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

Abstract

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.

Definition and Contextual Factors of Nursing Home Residents’ Mobility in a Holistic View: A Delphi Study

“…For the social isolation measurement tools (UCLA Loneliness Scale, Social Connectedness Questionnaire, Maastricht Social Participation Profile), the literature confirms their use in the nursing home setting ( 44–46 ). The Special Care Unit Environment Quality Scale (SCUEQS), Housing Enabler, and German Environmental Audit Kit (G-EAT) are tools developed to assess the structural resources of nursing home settings and are therefore typically used in this field of research ( 47–49 ).…”

The Perspective of Residents Living With Dementia Toward Their Built Environment: A Walking Interview Study in German Nursing Homes

“…We purposively selected two nursing homes in one federal state of Germany that had been included in our previous study explained previously ( Fahsold, Schmüdderich et al, 2022 ) and that differed in terms of dementia-specific environmental characteristics assessed by using the G-EAT (total G-EAT score of 52 and 84, respectively). They also varied in location—less than 25,000 versus approximately 600,000 inhabitants, facility size—three and five living units and 65 and 100 residents, respectively.…”

“…The walking interviews were conducted by one of the authors (A.F.) with a professional background as a nurse and knowledge of dementia-sensitive environmental design due to previous research involvement (see Fahsold, Fleming et al, 2022 ; Fahsold, Schmüdderich et al, 2022 ). The researcher familiarized herself with the residents and the environment for several days prior to data collection by visiting and participating in social activities (e.g., gymnastics, singing, and crossword puzzle groups).…”

“…We involved health care researchers and long-term care practitioners specializing in dementia care in adapting the original tool into a validated and culturally appropriate version for our context—the German Environmental Audit Tool (G-EAT; Fahsold, Fleming et al, 2022 ). The tool was then tested in German nursing homes to assess feasibility and reliability, involving the interdisciplinary care team ( Fahsold, Schmüdderich et al, 2022 ). Adaptation and testing activities revealed that there may be environmental features important to residents living with dementia in nursing homes that are difficult to assess systematically with an instrument such as the G-EAT.…”

Environmental Design for People Living with Dementia

“…Although the EAT was developed primarily in Australia, it has been adapted by others for use in other countries and cultures, including Germany [78], Singapore [79], and Japan [80]. One version, Plan-EAT, was especially adapted for evaluating dementia design quality in building layout planning in residential aged care settings [81].…”