysis. In total, nine items were assigned to two dimensions. The items assigned to the first dimension assess existing regulations for PCC as well as existing regulations regarding the involvement of the resident, relatives and the multiprofessional team in the collection of information concerning preferences, case conferences or decision making. The items assigned to the second dimension assess existing regulations regarding the systematic assessment of resident preferences and their requirements. CONCLUSION: The study produces exploratory evidence concerning the preliminary Dementia Policy Questionnaire. Since the dimensions of the items included in this questionnaire cannot be conceptualized clearly, the instrument in its current state requires further development.

Feasibility, Interrater Reliability and Internal Consistency of the German Environmental Audit Tool (G-EAT).

Dementia-specific environmental design has the potential to positively influence capabilities for daily living and quality of life in people with dementia living in nursing homes. To date, no reliable instrument exists for systematically assessing the adequacy of these built environments in Germany. This study aimed to test the adapted version of the Environmental Audit Tool-High Care (EAT-HC)-the German Environmental Audit Tool (G-EAT)-with regard to its feasibility, interrater reliability and internal consistency. The G-EAT was applied as a paper-pencil version in the German setting; intraclass correlation coefficients at the subscale level ranged from 0.662 (III) to 0.869 (IV), and 42% of the items showed at least substantial agreement (Cohen's kappa ≥ 0.60). The results indicate the need to develop supplementary material in a manual that illustrates the meaning of the items and practical implications regarding dementia-specific environmental design. Furthermore, the intersectionality of built and physical environments must be considered when interpreting G-EAT results in future research and applications to residential long-term care practice.

German Translation, Linguistic Validation, and Cultural Adaptation of the Environmental Audit Tool-High Care.

BACKGROUND: In dementia-specific care, the design of the environment is regarded as an influential element in the support and maintenance of skills and can improve the quality of life of residents. To date, there is no valid instrument in the German-speaking countries with which the quality of the physical environment in residential long-term care facilities can be systematically assessed. OBJECTIVE: To report the translation, linguistic validation, cultural adaptation, and content validity evaluation of the Australian Environmental Audit Tool-High Care in preparation for use in German nursing homes. METHOD: The procedure was guided by an adapted multistep process of the World Health Organization (1998) and included focus groups involving potential users of the new tool such as scientific experts and healthcare professionals (n = 40). Content validity indices were calculated following a two-step expert survey. RESULTS: The final draft versions of the German Environmental Audit Tool (G-EAT) included 74 and 77 items, for non-secured units and secure units, respectively, divided into 10 key design principles according to the Australian original. The evaluation of content validity showed that cultural differences existed in several items. CONCLUSIONS: The G-EAT provides the means for conducting a valid assessment of the environmental quality of people with dementia in German nursing homes. However, its usability in healthcare research must be preceded by testing its interrater reliability.

Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology.

BACKGROUND: Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. METHODS: The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. RESULTS: We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. DISCUSSION: As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.