Reliability and Validity of a Person-Centered Care Staff Survey in Veterans Health Administration Community Living Centers

BackgroundPerson-centredness is promoted as a central feature of the long-term care of older adults. Measures are needed to assist researchers, service planners and regulators in assessing this feature of quality. However, no systematic review exists to identify potential instruments and to provide a critical appraisal of their measurement properties.MethodA systematic review of measures of person-centredness was undertaken. Inclusion criteria restricted references to multi-item instruments designed for older adult services, or otherwise with measurement properties tested in an older adult population. A two-stage critical appraisal was conducted. First, the methodological quality of included references was assessed using the COSMIN toolkit. Second, seven measurement properties were rated using widely-recognised thresholds of acceptability. These results were then synthesised to provide an overall appraisal of the strength of evidence for each measurement property for each instrument.ResultsEleven measures tested in 22 references were included. Six instruments were designed principally for use in long-stay residential facilities, and four were for ambulatory hospital or clinic-based services. Only one measure was designed mainly for completion by users of home care services. No measure could be assessed across all seven measurement properties. Despite some instruments having promising measurement properties, this was consistently undermined by the poor methodological quality underpinning them. Testing of hypotheses to support construct validity was of particularly low quality, whilst measurement error was rarely assessed. Two measures were identified as having been the subject of the most rigorous testing.ConclusionThe review is unable to unequivocally recommend any measures of person-centredness for use in older adult care. Researchers are advised to improve methodological rigour when testing instruments. Efforts may be best focused on testing a narrower range of measurement properties but to a higher standard, and ensuring that translations to new languages are resisted until strong measurement properties are demonstrated in the original tongue. Limitations of the review include inevitable semantic and conceptual challenges involved in defining ‘person-centredness’.The review protocol was registered with PROSPERO (ref: CRD42014005935).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0229-y) contains supplementary material, which is available to authorized users.

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“… PCHC Dow et al [ 48 ] ? (4/8) + + PDC White et al [ 47 ] + + + Sullivan et al [ 52 ] + + ‘Untitled’ Terada et al [ 45 ] ? + ?…”

Section: Resultsmentioning

confidence: 99%

Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties

et al. 2016

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“…A minimum of 10 care staff on the study units completed the valid and reliable Person-Directed Care measure [60, 61], which collects staff perception of resident-centered care and organizational support with 50 items. Demographic information was also provided.…”

Section: Methodsmentioning

confidence: 99%

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

et al. 2017

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BackgroundOlder adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study.MethodsA conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined.DiscussionThis rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Trial RegistrationClinicalTrials.gov ID: NCT02800291, retrospectively registered June 7, 2016.

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“…Cognitive interviewing is used to examine the language and meaning of items and adapt a measurement tool for use with different groups in alternative settings (Sullivan et al, 2013;Willis, 2005). To revise the PELI, cognitive interviewing was a useful approach to assess each preference item separately to ensure it reflected the language used by NH residents to describe preferences important to them.…”

Section: Cognitive Interviewingmentioning

confidence: 99%

Cognitive Interviewing: Revising the Preferences for Everyday Living Inventory for Use In the Nursing Home

Curyto¹,

Haitsma²,

Towsley³

2016

Research in Gerontological Nursing

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A valid tool is needed to assess preferences that are relevant and important to nursing home (NH) residents. Originally developed for older adults receiving home care services, the authors adapted the Preferences for Everyday Living Inventory (PELI) for use with NH residents. Content validity was initially established using a panel of experts in long-term care. PELI items were cognitively interviewed with 31 Veteran and 39 non-Veteran participants (N = 70). Responses from cognitive interviewing guided substantial revisions of the PELI (>25% of items) to include language that NH residents use and understand, reducing potential measurement error and ensuring the preferences assessed are relevant to NH residents. Future work will further adapt the PELI for use with more diverse groups and health care settings, and assess its psychometric properties. Using the PELI will help move clinical teams closer to the goal of providing person-centered care informed by individual preferences.

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Reliability and Validity of a Person-Centered Care Staff Survey in Veterans Health Administration Community Living Centers

Cited by 22 publications

References 14 publications

Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties

Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Cognitive Interviewing: Revising the Preferences for Everyday Living Inventory for Use In the Nursing Home

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