A qualitative interview study comparing and contrasting resident and staff perspectives of engaging in meaningful activity in a UK care home.

The provision of meaningful activities in care homes is essential for maintaining residents' mental and physical health, yet many do not get adequate opportunities to participate. This qualitative study explored resident and staff perceptions of engaging in meaningful activities in a residential care home for older people (aged over 65 years) in South London, UK. Nine residents and eleven staff members were recruited and their experiences explored through semi-structured interviews. Data were analysed thematically, and three themes emerged. (1) Appreciation of activity: both staff and residents were aware of the benefits of activity to physical and mental health, yet there was a lack of provision within the home. (2) Residents' desire for engagement: residents perceived themselves as active individuals who had previously enjoyed activities, and had goals that they wanted to achieve. This was in contrast to views of care staff, who perceived residents as inactive, lacking in motivation and sedentary due to intrinsic factors such as their age. (3) Impact of care home culture and physical space: staff and residents perceived different barriers to activity; staff reported they were often expected to take on multiple roles within the home leading to a lack of time to engage residents in activities, whilst residents perceived that the layout and design of the home hindered provision. It was concluded that comparing and contrasting views of residents and staff could assist residential homes to reach greater levels of shared understanding of activity provision and highlight particular areas to target for increasing activity engagement.

Active Residents in Care Homes (ARCH): study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people.

OBJECTIVES: To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. DESIGN: Feasibility study. SETTING: Residential care homes for older people. PARTICIPANTS: 10-15 residents, staff and family members will be recruited in each of the three participating care homes. INTERVENTION: ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. MAIN OUTCOME MEASURES: Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. CONCLUSIONS: Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them. TRIAL REGISTRATION: ISRCTN24000891.

Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study.

BACKGROUND: Osteoarthritis is highly prevalent and has enormous personal and socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is an integrated rehabilitation program that helps people understand how exercise can improve physical and psychosocial well-being. Unfortunately, its availability is limited. A Web-based version of the program could increase access for more people. Many Web-based resources are developed without end-user input and result in over-complex, unwanted, ineffective products with limited uptake. OBJECTIVE: The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful. METHODS: To establish older persons' Internet use we conducted a postal survey of 200 people. To establish their opinions, likes or dislikes, and requirements for a Web-based version of the ESCAPE-pain program, we conducted two focus groups with 11 people who had participated in a program based on ESCAPE-pain and two with 13 people who had not. Information from the postal survey and focus groups was used to develop an online prototype website. People's opinions of the prototype website were gauged from thematic analysis of eight semistructured "think aloud" interviews. RESULTS: The survey response rate was 42% (83/200), of whom 67% (56/83) were female and mean age was 67 years. Eighty-three percent of the people had used the Internet, 69% described themselves as either very confident or confident Internet users, and 77% had looked online for health information. With regard to participating online, 34% had read a commentary or watched a video of someone else's experience of a health problem and 23% had tracked a health issue. Key qualitative themes emerged that included engagement, acceptability and usability, and structure and content of the program. CONCLUSIONS: Older people use the Internet as a source of health information but have concerns about safe use and quality of information. Users require a credible website that provides personalized information, support, monitoring, and feedback.