Ease of use, feasibility and inter‐rater reliability of the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme

Abstract

Aims To refine the Cue Utilization and Engagement in Dementia mealtime video‐coding scheme and examine its ease of use, feasibility, and inter‐rater reliability in assessing the food intake process and dyadic verbal and nonverbal interactions. Design This study was a secondary analysis of 110 videotaped observations of mealtime interactions collected under usual care conditions from a dementia communication trial during 2011–2014. Methods The videos involved 29 staff and 25 residents with dementia (42 unique staff‐resident dyads) in nine nursing homes. Data coding and analysis were performed in 2018–2019. Logs of coding challenges with matched solutions and coding time were collected. Inter‐rater reliability was examined through rating of randomly selected 22 videos across four trained coders. Results It took a mean of 10.81 hr to code a one‐hour video using the refined coding scheme. Coding challenges, including identification of key intake process characteristics and differentiation of similar verbal or nonverbal behaviours, were identified with appropriate solutions. The refined coding scheme had good inter‐rater reliability (Cohen's Kappa range = 0.93 – 0.99, 95% CI = 0.92 – 0.99). Conclusion Findings supported preliminary evidence on feasibility, usability and inter‐rater reliability of the refined coding scheme. Future psychometric testing is needed in diverse populations with dementia across different care settings. Impact Existing tools assessing the food intake process and dyadic interactions are few and have limited feasibility and/or reliability and fail to capture the complexity and dynamics of mealtime care. The refined coding scheme showed preliminary feasibility, usability, and inter‐rater reliability. In consideration of the balance between time intensity and the richness of data obtained, the tool may be appropriate and useful in addressing certain research inquires (e.g., characterizing and clustering dyadic behaviours, temporal relationship between behaviours and intake) pertaining older adults with or without dementia and their formal or informal caregivers.

Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations

“…All utterances in the videos were transcribed and then coded second‐by‐second using Noldus Observer® 14.0 (Noldus Information Technology Inc., Leesburg, VA, USA) during 2018–2019. Four research assistants were trained by the first author through coding gold standard videos following a standard CUED coding manual (Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020). Each full sentence ended with a period or a question mark was considered as an utterance [e.g., “No?” was considered an utterance; “mmh.…”

“…Part II of CUED demonstrated feasibility and good intercoder reliability through ratings of randomly selected 22 videos of the study sample across four trained coders (per cent agreement range = 94.5–97.6%, all p < .001, ±1s tolerance; Cohen's Kappa range = 0.94–0.97, 95% CI = 0.93, 0.98, ±1s tolerance) (Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020). For ease of use, it took an average of 5.12 hr to transcribe utterances and 4.16 hr to code utterances for a 1‐hr video (Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020).…”

“…In total, 1,125 baseline videos were screened, among which 110 videos were eligible for this study. Prior work described the screening procedures (Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020). The 110 videos involved 29 staff (mean age = 34.9 years, 82.8% female, 79.3% non‐Hispanic, 72.4% white, 72.4% completed or were receiving college education, 100% Certified Nursing Assistants, mean care‐giving length = 8.9 years, mean working length in the current NH = 3.7 years) and 25 residents (mean age = 84.6 years; 60% female, 92% non‐Hispanic, 100% white) in 9 NHs.…”

“…Mealtime care is provided multiple times every day for residents needing assistance and is a critical component of daily care in promoting function and nutrition. Multilevel factors (i.e., resident, staff, environmental) influence mealtime difficulties (Liu et al., 2016, 2017, 2018) and intake (Liu, Jao, et al., 2019; Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020; Liu, Williams, et al., 2019). Person‐centred, individualized mealtime care that acknowledges resident preferences and supports independence through positive engagement and social interactions is critical to promote eating performance and improve intake (Liu et al., 2015, 2017, 2018, 2019; Reimer & Keller, 2009).…”

“…To address this gap, we refined the Cue Utilization and Engagement in Dementia (CUED) Mealtime Video Coding Scheme based on multiple established observational tools, addressing an inclusive list of verbal and non‐verbal behaviours from staff and residents in dementia mealtime care (Aselage, 2010; Edahiro et al., 2012; Lann‐Wolcott et al., 2011; Liu et al., 2018). The CUED assesses characteristics of resident intake process (Part I) and dyadic verbal (Part II, focus of this study) and non‐verbal (Part III) mealtime interactions (Liu, Batchelor, et al., 2020; Liu, Perkhounkova, et al., 2020). This tool will facilitate understanding of dyadic mealtime interactions and guide the development and evaluation of innovative mealtime care interventions with a focus on supporting resident independence through positive dyadic interactions.…”